Journal of Pediatric Psychology, Vol. 28, No. 7, 2003, pp. 463-472
© 2003 Society of Pediatric Psychology
Obesity, Appearance, and Psychosocial Adaptation in Young African American Children
1 University of Maryland Medical School, 2 Vanderbilt University, Department of Psychology
All correspondence should be sent to Deborah Young-Hyman, PhD, National Institutes of Health, Center for Scientific Review, 6701 Rockledge Drive, Rm 4188 MSC 7848, Bethesda, Maryland 20892. E-mail: younghyd{at}csr.nih.gov.
 |
Abstract |
|---|
 Top Abstract IntroductionMethodsResultsDiscussionReferences |
|---|
Objective To evaluate the contributions of weight status, skin tone, peer teasing, and parental appraisals of child's size to self-esteem and psychosocial adjustment in overweight African American children. Method Overweight to very obese 5- to 10-year-old African American children (N = 117) completed measures of self-esteem, skin tone satisfaction, peer teasing, and body size perception. Caregivers completed the Child Behavior Checklist and rated their child's body size. Results Overweight was associated with low appearance self-esteem, and body size dissatisfaction with low global self-worth and low appearance self-esteem in children 8 and older. Appearance self-esteem but not global self-worth was lower in girls than boys. Parental perception of child's size as heavier than average was associated with low child appearance self-esteem. Heavier children also had more parental report of behavior and psychosocial problems, but their scores were in the nonclinical range. Child skin tone dissatisfaction was associated with low global self-worth. Weight-related peer teasing was associated with low self-esteem. Conclusions The relationship between obesity and self-esteem in African American children depends upon age, gender, and children's experiences with teasing and parental evaluation of their size. Other factors, like skin tone satisfaction, contribute to a child's sense of self-worth.
Key words: African-American children; obesity; appearance; self-esteem.
|
Introduction |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Childhood obesity is thought to lead to the development of low self-esteem and other psychosocial problems (French, Story, & Perry, 1995
). Minority children are at greater risk
for obesity (Kumanyika et al.,
1990), suggesting that they might also be at greater risk for
developing low self-esteem. Some studies have not found a strong association
between overweight and self-esteem in minority adults
(Brown et al., 1998;
Kimm et al., 1997;
Miller & Downey, 1999;
Strauss, 2000), and few
studies have examined weight and self-esteem in minority children.
The magnitude of association between weight and self-esteem has been shown
to be stronger for girls than for boys
(Steen, Wadden, Foster, & Andersen,
1996; Strauss,
2000). However, many studies have not explicitly examined gender
differences. Most studies of children's self-esteem have equated actual weight
with physical appearance. In a meta-analysis of the relationship between
weight and self-esteem, Miller and Downey
(1999) reported that even in
children, perceived size was a better predictor of self-esteem than was actual
body weight. Other studies have looked at the contributions of parental
attitudes and beliefs about body weight and suggest that parental attitudes
and behaviors can cause additional harm to a child's self-esteem beyond that
which is directly associated with body size
(Davison & Birch, 2001). In
a study of overweight African American children, physical self-esteem was
predicted by the degree of parental dissatisfaction with the child's body size
(Herman, 2000).
Studies of the psychosocial impact of childhood obesity have focused on
self-esteem, body esteem, and peer and parental teasing
(French, Story, & Perry,
1995; Gardner, Sorter, &
Friedman, 1997; Gleason,
Alexander, & Somers, 2000;
Schwartz, Phares, Tantleff-Dunn, &
Thompson, 1999). Other investigators have examined the effect of
body weight on depression, trouble in school, school connectedness
(Pesa, Syre, & Jones,
2000), behavior problems
(Stradmeijer, Bosch, Koops, & Seidell,
2000), social isolation, hopelessness, and suicide attempts
(Falkner et al., 2001).
Retrospective studies of young adults have established the relationship
between weight-related parental teasing and low self-esteem
(Schwartz, Phares, Tantleff-Dunn, &
Thompson, 1999) and concurrent peer teasing and estimation of body
size (Gardner, Sorter, & Friedman,
1997). However, studies could not be found in which young children
were asked about current or recent experiences of weight-related teasing,
parental size satisfaction, and self-esteem.
The clinical relevance of weight-related differences in self-esteem between
normal and overweight children needs to be established by comparing scores
with test norms. Studies comparing the self-esteem and psychological
functioning of obese children with established norms found that the scores of
obese children were within normal limits
(Kaplan & Wadden, 1986).
These data suggest that the lower self-esteem of obese children is not
necessarily pathological, but this has not been established in young,
overweight African American children.
Skin tone may be an important element of body image in African Americans
(Falconer & Neville,
2000). Studies of adults have investigated the impact of skin tone
on self-esteem in African Americans
(Altabe, 1998;
Thompson & Keith, 2001).
This dimension of appearance may be as or more important than body size
satisfaction in influencing the development of African American children's
self-esteem (Thompson & Keith,
2001).
This study was undertaken to assess the cross-sectional relationships among perceptions of appearance, obesity, psychosocial adaptation, and self-esteem in 5–10 year old African American children. We had seven hypotheses in this sample of young, overweight African American children: (a) there will be no association between obesity and global self-worth and an inverse relationship between obesity and appearance self-esteem; (b) girls will have lower appearance self-esteem than boys but there will be no gender difference in global self-worth; (c) body size dissatisfaction will be a better predictor of appearance self-esteem than will actual body weight but will not be a better predictor of global self-worth; (d) appearance self-esteem will be lower in children whose parents view them as overweight and there will be no association between parental perception of overweight and global self-worth; (e) there will be an association between obesity and psychosocial adjustment but psychological and behavioral problems will fall in the normal range; (f) appearance self-esteem and global self-worth will be lower in children who are dissatisfied with their skin color; (g) appearance self-esteem and global self-worth will be lower in children who report weight-related teasing.
|
Methods |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Participants
Children and caregivers were recruited using letters sent to parents of children identified as overweight by chart reviews, direct physician referral, and self-referral secondary to media exposure. All children were from the Baltimore metropolitan area. After the initial contact by a family member or physician, phone screening was conducted by study staff. Baseline evaluation occurred if the child was documented or reported to be greater than the 90th percentile weight for height relative to his or her age, there were no obvious reasons the child or parent could not participate in a weight management program, and parents expressed a desire to have their child entered into a diabetes prevention program. Informed consent was obtained prior to beginning the screening visits.
One hundred seventeen children, 70 girls and 47 boys, provided data for
this analysis. Children were 5–10 years old (mean ± standard
deviation = 8.6 ± 1.3) and all were African American. Body mass index
(BMI = kg/m2) was computed from a measured weight (52.8 ±
17.7 kg) and height (137.7 ± 11.2 cm) and was standardized using age-
and gender-specific norms (Frisancho,
1990) because children's BMI normally increases with age.
Age/gender standardized BMI (z-BMI) allows the direct comparison of
relative weight across age groups and gender in children. To further describe
the degree of obesity in this sample, weights were categorized into three
groups. Children with z-scores less than 2.54 (the 99th percentile)
were classified as overweight (n = 16). Children with
z-scores between 2.54 and 5.0 were classified as obese (n =
63). Any child more than 5 standard deviations above gender- and age-specific
means was classified as superobese (n = 38). On average, children
used in this analysis were 4.4 ± 1.7 standard deviations above the
age/gender-specific means. Table
I summarizes subject characteristics by gender.
|
Socioeconomic status (SES) was estimated from caregiver education and
occupation using the Hollingshead four-factor index
(Hollingshead, 1975). There
were no SES differences between the boys and girls or as a function of weight
category. There were significant (p < .01) gender differences in
Tanner stage (Marshall & Tanner,
1969,
1970), with more boys at stage
1 than girls, and more girls at stage 3 than boys.
Measures
Child Behavior Checklist (CBCL). The CBCL is a parental
report of child function that includes measures of social competence, school
function, emotional adjustment, and behavior problems
(Achenbach & Edelbrock,
1983). The questionnaire yields four competence scores: activity,
social, school, and total social competence. We also used nine of the problem
scales: withdrawn, somatic, anxious/depressed, attention problems, social
problems, aggressive behavior, thought problems, delinquent behavior, and a
total problems score. The scale has well-established age- and gender-specific
norms and is widely used as a measure of psychosocial adjustment in research
on children. The applicability of the norms to minority populations may be
problematic, especially for children who are not suffering from significant
psychopathology (Drotar, Stein, &
Perrin, 1995). The parent or primary caregiver completed the
checklist during a baseline screening visit.
Harter Self-Perception Profile for Children. The Harter
(Harter, 1985) is a 36-item
self-report revision of the Perceived Competence Scale for Children
(Harter, 1982). The Harter
assesses child self-perception in six areas believed to be important for
self-esteem: scholastic competence, social acceptance, athletic competence,
physical appearance, behavioral conduct, and global self-worth. The scale has
adequate reliability and validity, and norms are available for children 8
years and older. The Harter was self-administered or read to the child when
necessary. To help the child answer the questions, each item was broken down
into two tasks. First, he or she was asked to decide which child in the
statement selected was most like him or her. Once the child made that
decision, he/she was asked if the child in the statement was sort of
like or really like him/her. When presented in this manner,
children as young as 5 years old were able to make the discriminations
necessary to answer the questions.
Peer Teasing Scale. A peer teasing scale was constructed specifically for this study. There were five questions asking the child to report how often he/she had been teased about weight, teased about appearance, excluded from activities because of weight, and excluded from activities because of appearance, and whether he/she had been in fights with other children because of weight. The children rated each item as 1 = never, 2 = sometimes, or 3 = often.
Thirty-eight children who completed visit 1 did not return for visit 2. The peer teasing scale was administered at the second screening visit, hence the sample size for this measure was smaller (n = 79). Seventy-three percent of the children who did not complete the peer teasing scale were girls (p < .05). These children were also heavier (z-BMI: 4.9 ± 2.1 vs. 4.2 ± 1.4, p < .02). There were no differences in age (p < .17) or SES (p < .80) between children who completed and who did not complete the peer teasing scale.
A factor analysis was conducted on the peer teasing scale using principal components analysis. The results showed that the scale has a single factor. A teasing score was computed by summing the ratings from the five items. Coefficient alpha for this scale was .76, suggesting that it has adequate internal consistency.
Body Silhouettes. A series of seven pictures of boys and
girls graded from very thin to very fat were adapted from
Collins (1991). The faces of
the figures were replaced by faces with hair and features which reflect
African American ethnicity. Faces and hair were identical within gender.
Children were asked to pick the silhouette which most looked like themselves
(actual size), the figure which they would most like to look like (ideal
size), and the figure which was most like what a child their age should look
like. They were asked to make the determination based on their own size.
Caregivers also were asked to pick the figure representing their child's
actual body size, what they thought their child's size "should"
be, and the ideal sizes of a child of the same and of the opposite gender of
their child. The Collins (1991)
measure has been validated and normed in school-age children from the first to
third grades.
The children's satisfaction with their body size was quantified from the silhouette task by subtracting the ideal size from the actual size. Positive numbers indicated dissatisfaction, that the child would have liked to be smaller. Negative numbers showed that the child would have liked to have a larger body size. Caregivers' perception of the child's body size was evaluated in two ways. Parental actual/ideal discrepancy score was computed from the caregivers' choices of their child's actual and ideal body sizes using the same silhouettes as shown to the children. Parents were also asked to describe their child's weight as 1 = too thin, 2 = just right, 3 = overweight, or 4 = very overweight.
Skin Tone Faces. Eight computer-generated pictures of a child with African American facial features were generated with the skin tone varying from very dark to very light. Facial features of each gender were identical. The faces were scored such that the lightest-colored face was a 1 and the darkest face was an 8. Based on skin color, the child was asked to select the picture that looked most like himself/herself and the one he/she would most like to look like. The children's satisfaction with their skin color was measured by subtracting their desired skin color from their rating of their actual skin color. Positive numbers indicated that a child would have liked to have lighter skin, and negative numbers indicated that the child would have liked to have darker skin.
Physical Exam. During a physical examination conducted by a
physician, the child's height, in centimeters, and weight, in kilograms, were
measured. Tanner staging (Marshall & Tanner,
1969,
1970) was done by the
physician, and none of the children were fully pubertal.
Procedures
Assessments were obtained during baseline screening for a diabetes
prevention study. All assessments were conducted before entry into the
intervention program for weight management, before families knew whether they
were eligible to participate, and before they had decided whether they wished
to participate. Questionnaires were administered either by the trial
coordinator who recruited the family into the study or by a study
psychologist. All questionnaires were administered in interview format or read
to the participants if review of forms indicated that the child or parent did
not understand the content, format, or how to follow the directions.
|
Results |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Our seven hypotheses were tested using hierarchical multiple linear regression and t-test comparisons. Age, gender, SES, and z-BMI were entered sequentially as independent variables in all hierarchical models. Table II presents the results for appearance self-esteem, and Table III the results for global self-worth.
|
|
Hypothesis 1 was that there will be no association between obesity and global self-worth and an inverse relationship between obesity and appearance self-esteem. z-BMI did not make a significant contribution to the prediction of either the global self-worth (p < .37) or appearance self-esteem scales (p < .09) of the Harter.
Since the Harter Self-Perception Scale for Children has reliability and validity data only for children 8 years and older, the regression analyses were repeated using this age group (n = 83). In children 8 and older, z-BMI was a significant predictor of appearance self-esteem (R2 change = .09, p < .002). Children with a higher z-BMI had lower appearance self-esteem scores. z-BMI did not significantly predict (p < .57) global self-worth in the older children.
Hypothesis 2 was that girls will have lower appearance self-esteem than boys but that global self-worth will not differ. Using a t-test, a significant gender difference was found for appearance self-esteem, t(112) = 2.00, p < .05, with girls lower than boys (2.9 ± 0.7 vs. 3.2 ± 0.6, respectively). No gender difference was found for global self-worth, t(112) = 0.66, p <.51. Regression results show that gender predicts appearance self-esteem (p < .01) but not global self-worth (p < .86).
Hypothesis 3 stated that body size dissatisfaction will be a better predictor of appearance self-esteem than actual body weight but not be a better predictor of global self-worth. The regression analysis showed that child's body size dissatisfaction did not contribute to the prediction of appearance self-esteem (p < .47) or global self-worth (p < .07) after controlling for z-BMI, age, SES, and gender. The analysis was repeated for children 8 years and older. Body size dissatisfaction made a significant contribution to the prediction of appearance self-esteem (R2 change = .07, p <.02) and global self-worth (R2 change = .08, p < .01). Hypothesis 3 was partially confirmed in the subset of older children. Body dissatisfaction was predictive of appearance self-esteem, as hypothesized, but also of global self-worth, contrary to our hypothesis.
Hypothesis 4 was that appearance self-esteem will be lower in children whose parents view them as overweight and that there will be no association between parental perception of overweight and global self-worth. The effect of parental size dissatisfaction on child's appearance self-esteem was not quite statistically significant (p < .06) and not significant for parental dissatisfaction (p < .42). Hypothesis 4 was also tested using parental categorization of child's weight (1 = underweight, 2 = just right, 3 = overweight, and 4 = very overweight). When parental categorization of weight was used as the measure of parental perception, our fourth hypothesis was confirmed for appearance self-esteem (p < .01) but not for global self-worth (p < .996).
Hypothesis 5 was that there will be an association between obesity and psychosocial adjustment but that psychological and behavioral problems will fall in the normal range. On the four Harter self-perception scales not tested in the Hypothesis 1 (social acceptance, scholastic competence, athletic competence, and behavioral conduct), there were no significant effects for z-BMI after controlling for age, gender, and SES. Table IV presents the means and standard deviations of the Harter scales by child weight category. The table also compares our means with the published norms for third graders and shows that the self-esteem and competence of these children was equal to or better than the published norms in all cases.
|
|
After controlling for age, gender, and SES, z-BMI was added to a hierarchical regression equation to predict T scores of the CBCL subscales. Figure 1 presents the mean T score by weight category (overweight, obese, superobese) and the results of the R2 change test for each subscale. z-BMI made a significant contribution to the prediction of CBCL T scores for somatic complaints (R2 change = .07, p < .007), social problems (R2 change = .18, p < .0001), aggressive behavior (R2 change = .08, p < .005), and total problems (R2 change = .12, p < .0001). Problem scores increased as children got heavier. The T-score means were all within the normal range. Only 3% of the children fell into the clinical range for the score for total social competence (t score below 30) and 8% fell into the clinical range for the total problems score (t score above 70). The first part of Hypothesis 5, that increasing z-BMI will be associated with problems in psychosocial adaptation, was confirmed for several of the CBCL measures but not for the self-esteem measures from the Harter scale. The second part of the hypothesis, that children's scores will be in the normal range when compared with scale norms, was confirmed for all scales.
Hypothesis 6 predicted that appearance self-esteem and global self-worth will be lower in children who are dissatisfied with their skin color. Skin tone dissatisfaction occurred in both directions, with children indicating a preference for both lighter and darker skin. Over a third of the children were completely satisfied (difference score of zero) with their skin tone, and half of the children were somewhat dissatisfied (absolute value of the difference score of 1, 2, or 3), with slightly more wanting to be lighter than darker in skin tone. A small proportion of the children expressed strong dissatisfaction (absolute value of 4 or more). Table II shows that skin tone dissatisfaction was not a significant predictor of appearance self-esteem (p < .11) but it was predictive of lower global self-worth (p < .05).
For Hypotheses 7, we predicted that appearance self-esteem and global self-worth will be lower in children who report weight-related teasing. Significant effects were found for teasing on appearance self-esteem (p < .05) and global self-worth (p < .04) for the subset of participants (n = 79) who completed the teasing measure.
|
Discussion |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Using the entire sample of African American children, we found no relationship between weight status and low self-esteem despite the fact that many of these children were extremely obese. However, we found that z-BMI accounted for 9% of the variance in appearance self-esteem in children 8 years and older. The finding that weight predicted self-esteem when the younger children were excluded could be a developmental effect (Strauss, 2000
) or it could be
because the Harter scale is not reliable or valid for children younger than 8
years (Harter, 1985). This
lack of association between obesity and global self-worth/appearance
self-esteem in the full sample contrasts with other studies, which focused
primarily upon white participants (e.g.,
Miller & Downey, 1999). If
anything, self-worth scores in our children tended to be higher than the test
norms regardless of weight status.
There are several other possible explanations for the lack of relationship
between degree of obesity and global self-worth in the entire subject group.
The study may have lacked statistical power to find the relationship. Cultural
standards in the African American community may focus children's attention on
attributes other than size when judging self-worth. Crocker and colleagues
have suggested that stigmatization is situational, and that self-appraisal
(maintenance of self-esteem) may be moderated by selective devaluation of the
stigmatized characteristic, in this case overweight status
(Altabe, 1998;
Crocker, 1999;
Crocker, Cornwell, & Major,
1993; Crocker & Major,
1989; Smith, Thompson,
Raczynski, & Hilner, 1999). It may also be that children are
not subjected to negative evaluations of being overweight, that is,
"weightism," before age 8.
As hypothesized, children whose parents judged them to be more overweight
than expected had lower appearance self-esteem. With 90% of boys and 80% of
girls being obese or very obese, it is remarkable that only 30% of the parents
rated their child as very overweight. Among some African Americans, larger
body habitus is culturally acceptable
(Wilson, Sargent, & Dias,
1994). If parents are unconcerned about or misperceive their
child's weight based on cultural norms, negative attitudes about size may not
be communicated to the child (Young-Hyman,
Herman, Scott, & Schlundt, 2000).
Girls had lower appearance self-esteem than boys, but did not differ from boys on a measure of global self-worth. In the larger American culture, women experience more pressure to be thin and are more often evaluated based upon their appearance than men. This cultural "weightism" is reflected in these African American girls' lower appearance self-esteem.
Parents rated larger children as having more social and behavioral
problems, replicating the results of others
(Pesa et al., 2000;
Stradmeijer et al., 2000). The
CBCL does not have norms specific to minority populations. Since this cohort
was not compared with a matched group of overweight children of a different
ethnic group, it is not possible to specifically ascribe variation in CBCL
scores to the children's race (Drotar et
al., 1995). Rather, we attribute variation in CBCL scores within
this cohort to variation in weight status.
"Colorism," social ranking on the basis of skin tone, has been
shown to be associated with self-worth, self-competence, and self-efficacy for
African American men and women (Thompson
& Keith, 2001). In this sample of young children, skin tone
satisfaction was associated with global self-worth, a finding which is
consistent with studies of adults. Our study design prevents understanding the
cause-and-effect relationships between self-worth, actual size (weight),
perceived size, and skin tone.
Of all psychosocial factors used to predict self-esteem, weight-related peer teasing was the only significant contributor to child rating of global self-worth and appearance self-esteem. As children became bigger, they reported more peer teasing in social situations, less social acceptance, and more peer attention to their weight. Our findings suggest that these parents and children do not often perceive weight as a negative personal characteristic. Rather, social maladjustment and low appearance self-esteem in these African American children appear to be related to being teased and to extreme obesity.
Five- to 10-year-old African American children may not yet experience social bias due to "weightism" unless they have been teased. On the teasing scale, none of the overweight children, 40% of the obese children, and 48% of the superobese children reported fighting with other children because of their weight. Some children may cope with weight-related teasing by fighting, thus preserving self-esteem. Parental report of increased behavior problems, relative to weight status, may in part reflect this coping process: Heavier children are reported to show more aggression.
There are several limitations of this study. The sample included only overweight African American children. Therefore, our results cannot be generalized to lean children, or to children of other ethnic groups. The children included in this study were not a population-based sample, since their parents responded to an invitation to participate in a diabetes prevention trial. The peer teasing analyses were performed on a subset of the sample in which girls and heavier children were more likely to be eliminated. This reduced the range on the independent variables and may have attenuated some of the predictive relationships or introduced unknown confounds. It is possible that different results would have been obtained had older children been included in the sample. Parental perceptions were obtained only from mothers or female caregivers. The effect of the perceptions of fathers and other relatives on child self-esteem cannot be inferred from these data.
Future studies should include multiethnic samples of children and adolescents representing the full range of body weights, from lean to superobese, and a larger age span. A more diverse sample could better address the developmental changes in body size satisfaction and the impact of weight-related teasing. A study based on a population sample would allow a more definitive evaluation of the relationships among age, ethnicity, body size, self-perception, socioeconomic status, and psychosocial adjustment.
Because of gender and ethnic disparities in diabetes and cardiovascular
disease, it is important to find better ways of attracting minority children,
especially girls, into weight management and health promotion programs
(Sinaiko, Donahue, Jacobs, & Prineas,
1999; Young-Hyman, Schlundt,
Herman, De Luca, & Counts, 2001). If both children and adults
fail to see childhood obesity as a health, appearance, or psychosocial
problem, there appears to be little motivation for entering into a weight
management intervention (Greene et al.,
1999; Ni Mhurchu, Margetts,
& Speller, 1997). Our results suggest that families may be
more receptive to behavioral interventions once the child and caregiver
perceive the need to make changes in weight in order to improve appearance and
social adaptation or alleviate weight-related social distress (peer teasing).
Cultural, gender, and ethnic differences in valuation of size
(Smith et al., 1999) can be
addressed through education about the health implications of obesity.
|
Acknowledgments |
|---|
This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant # RO1 DK48201.
Received January 14, 2002; revision received May 2, 2002; revision received July 17, 2002; revision received January 29, 2003; accepted February 10, 2003
|
References |
|---|
|
TopAbstractIntroductionMethodsResultsDiscussionReferences |
|---|
Achenbach, T. M., & Edelbrock, C. S. (1983). Manual for the Child Behavior Checklist and revised child behavior profile. Burlington: Queen City Printers/University of Vermont, Department of Psychiatry.
Altabe, M. (1998). Ethnicity and body image: Quantitative and qualitative analysis. International Journal of Eating Disorders, 23, 153 –159.
Brown, K. M., McMahon, R. P., Biro, F. M., Crawford, P., Schreiber, G. B., Similo, S. L., et al. (1998). Changes in self-esteem in black and white girls between the ages of 9 and 14 years. The NHLBI Growth and Health Study. Journal of Adolescent Health, 23 , 7 –19.[CrossRef][ISI][Medline]
Collins, M. E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 10, 199 –208.
Crocker, J. (1999). Social stigma and self-esteem: Situational construction of self-worth. Journal of Experimental Social Psychology, 35, 89 –107.[CrossRef][ISI]
Crocker, J, Cornwell, B, & Major, B. (1993). The stigma of overweight: Affective consequences of attributional ambiguity. Journal of Personality and Social Psychology, 64 , 60 –70.[CrossRef][ISI][Medline]
Crocker, J., & Major, B. (1989). Social stigma and self-esteem: The self-protective properties of stigma. Psychological Review, 96, 608 –630.[CrossRef][ISI]
Davison, K. K., & Birch L. L. (2001). Weight
status, parent reaction, and self-concept in five-year-old girls.
Pediatrics, 107, 46
–53.
Drotar, D., Stein, R., & Perrin, E. (1995). Methodological issues in using the Child Behavior Checklist and its related instruments in clinical child psychology research. Journal of Clinical Child Psychology, 24, 184 –192.[CrossRef][ISI]
Falconer, J. W., & Neville, H. A. (2000). African American college women's body image: An examination of body mass, African self-consciousness, and skin color satisfaction. Psychology of Women Quarterly, 24, 236 –243.[CrossRef]
Falkner, N. H., Neumark-Sztainer, D., Story M., Jeffery, R. W., Beuhring, T., & Resnick, M. D. (2001). Social, educational, and psychological correlates of weight status in adolescents. Obesity Research, 9, 32 –42.[ISI][Medline]
French, S. A., Story, M., & Perry C. L. (1995). Self-esteem and obesity in children and adolescents: A literature review. Obesity Research, 3, 479 –490.[ISI][Medline]
Frisancho, A. R. (1990). Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor: University of Michigan Press.
Gardner, R. M., Sorter, R. G., & Friedman, B. N. (1997). Developmental changes in children's body images. Journal of Social Behavior and Personality, 12 , 1019 –1036.
Gleason, J. H., Alexander, A. M., & Somers, C. L. (2000). Later adolescents' reactions to three types of childhood teasing: Relations with self-esteem and body image. Social Behavior and Personality, 28, 471 –480.[CrossRef]
Greene, G. W., Rossi, S. R., Rossi, J. S., Velicer, W. F., Fava, J. L., & Prochaska, J. O. (1999). Dietary applications of the stages of change model. Journal of the American Dietetic Association, 99, 673 –678.[CrossRef][ISI][Medline]
Harter, S. (1985). Manual for the Self-Perception Profile for Children. University of Denver.
Harter, S. (1982). The Perceived Competence Scale for Children. Child Development, 53 , 87 –97.[CrossRef][ISI]
Herman, L. J. (2000). Self-Esteem in overweight African American children: Contribution of parent and child appraisal of body size. Unpublished master's thesis. University of Maryland, Baltimore County.
Hollingshead, A. B. (1975). Four-factor index of social status. Unpublished paper, New Haven, CT: Yale University, Department of Sociology.
Hollingshead, A. B., & Redlich, F. C. (1958). Social class and mental illness. New York: John Wiley.
Kaplan, K. M., & Wadden, T. A. (1986). Childhood obesity and self-esteem. Journal of Pediatrics, 109 , 367 –370.[CrossRef][ISI][Medline]
Kimm, S. Y., Barton, B. A., Berhane, K., Ross, J. W., Payne, G. H., & Schreiber, G. B. (1997). Self-esteem and adiposity in black and white girls: The NHLBI Growth and Health Study. Annals of Epidemiology, 7, 550 –560.[CrossRef][ISI][Medline]
Kumanyika, S. K., Huffman, S. L., Bradshaw, M. E., Waller, H.,
Ross, A., Serdula, M., et al. (1990). Stature and weight status
of children in an urban kindergarten population.
Pediatrics, 85, 783
–790.
Marshall, W. A., & Tanner, J. M. (1969). Variations in pattern of pubertal changes in girls. Archives of Disease in Children, 44, 291 –303.
Marshall, W. A., & Tanner, J. M. (1970). Variations in the pattern of pubertal changes in boys. Archives of Disease in Children, 45, 13 –23.
Miller, C. T., & Downey, K. T. (1999). A meta-analysis of heavyweight and self-esteem. Personality and Social Psychology Review, 3, 68 –84.
Ni Mhurchu, C., Margetts, B. M., & Speller, V. M. (1997). Applying the stages-of-change model to dietary change. Nutrition Reviews, 55, 10 –16.[ISI][Medline]
Pesa, J. A., Syre, T. R., & Jones, E. (2000). Psychosocial differences associated with body weight among female adolescents: The importance of body image. Journal of Adolescent Health, 26 , 330 –337.[CrossRef][ISI][Medline]
Schwartz, D. J., Phares, V., Tantleff-Dunn, S., & Thompson, J. K. (1999). Body image, psychological functioning, and parental feedback regarding physical appearance. International Journal of Eating Disorders, 25, 339 –343.
Sinaiko, A. R., Donahue, R. P., Jacobs, D. R., Jr., & Prineas, R. J. (1999). Relation of weight and rate of increase in weight during childhood and adolescence to body size, blood pressure, fasting insulin, and lipids in young adults. The Minneapolis Children's Blood Pressure Study. Circulation, 23, 1471 –1476.
Smith, D. E., Thompson, J. K., Raczynski, J. M., & Hilner, J. E. (1999). Body image among men and women in a biracial cohort: The CARDIA study. International Journal of Eating Disorders, 25, 71 –82.
Steen, S. N., Wadden, T. A., Foster, G. D., & Andersen, R. E. (1996). Are obese adolescent boys ignoring an important health risk? International Journal of Eating Disorders, 20 , 281 –286.
Stradmeijer, M., Bosch, J., Koops, W., & Seidell, J. (2000). Family functioning and psychosocial adjustment in overweight youngsters. International Journal of Eating Disorders, 27, 110 –114.
Strauss, R. S. (2000). Childhood obesity and
self-esteem. Pediatrics, 105, e15
.
Thompson, M. S., & Keith, V. M. (2001). The blacker the berry: Gender, skin tone, self-esteem and self-efficacy. Gender and Society, 15, 336 –357.
Wilson, D. B., Sargent, R., & Dias, J. (1994). Racial differences in selection of ideal body size by adolescent females. Obesity Research, 2, 38 –43.[Medline]
Young-Hyman, D., Herman, L. J., Scott, D. L., & Schlundt, D. G. (2000). Care giver perception of children's obesity-related risk: A study of African American families. Obesity Research, 8 , 241 –248.[ISI][Medline]
Young-Hyman, D., Schlundt, D. G., Herman, L., De Luca, F., &
Counts, D. (2001). Evaluation of the insulin resistance syndrome
in 5- to 10-year-old overweight/obese African-American children.
Diabetes Care, 24, 1359
–1364.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. S. Margulies, R. G. Floyd, and R. L. Hojnoski Body Size Stigmatization: An Examination of Attitudes of African American Preschool-Age Children Attending Head Start J. Pediatr. Psychol., June 1, 2008; 33(5): 487 - 496. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Owens, R. Mehlenbeck, J. Lee, and M. M. King Effect of Weight, Sleep Duration, and Comorbid Sleep Disorders on Behavioral Outcomes in Children With Sleep-Disordered Breathing Arch Pediatr Adolesc Med, April 1, 2008; 162(4): 313 - 321. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. W. Lowry, B. J. Sallinen, and D. M. Janicke The Effects of Weight Management Programs on Self-Esteem in Pediatric Overweight Populations J. Pediatr. Psychol., November 1, 2007; 32(10): 1179 - 1195. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Musher-Eizenman and S. Holub Comprehensive Feeding Practices Questionnaire: Validation of a New Measure of Parental Feeding Practices J. Pediatr. Psychol., September 1, 2007; 32(8): 960 - 972. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Storch, V. A. Milsom, N. DeBraganza, A. B. Lewin, G. R. Geffken, and J. H. Silverstein Peer Victimization, Psychosocial Adjustment, and Physical Activity in Overweight and At-Risk-For-Overweight Youth J. Pediatr. Psychol., January 1, 2007; 32(1): 80 - 89. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. L. Mitola, M. A. Papas, K. Le, L. Fusillo, and M. M. Black Agreement with Satisfaction in Adolescent Body Size between Female Caregivers and Teens from a Low-income African-American Community J. Pediatr. Psychol., January 1, 2007; 32(1): 42 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Gilliland, M. Windle, J. A. Grunbaum, A. Yancey, D. Hoelscher, S. R. Tortolero, and M. A. Schuster Body Image and Children's Mental Health Related Behaviors: Results from the Healthy Passages Study J. Pediatr. Psychol., January 1, 2007; 32(1): 30 - 41. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Mulvaney, D. G. Schlundt, E. Mudasiru, M. Fleming, A. M. Vander Woude, W. E. Russell, T. A. Elasy, and R. Rothman Parent Perceptions of Caring for Adolescents With Type 2 Diabetes Diabetes Care, May 1, 2006; 29(5): 993 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L J Griffiths, D Wolke, A S Page, J P Horwood, and the ALSPAC Study Team Obesity and bullying: different effects for boys and girls Arch. Dis. Child., February 1, 2006; 91(2): 121 - 125. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Storch and D. R. Ledley Peer Victimization and Psychosocial Adjustment in Children: Current Knowledge and Future Directions Clinical Pediatrics, January 1, 2005; 44(1): 29 - 38. [Abstract] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||