Obesity in Children and the 'Myth of Psychological Maladjustment': Self-Esteem in the Spotlight.

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childhood obesity 2969 preconceptions and to identify factors that protect psychological well-being.The literature on self-esteem in childhood obesity exemplifies the challenge of understanding the psychology of young people with obesity. In their review,
obesity 351 /2017AbstractPurpose of ReviewThere are contrasting views regarding the psychological well-being of children with obesity . Responding to limitations of existing evidence, Jane Wardle in 2005 argued for a ‘myth of psychological
obesity 669 of self-esteem each offer value. Global self-esteem is reduced in nearly all studies of youth with obesity . Dimensional self-esteem reveals physical appearance, athletic and social competence as the most affected
obesity 872 most affected areas, confirmed by research that has operationalised low self-competence. Children with obesity are also more likely to be victimised by their peers, generally and for their fatness. Victims who bully
obesity 1090 others appear to preserve some aspects of self-esteem.SummaryA relatively small proportion of youth with obesity has low self-esteem, but those with severe and persistent obesity are especially compromised. Weight
obesity 1156 relatively small proportion of youth with obesity has low self-esteem, but those with severe and persistent obesity are especially compromised. Weight loss is only weakly associated with improved self-competence suggesting
obesity 1412 approaches to improving well-being.IntroductionOne of Jane Wardle’s early interests was in children with obesity , their self-perception and self-esteem [[], []]. This was commensurate with her broader regard for the
obesity 1544 and self-esteem [[], []]. This was commensurate with her broader regard for the needs of people with obesity , seen in her driving the establishment of the charity Weight Concern. At that time, I was also working
obesity 1710 Weight Concern. At that time, I was also working and publishing on the self-perception of children with obesity and have continued this interest (while Jane’s research interests and outputs proliferated). One paper
obesity 1981 others, was written by Jane with Lucy Cooke in 2005 [[]]. If the title was benign, ‘The impact of obesity on psychological well-being’, the conclusion was not. They wrote ‘The persistence of the myth of
obesity 2297 recent publications on body dissatisfaction, self-esteem and depression in children and adolescents with obesity . Interestingly, in the same year, Carl-Erik Flodmark published a short overview of the literature titled
obesity 2544 Both publications shared the message that outside of a clinical environment, very few children with obesity are either depressed or have low self-esteem. Neither of these publications sought to dismiss children
obesity 2660 either depressed or have low self-esteem. Neither of these publications sought to dismiss children with obesity who are in distress and in need of help. Rather, they challenged practitioners to look again at the
obesity 2979 to identify factors that protect psychological well-being.The literature on self-esteem in childhood obesity exemplifies the challenge of understanding the psychology of young people with obesity. In their review,
obesity 3066 in childhood obesity exemplifies the challenge of understanding the psychology of young people with obesity . In their review, Wardle and Cooke noted the following problems [[]]. Self-esteem appears poorer in
obesity 3210 noted the following problems [[]]. Self-esteem appears poorer in clinical samples of youngsters with obesity than those from the community; so, it is unwise to generalise. Researchers rarely look beyond mean scores
obesity 3443 measures, or whether small differences in mean scores between children of healthy weight and those with obesity have real-life significance. Little effort has been directed to potential moderators or mediators of
obesity 3577 significance. Little effort has been directed to potential moderators or mediators of the relationship between obesity and self-esteem. Over the course of treatment, weight loss appears poorly related to any change in self-esteem.
obesity 3828 little serious consideration of how self-esteem is conceptualised (and measured) in the context of obesity . Few authors have sought to define (and measure) low self-esteem and apply this to obesity. Furthermore,
obesity 3919 context of obesity. Few authors have sought to define (and measure) low self-esteem and apply this to obesity . Furthermore, the predominant view of the relationship between obesity in childhood and self-esteem
obesity 3990 self-esteem and apply this to obesity. Furthermore, the predominant view of the relationship between obesity in childhood and self-esteem has been unidirectional rather than dynamic. Recognising the challenge
obesity 4210 Jane (and Lucy), a re-evaluation of the literature on self-esteem in children and adolescents with obesity is timely.Conceptualising Self-EsteemSelf-esteem is a long established psychological construct with
obesity 5211 (or likely rejection). These perspectives each have something to say about the relationship between obesity and self-esteem.Global Self-EsteemThe idea that self-esteem can be assessed as an evaluative attitude
obesity 5688 popularity is in part due to its simplicity and brevity.Unsurprisingly, this scale is prominent in obesity research. In a meta-analysis looking at global self-esteem in all age groups, Miller and Downey found
obesity 6030 difference in global self-esteem scores between people of healthy weight, who are overweight, and with obesity .Important influences on the strength of this relationship were age and gender. The correlation between
obesity 6433 (−0.23) than males (−0.09). More recently, a systematic review of studies comparing youth with obesity and healthy weight controls found lower global self-esteem scores in those with obesity in 17 of the
obesity 6521 youth with obesity and healthy weight controls found lower global self-esteem scores in those with obesity in 17 of the 21 included studies [[]•]. The four exceptions had a feature in common. They all reported
obesity 6927 from the same countries and ethnicity/income groups that do show lower self-esteem in individuals with obesity [[]].Perceived Self-CompetenceThe global perspective of self-esteem is in fact pre-dated by an elaborated
obesity 8358 humour.We conducted a systematic review of multi-competence assessments in young people with defined obesity . Studies that had only looked at overweight were excluded as we were interested in what the literature
obesity 8533 were interested in what the literature had to say specifically about the self-competence of those with obesity . There were 17 studies, of which 9 were cross-sectional and 7 weight management interventions [[]].
obesity 8801 that assessed physical appearance and athletic/physical competence found lower scores in youth with obesity . Obesity also impacted on perceived social acceptance, with lower scores reported in half of those measuring
obesity 9068 observed in scholastic competence or behavioural conduct. Global self-worth was lower in children with obesity compared with those healthy weight in six of the nine cross-sectional studies, a finding comparable
obesity 9734 this area.Thus far, this literature says much more about successes than pretensions in children with obesity . The competencies included in Harter’s self-perception profiles may indeed be those most important
obesity 10539 suggests that for a community sample of 12-year olds at least, healthy weight children and those with obesity do not differ in how important they rate appearance and athletic competencies. However, and in accord
obesity 11744 perception of physical appearance was particularly affected, with 63% of girls and 33% of boys with obesity identifying with the depiction of a physically unattractive child [[]]. In contrast, the proportion
obesity 11982 measure of self-worth was smaller. Although the relative risk of low global self-worth in girls with obesity was 4.1 times more than normal weight peers, only 20% of the group scored in this range. Complementing
obesity 12110 than normal weight peers, only 20% of the group scored in this range. Complementing this, girls with obesity were more than five times less likely to have high global self-worth, something achieved by around 70%
obesity 13455 social referents.Mark Leary has taken this social view in a particular direction, one very relevant to obesity . Sociometer theory proposes that the self-esteem system evolved primarily as a monitor of social acceptance,
obesity 14147 possibility of rejection can lower self-esteem. Two areas of research are particularly relevant to youth with obesity —interpersonal relations and victimisation.Interpersonal RelationsSociometric procedures using peer-nominated
obesity 14425 community samples of primary school aged children. Some 20 years ago, for example, young children with obesity in the UK were just as likely to be chosen as their lean peers as people to socialise with both inside
obesity 14880 liked peer nominations to generate standard social preference classifications [[]•]. Children with obesity were more likely than healthy weight children to be neglected, i.e. with few positive or negative nominations.
obesity 15017 weight children to be neglected, i.e. with few positive or negative nominations. Those with severe obesity were significantly more likely to be rejected, i.e. with more least-liked, negative nominations. Even
obesity 15176 with more least-liked, negative nominations. Even so, more than twice as many 6–7-year olds with obesity were classified as popular or average than were those rejected, neglected or controversial.Looking at
obesity 16174 failure to be named a friend by people you nominate suggests that the friendship ties of adolescents with obesity are less plentiful, potentially weaker and more directed to others with obesity. In terms of self-esteem,
obesity 16254 of adolescents with obesity are less plentiful, potentially weaker and more directed to others with obesity . In terms of self-esteem, the peer referent for self-evaluation chosen by teenagers with obesity determines
obesity 16351 with obesity. In terms of self-esteem, the peer referent for self-evaluation chosen by teenagers with obesity determines their social standing: valued and held in esteem by others similarly overweight but likely
obesity 16622 healthy weight.VictimisationPeer difficulties and rejection have been observed in young children with obesity . By age 5, parents of children with obesity are more likely to report peer relationship problems in
obesity 16666 and rejection have been observed in young children with obesity. By age 5, parents of children with obesity are more likely to report peer relationship problems in their girls and boys than parents of healthy
obesity 17054 from perceived victimisation.The research evidence is unequivocal regarding the association between obesity and victimisation. A meta-analysis of 16 studies and 28 effect sizes showed a significant relationship
obesity 17450 Primary school teachers in the Netherlands and the children themselves revealed that children with obesity were more likely to be victimised by their peers but also more likely to bully others [[]•]. Indeed,
obesity 17700 referred to as bully-victims who were both recipients and perpetrators of victimisation. Children with obesity were twice as likely to be in this category as healthy weight peers.The work above has examined the
obesity 18046 at weight-related victimisation in young people. We reported that some 42% of 9–12-year olds with obesity identified themselves as fat victimised compared with 7% of their healthy weight peers [[], []]. Interestingly,
obesity 20632 2 girls) reported themselves as fat bullies without being victimised. There were more children with obesity in the bully-victim group (32%) than in the fat victimised (29%), fat bullies (18%) or not involved
obesity 22816 significantThree additional points are noteworthy. First, while being fat-teased was more common in children with obesity , over half did not identify themselves as such. We know very little about what has protected these children
obesity 24837 recently reported on the outcomes of an intensive, residential weight loss programme for youth with obesity . Attendees lost 5.5 kg (−0.25 BMI z-score) during an average stay of just over 4 weeks [[]•].
obesity 26111 interventions such as residential programmes, these may include the daily company of others who have obesity in common, improvements in competence or self-efficacy in newly prioritised areas (such as exercising
obesity 26506 either personal or clinical significance [[]•].Conclusions and ImplicationsThe relationship between obesity and impaired well-being in youth is present but modest in overall strength and varies between individuals.
obesity 26657 but modest in overall strength and varies between individuals. Children with severe and persistent obesity are especially compromised. The ‘myth of psychological maladjustment’ can be dispelled, although
obesity 26961 features such as low self-esteem are likely minor contributors to the development and maintenance of obesity , albeit with the potential to interact with other risk factors. And obesity is undoubtedly only one
obesity 27037 development and maintenance of obesity, albeit with the potential to interact with other risk factors. And obesity is undoubtedly only one of the several influences on an individual’s sense of self-value, albeit a
obesity 27192 influences on an individual’s sense of self-value, albeit a potentially important one. Additionally, both obesity and self-esteem are resistant to change. Longitudinally, any association will be bi-directional, in
obesity 27362 association will be bi-directional, in the same manner to that proposed for the relationship between obesity and depression [[]]. Bi-directionality between obesity and impaired health-related quality of life,
obesity 27417 to that proposed for the relationship between obesity and depression [[]]. Bi-directionality between obesity and impaired health-related quality of life, a concept that overlaps with self-esteem, emerges in middle
obesity 27940 well-being, alongside low self-esteem. They are undoubtedly all interrelated. Furthermore, given that obesity persists, then the negativity associated with being fat is likely to accumulate. Unsurprisingly therefore,
obesity 28243 depressive symptoms [[]] and binge eating [[]]. This is a reminder that the priority for preventing obesity should never distract from addressing the needs of those already obese. For some, these needs are apparent
obesity 28602 child’s environment and supportive networks are also important. As previously observed, many people with obesity , adults and children alike, have high self-esteem, do not suffer major depression, are in well-paid

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