Richard S. Strauss

The prevalence of overweight is increasing dramatically in the United States. Results from the Behavioral Risk Factor Surveillance System suggest that obesity prevalence has increased by more than 50% among adults between 1991-1999.^1,2 The prevalence of childhood overweight is also increasing at an accelerating rate.³ The most recent data from the 1988-1991 National Health and Nutrition Examination Survey III (NHANES III) demonstrate that the number of overweight children has increased among all age, race, and sex groups since the NHANES II, 1963-1970.⁴ Preliminary data from the most recent NHANES study (NHANES IV, 1999) indicate that overweight continues to increase.⁵

Research from JAMA Pediatrics — Psychosocial Correlates of Physical Activity in Healthy Children

The long-term effects of fetal growth retardation on intellectual and educational outcome remain controversial. Those born small for gestational age (SGA) may demonstrate developmental delays in childhood,^1-4 although other studies have not substantiated these findings.^5-9 Even when cognitive impairments have been identified, these deficits are typically quite small. Unfortunately, because of study design and difficulty in long-term tracking of patients, the vast majority of outcome studies follow up children who were SGA to mid-childhood. In adolescence, Westwood and colleagues⁵ found no significant differences in IQ between those children who were SGA and those who were normal birth weight (NBW); however, only 33 (28%) of the original 118 children were located. Similarly, Stein et al,¹⁰ Douglas and Gear,¹¹ and Nilsen et al¹² also found no cognitive deficits among those aged 18 to 19 years who were SGA; however, relatively few adolescents were studied and follow-up rates were low. In contrast, Paz et al¹³ reported that boys who were SGA had lower levels of educational attainment and adolescent girls who were SGA had lower IQ scores than those who were NBW.

Background.: Although childhood obesity may have detrimental consequences for childhood self-esteem, the prevalence and magnitude of this problem is controversial. In addition, the social and emotional effects of decreased self-esteem in obese children are unknown.Methods.: A total of 1520 children, 9 to 10 years of age, born to mothers in the National Longitudinal Survey of Youth were studied. Comprehensive demographic data including race and family income were available in 97% of the cohort. Self-esteem was measured using Self-Perception Profile for Children. The 4-year follow-up Self-Perception Profile for Children scores were available in 79% of the children. Obesity was defined as a body mass index greater than the 95th percentile for age and gender. Additional data include a self-administered questionnaire at 13 to 14 years of age concerning emotional well being, smoking, and alcohol consumption. Data were stratified by race and gender. The data were weighted to reflect a nationally representative sample of children born to mothers 17 to 28 years of age.Results.: Scholastic and global self-esteem scores were not significantly different among 9- to 10-year-old obese and nonobese children. However, over the 4-year period, obese Hispanic females and obese white females showed significantly decreased levels of global self-esteem compared with nonobese Hispanic females and nonobese white females, respectively. Mild decreases in self-esteem also were observed in obese boys compared with nonobese boys. As a result, by 13 to 14 years of age, significantly lower levels of self-esteem were observed in obese boys, obese Hispanic girls, and obese white girls compared with their nonobese counterparts. Decreasing levels of self-esteem in obese children were associated with significantly increased rates of sadness, loneliness, and nervousness compared with obese children whose self-esteem increased or remained unchanged. In addition, obese children with decreasing levels of self-esteem over the 4-year period were more likely to smoke and drink alcohol compared with obese children whose self-esteem increased or remained unchanged.Conclusion.: Obese Hispanic and white females demonstrate significantly lower levels of self-esteem by early adolescence. In addition, obese children with decreasing levels of self-esteem demonstrate significantly higher rates of sadness, loneliness, and nervousness and are more likely to engage in high-risk behaviors such as smoking or consuming alcohol.

Context. Obesity is the most common health problem facing children. The most recent data from the National Health and Nutrition Examination Survey III suggest that 22% of children and adolescents are overweight and that 11% are obese. Objective. To investigate prospectively the association between the home environment and socioeconomic factors and the development of obesity in children. Design. Prospective cohort study. Setting. The National Longitudinal Survey of Youth. Population. A total of 2913 normal weight children between the ages of 0 and 8 years were followed over a 6-year period. We examined the roles of race, marital status, maternal education, family income, and parental occupation, as well as standardized measures of the home environment (The Home Observation for Measurement of the Environment [HOME]-Short Form) on the development of childhood obesity. Primary Outcome Measure. Incidence of obesity. Obesity was defined as a body mass index >95th percentile for age and gender at the 6-year follow-up. Results. Maternal obesity was the most significant predictor of childhood obesity (OR: 3.62 [2.65–4.96]). The HOME-Short Form cognitive scores and household income were also significant predictors of childhood obesity (OR, low HOME-cognitive: 2.64 [1.48–4.70], medium HOME-cognitive: 2.32 [1.39–3.88]; low income: 2.91 [1.66–5.08], medium income: 2.04 [1.21–3.44]). Children who lived with single mothers were also significantly more likely to become obese by the 6-year follow-up, as were black children, children with nonworking parents, children with nonprofessional parents, and children whose mothers did not complete high school. Neither the child9s gender nor the HOME-emotional scores contributed to the development of obesity. After controlling for the child9s initial weight-for-height z-score, maternal body mass index, race, marital status, occupation, education, and HOME emotional scores, only the HOME cognitive score and family income remained significant predictors of childhood obesity. Conclusion. Children with obese mothers, low family incomes, and lower cognitive stimulation have significantly elevated risks of developing obesity, independent of other demographic and socioeconomic factors. In contrast, increased rates of obesity in black children, children with lower family education, and nonprofessional parents may be mediated through the confounding effects of low income and lower levels of cognitive stimulation.