Introduction

Obesity is the most common health problem facing children today. It has been suggested that obese children have increased problems with self-esteem and depression when compared to the normal pediatric population. Research in exercise and depression is persuasively showing how exercise may be elemental in treating low self-esteem. Moderate exercise seems to be the most effective intensity in reducing depression and increasing levels of self-esteem. This literature review will illustrate what other researchers have found and concluded in a.) finding a relationship between self-esteem and obesity, b.) the effects of exercise on self-esteem, c.) studies on motivation among children, and d.) the need for more research.

Finding A Relationship

In order to establish a relationship between obesity and self-esteem, a Rosenberg Self-esteem Scale was administered to 550 14 and 16 year old girls. Self-esteem scores were categorized by weight and weight by height. Scores on the Quetelet Index for Obesity were correlated with self-esteem scores. Mean self-esteem of the low-and-middle weight by height group was higher than the mean of the high weight group. In analyzing weight alone, the self-esteem of the middle-weight group was significantly higher than the self-esteem of the high-weight group. The correlation of the obesity index and self-esteem indicated that as weight increased, self-esteem decreased (Martin, Housley, & McCoy, 1988).

In another study, the relationship between obesity and self-esteem was examined cross-sectionally and prospectively over three years in a cohort of 1278 adolescents in grades 7 to 9 at baseline. Cross-sectional analysis revealed an inverse association between physical appearance self-esteem and body mass index in both males and females. In females, body mass index was inversely associated with global self-esteem, close friendship, and behavioral conduct. In males, body mass index was inversely associated with athletic and romantic appeal. These results suggest that low self-esteem may be an important factor in preventing or reversing obesity (French, Perry, Leon, & Fulkerson, 1996).

A study by Strauss supports data from Martin, Housely, and McCoy. Straus's data demonstrates that negative weight perceptions are particularly common among young adolescent white females, which reveals that young obese adolescent females show the lowest levels of self-esteem. Nevertheless, negative perceptions of obesity also exist among adolescent boys. The data also demonstrates significant social consequences of decreasing self-esteem in obese children. Obese children with decreasing levels of self-esteem showed significantly elevated levels of loneliness, sadness, and nervousness. Although these efforts are not unique for obese children, they are nevertheless quite important because nearly 70% of white obese females demonstrated decreasing levels of self-esteem by early adolescence (Strauss, 2000).

Additional studies need to focus on whether positive family or social interactions can alleviate the negative psychosocial effects of adolescent obesity. Strauss concludes that children with obese mothers, low family incomes, and lower cognitive stimulation have significantly higher risks of developing obesity, independent of other demographic and socio-economic factors. In contrast, increased rates of obesity in black children, children with lower family education, and non-professional parents may be mediated through the confounding effects of low income and lower levels of cognitive stimulation (Strauss & Knight, 1999).

Effects of Exercise

The case for exercise and health has primarily been made on its impact on diseases such as coronary heart disease, diabetes, and obesity. However, there has been increasing research into the role of exercise in improving mental well-being, including global self-esteem.

Sufficient evidence now exists for the effectiveness of exercise in the treatment of clinical depression and low self-esteem. Additionally, exercise has a moderate reducing effect on state and trait anxiety and can improve physical self-perceptions and in some cases, global self-esteem. There is also good evidence that aerobic and resistance exercise (weight training) enhances mood states, and weaker evidence that exercise can improve cognitive function (Fox, 1999).

One study which supports the fundamentals of CHAMP is revealed in the Journal of Sports Medicine and Physical Fitness. In the study, 37 males and 28 females participated in a 10-week exercise program. Participants were selected from existing classes forming weight training, aerobic exercise, and activity control group. Results revealed change in physical self-perception, strength, and body composition. Improvements in physical self-perceptions and fitness occurred independent of the exercise group. Correlations among the measures revealed relationships among physical self-perceptions, body satisfaction, global self-esteem, and fitness (Caruso & Gill, 1992).

Study of Motivation

In order to study motivation among obese children, a study used a body video distortion method to compare their body image with the body perception of non-obese peers. A standardized series of body size estimations were used: cognitive (what subject "think" they look like), affective (what they "feel" they look like), and optative (what they "wish" they looked like). Forty-one obese children (16 boys and 25 girls; average 12 years old) and 42 age-matched control subjects compared percentages of deviation from the accurate body image. The results showed that obese children were more accurate in estimating their real body width, but desired to reduce their body size by about 25% (Probst, Braet, & De Vos, 1995).

The significance of exercise as a healthy related behavior has brought forth the need to address motivational problems associated with its adoption and maintenance. In this respect, exercise psychology research would appear to provide potential for guiding significant public health initiatives. Cognitions about self-perceived quality of life vary across the stages of change, with those who are least prepared to adopt regular exercise reporting the lowest levels of quality of life. These finding suggests that cognitive-motivational messages designed to emphasize quality of life benefits associated with exercise may be useful intervention strategies for people who are less motivationally ready for change (Laforge & Rossi, 1999).

To remedy the localized problem of motivation, CHAMP has incorporated the use of one-on-one fitness specialists who act not only as instructors, but as mentors also.

In general, research has demonstrated that engaging in exercise and physical activity significantly enhances mental health and can increase self-esteem. Extensive meta-analysis states that exercise has a positive impact on enhancing mood, self-concept, and self-esteem. In addition, feelings of depression, anger, and anxiety tend to dissipate after exercise (Greenberg & Oglesby, 1999).

Need for More Research

Many questions still exist regarding the combination of specific modes of exercise with different intensities and their resulting productivity. Studies show that resistance training is beneficial, but not much is known on intensity and duration.

The relationship between self-esteem and obesity has not received a great deal of empirical evaluation using strong research methodologies. Thus, it is not clear:

? whether self-esteem is consistently related to obesity,

? whether the relationship is global or specific to physical appearance, whether the relationship differs by demographic variables such as age, gender, or race/ethnicity, or

? whether self-esteem moderates weight changes during weight loss treatment programs (French, Story, & Perry, 1995).

More studies need to be done to clarify whether increases in self-esteem are related to enhanced weight-loss. Many studies are methodologically weak primarily due to small and select samples and lack appropriate comparison groups.

Although some inconsistencies still exist and much research remains to be done, the pursuit of exercise therapy to treat obese children is well underway. All of these research efforts work towards improving the future of preventative medicine and better the well being and lifestyle of children suffering from obesity and low self-esteem.

References

Biddle, S & Fox, K. (1989). Exercise and Health Psychology: Emerging Relationships. British Journal of Medicine and Psychology, 62(3), 205-216 Caruso, C. & Gill, D. (1992). Strengthening physical self-perceptions through exercise. Journal of Sports Medicine and Physical Fitness. 32 (4), 416-427

Fox, K. (1999). The influence of physical activity on mental well being. Public Health Nutrition. 2(3). 411-418

French S, Perry C, Leon G, & Fulkerson J. (1996) Self-esteem and changes in body mass index over 3 years in a cohort of adolescents. Obesity Resource, 41(1). 27-33

FrenchS, Story M, & Perry C. (1999). Mental Health Disorders. Presidents Council on Physical Fitness and Sports Report. 4(1). 10-12

Hunter S, Larrieu J, Ayad F, & O'Leary P (1997). Roles of Mental Health Professionals in Multidisciplinary Medically Supervised Treatment Programs for Obesity. Journal of the American Medical Association (2), 97-113.

Retrieved from the World Wide Web February 24, 2000: http://www.sma.org/smj/97/iune2.

Laforge R & Rossi J. (1999). Stages of regular exercise and health related to quality of life. Preventative Medicine. 28(4). 349-360 Martin S, Housley K, & McCoy H. (1988). Self -esteem of adolescent girls as related to weight. Perceptual and Motor Skills. 67(3). 879-884

Probst M, Braet C, & De Vos P. (1995). Body size estimation in obese children: a controlled study with the video distortion method. International Journal of Obesity Related to Metabolic Disorders. 19(11), 820-824

Sheslow D, Hassink S, Wallace W, & Delancey E. (1993). The relationship between self-esteem and depression in obese children. (Abstract). Annual New York Academy of Science. Oct. 29 L699), 289-291

fV/-wv?*? Strauss, R (2000). Childhood obesity and self-esteem. Pediatrics, 105(1), 15. Retrieved February 19, 2000 from the World Wide Web: http://www.pediatrics.org Strauss, R & Knight, J (1999). Influence of the home environment on the development of obesity in children. Pediatrics, 103(6). 85. Retrieved February 19, 2000 from the World Wide Web: http://www.pediatrics.org

John Izzo, BS, NASM-CPT, is currently the Fitness Director of the YMCA of Greater Hartford (CT) and Master Lecturer for WITS. He holds multiple certifications in personal training and has an extensive successful background in weight management and athletic improvement among clients. For more info, please contact: john12774@hotmail.com