Self-Esteem and Obesity: A Longitudinal Analysis among Children and Adolescents in Niagara, Canada

Abstract

As the prevalence of obesity has surged in the past decade, with a marked increase in the rates among North American youth, it is important to comprehensively understand its downstream effects and the burden these may have on society. Besides the countless physical comorbidities of overweight and obesity in youth, several psychosocial effects have been identified including self-esteem issues. The purpose of this study is to understand the longitudinal relationship between obesity and self-esteem in Canadian children and adolescents. By quantifying this association, it may not only provide evidence for prevention, but be useful for future resource planning. The research questions are as follows: Is there a correlation between body mass and self-esteem? Is obesity status and body mass over time associated with changes in self-esteem, and if so among which sub-domains? Is the temporal relationship bi-directional where self-esteem also predicts changes in body mass? Is the relative difference in body mass between those in the same cohort also associated with self-esteem change longitudinally? Which covariate factors are significant in these suggested relationships? Data was obtained from the PHAST cohort study conducted from 2004-2010 among 2,278 children at baseline from Niagara, Canada. Participants were excluded if missing all data related to body mass and self-esteem, and multiple imputation regression was utilized to impute missing observations. Cross-sectional analysis between variables was conducted using the Pearson correlation test. Linear mixed modelling regression was conducted to examine the proposed bi-directional relationships longitudinally, accounting for fixed and random variables as well as relevant covariates and interactions. There were weak to moderate significant negative linear correlations between BMI and all self-esteem sub-domains. Baseline obesity status and BMI increases were significant predictors of decreased physical, global, athletic, and social self-esteem longitudinally. With each kg/m2 increase in BMI, physical appearance self-esteem was reduced by 0.25 units (95% CI: -0.29, -0.21, p<0.0001) over a 5-year period. Compared to those of a normal weight, those obese at baseline had an average athletic self-esteem 1.51 units lower (95% CI: -2.15, -0.87, p<0.0001). With each standard deviation increase from the mean BMI of one’s sex and age, global self-esteem was reduced by 0.53 units (95% CI: -0.62, -0.43, p<0.0001). Also, low baseline self-esteem and decreases in physical, global, and athletic self-esteem levels significantly predicted increased BMI over time. Physical activity was a significant covariate, predicting both increased self-esteem levels and decreased BMI longitudinally. The results suggest that there is a bi-directional relationship present between body mass and self-esteem in school children. Having a greater body size impairs areas of self-esteem, and having stronger self-esteem helps mitigate obesity. Physical activity is a key factor in maintaining appropriate self-esteem and body mass levels. This study can be used to guide public health officials and resource planners given the escalation of the obesity epidemic in youth.