Maintenance of Self-Esteem by Obese Children Helen E Manus, MSN, RN, and Maureen R Killeen, PhD, RN Forty-five fifih grade children participated in a study to examine whether obese children differ in self-esteem from their average-weight peers The study also explored whether obese children use the processes of discounting and cognitive distortion to maintain self-esteem The obese children had lower scores than average-weight children in global selfworth, and in perceived competence in physical appearance and social acceptance, but not in scholastic competence, athletic competence, or behavioral conduct The pattern of results indicate that obese children not discount the importance of physical appearance and zueight, but use distortion Further, the use of distortion by obese children was associated with more positive self-perceptions Although the use of defensive cognitions was effective in enhancing obese children’s global self-worth, it was not powerjkl enough to prevent completely the negative effectsof obesity on self-esteem Key words: Obesity, overweight, self-esteem JCAPNVolume 8,Number 1,January- March, 1995 Helen E Manus, M S N , RN, is afilitated with Scottish Rite Children’s Medical Center, Atlanta, GA Maureen R Killeen, PhD, RN, is Professor of Mental HealthPsychiatric Nursing, Athens, GA o b e s i t y is a major health problem affecting increasing numbers of school-aged children, and often persisting into adulthood (Obese Children, 1986) Although the physical health risks associated with obesity have been well-documented (Koniz- Booher & Koniz, 1986; Weil, 19811, less attention has been given to the mental health risks Among the potential psychosocial consequences of obesity in childhood are social rejection (Staffieri, 1967) and low self-esteem (McCarthy, 1986) Self-esteem is also an important component of health, affecting numerous aspects of mental health and behavior (Roy & Andrews, 1991) Persons with high selfesteem have greater social adjustment, less anxiety and worry, and a lower incidence of psychosomatic symptoms (Mack, 1983) When persons value the self and have confidence in their abilities, they engage in activities that are growth-producing and increasingly become competent (Bandura, 1986).Conversely, low self-esteem has been linked to decreased motivation and performance (Bandura), as well as emotional disturbances and psychopathology (Rosenberg, 1986) Among children, low self-esteem has been associated with depression, and suicidal ideas (Hammen & Zupan, 1984; Harter, Marold, & Whxtesell, 1992; Zupan, Hammen, & Jaenicke, 1987) Obesity and Self-Esteem Although many factors may influence self-esteem, physical appearance, particularly one’s weight, is thought to be a major contributor Self-perceptions of physical appearance are more highly correlated with overall self-esteem than are perceptions of self-competence in scholastics, athletics, social acceptance, or behavior (Harter, 1985; Killeen, 1993) Although this link between obesity and the self-esteem of individuals, especially adolescents, is often cited (Allon, 1979; Harrison, 17 Maintenance of Self-Esteem by Obese Children 1983; Kizziar & Hagedorn, 1979; Mendelson & White, 1985),several gaps exist in the research literature For example, few studies have actually examined the relationship between obesity and children’s self- esteem Further, the conclusions drawn from investigations in t h area have been contradictory Some studies have found that obese children report lower levels of Self-esteem than their nonobese peers (Sallade, 1973; Strauss, Smith, Frame, & Forehand, 1985) Other studies have either failed to find sigxuficant differences (Bell, Kirkpatrick, & Rim, 1986; Wadden, Foster, Brownell, & Finley, 1984)or have found equivocal results (Mendelson & Wkute, 1982; Worsley, 1981).A similar pattern of conflicting results has been found in studies of obesity and other indicators of children’s and adolescents’ self-perceptions, such as body esteem and total esteem (Hendry & Gillies, 1978; Mendelson & White, 1982; 1985; 19911, and distortion of body- image (Bell et al.; Leon, Bemis, Melland, & Nussbaum, 1978) - have not addressed these issues For example, the measurement tools used in most studies have been criticized for being &dimensional, or for measuring global selfesteem by summing the scores on different areas of performance (Harter, 1986; Rosenberg, 1979), and for not addressing developmental differences among various age groups (Harter, 1985) Unidimensional measures, and those that sum over different areas of self-concept, tend to mask both the complexity of self-perceptionsand ddferences in patterns of self- perceptions between obese and average-weight children Virtually no research has examined whether obese children who exhibit low selfesteem differ from high self-esteem obese children, or average-weight cluldren, in their patterns of self-perceptions or in the cognitive defenses they use to maintain self-esteem The author’s purpose was to address these issues by exploring not only whether differences in self-esteem exist between average-weight and obese children, but also whether children use cognitive defenses to maintain high levels of self-esteem ~ Virtually no research has examined Maintaining Self-Esteem whether obese children who exhibit low Studies by Harter (1986) and Tesser (1988) provide possible explanations for the findings that some obese children maintain high self-esteem while others not Both Harter and Tesser view self-evaluation as a multidimensional construct that is related not only to performance in different areas, but also to the importance the person places on performing well in a given domain Harter has suggested that overall self-esteem or global self-worth (GSW) is a function of the discrepancy between one’s perceptions of competence in specific areas and the importance of competence in each area Her studies suggest that if a chdd is deficient in one domain, he or she may use a cognitive process, such as discounting or distortion, to maintain a high level of self-esteem Discounting is the process by which children maintain GSW by diminishing the importance of domains in which they are less competent By discounting, obese children may maintain high self- esteem by viewing self-esteem differ from high self-esteem obese children, or average-weight children, in their patterns of self-perceptions or in the cognitive defenses they use to maintain self-esteem Such conflicting findings may be the result of indwidual differences in patterns of self-perceptions among obese children, or they may be the result of differences in the methods used to assess self-esteem Prior studies 18 - JCAPNVolume 8, Number 1, January March, 1995 physical appearance, specificallyweight, as unimportant, and placing more importance on other domains in which they excel Distortion is the process by which children enhance their perception of competence Obese children who view physical appearance as very important, may maintain high self- esteem by underestimating - distorting - their actual body size or weight Both discounting and distortion may allow chddren to maintain high GSW by keeping the discrepancy between perceived competence and importance small By distorting, children inflate their competence scores, while by discounting they deflate their importancescores Several hypotheses for this study were suggested by the processes just described First, it was predicted that obese, overweight, and average-weight chddren would differ in their self-perceptions only in areas that were related to or affected by weight, such as physical appearance and global self-worth, but not scholastic competence or behavioral conduct No specific predictions were made concerning the effects of obesity on athletic competence or social acceptance Second, predictions were made concerning the processes by which children maintain self-esteem In general, it was expected that obese children would attempt to enhance their GSW either by discounting the importance of physical appearance and weight, or by distorfing their perceptions of weight, and that these processes would be effective The discounting hypothesis predicted that GSW scores would be negatively related to the importance of physical appearance and weight, for obese and overweight children in the sample This hypothesis also predicted that perceived competence and importance of physical appearance and weight would be positively correlated for all children in the sample It was further expected that obese children with high self-esteem would rate physical appearance and weight as less important than would obese children with low self-esteem The distortion hypothesis predicted that weight, the level of GSW, and the importance of physical appearance would interact to influence the level of distortion of weight Specifically,it was hypothesized that obese children who had high global self- worth and for whom JCAPNVolume 8, Number 1, January- March, 1995 physical appearance was important would distort their perception of weight more than those with low GSW, those for whom physical appearance was not important, and average- weight children Finally, it was expected that distortion would be an effective process for improving self-esteem It was predicted that, for obese children, GSW would be positively related to the degree of distortion of weight perception It was expected that distortion would be an effective process for improving self-esteem Methods Research Participants A convenience sample was drawn from approximately 120 students in a fifth-grade class in a rural Southeastern elementary school Fifth-graders were chosen because of the importance of physical appearancefor children age 10-12, their ability to compare themselves with others, and their emphasis on classmates as sources of information and support (Harter, 1990).In order to participate, children had to be present on the day of data collection, had to have given written assent, and had to have written, informed, parental consent No monetary or other incentive was provided A final sample of 45 students (21 boys, 24 girls), aged 10 to 13 (M = 11.1 yrs., S D = 0.7) met these criteria Instruments Self-perceptions.GSW and perceptions of competence in specific domains were measured using the Self-Perception Profile for Children (SPPC) (Harter, 1985) The measure was designed to be multidimensional and age-appropriate and to allow for GSW to be rated 19 Maintenance of Self-Esteem by Obese Children independently of ratings in specific domains The SPPC consists of 36 items in a structured-alternative format Five subscales (scholastic competence, social acceptance, athletic competence, physical appearance, and behavioral conduct) tap children’s domain-specific judgments of competence A sixth subscale measures GSW Scores on each item range from one to four Individual item ratings are averaged to yield separate subscale scores Harter (1985) assessed reliability and validity of the SPPC by administering the scale to 1,500 t h r d through eighth-grade children in four separate samples in Colorado Children in these samples were primarily from lower middle class to upper middle class neighborhoods; 90% were Caucasian Internal consistency was assessed using Cronbachs alpha, and was acceptable Coefficients for the SPPC subscales ranged from 71 for behavioral conduct to for scholastic competence Physical appearance internal consistency ranged from 76 to among lifth graders, whde the alpha for GSW was 78 Harter (1985)assessed validity using factor analysis to determine whether the five specific subscales constituted separate factors and could be replicated across samples Each subscale defined its own factor; factor loadings for each subscale were substantial (average greater than 55), with negligble cross-loadings (average between 04and 08, none greater than ,181 Four items were added to the SPPC in order to obtain additional data on the children’s physical self-perceptions and to serve as a measure of distortion These items were written in the identical format to the other SPPC items Two of these items tapped perceived competence in weight, and were used in this study Validity of the weight items was assessed by examining their intercorrelations with the items assessing perceived competence in the other specific domains and their correlation with the child’s actual weight (measured as a percentage of the median weight for age, sex, and height) Perceived competence in weight and actual weight were significantly correlated ( r = -.&, p < 001), as were perceptions of competence in weight and in physical appearance ( r = 49, p < 001) These correlations indicate the constructs overlapped substantially, but that they were not identical 20 Finally, the patterns of correlations between perceived competence in weight and the other domains were identical to the patterns of relations between perceived competence in physical appearance and the other domains Physical appearance and weight competence scores were sigruficantly correlated with each other and with social acceptance, but not with scholastic, athletic, or behavioral competence scores Importance of specific domains The perceived importance of competence in each of the speclfic domains of the SPPC was assessed using Harter’s Importance Scale T ~ 10-item E scale also uses a four-point structuredalternative format Two items were added to gain additional data on the importance cluldren place on the areas of height and weight Each of these items was worded identically to the other importance items, with the exception that the word height or ~ u ~ i gwas k f substituted for other domain-specific words The importance of the weight item was used in this study Weight Each child‘s weight and height were measured using an upright healthometer scale The scale was calibrated by w e i g h g an object of known weight (20 lbs.) The obtained weight and height measurements were used to class@ children according to weight norms for age, sex, and height Chddren were classified as obese (n = 18)if their weight was at least 20% greater than the median weight for their age, height, and sex on growth percentile charts (Hamill, Drizd, Johnson, Reed, & Moore, 1979).Children whose weight was at least 10% greater than the median were classified as ozvmeight (17 = lo), while those whose weight was less than 110% of the medmn were classified as azwa~e-zu&g~zt (iz = 17) Only one participant was less than 90%of the median weight for age, sex, and height Distortion In addition to the scores on specific and global self-perceptions, an additional score was constructed in order to test the hypotheses about distortion Distortion of weight was measured by comparing the children’s perceived competence in weight to their measured weight First, an actual weight competence score was derived from the children’s measured weight in relation to the median weight for their age, sex, and height Obese children’s (at least 120% of the median) acfual JCAPN Volume 8, Number 1,January- March, 1995 weight competence scores were coded as one; overweight children’s (between 110 and 119 % of the median) scores were coded as two Children between 100 and 109 percent of the median weight were coded as three, and those less than 100% of the median weight were coded as four Distortion scores were then constructed by subtracting the actual weight competence score from the perceived competence in weight score from the SPPC Higher distortion scores indicate inflated perceived competence in weight scores relative to actual weight status For example, an obese child (actual weight competence score = 11, who views herself or himself very positively in weight (perceived competence in weight = 4), would have a distortion score of (4 - = 3) The same child who rates the self as less competent in weight (perceived competence = 2), would have a distortion score of (2 - = 1) Procedure Two weeks prior to the data collection date, the fifthgrade science teacher distributed an informed consent form and an assent form to each student in science class The teacher read written instructions prepared by the investigator, while distributing the consent and assent forms On the day of data collection, children who were present in science class, and who had signed assent forms and returned consent forms signed by their parents, were given the research instruments by the investigator Students not participating in the study were sent to another room to watch a film The investigator read the instructions included in the manual to the participants as a class After completing and returning the self-reportinstruments, each participant was brought to a separate mom to be measured and weighed individually and privately Each student was weighed wearing school clothes, but without shoes or jacket Age and sex were also recorded Then, each student was thanked and returned to the classroom Results A preliminary analysis was performed to determine whether boys and girls differed in self-perceptions on any of the subscales of the SPPC Since no sigruficant differences were found, F (1,43) < 1, boys’ and girls’ scores were combined in all subsequent analyses To facilitate comparisons of subscales of the SPPC and other measures, all scores were standardized prior to analyses To test the first hypothesis, a (obese, overweight, averageweight) x (perceived competence subscales) mixed design analysis of variance was performed A sigruficant main effect was found for weight status, F(2,42) = 5.181, p < 01 Obese children generally rated themselves lower than average-weight or overweight children Neither the main effect for the within-subjects factor (SPPC subscales) nor the interaction of weight status and subscales was sigruficant(both FS < I) The effect of weight status was then examined for each subscale separately Obese children differed from both overweight and average-weight peers in global selfworth ( F 12,421 = 3.633, p< 04), perceived social competence ( F 12, 421 = 3.259, p < 05), and perceived competence in physical appearance, (F 12,421 = 5.735, p < 007), but not in athletics, ( F 12,421 = 2.441, p < lo), scholastics, or behavior, both (Fs [2,421< I);see Table Discounting hypothesis The discounting hypothesis was supported only for average- weight children It was expected that GSW would be negatively related to the importance of physical appearance and weight for obese and overweight children GSW was negatively related to Table Self-perception Subscale Means (Z Scores) for Obese, Overweight, and Average-Weight Children Subscale Average Overweight Obese Weight Scholastic Social acceptance Athletic competence Physical Appearance Behavioral conduct Global self-worth 0.00 0.33 0.43 0.49 0.18 0.35 0.33 0.32 -0.04 0.26 0.15 0.32 -0.18 -0.46 -0.36 -0.59 -0.23 -0.49 p ns [...]... health Journal of Personality and Social Psy~hol~gy, 103 ,193- 210 Hendry, L., & Gillies, P (1978).Body type, body esteem, school and leisure: A study of overweight, average and underweight adolescents Journal of Youth and Adolescence, 7,181-195 Tesser, A (1988).Toward a self-evaluation maintenance model of social behavior In L Berkowitz (Ed.),Advances in experimental social psychology Vol.22 (pp 181-227)... non-obese children.Journalof Psychosomatic Research, 17,89-% Staffieri, J (1967).A study of social stereotype of body image in children.Journal of Personality and Sorial Psychology, 7 ,101 -104 - JCAPN Volume 8, Number 1,January March, 1995 Save the Date The ACAPN '95 Conference Moving Ahead in Child & Adolescent Psychiatric Nursing: Innovations & Retooling September 21-23 Ramada Resort Hotel Orlando, FL Discount... issues in Mental Htdth N U ~ g24,323-336 , Wadden, T., Foster, C., Brownwell, K., & Finley, E (1984).Self-cuncept in obese and normal-weight children Journal of Consulting and Clinical Psychology, 52, 1104 - 1105 Kizziar J., & Hagedorn, J (1979).Search for acceptance: The adolescent and self-esteem Chicago: Nelson-Hall Weil, W (1981).Obesity in children Pediatric Review, 3,180-182 Koniz-Booher, P., & Koniz,... 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