Thursday, February 11, 2010

Get Those Kids Moving!

Childhood Obesity and Its Affect on Self-Esteem

By Margaret Lewin, MD,FACP – Medical Director, Cinergy Health

More than 30% of American children are overweight (50% in African American and Latino communities), and more than two-thirds of obese children over the age of 9 will become obese adults. The resulting medical problems of diabetes, premature heart disease, stroke, gallbladder disease, degenerative arthritis, breathing problems and sleep apnea, as well as cancer of the uterine lining, breast, prostate and colon are well-known, but the psychological problems surprisingly less so. Society in general responds negatively to obese individuals. Obese children in particular are often socially stigmatized and face discrimination from their peers, teachers, and even physicians and nurses – often leading to poor self-esteem.

Self-esteem refers to an individual’s sense of his or her value or worth – a favorable or unfavorable attitude toward one’s self. Formal studies show that parents’ and peers’ acceptance weigh most heavily on many children’s sense of self-esteem.

In a country with very thin celebrity role models and where it is common to say, “you can never be too thin,” being obese can be devastating to self-esteem, especially during childhood and adolescence.

Children can be cruel, especially to overweight peers who are often teased about their weight. Although any child whose physical appearance or intellectual capacity differs from the norm often is subjected to merciless teasing, it can be worse for obese children – who are blamed for their “different-ness” and closely watched (and criticized) in their eating and exercise habits. Studies have shown that obese children tend to have a smaller circle of close friends, leading to isolation and loneliness. Parents often join in the torment even if they are overweight. It can be difficult to escape from the self-image of unattractiveness and body dissatisfaction.

LJ Griffiths’ study of children at age 7 ½ showed that obesity predicts a higher likelihood of bullying (boys – presumable because of their physical dominance in their peer group) or being bullied (both sexes) than normal weight (or even moderately overweight) children.

Overweight girls are especially stigmatized when it comes to dating. In a study of adolescents, only 12% of the students had dated someone who was overweight, with only 8% of boys dating overweight peers.

Formal studies suggest a relationship between self-esteem and health. Whether obese or not, adolescents with poor self-esteem are more likely to engage in early sex, less likely to use birth control, have higher rates of teen pregnancies, are more likely to use tobacco, alcohol and illicit drugs, and to attempt suicide. Obesity can also lead teenagers into binge-eating, sometimes purging as well. In 2007, a study reported a 20 year research of obese adolescents in upstate New York. They found that obese girls were nearly four times more likely than normal weight girls to suffer major depression and anxiety disorders as adults.

Another study on overweight adolescents found that they were less likely to be married, had lower household incomes and higher rates of household poverty. The study concluded: “Overweight during adolescence has important social and economic consequences, which are greater than those of many other chronic physical conditions.” The New York Times yesterday printed an article saying that child obesity risks death at an early age. Heavier kids are twice as likely to die before age 55 of illness or self-inflicted injury.

Obese children can have a brighter future. This year, Sacher published the results of a randomized, controlled British trial of the MEND (Mind, Exercise, Nutrition, DO it) program, a family-based community intervention for childhood obesity. Parents and their obese children attended eighteen 2-hour group educational and physical activity sessions held twice weekly in sports centers and schools, followed up by a 12-week free family swimming pass. Compared to the controls, the study children not only reduced their weight and waistlines and increased their cardiovascular fitness and physical activity levels, they also had significant improvement in their self-esteem.

Doing something about childhood obesity and related issues of self-esteem is a kindness, but we also need to do so in our own self-interest. The economic consequences of childhood (and subsequent adult) obesity are staggering and threaten to overtake our healthcare system and national budget. For these reasons, Michelle Obama, Surgeon General Regina Benjamin, The Centers for Disease Control and Prevention, Federal Trade Commission, Food and Drug Administration, Department of Agriculture, and the nations’ mayors and other local leaders are placing a high priority on combating this growing problem. It will require enormous investing in education, availability of food in schools, making healthy affordable food more accessible in low-income neighborhoods, building schools within walking distance of residential areas, and building playgrounds and walking and biking paths. It will involve setting standards for marketing food to children and reconsidering the nutritional value of foods available on supermarket shelves. These investments are worth it – both to us and our nation’s children.

Dr. Margaret Lewin
Chief Medical Director of Cinergy Health
A graduate of Case Western University School of Medicine in Cleveland, Ohio, Dr. Lewin's undergraduate degree from Purdue University is in Aeronautics, Astronautics, and the Engineering Sciences and she holds an M.S. in applied mathematics from Rensselaer Polytechnic Institute.

Board-certified in Internal Medicine, Hematology and Medical Oncology, she is a Fellow of the American College of Physicians and Clinical Assistant Professor of Medicine at Weill Medical College of Cornell University. She is affiliated with New York-Presbyterian Hospital and The Hospital for Special Surgery.

Dr. Lewin has worked throughout her career to improve the American healthcare system. She has been on the boards of state and local medical societies and is Immediate Past President of the New York County Medical Society and Immediate Past District President of the American College of Physicians. Her decades-long volunteer work has included service to many local projects and organizations and has been enriched by her medical missions to the Third World.

Dr. Lewin has authored numerous articles in leading medical journals and lay magazines, as well as chapters for medical textbooks. Her areas of special interest and expertise include primary and preventive care, travel medicine, men's health and women's health.

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