chronic diseases and children with obesity are no exception [10]. Internalizing
problems are defined as lack of self-confidence and a lasting feeling
of insufficiency, which can manifest itself in withdrawal from social situations
and from achievement demands. Internalizing problems are often a sign of sub
clinical depression and a risk factor for more aggravating adjustment problems
later [11].
However, studies comparing obese and non-obese persons have generally
failed to find differences in global aspects of psychological functioning. One
probable explanation is that obese individuals in clinical treatment have more
problems than obese individuals in the general population [12].
Older studies comparing obese and non-obese adult populations have often
failed in demonstrating the predominance of depression in obese. In several more
recent studies depressive symptoms among clinically obese patients have been
reported. Especially obese women seem to suffer from depression to a much
higher degree than non-obese.
Usually it is believed that social stigmatization associated with obesity
causes individuals to become depressed. Obese children develop more easily
negative thoughts about themselves, experience fewer positive and more negative
social interactions and encounter more physical difficulties (which also reduces
their physical activity). Obese children learn also to feel helpless and vulnerable
if they have tried to control their weight and failed to do so. All these are potential
factors causing depression.
The study of depression in children has up to the last decade been rather
limited, because of disagreement about the existence of depression in children
in general and about possibly different manifestations of depression in children
[13]. It was only at the end of the 1980s that a majority agreed to the view that
mood disorders in children have basically the same manifestations as in adults,
a view adopted for example in DSM-III-R from 1987.
Depressed children show, in accordance with adults, depressed mood, feelings
of worthlessness, diminished ability to think and concentrate and loss of
energy. A recent survey at National Center for Childhood Obesity in Sweden
showed that obese children judged themselves to have these symptoms and that the
parents judged their children to have less stamina compared to healthy children.
According to the presentation so far depression would be a result of negative
experiences associated with obesity. But there is also some preliminary
evidence that depression might be an important risk factor for the development
of obesity, at least for some adolescents [14]. In some individuals depression is
followed by an increase in weight and subsequent obesity.
To get further insight into the role of depression and other psychiatric conditions
more data about early psychological development will be of help. A new
international completing diagnostic and statistical manual for children aged
0–3 years is under development. The focus of attention there is psychiatric
problems in infancy. This promising field of research might help us to find early
precursors to obesity. Depression, anxiety and posttraumatic stress disorder are
serious conditions in infant psychiatry and these states may play a contributing
role for early acquisition of obesity.
Do Obese Children Have Lower Self-Esteem
than Non-Obese?
A factor often associated with depression is self-esteem. In many studies
normal levels of self-esteem in obese children have been reported. This is surprising
considering the fact that obesity is stigmatizing and that people in our
contemporary culture identify who they are with how their own bodies compare
with idealized types. In an investigation of self-esteem in youths aged
14–18 years in Sweden [15] the team came to the conclusion that there was no
difference in self-esteem between the obese adolescents and non-obese. The
only exception was that the obese individuals rated themselves lower in physical
characteristics. A prospective large survey of 1,090 obese children in the
USA [16] showed that obese children develop decreased self-esteem during the
transition from preadolescence to adolescence. The slightly contradictory
results suggest nevertheless that obese children are affected in their self-esteem
by obesity but that there are differences in to what extent depending on sex, race
and age. Pre-adolescent girls, for example, are affected by overweight in their
physical self-esteem but not in their global. It seems furthermore that some
children are able to compensate for their lowered self esteem in physical
characteristics by feeling confident about their skills and talents.
Results from treatment studies [17] show that weight loss treatment programs
appear to improve self-esteem, at least initially. But we know that it is
difficult to loose weight permanently and little is known how repeated attempts
at loosing weight affect self-esteem. Clinical experience suggests that some
adolescents develop eating disorders, depressions, and poor confidence in their
capacity to ever gain control over weight as a result of repeated failed attempts
to lose weight.
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