Body weight, self-perception and mental health outcomes among adolescents.

BACKGROUND: The prevalence of childhood obesity in the United States has increased three-fold over the last thirty years. During the same period, the prevalence of depressive symptoms in children also rose significantly. Previous literature suggests an association between actual body weight and mental health, but there is little evidence on self-perception of weight and mental health status. AIM: To examine the relationship between actual body weight, self-perception of body weight and mental health outcomes among adolescents.
METHODOLOGY: Using data for a nationally-representative sample of adolescents in the United States, we ascertain the effect of body weight status on depressive symptoms by estimating endogeneity-corrected models including school-level fixed effects to account for bi-directionality and unobserved confounders. Actual body weight status was calculated using interviewer-measured height and weight. We also used a measure of self-perceived weight status to compare how actual versus self-perceived weight status affects mental health. The Rosenberg Self-Esteem (RSE) Scale, Center for Epidemiologic Studies Depression (CES-D) Scale, and a dichotomous version of self-reported indicator for depression were utilized as mental health indicators. Potential mediators between mental health and weight status such as levels of physical activity, participation in risky health behaviors and parental characteristics were also controlled for in the analysis. The analytical sample consisted of 13,454 adolescents aged 11 to 18. RESULTS AND DISCUSSION: After accounting for a wide array of relevant characteristics, we did not find a direct and significant association between actual weight status and mental health outcomes. Instead, our analysis revealed a strongly negative and significant relationship between self-perceived weight status and mental health. The negative relationship between self-perceived weight and depressive symptoms was more pronounced among females. The RSE scale was particularly correlated with body weight perceptions, suggesting a potentially important link between weight perception and self esteem. LIMITATIONS: While the data set has rich detail on body weight and mental health outcomes, it lacks information on weight stigmatization. The complex relationships between actual body weight, self-perception of weight and weight stigmatization also limit determination of causality. CONCLUSION AND IMPLICATIONS: The results from this study highlight the role of body weight perceptions in influencing mental health outcomes independent of actual weight status, especially among female adolescents. This suggests that policies aimed at improving mental health outcomes among adolescents might benefit from a focus on increasing awareness about healthy attitudes towards weight. FUTURE RESEARCH: Recent studies have found evidence that weight stigmatization and body dissatisfaction are predictors of depressive symptoms. It may be that the causal pathway between perceived weight status and depression occurs through weight stigmatization and body dissatisfaction. Future studies should investigate this causal mechanism further.