Poor self-esteem and body image drive weight gain and worse mental health in teenage years

In a study conducted by researchers from Imperial College London, they examined how psychological and social factors affect the connection between mental health and body mass index (BMI) in over 12,000 children in the UK during their adolescent years.

It is widely known that children with higher weight are more prone to experiencing negative mental health outcomes. Research shows that young people with obesity are about twice as likely to have emotional difficulties like depression and anxiety compared to those with a healthy body mass index (BMI). The percentage of young individuals with obesity facing such challenges is approximately 19%, while it is 10% among those with a healthy BMI [1].

In the recent study, researchers discovered that enhancing children’s satisfaction with their appearance and self-esteem during early adolescence could potentially safeguard against the detrimental effects of higher weight on their mental well-being. This suggests that promoting positive body image and self-confidence may serve as protective factors for mental health, even in the presence of higher weight.

By utilizing data gathered at ages 11, 14, and 17, the researchers assessed various factors such as adolescents’ perception of their appearance, self-esteem, encounters with bullying, dietary behaviors, as well as their body mass index (BMI) and mental health challenges. This comprehensive approach allowed for a thorough examination of the relationship between these factors over the course of adolescence.

The study revealed that, on a population level, the satisfaction children had with their appearance and their self-esteem had the most significant impact on the association between body mass index (BMI) and mental health. This finding suggests that children’s happiness with their appearance and their self-esteem play a crucial role in shaping mental health outcomes, which can persist into late adolescence.

The study discovered that 11-year-old children with higher weight faced a higher risk of experiencing negative body image and lower self-esteem as they transitioned into their teenage years, compared to those with average weight. Consequently, both boys and girls who were dissatisfied with their appearance and had low self-esteem at the age of 14 exhibited a greater likelihood of encountering mental health difficulties at age 17, including anxiety, depressive symptoms, aggression, and impulsivity. Additionally, these individuals were also more likely to have a higher BMI compared to those who had a more positive self-image.

The authors of the study claim that their research, published in the journal eClinical Medicine, is the largest and most comprehensive of its kind. They assert that their study offers the most representative insights into the population-level patterns of psychosocial factors among children in the UK. With a significant sample size and comprehensive data analysis, this study provides valuable and reliable information on these important aspects of children’s well-being.

The authors of the study emphasize the necessity for prevention strategies targeting weight stigma and promoting healthy body image among children. They propose that such strategies should be incorporated into the national curriculum, implemented within the industry, and actively employed on social media platforms. By destigmatizing weight-related issues and fostering positive body image, these preventive measures have the potential to alleviate various negative social and emotional problems that may arise in later years.

Dr. Hanna Creese, the first author of the study and affiliated with the School of Public Health at Imperial College London, emphasized the well-established connections between mental and physical health. She highlighted that children who are overweight or obese are at a higher risk of experiencing social and emotional difficulties, including depression and anxiety. However, understanding the underlying factors that contribute to these outcomes is a complex task. Dr. Creese specifically mentioned the intricate and reciprocal relationship between mental health and body mass index (BMI) as one of the challenges in unraveling these associations.

Dr. Hanna Creese stresses the significance of maintaining a healthy weight in children. However, she emphasizes that this should not be pursued at the cost of their long-term mental well-being. Stigmatizing their weight and promoting negative body image and low self-esteem can have detrimental and enduring consequences. The study’s findings underscore the importance of taking a holistic approach that considers both physical health and mental well-being when addressing weight-related issues in children.

In their analysis, the researchers utilized data from the Millennium Cohort Study, which is a comprehensive dataset comprising information on nearly 19,000 children born in England, Scotland, Wales, and Northern Ireland between 2000 and 2002. The study included data from 12,450 children, spanning from the age of 11 to 17 (as of 2018). The data encompassed various measurements such as body mass index (BMI) standardized by sex and age (BMI Z score), parent-reported scores on a validated questionnaire regarding the mental health and dieting behavior of young people, self-reported information on happiness with appearance, self-esteem, and experiences of bullying at the age of 14, as reported by the young people themselves.

Body image and self-esteem

The analysis of the data revealed that children’s happiness with their appearance and self-esteem played a role in explaining the impact of being higher weight on the risk of experiencing mental health difficulties. It was found that with each increase in BMI Z score at 11 years old, there was a corresponding increase in scores indicating unhappiness with appearance (0.12 for boys, 0.19 for girls) and an increase in the likelihood of having low self-esteem (16% for boys, 22% for girls) at age 14. Additionally, at age 14, both boys and girls who were unhappy with their appearance and had lower self-esteem were more likely to exhibit emotional and social symptoms at age 17, including anxiety, depressive symptoms, aggression, and impulsivity.

Obesity, dieting and bullying

The study revealed that there is an association between increased BMI and mental health issues. Obese children had a higher prevalence of emotional problems at the age of 11 compared to children with a healthy weight (18.9% vs 10.3% for boys; 18.7% vs 10.8% for girls). It is well-known that being overweight is a common reason for childhood bullying, but the analysis did not find a significant link between being overweight and experiencing frequent bullying. Additionally, being bullied did not have a significant impact on later weight status. The analysis also found that engaging in dieting behaviors was associated with higher BMI, but it did not lead to worse mental health outcomes.

Measures to destigmatise weight

The authors suggest that various interventions can be implemented to address both obesity and mental health issues in young people. These interventions include campaigns promoting healthy eating at home and in schools, as well as the use of apps and helplines to provide mental health support. Additionally, they emphasize the importance of promoting positive body image and self-esteem among young people through educational initiatives and media regulations. Limiting children’s exposure to social media that promotes unrealistic or unhealthy body image and incorporating lessons on positive body image in schools are some of the recommended approaches. Such interventions can have a positive impact on the physical and mental well-being of the UK population.

Dr. Dougal Hargreaves, a senior author of the study and a researcher at Imperial College London’s School of Public Health, highlights the significance of adolescence in shaping long-term mental health and weight patterns. He emphasizes that providing appropriate support to young people during this crucial developmental phase can yield lifelong health benefits and positive economic outcomes. The study suggests that addressing weight stigma during adolescence could be a crucial step toward improving long-term outcomes for individuals.

Dr. Dougal Hargreaves emphasizes the importance of recognizing the unique social pressures faced by children in today’s world, which differ from those experienced by previous generations. He highlights the need to take concrete actions at the societal level to promote healthy behaviors and attitudes. It is crucial to prioritize the well-being of children and support them in navigating the challenges they face, ensuring a positive and nurturing environment for their growth and development.

Dr. Dasha Nicholls, an expert in child psychiatry and eating disorders, emphasizes the increased risk of mental health problems, including eating disorders, among children with higher weight. The study further supports the existing evidence that promoting a positive body image, fostering confidence, and developing self-esteem in young adolescents are crucial for their long-term mental and physical well-being. By addressing these factors, we can potentially reduce the risk of mental health issues and promote healthier outcomes for children.

The authors caution that while the study provides valuable insights at the population level, it cannot be used to make predictions about individual children. Additionally, they note that the study did not specifically examine the direct effects of social media on body image and self-esteem, although its significant influence is acknowledged. It’s important to recognize that the data collection for the study concluded in 2018, so it does not reflect the potential impact of increased social media use among children and teenagers in recent years or during the COVID-19 pandemic.

The research was funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research.

‘The role of dieting, happiness with appearance, self-esteem, and bullying in the relationship between mental health and body-mass index among UK adolescents: a longitudinal analysis of the Millennium Cohort Study’ by Hanna Creese, Sonia Saxena, Dasha Nicholls, Ana Pascual-Sanchez, and Dougal Hargreaves is published in eClinicalMedicine. DOI: https://doi.org/10.1016/j.eclinm.2023.101992