Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents

Abstract

Objective:

To investigate weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population-based multiethnic sample of early adolescents.

Design:

Cross-sectional population-based survey.

Subjects:

In total, 2789 adolescents 11–14 years of age from three highly deprived regional authorities in East London, in 2001.

Measurements:

Data were collected by student-completed questionnaire on weight perception, dieting history, mental and physical health, health behaviours, social capital and sociodemographic factors. Height and weight were measured by trained researchers. Overweight was defined as BMI 85th centile and obesity as BMI 98th centile. Underweight was defined as BMI15th centile.

Results:

In all, 73% were from ethnic groups other than white British. Valid BMI were available for 2522 subjects (90.4%) of whom 14% were obese. Only 20% of overweight boys and 51% of overweight girls assessed their weight accurately. Accuracy of weight perception did not vary between ethnic groups. In all, 42% of girls and 26% of boys reported current dieting to lose weight. Compared with white British teenagers, a history of dieting was more common among Bangladeshi, Indian and mixed ethnicity boys and less likely among Pakistani girls. Self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P=0.02). Within ethnic subgroups, self-esteem was significantly lower in overweight white British boys (P=0.03) and obese Bangladeshi boys (P=0.01) and Bangladeshi girls (P=0.04), but significantly higher in obese black African girls (P=0.01) than those of normal weight. Obese young people had a higher prevalence of psychological distress (P=0.04), except among Bangladeshi teenagers, where overweight and obese young people had less psychological distress than those of normal weight (P=0.02). Birth outside the UK was associated with reduced risk of obesity in girls (P=0.02) but not with history of dieting, weight perception or psychological factors in either gender.

Conclusion:

High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, dieting history and the associations of obesity with self-esteem and psychological distress vary between ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress.

Introduction

In the past two decades, most developed countries have seen a shift in the body mass distribution of adolescents towards overweight,1, 2 together with an increase in weight-related concerns and behaviours among young people.3, 4 This relationship may in part be causal; overweight during adolescence has been associated with higher levels of weight control behaviours including dieting5, 6 and binge eating,7 as well as with psychological comorbidity, including low self-esteem,8 poor body image and depression.9

The obesity epidemic has disproportionately affected those from non-white ethnic groups,1, 10 yet little is known about the weight control behaviours and psychological concomitants of overweight in adolescents from minority ethnic groups. In US adolescents, obesity appears to have a less negative impact on self-esteem,8 weight-related concerns11 and body satisfaction12 in black compared with white adolescent females. In the UK, studies suggest that second-generation South Asian young women of normal weight born in the UK report higher levels of abnormal eating attitudes and behaviours compared to their white counterparts.13, 14 However, perceptions of weight, shape and dieting behaviour have been little studied in overweight and obese young people from minority ethnic groups, particularly boys. The role of immigration and acculturative processes in influencing these issues requires exploration, particularly given US data suggesting that young people who have resided for longer periods in the US are at higher risk for obesity.15 Given that a recent review by the UK Health Development Agency noted that there was ‘a complete lack of evidence regarding the effectiveness of interventions targeting specific socioeconomic, ethnic or vulnerable groups’,16 such data are needed to inform future obesity-related health promotion and interventions among black and minority ethnicity young people.

A unique data set to examine these issues is provided by the Research with East London Adolescents Community Health Survey (RELACHS), an ongoing study of physical and mental health in an ethnically diverse population of early adolescents. We have previously shown that overweight and obesity are highly prevalent among this population,17 and that there is ethnic variation in the prevalence of mental health problems.18 We used data from RELACHS phase 1 (2001) to examine the hypotheses that there are cultural variations in the associations of body mass index (BMI) with perceived weight, self-esteem, mental health and dieting behaviour distinct from those associated with socioeconomic status.

Methods

Research with East London Adolescents Community Health Survey is a school-based epidemiological study of a representative sample of 2789 adolescents from year 7 (11–12 years) and year 9 (13–14 years) attending secondary schools in three authorities in East London, UK.19 In 2001, 30 of 42 eligible schools were randomly selected and balanced to ensure representation of single and mixed sex schools. In the 28 schools that agreed to participate, four representative mixed ability classes were selected (two classes from year 7 and year 9). Height (Leicester portable stadiometer, CMS Camden Ltd) and weight (Tanita Body Fat 300 electronic scales) were measured by trained field researchers. Body mass index (BMI) was calculated and BMI z-score (zBMI) for each subject was derived using the UK 1990 growth reference.20 For analysis, we divided zBMI into four categories; underweight (<−1 s.d.), normal weight (−1 to +0.9 s.d.), overweight (1.0–1.9 s.d., equivalent to 85–98th BMI centile) and obese (2.0 s.d., equivalent to 98th BMI centile). Perception of weight was coded as appropriate or inappropriate depending on BMI. Those with zBMI <−1 were coded as ‘appropriate’ if perceived as ‘too light’ and inaccurate if other. Those with zBMI 1.0 were coded as ‘appropriate’ if perceived as ‘too heavy’ and inaccurate if other. Those with zBMI between −1 and +1 were coded as ‘appropriate’ if perceived as ‘about the right weight’ and inaccurate if other.

Other data were collected by in-class confidential questionnaire. Three questions concerned weight and weight control; two were drawn from Health Survey for England;21 (1) Given your age and height, would you say that you are (a) about the right weight, (b) too heavy, (c) too light or (d) not sure? (2) At the present time, are you (a) trying to lose weight, (b) trying to gain weight, or are you (c) not trying to change your weight? Young people were also asked Have you ever dieted to lose weight?

Ethnicity was self-assigned using the UK Census 2001 categories. Young people provided data on country of birth. Socioeconomic status (SES) indicators included: parental employment and household crowding (>1.5 persons per room). Mental health status was measured using the self-reported strengths and difficulties questionnaire (SDQ), a valid instrument widely used in the UK for assessing psychological distress in adolescents.22 Thresholds suggestive of significant psychological distress were obtained from a recent UK national survey.23 Self-esteem was measured by the Rosenberg Self Esteem Scale, a widely used scale validated for adolescents; a higher score represents poorer self-esteem.24

Analysis

Analyses were weighted to take account of unequal probabilities of selection. As the sample selection used a stratified cluster design with pupils clustered within schools, standard errors and 95% confidence intervals (CI) for means and proportions were calculated using the survey estimation (svy) commands available in STATA 8. Differences between groups were first assessed using χ2. Logistic regression was used to assess the association of BMI category with outcomes including weight perception, dieting and distress. All analyses were controlled for year-group and SES (overcrowding and parental employment). Analyses were repeated in the larger ethnic sub-groups where sample size permitted.

Results

Valid height and weight allowing calculation of BMI were available for 2522 subjects (90.4%). Ethnicity: 21% white UK, 6% white other, 25% Bangladeshi, 7% Pakistani, 9% Asian Indian, 6% black Caribbean, 11% black African, 4% black British, 7% mixed ethnicity and 4% other ethnic groups. Obesity was seen in 14% of boys (95% CI: 12, 16) and 15% of girls (13, 17). Underweight was seen in 12% of boys (11, 14) and 11% of girls (9, 13). We have previously shown that there were no significant differences in the prevalence of obesity among ethnic groups in our sample when controlled for socioeconomic status, but that Bangladeshi and Pakistani boys were significantly more likely to be underweight.17 In all, 22% of boys (20, 24) and 20% of girls (18, 22) were born outside the UK. Birth outside the UK was associated with lower risk of obesity in girls (OR 0.5; 95% CI 0.3, 0.9; P=0.02) but not boys when adjusted for SES and ethnicity.

Weight perception

Weight perception by BMI is shown in Table 1. Nearly 60% of overweight and nearly 30% of obese boys believed themselves to be ‘about the right weight’. For girls, 34% of overweight and 9% of obese girls believed themselves to be ‘about right’. Appropriateness of weight perception decreased with increasing zBMI in boys (P<0.0001) but increased with increasing zBMI in girls (P=0.008) (Figure 1). Girls were significantly more likely to assess their weight appropriately than boys if overweight or obese (P<0.0001). Weight perception was not associated with socioeconomic status. Weight perception in the largest ethnic groups is shown in Table 2 for boys and Table 3 for girls. Overweight boys of all ethnic groups showed significantly poorer accuracy in weight perception than normal or obese boys. Among girls, a similar pattern was seen except in black African girls, in whom accuracy of weight perception was not related to BMI. Birth outside the UK was not associated with weight perception in either gender.

Table 1 Perceived weight and dieting history by body mass index category in boys and girls
Figure 1
figure1

Appropriate weight perception by body mass index (BMI) status for boys and girls. Figure shows proportions and 95% CI of each sex reporting appropriate weight perception for their BMI category.

Table 2 Weight perception and weight control behaviour by ethnicity in boys
Table 3 Weight perception and weight control behaviour by ethnicity in girls

Current weight control behaviour

Girls were more likely to be currently dieting to lose weight than boys (girls; 42%, 95% CI: 40, 45; boys 26%, 95% CI: 24, 29; P<0.0001) (Table 1). In both sexes, current dieting and a history of every having dieted were each associated with higher BMI category (P<0.0001). The proportions of boys or girls currently trying to lose weight did not vary significantly between ethnic groups either in the entire sample nor among those overweight or obese (Table 3). Ever having dieted was more common among Bangladeshi (OR 1.6, 95% CI: 1.0, 2.4, P=0.05) Indian (OR=2.1, 95% CI: 1.3, 3.7, P=0.006) mixed ethnicity (OR=1.9, 95% CI: 1.1, 3.4, P=0.02) and Other ethnicity (OR=1.9, 95% CI: 1.0, 3.7, P=0.05) boys than among white British boys, when adjusted for age and SES. Among girls, Pakistani girls (OR=0.5, 95% CI: 0.3, 0.9, P=0.02) were less likely to have ever dieted than white British girls. Birth outside the UK was not associated with current or past dieting.

Self-esteem

Mean self-esteem scores were 19.0. (95% CI: 18.7, 19.3) in boys and 20.3 (20.0, 20.6) in girls. Self-esteem scores by BMI category for each gender by ethnicity are shown in Table 4. In the whole sample, self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P=0.02). Among boys, self-esteem was significantly lower in overweight white British boys (P=0.03) and obese Bangladeshi boys (P=0.01) than those of that ethnic group of normal weight. In contrast, self-esteem did not vary significantly by BMI in black African or Caribbean and British boys. Among girls, self-esteem was significantly lower in obese Bangladeshi girls (P=0.04), but significantly higher in obese black African girls (P=0.01) than those of normal weight within that ethnic group, but not related to BMI in other ethnic groups. Country of birth did not significantly modify the association between self-esteem and zBMI.

Table 4 Self-esteem score in relation to BMI category by ethnicity for boys and girls

Mental health

Psychological distress was found in 10% of boys and 11% of girls, with Bangladeshi young people of both sexes reporting significantly lower rates of distress compared with white British young people, as previously reported. The proportion of SDQ high scorers by BMI status is shown in Figure 2. Obese young people had higher prevalence of psychological distress (13%, 95% CI: 10,17) than those of lower BMI (9%; 8, 11) when controlled for sex, socioeconomic status and age (OR 1.5, 95% CI: 1.1, 2.1, P=0.04). This association was apparent but not significant when each sex was examined separately. The proportions of SDQ high scorers across BMI categories by ethnicity are shown in Table 5. Bangladeshi young people appeared to have a different pattern of association of BMI with SDQ high score to that seen in other ethnic groups, with proportions with psychological distress lower in the overweight and obese groups than in the normal group. Among normal weight young people, there were no significant differences in prevalence of psychological distress by ethnicity. Among overweight and obese young people, Bangladeshi subjects had significantly lower risk of SDQ high score than white British young people (adjusted OR 0.4 (95% CI 0.2, 0.9) P=0.02). Among underweight young people, Bangladeshi adolescents had significantly lower risk of psychological distress than white British young people (OR=0.2, 0.04, 0.7, P=0.02).

Figure 2
figure2

Proportions of strengths and difficulties questionnaire (SDQ) high scorers by sex. Figure shows proportions of SDQ high scorers and 95% CI by body mass index (BMI) category for boys and girls.

Table 5 Proportion of SDQ high scorers by BMI category amongst different ethnic groups

Discussion

These data from a population-based survey of early adolescents from a range of ethnic groups and a wide range of BMI show that dieting to lose weight and inaccurate perception of actual body mass were concerningly common across boys and girls of all ethnic groups. In contrast, the associations of self-esteem and psychological distress with BMI showed heterogeneity across ethnic groups after adjustment for socioeconomic status. Birth outside the UK, a factor related to acculturation, was associated with reduced risk of obesity in girls but not with weight perception, dieting history or psychological factors in either gender.

Weight perception

Accuracy of weight perception was worryingly low among those above normal weight. Only one-sixth of overweight and half of obese boys recognised they were ‘too heavy’; girls were more accurate, yet only just over one-third of overweight and around two-thirds of obese girls recognised they were ‘too heavy’. Wardle et al.25 have recently shown that young people from higher socioeconomic groups had greater awareness of social ideals of slimness and more negative attitudes towards obesity.26 However, we are unaware of published data on accuracy of weight perception compared with measured BMI in UK adolescents. Levels of inaccuracy in weight perception in our sample were markedly higher than reported from the US National Health and Nutrition Examination Survey (NHANES) III survey, where approximately 75% of girls and 40% of boys who were overweight recognised that they were overweight or obese.3 We found no variation between ethnic groups in accuracy of weight perception in either gender.

Girls of all ethnic groups were more likely than boys to assess their weight accurately, particularly in the higher BMI ranges. This finding is similar to that seen in adults,27 and may suggest that girls are more aware of their body shape and weight, potentially because of social and cultural cues. Another possible explanation is that high BMI in boys is a less accurate estimate of body fat than in girls,28 and that the overweight categories may include active boys with high lean mass. However, in analyses not shown here, we did not find that level or frequency of physical activity was associated with accuracy of weight perception.

Dieting

Proportions currently dieting to lose weight (42% of girls; 26% of boys) were higher than comparative data suggesting that 15% of 11–15 year olds across Europe reported currently dieting in the late 1990s.29 As expected,3, 5 current dieting was more common among overweight and obese young people in all ethnic groups. We found no significant ethnic differences in prevalence of current dieting in either gender. This is in contrast to US data which suggests that current dieting aimed at losing weight is less common among African American than white girls.11 However, lifetime history of dieting showed differences among ethnic groups, with Bangladeshi, Indian and mixed ethnicity boys more likely to have ever dieted than white British boys, and Pakistani girls less likely to have ever dieted than white British girls.

Self-esteem

The association of self-esteem and BMI differed among ethnic groups. Among girls, obesity was associated with higher self-esteem among black African girls but lower self-esteem among Bangladeshi girls, and not associated with self-esteem among white British or black Caribbean and black British girls. This finding for black African girls is supported by findings from a number of studies comparing black and white American girls which have reported that the deleterious effects of obesity on self-esteem appear greater in white than black girls.8, 30, 31 Among boys, overweight or obesity had a negative impact on self-esteem in white British and Bangladeshi boys but was not associated with self-esteem among black Caribbean and black British boys. The only comparative data for boys comes from the US, where a single study noted that there were no differences between black, Hispanic and white boys in the impact of obesity on self-esteem.30

Psychological distress

Obese young people of both sexes were 1.5 times as likely to have significant psychological problems as those of lower BMI. The prevalence of psychological distress among overweight and underweight young people was not different to those of normal weight. This accords with previous reports that overweight in early adolescence is associated with measures of childhood behavioural problems32 and that psychological distress is associated with chronic obesity persisting from childhood.33

The associations of BMI with distress differed among ethnicities, although we acknowledge that CI were wide for some smaller groups. Higher distress among obese young people was seen in white British, and black Caribbean and black British young people. Among black African young people, psychological distress was not associated with BMI. However, among Bangladeshi adolescents of both sexes, the highest prevalence of psychological distress was seen in those with normal BMI, with significantly lower prevalence among underweight and overweight and obese teenagers. The reasons for this are unclear and may reflect differences in cultural valuation of weight and shape. It is notable here that we found overweight to be associated with poorer self-esteem but also with less psychological distress among Bangladeshi young people of both sexes. This may suggest that the influence of cultural valuation of weight and shape on self-perception and psychological distress may differ between ethnic groups.

Country of birth

Our finding that birth outside the UK was associated with reduced risk of obesity in girls is similar to US studies suggesting that birth outside the US is associated with reduced risk of obesity.15, 15, 34 It is possible that these findings reflect uncontrolled confounding by socioeconomic factors, but they are also likely to reflect acculturative processes such as the adoption of less healthy attitudes towards food, dietary practices and lifestyles of the host country.35

Strengths and limitations

We present data from a population-based sample of early adolescents from a wide range of ethnic groups and a wide range of BMI. Analyses were adjusted for measures of socioeconomic status. Questions on weight perception and current attempts to change weight were based upon those from the Health Survey for England. Our use of BMI categories to assign appropriateness of weight perception was similar to that used in a similar recent analysis of ethnic differences in weight concerns in Minnesota youth.11 We chose to define underweight, overweight and obesity by BMI z-scores rather than by use of the International Obesity Taskforce definitions, as we sought to examine weight perception, dieting and mental health across the BMI spectrum, and because no standardised definitions of underweight have been published. Psychological measures were appropriate for age, and our measure of psychological distress (SDQ) has been validated in our largest minority ethnic group, Bangladeshi young people.36

Our data has a number of limitations. We present cross-sectional analyses and the direction of relationships cannot be determined. Sample sizes in some individual ethnic groups were too small to allow analysis. Data on BMI were not available in 10% of subjects; those who refused to be weighed often appeared obese. Additionally, those subjects who participated but have missing weight data had lower self-esteem (P=0.02) and higher prevalence of psychological distress (P=0.04) than those who agreed to be weighed. Thus, it is likely that our findings both slightly underestimate the prevalence of obesity and the association between overweight and self-esteem and psychological distress. Further longitudinal work is needed to explore the directions of associations identified and investigate potential pathways by which overweight may influence psychological function and behaviour.

Conclusions

High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, we found significant variations among ethnic groups in dieting history and the associations of obesity with self-esteem and psychological distress. In particular, obesity was associated with higher self-esteem among black African girls, and both overweight and underweight were associated with protection against psychological distress in Bangladeshi young people. Obesity was less common among girls born outside the UK, regardless of socioeconomic status. Together, these findings suggest that the impacts of obesity on weight control behaviours and psychological function are mediated by cultural factors including cultural differences in the valuation of weight and shape.

These findings indicate that interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress. Longitudinal work is needed to investigate the relationships between BMI, weight perception, self-esteem and distress in different ethnic groups, particularly in Bangladeshi young people. Further work is also needed to examine whether addressing inaccurate weight perceptions is useful and safe37 in preventing obesity in adolescence.

References

  1. 1

    Strauss RS, Pollack HA . Epidemic increase in childhood overweight, 1986–1998. JAMA 2001; 286: 2845–2848.

  2. 2

    Chinn S, Rona RJ . Prevalence and trends in overweight and obesity in three cross sectional studies of British Children, 1974–94. BMJ 2001; 322: 24–26.

  3. 3

    Strauss RS . Self-reported weight status and dieting in a cross-sectional sample of young adolescents: National Health and Nutrition Examination Survey III. Arch Pediatr Adolesc Med 1999; 153: 741–747.

  4. 4

    Halvarsson K, Lunner K, Westerberg J, Anteson F, Sjoden PO . A longitudinal study of the development of dieting among 7–17-year-old Swedish girls. Int J Eat Disord 2002; 31: 32–42.

  5. 5

    Boutelle K, Neumark-Sztainer D, Story M, Resnick M . Weight control behaviors among obese, overweight, and nonoverweight adolescents. J Pediatr Psychol 2002; 27: 531–540.

  6. 6

    Halpern CT, Udry JR, Campbell B, Suchindran C . Effects of body fat on weight concerns, dating, and sexual activity: a longitudinal analysis of black and white adolescent girls. Dev Psychol 1999; 35: 721–736.

  7. 7

    Ackard DM, Neumark-Sztainer D, Story M, Perry C . Overeating among adolescents: prevalence and associations with weight-related characteristics and psychological health. Pediatrics 2003; 111: 67–74.

  8. 8

    Kimm SYS, Barton BA, Berhane K, Ross JW, Payne GH, Schreiber GB . Self-esteem and adiposity in black and white girls: the NHLBI Growth and Health Study. Ann Epidemiol 1997; 7: 550–560.

  9. 9

    Goodman E, Whitaker RC . A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics 2002; 109: 497–504.

  10. 10

    Saxena S, Ambler G, Cole TJ, Majeed A . Ethnic group differences in overweight and obese children and young people in England: cross-sectional survey. Arch Dis Child 2004; 89: 30–36.

  11. 11

    Neumark-Sztainer D, Croll J, Story M, Hannan PJ, French SA, Perry C . Ethnic/racial differences in weight-related concerns and behaviors among adolescent girls and boys. Findings from Project EAT. J Psychosom Res 2002; 53: 963–974.

  12. 12

    Story M, French SA, Resnick MD, Blum R . Ethnic/racial and socioeconomic differences in dieting behaviours and body image perceptions in adolescents. Int J Eat Disord 1995; 18: 173–179.

  13. 13

    Furnham A, Adam-Saib S . Abnormal eating attitudes and behaviours and perceived parental control: a study of white British and British-Asian school girls. Soc Psychiatry Psychiatr Epidemiol 2001; 36: 462–470.

  14. 14

    Hill AJ, Bhatti R . Body shape perception and dieting in preadolescent British Asian girls: links with eating disorders. Int J Eat Disord 1995; 17: 175–183.

  15. 15

    Gordon-Larsen P, Harris KM, Ward DS, Popkin BM . Acculturation and overweight-related behaviors among Hispanic immigrants to the US: the National Longitudinal Study of Adolescent Health. Soc Sci Med 2003; 57: 2023–2034.

  16. 16

    Mulvihill C, Quiqley R . The Management of Obesity and Overweight: An Analysis of Reviews of Diets, Physical Activity and Behavioural Approaches. Evidence Briefing. Health Development Agency: London, 2003.

  17. 17

    Taylor SJ, Viner R, Booy R, Head J, Tate H, Brentnall SL et al. Ethnicity, socio-economic status, overweight and underweight in east London adolescents. Ethn Health 2005; 10: 113–128.

  18. 18

    Stansfeld SA, Haines MM, Head JA, Bhui K, Viner R, Taylor SJ et al. Ethnicity, social deprivation and psychological distress in adolescents: school-based epidemiological study in east London. Br J Psychiatry 2004; 185: 233–238.

  19. 19

    Stansfeld S, Haines MM, Booy R, Taylor S, Viner RM, Head JJ et al. Health of Young People in East London: The RELACHS Study 2001. The Stationery Office: London, 2003.

  20. 20

    Cole TJ, Freeman JV, Preece MA . Body mass index reference curves for the UK, 1990. Arch Dis Child 1995; 73: 25–29.

  21. 21

    Health Survey for England. The Health of Young People ‘95–97. Stationery Office: London, 1998.

  22. 22

    Goodman R, Ford T, Simmons H, Gatward R, Meltzer H . Using the strengths and difficulties questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatr 2000; 177: 534–539.

  23. 23

    Meltzer H, Gatward R, Goodman R, Ford T . Mental Health of Children and Adolescents in Great Britain. The Stationary Office: London, 2000.

  24. 24

    Rosenberg M . Society and the Adolescent Self-Image. Wesleyan University Press: Middletown, CT, 1989.

  25. 25

    Wardle J, Robb KA, Johnson F, Griffith J, Brunner E, Power C et al. Socioeconomic variation in attitudes to eating and weight in female adolescents. Health Psychol 2004; 23: 275–282.

  26. 26

    Wardle J, Volz C, Golding C . Social variation in attitudes to obesity in children. Int J bes Relat Metab Disord 1995; 19: 562–569.

  27. 27

    Grover VP, Keel PK, Mitchell JP . Gender differences in implicit weight identity. Int J Eat Disord 2003; 34: 125–135.

  28. 28

    Daniels SR, Khoury PR, Morrison JA . The utility of body mass index as a measure of body fatness in children and adolescents: differences by race and gender. Pediatrics 1997; 99: 804–807.

  29. 29

    Anonymous. Health and health behaviour among young people. Health Behaviour in School-Aged Children: A WHO Cross-National Study (HSBC) International Report. WHO: Copenhagen, 2000.

  30. 30

    Strauss RS . Childhood obesity and self-esteem. Pediatrics 2000; 105: e15.

  31. 31

    Brown KM, McMahon RP, Biro FM, Crawford P, Schreiber GB, Similo SL et al. Changes in self-esteem in black and white girls between the ages of 9 and 14 years. The NHLBI Growth and Health Study. J Adolesc Health 1998; 23: 7–19.

  32. 32

    Lumeng JC, Gannon K, Cabral HJ, Frank DA, Zuckerman B . Association between clinically meaningful behavior problems and overweight in children. Pediatrics 2003; 112: 1138–1145.

  33. 33

    Mustillo S, Worthman C, Erkanli A, Keeler G, Angold A, Costello EJ . Obesity and psychiatric disorder: developmental trajectories. Pediatrics 2003; 111: 851–859.

  34. 34

    Sundquist J, Winkleby M . Country of birth, acculturation status and abdominal obesity in a national sample of Mexican-American women and men. Int J Epidemiol 2000; 29: 470–477.

  35. 35

    Kaplan MS, Huguet N, Newsom JT, McFarland BH . The association between length of residence and obesity among Hispanic immigrants. Am J Prev Med 2004; 27: 323–326.

  36. 36

    Goodman R, Renfrew D, Mullick M . Predicting type of psychiatric disorder from strengths and difficulties questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry 2000; 9: 129–134.

  37. 37

    Gowers SG, Shore A . Development of weight and shape concerns in the aetiology of eating disorders. Br J Psychiatry 2001; 179: 236–242.

Download references

Acknowledgements

We thank Professor George Patton and Professor Susan Sawyer of the Centre for Adolescent Health, Melbourne, Australia for support during the writing of this paper. The RELACHS Study was funded by the East London & City Health Authority. Russell Viner was supported by a grant from the Health Foundation while writing this paper.

Author information

Correspondence to R M Viner.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Viner, R., Haines, M., Taylor, S. et al. Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents. Int J Obes 30, 1514–1521 (2006). https://doi.org/10.1038/sj.ijo.0803352

Download citation

Keywords

  • adolescent
  • ethnicity
  • weight perception
  • dieting
  • mental health

Further reading