Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children

Body Image 10 (2013) 78–84

Contents lists available at SciVerse ScienceDirect

Body Image journal homepage: www.elsevier.com/locate/bodyimage

Differences in body esteem by weight status, gender, and physical activity among young elementary school-aged children Lenka H. Shriver a,∗ , Amanda W. Harrist b,1 , Melanie Page c,2 , Laura Hubbs-Tait d,3 , Michelle Moulton e,4 , Glade Topham f,5 a

Department of Nutritional Sciences, 311 Human Sciences, Oklahoma State University, Stillwater, OK, USA Department of Human Development and Family Science, 323 Human Sciences, Oklahoma State University, Stillwater, OK, USA c Department of Psychology, 215 N. Murray, Oklahoma State University, Stillwater, OK, USA d Department of Human Development and Family Sciences, 341 Human Sciences, Oklahoma State University, Stillwater, OK, USA e Department of Nutritional Sciences, 301 Human Sciences, Oklahoma State University, Stillwater, OK, USA f Department of Human Development and Family Science, 233 Human Sciences, Oklahoma State University, Stillwater, OK, USA b

a r t i c l e

i n f o

a b s t r a c t

Article history: Received 29 February 2012 Received in revised form 22 October 2012 Accepted 23 October 2012 Keywords: Body esteem Children Weight status Gender Physical activity

Body satisfaction is important for the prevention of disordered eating and body image disturbances. Yet, little is known about body esteem and what influences it among younger children. The purpose of this study was to evaluate body esteem and the relationships between body esteem, weight, gender, and physical activity in elementary school children. A total of 214 third graders in a U.S. Midwestern state participated in this correlational study. The Body Mass Index-for-age, the Body Esteem Scale (BES), BE-Weight, BE-Appearance, and a Physical Activity Checklist were used to examine the relationships between the variables using bivariate correlations and analysis of variance. While children’s body esteem did not differ by physical activity, important interactions were identified between weight status and gender in global body esteem and BE-Appearance. It is critical to examine attitudes about weight and appearance and the relationship between body esteem and self-esteem further among middle childhoodaged children. © 2012 Elsevier Ltd. All rights reserved.

Introduction Research shows that high self-esteem and positive body image are important for the prevention of disordered eating and the development of body image disturbances among children and adolescents (Allen, Byrne, Blair, & Davis, 2006; Flament, Hill, Buchholz, Henderson, Tasca, & Goldfield, 2012; Smolak, 2004). A substantial body of literature has emerged in the last two decades examining the relationship between global self-esteem and body weight in the light of the current global childhood obesity epidemic and concerns related to psychological well being of overweight children (Wang & Veugelers, 2008;

∗ Corresponding author. Tel.: +1 405 744 8285; fax: +1 405 744 1357. E-mail addresses: [email protected] (L.H. Shriver), [email protected] (A.W. Harrist), [email protected] (M. Page), [email protected] (L. Hubbs-Tait), [email protected] (M. Moulton), [email protected] (G. Topham). 1 Tel.: +1 405 744 7043; fax: +1 405 744 6344. 2 Tel.: +1 405 744 7334; fax: +1 405 744 8067. 3 Tel.: +1 405 744 8360; fax: +1 405 744 6344. 4 Tel.: +1 405 744 5040; fax: +1 405 744 1357. 5 Tel.: +1 405 744 8356; fax: +1 405 744 6344. 1740-1445/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bodyim.2012.10.005

Wardle & Cooke, 2005). In contrast, the physical counterpart to self-esteem known as body esteem has not been well studied especially among young elementary school-aged children, between Grades 1 and 3. The construct of body esteem is multidimensional and consists of self-evaluation of body weight, self-evaluation of general appearance, and attributions to others of evaluations about one’s body or appearance (Mendelson & White, 1985). Researchers have suggested that similar to adolescents and adults (Tiggemann, 2005) children’s body esteem is strongly related to overall self-esteem (Mendelson, White, & Mendelson, 1996). Such relationship is not surprising in Western societies because of ubiquitous images in the media of ideal bodies and pressure to look a certain way, typically very thin for women and bigger and more muscular for men (Mendelson, Mendelson, & White, 2001; Mendelson et al., 1996; Wardle & Cooke, 2005). Research shows that children as young as five may develop weight concerns and can become dissatisfied with their bodies (Davison & Birch, 2002; Davison, Markey, & Birch, 2003). These alarming findings suggest that children are sensitive to societal norms for weight and appearance very early, which may negatively influence their body esteem even before they reach their adolescent years (Herbozo & Thompson, 2006; Mendelson et al., 1996).

L.H. Shriver et al. / Body Image 10 (2013) 78–84

Body Esteem and Weight Previous research has examined the relation between weight and body esteem; however, most studies have focused on adolescents. A definitive 2001 review by Ricciardelli et al. identified a consistent link between body mass index (BMI) and body image in children from ages 6 to 11: the higher the BMI the more negative the body image. They confirmed this finding in children ages 8–11 in their own research (Ricciardelli, McCabe, Holt, & Finemore, 2003). Xanthopoulos et al. (2011) recently replicated the relation between BMI and body image among 10–12-year-old children. This relation in children is of concern, because during the adolescent years negative body image is associated with disordered eating (Flament et al., 2012). As noted above, body esteem is a multidimensional construct that includes self-evaluation of both appearance (BE-Appearance) and weight (BE-Weight). Mendelson et al. (1996) found that, compared to BE-Appearance, BE-Weight was more closely related to 8–12-year-old children’s relative weight (relative to appropriate weight for height and age). BE-Weight appears to be somewhat more closely associated with restrained eating in adolescence (Flament et al., 2012) emphasizing the importance of studying these two separate components of body esteem in children since the Mendelson et al. (1996) study was conducted almost 20 years ago and only in Quebec, Canada. A study by Lunde, Frisén, and Hwang (2006) examined body esteem and weight status among 10-year-old boys and girls; however, body esteem was assessed in relation to peer victimization and the sample consisted of Swedish children who may be exposed to different cultural and societal influences than American children. Given the high prevalence of obesity in the U.S. (Flegal, Carroll, Ogden, & Curtin, 2010), research specifically examining how both weight- and appearance-esteem co-vary with weight status among young elementary school-aged American children is needed in the literature. Body Esteem and Gender Having healthy body esteem may be especially difficult for girls because they often compare themselves to unrealistic standards of beauty portrayed by media and they face pervasive societal pressure to be thin (Ricciardelli & McCabe, 2001; Wardle & Cooke, 2005). Blokstra, Burns, and Seidell (1999) found that 23% of women in their study viewed themselves as fat despite being normal weight. A number of studies have indicated that adolescent and adult women tend to have lower body satisfaction compared to the same age men (Muris, Meesters, Vande, & Mayer, 2005; Stradmeijer, Bosch, Koops, & Seidell, 2000; Wardle & Cooke, 2005) and Ricciardelli and McCabe (2001) identified the period between 8 and 10 years of age as the period during which these gender differences appear. However, previous research is not consistent. For instance, studies with children aged 7–12 reported no significant differences in body satisfaction between girls and boys (Hill, Draper, & Stack, 1994; Ricciardelli et al., 2003). Several recent studies have also reported inconsistent findings on the moderating effect of gender on the relation between body esteem and BMI in children. Xanthopoulos et al. (2011) reported no significant moderating effect in their study of 4th to 6th graders. In contrast Duncan, Al-Nakeeb, and Nevill (2009) reported that a physical activity intervention for 10–11-year-old children significantly decreased BMI and significantly increased body esteem scores, but the latter increase was greater for girls than boys. The importance of possible gender differences in the BMI-body esteem link is underscored in the research on adolescents by Flament et al. (2012); BE-Weight was a stronger mediator than BE-Appearance of the relation between adolescent body ideal and restrained eating for boys whereas BE-Appearance was a stronger mediator for girls.

79

Thus, research on gender differences in the link between BMI and body esteem specifically among younger elementary school-aged children is important in order for researchers and practitioners to understand whether interventions prior to adolescence are needed. Body Esteem and Physical Activity Physical activity is defined as structured or unstructured movement that promotes health with substantial benefits gained through a variety of moderate- or vigorous-intensity activities among adults and children (U.S. Department of Health and Human Services [USDHHS], 2008). Previous studies have linked physical activity to positive body image and self-esteem among adults, adolescents and older children (Furnham, Titman, & Sleeman, 1994; Gehrman, Hovell, Sallis, & Keating, 2006; Williams & Cash, 2001). A handful of studies have investigated the relationship between physical activity and global self-esteem—but not body esteem—among children and adolescents (DeBate, Gabriel, Zwald, Huberty, & Zhang, 2009; Wang & Veugelers, 2008). Even fewer studies have examined physical activity in relation to body esteem and body satisfaction among elementary school-aged children and the existing results are mixed, with some finding a positive relationship between physical activity and body esteem (Duncan et al., 2009) while others reporting no link between the two constructs (McCallum et al., 2007). Given the close link between overall self-esteem and body esteem, and the positive influence of physical activity on body image reported for young adults and adolescents (Altintas & Asci, 2008; Furnham et al., 1994; Williams & Cash, 2001), it is critical to explore the potential influence of physical activity on body esteem among children in the preadolescent years. Current Study Body esteem has been shown to decline during adolescence (Robins, Trzesniewski, Tracy, Gosling, & Potter, 2002; Tiggemann, 2005) and low body esteem has been linked to increased risk of emotional/restrained eating (Flament et al., 2012). Thus, it is important to better understand development of body esteem and potential factors that influence body esteem in younger elementary school-aged children, between ages 8 and 10, the age period during which inconsistent findings on gender differences or similarities exist (Ricciardelli et al., 2003; Xanthopoulos et al., 2011), to better inform prevention and early intervention efforts with both boys and girls. The main purpose of this study was to evaluate body esteem and to explore the relationships among body esteem, weight status, gender, and physical activity in a sample of 3rd grade children living in the U.S. We hypothesized that there would be a significant interaction effect between weight, gender and physical activity on body esteem of children in the sample. Specifically, we hypothesize that obese children with low reported physical activity will have the lowest body esteem and these effects will be especially evident in girls. Method Study Design Data for this correlational study were collected as part of a large multi-disciplinary project titled Families and Schools for Health (FiSH), with two cohorts and a total of 29 schools participating in the study between 2005 and 2010. Children and their parents were recruited purposively from elementary schools located in a Midwestern U.S. state. The initial written informed consent was obtained from each school’s principal. Members of the research team then met with parents of 1st graders at back-to-school nights

80

L.H. Shriver et al. / Body Image 10 (2013) 78–84

and other school events (the principal and parental consent forms were renewed annually thereafter). Letters about the nature, benefits, and risks associated with the study were also sent home with the children. Parents of the participating children were asked to sign an informed consent form prior to data collection. In addition, each child was asked for assent before any information was obtained. Starting in Grade 3, physical activity assessment was conducted in a subsample of 12 schools randomly selected from participating schools (Cohort 1) to be representative of the children participating in the larger study. Random selection strategy was as follows: two schools from each intervention condition (all schools had originally been randomly assigned to condition) in the larger study were selected, with a third school sampled for the two conditions in which only small-enrollment schools had been randomly selected for the subsample (to correct for unequal representation). Data in the current study came from anthropometric assessments and individual interviews conducted in the larger study to assess body esteem as well as one-on-one interviews that were completed to evaluate the physical activity of each child in the subsample. The study protocol was reviewed and approved by the University Institutional Review Board prior to data collection. Participants Complete data were collected from a total of 214 3rd graders (86% of the subsample), including 115 boys and 99 girls. The majority of the children were Caucasian (76.6%; n = 164), 15.9% were Native American (n = 34), 1.9% were African American (n = 4), and 1.9% were Hispanic (n = 4). The sample ranged from 8 to 10 years of age. The demographic and anthropometric characteristics of the sample are shown in Table 1.

BMI-for-age percentile was used to group children into three categories: normal (<85th BMI percentile), overweight (≥85th to <95th BMI percentile), and obese (≥95th BMI percentile) (CDC, 2000; Shriver et al., 2011). Underweight children (<5th BMI percentile) were included in the category <85th percentile (n = 3). Body esteem assessment. Body esteem of the participating children was assessed using the Body Esteem Scale (BES) developed by Mendelson and White (1993). The 20-item scale was derived from the original 24-item BES and answered in a “yes” or “no” format (Mendelson & White, 1982, 1993). The modified scale has a multidimensional aspect and the individual items are designed to measure children’s affective evaluations of their own body, with the minimum of 0, reflecting low body-esteem, and the highest score of 20, indicating high body-esteem. The scale assesses child body esteem using three subscales with the psychometric properties being established in previous research with school-aged children: BE-Appearance (general appearance and body-esteem, ˛ = .87), BE-Weight (satisfaction with weight, ˛ = .77), and BE-Attribution (attribution of positive evaluations to others, ˛ = .55) (Mendelson et al., 1996). The item to total score correlations were significant and positive for all of the 20 questions and a high internal reliability was observed at ˛ = .88 (Mendelson & White, 1993; Mendelson et al., 1996). All three subscales of BES were also shown to share significant variance with the Physical Appearance Subscale of Harter Self-Perception Scale, which has been used previously for assessment of self-perception among children (Harter, 1985). In our sample, the global BES scale was internally consistent, with Cronbach’s ˛ = .88. The internal consistency was also acceptable for the individual subscales, with Cronbach’s ˛ of .77 for BE-Weight and .83 for BE-Appearance. However, Cronbach’s ˛ for BE-Attribution was low (˛ = .49). The BE-Attribution subscale was thus omitted from the data analyses in this study.

Procedures and Measures Demographics and anthropometric variables. Children’s demographic and anthropometric characteristics were obtained during individual child assessments that were designed to obtain anthropometrics and a variety of psychosocial data. The assessments took place during regular school days, during class time or recess, depending on teachers’ schedules. The procedures used for the child interviews are described in detail elsewhere (Topham et al., 2011). Standard procedures for anthropometric measures were utilized in the study (CDC, 2007). Height and weight were measured for each child in order to calculate his/her Body Mass Index-for-age (BMI-for-age) percentile using the “Epi Info software program” (CDC, 2008). Measurements of height were taken two times during the same visit using a portable board to measure each child’s height to the nearest .2 cm. If the height was not within ±.3 cm then it was measured a third time. The average of the height measurements was the value used in analysis (Shriver, Harrist, Hubbs-Tait, Topham, Page, & Barrett, 2001). Weight was determined to the nearest ±.2 pounds using a portable digital scale (Tanita Electronic Scale, BWB-800). Table 1 Demographic and anthropometric characteristics of the sample. Variable

M ± SD

Age (years) Weight (kg) Height (in) BMI-for-age percentile BMI z-score Physical activitya (min)

9.2 34.9 53.0 66.8 0.6 124.0

± ± ± ± ± ±

0.4 10.6 2.6 28.3 1.1 102.49

Minimum

Maximum

8.3 19.9 37.6 2.0 −2.2 0.0

10.4 113.6 60.7 100.0 3.1 405.0

a The amount of combined moderate and vigorous activity children reported in minutes.

Physical activity evaluation. The Self-Administered Physical Activity Checklist (SAPAC) was utilized to measure the amount of moderate, vigorous and combined moderate and vigorous physical activity the children engaged in (Sallis et al., 1996). The SAPAC has been validated with school-aged children with moderate criterion validity (r = .57–.75) and test–retest reliability (r = .60) (Sallis et al., 1996). A recent study by Gioxari, Kavouras, Tambalis, Maraki, Kollia, and Sidossis (2011) also indicated that physical activity estimates collected via SAPAC among 10-year-old children agree with accelerometer measurements, which currently represent the gold standard in physical activity assessment in adults and children. The SAPAC checklist includes 24 common physical activities that school-aged children engage in (e.g., walking, playing soccer, hopscotch). Children report whether or not they participated in the individual activities on the previous day. For the purpose of the current study, the original checklist was administered via interview rather than by self-report by trained research assistants to decrease error and minimize inaccuracies related to younger children’s ability to fill out the measure on their own (Shriver et al., 2011). The interviews were not conducted on Mondays to ensure that data reflected children’s physical activity on a weekday. The research assistants completed online video training and participated in a pilot test with 3rd grade children prior to the beginning of the study (Shriver et al., 2011). The children were asked questions about the individual types of activity, the length of time of each activity (in minutes), and the intensity of each activity (i.e., breathing heavy with response options of none, some or most of the time) (Sallis et al., 1996). Prior to data analysis, each of the reported activities was assigned a specific metabolic equivalent (MET) by a trained research assistant using the “updated Compendium of Physical Activities” (Ainsworth et al., 2000). One MET “is defined as the amount of oxygen per

L.H. Shriver et al. / Body Image 10 (2013) 78–84

kilogram of body weight per minute consumed when sitting quietly (3.5 ml/kg/min)” (Ainsworth et al., 2000). Levels of physical activity were defined as moderate (METs 3–5.99), vigorous (METs ≥ 6), and combined moderate and vigorous activity (METs ≥ 3), and were calculated for each participating child. Three physical activity categories were created by splitting the sample by the reported amount of time spent in moderate-to-vigorous physical activity, using the physical activity recommendation for children as a guide (1 ≤ 60 min/day; 2 = 60–150 min/day; 3 ≥ 150 min/day, USDHHS, 2008). Statistical Analysis The statistical analyses were performed using the Statistical Package for Social Sciences for Windows (18.0, SPSS Inc., Chicago, IL, 2010). Descriptive statistics were used to describe the study sample in terms of body weight, body-esteem, and physical activity using means, standard deviations, and frequencies. Pearson’s bivariate correlations were used in preliminary analyses to examine the nature of the relationships between BES scores, BMI-for-age percentile, and physical activity. Factorial analysis of variance (ANOVA) with a 3-way design (3 × 2 × 3) was utilized to examine the main effects and interaction effects of weight status, gender, and physical activity on global BES scores as well as on BE-Weight and BE-Appearance subscales. For these analyses, global BES, BE-Appearance and BE-Weight scores served as the individual dependent variables with weight status, gender, and physical activity serving as independent variables. The weight status variable consisted of three levels (1 = normal weight; 2 = overweight; 3 = obese). The gender variable consisted of two levels (1 = boys; 2 = girls). The physical activity variable consisted of three levels (1 ≤ 60 min/day; 2 = 60–150 min/day; 3 ≥ 150 min/day). Fisher’s Least Significant Difference (LSD) post hoc tests were performed to identify significant mean differences between individual groups of children. The level of statistical significance was set at p < .05 for all tests. Results Anthropometrics and Physical Activity Table 1 presents the demographic and anthropometric characteristics of the sample. The proportion of normal weight, overweight, and obese boys and girls is presented in Table 2, with 37.8% of the children being overweight or obese. The mean global BES score of the children in the sample was 17.0 (range 1.0–20.0), with significant differences by weight in the global BES: F(2, 211) = 11.86, p = .001, partial (eta)2 = .101; in the BEWeight: F(2, 211) = 26.77, p = .001, partial (eta)2 = .202; and in the BE-Appearance: F(2, 211) = 8.72, p = .001, partial (eta)2 = .076. The analysis of the SAPAC revealed that 30.4% of the children spent less then 60 min in moderate or vigorous physical activity on the Table 2 Distribution of children in the sample by weight status. Weight statusa Normal weight Overweightc Obesed Total

Boys n (%)a

Girls n (%)a

Total n (%)

71 (61.7) 19 (16.5) 25 (21.7)

62 (62.6) 18 (18.2) 19 (19.2)

133 (62.2) 37 (17.2) 44 (20.6)

115 (53.7)

99 (46.3)

214 (100)

Note: Normal weight was defined as <85th percentile for BMI-for-age; overweight was defined as BMI between ≥85th to ≤95th percentile for BMI-for-age; and obese was defined as >95th percentile for BMI-for-age. a Percentage calculated from total of each gender, not total sample.

81

recalled day, 36.5% engaged in 60–150 min of physical activity, and 33.1% reported spending more than 150 min in physical activity. No significant correlations were found between physical activity as a continuous variable (minutes per day) and body esteem scores (global, BE-Weight, BE-Appearance).

Differences in Global Body Esteem as a Function of Weight, Gender, and Physical Activity All effects involving physical activity were nonsignificant. There was a significant interaction effect between weight status and gender on the global BES score in the sample, F(2, 196) = 3.51, p = .03, partial (eta)2 = .035. The interaction effect was explored further using the LSD post hoc test. The findings indicated that normal weight boys had similar global BES scores (17.8 ± 2.41) as overweight boys (17.5 ± 3.23); however, the global BES scores of obese boys (15.8 ± 3.76) were lower than the scores of both normal weight (p = .03) and overweight boys (p = .04). In contrast, the global BES scores of overweight girls were lower compared to normal weight girls in the sample (p = .03, 15.8 ± 5.20 vs. 18.2 ± 2.43). Obese girls also had significantly lower global BES scores (13.4 ± 6.01) than normal weight girls (p = .001, 18.2 ± 2.43) but did not differ significantly from overweight girls (15.8 ± .93) although there was a trend-level difference (p = .06). As expected, the main effect of weight status on BES was statistically significant F(2, 196) = 11.4, p = .001; partial (eta)2 = .106. There was a significant main effect of gender on BES with girls scoring lower than boys (15.83 ± 4.31 vs. 17.02 ± 3.29), F(1, 196) = 3.82, p = .05, partial (eta)2 = .019. Both of these significant main effects were qualified by the gender by weight status interaction described above.

Weight- and Appearance-Related Body Esteem by Weight, Gender, and Physical Activity There was a significant interaction between weight status and physical activity on the BE-Weight subscale, F(4, 196) = 3.03, p = .019, partial (eta)2 = .058. Follow-up LSD tests showed that for the lowest physical activity group (≤60 min/day), the obese children had significantly lower BE-Weight scores than the overweight (p = .037) and normal weight children (p = .001). In the middle physical activity group (60–150 min/day), significant differences in BE-Weight were detected between obese and normal weight children (p = .01) and overweight and normal weight children (p = .019), but not between overweight and obese children. In the highest physical activity group (≥150 min/day), the obese children scored lower than the overweight and normal weight children (p = .001), but there was no difference between normal weight and overweight children (p = .54). There was also a main effect of weight status: F(2, 196) = 24.99, p = .001, but this was qualified by the significant interaction. No gender effects were significant. For the BE-Appearance subscale, similar to the results for the global BES analyses, effects with physical activity were nonsignificant; the interaction effect between weight status and gender was significant: F(2, 196) = 3.08, p = .048, partial (eta)2 = .031. Among boys, no significant differences in BE-Appearance were found by weight status: F(2, 112) = 1.84, p = .164. In contrast, significant differences were detected among girls by weight status: F(2, 96) = 9.96, p = .001, with normal weight girls having significantly higher BEAppearance scores than overweight (p = .03) as well as obese girls (p = .001). The difference in BE-Appearance scores between overweight and obese girls was nonsignificant (p = .08). There was a significant main effect of weight status on BE-Appearance, F(2, 196) = 8.1, p = .001, but this was qualified by the significant interaction described above.

82

L.H. Shriver et al. / Body Image 10 (2013) 78–84

Discussion The purpose of the current study was to assess body esteem among 3rd grade elementary school children and to examine whether differences in body esteem exist by weight, gender, and/or physical activity in this young population. Our findings provide several important insights about body esteem and some of the factors that may influence body esteem among children before they reach their adolescent years. Gender differences in body satisfaction have been consistently reported in research with adolescents and adults; however, results of studies with children are inconsistent (Hill et al., 1994; Ricciardelli & McCabe, 2001). Thus, it is not known at what age gender differences in body satisfaction/esteem can be expected. In our study, differences in body esteem were clearly observed among the individual weight categories, with important gender main and interaction effects. Our findings indicate that the effect of children’s weight status on global body esteem differs between 3rd grade boys and girls. For global and appearance-related esteem, obese and overweight girls reported lower esteem than normal weight girls, but were not different from each other. In contrast, for boys, normal weight boys reported higher global esteem than obese boys but did not differ from overweight boys, overweight boys reported higher global esteem than obese boys, and boys did not differ significantly in the appearance-related esteem as a function of weight status. It is important to note that a similar number of boys and girls in the sample were overweight or obese (approximately 38% of the sample). These findings are interesting and could be explained by the notion that boys do not get worried about their weight or appearance until they actually have a very high BMI (Smolak, 2004). Previous research shows that this is different from girls who worry about being fat when they are normal or even underweight (McCreary, 2002; Wojtowicz & von Ranson, 2012). Given the societal pressures related to appearance of women (Mendelson et al., 1996), girls may become more sensitive to their weight and appearance at a younger age than boys, which helps explain our findings. This finding is potentially of great importance because body esteem related to weight has been shown to be a strong mediator of the relationship between thin ideal and restrained eating in a recent study of adolescent girls (Flament et al., 2012). Furthermore, body esteem related to appearance has been found in the same study to be a significant mediator of the relationship between thin ideal and emotional and external eating. In our sample of middle childhood-aged children, girls showed a more nuanced pattern of differences between weight categories than did boys. Since only a few previous studies on body esteem were conducted with similar age groups of children (Hill et al., 1994; Lunde et al., 2006; Ricciardelli et al., 2003; Xanthopoulos et al., 2011), our findings add to the limited amount of literature and suggest that for boys, global body esteem of children in the age range of 8–10 years may not be affected until they become obese, but for girls, who face more social pressure to be thin, it is already affected when they are overweight. Given our findings, however, it is important to examine the accuracy of children’s perceptions of their own weight status in further studies in order to better understand the development and evolution of body esteem in middle childhood. It has been suggested that body esteem is multidimensional and certain components of body esteem, especially positive feelings about appearance, may have a greater influence on adolescents’ overall self-esteem than other components (Herbozo & Thompson, 2006; Mendelson et al., 1996). We have extended this understanding and suggest that the importance of self-evaluations of appearance and their contribution to global body esteem is an issue that is of more salience to 8–10-year-old girls than boys. Overweight and obese girls in our sample evaluated their appearance

esteem more negatively than their normal weight peers, whereas for boys, there were no significant differences in appearance esteem as a function of weight status. Our finding is important because it may represent early signs of negative body image development and concerns about appearance in these young elementary school-aged children. Given that body dissatisfaction and weight concerns have been associated with lower self-esteem among adolescents (Herbozo & Thompson, 2006; Mendelson et al., 1996), effective interventions promoting healthy behaviors as well as positive feelings about appearance and weight may be needed for young elementary school-aged children (i.e., first to third grades). One important qualification of our findings is that body esteem measures may be particularly sensitive to weight differences among children due to the nature of the questions included. For example, the global BES includes three weight-related questions (my weight makes me unhappy, I wish I were thinner, and I really like what I weigh). Thus, these items could be responsible for the lower scores of obese children on the global BES scale compared to other children. While the significant difference in global BES between weight status groups was upheld in our sample even after we conducted analyses with the weight-related items removed from the scores, F(2, 211) = 5.42, p = .005; partial (eta)2 = .049, we note that these items could have influenced children’s responses to other items. An important topic for future research would be the systematic evaluation of the impact of weight status differences on body esteem with the inclusion and exclusion of weightrelated items from body esteem measures. It is important for both researchers and practitioners to understand whether weight status differences in body esteem are upheld for measures that refer only to aspects of body esteem that are independent of weight. Previous research suggests that greater levels of physical activity are strongly related to higher global self-esteem, more positive body image and other favorable outcomes in adults and adolescents (Furnham et al., 1994; Williams & Cash, 2001). A limited number of studies suggest that higher levels of physical activity are positively related to self-esteem and body esteem among children, especially those in the obese category (DeBate et al., 2009; Wang & Veugelers, 2008). In our study, physical activity was not associated with global and appearance-related body esteem, but there was a significant interaction between physical activity and weight status on the children’s weight-related body esteem. Specifically, it seems that weight status has a greater effect when physical activity is very low. It is important to note that the evaluation of physical activity was limited to a snapshot of physical activity on one weekday due to the nature of the school environment, limited data collection time that was available for each child, and the class schedule of the children during the study. Although the positive impact of physical activity on self-esteem and body image has been established among young adults (Furnham et al., 1994; Williams & Cash, 2001), the influence of physical activity on body esteem or body esteem on physical activity, including the individual components of body esteem, among children is not yet clear. It is possible that being athletic does not necessarily translate into current norms of beauty and increased activity does not contribute to the development of higher overall body esteem but may be important for specific components of body esteem that are weight-related. Thus, it is important to further examine the relation between physical activity and young elementary school-age children’s body esteem in future research. Limitations Our study has several limitations that should be considered in future research. First, the results of our study come from a sample of 3rd grade children in a Midwestern state of the U.S. and thus the sample is not representative of all American 3rd graders. For

L.H. Shriver et al. / Body Image 10 (2013) 78–84

example, the development of body esteem and/or the frequency of physical activity in our sample may be influenced by different factors due to the geographical location. It is also important to note that the prevalence of overweight and obesity in our sample was 37.8%, which is somewhat higher than the national average. Second, physical activity was assessed using the modified SAPAC during which children recalled activities on the previous day and the recall was limited to weekdays. Although collection of data from multiple days would have been ideal, several factors did not allow for this approach, including lack of time and teachers’ hectic schedules that are well recognized limitations of research studies in school settings. Therefore, our data represent a cross-sectional snapshot of children’s physical activity on one weekday rather than their overall physical activity level. When feasible, the utilization of a multiple-day SAPAC and/or utilization of one of the objective physical activity assessment methods, such as the use of accelerometers, are suggested for a future study. Third, the current study was correlational and thus cause-and-effect relationships between the individual variables could not be established. Conclusion In conclusion, our study contributes to the current literature by examining overall body esteem and feelings about weight and appearance among young elementary school children, a population that has not been researched extensively in this aspect. While body esteem was not associated with the amount of physical activity in our study, we have identified significant interaction effects between weight status and gender on global body esteem and appearance-related body esteem among 8–10-year-old children, as well as an interaction between physical activity and weight status for weight-related esteem. The large difference in body esteem and BE-Appearance between normal weight and overweight girls suggests that 3rd grade girls are already more sensitive to how their weight status affects their appearance compared to boys. Given the established relation between adolescents’ body dissatisfaction and self-esteem, it is critical to build upon the current study and further examine body esteem, specific attitudes related to weight and appearance, and the relationship between body esteem and overall self-esteem among children before they enter their adolescent years. Acknowledgments The authors would like to thank all the children who participated in this study and also the parents, teachers, and principals who took part in or assisted with the project. This research project was funded by the Oklahoma Center for Advancement of Science and Technology (Project #HR07-044) to Amanda W. Harrist, Melanie Page, Glade Topham, Lenka H. Shriver, and Laura HubbsTait and by USDA-CSREES (Grant 05545) to Amanda W. Harrist, Tay S. Kennedy, Glade Topham, Laura Hubbs-Tait, and Melanie Page. References Ainsworth, B. E., Haskell, W. L., Whitt, M. C., Irwin, M. L., Swartz, A. M., Strath, S. J.,. . . & Leon, A. S. (2000). Compendium of physical activities: An update of activity codes and MET intensities. Medicine and Science for Sports and Exercise, 32, S498–S516. http://dx.doi.org/10.1097/00005768-200009001-00009 Allen, K. L., Byrne, S. M., & Blair, E. M. (2006). Why do some overweight children experience psychological problems? The role of weight and shape concern. International Journal of Pediatric Obesity, 1, 239–247. http://dx.doi.org/10.1080/17477160600913552 Altintas, A., & Asci, H. (2008). Physical self-esteem of adolescents with regard to physical activity and pubertal status. Pediatric Exercise Science, 20, 142–156. Blokstra, A., Burns, C. M., & Seidell, J. C. (1999). Perception of weight status and dieting behaviour in Dutch men and women. International Journal of Obesity, 23, 7–17. http://dx.doi.org/10.1038/sj.ijo.0800803

83

Center for Disease Control and Prevention. (2000). Childhood growth charts. Retrieved from http://www.cdc.gov/growthcharts/ Center for Disease Control and Prevention. (2007). National Health and Nutrition Examination Survey. Anthropometry Procedures Manual. Retrieved from http://www.cdc.gov/nchs/data/nhanes/nhanes 07 08/manual an.pdf Center for Disease Control and Prevention. (2008). EpiInfo for Windows. Retrieved from http://wwwn.cdc.gov/epiinfo/ Davison, K. K., & Birch, L. L. (2002). Processes linking weight status and self-concept among girls from ages 5 to 7 years. Developmental Psychology, 38, 735–748. http://dx.doi.org/10.1037//0012-1649.38.5.735 Davison, K. K., Markey, C. N., & Birch, L. L. (2003). A longitudinal examination of patterns in girls’ weight concerns and body dissatisfaction from ages 5 to 9 years. International Journal of Eating Disorders, 33,, 320–332. http://dx.doi.org/10.1002/eat.10142 DeBate, R. D., Gabriel, K. P., & Zwald, M. (2009). Changes in psychosocial factors and physical activity frequency among third to eighthgrade girls who participated in a developmentally focused youth sport program: A preliminary study. Journal of School Health, 79, 474–484. http://dx.doi.org/10.1111/j.1746-1561.2009.00437.x Duncan, M. J., Al-Nakeeb, Y., & Nevill, A. M. (2009). Effects of a 6-week circuit training intervention on body esteem and Body Mass Index in British primary school children. Body Image, 6, 216–220. http://dx.doi.org/10.1016/j.bodyim.2009.04.003 Flament, M. F., Hill, E. M., & Buchholz, A. (2012). Internalization of the thin and muscular body ideal and disordered eating in adolescence: The mediation effects of body esteem. Body Image, 9, 68–75. http://dx.doi.org/10.1016/j.bodyim.2011.07.007 Flegal, K. M., Carroll, M. D., & Ogden, C. L. (2010). Prevalence and trends in obesity among US adults, 1999–2008. Journal of the American Medical Association, 303, 235–241. http://dx.doi.org/10.1001/jama.2009.2014 Furnham, A., Titman, P., & Sleeman, E. (1994). Perception of female body shapes as a function of exercise. Journal of Social Behaviour and Personality, 9, 335–352. Gehrman, C. A., Hovell, M. F., & Sallis, J. F. (2006). The effects of a physical activity and nutrition intervention on body dissatisfaction, drive for thinness, and weight concerns in pre-adolescents. Body Image, 3, 345–351. http://dx.doi.org/10.1016/j.bodyim.2006.07.006 Gioxari, A., Kavouras, S. A., & Tambalis, K. D. (2011). Reliability and criterion validity of the Self-Administered Physical Activity Checklist in Greek children. European Journal of Sports Sciences, http://dx.doi.org/10.1080/17461391.2011.606838 Harter, S. (1985). Manual for the Self-Perception Profile for Children. Denver, CO: University of Denver. Hill, A. J., Draper, E., & Stack, J. (1994). A weight on children’s minds: Body shape dissatisfactions at 9-years old. International Journal of Obesity Related Metabolic Disorders, 18, 383–389. Herbozo, S., & Thompson, J. K. (2006). Appearance-related commentary, body image, and self-esteem: Does the distress associated with the commentary matter? Body Image, 3, 255–262. http://dx.doi.org/10.1016/j.bodyim.2006.04.001 Lunde, C., Frisén, A., & Hwang, C. P. (2006). Is peer victimization related to body esteem in 10-year-old girls and boys? Body Image, 3, 25–33. http://dx.doi.org/10.1016/j.bodyim.2005.12.001 McCallum, Z., Wake, M., & Gerner, B. (2007). Outcome data from the LEAP (Live, Eat and Play) trial: A randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. International Journal of Obesity, 31, 630–636. http://dx.doi.org/10.1038/sj.ijo.0803509 McCreary, D. (2002). Gender and age differences in the relationship between Body Mass Index and perceived weight: Exploring the paradox. International Journal of Men’s Health, 1, 31–42. http://dx.doi.org/10.3149/jmh.0101.31 Mendelson, B. K., Mendelson, M. J., & White, D. R. (2001). Body-esteem scale for adolescents and adults. Journal of Personality Assessment, 76, 90–106. http://dx.doi.org/10.1207/S15327752JPA7601 6 Mendelson, B. K., & White, D. R. (1982). Relation between body-esteem and selfesteem of obese and normal children. Perceptual and Motor Skills, 54, 899–905. http://dx.doi.org/10.2466/pms.1982.54.3.899 Mendelson, B. K., & White, D. R. (1985). Development of self-bodyesteem in overweight youngsters. Developmental Psychology, 21, 90–96. http://dx.doi.org/10.1037//0012-1649.21.1.90 Mendelson, B. K., & White, D. R. (1993). Manual for the body-esteem scale for children. Research Bulletin, 1993–94, 9, 1–6. Mendelson, B. K., White, D. R., & Mendelson, M. J. (1996). Self-esteem and body esteem: Effects of gender, age and weight. Journal of Applied Developmental Psychology, 17, 321–346. http://dx.doi.org/10.1016/S0193-3973(96)90030-1 Muris, P., Meesters, C., & Vande, B. W. (2005). Biological, psychological, and socio-cultural correlates of body change strategies and eating problems in adolescent boys and girls. Eating Behaviours, 6, 11–22. http://dx.doi.org/10.1016/j.eatbeh.2004.03.002 Ricciardelli, L. A., & McCabe, M. P. (2001). Children’s body image concerns and eating disturbance: A review of the literature. Clinical Psychology Review, 21, 325–344. http://dx.doi.org/10.1016/S0272-7358(99)00051-3 Ricciardelli, L. A., McCabe, M. P., & Holt, K. E. (2003). A biopsychosocial model for understanding body image and body change strategies among children. Journal of Applied Developmental Psychology, 24, 475–495. http://dx.doi.org/10.1016/S0193-3973(03)00070-4 Robins, R. W., Trzesniewski, K. H., & Tracy, J. L. (2002). Global selfesteem across the life span. Psychology and Aging, 17, 423–434. http://dx.doi.org/10.1037//0882-7974.17.3.423 Sallis, J. F., Strikmiller, P. K., Harsha, D. W., Feldman, H. A., Ellinger, S., Stone, E. J.,. . .& Woods, S. (1996). Validation of interviewer-and self-administered physical

84

L.H. Shriver et al. / Body Image 10 (2013) 78–84

activity checklists for fifth grade students. Medicine and Science in Sports and Exercise, 28, 840–851. http://dx.doi.org/10.1097/00005768-199607000-00011 Shriver, L. H., Harrist, A. W., & Hubbs-Tait, L. (2011). Weight status, physical activity, and fitness among third-grade rural children. Journal of School Health, 81, 536–544. http://dx.doi.org/10.1111/j.1746-1561.2011.00624.x Smolak, L. (2004). Body image in children and adolescents: Where do we go from here? Body Image, 1, 15–28. http://dx.doi.org/10.1016/S1740-1445(03)00008-1 Stradmeijer, M., Bosch, J., & Koops, W. (2000). Family functioning and psychosocial adjustment in overweight youngsters. International Journal of Eating Disorders, 27, 110–114. http://dx.doi.org/10.1002/(SICI)1098-108X(200001)27: 1<110::AID-EAT14>3.0.CO;2-5 Tiggemann, M. (2005). Body dissatisfaction and adolescent self-esteem: A prospective findings. Body Image, 2, 129–135. http://dx.doi.org/10.1016/j.bodyim. 2005.03.006 Topham, G. L., Hubbs-Tait, L., & Rutledge, J. M. (2011). Parenting styles, parental response to child emotion, and family emotional responsiveness are related to child emotional eating. Appetite, 56, 261–264. http://dx.doi.org/10.1016/j.appet.2011.01.007

U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Retrieved from http://www.health.gov/paguidelines Wang, F., & Veugelers, P. J. (2008). Self-esteem and cognitive development in the era of the childhood obesity epidemic. Obesity Reviews, 9, 615–623. http://dx.doi.org/10.1111/j.1467-789X.2008.00507.x Wardle, J., & Cooke, L. (2005). The impact of obesity on psychological well-being. Best Practice & Research Clinical Endocrinology & Metabolism, 19, 421–440. http://dx.doi.org/10.1016/j.beem.2005.04.006 Williams, P. A., & Cash, T. (2001). Effects of a circuit weight training program on the body images of college students. International Journal of Eating Disorders, 12, 31–36. http://dx.doi.org/10.1002/eat.1056 Wojtowicz, A., & von Ranson, K. (2012). Weighing in on risk factors for body dissatisfaction: A one-year prospective study of middle-adolescent girls. Body Image, 9, 20–30. http://dx.doi.org/10.1016/j.bodyim.2011.07.004 Xanthopoulos, M. S., Borradaile, K. E., Hayes, S., Sherman, S., Veur, S., Grundy, K. M.,. . .& Foster, G. D. (2011). The impact of weight, sex, and race/ethnicity on body dissatisfaction among urban children. Body Image, 8, 385–389. http://dx.doi.org/10.1016/j.bodyim.2011.04.011