they place on various aspects of their well-being (Buchanan, 2000). Depending on these values, childhood obesity may represent a greater concern to some than to others. Failing to reverse the trend in childhood obesity means that many obese children, over their lifetimes, could experience significant impairments in multiple domains of functioning. They are more likely to be chronically ill, to have a negative impact on their earning potential, and to even die prematurely.

Social and Emotional Health

While childhood obesity may not result in recognized clinical symptoms until later in life, the social and emotional correlates often have immediate effects on children’s lives. Research on the short- and long-term impacts of obesity on children’s emotional and social functioning has been extensively reviewed (French et al., 1995; Dietz, 1998b; Must and Strauss, 1999; Puhl and Brownell, 2001; Styne, 2001; Must and Anderson, 2003; Schwartz and Puhl, 2003), and the collective body of research clearly indicates that obese children and youth are stigmatized, and subject to negative stereotyping and discrimination by their peers (Schwartz and Puhl, 2003; Strauss and Pollack, 2003).

This sort of treatment, which is hypothesized to produce adverse emotional consequences such as low self-esteem, negative body image, and depressive symptoms for obese children, is not limited to peers; it may also come from adults, including parents, teachers, and health-care providers (Strauss et al., 1985). Even though obesity in children has become more common, such negative treatment has not diminished (Latner and Stunkard, 2003), as revealed by obese children who continue to be socially marginalized by their peers (Strauss and Pollack, 2003).

The results of studies on the emotional well-being of obese children are difficult to succinctly summarize, given the differences between studies. Variations include the outcome measures used, the characteristics of the study subjects (particularly age, gender, racial/ethnic status, and degree of obesity), and whether the samples were clinical or community-based. Furthermore, because many of the study designs are cross-sectional, it is often impossible to distinguish between time course, and impossible to determine whether the associations are causal. Nonetheless, a few general statements can be made.

In one longitudinal study, associations between obesity and low self-esteem appear to emerge by early adolescence and were strongest in Hispanic and white adolescent girls but not in African-American girls (Strauss, 2000). The emotional consequences are somewhat stronger in girls than in boys, increase with age, and may be greater in those obese children who seek treatment (Schwartz and Puhl, 2003). Having concerns about being



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