Is Teenage Obesity Associated with Depression and Low Self-Esteem?: A Pilot Study

Objectives: A pilot study to explore the impact of perceived and actual overweight on self-esteem and depression in Hong Kong teenagers. Methods: A cross-sectional questionnaire study on 152 Chinese adolescents aged 12-16 was conducted in a secondary school in Hong Kong. Overweight was defined as a body mass index (BMI) above 90 percentile of age-adjusted BMI reference. The short form Beck Depression Inventory (BDI-13) and the Chinese version of Piers-Harris 2 Self-Concept Scale were used to measure depression and self-esteem respectively. Results: Our results showed that perceived overweight but not actual overweight female subjects had statistically significantly lower Piers-Harris score and higher depression score. Kruskal-Wallis test showed that depression was significantly more common in female teenagers who perceived themselves as being overweight but who were not actually overweight compared to those with normal BMI and body image. On the contrary, male teenagers who perceived themselves as thin were more at risk for lower Piers-Harris subscale scores. Conclusions: Our findings suggest that perceived body image has more detrimental impact on depression and self-esteem than actual body mass index in both male and female Hong Kong teenagers. This may reflect a probable influence from the mass media, advertisement, or prevailing societal values in over-promoting a slim body-image which may result in self-depreciating tendencies if female teenagers perceived themselves as being overweight. Health care professionals need to pay attention to body image perception rather than focusing solely on the physical build of teenagers.