The association of self-esteem, depression and body satisfaction with obesity among Turkish Title: adolescents Authors:

Backgroud: The purpose of this study was to determine the prevalence of overweight and obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on selfesteem and depression in a high school population in Turkey. Methods: A cross-sectional survey of 2101 tenth-grade Turkish adolescents aged 15-18 was conducted. Body mass index (BMI) was calculated using weight and height measures. The overweight and obesity were based on the ageand gender-spesific BMI cut-off points of the International Obesity Task Force values. Self-esteem was measured using the Rosenberg Self-Esteem Scale, and depression was measured using Children’s Depression Inventory. Logistic regression analysis was used to examine relationships among the variables. Results: Based on BMI cut-off points, 9.0% of the students were overweight and 1.1% were obese. Logistic regression analysis indicated that (1) being male and being from a higher socio-economical level were important in the prediction of overweight based on BMI; (2) being female and being from a higher socio-economical level were important in the prediction of perceived overweight; (3) being female was important in the prediction of body dissatisfaction; (4) body dissatisfaction was related to low self-esteem and depression, perceived overweight was related only to low self-esteem but actual overweight was not related to low self-esteem and depression in adolescents. Conclusion: The results of this study suggest that school-based adolescents in urban Turkey have a lower risk of overweight and obesity than adolescents in developed countries. The findings of this study suggest that psychological well-being of adolescents is more related to body satisfaction than actual and perceived weight status is. Backgroud It is a well-recognised fact that obesity is a major public health problem in the world, and the prevalence of obesity is increasing in both developed and developing countries [1,2]. Although the prevalence of overweight and obesity varies between different countries and ethnic groups, adolescent obesity is also one of the major health problems all over the world [3,4]. Comparison of cross-sectional data from Israel, United States and 13 European countries has shown that the prevalence of overweight, defined as a BMI above the 85 th centile and below 95 th centile varied between 5.2% and 28.9% for boys and 8.1% and 31.0% for girls; the prevalence of obesity defined as a BMI above 95th centile varied between 1.9% and 13.9% for boys and 1.1% and 15.1% for girls among adolescents [5]. The prevalence of overweight and obesity (excess of the 85 th and 95 th percentiles) has been found to be 21.1% and 7.8% among Iranian adolescents [6], 19.8% and 7.9% among Mexican adolescents, 12.1% and 6.2% among Egyptian adolescents [7], 15.9% and 18.4% among Bahraini adolescents [8] respectively. The prevalence of overweight ranged from 10.3% to 12.0% and obesity from 1.6% to 3.6% among Turkish adolescents [9-12]. Although obesity is a prevalent disorder, its social determinants and psychosocial consequences have not yet been fully understood, because obesity is a heterogeneous disorder of multiple aetiology [13]. Adolescence is a critical developmental phase characterised by dramatic physical and psychological changes. Physical changes and appearance are important preoccupations of adolescents, and for this reason obesity may predispose them to mental health consequences. But there is no consistent finding in the literature concerning the relationship between obesity, mental health and psychopathology [14,15]. The relationship between self-esteem and obesity was unclear whether selfesteem was consistently related to obesity [15]. In general, clinic-based studies have found a relationship between overweight and depression more often than have population-based studies [8,16]. In addition, it is not fully known if certain variables such as demographic variables, physical appearance, body satisfaction and self image have an effect on overweight or not. Perceived overweight adolescents were more likely to experience anxiety and depression than perceived normal and underweight adolescents [17]. On the other hand, many overweight adolescents are socially marginalized. Dissatisfaction with body and discrimination may aggravate the social and emotional consequences of overweight in this age group [18]. Although adolescent obesity is a prevalent disorder all over the world, there are only a few studies which have examined the prevalence of adolescent overweight and its psychological consequences in Turkey. The purpose of this study was to determine the prevalence of obesity and to examine the effects of actual weight status, perceived weight status and body satisfaction on selfesteem and depression in a high school population in Turkey. Materials and Methods