High adiposity is associated cross-sectionally with low self-concept and body size dissatisfaction among indigenous Cree schoolchildren in Canada

BACKGROUND Obesity and mental health problems are prevalent among indigenous children in Canada and the United States. In this cross-sectional study the associations between adiposity and body size satisfaction, body image and self-concept were examined in indigenous children in grades four to six living in Cree communities in the Province of Quebec (Canada). METHODS Weight status and body mass index (BMI) z-scores were derived from children's measured height and weight using the World Health Organization growth reference. Multivariate regression models that included child's age and sex were used to assess the association between (a) weight status and physical appearance satisfaction using pictorial and verbal body rating measures in 202 of 263 children, and (b) BMI z-score and self-concept measured using the Piers-Harris Children's Self-Concept Scale in a subset of 78 children. RESULTS Children (10.67 ± 0.98 years) were predominantly overweight (28.2%) or obese (45.0%). Many (40.0%) children had low global self-concept indicating that they had serious doubts about their self-worth and lacked confidence. About one-third (34.7%) of children did not like the way they looked and 46.3% scored low on the physical appearance and attributes domain of self-concept indicating poor self-esteem in relation to their body image and physical strength, feeling unattractive, or being bothered by specific aspects of their physical appearance. Compared to normal weight children, overweight and obese children were more likely to desire being smaller (OR=4.3 and 19.8, respectively), say their body size was too big (OR=7.7 and 30.6, respectively) and not liking the way they looked (OR=2.4 and 7.8, respectively). Higher BMI z-score was associated with lower scores for global self-concept (β=-1.3), intellectual and school status (β=-1.5) and physical appearance and attributes (β=-1.3) indicating negative self-evaluations in these areas. Despite comparable weight status to boys, girls were more likely to have lower scores for global self-concept (β=-3.8), physical appearance and attributes (β=-4.2), desiring to be smaller (OR=4.3) and not liking the way they looked (OR=2.3). CONCLUSIONS The psychosocial correlates of obesity are important considerations for indigenous children, particularly girls, given that poor self-concept and body size dissatisfaction negatively impact mental and emotional qualities of life.