Adolescent girls who view themselves as unpopular have a higher risk of gaining weight in subsequent years, researchers have found.
The study asked more than 4,400 girls aged 12 to 18 how they viewed their status on the social ladder, from a scale of 1 to 10. Two years later, researchers compared the weight gained by those who ranked themselves as a 5 or higher, compared with the weight gained by those who ranked themselves 4 or lower.
Those who perceived themselves as unpopular were 69 percent more likely to gain two points on the body mass index scale in the two years that followed the questionnaire.
Lead study author Adina Lemeshow, project analyst for the New York City Department of Health, actually completed the study when she was a graduate student at the Harvard School of Public Health. The study was published in the journal Archives of Pediatrics & Adolescent Medicine
The study adds to past evidence that social and emotional factors -- including depression and low self-esteem -- are important contributors to obesity in adolescents. But it also takes these findings one step further by demonstrating that for many girls, feelings of social inadequacy precede weight gain.
"Ours is the first study to look at this data prospectively," Lemeshow says. "One question which had always come up was whether it wasn't the other way around -- in other words, how BMI would cause a lower social standing."
Childhood obesity experts who were not affiliated with the research agreed that the study gives a clearer picture of how emotional and social factors could contribute to risk of overweight and obesity.
"Previous studies have been 'snapshots' of children with low self-esteem, which found that they are more likely to be overweight," says Dr. Goutham Rao, clinical director of the Weight Management and Wellness Center at the Children's Hospital of Pittsburgh. "This study tells us that low self-esteem, in the form of low-perceived social status, precedes weight gain."
But some health experts point out that though the study findings are intriguing, more information is needed before it can be said for sure whether low social standing leads to weight gain.
"Do adolescents become obese because they are not popular, or do they become less popular as they gain weight?" asks Judith Myers-Walls, associate professor and extension specialist at Purdue University's department of child development and family studies. "It is likely that there is a cycle and that both things are happening. A much more detailed study would need to be conducted to explore what happens in the minds and bodies of the young women."
Making Weight Control a Priority
But while the study sheds light on social standing and weight gain in girls, the findings raise the natural question: Why might this be happening?
The answer may lie in the possibility that girls who don't enjoy popularity among their peers may feel they cannot reap significant rewards from maintaining a healthy weight.
"The most obvious connection that struck me was that girls with lower self-esteem do not believe they can benefit much from maintaining a socially acceptable appearance -- in other words, being slim," Rao says. "Therefore, they may invest less time and energy in good nutrition and physical activity, and gain more weight as a consequence.
"Slimness has an enormous social value among girls. If a girl doesn't value herself to begin with, being slim is unlikely to be a priority."
But recent figures suggest weight control should be a priority in this group. According to a separate study published in the Journal of the American Medical Association in 2006, the number of overweight girls in the United States increased from 14 to 16 percent between 1999 and 2004. And a 2005 study in the journal Pediatrics showed that the weight problems in children cost the United States about $127 million -- three times more than 20 years ago.
So what can be done? Myers-Walls says that one possible implication of the study is that parents and others may be able to help improve the health of young women by helping them find accepting and supportive social environments.
"Girls who do not fit the standards of beauty in any area, including height, skin condition, attractiveness or weight, may have difficulty with finding friends and feeling comfortable among peers," she says. "Adults can help to locate and encourage those environments, and they also can help nonobese adolescents learn to look beyond the surface-level characteristics."
Opening Doors to Further Research
Lemeshow says that while her research does lead to a greater understanding of the social and emotional factors that may contribute to weight gain in adolescent girls, more research is needed before researchers can say for sure that, for girls, being unpopular can directly cause weight gain.
But the research suggests that health professionals working with adolescent girls may have a new direction for helping them maintain a healthy weight.
"While diet and exercise are very important contributors to a healthy weight, how girls feel about themselves should be a part of all of these preventive strategies," Lemeshow says.
Rao agrees. "This study is very important and does provide considerable support for the idea that lower social status negatively influences future health," he says. "After all, obesity itself is related to high cholesterol, high blood pressure, diabetes and heart disease in later life.
"Reaching out to children with low self-esteem to determine why their self-perceived social status is low -- and how it can be improved -- would be a good investment to improve their future health."