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Self‑esteem and weight status of
young adults: Findings from a pilot
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study
Echu Liu, Su‑Hsin Chang1
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Website:
www.jehp.net
Abstract:
DOI:
10.4103/jehp.jehp_1195_21 BACKGROUND: Researchers have examined the association between self‑esteem and obesity in
past studies. However, most studies have focused on pediatric or adolescent populations. In this
pilot study, we aim to explore the association of self‑esteem with weight status in young adults, a
group of individuals in a significant and pivotal period of their lives whose needs and challenges
have received little attention in previous studies.
MATERIALS AND METHODS: Exactly 127 college juniors and seniors in the Midwest participated
in late 2017. For our survey, we collected the following information: body weight, height, self‑esteem
score from the state self‑esteem scale, grade point average, risk of eating disorders, sleep quality,
nutritional behavior, lifestyle (smoking, frequency of exercise, alcohol drinking, average daily time
watching television, playing video games, and social media use), and demographic and socioeconomic
background. We used logistic regression for our analysis.
RESULTS: The logistic regression indicates that a one‑point increase in the self‑esteem
score was negatively associated with a young adult’s odds of having an unhealthy weight
(being overweight or obese) by approximately 3%. Furthermore, soda drinking is a statistically
significant factor associated with weight status.
CONCLUSIONS: This finding suggests self‑esteem is positively associated with a healthy weight
in young adults. A larger‑scale study should be conducted in the future to validate this relationship
and better understand young adults’ needs.
Keywords:
Humans, pilot projects, self‑concept, young adult

Introduction experience self‑awareness as painful.[3] If

eating becomes their channel for reducing
Department of Health
Management and Policy,
Saint Louis University, T he association between self‑esteem
and body weight has drawn the
attention of researchers in the health,
painful self‑awareness, it may negatively
impact their weight status. Some studies
have shown that self‑esteem is an excellent
Saint Louis, Missouri,
USA, 1Department of psychological, and psychiatric fields. predictor of eating disorders;[4] therefore, it
Surgery, Division of We can explain the association in two is reasonable to hypothesize that self‑esteem
Public Health Sciences, ways. First, an individual with unhealthy is an essential predictor of an individual’s
Washington University weight generally prompts stereotyped and likelihood of having an unhealthy weight.
School of Medicine, Saint
stigmatizing beliefs from others, leading
Louis, Missouri, USA Most studies on self‑esteem and body
them to act in prejudicial and discriminatory
Address for practices.[1,2] Such discriminatory behaviors weight have focused on pediatric
correspondence: affect how individuals feel about themselves populations, and their findings are mixed.
Prof. Echu Liu, Ph.D. and negatively impact self‑esteem. Second, Some reported lower self‑esteem among
Department of Health obese children.[5] However, others found no
people with low self‑esteem commonly
Management and Policy,
Saint Louis University,
significant association between self‑esteem
This is an open access journal, and articles are and childhood obesity. [6] Some studies
Saint Louis, Missouri distributed under the terms of the Creative Commons
63104, USA. Attribution‑NonCommercial‑ShareAlike 4.0 License, which
E‑mail: [email protected] allows others to remix, tweak, and build upon the work
non‑commercially, as long as appropriate credit is given and How to cite this article: Liu E, Chang SH. Self-esteem
Received: 12‑08‑2021 and weight status of young adults: Findings from a pilot
the new creations are licensed under the identical terms.
Accepted: 29‑12‑2021 study. J Edu Health Promot 2022;11:263.
Published: 25-08-2022 For reprints contact: [email protected]

© 2022 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow 1
 Liu and Chang: Self‑esteem and weight status

have shown that obesity is independent of self‑esteem Study participants and sampling
in adolescents. [7] Nevertheless, other studies have Our survey participants were juniors and seniors
revealed that obesity negatively impacts adolescents’ studying at this university in a Midwest urban area of the
self‑esteem.[8,9] United States. The survey has a two‑step process. A short
web‑based survey was sent to all juniors and seniors to
The association between self‑esteem with weight status solicit their willingness to participate in the study on
in the young adult population is understudied. Young November 27, 2017. By the end of November 29, 2017,
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adulthood, which generally refers to 18–26, is a period of 762 students consented to participate in the study. Due to
heightened psychological vulnerability, potentially due the funding limit, we sent a full version of the web‑based
to challenges associated with the new responsibilities and survey consisting of 102 questions to 127 randomly
obligations that young adults are expected to take on selected students from these 762 consenting students
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and fulfill.[10] However, researchers have seldom treated on November 30, 2017. All these 127 selected students
young adults as a distinct population.[10] Moreover, completed the survey on December 9, 2017, and each
young adults are more likely to develop preventable was aware that they would receive a $10 Amazon gift
illnesses, including obesity, than older adults and card in advance of completing the study.
adolescents.[10] Therefore, the psychological dimensions,
such as self‑esteem, related to young adults’ weight Data collection tool and technique
status is worth exploring. The survey was distributed through Qualtrics, a
simple but powerful web‑based survey tool to conduct
Among the minimal studies targeting this population, research, evaluations, and other data collection
Singleton et al. surveyed 49 college students between activities. Our survey contained questions intended
the ages of 20 and 39 at a historically Black southern to collect data on self‑esteem scores as measured
university in the United States. They found no association by the state self‑esteem scale (SSES),[14] body height
between self‑esteem and body mass index (BMI).[11] and weight, and individual characteristics [Table 1],
Sanlier et al. analyzed data from a survey of 503 college including age, grade point average (GPA), risk of
students aged 18–23 in Turkey, finding no association an eating disorder (measured by eating attitudes
between self‑esteem and BMI.[12] This finding is consistent test (EAT‑26) scores), sleep quality (measured with the
with the study Herbozo et al. conducted.[13] They analyzed Pittsburgh sleep quality index), gender, race/ethnicity
data from 194 overweight or obese female undergraduate (nonHispanic Caucasian, African American, Hispanic or
students between 18 and 30 years old in the United States. Spanish/Latino, and Asian), employment status, marital
status, nutritional behavior (frequency of skipping meals,
The results of these studies were subject to one of consumption of fast food, rate of drinking soda, amount
the following two methodological limitations. First, of fruits and vegetables consumed, and amount of bread
the researchers used only correlation analysis,[11,13] or grains consumed), frequency of exercise, frequency
or unadjusted analyses to examine differences in of drinking alcohol, number of cigarettes smoked,
self‑esteem across BMIs.[12] Second, they focused on average time watching television every day, average time
only one gender.[13] Therefore, the association between playing video games every day, average time on social
self‑esteem and weight status among young adults media every day, parent’s educational attainment, and
requires better elucidation because of these limitations household income.
in the literature. We conducted a pilot study to survey
juniors and seniors at a university in the Midwest urban After every participant completed the survey, their BMIs
area of the United States to fill this gap. In this study, are calculated as self‑reported weight in pounds divided
we aim to analyze more comprehensive data collected by height in inches for each survey participant. Afterward,
from this survey and examine empirical evidence of the we categorized their BMIs as underweight (BMI <18.5),
association between self‑esteem and unhealthy weight healthy weight (BMI 18.5–24.9), overweight (BMI 25–29.9),
among young adults using a more robust method. or obese (BMI ≥30) based on the standards of the World
Health Organization.[15] We then defined the outcome
Materials and Methods variable as a dichotomous variable indicating unhealthy
weight (overweight or obese). In addition, participants’
Study design and setting self‑esteem was measured using the score from the SSES,
As mentioned previously, a survey was conducted on a a multidimensional scale that includes three facets of an
university campus in the urban Midwest of the United individual’s self‑esteem: performance, social comfort, and
States to collect data for this study. Before the survey appearance.[14] Since the SSES questionnaire consists of
was conducted, it was approved by this university’s 20 items with scores ranging from 1 to 5, the scale score
institutional review board (IRB). All survey responses ranges from 5 to 100. This approach was proposed and
are anonymous. validated by Heatherton and Polivy.[14]
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 Liu and Chang: Self‑esteem and weight status

Table 1: Demographics and characteristics of the Table 1: Contd...

survey participants Variables n (%)
Variables n (%) Associate degree 6 (4.72)
Weight status Four‑year college graduate 37 (29.13)
Healthy weight 95 (74.80) Master’s degree 31 (24.41)
Unhealthy weight (overweight or obese) 32 (25.20) Professional degree (for example, MD, DDS, DVM, 15 (11.81)
Self‑esteem score, mean (SD) 67.77 (15.28) LLB, JD)
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Age, years Doctorate degree (for example, PhD, EdD) 3 (2.36)

19 5 (3.94) Mother’s educational attainment
20 42 (33.07) Eighth grade or less 1 (0.79)
21 53 (41.73) High school graduate, diploma, or the equivalent 10 (7.87)
Some college credit, no degree 13 (10.24)
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22 18 (14.17)
23 6 (4.72) Trade/technical/vocational training 3 (2.36)
24 1 (0.79) Associate degree 10 (7.87)
26 1 (0.79) Four years college graduate 46 (36.22)
30 1 (0.79) Master’s degree 33 (25.98)
GPA Professional degree (for example, MD, DDS, DVM, 7 (5.51)
<3.0 10 (7.87) LLB, JD)
Between 3.0 and 3.5 41 (32.28) Doctorate degree (for example, PhD, EdD) 4 (3.15)
>3.5 76 (59.84) EAT‑26 score, mean (SD) 9.51 (7.32)
Gender Having a low‑quality sleep in the past month (PSQI 88 (69.29)
score≥5)
Male 28 (22.05)
Number of times skipping breakfast last week
Female 96 (75.59)
0 51 (40.16)
Other 3 (2.36)
1 12 (9.45)
Race
2 15 (11.81)
Non‑Hispanic White 97 (76.38)
3 12 (9.45)
Black or African American 1 (0.79)
>3 37 (29.13)
Hispanic or Spanish/Latino 3 (2.36)
Number of times skipping lunch last week
Asian 26 (20.47)
0 60 (47.24)
Marital status
1 27 (21.26)
Single, never married 125 (98.43)
2 22 (17.32)
Married 1 (0.79)
3 11 (8.66)
Other 1 (0.79)
>3 7 (5.51)
Employment status
Number of times skipping dinner last week
Employed full‑time 4 (3.15)
0 93 (73.23)
Employed part‑time 83 (65.35)
1 16 (12.60)
Not employed but looking for work or awaiting recall 7 (5.51)
2 10 (7.87)
Not employed and not looking for work or awaiting 21 (16.54)
recall 3 3 (2.36)
Other 12 (9.45) >3 5 (3.94)
Household income ($) Number of times eating fast food last week
<10,000 2 (1.57) 0 42 (33.07)
10,000-19,999 0 (0.00) 1 42 (33.07)
20,000-29,999 2 (1.57) 2 20 (15.75)
30,000-39,999 7 (5.51) 3 13 (10.24)
40,000-49,999 6 (4.72) >3 10 (7.87)
50,000-59,999 7 (5.51) Number of sodas consumed last week
60,000-69,999 6 (4.72) 0 79 (62.20)
70,000-79,999 4 (3.15) 1 26 (20.47)
80,000-89,999 11 (8.66) 2 7 (5.51)
90,000-99,999 6 (4.72) 3 8 (6.30)
100,000-149,999 37 (29.13) >3 7 (5.51)
>150,000 39 (30.17) Number of cigarettes smoked last week
Father’s educational attainment 0 122 (96.06)
High school graduate or the equivalent 11 (8.66) 1-10 3 (2.36)
Some college credit, no degree 15 (11.81) 11-20 1 (0.79)
Trade/technical/vocational training 9 (7.09) ≥21 1 (0.79)

Contd... Contd...
Journal of Education and Health Promotion | Volume 11 | August 2022 3
 Liu and Chang: Self‑esteem and weight status

Table 1: Contd... the student had fast food in the past week, whether the
Variables n (%) student had soda in the past week, whether the student
On average, I ate at least five portions of fruits and 46 (36.22) ate at least five portions of fruit and vegetables on
vegetables a day in the past week average every day during the past week, whether the
Number of days eating bread or grains in the past
student performed exercise for at least 30 min and at
week
least three times in the past week, whether the student
0 4 (3.15)
used social media on average at least 2 h every day
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1 4 (3.15)
2 13 (10.24) during the past week, and whether the student’s father
3 23 (18.11) has a college degree or higher. All tests were two‑sided,
>3 83 (65.35) and we considered a P < 5% statistically significant. We
Number of days doing exercise for at least 30 min in performed all statistical analyses using STATA 15.
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the past week

0 32 (25.20) Ethical consideration
1 22 (17.32) As mentioned earlier, this study received approval from
2 17 (13.39) the university’s IRB. At the time of recruitment, this
3 14 (11.02) study’s protocols, procedures, duration, and benefits
>3 42 (33.07) were explained to all potential survey participants. The
Number of times having alcoholic drinks in the past approval document was available upon request.
week
0 55 (43.31)
Results
1 31 (24.41)
2 22 (17.32)
Of the 127 randomly selected participants [Table 1],
3 6 (4.72)
the majority were female (75.59%), nonHispanic
>3 13 (10.24)
whites (76.38%), single (98.43%), reportedly between
The average amount of time spent watching
television every day (h) 20 and 22 years old (20 years: 33.07%; 21 years: 41.73%;
0 21 (16.54) 22 years: 14.17%), reported a GPA >3.5 (59.84%) and had
<1 43 (33.86) part‑time jobs (65.35%). In addition, approximately 69%
1-<2 38 (29.92) of respondents reported problems with sleep quality.
2-<3 14 (11.02) Moreover, only about 36% of the participants ate, on
≥3 11 (8.66) average, at least five portions of fruits and vegetables
The average amount of time spent on video games per day in a week, and about 42% reported spending on
every day (h) average at least 2 h on social media every day in a week.
0 95 (74.80) Most of the participants were nonsmokers (96.06%)
<1 13 (10.24)
and exercised for at least 30 min at least one day a
1-2 13 (10.24)
week (1 day: 17.32%, 2 days: 13.39%, 3 days: 11.02%,
>2 6 (4.72)
>3 days: 33.07%). Approximately 50% of the participants
The average amount of time spent on social media,
such as Facebook or Twitter, every day (h) spent more than one‑hour watching television on
0 9 (7.09) average every day. A high percentage of participants ate
<1 27 (21.26) fast food and consumed alcoholic drinks at least once a
1-2 38 (29.92) week. The participants’ average self‑esteem score was
2-3 31 (24.41) 67.77 (standard deviation [SD] = 15.28), and the average
≥3 22 (17.32) EAT‑26 score was 9.51 (SD = 7.32). Approximately
GPA=Grade point average, SD=Standard deviation, EAT=Eating Attitudes 25% of the participants had an unhealthy weight
Test, PSQI=Pittsburgh Sleep Quality Index
(were overweight or obese).

We performed a logistic regression to find the association As Table 2 shows, self‑esteem was negatively associated
between self‑esteem and weight status among our study with unhealthy weight. With a one‑point increase
participants. Following the suggestion of Garrett,[16] we in the self‑esteem score, the odds of having an
used a bootstrap stepwise (SWBOOT) method to select unhealthy weight decreased by roughly 3%, holding
the independent variables, which we defined based on other factors constant (odds ratio [OR] = 0.97, 95%
the demographic and personal characteristics variables confidence interval [CI]: 0.94–1.00). Moreover, skipping
reported in Table 1 for inclusion in the logistic regression dinner (OR = 2.86, 95% CI: 1.12–7.31), having five or more
model. In the end, independent variables we considered portions of fruits and vegetables daily (OR = 2.46, 95%
appropriate for inclusion using the SWBOOT method CI: 0.96–6.31), and doing exercise for at least 30 min at
were the EAT‑26 score, the self‑esteem score, whether the least three times in the past week (OR = 2.15, 95% CI:
student had skipped dinner in the past week, whether 0.82–5.63) increased the participants’ odds of having
4 Journal of Education and Health Promotion | Volume 11 | August 2022
 Liu and Chang: Self‑esteem and weight status

Table 2: Estimated odds ratios and 95% confidence To better understand the psychological dimension of
intervals from the logistic regression health for young adults, we conducted a pilot study to
Variables OR 95% CI collect data and examine the relationship between young
EAT‑26 score 1.01 0.95-1.07 adults’ self‑esteem and weight status. Our results indicate
Self‑esteem score 0.97 0.94-1.00 that higher self‑esteem is associated with lower odds of
Skipping dinner in the past 2.74 0.95-7.89 an unhealthy weight. This finding is very different from
week (= 1 if yes; = 0 otherwise)
the null findings in the limited literature,[11‑13] in which
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Eating fast food in the past 1.07 0.38-3.00

week (=1 if yes; =0 otherwise) the researchers found no association between self‑esteem
Drinking soda in the past 4.05 1.41-11.67 and BMI. As we discussed previously, in these past
week (=1 if yes; =0 if no) studies, researchers used correlation or unadjusted
On average, I ate at least five portions of fruits 2.46 0.96-6.31 analysis only, and our sample’s composition differs from
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and vegetables every day during the past theirs. Moreover, outcome measures in the literature are
week (=1 if yes; =0 otherwise)
BMI, not weight status.
Doing exercise for at least 30 minutes at least 2.15 0.82-5.63
three times in the past week (=1 if yes; =0 if no)
We also found that the risk of an eating disorder, which
On average, I used social media for at 1.20 0.47-3.07
least two hours every day in the past we measured as the EAT‑26 score, is positively but
week (=1 if yes; =0 if no) insignificantly associated with young adults’ odds of
Father has a college degree or 1.02 0.35-2.94 having an abnormal weight status. This insignificance
higher (=1 if yes; =0 if no) seems counterintuitive and differs from findings in the
Constant 1.56 0.16-15.03 literature.[17] This lack of significant association between
EAT=Eating Attitudes Test, OR=Odds ratio, CI=Confidence interval
the risk of an eating disorder and weight status is
potentially due to the smaller survey size. Yamamoto
an unhealthy weight when all other variables were et al. found that skipping dinner is the most potent
equal. However, the OR estimates of these variables are predictor of weight gain and subsequent development
statistically insignificant. Table 2 also shows that [insert of obesity because it may increase calorie intake the next
Table 2 here] the EAT‑26 score (OR = 1.01, 95% CI: day.[18] This conclusion is somewhat consistent with what
0.95–1.07) and whether a respondent’s father has a we found in this study: skipping dinner is associated with
college degree or higher (OR = 1.02, 95% CI: 0.35–2.94) the odds of having unhealthy weight for the students we
are not significant predictors of our sample’s weight surveyed but in a statistically insignificant way. Past
status although SWBOOT indicated that we should studies have shown that drinking soda increases the
include these two variables in the logistic regression. The likelihood of becoming overweight or obese because of
OR estimate on the variable “using social media for, on soda’s high added‑sugar content.[19] The significant and
average, at least two hours per day in the past week” in positive association between drinking soda and the odds
Table 2 demonstrates that comparatively heavy users of of having an unhealthy weight in this study is consistent
social media are 20% more likely to have an unhealthy with evidence from the literature.
weight (OR = 1.20, 95% CI: 0.47–3.07) on average, holding
all else constant. However, this OR estimate is statistically Our study shows a positive but insignificant association
insignificant. We found drinking soda, on average, between eating fast food and the odds of having an
to be significantly associated with our participants’ unhealthy weight. This insignificance may also be due
odds of having an unhealthy weight (OR = 4.05, 95% to our survey’s smaller scale. Past studies also showed
CI: 1.41–11.67), holding all else constant. that a generous intake of vegetables and fruits might help
weight management because they are low in calories but
Discussion high in fiber and water to generate a satiating effect.[20]
However, the impact of increasing fruit and vegetable
Young adulthood is a critical development period, as consumption on weight control may become small
it bridges adolescence and independent adulthood.[10] and insignificant if the energy from other food is not
An individual’s experiences and accomplishments in well‑controlled.[21] Adherence to a healthy diet is also
this period play a crucial role in determining the route significantly related to social‑economic factors, such as
of their adult life. Compared to previous generations, family income,[22] and personal characteristics, such as
today’s young adults face more challenges stemming degree of control over decisions and actions affecting
from diverse and dynamically changing environments. health. [23] Among our 46 survey respondents who
Their physical and mental health should be areas of reported eating at least five portions of vegetables and
concern, as they are under increased social pressure. fruits on an average a day, most of them (29; 63.04%) ate
However, researchers have rarely studied young adults fast food at least once a week. This high percentage may
as a separate population. Instead, they are often grouped undermine the benefits of a healthy diet and explain the
with adolescents or with all adults.[10] counterintuitive positive but insignificant association
Journal of Education and Health Promotion | Volume 11 | August 2022 5
 Liu and Chang: Self‑esteem and weight status

between having at least five portions of vegetables and these dimensions) and participants’ privacy, we did not
fruits a day and the odds of having unhealthy weight include inquiries related to depression, genetics, illness,
reported in Table 2. It is common knowledge that or environment in the questionnaire. The exclusion
doing regular exercise helps maintain healthy weight of variables related to these dimensions may limit the
status. However, vigorous exercise can also increase a power of our analysis. Still, our findings can serve
person’s appetite.[24] Therefore, the benefit of exercising as a basis for implementing a more comprehensive,
in maintaining or enhancing weight status can be highly larger‑scale study in the future and help policymakers
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individual.[25] The positive but statistically insignificant design effective interventions to alleviate low self‑esteem
association between exercising for at least 30 min three in younger adults and improve their health. Finally,
times per week and unhealthy weight status reported in this is a smaller scale and cross‑sectional study of
this study needs more research. college students. Although it is based on a survey that
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includes many lifestyles and critical predictors of young

Naess et al. found that mothers, not fathers, play a critical adult’s weight status that relevant literature did not
role in children’s BMI.[26] This finding is possibly due to consider, it would be interesting to conduct a similar but
an important fact: mothers are still considered children’s larger‑scale panel study that includes more age cohorts,
primary caregivers, although children are largely more such as those who are between 22 and 26, to allow for
independent and involved in modern society. Therefore, more variations in data and the control of individuals’
a mother’s influence on children’s physical health unobservable characteristics to examine the causation
development is more significant than her spouse’s. As a between self‑esteem and weight status.
result, it is not highly surprising to see only a marginal
association between a father’s education and a student’s Conclusions
odds of having an unhealthy weight from our analysis
even though SWBOOT suggested the inclusion of this This study demonstrates that low self‑esteem is
variable in the logistic regression. A cross‑sectional study associated with increased odds of having an unhealthy
by Alley et al. showed social media was not associated weight among young adults, highlighting the strong
with BMI.[27] This finding is consistent with our analysis relationship between self‑esteem and health in this
reports: using more social media may be positively population. Prospective studies are necessary to
related to the odds of having an unhealthy weight, but determine whether this relationship is causal to inform
this association is not statistically significant. A possible future interventions and improve this population’s
explanation for this lack of association is that although mental and physical health.
social media increases sitting time, it may educate people
on the importance of a healthy diet and exercise. [27] Acknowledgment
Therefore, the connection between social media use and The valuable comments and suggestions from the
weight cannot develop in the literature or this study. anonymous reviewers and editor are much appreciated.
IRB’s assistance to ensure that appropriate steps are taken
Limitation and recommendation to protect the rights and welfare of humans participating
This study had several limitations. First, due to the lack of as subjects in our study is also deeply appreciated.
information on our study population’s likely proportion
of unhealthy weight, we did not estimate the appropriate Financial support and sponsorship
sample size following a conventional approach in the This study is supported by the Spark Microgrant of the
literature before the survey started.[28] Consequently, corresponding author’s affiliation.
we only surveyed the number of students for which our
funding budget allowed. Therefore, the power of our Conflicts of interest
analysis may not be as strong as that of any larger‑scale There are no conflicts of interest.
study, given the nature of a pilot study with a relatively
small sample size. Second, participants self‑reported References
weight and height in this study, which may have been
1. Stunkard AJ, Wadden TA. Psychological aspects of severe obesity.
subject to some bias. Third, low self‑esteem is often Am J Clin Nutr 1990;55:524S‑32S.
associated with depression, and depression potentially 2. Wadden TA, Stunkard AJ. Social and psychological consequences
affects weight status.[29,30] Therefore, depression seems of obesity. Ann Intern Med 1985;103:1062‑7.
an important confounding factor that must be controlled 3. Heatherton TF, Baumeister RF. Binge eating as escape from
when estimating the association between self‑esteem and self‑awareness. Psychol Bull 1991;110:86‑108.
weight status. Genetic factors, environmental factors, 4. Kelly AC, Vimalakanthan K, Carter JC. Understanding the roles
of self‑esteem, self‑compassion, and fear of self‑compassion in
and diseases are also critical determinants of weight eating disorder pathology: An examination of female students
status. However, due to concerns regarding the survey’s and eating disorder patients. Eat Behav 2014;15:388‑91.
length (102 items in total without questions related to 5. Griffiths LJ, Parsons TJ, Hill AJ. Self‑esteem and quality of life in

6 Journal of Education and Health Promotion | Volume 11 | August 2022

 Liu and Chang: Self‑esteem and weight status

obese children and adolescents: A systematic review. Int J Pediatr 18. Yamamoto R, Tomi R, Shinzawa M, Yoshimura R, Ozaki S,
Obes 2010;5:282‑304. Nakanishi K, et al. Associations of skipping breakfast, lunch,
6. Hill AJ. Obesity in children and the ‘myth of psychological and dinner with weight gain and overweight/obesity in
maladjustment’: Self‑esteem in the spotlight. Curr Obes Rep university students: A retrospective cohort study. Nutrients
2017;6:63‑70. 2021;13:271.
7. Meland E, Breidablik HJ, Thuen F, Samdel GB. How body 19. Malik VS, Schulze MB, Hu, FB. Intake of sugar‑sweetened
concerns, body mass, self‑rated health, and self‑esteem are beverages and weight gain: A systematic review. Am J Clin Nutr
mutually impacted in early adolescence: A longitudinal cohort 2006;84:274‑88.
Downloaded from http://journals.lww.com/jehp by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

study. BMC Pubic Health 2021;21:496. 20. Nour M, Lutze SA, Grech A, Allman‑Farinelli M. The relationship
8. McClure AC, Tanski SE, Kingsbury J, Gerrard M, Sargent JD. between vegetable intake and weight outcomes: A systematic
Characteristics associated with low self‑esteem among US review of cohort studies. Nutrients 2018;10:1626.
adolescents. Acad Pediatr 2010;10:238‑ 44.e2. 21. Kaiser KA, Brown AW, Bohan Brown MM, Shikany JM,
9. Radziwillowicz W, Macias M. Self‑esteem, and achievement Mattes RD, Allison DB. Increased fruit and vegetable intake has
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 09/15/2024

motivation level in overweight and obese adolescents. Health no discernible effect on weight loss: A systematic review and
Psychol Rep 2014;2:132‑43. meta‑analysis. Am J Clin Nutr 2014;100:567‑76.
10. Committee on Improving the Health, Safety, and Well‑Being of 22. Mohebbi B, Tafaghodi B, Sadeghi R, Tol A, Yekanenejad MS.
Young Adults; Board on Children, Youth, and Families; Institute Factors predicting nutritional knowledge, illness perceptions,
of Medicine; National Research Council. Investing in the health and dietary adherence among hypertensive middle‑aged women:
and well‑being of young adults. In Bonnie RJ, Stroud C, Breiner H, Application of transtheoretical model. J Educ Health Promot
editors. Investing in the Health and Well‑Being of Young Adults. 2021;10:212.
Washington (DC): National Academies Press (US); 2015. Available 23. Sabouri M, Shakibazadeh E, Mohebbi B, Tol A, Yaseri M, Babaee S.
from: https://www.ncbi.nlm.nih.gov/books/NBK284787/. [doi: Effectiveness of an educational intervention using theory of
10.17226/18869] [Last accessed on 2021 Dec 01]. planned behavior on health care empowerment among married
11. Singleton EK, Bienemy C, Hutchinson SW, Dellinger A, Rami JS. reproductive‑age women: A randomized controlled trial. J Educ
A pilot study: A descriptive correlational study of factors Health Promot 2020;9:293.
associated with weight in college nursing students. ABNF J 24. Barutcu A, Taylor S, McLeod CJ, Witcomb GL, James, LJ. Planned
2011;22:89‑95. aerobic exercise increases energy intake at the preceding meal.
12. Sanlier N, Biyikli AE, Biyikli ET. Evaluating the relationship of Med Sci Sports Exerc 2018;52:968‑75.
eating behaviors of university students with body mass index 25. West, H. Does Exercise Help You Lose Weight? The Surprising
and self‑esteem. Ecol Food Nutr 2015;54:175‑85. Truth; 2021. Available from: https://www.healthline.com/
13. Herbozo S, Schaefer LM, Thompson JK. A comparison of nutrition/does‑exercise‑cause‑weight‑loss. [Last accessed on
eating disorder psychopathology, appearance satisfaction, and 2021 Nov 15].
self‑esteem in overweight and obese women with and without 26. Naess M, Sund ER, Holman TL, KvalØy K. Implications of
binge eating. Eat Behav 2015;17:86‑9. parental lifestyle changes and education level on adolescent
14. Heatherton TF, Polivy J. Development and validation of a scale offspring weight: A population‑based cohort study‑The HUNT
for measuring state self‑esteem. J Per Soc Psychol 1991;60:895‑910. study, Norway. BMJ Open 2018;8:E023406.
15. World Health Organization. Obesity: Preventing and Managing 27. Alley S, Wellens P, Schoeppe S, de Vries H, Rebar AL, Short CE,
the Global Epidemic: Report of a WHO Consultation. World et al. Impact of increasing social media uses on sitting time and
Health Organization; 2000. Available from: https://apps.who. body mass index. Health Promot J Austr 2017;28:91‑5.
int/iris/handle/10665/42330. [Last accessed on 2022 Feb 24]. 28. Charan J, Biswas T. How to calculate sample size for different
16. Garrett JM. SWBOOT: Stata Module to Bootstrap Stepwise Linear study designs in medical research? Indian J Psychol Med
or Logistic Regression Models. Statistical Software Components 2013;35:121‑6.
S415601, Boston College Department of Economics; 2000. 29. Sowislo JF, Orth U. Does low self‑esteem predict depression and
Available from: https://ideas.repec.org/c/boc/bocode/s415601. anxiety? A meta‑analysis of longitudinal studies. Psychol Bull
html. [Last accessed on 2021 Nov 15]. 2013;139:213‑40.
17. Abdalla MM, Alsadi NA, Azman AH, Thivakaran, AQ, Vin HS, 30. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P,
Karunakaran K, et al. The association between abnormal eating Penninx BW, et al. Overweight, obesity, and depression:
behaviors, body mass index, and waist‑to‑height ratio among A systematic review and meta‑analysis of longitudinal studies.
university students in Malaysia. US Endocrinol 2020;16:69‑73. Arch Gen Psychiatry 2010;67:220‑9.

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