ORIGINAL ARTICLE Why do some overweight children experience psychological problems? The role of weight and shape concern KARINA L. ALLEN 1 , SUSAN M. BYRNE 1,2 , EVE M. BLAIR 2 & ELIZABETH A. DAVIS 3,2 1 School of Psychology, The University of Western Australia, Crawley, Australia, 2 Telethon Institute for Child Health Research, Subiaco, Australia, 3 Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Subiaco, Australia Abstract Objective. To examine the associations between weight status, weight and shape concern, self-esteem, body dissatisfaction and depression in children. Methods. Interviews were conducted with 7- to 13-year-old overweight (n  /89) and healthy weight (n  /118) children, using the Child Eating Disorder Examination, Self-Perception Profile for Children, Children’s Body Image Scale and Child Depression Inventory. Results. Overweight children were more concerned about weight and shape than healthy weight children. After controlling for BMI z-score, children with high weight and shape concern reported lower self-esteem, higher body dissatisfaction and higher depression than children with low weight and shape concern. Concern about weight and shape mediated the relationships between BMI z-score and low self-esteem, body dissatisfaction and depression. Conclusions. Results support the hypothesis that differences in weight and shape concern, within samples of overweight and healthy weight children, can account for differences in degree of psychological distress. Findings have implications for the prevention and treatment of psychological problems in overweight children. Key words: Weight and shape concern, childhood obesity, depression, self-esteem, body dissatisfaction Introduction Childhood obesity is a major problem in Western societies. It is currently estimated that almost one quarter of Australian children and adolescents are overweight or obese, and these rates are increasing (1). Childhood obesity is associated with a range of serious physical health problems, and is a recognised risk factor for adult obesity (2), bulimia nervosa (3) and binge eating disorder (4). Research focusing on the psychological conse- quences of childhood obesity has generated incon- sistent results. Evidence suggests that overweight children are at risk of experiencing low self-esteem (5  8), body dissatisfaction (8  11) and depression (12,13). However, not all studies provide support for these relationships (14,15), and it is clear that not all overweight children experience psychological diffi- culties (16). Self-esteem research has attempted to address these issues through the use of domain- specific measures of self-esteem, which show that overweight children are at risk of experiencing low body- or appearance-related self-esteem, without necessarily being at risk of low self-esteem in other domains (17  19). Another approach has been to consider individual differences in domain impor- tance. In a study of adolescent boys and girls, Body Mass Index (BMI; kg/m 2 ) and global self-esteem were significantly and negatively related only for participants who rated weight as important (20). This finding suggests that factors other than weight status need to be considered if psychological pro- blems in overweight children are to be fully under- stood. Weight and shape concern is one factor that may account for individual differences in the psychologi- cal consequences of overweight and obesity. Weight and shape concern refers to a preoccupation with, or overconcern about, issues relating to weight and shape, and to the evaluation of self-worth, largely in terms of weight and shape (21). Weight and shape concern is recognised as a critical factor in the development and maintenance of disordered eating Correspondence: Karina Allen, School of Psychology, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009 Australia. E-mail: allenk01@student.uwa.edu.au International Journal of Pediatric Obesity . 2006; 1: 239  247 (Received 30 November 2005; accepted 6 July 2006) ISSN Print 1747-7166 ISSN Online 1747-7174 # 2006 Taylor & Francis DOI: 10.1080/17477160600913552