Although an increasing number of children and adolescents are becoming obese, the psychological morbidities associated with obesity are not well established. Existing reviews report modest associations between obesity and global self-esteem. However, none have examined how this affects multi-component assessments of self-esteem and quality of life in young people with defined obesity. A literature search identified 17 self-esteem and 25 quality of life studies of cross-sectional, longitudinal or intervention design published since 1994. Child-completed and parent-proxy assessments were consistent in showing significant reductions in global self-esteem and quality of life in obese youth. Competences particularly affected were physical competence, appearance and social functioning. There were no clear differences in effects between children and adolescents, and evidence on gender and ethnicity was lacking. Competency improvements occurred in the presence and absence of weight loss, suggesting their value as intervention outcomes and the need for further investigation.

Objective To assess if a school based intervention was effective in reducing risk factors for obesity. Design Group randomised controlled trial. Setting 10 primary schools in Leeds. Participants 634 children aged 7-11 years. Intervention Teacher training, modification of school meals, and the development of school action plans targeting the curriculum, physical education, tuck shops, and playground activities. Main outcome measures Body mass index, diet, physical activity, and psychological state. Results Vegetable consumption by 24 hour recall was higher in children in the intervention group than the control group (weighted mean difference 0.3 portions/day, 95% confidence interval 0.2 to 0.4), representing a difference equivalent to 50% of baseline consumption. Fruit consumption was lower in obese children in the intervention group ( − 1.0, − 1.8 to − 0.2) than those in the control group. The three day diary showed higher consumption of high sugar foods (0.8, 0.1 to 1.6)) among overweight children in the intervention group than the control group. Sedentary behaviour was higher in overweight children in the intervention group (0.3, 0.0 to 0.7). Global self worth was higher in obese children in the intervention group (0.3, 0.3 to 0.6). There was no difference in body mass index, other psychological measures, or dieting behaviour between the groups. Focus groups indicated higher levels of self reported behaviour change, understanding, and knowledge among children who had received the intervention. Conclusion Although it was successful in producing changes at school level, the programme had little effect on children's behaviour other than a modest increase in consumption of vegetables.

Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite, 52(2), pp. 396-404. doi: 10.1016/j.appet.2008.11.012 This is the unspecified version of the paper.This version of the publication may differ from the final published version. Design: Sixty-two women (ages 19-64; BMI 22.5-52.1) who were attempting to lose weight were randomised to an intervention or control condition. The former were invited to attend four 2-hour workshops, the latter were asked to continue with their normal diets. Data were collected at baseline, 4 and 6 months. PermanentMain outcome measures: BMI, physical activity, mental health.Results: At 6 months intervention participants showed significantly greater increases in physical activity compared to controls (p<.05) but no significant differences in weight loss or mental health. However, when intervention participants who reported 'never' applying the workshop principles at 6 months (n=7) were excluded, results showed both significantly greater increases in physical activity (3.1 sessions per week relative to controls, p<.05) and significantly greater reductions in BMI (0.96 relative to controls, equivalent to 2.32kg, p<0.5). Reductions in BMI were mediated primarily by reductions in binge eating. Conclusion:Despite its brevity, the intervention was successful at bringing about change.Further refinements should increase its efficacy.

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Obesity impacts the self-perception of children entering adolescence, especially in girls, but in selected areas of competence. Obese children are at particular risk of low perceived competence in sports, physical appearance, and peer engagement. Not all obese children are affected, although the reasons for their resilience are unclear. Quantifying risk of psychological distress alongside biomedical risk should help in arguing for more resources in child obesity treatment.