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Do Low Self-Esteem and External Control in Childhood Predict Adult Obesity?

Current concern about the childhood obesity epidemic is largely driven by the notion that overweight and obese children have a greater risk of becoming overweight and obese adults. So far, however, efforts to reverse or even contain the prevalence of childhood obesity have yet to produce results.

Currently, much of the efforts to address obesity focus on improving nutrition and physical activity, but as blogged before, the results so far are modest.

Now new data suggests that perhaps rather than targeting nutrition and physical activity, the best targets for preventing and reversing the obesity epidemic may be emotional issues including self-esteem and self-efficacy rather than harping on the simplistic notion of energy in and energy out.

New data on the possible importance of this issue comes from a study by Andrew Ternouth and colleagues from King’s College London, UK, just published in BMC Medicine.

They examined data on around 6,500 individuals from the UK 1970 Birth Cohort Study (a representative sample of individuals born in the UK in one week in 1970) regarding the possible role of childhood emotional problems and self-perception as predictors of adult obesity.

Using sophisticated analyses and correcting for numerous potential confounders like childhood body mass index, parental body mass index, and social class, the researchers found that childhood emotional problems, low self-esteem and an external locus of control at age 10 predicted adult weight gain at age 30, whereby these effects tended to be stronger in women than in men.

The authors appeared particularly impressed by the strong impact of external locus of control on weight gain. As explained by the authors,

“Locus of control concerns individuals’ perceptions of the extent to which their own actions affect their destiny. Those with an internal locus of control believe that their behaviours have an important influence on outcomes, whereas those with a more external locus of control believe that their fate lies more in the hands of others, or is dependent on circumstance.

An external locus of control may be related to low self-efficacy, a lack of belief in one’s own capabilities, which in turn could lead to a feeling of loss of control of one’s actions.

While studies have shown that people with a more internal locus of control tend to be more physically active, a more external locus of control has been linked with disordered eating behaviours such as binge eating.

I cannot help but wonder if this “locus of control” issue is perhaps far more important than we may have considered in the past. Given that we are living in a time where overprotection and overscheduling of children is the norm, I wonder if kids today have a much lower sense of being in control of their lives than ever before.

In the era of “helicopter” parents and organized sports, where children are forced to live by a schedule dictated by the busy lives and (often) irrational fears of their parents, it would not surprise me that we are rearing a generation of kids, who truly experience and believe that their destiny lies in the hands of others.

Will this generation of kids, therefore, as adults, be less able to make “sensible” food choices or engage in “self-directed” play than earlier generations? Do the very kids, who are forced to eat healthy as kids, seek out junk food as adults? Do the very kids, who sucked at soccer or hockey but had to go simply because their parents thought it good for them, turn into sedentary adults?

if emotional problems, poor self-esteem and external control promote obesity, should the solutions not ultimately lie in improving mental health, increasing self-esteem and letting kids be kids?

Are our attempts at banning junk food and prescribing more physical activity simply toying with the “symptoms” rather than addressing the root causes of these “behaviors”.

To be clear, I am not saying that eating crap and not moving enough are not part of the problem. I am merely suggesting that the path to changing these behaviors may not lie in simply teaching people about healthy eating and the benefits of physical activity.

As blogged before, perhaps our messages around healthy eating and more activity do little more than perpetuate the prevailing model of “blame”, which does little to address either the emotional problems or the poor self-esteem and lack of control that may in the end be the real cause of the obesity problem.

Could it be that the root cause of unhealthy eating is not junk food but rather the “NEED FOR” junk food? After all, if no one NEEDED to buy junk food (be it for economic or hedonic reasons), wouldn’t it simply shrivel and disappear?

Could it be that with LESS organized sports and FEWER restrictions more kids would be playing outside, disappearing into the neighbourhood never to be seen again till dinner?

I would certainly love to hear opinions on this post!

Edmonton, Alberta


  1. While it is certainly a nice idea to address mental health issues, the task is much bigger than the idea. I have seen many patients with weight issues whose self esteem deficits were the results of horrible childhood experiences such as incest and sexual abuse. Campaigns which I see to stop this type of crime do nothing more than make people aware of sexual abuse, but do little to stop it. Addressing the way we treat each other as human beings is not a medical issue and even if the consequences are medical, addressing this is more involved than at first seems. A lot of this is a result of poverty and lack of resources but we see very few people with affluent lifestyles doing little more than consuming more themselves and as William Reese says, kicking those who don’t have away from the lifeboat. In Malcolm Gladwell’s newest book he talks about the idea that those who have get more and those who don’t have anything, receive even less. It is time that we affluent start sharing and stop being so greedy. Then those who struggle with basics need not feel it is their fault or there is something wrong with them (the essence of low self esteem) because they don’t have the same amount of stuff.

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  2. It’s of great relevance the elaboration of these studies and the reflection upon these facts. I actually think that patients tell us what stands in the way with moving more and eating healthier when we listen, only I think most of us treating patients with obesity haven´t been recognizing that clearly the emotional problems of the patients and so it is difficult to uderstand in what way that information should guide treatment. Thank you for your excellent insights.

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  3. Yaaay! Finally someone that hit the nail, dead on! Please, let kids be kids!

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  4. i yi yi !!!  I tried to be the opposite of my parents, as an abuse survivor.  I believe some of my children’s weight is my poor example… i.e  Oh, you fell down and scraped your knee, have a cookie I just baked.  My kids associated treats with feeling better.  It was not my intention.  Meals were very healthy and balanced.  I was a ‘closet’ nighttime (after their bedtime) eater. 
    I am certain some of our obesity is genetic, but a LOT of our problem stems from emotional eating.  I have learned much from therapy and eat a well balanced diet and exercise daily.  I am close to goal weight after two years.  My son is scheduled to go for bypass at the end of this month.  My daughter is also obese and not choosing anything after failures at WW.
    I so wish you had a simple answer.  But like you, I believe the issue is so much more complex.  Our family doc says to my daughter as a teen, “… this is not a judgement, but you are obese…” Try the Balance diet. 
    If you could do only one thing about obesity, my wish would be that your message of raising the awareness among family practioners would go far to help.  I know docs are not paid enough for a visit, so perhaps it needs to be recognized as the epidemic it is.  Instead of paying higher fees for the flu, perhaps the gov’t should also come on board and pay the docs more for consults and encourage further education?
    I really appreciate reading your blog.  It makes me feel better to know that it isn’t as simple as everything being my fault.  When I felt like that, it just made me seek food for comfort.  Bless you! 

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  5. Intersting blog, Dr. Albert Bandura has been writing about self efficacy for many years. There may also be a connection to anoretics, they seem to have an external efficacy and the only thing in their lives they can control is food intake. So perhaps people with external efficacy can be obese or anorectic depending on something else, what ever that may be.
    So does parenting modify kids external efficiency rates? It must to some degree, or not?
    I don’t think riding the bench as a kid needs to makes one obese, I can easily imagine it may drive one to an individual sport like cycling or running.
    I can easily see letting kids be kids making a different subgroup obese. A single environmental input in a group of kids can cause disparate obesity rates as an adult.
    Lots of questions.

    thanks again for your blog

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  6. These are interesting ideas, and the angle you mentioned briefly is, I think, the crux of it: imposing diets is imposing the ultimate external control. The more parents attempt to control what children eat and the less we allow children to eat intuitively, the more disordered their eating will ultimately be.

    Is there anything more controlling and disempowering than teaching your child that they (literally) cannot trust their own guts?

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  7. Thank you so much for this article! We have an 11 yr old daughter who is struggling with obesity and everyone around me keeps telling her and I that she needs to fix her diet and exercise more to get better. I am not exaggerating when I say her ‘diet’ is extremely healthy including very little packaged foods, very little sweets, plenty of filtered water, no refined flours or sugars in anything we eat and actually 80% of our food comes straight off the produce bins at the Calgary Farmer’s Market. She is as active as any of her friends; always outside playing, biking, jumping rope etc. The other 3 of us are not having weight issues and we eat precisely the same as her and very active as well.

    HOWEVER, she has some learning struggles and we notice that her grades shift very dramatically with her mood. She is often struggling with depression and low self-esteem. She feels very little control over her life (I even retired from the army early to address that particular issue though my husband remains in). We seem completely at a loss to help her and we have not yet found a health practioner (we’ve been through many GPs, Pediatricians, Social Workers etc.) that can help us reach her and substantively address her ‘condition’ on a meaningful, long term level.

    In any case, your article gives me confidence in myself because I’ve been telling literally everyone all along that “there is something more going on-it can’t simply be food and exercise, we fixed that 2 yrs ago and haven’t deviated.” I’ll take this with me and try again with the latest Pediatrician we are working with.


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  8. Absolutely. Dr. Spock wrote that, left to its own devices, in a room full of a variety of food, even a one year old child would, over a certain period of time, choose a healthy diet. My mother tried to control my food intake all my life, beginning when she brought me home from the hospital. Her feeding instructions were on a mimeographed sheet; she was to feed the newborn “x” ounces every four hours. She tried valiantly to follow orders;, but after drinking “x” ounces, I always started to throw up. I only needed “w” ounces, because the mimeographed instructions were for an average sized baby and I only weighed 5 lbs. 4 oz.. But I also needed to be fed every three hours, not every four hours, and Mom refused to do that, since the instructions told her not to. I usually cried for an hour before she fed me, then threw up afterward. So, as I grew to be school aged, Mom decided to put me on a diet. This meant that, while she continued to bake luscious cakes and cookies and other desserts, as soon as they were placed on the dinner table, I was told that it was time for me to leave the room. My brothers thought the emotional pain this gave me was hysterically funny.

    There is no way a child with that kind of start can learn to listen to his or her own body’s signals. Believe me, I’ve tried. Unfortunately, every time I experience the least amount of stress, I head for my comfort foods. I’ve actually managed to fight my weight down more than a hundred pounds a couple of times, but it inevitably climbs up higher than it had been before.

    I honestly don’t know what to do to solve this problem. I joined a gym, and loved working out, but my weight went up despite those efforts. I’m not stupid or lazy; I’m an obese Harvard graduate, and have tried desperately for almost all of my 61 years to find a healthy lifestyle I can stick with. I don’t understand why it is so easy for so many other people to control their weight and so impossible for me.

    Unfortunately, I believe that medical researchers in general bought into the prevailing beliefs that fat people were lazy, stupid, and slobby and that they were fat BECAUSE they were lazy, stupid and slobby. Not only have those beliefs enabled the one remaining socially acceptable prejudice in this country, I believe it kept scientists from doing much, if any, research into the cause and treatment of obesity. Or rather, the causes, because there are surely a number of causes, and ALL of them are intertwined with and related to the cultures and the societies in which we live.

    My great dream is that someone, somewhere, will find the solution which works for me before I become a dead fat woman.

    Thank you for the article.


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  9. Those with an internal locus of control believe that their behaviours have an important influence on outcomes, whereas those with a more external locus of control believe that their fate lies more in the hands of others, or is dependent on circumstance.

    I find this unconvincing. If anything, I think I’d say the closer to the opposite is worth investigating, that is, people’s idea of an external locus of control is busted/ rudely interrupted, i.e. death/ loss of a parent, too much responsibility too young, often being made to feel responsible for your weight, when others are barely even aware of it.

    But in the end, this has to be taken with some degree of scepticism, as whatever you think you can find out about fat children/adults you seem to find it just as easily in those that aren’t.

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  10. Sorry, when I wrote ‘people’s (idea of an external locus of control is busted), I should have written ‘children’s’.

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