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Graduate Student Journal of Psychology                                                        Copyright 2007 by the Department of Counseling & Clinical Psychology  
2007, Vol. 9                                                                                Teachers College, Columbia University                          ISSN 1088-4661 
 
 
 

Adolescent Body Mass Index in Relation to  
Depression, Self-Esteem, and Academic Achievement 

 
Mathew Malter-Cohen 

Teachers College, Columbia University 
 

The differences in school achievement, depression, and self-esteem among overweight and normal 
weight adolescents were investigated. Body Mass Index (BMI), measured weight status, and group 
classification (overweight or normal weight) were determined by k-means cluster analysis. Multi-
variate analyses of variance (MANOVA) indicated significant effects across weight classifications. 
Overweight adolescents had a significantly lower grade point average than their normal weight 
counterparts. However, differences between weight groups for depression and self-esteem were in-
significant. The implications and possible causes for these differences and similarities are dis-
cussed. 

 
 

Recent research has documented extensively the ad-
verse effects of obesity on orthopedic, neurological, pulmo-
nary, and gastroenterological health (Must & Strauss, 1999; 
Zametkin, Zoon, Klein, & Munson, 2004). Overweight 
(Body Mass Index ≥ 85th percentile for age and gender) and 
obese (Body Mass Index ≥ 95th percentile for age and gen-
der) individuals are at increased risk for a number of ill-
nesses, including hypertension, hyperlipidemia, osteoarthri-
tis, and Type II Diabetes, to name a few (Flegal, Carroll, 
Kuczmarski, & Johnson, 1998). Obese children between the 
ages of 10 and 13 have a 70% chance of being obese adults 
(The Office of the Surgeon General website, 2006). Given 
these findings, it is quite alarming to see the rates of child-
hood and adolescent obesity nearly triple in the USA, from 
5.7% to 15.3%, between 1980 and 2000 (Ogden, 2002). 
These increases in childhood and adolescent obesity span 
age, gender, and ethnicity (Dietz & Gortmaker, 2001). 
While the health effects of the obesity epidemic in the 
United States have been examined in great detail (Dietz & 
Gortmaker, 2001; Flegal et al., 1998; Zametkin, Zoon, 
Klein, & Munson, 2004), not much attention has been di-
rected toward other important effects, such as decreased 
school performance in children and adolescents, and the 
ramifications for professional life in adults.  

 
Obesity and School Achievement 

 
While the research on the relationship between obesity 

and school achievement has been sparse, it has also been 
varied in its parameters. Taras and Potts-Datema (2005) 
published a literature review examining 10 studies from the 
past 50 years coming from Brazil, China, Finland, Thailand,  
the United Kingdom and the United States of America 
(USA).    Only  four  of  these  studies  originated  from  within 
 
Correspondence concerning this article should be addressed to 
Mathew Malter-Cohen; e-mail: mhm2108@columbia.edu. 

the USA (Datar, Sturm, & Magnabosco, 2004; Falkner et 
al., 2001; Schwimmer, Burwinkle, & Varni, 2003; Ter-
shakovic, Weller, & Gallagher, 1994), even though the obe-
sity problem in the USA is more pronounced than in other 
countries. In China, for example, Li (1995) examined an 
evenly matched cohort (obese and normal weight) of 204 
elementary school children and found that severely obese 
children had significantly lower intelligence quotient (IQ) 
scores on the Wechsler Intelligence Scale for Children 
(WISC) than controls. Campos, Sigulem, Moraes, Escrivao 
and Fisberg (1996) found that children ages 8-13 years with 
normal height/weight ratios had significantly better per-
formance on the WISC than their obese counterparts. In 
Thailand, Mo-suwan, Lebel, Puetpaiboon and Junjana 
(1999) found that being overweight during adolescence 
(grades seven to nine) was associated with poor school per-
formance. Furthermore, adolescents who were more over-
weight were at greater risk for low GPA. Li (1995) found 
that obese children performed significantly lower in six of 
the eight categories examined: Chinese, arithmetic, foreign 
language, general knowledge, art, and gym. Defining obe-
sity as greater than 120% of sex/height specific mean 
weight for age, Mikkila, Lahti-Koski, Pietinen, Virtanen 
and Rimpela (2003) found good school performance to be 
inversely associated with being obese for boys and girls in a 
cohort of over 60,000 Finnish adolescents, ages 14-16.  

Within the USA, Datar, Sturm and Magnabosco (2004) 
analyzed data from a nationally representative cohort of 
11,192 first-time kindergartners from the Early Childhood 
Longitudinal Study (ECLS), a project funded by the United 
States Department of Education. The ECLS began follow-
ing these children in 1998 and will follow them through 
twelfth grade in order to test hypotheses about the effects of 
a wide range of family, school, community and individual 
variables on children's development, early learning, and 
early performance in school. The overweight kindergarten-
ers enrolled in the ECLS had significantly lower math and 

10 



OBESITY AND SCHOOL ACHIEVEMENT 
 

11 

reading test scores compared with the non-overweight chil-
dren. However, once they included socioeconomic and be-
havioral variables in their model, Datar’s group concluded 
that overweight status is a marker, and not a causal factor, 
of poor test scores (Datar et al. 2004). 

 
The Affective Component 

 
Clinical reports and other qualitative data seem to indi-

cate that weight is linked to both depression and self-
esteem. However, recent studies on adolescents concerning 
emotional health indicate that the data are not so clear-cut. 
Swallen, Reither, Haas and Meier (2005) found that while 
overweight and obese adolescents (ages 15-17) had signifi-
cantly worse self-reported health than normal weight ado-
lescents, no difference existed between the groups on 
measures of depression, self-esteem, and school/social 
functioning. Several other studies found no differences in 
self-esteem between obese children and adolescents and 
non-obese controls (Gortmaker et al., 1993; Renman, Eng-
strom, Silfverdal, & Aman, 1999; Rumpel & Harris, 1994). 
Other studies indicate that obese children and adolescents 
have somewhat lower self-esteem than their normal weight 
counterparts (Manus & Killeen, 1995; Stradmeijer, Bosch, 
Koops, & Seidell, 2000; Strauss, 2000). Still others found a 
difference in self-esteem between obese and normal weight 
children and adolescent girls that was rendered insignificant 
once body image was controlled for (French, Perry, Leon, 
& Fulkerson, 1995; Pesa, Syre, & Jones, 2000).  

Similar problems of confounding variables arise when 
examining the relationship between obesity and depression. 
Sjoberg, Nilsson and Leppert (2005) concluded that there is 
a significant statistical association between adolescent obe-
sity and depression, although it disappeared when shaming 
experiences, parental employment, and parental separation 
were controlled for. These findings were similar to those of 
Erickson, Robinson, Haydel and Killen (2000), although 
they were studying a cohort of children in the third grade. 
In girls, they found a modest association (r = 0.14, p < .01) 
between depressive symptoms and Body Mass Index 
(BMI), which dropped out after controlling for level of 
overweight concerns. Erickson et al. (2000) found no asso-
ciation between depressive symptoms and BMI in boys.  

The objective of this study of eleventh graders, in the 
USA, was to build on prior evidence (Datar et al., 2004; 
Mikkila et al., 2003; Mo-suwan et al., 1999) that has sug-
gested that there exists a negative relationship between BMI 
and school achievement. As BMI increases, school 
achievement, measured here by grade point average (GPA) 
is expected to decrease. Due to the conflicting evidence 
presented by the literature concerning the relationship be-
tween BMI and depression, we do not expect to see a rela-
tionship between BMI and depression (Sjoberg et al., 2005; 
Swallen et al., 2005; Erickson et al., 2000). Additionally, no 
relationship is expected between BMI and self-esteem 
(Swallen et al., 2005; Renman et al., 1999; Rumpel & Har-
ris, 1994; Gortmaker et al., 1993). Current research efforts 

into the possible biological correlates of obesity that have 
an impact on cognition will be examined.  

 
Method 

 
Sample 
 

Participants in this study consisted of students in elev-
enth grade attending a public high school in an affluent 
community in the Northeast. During the year 2000, the me-
dian annual family income in this region was reported to be 
almost $102,000 (U.S. Census Bureau, 1999); the highest 
national median income ever recorded by the U.S. Census 
is $43,318 (DeNavas-Walt, Proctor, & Mills, 2004). The 
majority of students, 87.1%, were of European American 
background, 0.8% were African American, 5% were His-
panic, 4.2% were Asian American, and 2.9% were of other 
ethnic backgrounds. With regard to gender of the students, 
46.7% were female and 53.3% were male.  

This study was implemented as part of a school-based 
initiative that targeted positive youth development, and 
inclusion of students in the sample was based on passive 
consent procedures (i.e. students are automatically included 
and given the opportunity to opt-out at any point, before, 
during, or after the study). Given increasing anecdotal and 
media-based evidence of various problems in communities 
such as theirs, school administrators and parent representa-
tives in this particular community had sought a rigorous 
assessment of the nature and extent of difficulties among 
their high school students. Following the development of a 
collaborative relationship between the local school district 
and a Columbia University researcher, Dr. Suniya Luthar 
(which ensued from a series of talks she gave for the com-
munity), the survey was initiated. School administrators 
sent letters to the parents of all eleventh graders by U.S. 
mail that described the project, indicated that survey results 
would be presented only in aggregate form (with no infor-
mation on individual children), and requested notification if 
they preferred that their children not participate. A second 
notice was mailed a few days before data collection, once 
again offering parents the option to refuse consent. On each 
of the two days of data collection, all students were also 
told that their participation was entirely voluntary. On com-
pletion of data collection, questionnaires were scored with 
only participant numbers as identifiers. Most of these stu-
dents had participated in similar data collections conducted 
by Dr. Luthar during the sixth through tenth grades. Of the 
252 eleventh graders who participated, BMI data was avail-
able for only 240 of the students; 12 students did not report 
their heights and weights. 

 
Measures 

 
Subjective Reports of Maladjustment 

 
Depressive symptoms.  



MALTER-COHEN 
 

12 

The Children’s Depression Inventory is a widely used 
27-item, three-choice scale designed to measure depression 
for school-age children and adolescents (Kovacs, 1992). 
This measure has acceptable internal consistency as well as 
criterion and concurrent validity (Kovacs, 1992). Alpha 
coefficients of internal consistency in this sample were .82 
and .84 for girls and boys, respectively. 

 
Self-Perception Profile for Adolescents.  
 
The global self-worth subscale from the Self-

Perception Profile for Adolescents (Harter, 1988) was ad-
ministered to tap each participant’s overall perception of his 
or her worth as a person. Item content examines the extent 
to which adolescents approve of themselves along four di-
mensions: (a) social competence, (b) physical competence, 
(c) romantic appeal, and (d) friendship. For each item, two 
sentence stems were presented side by side, for example, 
“Some teenagers are often disappointed with themselves,” 
but “Other teenagers are pretty pleased with themselves.” 
Students were asked to decide which stem best described 
them and whether the statement was “sort of true” or “really 
true” for them. Questions are written in a “structured alter-
native format” designed to reduce the tendency to give so-
cially desirable responses (Harter, 1982). Harter (1988) 
reports good psychometric characteristics for these scales. 
Alpha coefficients of internal consistency in this sample 
were .96 and .89 for girls and boys, respectively. 

 
Objective Reports of Maladjustment 

 
Body mass index.  
 
BMI is a measure of the weight of a person scaled 

according to height. A frequent use of BMI is to assess how 
much an individual's body weight departs from what is 
normal for a person of his or her height. The weight excess 
or deficiency may, in part, be accounted for by body fat 
(adipose tissue) although other factors, such as muscularity, 
also affect BMI. As a rough guideline for adults, a BMI of 
less than 20 implies underweight, over 25 is overweight, 
and over 30 is obese. BMI is calculated by taking the 
weight of the individual in kilograms and dividing by the 
square of the height in meters. BMI for children age 2 to 20 
is calculated just as it is for adults, but it is classified 
differently. A BMI that is less than the 5th percentile is 
considered underweight and above the 95th percentile is 
overweight. Children with a BMI between the 85th and 95th 
percentile are considered to be at risk of becoming 
overweight. BMI categories are generally regarded as a 
satisfactory tool for measuring whether sedentary 
individuals are "underweight," "overweight," or "obese." It 
has been used by the World Health Organization as the 
standard for recording obesity statistics since the early 
1980s. Additionally, Piertobelli et al. (1998) tested the hy-
pothesis that in a healthy pediatric population, BMI is a 

valid measure of fatness (total body fat and percent of body 
weight as fat were estimated by dual energy x-ray absorpti-
ometry). The measure is also independent of age for both 
sexes (Piertobelli et al., 1998). Research thus supports the 
use of BMI as a fatness measure in groups of children and 
adolescents. Goodman and Strauss (2000) found self-report 
of BMI by adolescents to be a reliable indicator of actual 
BMI; 96.2% of teens were correctly classified as obese 
based on self-reported height and weight measures. 

 
Procedure 

 
Data for each student were collected during two 45-

minute class periods on two separate days, and testing of 
the adolescents was done in groups of 15 to 20. To guard 
against biases due to variability in reading proficiencies, a 
member of the research team read each questionnaire aloud, 
and students marked their responses accordingly. Question-
naires were administered in the same order to all groups, 
with relatively structured, non-threatening measures admin-
istered at the beginning and end of each session. Students 
reported height and weight data in the demographics sec-
tion. On completion of data collection, money to support a 
pizza party was given to all participating classes. Following 
the data collection, GPA was obtained directly from school 
administrators. 

 
Results 

 
Complete data were obtained for 238 of the eleventh 

graders who were attending the school sampled; the school 
withheld GPA for two of the students for reasons unknown 
to the investigators. Means and standard deviations on all 
variables are presented in Table 1. A k-means cluster analy-
sis was performed on BMI to create two groups with maxi-
mum distance between group averages. Multivariate analy-
ses of variance (MANOVA) indicated significant effects 
across weight classifications (Wilks’s λ = .959, p < .05). 
Individual t-tests showed a significant difference between 

 
Table 1   
Descriptive Data on All Variables 
 
 Weight Classification  

 Normal 
(BMI  =  21.09) 

(n = 208) 

Overweight 
(BMI = 29.48) 

(n = 28) 

 

 M SD M SD F 

Grade Point Averagea 9.10b 1.94 7.88 2.07 9.604**

Depression 7.51 5.45 8.03 5.63 0.225 

Global Self Esteem 3.18 0.52 3.05 0.40 1.625 

 
a   GPA measured on a 12 point scale, 12=A, 9=B, 6=C, 3=D 
b   Means are convertible to standard collegiate 4-point scale by dividing   
by 3; subsequent group means are 3.03 and 2.63, respectively.   
** p < .01 



OBESITY AND SCHOOL ACHIEVEMENT 
 

13 

 
classifications for GPA (F = 9.604, p < .01), but not for 
depression (F = .225, p = .636), or global self-esteem (F = 
1.625, p = .204). Error variance of all dependent variables 
was equal across groups and homogeneity was not violated. 
 

Discussion 
 

 This study replicates findings of a strong association 
between BMI and GPA (Mikkila et al., 2003; Mo-suwan et 
al., 1999), while also furthering hypotheses that BMI is not 
associated with depression (Erickson, 2000; Swallen, 2005) 
or self-esteem (Gortmaker, 1993; Renman et al., 1999; 
Rumpel & Harris, 1994). Normal weight adolescents had an 
average GPA of 3.03 (when grades were converted to a 
standard collegiate 4-point scale), in comparison to an aver-
age GPA of 2.63 for the overweight group. Miller (1998) 
found that high school grades “have a strong and significant 
effect on earnings 9 years after high school for both men 
and women, with or without bachelor’s degrees,” even after 
controlling for SES, race/ethnicity, region of the country 
and public or private status of the high school. While it was 
beyond the scope of this study to examine why overweight 
students are performing worse in school than their normal 
weight counterparts, current research efforts in the field 
suggest that certain structural and chemical differences in 
the brain among overweight individuals adversely affect 
memory and cognitive functioning (Jeong, Nam, Son, Son 
and Cho, 2004; Pannacciulli et al, in press).  
 Pannacciulli et al. (in press) examined associations 
between excess body fat and regional alterations in brain 
structure using voxel-based morphometry. In comparison 
with the group of lean subjects, the group of obese indi-
viduals had significantly lower gray matter density in sev-
eral regions in the brain. In general, gray matter can be un-
derstood as the parts of the brain responsible for informa-
tion processing. Pannacciulli et al. identified structural 
brain differences associated with obesity in several brain 
areas involved in the regulation of reward and behavioral 
control, two processes that, along with information process-
ing, have a significant impact on learning. Jeong, Nam, 
Son, Son and Cho (2004) used measurements of BMI and 
waistline circumference to study a Korean sample of 467 
adults over age 64. Waistline circumference was included 
to better identify those adults who were overweight due to 
excess body fat and not due to other causes such as greater 
muscle mass or enlarged skeletal structure. Poor cognition 
was strongly associated with obesity (BMI ≥ 25) in the 
presence of abdominal obesity. In Korea, a BMI ≥ 25 is 
defined as obese while a BMI of 23-25 is defined as over-
weight. In individuals with normal waist circumference, 
poor cognition was negatively associated with being over-
weight. Additionally, abdominal obesity interacted with 
BMI in its association with poorer cognition. In this elegant 
study, Jeong, Nam, Son, Son, and Cho (2004) were able to 
isolate the effects of abdominal obesity (i.e. excessive body 
fat) on cognition above and beyond having elevated BMI. 

Finally, several other studies have shown that insulin defi-
ciency, acute hyperglycemia and poor glucose tolerance are 
associated with impaired memory and cognitive dysfunc-
tion in the elderly (Craft, 2005; Stockhorst, de Fries, Stein-
grueber, & Scherbaum, 2004; Sommerfield, Deary, & Frier, 
2004; Convit, Wolf, Tarshish, & de Leon, 2003). These 
conditions are more prevalent in obese populations, and are 
a consequence of Type II diabetes, a weight-related disor-
der. 
 In addition to the biological effects on learning, cogni-
tion and memory, there is a socio-cultural impact on stu-
dent’s academic outcomes. Unfortunately, at present, there 
is a dearth of quantitative research on this matter (Puhl & 
Brownell, 2001). The only examination of this topic known 
to this author found that obese adolescents were signifi-
cantly less likely than their normal weight counterparts to 
gain college admission, despite equivalent academic re-
cords and application rates (Canning & Mayer, 1966). 
While there has been considerable attention directed to-
wards the harassment of, and shame wrought upon, obese 
children and adolescents in the school setting (Neumark-
Sztainer, Story, & Harris, 1999; National Education Asso-
ciation, 1994; Crandall, 1994), no attention has been paid to 
the direct or indirect effect this has upon their grades.  
 While other studies have found mixed results when 
examining the relationship between obesity and depression 
in adolescents (Sjoberg et al. 2005; Erickson et al., 2000), 
this study did not (p=.636). Richardson et al. (2003) con-
ducted a study of New Zealand adolescents that may ex-
plain why this is so, at least for girls. They found that girls 
with major depression in late adolescence were twice as 
likely to be obese at age 26. The heterogeneous etiology of 
depression and subsequent complex effects this disease has 
on an individual likely explains why this study found no 
relationship with obesity. While some depressed adoles-
cents may be obese, others have not yet experienced the 
effects of depression on their bodies. In essence, they may 
be too young for depression to have had an effect on their 
weight.  
 Many researchers use the global self-worth subscale 
from the Self-Perception Profile for Adolescents (Harter, 
1988) as a valid measure of self-esteem (French et al, 1995; 
Strauss, 2000; Strodmeijer et al., 2000). While the four di-
mensions tapped by this instrument (social competence; 
physical competence; romantic appeal; and friendship), are 
areas in which obese adolescents experience difficulty 
(Puhl & Brownell, 2001; Neumark-Sztainer et al., 1999), 
normal weight adolescents also experience difficulty in 
these areas. Put more succinctly, it is not surprising that in 
this study the relationship between self-esteem and obesity 
was not statistically significant (p=.204); self-esteem is an 
issue with which most, if not all, adolescents struggle. 
 

Limitations and Conclusion 
 

 One limitation of this study is sample size. Weight 
classification groups are of unequal size, and the size of the 



MALTER-COHEN 
 

14 

overweight group (N=28) significantly impacts the power 
of this study to examine all possible risk factors of elevated 
BMI. In a study such as this one, power of .8 or greater is 
ideal (Cohen, 1988). While the power of individual t-tests 
examining differences in depression (.076), and self-esteem 
(.246) between weight class groups in this study is less than 
ideal, this discrepancy is not significantly meaningful in 
this case. Extrapolating to larger group samples, it is 
unlikely that greater power would alter statistical signifi-
cance between weight group averages on the CDI because 
the distributions are homoscedastic. A similar pattern of 
insignificant group differences, homoscedasticity, and neg-
ligible clinical differences is observed when examining the 
group differences in self-esteem. Sample size further limits 
the ability to examine path models that may indicate direc-
tion of causality. 
 The devastating effects of obesity have gained national 
attention in the United States and articles are written 
weekly documenting these effects. Studies examining the 
biological effects of obesity on cognition are a recent de-
velopment. More work needs to be done in this area, espe-
cially replicating findings in younger populations and with 
samples that are a better representation of the population at 
large. The results reported here indicate that physical fac-
tors such as obesity are a good indicator to parents and 
school administrators that a child may be doing poorly in 
school.  

 
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