Assessment of Adolescents' Self-Esteem in Secondary Schools

: Objectives : To assess the secondary schools obese adolescents’ self esteem level . Methodology A descriptive study is carried out at AL-Najaf AL-Ashraf City, from December 1 st , 2011 to April 6 th , 2012. A multi stage sample of (1350) subjects; it is selected throughout the use of probability sampling. The data are collected through the use of semi-constructed questionnaire, which consist of three parts (1) Economic Sociodemographic data form that consist of 14-items (2) Index of Self Esteem Scale that consists of 25-items (3) Anthropometric Measurements which consist of Weight and Height. Reliability of the questionnaire is determined through a pilot study and the validity through a panel of (24) experts. Results The finding of the present study indicate that there is highly significant relationship between the obesity and the study participants' gender, their order in the family, mother education level, and family socio-economic status. While the obesity and the other variables indicated no significant relationship. The results also shows highly significant relationship between the obesity and the index of self esteem. There is a significant relationship between the index of self-esteem domain and the order of student in family, fathers' education level, and socio-economic status. Other variables indicated no significant . Conclusion Present study concluded that the most of the secondary schools obese adolescents have self-esteem problem, and percentage of obesity (17.3%). Recommendation the study recommends that the students would be given an opportunities to participate in social organizations, conferences, and study projects to promote their level of self-esteem constructing and implementing educational programs for secondary schools teachers about how to decrease obesity among their students. Mass media approach should be employed by the Ministry of education to increase students knowledge and awareness of the obesity as a health problem.


INTRODUCTION
Childhood obesity has now become the most prevalent nutritional disease in developed countries.For example, the prevalence of obesity, defined as a body mass index (BMI) equal to or above the 95th percentile for children of the same age and sex (1)   .Obesity is increasing dramatically worldwide and is projected to affect 1.12 billion people by 2030 (2) .The prevalence of obesity is continuing to rise at an alarming rate in many parts of the world and is a major challenging public health issue.The latest projections of the World Health Organization (2010) indicate that globally in 2005, 1.6 billion adults were overweight and 400 million were obese, and that by 2015, 2.3 billion will be overweight and more than 700 million will be obese (15) .Until quite recently, obesity in children was viewed as a cosmetic problem.The major risks associated with obesity in children and adolescents were those consequences that resulted when obesity persisted into adulthood (3) .Adolescence is the final critical period for the development of obesity in childhood (4) .Some obese adults were fat as children, so child fatness may be a risk factor in its own right for later disease (5) .
The rate of obesity and overweight is increasing.Obesity has become a major health problem in large and medium-sized cities.Comparison of data from 1985 and  1990 shows that the proportions of overweight and obesity increased from 2.75 percent to 8.65 percent among boys and from 3.38 percent to 7.18 percent among girls.The rate among boys in urban areas was up to 12 percent in 1995.Both genes and environment have an impact on obesity (6) .
The shifts in obesity and related dietary and physical activity patterns across the globe during the past two decades have been remarkable.The rate of increase in obesity has accelerated, particularly for children and adolescents.The large-scale shifts in intake of calorically sweetened beverages, fried foods, and animal food products are striking, accompanied by powerful changes in patterns of eating.Concurrent trends toward reduced physical activity and increased sedentary behavior have led to dramatic shifts in energy balance.The worldwide increases in intake of caloric sweeteners and the increased snacking and food consumption away-from home are serious causes for concern (7) .Obesity, in childhood as in adolescence, is not a uniform condition.Some obese children hide severe emotional and personality disturbances behind their obesity.The risk of disordered eating increased during adolescence and correlated with depressive patterns of behavior and low self-esteem (8)   .
The aims of the study are to identify the secondary school adolescents obesity, to assess the secondary schools obese adolescents' self esteem levels, and to find out the association between the obese adolescents' self esteem and their socio-demographic characteristics of age, gender, parents education levels, family type and socio-economic status.

METHODOLOGY
Study Design: A descriptive study is conducted through the period between December 1st, 2011 to April 6 th , 2012 in-order to assess obese adolescents' self esteem in secondary schools at Al-Najaf Al-Ashraf City.
Study Sample: A multi stage sample of (1350) subjects, were selected throughout the use of probability sampling.The sample of study is divided into two stages which include: First stage: schools selection by stratified-cluster.AL-Najaf City divided to six districts.The schools Selected randomly (18) schools boys and girls, from (110) total schools in AL-Najaf City.Second stage: students' selection by disproportional stratified sampling.From each schools randomly selected (75) students.The total of students were (1350), (675) boys and (675) girls, their age between 13 to 16 years.The Study Instruments: A literature draft of instrument questions was developed by the investigator after extensors which addressed the demographic socio-economic data, a draft instrument was developed and pretested with (50) adolescents, the content validity was established after experts reviewed.Furthermore, changes were made in the questionnaire to various terms according to recommendations and notes of experts and Ministry of Planning/Central Council of Statistics.The final study instrument consisted of six major parts and those parts are:Part 1: Economic-Sociodemographic Data Form: An economic-sociodemographic data sheet, consisted of many items categorized as general information (gender, birth date, level of education, total number of siblings and number of student between siblings); and socioeconomic data(parents social status, parents occupation status, parents education levels, family type, family number, number of rooms, type of house, house area, house content and car possession)Part 2: Index of Self Esteem Scale (ISE-25-items).The adolescents' self esteem was measured by the Arabic version (ISE) .this is a 25-item questionnaire that uses a 5 -point Likert-type scale for responses (9) .Instruments are generally used to assessment of obese adolescents' problems with self -esteem.Part 3: Anthropometric Measurements: Weight Electronic weighting was used to obtain the weight.The scale was placed on a hard-floor surface.Height was measured for all participants, with the students bare footed and head upright.
Data collection: Data collected by utilizing of the Adopted & developed questionnaire.Weight, Height are checked for each respondent.The data collection process has been performed from February 19 th 2012 until April 16th 2012.Each subject takes approximately (5-10) minute to respond to the interview.Data Analyses: In order to achieve the early stated objectives, the data of the study were analyzed through the use of statistical package of social sciences (SPSS) version 16through descriptive and inferential statistical analyses.

Table (1) Distribution of the study sample by their overall measurement through BMI percentiles
Table (1) shows that more than half of the study sample in regard to their BMI percentile has normal weight (65.2 %), only (17.3 %) were obese, and (15.2 %) was overweight.

BMI percentiles
No Table (2) reflects the correlation between the index of selfesteem and the different studied general information.The results shows that is a significant relationship between the index of self-esteem domains and the order of student in family, fathers' education level, and socio-economic status at p-value (0.007, 0.011, and 0.049) respectively.there is a non significant relationship with the other general information at p-value more than (0.05).

Table (4) Correlation Between the BMI Percentiles Results and the index of self esteem
Table (4) shows a highly significant association between the BMI percentile results and the index of self esteem p-value (0.0001).

DISCUSSION
Part-1-: Discussion of the BMI Percentiles Related to the Adolescents' in Secondary Schools (table 1, 3) The study results (table 1), reflects that more than half of the study sample in regarding to their BMI percentile has normal weight (65.2 %), only (17.3 %) were obese, and (15.2 %) was overweight.The correlation between the BMI percentile results and the different general information (table 3).The study results indicate that there is highly a significant relationship between the BMI percentile result and the study participants gender, student order in family, mother education level, and socio-economic status at pvalue (0.001 , 0.007 , 0.004 , and 0.0001 )respectively.While there is a non significant relationship between the BMI percentile results and the other information( age, number of sibling, father alive, mother alive, parents social status, and father educational level) at p-value more than 0.05 .The correlation between the index of selfesteem and the different studied general information (table 2).The study results show that there is a significant relationship between the index of self-esteem domains and the order of student in family, fathers' education level, and socio-economic status at p-value (0.007, 0.011, and 0.049) respectively.While there is a non significant relationship with the gender, age, number of sibling, father alive, mother alive, parents social status, and mother educational level at p-value more than (0.05).Females tend to be more critical of less satisfied with their overall body image than their male peers (11) .Self-esteem is higher in boys than girls during adolescence (12) .

Under
The study results (table 4), This table shows the correlation between the BMI percentile results and the index of self esteem.The results show that there is a highly significant relationship between the BMI percentile results and the index of self esteem at p-value (0.0001).In this study, the obesity and self-esteem (table 4), the study results shows that (79.8%) of obese adolescents have a self-esteem problems, while (20.2%) of obese adolescents have no problem with self-esteem.Green(2005) reported that the obese adolescents often suffer from lower self-esteem and a negative self-image, thus creating heightened levels of psychological distress Hence, those who are overweight are at risk of not only a host of physical problems and ailments but also the psychological damage caused by ridicule and social isolation (13) .Yet empirical research indicates that not all obese persons suffer from low self-esteem (14) .

CONCLUSIONS:
According to the present study findings, the researcher concluded the following 1.The study confirms that the majority of obese are male, while the majority of overweight were female.
2.The study confirms that obesity most common occurs among adolescents in middle child in the family.
3.The study indicates that the obesity associated with mother educational level.
4.The study indicates that the obesity has a significant relationship to SESS.
5.The study indicates that most of obese adolescents have problem with their selfesteem.
6. Excess weight is also likely to lead to prejudice in the school, lower self-esteem and reduced self confidence.

Table ( 3
) indicates the correlation between the BMI percentile results and the different general information.The study results indicate that there is highly a significant relationship between the BMI percentile result and the study gender participants, student order in the family, mother education level, and socio-economic status at p-value (0.001 , 0.007 , 0.004 , and 0.0001 )respectively.While there is a non significant relationship between the BMI percentile results and the other information( date of birth, number of sibling, father alive, mother alive, parents couple, parent separation, and father educational level) at p-value more than 0.05 .