The ballooning waistlines of children hit the spotlight when Michelle Obama admitted publicly her daughters had an unhealthy body mass index. And while many urge kids to slim down to avoid heart disease and other physical ailments, the emotional consequences from teasing and low self-esteem could be just as debilitating, scientists say.

About 37 percent of children in the United States are overweight and roughly 16 percent of children ages 2 to 19 are obese, according to the Centers for Disease Control and Prevention. Among 6- to 19-year-olds, obesity has tripled over the past two decades, according to the National Health and Nutrition Examination Survey.

We've heard that these fat children may be set up for a life at the doctor's office with health risks including type-2 diabetes, high cholesterol and blood pressure, and sleeping problems. But these same kids are more likely to have a hard time with emotions and with their peers.

"Overweight kids are more likely to have depression and low self-esteem, to be teased or bullied, and to bully other children," said Catherine Davis, associate professor of pediatrics at the Medical College of Georgia. "These can be serious problems for these children."

Researchers point out that no matter your age, carrying around lots of extra weight has its psychological consequences.

"Overweight and obesity are terribly stigmatizing conditions, regardless of age," said Sara Gable of the University of Missouri, Columbia.  "Living as a member of a stigmatized group is stressful and can produce feelings of anxiety, depression, and loneliness."

Gable said research on other stigmatized groups, such as racial minorities, shows these negative feelings can interfere with academic performance and other aspects of a person's life, and "there is good reason to think” these findings would apply to children struggling with weight problems, Gable told LiveScience.     

While some responded to the First Lady's divulging of her kids' weight problems as insensitive, psychologists say pretending the issue isn't there doesn't help anyone involved. And they offer tips for how parents can be sensitive to their child's feelings while encouraging healthy behaviors.

Toughest spot: the playground

Playground teasing may seem like a childhood rite of passage, but overweight children get more of it. And that name-calling can grate on a child's self-esteem. "A lot of who we are is based on how others interact with us," said Eric Storch of the Departments of Pediatrics and Psychiatry at the University of South Florida. "With kids who are overweight they internalize others' feedback, 'You're fat, you're no good, no one wants to go out with you.' That contributes to anxiety and depression."

He estimates rates of depression are as high as 20 percent in kids who are overweight.

"It's not simply being overweight that leads to depression," Storch said in a telephone interview. "It's being overweight and getting a bunch of crap about it from peers that leads to anxiety or depression."

While one paradigm suggests weight leads to teasing, which then leads to psychological issues, another reverses those arrows to suggest depressed kids are less likely to exercise and more likely to gain weight.

In fact, Storch and his colleagues studied 100 overweight children and those at risk for being overweight, ages 8 to 18, to find out the effects of bullying. About a quarter of the children reported significant problems with bullies during the prior two weeks. The study, published in a 2007 issue of the Journal of Pediatric Psychology, revealed bullying often caused kids to avoid situations where they had been picked on, such as gym class and sports fields.
Storch's team also found bullied kids were more likely to be depressed, lonely and anxious.

"When you think about it, it makes intuitive sense, when you consider the hallmark signs of depression – sadness, fatigue, lack of interest in things you used to like," Storch said in a statement about the study. "When kids are having a tough time with peers, and struggling with depression, then this can translate to reduced rates of physical activity."

Problems start early

Though steering clear of physical activity may, in part, lead to a heavy child, it doesn't explain the weight gain in very young kids. Before the age of 2 and as early as three months old, infants could be on the path toward obesity, according to a new study published this month in the journal Clinical Pediatrics.

And just as the extra weight comes early in life, so do the social and psychological consequences. A nationally representative study of about 8,000 children who were followed from kindergarten through third grade, beginning in 1998, showed the psychological ramifications of being plus-sized start young. For instance, by third grade overweight kids reported less favorable peer relations and feeling unpopular. 

The study, published last year in the journal Applied Developmental Science, also showed overweight girls were also more likely to act out – fighting and arguing – than slim peers, according to their teachers.

Kids with weight problems from the start (in kindergarten) were more likely to be sad, lonely and to worry than kindergarteners without extra poundage, according to reports by their teachers and the kids themselves. As overweight kids entered higher grades, these feelings just got worse.

The fact that overweight boys and girls reported more loneliness and worrying suggests that, as early as first grade, they may have an understanding of the stereotypes that accompany living with the stigma, the researchers say.

What's a parent to do?

For parents wanting to help their children slim down while also keeping self-confidence intact, the key is balance, researchers say. A mom who's constantly nagging Billy about his weight is not going to see a positive outcome, Storch said. But neither will a laissez-fare parent who lets a kid eat with abandon.

Parents should let children know they are concerned about their health, not kids' looks, Davis said.

"Pretending the child is not overweight or obese sends a harmful message that they should ignore their health," Davis said. "Rather than being punitive or setting dietary rules that only the child has to follow, have the whole family improve their diet and physical activity habits together."

And when overweight or obese children get out and exercise, the results can be a boost to their self-esteem, in addition to any physical gains.

A study published last year in the Journal of Pediatric Psychology suggested 40 minutes a day of exercise lessened depression in overweight kids and made them feel better about themselves.

The study, conducted by Davis and her colleagues, included more than 200 overweight children who either continued their sedentary lifestyle, or engaged in 20 minutes or 40 minutes of fun activities that increased heart rate, such as running games, jumping rope, basketball and soccer.

"Just by getting up and doing something aerobic, they were changing how they felt about themselves," said the lead researcher and Davis' colleague at MCG Karen Petty. "Hopefully these children are taking home the idea: Hey, when we do this stuff, we feel better."

Overall, the emotional consequences are just as bad as the physical ones.

"Comparing the emotional consequences of pediatric obesity to the health related consequences is sort of like missing the forest for the trees," Gable said. "Obesity has the potential to interfere with all areas of human functioning; that’s part of what makes its treatment during childhood such a tricky undertaking.  Children suddenly get lots of attention for the exact reason that makes – at least some of them – feel really bad."

Tips for overweight children

Gable and her colleagues put together some tips to help children navigate a world they say is "critical of body size." Among them:

  1. Create an environment where children learn to feel good about themselves. For instance, you could introduce children to different hobbies, sports and neighborhood activities. And encourage them to pursue what they enjoy. And help children recognize that taking care of their bodies allows them to do what they like to do.
  2. Help children learn how to deal with teasing and bullying. You could role play (and talk about) ways to avoid reacting to unkind words and actions, and how to calmly walk away from these peer provocations. Also, help children to develop positive "I messages," such as "I'm going to ignore these words because I know they are not true."
  3.  Set and maintain limits on the amount of time children spend watching TV and playing computer games. Make sure to turn off the TV during meals and when no one is watching it. Bottom line: make television a special activity, not a routine one.
  4. Help children to like healthy foods. Involve them in menu planning and have them munch on fruits and veggies between meals rather than fatty, sugary and salty snacks.

The researchers also suggest you keep track of the visual media that children see. Limit the number of fashion, glamour and muscle-building magazines that come into your home.