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<p>This dissertation encompasses three essays which examine the development of obesity
in black and white girls and its responses to interventions. </p><p>The first chapter
asks the question, how does obesity develop in girls? Using the National Growth and
Health Study (NGHS), a longitudinal study of 2400 girls from age 9 to age 18, this
chapter aims to address gaps in knowledge about the development and persistence of
obesity in girls. Analyses using multivariate regression and growth-mixture modeling
describe trajectories of body mass change in children and their correlates. Results
suggest that obesity in children begins early and persists in most cases--BMI at age
17 is, on average, 1.3 times BMI at age 9. However, change does occur; 0.8 percent
of the sample move from being obese at age 9 to healthy weight at age 17, and 2.2
percent of the sample make the reverse journey from healthy weight to obese. Where
change occurs, it is most commonly seen among those who socio-demographically were
anomalies among their body mass cohort at age 9. These results emphasize the importance
of early interventions as well as the need for more study into body mass mutability
in population subsamples. </p><p>The second chapter investigates 1) what motivates
children to pursue weight loss; and 2) what aspects of interventions may most effectively
support healthy child motivations and program success. These questions are qualitatively
studied among a sample of 45 obese girls aged 9 to 13 girls participating in a behavior
modification intervention. In total, 106 interviews were conducted. All of the girls
in the study were interested in losing weight, most commonly in order to fit in (n=11),
reduce teasing (n=10), or express particular social identities (n=6). However, not
all of the girls were able to translate this desire to lose weight into a healthy
and effective lifestyle change motivation. Several factors were associated with adopting
healthy motivation and behavior, including familial involvement, self-regulation skills,
non-social weight desires, realistic weight loss goals, and clear messages about body
ideals. Other program protocols also supported motivation during difficult periods
for those who adopted healthy motivation, including nutrition information, incentives,
lack of physician judgment, and patient autonomy. Finally, two other potential program
protocols were mentioned by girls in the study as useful aids. More support services,
particularly during the summer, and more information on the expected course of weight
loss could, these girls argued, help sustain motivation. Together, these findings
suggest a role for self-regulation theory in the design of lifestyle change motivation
and for more directly addressing expectations in weight loss treatment.</p><p>The
third chapter investigates the relationship between self-worth and obesity among girls,
again using the National Growth and Health Study. Results indicate a negative relationship
between self-worth and obesity across all participants. However, this relationship
only has predictive power from early body mass to later self-worth and self-worth
trajectories. That is, higher body mass at age 9 predicts lower self-worth at age
17 and decreases in self-worth from age 9 to age 17. The effect is larger for Caucasians
and for those in young adolescence but persists across the sample. Mechanisms for
this relationship are also investigated, and some support found for stigma. Analyses
using self-worth components suggest most of the self-worth effects are driven by social
concerns, while mediational analyses suggest social body image pressures explain the
relationship between global self-worth and body mass. Overall, the findings suggest
a complex interrelation between self-worth and body mass in girls, meriting further
investigation as well as a more nuanced discussion in the public realm.</p>
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