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This dissertation, Lifestyle, Self-esteem and Obesity Among Children by Sze-pui, Pamela, Tin, 田詩蓓, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Background: Childhood obesity remains a major public health concern. While preventing childhood obesity is important, the effectiveness of existing prevention strategies is indefinite. Important obesity contributors are speculated to be overlooked while the role of well-studied obesity-related factors has been questioned. Objectives: 1) Although the association between lifestyle and obesity is seemingly well-established, how an overlooked dietary factor, breakfast location, associates with obesity was investigated2) At a time where inconsistencies in findings for the frequently studied association between TV viewing and obesity still exist, this thesis tested for the existence of the said association in the understudied Chinese population3) The effect of mental health on childhood obesity is understudied. Using self-esteem as a mental health indicator, the effect of self-esteem on childhood obesity was investigated To understand the role of lifestyle factors in the association between self-esteem and obesity, how 4) breakfast habit and 5) TV viewing habit associates with self-esteem was explored Methods: A cohort of 83405 primary 4 (P4) Department of Health Student Health Service participants (49.7% male, mean age 9.9 years) in 1998-2000 were successfully tracked for 2 years into primary 6 (P6). A self-administered health questionnaire collected information on the breakfast and TV habits of participants alongside other lifestyle characteristics. Self-esteem was assessed using the four Culture Free Self-Esteem Inventories for Children (SEI) subscales. Body mass index (BMI) was derived using objectively measured weight and height. Weight status was classified in accordance to International Obesity Task Force standards. Logistic, multinomial logistic and linear regression were used to yield adjusted odds ratios (AOR) and β-coefficients for becoming overweight/obese in P6 (among P4 normal weight children), breakfast skipping/location, TV viewing habit and SEI subscale scores. Breakfast skipping behaviour was tested as a mediator in the association between self-esteem and obesity using standard mediation procedures. Breakfast and TV viewing habits were tested as effect modifiers in the same association by inclusion of interaction terms in models. Results: Among normal weight P4 children, those who skipped breakfast (AOR: 1.24; 95% CI: 1.02 to 1.51) or ate away from home (1.39; 1.20 to 1.60) were more likely to become overweight/obese in P6. Poor self-esteem was also associated with higher AORs for becoming overweight/obese, particularly among girls. While TV viewing in P4 did not predict overweight/obesity in P6, those who increased TV watching hours (Breakfast habit and self-esteem was bi-directionally associated. Although a curvilinear inverted J-shaped relation between P4 TV viewing and P6 self-esteem was observed, self-esteem did not predict TV viewing habit. While neither breakfast nor TV viewing habit significantly interacted with self-esteem to predict obesity, breakfast skipping was found to be a potential partial mediator in the association between self-esteem and obesity. Conclusion: Breakfast location, self-esteem and TV viewing patterns over time are important to consider i

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