Body Physique and Psychological Problems of Elementary Schoolchildren relationship between psychosocial or educational problems and short stature in school children.21,22 Although it is well documented that children with obesity or short statures tend to show more psychological problems than normal children, there have been no studies conducted in conjunction with underweight vs. obesity and short stature vs. tall stature together. Since children are growing, it is difficult to diffe- rentiate weight or height status. Height or weight standard deviation score (SDS) is the most exact validation marker of height or weight status by age and gender. This study was designed to assess the prevalence of body dissatisfac- tion, and the association between the weight and height status and a psychological problems among Korean elementary schoolchildren using SDS. MATERIALS AND METHODS Materials A total of 405 elementary school students (fourth to sixth- graders, aged 10-13 years, 211 boys and 194 girls), living in Seoul, Korea, were recruited from the community setting (Table 1). We excluded students who were diagnosed as having specific organic diseases, including a pathologically short stature or pathological obesity. The study was approved by the institutional review board of Sanggyepaik Hospital. Measures Height was measured to the nearest 0.1 cm on a harpendin stadiometer, and body weight was measured to the nearest 0.1 kg on a balanced scale by a trained nurse. Age and gender specific standard deviation scores (SDS) for the height and weight were calculated according to the physical growth reference data for Koreans.23 Height was categorized into three groups: short (< -2 SDS), normal (-2 SDS to 2 SDS), and tall (> 2 SDS), while weight was categorized into three groups: underweight (< -2 SDS), normal (-2 SDS to 2 SDS), and obesity (> 2 SDS). The children were evaluated using the Korean version of the Child Behavior Checklist (K-CBCL).24 The CBCL Table 1. General Characteristics of the Children Cases School grade 405 (211 male, 194 female) 4th grade 158 (80 male, 78 female) 5th grade 130 (67 male, 63 female) 6th grade 117 (64 male, 53 female) Age (yrs) 10.6 ± 0.9 8 underweight / Weight status 347 normal / 36 obesity 15 short stature / Height status 298 normal / 29 tall stature crafted by Achenbach25,26 is a frequently-used questionnaire with 112 items, providing parent-reported data on problem behavior in children. A total problem behavior score was computed by summing the scores obtained for each item. The K-CBCL produces externalizing behavior problems, which are composed of attention problems and aggressive and delinquent behavior; internalizing behavior comprises withdrawal, depressed behavior, and somatic complaints. The social functioning scale includes socialization and academic functioning in the K-CBCL. Body dissatisfaction was measured using the question- naire developed by the authors, and this questionnaire included the degree of satisfaction about the subjects’ height and weight. The degree of satisfaction was categorized into 3 groups: dissatisfied, fair, and satisfied. The subjects’ economic status was categorized into 5 classes based on their parents’ monthly income, according to the data from the Korean statistical office: high, middle high, middle, middle low, and low economic classes. The educational level of the parents was categorized into 5 groups: unschooled, elementary school, middle or high school, college/univer- sity, and postgraduate degrees. The height and weight of the subjects’ parents and number of family member were also inquired. Statistical analysis All statistical analyses were performed using SAS software (version 9.1.3 SAS Institute, Cary, NC, USA). Comparisons of the means of the variables between the two groups were performed using a Wilcoxon rank sum test. Comparisons of the means of the variables among three groups (by weight or height status) were performed by the Kruscal Wallis test. A chi-square test was used to determine the percentage of dissatisfaction by gender or weight/height status. Pearson correlation analyses were utilized in order to assess relation- ship between total problem scores and other environment factors. RESULTS In this study, 34.4% of boys and 32.1% of girls showed dissatisfaction with their weight, whereas 26.2% of boys and 30.2% of girls showed dissatisfaction with their height (Table 2). The obese group showed higher weight dissatis- faction than the normal or underweight groups (p < 0.001). The short stature group showed higher dissatisfaction in their height than the normal group (p = 0.01) (Table 2). There was no significant difference in total CBCL prob- lems score according to weight or height status (Fig.1). The underweight and the obese groups had higher scores for social problems than normal weight group (p < 0.05 respec- tively) (Fig. 2). There were no significant differences in Yonsei Med J http://www.eymj.org Volume 50 Number 3 June 2009 341