Body Physique and Psychological Problems of Elementary Schoolchildren Table 4. Comparison between Psychological Problematic vs. Normal Children Problem Cases (n = 12) Normal (n = 393) Weight SDS 0.217 0.117 Height SDS 0.230 0.119 Socioeconomic status 3.13 3.19 School performance 3.30 3.71 Paternal Age (yrs) 43.0 43.2 Maternal Age (yrs) 40.9 40.1 NS, non significant; SDS, standard deviation score. p value NS NS NS < 0.05 NS NS feel alienated, and to suffer from excessive stress.28 Obese adolescents are reported to be socially isolated and are likely to face difficulty when integrating themselves into the social network.29 Some studies demonstrated that overweight children had higher scores in social problems compared to normal children, whereas other studies showed no differences in anxious/depressed scale.11,30,31 Our findings are consistent with previous findings that obese children have high scores for social immaturity, but did not find significant differences in the anxious/depressed score. Since this is a population- based study which was confined to elementary school students, the prevalence of psychopathology may be lower than that in treatment-seeking clinical pubertal age samples. Interestingly, we found significantly higher social imma- turity in underweight children than normal weight children. This implies that less attention has been paid to under- weight children than to obese children, and they may also face serious psychological problems as well. At present, Korean students are inclined to regard being tall as superior.19 In this study, 36.9% of short stature children are dissatisfied with their height. Social stereotypes for the height are established at an early age, and even young child- ren ascribe positive attributes to tall children and negative attributes to short silhouettes.32 Although some researchers noted that short children have more emotional problems such as immaturity,33 anxious/depression, behavioral disor- ders, and social withdrawal than children with normal height,7,34 we did not find significant differences in terms of psychosocial problems in this study. This result might be ascribed to several factors. There is a possibility that children with short stature might have had less psychological prob- lems even than medically-referred group because the present study was a population-based study. Another important factor is that we excluded pathologically short stature child- ren because it is possible that idiopathic short stature has less psychological effects than pathologically (hormone deficiency or syndromatic) short stature. In addition, we confined our subjects to elementary schoolchildren, who were not seriously concerned about their short stature because of their future growth potential. Reijneveld et al.35 reported that the prevalence of CBCL problems score in the clinical range was 8.9% in the general childhood popula- tion, and Visser-van Balen et al.36 reported 7.8% prevalence in the medically referred idiopathic short stature adolescents. In this study, the overall prevalence of scores in the clinical range was only 3.0 percent (12/405). This low prevalence might be explained by different age distributions or ethnic backgrounds in the study population or by the fact that our study used CBCL data, which were reported by parents instead of children. The children whose CBCL total problems score were in problematic range showed no difference in terms of weight or height, compared with normal students. Among the factors related, only school performance was negatively correlated with the total problems score. This reflects the fact that fourth to sixth-grade children are more affected by their school performance scores than their height or weight status. Since the parental expectation of school performance in Korea is high, there is a possibility that children with low school performance may have increased psychological problems. Our study has some limitations. First, our analysis is based on parent-reported CBCL data, which are less valid than children’s self- reported data, and the questionnaire did not specify an accurate definition of the degree of body dissatisfaction. Second, the prevalence of problematic cases was too small to analyze the factors related. Third, pubertal adolescents could have different results. In spite of these limitations, our study is the first report which elucidated psychosocial problems in relation with weight and height status, using the validation marker of standard deviation score. In conclusion, approximately one-third of elementary schoolchildren were dissatisfied with their height or weight. However, the total CBCL psychological problem scores were closely related with school performance, but not with height or weight status. Contrary to a general view, our study suggests that psychological problems in school- children may be related more with school performance than body physique. REFERENCES 1. Park MJ, Kang YJ, Kim DH. Dissatisfaction in with height and Yonsei Med J http://www.eymj.org Volume 50 Number 3 June 2009 343