Direct and indirect associations of weight status, self-efficacy, and gender attitudes with cognitive and academic skills among adolescent girls in Zambia

The role of adolescent weight status in psychosocial, cognitive, and academic outcomes remains understudied, particularly among girls in low- and middle-income countries. This study examined the direct and indirect effects of weight status, self-efficacy, and gender attitudes on cognitive and academic skills among adolescent girls. We analyzed two rounds of data collected from adolescent girls (N = 4,693) who participated in the Adolescent Girls Empowerment Program in Zambia. Weight status, self-efficacy, and gender attitudes were measured in 2014-2015. Cognitive and academic skills were measured, 1 year later. Analyses were conducted using confirmatory factor analysis and structural equation modeling. Being underweight was significantly associated with lower self-efficacy, and cognitive and academic skills. Self-efficacy and gender attitudes were significantly associated with cognitive and academic skills. Self-efficacy mediated the association of being underweight with cognitive and academic skills. Our results found no significant association of normal weight with cognitive and academic abilities. Undernutrition, low self-efficacy, and weak cognitive and academic abilities during adolescence illustrate the intersecting vulnerabilities faced by adolescent girls. Study findings suggest multiple pathways to improve adolescent girls' weight status and cognitive and academic skills.