Weight discrimination and bullying

Stigmatizing effects of weight status on lay perceptions of eating disorder-related distress

The present study examined how weight status would affect lay perceptions of a White female student presenting signs of eating disorder-related distress. We recruited a mixed-gender, weight-diverse U.S. community sample through Mechanical Turk (N = 130; 49.2% female) to complete an online survey. Participants were randomly assigned to one of two conditions in which they read a personal statement section of a college application revealing eating disorder-related distress from a student who was either 'overweight' or 'underweight.' Participants evaluated the student on need for support, behavioural prescriptions for eating and exercise, and personal qualities. Although participants recognized a serious mental health concern in both conditions, they were more likely to prescribe eating disorder behaviors to the higher weight student. Findings suggest that weight stigma may bias lay perceptions of and even reinforce an eating disorder when exhibited by higher weight individuals.

Social alienation of adolescents with obesity in classrooms: A multilevel approach

INTRODUCTION

Adolescents with obesity are more likely to be isolated by peers, but whether they also choose to disengage from their peers remains unclear.

METHODS

This study examined a sample of 646 adolescents between the age of 13 and 16 across 34 classrooms in 3 junior high schools in Taiwan, with data collected from May to June 2019. The sociometric network nomination method assessed peer relationships, such as unpopularity, unsociability, and alienation. Multilevel models were applied to explore the extent to which the class-level prevalence of overweight and obesity and peer support moderate the relationship between student-level obesity and peer relationships.

RESULTS

Overall, students with obesity were more likely to experience unpopularity, unsociability, and alienation from their peers in classroom settings (adjusted odds ratio [AOR] = 1.904, 2.208, 2.777, p < .05). Regardless of their obesity status, students in high classroom peer support were less likely to report unsociability (AOR = 0.124, p < .05). No cross-level interactions were observed, indicating that students with obesity did not experience a reduction of peer rejection in high peer support classrooms. Neither did obese students in classrooms with higher rates of overweight and obesity.

CONCLUSIONS

Students with obesity were more likely to experience interpersonal problems. Classroom peer support can increase peer acceptance for typical students but has no beneficial influence on adolescents with weight problems. Classroom peer support needs to be directed to become adequate support for students with obesity.

Interrelation between weight and weight stigma in youth: is there evidence for an obesogenic vicious cycle?

Many children and adolescents are confronted with weight stigma, which can cause psychological and physical burden. While theoretical frameworks postulate a vicious cycle linking stigma and weight status, there is a lack of empirical evidence. The aim was to analyze the longitudinal bidirectional relationship between body weight and weight stigma among children and adolescents. The sample consisted of 1381 children and adolescents, aged 9-19 years at baseline (49.2% female; 78% normal weight), from a prospective study encompassing three measurement points over 6 years. Participants provided self-reported data on experienced weight-related teasing and weight/height (as indicators for weight status). Latent structural equation modelling was used to examine the relationship between weight-related teasing experiences and weight. Additionally, gender-related differences were analyzed. Between the first two waves, there was evidence for a bidirectional relationship between weight and weight-related teasing. Between the last two waves, teasing predicted weight, but there was no reverse association. No gender-related differences were found. The data indicate a reciprocal association between weight stigma and body weight across weight groups and independent of gender. To prevent vicious cycles, approaches that simultaneously promote healthy weight and reduce weight stigma are required.

Associations among weight-based teasing distress, impulsive emotion regulation, and loss of control eating in racially and ethnically diverse young men

According to affect regulation models, distress associated with weight-based teasing may be related to loss of control (LOC) eating. Maladaptive coping strategies may further exacerbate this association, but such hypotheses have not been evaluated in men. The purpose of the current study was to examine the association between distress from weight-based teasing and LOC eating in racially and ethnically diverse young men. The degree to which men engage in impulsive behavior when distressed was investigated as a moderating variable. Exploratory analyses examined the proposed associations within racial/ethnic identity groups. The current study included 1011 young men (18-30 years, M_age = 23.9 ± 3.6 y, 28.3% non-Hispanic White; 23.4% African American; 24.3% Hispanic/Latino; 23.8% Asian/Asian American). Participants completed an online survey with measures of weight-based teasing, LOC eating frequency, engagement in impulsive behavior when distressed, and demographics. After adjusting for age, race/ethnicity, and body mass index, there was a positive association between distress from weight-based teasing and LOC eating frequency (p < .001). In the full sample, the tendency to engage in impulsive behavior when distressed exacerbated this link (p < .01). Exploratory analyses revealed the moderating effect of impulsive coping on distress from teasing was significant in non-Hispanic White men, but was not significant for all others. These findings suggest that men are not immune to the negative correlates of weight-based teasing. LOC eating may function as a maladaptive coping mechanism, or may be an artifact of the disordered eating symptoms that can emerge during extreme efforts to obtain a thinner physique.

Examining 24-Hour Activity and Sleep Behaviors and Related Determinants in Latino Adolescents and Young Adults With Obesity

Background. Few studies have examined 24-hour activity and sleep behaviors and their contribution to type 2 diabetes (T2D) in Latino adolescents and young adults with obesity. Aim. This study included quantitative data on T2D risk and 24-hour activity and sleep behaviors and qualitative data on individual, social, and environmental behavioral determinants. Method. A 7 day, 24-hour, wrist-worn accelerometer protocol assessed moderate-to-vigorous physical activity (PA), sedentary behaviors (SB), sleep, and sleep regularity, in adolescents (N = 38; 12-16 years) and young adults (N = 22; 18-22 years). T2D-related outcomes included adiposity (BMI, BF%, waist circumference), fasting, and 2-hour glucose. A subsample of participants (N = 16 adolescents, N = 15 young adults) completed interviews to identify behavioral determinants. Results. High levels of PA were observed among adolescents (M = 103.8 ± 67.5 minutes/day) and young adults (M = 96.8 ± 78.8 minutes/day) as well as high levels of SB across both age groups (≥10 hours/day). Sleep regularity was negatively associated with adiposity (all ps < .05) in both age groups as well as fasting and 2-hour glucose in young adults (all ps < .05). Social support was associated with PA in both age groups as well as SB in younger youth. Auditory noises, lights, and safety inhibited sleep in both age groups. Conclusion. PA is critical for disease reduction, yet reducing SB and improving sleep are also important targets for reducing T2D risk in Hispanic adolescents and young adults. Future health promotion and disease prevention strategies should leverage qualitative findings regarding behavioral determinants.

School violence negative effect on student academic performance: a multilevel analysis

The relative roles of school context and individual student factors are of special interest to educators in measuring academic performance. Little is known about the effect of school violence on a student's academic performance and well-being. The aims of this study were to examine the effects of three types of school violence (direct violence, discrimination, and cyberbullying) on students' academic performance in standardized tests of mathematics, reading and history, and to identify individual student factors that contribute to reducing the negative effect of exposure to violence at school. We used 10th grade Chilean student data from the representative cross-sectional test of the Education Quality Measurement System (SIMCE in Spanish) from 2015. Multilevel linear models, adjusted for gender, incorporated other school and environmental contextual factors, as well as individual student factors. The results show that school violence in its three forms had a negative effect on academic performance. Student self-efficacy, educational expectations and satisfaction with interpersonal relations with their teachers, were important in reducing the negative effect of exposure to violence. The implications for the school are discussed.

Exploring the association between parental anti-fat attitudes and restrictive feeding practices in a British and Irish sample

Parental restriction of food intake has been associated with heightened eating disorder psychopathology in some longitudinal research. Yet, relatively little is known about the determinants of restrictive feeding practices. This cross-sectional study explored the association between parents' anti-fat attitudes and their use of restrictive feeding practices in a mixed British (41.10% England, 39.90% Scotland, 4.20% Other) and Irish (14.80%) sample. Parents and caregivers (N = 472; 94.10% female; 70.90% university level education) of children between the ages of 4-8 (48.20% female; 91.10% rated as "normal weight" by their parents) completed self-report questionnaires assessing their anti-fat attitudes (dislike, fear, and blame subscales), use of restrictive feeding practices (for weight control, health purposes, and covert restriction), and how influential their child's body-weight and -shape is for their perception of themselves as parents. Overall, our hypothesis that parental anti-fat attitudes would be significantly associated with restrictive feeding practices was supported. Anti-fat attitudes related to disliking higher body-weight people and blaming parents for their child's weight were significant predictors of all forms of restrictive feeding (all ps < .05). However, anti-fat attitudes related to fearing being a higher body-weight were not significant predictors of restrictive feeding for the purposes of health nor for covert restriction (ps > .05). Additionally, our hypothesis that the associations between anti-fat attitudes and restrictive feeding practices would be stronger for parents for whom their child's body-weight and -shape more strongly influenced how they judged themselves as parents was not supported (the interaction term was not significant in two out of three analyses). Future research is needed to investigate these associations across time and in samples of higher body-weight children.

The ruling of weight: An institutional ethnography investigating young people's body weight surveillance work

RATIONALE

Dominant framing of childhood obesity as a public health burden has increased weight stigma towards young people in larger bodies. However, weight stigma literature is generally limited by its focus on individuals' attitudes and beliefs, overlooking the broader social conditions shaping stigma. Further, few weight stigma studies have been conducted from young people's standpoint; little is known about how they navigate stigmatizing environments while growing up.

OBJECTIVE

This study aimed to examine the social organization of young people's everyday work of growing up in a larger body, interpreting work generously as any activity requiring thought and intention.

METHODS

Using institutional ethnography, we conducted individual interviews in Alberta, Canada with 16 informants aged 15-21 who grew up in larger bodies. Five, repeated group interviews were then held with a subset (n = 5) of these informants.

RESULTS

Weight surveillance work (e.g., self-weighing on scales, social comparison) was informants' most common form of weight-related work while growing up. Surveillance results instructed them on next steps, whether that be working to fit in (literally and figuratively) or resisting social conformity altogether. Informants' bodies were monitored by nearly everyone around them: family, peers, educators, and healthcare providers. Informants learned how and why to do the work expected of them through social relations. Despite their (mostly) good intentions, surveillance by respected adults conveyed to informants that their self-worth depended on their weight. Biomedical, individuated health and weight discourses guided the enactment of institutional policies and practices in healthcare and education, such as those related to the Body Mass Index. These ruling discourses objectified bodies as normal or abnormal, healthy or unhealthy, good or bad.

CONCLUSION

Overall, study findings show how young people's experiences of growing up in their bodies were predictably organized by dominant weight and health discourses, identifying possible levers for public health intervention.

Defining paediatric metabolic (dysfunction)-associated fatty liver disease: an international expert consensus statement

The term non-alcoholic fatty liver disease (NAFLD), and its definition, have limitations for both adults and children. The definition is most problematic for children, for whom alcohol consumption is usually not a concern. This problematic definition has prompted a consensus to rename and redefine adult NAFLD associated with metabolic dysregulation to metabolic (dysfunction)-associated fatty liver disease (MAFLD). Similarities, distinctions, and differences exist in the causes, natural history, and prognosis of fatty liver diseases in children compared with adults. In this Viewpoint we, an international panel, propose an overarching framework for paediatric fatty liver diseases and an age-appropriate MAFLD definition based on sex and age percentiles. The framework recognises the possibility of other coexisting systemic fatty liver diseases in children. The new MAFLD diagnostic criteria provide paediatricians with a conceptual scaffold for disease diagnosis, risk stratification, and improved clinical and multidisciplinary care, and they align with a definition that is valid across the lifespan.

Investigating Managers' Fine-Grained Evaluation Processes in Organizations: Exploring Two Dual-Process Perspectives

The dual-process theory is a significant theory in both organizational theory and social psychology and two conjectures about this theory are considered in this manuscript; the default-interventionist vs. parallel-competitive account. Our research goal is to empirically investigate these two views. In concrete terms, by using event-related potentials (ERPs), we seek to study the fine-grained brain processes and self-reported feelings involved in managers' evaluations of target employees within an economic context (firing employees) vs. a social network context (excluding employees). Using the stereotype content model categories, each target employee has high (or low) warmth and high (or low) levels of competence. In the fine-grained ERP analysis of the brain process, we focus on three time windows of interest: novelty detection (N2) and goal violation detection (N400) at the unconscious level, and we then evaluate conscious emotional arousal (late positive potential, LPP). Finally, we focus on the self-reported feelings when having to fire or exclude target employees. As goal pursuit theory predicts, the brain dynamics and self-reported measures differ widely across the two organizational contexts; in concrete terms, processes at a later stage overrule early stages depending on the context. This implies that the data bespeaks more for the parallel-competitive account than the default-interventionist account. We discuss the implications of these findings for research in management and management practice.

#quarantine15: A content analysis of Instagram posts during COVID-19

There has been a surge in "quarantine15" social media posts during the self-isolation and lockdowns associated with the COVID-19 global pandemic. Given the influence of other body and weight-centered social media content (e.g., Fitspiration, Fatspiration) on body image and weight stigmatizing thoughts and attitudes, characterizing the features of quarantine15 content is an imperative first step towards understanding its impact on those who view it. Therefore, the present study is a content analysis of quarantine15 content on Instagram. A total of 668 posts were sampled using the hashtag quarantine15, and systematically analyzed for features related to positive and negative body image, as well as weight stigma. The results showed that the posts containing human figures (57.5 %) showcased individuals who were perceived as lower-weight (88.8 %), White (70.3 %), and women (87 %). Approximately one-third (34.4 %) of the images containing individuals were considered objectifying. Posts also perpetuated the controllability of weight through diet (51.5 %) and physical activity (27.5 %), while 46.9 % expressed dislike towards higher-weight bodies. Future experimental research in this area will be important for understanding both the acute and long-term effects of viewing quarantine15 content on body image, weight stigmatizing attitudes and thoughts, and internalized weight stigma.

Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents

OBJECTIVE

Little research has investigated variables affecting the relationship between weight- or shape-related bullying (WSB) and specific forms of disordered eating in adolescence. This study aimed to examine the relationship between WSB and eating disorder behaviors in Australian adolescents, and whether this relationship was moderated by body image attitudes.

METHOD

Data were used from the first wave of the EveryBODY study, a survey of body image concerns and eating disorders in a large representative sample of Australian adolescents (N = 573), aged 11-19 years. Participants completed an online survey with measures of WSB frequency, body image attitudes (drives for thinness, leanness, and muscularity), and disordered eating behaviors.

RESULTS

Results indicated that frequency of WSB was positively associated with purging and muscularity-oriented behavior (MOB), but not dietary restriction, binge eating, or compulsive exercise. The relationship between WSB and MOB was moderated by drive for muscularity, such that victimization frequency was positively associated with MOB for those with high, but not low, desire to attain a muscular physique.

DISCUSSION

Findings indicate that WSB is positively associated with purging and MOB but not other eating disorder behaviors, and that drive for muscularity moderates its effect on some behaviors. Understanding these relationships will be important in implementing tailored interventions for adolescents based on screening for victimization experiences and specific body image attitudes.

Family Management of Severe Obesity in Adolescents

PURPOSE

Severe obesity, defined as a body mass index (BMI) ≥120th percent of the 95th BMI percentile for age and sex, is the fastest growing subcategory of obesity among youth, yet little is known about how this group understands and incorporates weight management strategies. The aims of this study were to explore how parents and adolescents understand severe obesity and incorporate management into their daily lives and evaluate the applicability of the Family Management Styles Framework (FMSF) to better understand the impact of severe obesity for adolescents.

DESIGN AND METHODS

Directed content analysis grounded in a modified version of the FMSF was used to analyze one-time in-home face-to-face interviews with adolescents aged 12-17 years (N = 14) who received pediatric weight management care and a parent (N = 17).

RESULTS

Both adolescents and parents described the day-to-day management as challenging and impactful to parent-child and sibling relationships. They described the need for sustained support and coaching in meeting daily physical activity requirements and related stories of weight stigma experienced. Further, parents' and adolescents' views were mostly congruent, except in their view of effectiveness of daily routines and how family attitudes and actions did or did not support the adolescent.

CONCLUSIONS

The FMSF was successfully applied to understand family management of adolescents with severe obesity. These adolescents have complex physical and psychological needs impacting effective weight management and family life.

PRACTICE IMPLICATIONS

Technology interventions should be considered to improve physiological and psychological outcomes for youth with severe obesity.

Anti-Fat Biases of Occupational and Physical Therapy Assistants

Fat people are highly stigmatized, and anti-fat bias is pervasive resulting in stigma, prejudice, and discrimination, including in health care. The aim of this study was to explore occupational and physical therapy assistants' anti-fat biases. We analyzed secondary weight implicit association tests from 5,671 occupational/physical therapy assistants. The overwhelming majority (82%) of occupational/physical therapy assistants were implicitly prejudiced against fat people. Interventions for occupational/physical therapy assistants' anti-fat biases are critical, especially with increasing prevalence and responsibilities of occupational/physical therapy assistants in the provision of rehabilitation services.

Relationship between Weight Status and Health-Related Quality of Life in a Sample of Early Adolescents from Central and Northern Italy: A Cross-Sectional Study of the AVATAR Project Participants

Among the various factors that could influence health-related quality of life (HRQoL) in adolescence, body mass index (BMI) seems to play a key role as a main anthropometric parameter. The aim of this cross-sectional study was to determine, in a sample of Italian adolescents, whether HRQoL is associated with the different weight status categories (underweight, normal weight, overweight, obese), according to BMI cut-off points for children, even considering sex differences. Data were collected from 1707 adolescents (n = 828 males) in seven schools. HRQoL was analyzed using the Italian version of KIDSCREEN-52. Males were more overweight and obese than females (13% vs. 10% and 4% vs. 2%, p < 0.05, respectively). In females, BMI categories are associated with physical well-being (p < 0.05), emotion/mood (p < 0.05), self-perception (p < 0.001), financial resources (p < 0.05), and bullying behavior (p < 0.05). In males, weight status is linked to physical well-being dimension (p < 0.001) and perception of self (p < 0.05). Our results may suggest that there is an association between weight status categories and HRQoL, more pronounced in females than in males. Interestingly, the weight status correlated more with the psychological dimension mainly in females, whereas in males, a stronger association between weight and physical status was observed, suggesting that given the complex, multifaceted, and dynamic nature of relationship between health-related quality of life and weight status in adolescents, multiple factors must be considered.

The Impact of Perspective Taking on Obesity Stereotypes: The Dual Mediating Effects of Self-Other Overlap and Empathy

Previous studies have indicated that obese people face many forms of severe prejudice and discrimination in various settings, such as education, employment, and interpersonal relationships. However, research aimed at reducing obesity stereotyping is relatively rare, and prior studies have focused primarily on negative stereotypes. Based on the empathy-altruism hypothesis and self-other overlap hypothesis, this study investigates the impact of perspective taking (PT) on both positive and negative obesity stereotypes and examines the mediating effects of empathy and self-other overlap. A sample of 687 students (191 males and 496 females) at Chinese universities participated by completing self-report questionnaires on trait tendency and evaluation toward obese people. Structural equation modeling and the bootstrap method revealed that self-other overlap (but not empathy) mediated the relationship between PT and negative obesity stereotypes. While self-other overlap and empathy both mediated the relationship between PT and positive obesity stereotypes. These findings address the importance of PT for improving positive and negative obesity stereotypes: specifically, PT promotes psychological merging, and produces empathic concern (EC).

Consider the context: An analysis of personal social networks of caregivers of children participating in a paediatric weight management program

Social networks influence the health and well-being of children and families. This study aimed to identify and understand the social networks of caregivers of children participating in the KidFit Health and Wellness Clinic, a paediatric weight management program. An egocentric social network analysis was used. Caregivers with children enrolled in KidFit participated in semi-structured interviews by completing a personal network map and discussing the individuals in their social networks and their influence on them and their family. Twenty-two caregivers (90.9% mothers) completed the interview. Four structural patterns were identified within the networks: existence of a core, star-shaped network, well-connected network and existence of multiple clusters. Healthcare providers and family had the most influence within the caregivers' networks. With the exception of healthcare providers, individuals who communicated less frequently with caregivers tended to have less influence on caregivers. Internet resources, activity-related resources and social media were the top three services, resources or supports that caregivers reported accessing. It is important that practitioners working with children and families within paediatric settings recognize the unique sociocultural context of each family. Reconceptualising a care model that includes community and incorporates services, supports and resources beyond the clinic could enhance treatment.

"Better If They Laugh with Me than at Me": The Role of Humor in Coping with Obesity-Related Stigma in Women

This study investigated the role of perceived stigmatization in the relationship between humor styles and coping with stress among young women suffering from stigma due to obesity. In the 21st century, obesity is an increasing global health issue with many physical and mental consequences for obese women. As a chronic stigmatizing disease, it requires that the affected individuals cope with social consequences; women with obesity are more prone to such consequences than men. Humor fosters the breaking of stereotypes and alleviating the consequences of stigmatization. A total of 127 young adult women (age M = 25.74, SD = 2.73) participated in the study (n = 54 with overfat and n = 73 with healthy fat). Participants filled out the Humor Styles Questionnaire, Perceived Stigmatization Questionnaire, and the Brief COPE Scale. Anthropometric data were gathered using a body composition analyzer. Results indicate that, when perceiving hostile behaviors toward themselves and using humor as a coping strategy, women with overfat select maladaptive styles of humor (i.e., self-defeating and aggressive styles). Women with overfat were also more likely to use humor as a coping strategy in difficult situations. Furthermore, none of the participants were satisfied with their body mass. At the same time, among women without obesity, a lack of compliments was not treated as a problem, even if they had high body fat.

Internalized weight stigma and the relationship between weight perception and negative body-related self-conscious emotions

Individuals who perceive themselves as "overweight" experience higher negative body-related self-conscious emotions than those who do not. Theoretical and empirical evidence suggests internalized weight stigma may be an important mediator of the relationship between weight perception and self-conscious emotions. Overcoming common measurement limitations and sampling limitations, the present study investigated whether gender moderates the associations among weight perceptions, internalized weight stigma, and negative body-related self-conscious emotions in 104 young adults (64 % women). Individuals who perceived themselves as too heavy (52 %) experienced higher body-related shame and guilt compared to those who perceived themselves as about right. Internalized weight stigma mediated these associations in women but not men, such that perceiving oneself as too heavy was associated with higher internalized weight stigma, which was associated with higher body-related shame and guilt in women. Results underscore the importance of internalized weight stigma as a potential target for intervention among women of diverse weight statuses who are prone to experiencing body-related shame and guilt.

"I don't want them to think that what they said matters": How treatment - seeking adolescents with severe obesity cope with weight-based victimization

Adolescents with severe obesity are subject to a high prevalence of weight-based victimization that may lead to pervasive mental health symptoms. However, different coping strategies could potentially modulate these psychological consequences. This study aims to explore how treatment-seeking adolescents with severe obesity cope with weight-based victimization. This was a qualitative research study using an interpretive phenomenological analytic approach. One-on-one semi structured interviews were completed with 19 adolescents (63% female) enrolled in a weight management program. The interviews were transcribed and sequentially analysed until data saturation was attained. The majority of participants (89.5%) described being a victim of weight-based victimization and highlighted a significant emotional toll. Two key themes were identified that captured the various coping strategies used by participants. Over half (52.9%) described approach coping strategies where they acted on the source to invoke change by standing up for themselves, helping others in similar situations or becoming a bully themselves. Whilst the majority (94.1%) used avoidant coping strategies such as feigning a strong exterior façade, denial, isolation and self-harm. Nearly half (47.1%) used both strategies. Treatment-seeking adolescents with severe obesity commonly use avoidant coping strategies to deal with weight-based victimization. These strategies are associated with negative mental health outcomes and should be evaluated when counselling adolescents with obesity who have experienced weight-based victimization.

Complexity and Stigma of Pediatric Obesity

Weight stigma is rooted in a fundamental misunderstanding of the origins of obesity, wherein the interplay of behavioral, environmental, genetic, and metabolic factors is deemphasized. Instead, the widespread societal and cultural presence of weight stigma fosters misconceptions of obesity being solely a result of unhealthy personal choices. Weight stigma is pervasive in childhood and adolescence and can affect individuals throughout their life. Although the prevalence of pediatric obesity remains high throughout the world, it becomes increasingly important to understand how weight stigma affects weight and health outcomes in children and adolescents with overweight or obesity, including in those with rare genetic diseases of obesity. We identified and reviewed recent literature (primarily published since 2000) on weight stigma in the pediatric setting. Articles were identified with search terms including pediatric obesity, weight bias, weight stigma, weight-based teasing and bullying, and weight bias in health care. In this narrative review, we discuss the stigma of pediatric obesity as it relates to the complex etiology of obesity as well as describe best practices for avoiding bias and perpetuating stigma in the health care setting.

Nutritional Characteristics, Sites of Origin, and Cost of Foods Consumed during School Hours and Their Relationship to Nutritional Status of Schoolchildren in Mexico City

Access, nutritional characteristics, preferences, and cost can affect food intake at school. A cross-sectional study was performed to determine the nutritional characteristics, sites of origin, and cost of foods consumed during school hours. Three hundred and sixty-nine children from five public elementary schools in Mexico City participated. The children gave information about the foods that they consumed five days out of the week during school hours, including the place of acquisition, cost of the food, and portion size. Anthropometric measurements of height and weight of the children were taken. Caloric consumption and percentage of recommended daily energy intake from food during school hours was determined. Children were 10.9 ± 0.9 years old; 55.6% were girls, 26% were overweight, 23% were obese, and 3.3% were of low height for age. The average calorie intake was 515 kilocalories (kcal) (boys, 535 kcal; girls, 476 kcal, p = 0.051); calorie intake was higher when school meal intakes included foods from home, school, and outside of school. No significant differences were found in calorie intake by children’s nutritional status. The cost in Mexican pesos per 100 kcal consumed showed differences according to the nutritional status of the children; it was 4.0 Mexican pesos for children with normal weight and 4.2 and 3.8 pesos in children who were overweight or obese, respectively. The information obtained in this study should be used to provide nutritional guidance. The food portion size intake during school hours should be reduced, and the food should come from one or at most two sites, because each extra food represents an increase in the total kilocalorie intake.

‘She Should Not Be a Model’: The Effect of Exposure to Plus-Size Models on Body Dissatisfaction, Mood, and Facebook Commenting Behaviour

Objectives: The present study investigated the exposure effect of plus-size models on body dissatisfaction and mood, and the nature of participants’ commenting behaviour towards images of plus-size models. Method: The study was comprised of 92 female university students who were exposed to Facebook photos of plus-size models. Participants were randomly allocated to having the exposed photo paired with positive, negative, or neutral comments, and participants were asked to leave an anonymous comment on each picture. Results: Results showed that participants had less body dissatisfaction and better mood after exposure to plus-size models regardless of the comment condition. Additionally, comment condition significantly influenced the type of comments participants contributed — in photos paired with negative comments, participants were significantly more likely to leave negative comments themselves, with 40% of participants leaving negative comments compared with 4% in the positive condition, and 12% in the neutral condition. Conclusion: This study provides evidence that the negative comments of plus-size models can encourage bystanders to contribute negative comments themselves; reinforcing the need to develop better protocols to oppose cyberbullying and encourage an online environment of positivity.

Exploring adolescent girls' experiences of body talk in non-aesthetic sport

INTRODUCTION

Body image concerns may contribute to poor sport experiences and low sport participation in girls. Objectification theory and evidence from studies in non-sport contexts suggests body talk may elicit an environment that fosters negative body image. However, the phenomenon of body talk within adolescent girls sport is not well-understood from an in-depth person-centered perspective. Therefore, the purpose of the present study was to explore adolescent girl athletes' experiences of body talk within sport.

METHODS

Twenty Canadian girl athletes (ages 14-18 years) enrolled in team-based non-aesthetic sports participated in one semi-structured interview. Using a qualitative description approach, an inductive thematic analysis was used to generate three themes.

RESULTS

"Body talk as a performance tactic" highlighted complimentary and negative body talk pertaining to sport performance came from coaches, opposing players, and parents. "Casual conversations and body talk" reflected body talk from teammates and male spectators that was not specific to sport but occurred in the sport context. "Coping with body talk" reflected strategies athletes used to combat negative body talk from teammates, and reflected the athletes' perceptions that negativity towards the body is normative.

CONCLUSIONS

Body talk served many purposes within sport; researchers should further explore the diverse motivations and perceived utility of body talk across sport stakeholders. Creating standardized resources and policies to eliminate body talk may foster more positive and supportive sport experiences for girls.

Associations between weight-based teasing and disordered eating behaviors among youth

Weight-based teasing (WBT) is commonly reported among youth and is associated with disinhibited and disordered eating. Specifically, youth who experience WBT may engage in disordered eating behaviors to cope with the resultant negative affect. Therefore, we examined associations between WBT and disordered eating behaviors among youth and assessed whether negative affect mediated these relationships. Two hundred one non-treatment seeking youth (8-17y) completed questionnaires assessing WBT, disinhibited eating, depression, and anxiety. Disordered eating and loss-of-control (LOC) eating were assessed via semi-structured interview. Analyses of covariance were conducted to examine relationships between WBT and eating-related variables, and bootstrapping mediation models were used to evaluate negative affect (a composite of depressive and anxiety symptoms) as a mediator of these associations. All models were adjusted for sex, race, age, and adiposity. Among 201 participants (13.1 ± 2.8y; 54.2% female; 30.3% Black; 32.8% with overweight/obesity), WBT was associated with emotional eating, eating in the absence of hunger, and disordered eating attitudes and behaviors (ps ≤ 0.02). These associations were all mediated by negative affect. WBT was also associated with a threefold greater likelihood of reporting a recent LOC eating episode (p = .049). Among boys and girls across weight strata, WBT was associated with multiple aspects of disordered eating and these relationships were mediated by negative affect. Longitudinal studies are needed to clarify the directionality of these associations and to identify subgroups of youth that may be particularly vulnerable to WBT and its sequelae.

The Influence of Weight Bias on Processes and Outcomes in Negotiation

In two studies, using a mix of samples, we examined the influence of weight bias on behaviors in competitive, potentially high stakes situations. As predicted, weight bias directed focal actors' treatment of counterparts in a negotiation. Negotiators made lower value offers to overweight counterparts relative to average-weight counterparts. In addition, overweight counterparts also received more negative messages over the course of their negotiation and were evaluated less favorably after the negotiation than average-weight counterparts.

Social anxiety moderates the relationship between body mass index and motivation to avoid exercise

Higher weight individuals experience frequent weight-related discrimination, which is associated with exercise avoidance. Exercise is a health behavior with multiple physical and mental health benefits and should be accessible to all. The current study examined another factor that might influence exercise in addition to weight stigma: social anxiety (SA). Given the often public nature of exercise, individuals with SA may feel scrutinized when exercising, which may lead to avoidance. This study examined whether SA moderates the relationship between body mass index (BMI) and exercise and whether SA and its interaction with BMI predict exercise behavior after accounting for weight stigma. We administered an online survey to 603 undergraduates (72 % female, 60 % White). SA was not significantly associated with BMI, but it was positively associated with weight stigma and exercise-avoidance motivation and negatively associated with self-reported exercise. SA moderated the relationship between BMI and exercise-avoidance motivation; individuals with higher BMIs were motivated to avoid exercise, but only if they reported higher SA. This interaction predicted exercise-avoidance motivation after accounting for weight stigma and its interaction with BMI. However, SA did not moderate the relationship between BMI and self-reported exercise. SA may be associated with exercise avoidance among higher weight individuals.

Weight-based teasing in youth: Associations with metabolic and inflammatory markers

BACKGROUND

Research among adults suggests that weight stigma is associated with worsened cardiometabolic health. However, these relationships have not been examined among youth.

OBJECTIVE

Assess associations between weight-based teasing (WBT) and metabolic and inflammatory markers among two samples of youth: (1) a non-treatment-seeking sample and (2) a weight loss treatment-seeking sample with obesity.

METHOD

Weight, height, adiposity, waist circumference and blood pressure were measured. Fasting blood samples were collected for metabolic (triglycerides, glucose, high-density lipoprotein cholesterol) and inflammatory analytes (high-sensitivity C-reactive protein in Study 1 and erythrocyte sedimentation rate in both studies). Youths completed the Perception of Teasing Scale, a measure of WBT. Metabolic and inflammatory indices were compared between those with and without teasing, adjusting for demographics and body composition.

RESULTS

Study 1 enrolled 201 non-treatment-seeking youth (M_age = 13.1y; 54.2% female; 44.8% non-Hispanic White; 32.8% with overweight/obesity); 15.4% reported WBT. Study 2 enrolled 111 treatment-seeking adolescents with obesity (M_age = 14.0y; 66.7% female; 37.8% non-Hispanic White); 73.0% reported WBT. Adjusting for covariates, WBT was not associated with cardiometabolic risk factors in either study.

CONCLUSIONS

WBT was not associated with worsened cardiometabolic health. Longitudinal research is needed to elucidate associations between WBT and health in youth.

Motivations to exercise in young men following a residential weight loss programme conducted in National Service - a mixed methods study

Background

Physical activity is a critical component of lifestyle interventions to reduce body weight and maintain weight loss. The goal of this study was to examine the motivations to exercise in young men following a 5-month residential weight loss programme conducted in the Singapore military as part of National Service.

Methods

We conducted a sequential mixed methods study starting with three focus groups comprising 21 programme instructors. Fifteen former programme participants aged 20.8 years (±1.4) with an average body mass index (BMI) of 29.3 kg/m² (±4.6) were interviewed in-depth over a total duration of 9 h. Another 487 current programme participants aged 20.8 years (±1.1), BMI 27.1 kg/m² (±2.6), completed a survey on weight loss, physical fitness, and motivations to exercise using the Behaviours Regulating Exercise Questionnaire (BREQ-3). Qualitative data was coded thematically using the six constructs of exercise motivation described by self-determination theory: amotivation, external, introjected, identified and integrated regulation and intrinsic motivation. Quotes from interviewees were cross-tabulated according to their weight maintenance trajectories. BREQ-3 responses were analysed according to initial body mass index (BMI), percentage weight loss and fitness.

Results

Over the course of the residential programme interview and survey participants experienced an average weight loss of 15.6 kg (±6.5) and 13.0 kg (±5.4) respectively. Among the fifteen interviewees seven had gained no more than 34% of initial weight loss 6 months after completing the programme while another eight had gained more than 51%. We elicited three key themes from the data: (1) Barriers to exercise; (2) diminishing extrinsic motivation; and (3) unidentified exercise benefits. The integration of findings uncovered reinforcing motivational patterns in the areas of health, fitness, camaraderie and identified regulation. Narratives of self-acceptance and shift-work environments gave rise to potentially deleterious motivational patterns. Our findings suggest that successful transition from a residential programme to independent weight management requires a more deliberate pivot from predominantly extrinsic to intrinsic motivational approaches.

Conclusion

Residential programmes such as the one investigated here, should develop a deliberate transition strategy, replace weight loss targets with physical performance goals and promote sports that are appropriate for young men affected by overweight and obesity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10373-z.

Neural Mechanisms of Food Decision-Making in Children

PURPOSE OF REVIEW

The goal of the current paper is to review the literature on the neural and behavioral factors involved in food decision-making in youth.

RECENT FINDINGS

Recent neuroimaging studies that employ passive viewing paradigms have found that exposure to food-related cues activate reward, motor planning, and attentional salience signals in children. Greater activations of reward signals and/or lower activations of control signals are associated with overeating and weight gain. Neuroimaging studies with decision-making paradigms have found the reward network in the brain activates during food choices, while control network activates less strongly. Findings suggest that exposure to food cues activates reward/valuation network, but activation of control network tends to be relatively weaker in children. Hedonic aspects of foods are predominantly considered in children's food choices, and their dietary self-control is not matured yet. The increased activation in reward network and the decreased activation in control network are associated with risk of developing obesity.

Common health conditions in childhood and adolescence, school absence, and educational attainment: Mendelian randomization study

Good health is positively related to children's educational outcomes, but relationships may not be causal. Demonstrating a causal influence would strongly support childhood and adolescent health as important for education policy. We applied genetic causal inference methods to assess the causal relationship of common health conditions at age 10 (primary/elementary school) and 13 (mid-secondary/mid-high school) with educational attainment at 16 and school absence at 14-16. Participants were 6113 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Exposures were symptoms of attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), depression, asthma, migraines and BMI. Genetic liability for these conditions and BMI was indexed by polygenic scores. In non-genetic, multivariate-adjusted models, all health conditions except asthma and migraines were associated with poorer attainment and greater school absence. School absence substantially mediated effects of BMI (39.9% for BMI at 13) and migraines (72.0% at 10), on attainment with more modest mediation for emotional and neurodevelopmental conditions. In genetic models, a unit increase in standardized BMI at 10 predicted a 0.19 S.D. decrease (95% CI: 0.11, 0.28) in attainment at 16, equivalent to around a 1/3 grade lower in all subjects, and 8.7% more school absence (95% CI:1.8%,16.1%). Associations were similar at 13. Genetic liability for ADHD predicted lower attainment but not more absence. Triangulation across multiple approaches supports a causal, negative influence on educational outcomes of BMI and ADHD, but not of ASD, depression, asthma or migraine. Higher BMI in childhood and adolescence may causally impair educational outcomes.

Modeling Obesity in Norway (The MOON Study): A Decision-Analytic Approach-Prevalence, Costs, and Years of Life Lost

BACKGROUND

Limited knowledge exists on the expected long-term effects and cost-effectiveness of initiatives aiming to reduce the burden of obesity.

AIM

To develop a Norwegian obesity-focused disease-simulation model: the MOON model.

MATERIAL AND METHODS

We developed a Markov model and simulated a Norwegian birth cohort's movement between the health states "normal weight,""overweight,""obese 1,""obese 2," and "dead" using a lifetime perspective. Model input was estimated using longitudinal data from health surveys and real-world data (RWD) from local and national registers (N = 99,348). The model is deterministic and probabilistic and stratified by gender. Model validity was assessed by estimating the cohort's expected prevalence, health care costs, and mortality related to overweight and obesity.

RESULTS

Throughout the cohort's life, the prevalence of overweight increased steadily and stabilized at 45% at 45 y of age. The number of obese 1 and 2 individuals peaked at age 75 y, when 44% of women and 35% of men were obese. The incremental costs per person associated with obesity was highest in older ages and, when accumulated over the lifetime, higher among women (€12,118, €9,495-€15,047) than men (€6,646, €5,252-€10,900). On average, obesity shortened the life expectancy of women/men in the whole cohort by 1.31/1.08 y. The life expectancy for normal-weight women/men at age 30 was 83.31/80.31. The life expectancy was reduced by 1.05/0.65 y if the individual was overweight, obese (2.87/2.71 y), or obese 2 (4.06/4.83 y).

CONCLUSION

The high expected prevalence of obesity in the future will lead to substantial health care costs and large losses in life-years. This underscores the need to implement interventions to reduce the burden of obesity; the MOON model will enable economic evaluations for a wide range of interventions.

The impact of change in neighborhood poverty on BMI trajectory of 37,544 New York City youth: a longitudinal study

BACKGROUND

Neighborhood poverty may increase childhood obesity risk. However, evidence for the neighborhood poverty-obesity relationship is limited. The purpose of this study was to examine how moving to a higher or lower poverty neighborhood impacts body mass index (BMI) z-score trajectories among youth, with the goal of informing policy change, interventions, and clinical practices to reduce childhood obesity.

METHODS

Methods entailed secondary analysis of existing longitudinal data. The sample included youth attending New York City public schools in grades kindergarten through twelfth from school years 2006/2007 through 2016/2017. Eligibility criteria included moving to a higher or lower poverty neighborhood during the data midpoint [school years 2010/2011 through 2013/2014] of the 12-year data-period; New York City-specific metrics were used to define both neighborhood (Neighborhood Tabulation Area) and relevant neighborhood poverty levels (< 5, 5 to < 10%, 10 to < 20%, 20 to < 30%, 30 to < 40% and ≥ 40% of individuals below Federal Poverty Level). Two-piece latent growth curve models were used to describe BMI z-score trajectories of youth who moved to higher versus lower poverty neighborhoods, with propensity score weighting to account for preexisting differences between the two groups. Primary analyses were stratified by sex and exploratory subgroup analyses were stratified by sex and developmental stage (early childhood, middle childhood, and adolescence) to explore sensitive periods for neighborhood poverty exposure.

RESULTS

Of 532,513 youth with home address data, 18,370 youth moved to a higher poverty neighborhood and 19,174 moved to a lower poverty neighborhood (n = 37,544). Females and males who moved to a higher poverty neighborhood experienced less favorable BMI z-score trajectories for obesity risk, though effects were small. Exploratory subgroup analyses demonstrated that negative effects of neighborhood poverty were most pronounced among young and adolescent females and young males, whereas effects were mixed for other subgroups.

CONCLUSIONS

Youth who moved to higher poverty neighborhoods experienced less favorable BMI z-score trajectories for obesity risk, though effects were small and most consistent for females and younger youth. Additional research is needed to illuminate neighborhood poverty's impact on obesity, in order to inform policy, intervention, clinical, and research efforts to reduce obesity and improve child well-being.

Clinical Leadership and Management Perceptions of Inpatients with Obesity: An Interpretative Phenomenological Analysis

While obesity is recognized as a key global public health issue, there has been no research to date on the perceptions of care for people with this condition held by individuals in positions of organizational power. The aim of this study was therefore to describe the perceptions and experiences of clinical leaders and managers of providing care to inpatients with obesity at a metropolitan public health service. This study applied an interpretative phenomenological analysis (IPA) approach to qualitative research, conducting interviews with 17 participants. Their perceptions of care for inpatients with obesity encompassed both their personal understanding as an individual, and their observations about the organizational, patient and carer perspectives. Three overall themes were identified: (1) the problem of inpatients with obesity, (2) inpatients with obesity as sources of risk and (3) personal and professional perceptions of inpatients with obesity. While clinical leaders and managers were aware of the potential impact of stigma and weight bias on care given to this cohort, elements of implicit bias, stereotyping, "othering" and ambivalence were frequently present in the data. Ongoing efforts to improve care for patients with obesity must therefore include efforts to address perceptions and attitudes at all organisational levels of the workforce.

Prenatal and Pediatric Primary Care-Based Child Obesity Prevention Program: A Randomized Trial

OBJECTIVES

To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families.

METHODS

A randomized controlled trial comparing mother-infant pairs receiving either standard care or the Starting Early Program providing prenatal and postpartum nutrition counseling and nutrition parenting support groups targeting key obesity-related feeding practices in low-income groups. Primary outcomes were reduction in weight-for-age z-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects.

RESULTS

Pregnant women (n = 566) were enrolled in the third trimester; 533 randomized to intervention (n = 266) or control (n = 267). Also, 358 children had their weight measured at age 2 years; 285 children had weight measured at age 3 years. Intervention infants had lower mean WFAz at 18 months (0.49 vs 0.73, P = .04) and 2 years (0.56 vs 0.81, P = .03) but not at 3 years (0.63 vs 0.59, P = .76). No group differences in obesity prevalence were found. When generalized estimating equations were used, significant average treatment effects were detected between 10-26 months (B = -0.19, P = .047), although not through age 3 years. In within group dose analyses at 3 years, obesity rates (26.4%, 22.5%, 8.0%, P = .02) decreased as attendance increased with low, medium, and high attendance.

CONCLUSIONS

Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.

Internalized weight stigma and the progression of food addiction over time

Food addiction is associated with elevated levels of eating pathology, body image concerns, and internalized weight stigma. The role of internalized weight stigma in the progression of addictive-like eating has not been explored. This longitudinal study explored the relative contributions of weight-related self-devaluation and fear of being stigmatized by others in predicting changes in addictive-like eating behavior over time. 305 young adults (M_age = 18.7 years, SD = 1.1, range 18-28, M_BMI = 21.9 kg/m², SD =3.7 kg/m², range 13.7-38.9 kg/m²) completed online measures of "food addiction," weight-related self-devaluation, and fear of stigma from others at two time points (follow-up M = 280 days, SD = 30, range 155-474). At baseline, 7.9 % exhibited clinically relevant addictive-like eating behavior, 40.3 % self-classified as being "addicted to food", and 51.8 % neither. Using cross-lagged modelling, fear of being stigmatized, but not self-devaluation, was a predictor of worsening "food addiction" status over time. Fear of weight stigma, rather than weight-related self-devaluation per se, may be an important predictor of problematic eating behavior. As weight stigma is prevalent in Western populations, these findings have potential implications for the development of problem eating behaviors in non-clinical samples.

The Associations between Childhood Obesity, Academic Performance, and Perception of Teachers: From Kindergarten to Fifth Grade

Background: Obesity is weakly associated with negative academic achievement among school-aged children. The purpose of this study is to demonstrate the relationships between reading/mathematics scores (objective) and teachers' perception of learning ability (subjective) and childhood obesity-from kindergarten to fifth grade. Methods: This study examined a longitudinal study of a nationally representative sample of 18,174 children who were enrolled in kindergarten in 2010 in the United States (ECLS-K:2011). Weighted multiple logistic regression models were used to examine the associations between objective scores, subjective scores, and obesity (vs. healthy-weight children). Results: In the crude analyses, obesity was negatively associated with achieving above-median reading and mathematics scores. After adjusting for sex, race/ethnicity, age, and socioeconomic status (SES), the association weakened but was still present. Children with obesity were less likely to achieve above-median reading and mathematics scores than their healthy-weight peers (odds ratio [OR] 0.77 and 0.86 for reading; OR 0.85, 0.67, 0.79, 0.82, and 0.75 for mathematics). Similarly, teachers reported that children with obesity did not have Approaches to Learning and Attentional Focusing as good as their healthy-weight peers regardless of their objective test scores and SES (OR 0.82, 0.80, 0.78, 0.69, and 0.77 for Approaches to Learning; OR 0.80, 0.81, 0.83, 0.82, 0.80, and 0.74 for Attentional Focusing). Conclusions: Obesity during elementary school years is negatively associated with both objective and subjective measures of academic performance. Further studies are needed to understand if the connection is stemming from behavioral issues of children, weight-based bias of teachers, or both.

Intrapersonal predictors of weight bias internalization among elementary school children: a prospective analysis

BACKGROUND

Weight-related stigmatization is a widespread problem. Particularly the internalization of weight-related stereotypes and prejudices (weight bias internalization, WBI) is related to mental and physical health impairments. To date, little is known about the risk factors of WBI. Previous studies are mainly cross-sectional and based on adult samples. As childhood is a sensitive period for the development of a healthy self-concept, we examined predictors of WBI in children.

METHODS

The final sample included 1,463 schoolchildren (6-11 years, 51.7% female) who took part in a prospective study consisting of three measurement waves. The first two waves delivered data on objective weight status and self-reported weight-related teasing, body dissatisfaction, relevance of one's own figure, self-esteem and depressive symptoms; WBI was measured during the third wave. To examine predictors of WBI, we ran hierarchical regression analyses and exploratory mediation analyses.

RESULTS

Lower parental education level, higher child weight status, female gender, experience of teasing, higher body dissatisfaction, higher figure-relevance, and higher depression scores were found to be predictive for higher WBI scores. Body dissatisfaction (only for girls) and the relevance of one's own figure (both genders) mediated the association between self-esteem and WBI; no weight-related differences were observed.

CONCLUSIONS

Our study offers longitudinal evidence for variables that enable the identification of children who are at risk for WBI. Thus, the findings deliver starting points for interventions aimed at the prevention of adverse health developments that come along with WBI.

Weight Status and School Bullying Experiences in Urban China: The Difference Between Boys and Girls

This article examined the associations between weight status (body mass index [BMI] and perceived weight measures) and school bullying experiences (being bullied and bullying others) of children and adolescents in urban China. A national representative sample (n = 3,675) of all types of pre-college schools from seven Chinese cities was employed for the analysis. Students from all grades in high school, vocational school, middle school, and primary grades 4 to 6 were surveyed. Height, weight, perceived weight status, and experiences of being bullied and bullying others were obtained. The results demonstrated that the objective weight status (BMI) was neither associated with being bullied overall by others nor associated with bullying others, but the subjective/perceived weight status was significantly related to being bullied. Regarding the specific forms of being bullied, underweight (measured by BMI) students were less likely to be cyberbullied, whereas obese (measured by BMI) students were more likely to be cyberbullied. Students who perceived themselves as slightly fat and too fat were more likely to be verbally bullied. Overweight and obese students were more likely to bully others physically and relationally, and the students who perceived themselves as too thin were positively associated with physically bullying others. Moreover, BMI had a role in the involvement in school bullying for boys, whereas perceived weight status had a role in school bullying involvement in girls. These results indicate that school bullying prevention and intervention should consider weight status, as well as gender differences.

Demographic, psychological, behavioral, and cognitive correlates of BMI in youth: Findings from the Adolescent Brain Cognitive Development (ABCD) study

BACKGROUND

Previous research has implicated demographic, psychological, behavioral, and cognitive variables in the onset and maintenance of pediatric overweight/obesity. No adequately-powered study has simultaneously modeled these variables to assess their relative associations with body mass index (BMI; kg/m2) in a nationally representative sample of youth.

METHODS

Multiple machine learning regression approaches were employed to estimate the relative importance of 43 demographic, psychological, behavioral, and cognitive variables previously associated with BMI in youth to elucidate the associations of both fixed (e.g. demographics) and potentially modifiable (e.g. psychological/behavioral) variables with BMI in a diverse representative sample of youth. The primary analyses consisted of 9-10 year olds divided into a training (n = 2724) and test (n = 1123) sets. Secondary analyses were conducted by sex, ethnicity, and race.

RESULTS

The full sample model captured 12% of the variance in both the training and test sets, suggesting good generalizability. Stimulant medications and demographic factors were most strongly associated with BMI. Lower attention problems and matrix reasoning (i.e. nonverbal abstract problem solving and inductive reasoning) and higher social problems and screen time were robust positive correlates in the primary analyses and in analyses separated by sex.

CONCLUSIONS

Beyond demographics and stimulant use, this study highlights abstract reasoning as an important cognitive variable and reaffirms social problems and screen time as significant correlates of BMI and as modifiable therapeutic targets. Prospective data are needed to understand the predictive power of these variables for BMI gain.

The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery

INTRODUCTION

Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear.

MATERIALS AND METHODS

Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden.

RESULTS

A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first- or second-generation immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001).

CONCLUSION

At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.

The effects of parental and peer factors on psychiatric symptoms in adolescents with obesity

PURPOSE

The aim of this study was to examine the relationships among psychiatric symptoms, effect of beliefs and attitudes of parents about obese people and victimization or bullying in obese adolescents.

METHODS

The study group included 110 obese or overweight adolescents and 55 adolescents of normal weight as the control group. All adolescents completed the Brief Symptom Inventory (BSI) and Traditional Bullying Scale. The parents completed the Attitudes Toward Obese Persons (ATOP) Scale and Beliefs About Obese Persons (BAOP) Scale.

RESULTS

The BSI subscale scores for depression were significantly higher in the study group. There was no significant relationship found between psychiatric symptoms of obese or overweight adolescents and the ATOP and BAOP scores of parents. When victims, bullies/victims, bullies and those not included in any group among obese or overweight adolescents were examined, psychiatric symptoms of victims and bullies/victims were significantly higher.

CONCLUSIONS

The results of this study suggest that the clinical treatment of obesity is not just a matter of diet and exercise but additionally dealing with issues of depression and anxiety. A very satisfactory result of the study was that parents of obese or overweight adolescents did not show an increased weight bias. This study has also shown the association between negative social and psychological ramifications, as the study group was more likely to be the victims and perpetrators of bullying behaviors than their normal-weight peers.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Health-related quality of life among 13-14 year old adolescents with overweight-a mixed methods approach

BACKGROUND

Overweight and obesity are public concerns with risk of adverse health outcomes. Health-related quality of life (HRQoL) is lower in adolescents than children in general. An increase in body mass index (BMI) is associated with a decrease in HRQoL. The purpose of this study was to measure and explore the HRQoL among adolescents with overweight or obesity who had participated in an intervention study, Young & Active, with the aim of increasing physical activity (PA), reducing BMI and promoting HRQoL.

METHODS

Mixed methods, with a convergent design, were used to investigate how different methodological approaches could expand our understanding of the adolescents' HRQoL. Quantitative post-intervention data on HRQoL were collected among the 84 intervention participants, aged 13-14 years, using the KIDSCREEN 52 questionnaire. The data were compared with a Norwegian reference population of 244 individuals, and analysed using a non-parametric Mann-Whitney test. Qualitative semi-structured interviews were conducted with 21 adolescents from the intervention. A directed approach to content analysis was adopted, using the ten sub-scales from KIDSCREEN 52.

RESULTS

HRQoL in the intervention sample was significantly reduced on the sub-scale of physical well-being compared to the reference population. The reference population scored significantly lower than the intervention sample on the sub-scale of parent relation and home life. No significant differences were found on the other sub-scales. The qualitative data supported the quantitative findings on the sub-scale of physical well-being, but showed that perceptions of fitness, energy level or health could vary. Regarding parent relations, the interviewees extended this to include relationships to other family members as equally important. Most of the interviewees expressed a negative view of their bodies, but not their clothing or accessories. This may explain why no statistically significant differences were found on these aspects in the results from the KIDSCREEN questionnaire.

CONCLUSION

The use of the KIDSCREEN 52 instrument gave important indications about the adolescents' HRQoL and need for additional follow up. The qualitative data provided an in-depth understanding that nuanced the findings and widened our knowledge of the adolescents HRQoL. Combining methods enabled a comprehensive approach to research on HRQoL.

What's the name? Weight stigma and the battle against obesity

Childhood obesity has spread worldwide, it is on the rise, starts earlier and is more severe, despite all treatment attempts.

According to recent studies, weight stigma is a factor that can hinder the success of therapies. Healthcare workers, mainly paediatricians, need to feel the urgency of anti-stigma training. The use of non-stigmatizing terminologies and images in various areas (school, sports clubs, healthcare, media, society in general) can improve disease management.

Negative Social Evaluation Impairs Executive Functions in Adolescents With Excess Weight: Associations With Autonomic Responses

BACKGROUND

Adolescents with excess weight suffer social stress more frequently than their peers with normal weight.

PURPOSE

To examine the impact of social stress, specifically negative social evaluation, on executive functions in adolescents with excess weight. We also examined associations between subjective stress, autonomic reactivity, and executive functioning.

METHODS

Sixty adolescents (aged 13-18 years) classified into excess weight or normal weight groups participated. We assessed executive functioning (working memory, inhibition, and shifting) and subjective stress levels before and after the Trier Social Stress Task (TSST). The TSST was divided into two phases according to the feedback of the audience: positive and negative social evaluation. Heart rate and skin conductance were recorded.

RESULTS

Adolescents with excess weight showed poorer executive functioning after exposure to TSST compared with adolescents with normal weight. Subjective stress and autonomic reactivity were also greater in adolescents with excess weight than adolescents with normal weight. Negative social evaluation was associated with worse executive functioning and increased autonomic reactivity in adolescents with excess weight.

CONCLUSIONS

The findings suggest that adolescents with excess weight are more sensitive to social stress triggered by negative evaluations. Social stress elicited deterioration of executive functioning in adolescents with excess weight. Evoked increases in subjective stress and autonomic responses predicted decreased executive function. Deficits in executive skills could reduce cognitive control abilities and lead to overeating in adolescents with excess weight. Strategies to cope with social stress to prevent executive deficits could be useful to prevent future obesity in this population.

The Associations Between Self-Perceived Actual and Ideal Body Sizes and Physical Activity Among Early Adolescents

PURPOSE

This study examined the association between self-perceived actual and ideal body sizes and objectively assessed moderate-to-vigorous physical activity (MVPA) among adolescents, controlling for puberty, fat mass index, and sex. A secondary objective was to explore the association between objectively assessed fat mass index and MVPA.

METHODS

Participants were 438 early adolescents (Mage = 11.61, SD = 0.92). Participants selected body sizes that represented their self-perceived actual and ideal bodies. Participants then wore an accelerometer for 1 week to assess MVPA. Polynomial regression analysis with response surface methods was used to explore MVPA in relation to the discrepancy and agreement (ie, no discrepancy) between self-perceived actual and ideal body sizes.

RESULTS

When self-perceived actual and ideal body sizes were in agreement and represented smaller and larger bodies, MVPA was low. Participants with similar self-perceived actual and ideal bodies in the middle of the body-size spectrum demonstrated the highest levels of MVPA. The direction and degree of the discrepancy between self-perceived actual and ideal bodies were not significantly associated with MVPA. Fat mass index was significantly and negatively associated with MVPA.

CONCLUSIONS

These findings may inform physical activity promotion programs and provide methodological contributions to the study of how body image and MVPA are related.