Weight-based victimization toward overweight adolescents: observations and reactions of peers

The stress of stigma: exploring the effect of weight stigma on cortisol reactivity

OBJECTIVE

To determine the physiological impact of exposure to weight stigma by examining alterations in salivary cortisol among lean and overweight women.

METHODS

Participants were 123 lean and overweight adult women (mean body mass index = 26.99 [7.91] kg/m(2)). Participants' salivary cortisol was assessed both before and after either a weight stigmatizing or a neutral video. Participants completed self-report measures of mood and reactions to the video. Height and weight were obtained at the conclusion of the study.

RESULTS

Participants in the stigmatizing condition exhibited significantly greater cortisol reactivity when compared with those in the neutral condition, irrespective of weight status (Pillai trace = 0.077; F(1,85) = 7.22, p = .009). Lean and overweight women in the stigmatizing condition were equally likely to find the video upsetting and were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.

CONCLUSIONS

Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.

Weight-related teasing in the school environment: associations with psychosocial health and weight control practices among adolescent boys and girls

Weight-related teasing has been found to be associated with low self-esteem, depressive symptoms, body dissatisfaction, and weight control behaviors in adolescents. While research has typically examined weight-related teasing directed towards the individual, little is known about weight-related teasing at the school level. This study aimed to determine the association between the school-level prevalence of weight-related teasing and psychosocial factors, body dissatisfaction and weight control behaviors in adolescents. Adolescents (N = 2,793; 53.2% female) attending 20 US public middle and high schools were surveyed as part of the Eating and Activity in Teens (EAT) 2010 study. Generalized estimating equations were used to estimate the association between school-level weight-related teasing and health variables, controlling for individual-level weight-related teasing, clustering of individuals within schools, and relevant covariates. A greater school-level prevalence of weight-related teasing was associated with lower self-esteem and greater body fat dissatisfaction in girls, and greater depressive symptoms in boys, over and above individual-level weight-related teasing. Dieting was associated with the school-level prevalence of weight-related teasing in analysis adjusted for covariates in girls, but not following adjustment for individual-level weight-related teasing. Unhealthy weight control behaviors, extreme weight control behaviors, and muscle-enhancing behaviors were not associated with the school-level prevalence of weight-related teasing in girls or boys. Findings from the current study, in conjunction with previous findings showing associations between weight-related teasing, psychological concerns, and weight control behaviors, highlight the importance of implementing strategies to decrease weight-related teasing in schools.

Relationship of weight-based teasing and adolescents' psychological well-being and physical health

BACKGROUND

To date, research has focused primarily on psychological correlates of weight-based teasing. In this study, we extended previous work by also examining physical health-related variables (eg, physical self-concept and physical fitness [PF]).

METHODS

Participants included 1419 middle school students (637 boys and 782 girls). Of these, 245 (17.3%) reported being teased about being overweight. Participants completed measures of self-esteem, depression, physical self-concept, physical activity (PA) self-efficacy, and self-report physical and sedentary activities. Participants also completed PF testing.

RESULTS

After controlling for demographic characteristics, participants who were teased about being overweight had higher scores on depression and lower scores on self-esteem, physical self-concept, PA self-efficacy, and health-related measures of PF in comparison to participants who were not teased.

CONCLUSIONS

The results of this study support previous research indicating relationships between teasing and low levels of psychological well-being, physical self-concept, and PA self-efficacy, and establishes one between weight-based teasing and different types of PF. Research is needed to determine the potential causal nature of the relationships between teasing and fitness and evidence-based interventions are needed to reduce weight-based teasing and its potential effects on health and well-being.

Children's perceptions of weight, obesity, nutrition, physical activity and related health and socio-behavioural factors

OBJECTIVE

Approximately one-third of children in the USA are either overweight or obese. Understanding the perceptions of children is an important factor in reversing this trend.

DESIGN

An online survey was conducted with children to capture their perceptions of weight, overweight, nutrition, physical activity and related socio-behavioural factors.

SETTING

Within the USA.

SUBJECTS

US children (n 1224) aged 8-18 years.

RESULTS

Twenty-seven per cent of children reported being overweight; 47·1% of children overestimated the rate of overweight/obesity among US children. A higher percentage of self-classified overweight children (81·9%) worried about weight than did self-classified under/normal weight children (31·1%). Most children (91·1%) felt that it was important to not be overweight, for both health-related and social-related reasons. The majority of children believed that if someone their age is overweight they will likely be overweight in adulthood (93·1%); get an illness such as diabetes or heart disease in adulthood (90·2%); not be able to play sports well (84·5%); and be teased or made fun of in school (87·8%). Children focused more on food/drink than physical activity as reasons for overweight at their age. Self-classified overweight children were more likely to have spoken with someone about their weight over the last year than self-classified under/normal weight children.

CONCLUSIONS

Children demonstrated good understanding of issues regarding weight, overweight, nutrition, physical activity and related socio-behavioural factors. Their perceptions are important and can be helpful in crafting solutions that will resonate with children.

Bullying, adverse childhood experiences and use of texting to promote behavior change

PURPOSE OF REVIEW

This article addresses three areas in which new research demonstrates the potential to impact the health of children and adolescents: bullying, adverse childhood experiences (ACEs) and texting to promote behavior change.

RECENT FINDINGS

Recent research on bullying emphasizes its impact on children with chronic medical conditions, and highlights cyber bullying as a rising issue. ACEs are now recognized as risk factors for many health issues, particularly mental health problems. Text messaging is a promising new method to communicate with parents and adolescent patients.

SUMMARY

Pediatric healthcare providers can help patients with chronic medical problems by addressing bullying at well child visits. Screening for ACEs may identify children at risk for mental health issues. Incorporating text messaging into clinical practice can improve disease management and patient education.

Parental concerns about weight-based victimization in youth

BACKGROUND

The present study aimed to assess parental perceptions of weight-based victimization (WBV) and its consequences for children's health as well as how perceptions of WBV vary by parental and child weight status.

METHODS

A national sample of American parents with children ages 2-18 years (N=918) completed an online questionnaire to assess their perceptions of how common WBV is, compared to other forms of victimization among youth, their level of concern with this issue both generally and for their own child, and their perceptions of behavioral and psychological consequences of WBV. Descriptive statistics and censored regression models with standardized coefficients were used to analyze the data.

RESULTS

Fifty-three percent of parents perceived "being overweight" to be the most common reason that youth are bullied, regardless of parental or child weight status. Parents, both with and without overweight children, endorsed similar levels of general concern about WBV and its psychological and behavioral consequences for youth. However, parents with overweight children were substantially more concerned about WBV affecting their child(ren) and perceived it to be more common, serious, and posed risks to their child(ren)'s health, compared to parents without overweight children.

CONCLUSIONS

The present study, to the best of the authors' knowledge, is the first to indicate that parents have substantial concerns about WBV and its health consequences for youth. These findings highlight the need for educators and pediatric healthcare providers to be aware that WBV is a common concern among families, and suggest that increased efforts are needed to address WBV.

Attitudes of health care professionals towards female obese patients

OBJECTIVE

The health care setting has been reported to be one main source of weight stigma repeatedly; however, studies comparing different professions have been lacking.

METHODS

682 health care professionals (HCP) of a large German university hospital were asked to fill out a questionnaire on stigmatizing attitudes, perceived causes of obesity, and work-related impact of obesity. Stigmatizing attitudes were assessed on the Fat Phobia Scale (FPS) based on a vignette describing a female obese patient.

RESULTS

Only 25% graded current health care of obese patients to be 'good' or 'very good'. 63% of all HCPs 'somewhat' or 'strongly' agreed that it was often difficult to get the resources needed in order to care for obese patients. The mean FPS score was comparable to that in the general public (M = 3.59), while nursing staff showed slightly more positive attitudes compared to physicians and therapists. Higher age, higher BMI, and ascribing personal responsibility for obesity to the individual were associated with a higher level of stigmatizing attitudes. The nursing staff agreed on obesity as an illness to a greater extent while physicians attributed obesity to the individual.

CONCLUSIONS

In summary, by making complex models on the causes of obesity known among health care professionals, stigmatizing attitudes might be reduced. Ongoing further education for health care professionals ought to be part of anti-stigma campaigns in the medical field.

When overweight is the normal weight: an examination of obesity using a social media internet database

Using a large social media database, Yahoo Answers, we explored postings to an online forum in which posters asked whether their height and weight qualify themselves as "skinny," "thin," "fat," or "obese" over time and across forum topics. We used these data to better understand whether a higher-than-average body mass index (BMI) in one's county might, in some ways, be protective for one's mental and physical health. For instance, we explored whether higher proportions of obese people in one's county predicts lower levels of bullying or "am I fat?" questions from those with a normal BMI relative to his/her actual BMI. Most women asking whether they were themselves fat/obese were not actually fat/obese. Both men and women who were actually overweight/obese were significantly more likely in the future to ask for advice about bullying than thinner individuals. Moreover, as mean county-level BMI increased, bullying decreased and then increased again (in a U-shape curve). Regardless of where they lived, posters who asked "am I fat?" who had a BMI in the healthy range were more likely than other posters to subsequently post on health problems, but the proportions of such posters also declined greatly as county-level BMI increased. Our findings suggest that obese people residing in counties with higher levels of BMI may have better physical and mental health than obese people living in counties with lower levels of BMI by some measures, but these improvements are modest.

Perceived weight discrimination and obesity

Weight discrimination is prevalent in American society. Although associated consistently with psychological and economic outcomes, less is known about whether weight discrimination is associated with longitudinal changes in obesity. The objectives of this research are (1) to test whether weight discrimination is associated with risk of becoming obese (Body Mass Index≥30; BMI) by follow-up among those not obese at baseline, and (2) to test whether weight discrimination is associated with risk of remaining obese at follow-up among those already obese at baseline. Participants were drawn from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US residents. A total of 6,157 participants (58.6% female) completed the discrimination measure and had weight and height available from the 2006 and 2010 assessments. Participants who experienced weight discrimination were approximately 2.5 times more likely to become obese by follow-up (OR = 2.54, 95% CI = 1.58-4.08) and participants who were obese at baseline were three times more likely to remain obese at follow up (OR = 3.20, 95% CI = 2.06-4.97) than those who had not experienced such discrimination. These effects held when controlling for demographic factors (age, sex, ethnicity, education) and when baseline BMI was included as a covariate. These effects were also specific to weight discrimination; other forms of discrimination (e.g., sex, race) were unrelated to risk of obesity at follow-up. The present research demonstrates that, in addition to poorer mental health outcomes, weight discrimination has implications for obesity. Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity.

Prevalence of severe obesity among New Zealand adolescents and associations with health risk behaviors and emotional well-being

OBJECTIVE

To describe the prevalence of severe obesity among New Zealand young people attending secondary school and the associations of severe obesity with health risk behaviors and emotional well-being.

STUDY DESIGN

A random sample of 9107 secondary school students in New Zealand participated in a 2007 health survey. Participants had their height and weight measured and answered an anonymous survey on multiple aspects of their health and well-being.

RESULTS

Overall, 2.5% of students met the International Obesity Task Force definition of severe obesity. Students with severe obesity had more weight-related concerns, were more likely to have used unhealthy weight control strategies, and were more likely to experience bullying compared with healthy weight students. For example, students with severe obesity were 1.7 times more likely to have been bullied at school (95% CI 1.2-2.7) and 1.9 times more likely to vomit for weight loss (95% CI 1.1-3.3) than were healthy weight students. Indicators of emotional well-being and most health risk behaviors were similar among young people with severe obesity and a healthy weight.

CONCLUSIONS

Clinicians who work with young people with severe obesity should prioritize discussing issues of bullying and healthy weight control strategies with families and their children.

Weightism, racism, classism, and sexism: shared forms of harassment in adolescents

PURPOSE

To document the prevalence of harassment on the basis of weight, race/ethnicity, and socioeconomic status, as well as sexual harassment, among a diverse population of adolescents. Specifically, this study examined rates of each type of harassment reported across groups within the corresponding sociodemographic category (e.g., racial/ethnic category differences in prevalence of racial harassment), and also explored patterns of "cross-harassment" (i.e., differences in prevalence of each harassment type across all other sociodemographic characteristics).

METHODS

We used data from Project Eating and Activity in Teens 2010 for the study. The sample was composed of 2,793 adolescents (53% female; 81% nonwhite). We conducted regression analyses to yield prevalence estimates of each type of harassment in each demographic and body mass index category.

RESULTS

Weight- and race-based harassment (35.3% and 35.2%, respectively) was most prevalent, followed by sexual harassment (25.0%) and socioeconomic status-based harassment (16.1%). Overweight and obese adolescents reported disproportionately higher rates of all forms of harassment than did normal-weight and underweight adolescents. In addition, Asian and mixed-/other race adolescents were more vulnerable to harassment overall compared with those from other racial/ethnic groups.

CONCLUSIONS

Harassment experiences are prevalent among adolescent boys and girls. Differential rates of each type of harassment are reported across groups within the corresponding sociodemographic category, but a pattern of cross-harassment also is evident, such that differences in prevalence of each type of harassment emerge across a variety of sociodemographic characteristics. Adolescents from various intersecting sociodemographic and weight-status groups are particularly vulnerable to certain types of harassment.

A multilevel assessment of school climate, bullying victimization, and physical activity

BACKGROUND

This study integrated criminological and public health perspectives to examine the influence of bullying victimization and the school environment on physical activity (PA).

METHODS

We used a weighted sample of 7786 US middle school students surveyed as part of the Health Behavior in School-Aged Children study to conduct a multilevel analysis of bullying victimization as a predictor of self-reported PA and number of days attending physical education (PE) classes. Hierarchical models assessed the contribution of school climate and anti-crime programs.

RESULTS

Results indicated that bullying victimization was associated with fewer days in PE and lower odds of reporting at least 60 minutes of PA more than once a week. Although one of the school crime prevention policies examined was associated with more days in PE, the school-level factors did not account for a large portion of the variance in the 2-level models for either days in PE or PA.

CONCLUSIONS

The results suggest that reduced levels of PA can be added to the growing list of health issues associated with bullying victimization and provide support for the importance of bullying prevention efforts in conjunction with health promotion programs targeted to middle school students.

Three- and five-year follow-up of a combined inpatient-outpatient treatment of obese children and adolescents

Aim. “The combined DAK therapy for obesity in children and adolescents” combines a 6-week inpatient with a 10.5-month outpatient treatment. The aim of the study is to evaluate whether the therapeutic achievements are maintained two and four years after intervention. Method. All subjects who had participated in the 12-month program in 2004/2005 were included in the follow-up study. Body weight, height, and physical fitness were assessed through direct measurements, behaviour, and quality of life by self-report questionnaires. Statistical analysis is based on an intention-to-treat analysis. Results. The response rate after three years was 63.4% and 42.2% after five years. Within three years, participants reduced their BMI-SDS significantly by 0.20 (SD 0.49) and by 0.15 (SD 0.51) within five years. Significant positive changes could be observed with respect to the participants eating behaviour. Similarly, the food intake, particularly the consumption of calorie-reduced beverages, increased significantly while that of nonrecommended foods decreased. Improvement was also seen in the subjective quality of life as well as several aspects of self-perception. Conclusion. Compared to baseline data, significant reduction of BMI-SDS and positive changes of health-related behaviours could be observed even three and five years after the start of the initial program.

Weight discrimination and bullying

Despite significant attention to the medical impacts of obesity, often ignored are the negative outcomes that obese children and adults experience as a result of stigma, bias, and discrimination. Obese individuals are frequently stigmatized because of their weight in many domains of daily life. Research spanning several decades has documented consistent weight bias and stigmatization in employment, health care, schools, the media, and interpersonal relationships. For overweight and obese youth, weight stigmatization translates into pervasive victimization, teasing, and bullying. Multiple adverse outcomes are associated with exposure to weight stigmatization, including depression, anxiety, low self-esteem, body dissatisfaction, suicidal ideation, poor academic performance, lower physical activity, maladaptive eating behaviors, and avoidance of health care. This review summarizes the nature and extent of weight stigmatization against overweight and obese individuals, as well as the resulting consequences that these experiences create for social, psychological, and physical health for children and adults who are targeted.

Causal information on children's attitudes and behavioural intentions toward a peer with obesity

BACKGROUND

This study examined the effect of types of causal information about overweight on children's attitudes and intentions toward a peer presented as overweight.

METHODS

Participants (N = 176) were randomly assigned to read a vignette of an overweight peer in one of three conditions, which varied in the explanatory information provided for the aetiology of the peer's overweight condition: biological, environmental or no causal information, along with a vignette of an average-weight peer.

RESULTS

The provision of information that the overweight was the result of biological factors and of no causal information yielded more positive attitudes toward the overweight peer compared to those who were provided with environmental information. Information on overweight had no impact on behavioural intentions. A social desirability bias was found for each of the three experimental conditions and for the average weight condition.

CONCLUSION

Information explaining overweight had a minimal positive effect on attitudes and no effect on intentions toward an overweight peer.

Weight-based victimization: bullying experiences of weight loss treatment-seeking youth

OBJECTIVE

Few studies have comprehensively examined weight-based victimization (WBV) in youth, despite its serious consequences for their psychosocial and physical health. Given that obese and treatment-seeking youth may be highly vulnerable to WBV and its negative consequences, the current study provides a comprehensive assessment of WBV in a weight loss treatment-seeking sample.

METHODS

Adolescents (aged 14-18 years; N = 361) enrolled in 2 national weight loss camps were surveyed. An in-depth assessment of WBV was conducted by using an online survey, in which participants indicated the duration, typical locations, frequent perpetrators, and forms of WBV they had experienced.

RESULTS

Findings indicate that 64% of the study participants reported WBV at school, and the risk of WBV increased with body weight. Most participants reported WBV enduring for 1 year (78%), and 36% were teased/bullied for 5 years. Peers (92%) and friends (70%) were the most commonly reported perpetrators, followed by adult perpetrators, including physical education teachers/sport coaches (42%), parents (37%), and teachers (27%). WBV was most frequently reported in the form of verbal teasing (75%-88%), relational victimization (74%-82%), cyberbullying (59%-61%), and physical aggression (33%-61%). WBV was commonly experienced in multiple locations at school.

CONCLUSIONS

WBV is a prevalent experience for weight loss treatment-seeking youth, even when they are no longer overweight. Given the frequent reports of WBV from adult perpetrators in addition to peers, treatment providers and school personnel can play an important role in identifying and supporting youth who may be at risk for pervasive teasing and bullying.

Strategies to address weight-based victimization: youths' preferred support interventions from classmates, teachers, and parents

Weight-Based Victimization is a frequent experience for adolescents who are overweight or obese, and is associated with numerous psychosocial and physical consequences for those who are targets of victimization. Assessing targets` preferences for different types of support and intervention has been absent in the context of weight-based victimization, but is needed to help inform potential interventions, motivate action, and identify strategies to help adolescents cope with experiences of weight-related teasing or bullying. Adolescents (14-18 years, N = 361, 40 % female, 71 % Caucasian) enrolled in national weight-loss camps completed an on-line survey. Participants who reported previous experiences of weight-based victimization were surveyed about their preferred interventions from peers, friends, teachers, Physical Education (PE) teachers/coaches, and parents. Participants indicated their preferences for specific strategies pertaining to target support, bullying intervention and prevention (e.g., inclusion in peer activities, confronting the bully, telling an adult, and improving anti-bullying policies). Friends (66 %) and peers (58 %) were the most highly preferred intervention agents followed by teachers (55 %), PE teachers/coaches (44 %), and parents (43 %). Participants who experienced more weight-based victimization expressed increased desire for intervention. The frequency of victimization, social support from friends and family, and perceived likelihood and helpfulness of intervention significantly influenced participant preferences for certain types of intervention, although preferences were generally consistent across participants' characteristics. The current study is the first to document youth's preferences for interventions in response to weight-based victimization. The findings have important implications for encouraging appropriate intervention and informing bystanders, which may help to reduce the prevalence, recurrence, and consequences for youth who are targets of weight-based teasing or bullying.

Obese children, adults and senior citizens in the eyes of the general public: results of a representative study on stigma and causation of obesity

Obese individuals are blamed for their excess weight based on causal attribution to the individual. It is unclear whether obese individuals of different age groups and gender are faced with the same amount of stigmatization. This information is important in order to identify groups of individuals at risk for higher stigmatization and discrimination. A telephone interview was conducted in a representative sample of 3,003 participants. Experimental manipulation was realized by vignettes describing obese and normal-weight children, adults and senior citizens. Stigmatizing attitudes were measured by semantic differential. Causal attribution was assessed. Internal factors were rated with highest agreement rates as a cause for the vignette's obesity. Lack of activity behavior and eating too much are the most supported causes. Importance of causes differed for the different vignettes. For the child, external causes were considered more important. The overweight vignette was rated consistently more negatively. Higher educational attainment and personal obesity were associated with lower stigmatizing attitudes. The vignette of the obese child was rated more negatively compared to that of an adult or senior citizen. Obesity is seen as a controllable condition, but for children external factors are seen as well. Despite this finding, they are faced with higher stigmatizing attitudes in the general public, contradicting attribution theory assumptions. Internal and external attribution were found to be inter-correlated. Obese children are the population most at risk for being confronted with stigmatization, making them a target point in stigma-reduction campaigns.

Camp SHINE

According to the National Health and Nutritional Examination Survey (NHANES), in 2008, more than one third of children and adolescents were overweight or obese. This article describes the use of a residential, medically supervised summer camp to help overweight and obese children prevent excessive summertime weight gain. The theoretical framework guiding the program was Rosenstock’s health belief model (HBM). The weight loss results are included as well as information concerning adaptations of physical activities, environmental design considerations, and creating a supportive atmosphere, to meet the unique needs of this population. Data show that weight loss can be achieved for overweight/obese children/teens in residential camps designed to develop healthy behaviors.

Gene-environment interactions related to body mass: School policies and social context as environmental moderators

This paper highlights the role of institutional resources and policies, whose origins lie in political processes, in shaping the genetic etiology of body mass among a national sample of adolescents. Using data from Waves I and II of the National Longitudinal Study of Adolescent Health, we decompose the variance of body mass into environmental and genetic components. We then examine the extent to which the genetic influences on body mass are different across the 134 schools in the study. Taking advantage of school differences in both health-related policies and social norms regarding body size, we examine how institutional resources and policies alter the relative impact of genetic influences on body mass. For the entire sample, we estimate a heritability of .82, with the remaining .18 due to unique environmental factors. However, we also show variation about this estimate and provide evidence suggesting that social norms and institutional policies often mask genetic vulnerabilities to increased weight. Empirically, we demonstrate that more-restrictive school policies and policies designed to curb weight gain are also associated with decreases the proportion of variance in body mass that is due to additive genetic influences.

Experiences of weight stigmatization: a review of self-report assessment measures

BACKGROUND

Overweight and obese persons are vulnerable to frequent stigmatization and discrimination because of their weight. Despite widespread prejudice towards obese persons, many questions remain regarding the nature, extent, and impact of weight-based stigmatization experienced by so many people. However, improving our knowledge in this area will only be as good as the measures we have to study this phenomenon. Our paper is the first to provide a comprehensive summary of published quantitative self-report measures available for assessing experiences of weight stigmatization in children and adults.

METHODS

This review examined 22 measures of self-reported weight stigmatization and highlights the strengths and limitations of existing assessment.

RESULTS

Existing measures contain a number of limitations and have been assessed in samples lacking diversity. Improvements in measurement are needed to achieve a clearer understanding of the nature and extent of self-perceived weight stigmatization and to develop measures that accurately reflect this type of stigmatization.

CONCLUSIONS

Specific directions for future research that will help improve measurement of self-perceived weight stigmatization and advance this area of study are highlighted.