Obesity and bullying: different effects for boys and girls

Using therapeutic board games to promote child mental health

This article focuses on group work with children using a board game format. Combining the principles of group work and board games helps to engage and motivate children and adolescents to address and work through their difficulties. Lifegames are a series of six therapeutic board games developed for group work with children and adolescents who encounter adversity in their life as a consequence of bereavement, family break up, poor relationships, bullying, chronic illness or obesity. The games facilitate the understanding and disclosure of the complex feelings experienced by children and young people when they are confronted with traumatic life events. The games encourage and assist the participants to obtain and maintain behavioural change. Lifegames are a means to assist professionals in their group work with children and adolescents.

Psychosocial issues in youth with type 2 diabetes mellitus

Little published research exists on psychosocial issues in adolescents with type 2 diabetes mellitus (T2DM), because until two decades ago, diabetes diagnosed in children and adolescents was almost exclusively type 1 diabetes mellitus or insulin-dependent diabetes. In the past two decades, rates of T2DM have increased, especially in adolescents from families of minority racial and ethnic groups. Youth with T2DM are most often obese, have a parent or other first-degree relative with T2DM, and are of low socioeconomic status. To understand the complex set of interrelated psychological and social influences that affect the well-being of youth with T2DM, levels of influence from determinants of genetics, family, and community/societal and minority ethnic groups must be included.

Examining attendance, academic performance, and behavior in obese adolescents

Although academics and safety continue to rank as high-priority issues in public schools, educators and administrators are beginning to recognize the importance of student health on school success. This move toward a holistic approach suggests that efforts to improve a student's physical, social, and emotional well-being are as important as efforts to increase test scores. Adolescent obesity is epidemic, and it is a complex integration of social, psychological, and physical factors that exacerbate the turbulent transitional years of adolescence. Adolescents are vulnerable to issues related to weight, and they are at risk for suffering obesity's negative effects, thereby resulting in unfortunate school outcomes such as decreased rates of attendance, poor academic performance, and school suspensions. Disparities related to overweight and obesity exist; therefore, the negative effects of obesity may disproportionately affect minorities and poor schoolchildren. Examining school outcomes for the overweight or obese adolescent is crucial and may provide valuable insight into constructive changes required for a responsive school environment.

Consequences of Childhood Obesity

Introduction: The incidence of childhood obesity is rising across the globe, and obesity related co-morbidities are increasing concomitantly in the paediatric population. Materials and Meth- ods: PubMed search for research and review papers on complications of childhood obesity was performed. Results: The consequences of childhood obesity can be broadly classified into medical and psychosocial consequences. Medical consequences include metabolic complications such as diabetes mellitus, hypertension, dyslipidaemia and non-alcoholic fatty liver disease, and me- chanical problems such as obstructive sleep apnoea syndrome and orthopaedic disorders. Psychological and social consequences are prevalent but often overlooked. Local data on these complications were also discussed. Conclusion: Childhood obesity is associated with significant morbidities, which not only have immediate impact on the health of the obese children, but also significantly increase the risk of morbidities in adulthood. Key words: Medical consequence, Psychosocial consequence

Racial/ethnic differences in weight-related teasing in adolescents

OBJECTIVE

The current study examined general, peer, and family weight teasing across race/ethnicity and weight status (average weight, overweight, obese) in adolescents. For those participants who reported peer or family weight teasing, the extent to which this teasing bothered them was also reported.

METHODS AND PROCEDURES

Data were from the first wave of Project EAT (Eating Among Teens), a longitudinal study of eating and weight-related variables in 4,746 adolescent boys and girls. Participants completed a survey and their height and weight were measured.

RESULTS

Prevalences of general weight teasing were similar across race/ethnicity. Asian-American boys, black boys, and Asian-American girls reported lower prevalences of peer teasing than whites. Hispanic, Asian-American, and mixed/other girls reported higher prevalences of family weight teasing than did white girls. In nearly all racial/ethnic groups for all three teasing variables, obese adolescents were significantly more likely to report having been teased, compared to average-weight adolescents. In some racial/ethnic groups overweight adolescents were also significantly more likely than average-weight adolescents to report having been teased. Among girls who were teased, fewer black and mixed/other girls were bothered by peer teasing, compared to white girls. Similarly, fewer girls from most racial/ethnic groups were bothered by family weight teasing, compared to white girls.

DISCUSSION

The results of the current study suggest that weight-based teasing is a problem for all youth, and especially so for overweight and obese youth, regardless of racial/ethnic group. Asian-American adolescents may experience somewhat less weight teasing from peers, and possibly more weight teasing from family members. One-quarter to one-half of those teased by family or peers were bothered by it, and more white girls were bothered than other groups. Efforts to eradicate weight stigmatization could provide benefits to a sizable number of adolescents across a variety of racial and ethnic groups.

The impact of weight-related victimization on peer relationships: the female adolescent perspective

OBJECTIVE

Obesity is associated with undesirable psychological and social consequences. This qualitative study examined the relationship between obesity and victimization, and the impact this has on peer relationships.

METHODS AND PROCEDURES

Five obese female adolescents participated in multiple, semi-structured, in-depth interviews. Interview transcriptions were analyzed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Weight-related victimization experiences were common and their impact on peer relationships was complex. Low self-confidence, isolation, and peer anxiety were all identified as resulting from victimization and were all barriers to developing peer relationships. Participants sought protection from victimization by seeking the "ideal" nonjudgmental empathetic best friend(s) and supportive family members to shield them from negative experiences. However there was also evidence that, while they were guarded with their own feelings, the experience of victimization increased empathy in these obese female adolescents.

DISCUSSION

Social and psychological consequences of obesity in female adolescents are widespread, suggesting the importance of listening to those affected. Peer relationships have the opportunity to both amplify and reduce the psychological impact of living with obesity and victimization. Greater understanding of the social networks of obese adolescents and their impact on well-being is needed, as well as methods to reduce negative experiences through childhood obesity treatment and school-based prevention programs.

Stigmatization of obese children and adolescents, the importance of gender

To review the literature on stigmatization of overweight girls and boys, with a specific attention to gender differences, a search was performed in the medical as well as the psychological literature. The following databases, Medline, PsycINFO, EMBASE, Scopus, Web of Science and Cochrane as well as Google were used to retrieve information. Finally, chain references were sought. The search was concluded mid-2006. In total, 17 studies were identified. The results from the studies generally indicated that overweight girls seemed to experience a higher degree of stigmatization than overweight boys. The overweight girls were to a larger degree teased about their weight and relationally, verbally and physically bullied. In addition, they were more socially marginalized in respect to friendships and romantic relationships. Stigmatization of overweight children and adolescents indeed occurs, but is more prevalent in overweight girls than overweight boys. There is a need to conduct further studies that are specifically designed to evaluate gender differences in stigmatization of overweight children and adolescents, and for studies focusing on preventing this stigmatization.

Social implications of overweight and obesity in children

PURPOSE

To elucidate some of the social impacts that overweight and obesity in children has on families. Healthcare practitioners may be unaware of these impacts if not similarly affected.

DESIGN

Qualitative semistructured, interview-based study.

METHODS

A purposive sample of parents (n = 58) with overweight and obese children (n = 48) from three areas in the United Kingdom was used. Analysis was thematic and iterative, underpinned by Grounded Theory.

RESULTS

There are many social situations that have an impact on the child directly (stigmatization), on parents (blame), and on the family in general (being ostracized).

PRACTICE IMPLICATIONS

Seeing the child and his/her family in a broader context with improved understanding of the complexity of raising an overweight child.

Perceptions of weight discrimination: prevalence and comparison to race and gender discrimination in America

OBJECTIVE

Limited data are available on the prevalence and patterns of body weight discrimination from representative samples. This study examined experiences of weight/height discrimination in a nationally representative sample of US adults and compared their prevalence and patterns with discrimination experiences based on race and gender.

METHOD AND PROCEDURES

Data were from the National Survey of Midlife Development in the United States, a 1995-1996 community-based survey of English-speaking adults aged 25-74 (N=2290). Reported experiences of weight/height discrimination included a variety of institutional settings and interpersonal relationships. Multivariate regression analyses were used to predict weight/height discrimination controlling for sociodemographic characteristics and body weight status.

RESULTS

The prevalence of weight/height discrimination ranged from 5% among men to 10% among women, but these average percentages obscure the much higher risk of weight discrimination among heavier individuals (40% for adults with body mass index (BMI) of 35 and above). Younger individuals with a higher BMI had a particularly high risk of weight/height discrimination regardless of their race, education and weight status. Women were at greater risk for weight/height discrimination than men, especially women with a BMI of 30-35 who were three times more likely to report weight/height discrimination compared to male peers of a similar weight.

DISCUSSION

Weight/height discrimination is prevalent in American society and is relatively close to reported rates of racial discrimination, particularly among women. Both institutional forms of weight/height discrimination (for example, in employment settings) and interpersonal mistreatment due to weight/height (for example, being called names) were common, and in some cases were even more prevalent than discrimination due to gender and race.

ASSOCIATIONS BETWEEN SCHOOL BULLYING AND PSYCHOSOCIAL FACTORS

The aim of the study was to determine the relationship of bullying behavior at school with indicators of psychosocial health (self-esteem, happiness, relationships in family and with teachers, smoking and alcohol use) and with social-demographical factors (age, gender, socioeconomic status). Participants were 1,162 pupils from the 6th, 8th, and 11th grades of schools. A total of 56.5% of students were involved in bullying. 12.7% were ascribed as victims and 16.3% as bullies. Using logistic regression, it was established that involvement in bullying is most associated with grade (6th and 8th grades), masculine gender, tobacco smoking, lower self-esteem, and family teasing about appearance. Victimization was most associated with grade, masculine gender, lower self-esteem, unhappiness, and family teasing about appearance. For the bully, masculine gender, grades (6th and 8th), tobacco smoking and family teasing about appearance are typically associated factors. Results are interpreted against the background of other study findings, while emphasizing relevance of family teasing about appearance in bullying behavior.

Body mass index measurement in schools

BACKGROUND

School-based body mass index (BMI) measurement has attracted much attention across the nation from researchers, school officials, legislators, and the media as a potential approach to address obesity among youth.

METHODS

An expert panel, convened by the Centers for Disease Control and Prevention (CDC) in 2005, reviewed and provided expertise on an earlier version of this article. The panel comprised experts in public health, education, school counseling, school medical care, and a parent organization. This article describes the purposes of BMI measurement programs, examines current practices, reviews existing research, summarizes the recommendations of experts, identifies concerns, and provides guidance including a list of safeguards and ideas for future research.

RESULTS

The implementation of school-based BMI measurement for surveillance purposes, that is, to identify the percentage of students in a population who are at risk for weight-related problems, is widely accepted; however, considerable controversy exists over BMI measurement for screening purposes, that is, to assess the weight status of individual students and provide this information to parents with guidance for action. Although some promising results have been reported, more evaluation is needed to determine whether BMI screening programs are a promising practice for addressing obesity.

CONCLUSIONS

Based on the available information, BMI screening meets some but not all of the criteria established by the American Academy of Pediatrics for determining whether screening for specific health conditions should be implemented in schools. Schools that initiate BMI measurement programs should evaluate the effects of the program on BMI results and on weight-related knowledge, attitudes, and behaviors of youth and their families; they also should adhere to safeguards to reduce the risk of harming students, have in place a safe and supportive environment for students of all body sizes, and implement science-based strategies to promote physical activity and healthy eating.

Impact of psychosocial factors on quality of life in overweight youth

OBJECTIVE

The psychosocial functioning of overweight youth is a growing concern. Research has shown that overweight children report lower quality of life (QOL) than their non-overweight peers. This study sought to extend the literature by examining the association between peer victimization, child depressive symptoms, parent distress, and health-related QOL in overweight youth. Mediator models are used to assess the effect of child depressive symptoms on the relationship between psychosocial variables and QOL.

RESEARCH METHODS AND PROCEDURES

The sample consisted of 96 overweight and at-risk-for-overweight children (mean age=12.8 years) and their parents who were recruited from a Pediatric Endocrinology Obesity Clinic. Parents completed a demographic questionnaire, the Pediatric Quality of Life Inventory-parent-proxy version, and the Brief Symptom Inventory. Children completed the Children's Depression Inventory-Short Form, the Schwartz Peer Victimization Scale, and the Pediatric Quality of Life Inventory.

RESULTS

Increased parent distress, child depressive symptoms, and peer victimization were associated with lower QOL by both parent-proxy and self-report. Child depressive symptoms mediated the relationship between psychosocial variables (parent distress and peer victimization) for self-reported QOL but not for parent-proxy-reported QOL.

DISCUSSION

This study documented the important impact of peer victimization and parental distress on the QOL of overweight children. Expanding our understanding of how overweight children experience and interact with their environment is critical. Further research is needed to examine the mechanisms by which parent distress and peer victimization impact the development of depressive symptoms in overweight children, including coping and support strategies that may buffer these children against the development of depressive symptoms and ultimately lower QOL.

A meta-analysis of family-behavioral weight-loss treatments for children

Childhood obesity is a major concern in the United States. Because children's diets can be significantly influenced by parental behavior (e.g., food purchases, meal preparation), researchers have included family intervention components in some childhood weight-loss programs. The relative benefits of adding the family component have not been well-established. This meta-analysis compared the mean effect sizes of family-behavioral, other treatment, and control weight-loss groups for children. A comprehensive literature review identified 16 studies with a total of 44 treatment groups. Results indicated that interventions containing a family-behavioral component produced larger effect sizes than the alternative treatment groups. This demonstrates that the inclusion of a family component may be advantageous to a child's weight-loss treatment.

Sticks and stones can break...: building a case for when names can hurt you

Commentary on the paper by Griffiths et al (see page 121)