The Association Between Weight-Based Teasing from Peers and Family in Childhood and Depressive Symptoms in Childhood and Adulthood: A Systematic Review

Exploring the interplay of weight-based teasing and sociodemographic factors in adolescent weight bias internalization

OBJECTIVE

Research has highlighted the potential adverse effects of weight bias internalization (WBI) on adolescents, but there has been little examination of WBI and sources of weight teasing (family, peers, or both) or across racial/ethnic diversity of adolescents. We aimed to examine the relationship between WBI and sources of weight teasing across sociodemographic characteristics and weight status in a diverse community sample of adolescents.

METHODS

Data were collected from a U.S. sample of 1859 adolescents aged 10-17 years (59% female; 43% White, 27% Black or African American, and 25% Latino). An online questionnaire was used to assess participants' experiences of weight teasing from family members, peers, or both, and their weight status, weight-related goals, WBI, and sociodemographic characteristics.

RESULTS

Adolescents experiencing weight teasing from both family and peers reported the highest levels of WBI, while those reporting no teasing exhibited the lowest levels. These patterns were observed across sex, race/ethnicity, weight status, and weight goals, and persisted after controlling for depressive symptoms. Notably, family influences played a salient role, with adolescents reporting higher WBI if teased by family only compared to teasing from peers only. Sex and racial differences were also observed in adolescents' experiences with weight-based teasing.

CONCLUSION

Our study reveals associations between adolescent weight-based teasing, WBI, and sociodemographic factors. Weight-based teasing, whether from family and peers or from family only, was associated with increased WBI. Interventions targeting weight stigma in youth should not be limited to peer-focused efforts, but should also emphasize supportive family communication.

"A balancing act": parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment

Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.

Depressive Symptoms among Bariatric Surgery Candidates: Associations with Stigmatization and Weight and Shape Concern

Bariatric surgery candidates (BSC) are a highly vulnerable group for mental health impairments. According to the theoretical model of weight stigma, weight-related experienced stigmatization (ES) negatively influences mental health through weight bias internalization (WBI). This study tested this model among BSC and investigated whether this association depends on a negative body image in terms of weight and shape concern as a potential moderator. As part of a German multicenter study, ES, WBI, weight and shape concern, and depressive symptoms were assessed via self-report questionnaires among n = 854 BSC. Simple and moderated mediation analyses were applied to analyze whether WBI influences the relationship between ES and depressive symptoms, and whether this influence depends on weight and shape concern. WBI significantly mediated the relationship between ES and depressive symptoms by partially reducing the association of ES with depressive symptoms. Weight and shape concern emerged as significant moderators in the overall model and specifically for associations between WBI and depressive symptoms. The results suggest that the association between ES and depressive symptoms among BSC is stronger in those with high WBI. This association is strengthened by weight and shape concern, especially at low and mean levels. Studies evaluating longitudinal associations between weight-related stigmatization and mental health are indicated, as well as intervention studies targeting WBI in order to reduce adverse effects of ES on mental health in BSC.

Family body culture, disordered eating and mental health among young adult females during COVID-19

Different family interactions related to body weight and shape may co-occur and represent a broader 'family body culture'. This may be important in the context of COVID-19 due to a heightened focus on body weight/shape, and many young adults living back with their families. This study aimed to, first, explore relationships between different family body-related interactions to assess the presence of a family body culture, and second, explore relationships between aspects of family body culture, disordered eating and mental health among young adult females during the COVID-19 pandemic. Participants were 233 females aged 18-25 years who completed measures of family body culture (family fat talk; family weight concern; family weight teasing), disordered eating, anxiety and depression. Results showed all aspects of family body culture were significantly, positively related. Engaging in fat talk with family members (self fat talk) was a key correlate of disordered eating, anxiety and depression. Family concern with weight was also significantly associated with disordered eating. Findings suggest that among some families there is a more problematic family body culture with a greater importance placed on body weight and shape through various body-related interactions. Additionally, findings highlight two key aspects of family body culture related to disordered eating and wellbeing among young adult females. Specifically, vocalising critical remarks about one's own body when with family and an environment that may indirectly communicate a high importance of body weight and shape (e.g., via dieting). These should be considered in future family interventions to support healthy eating behaviours.

Individualized Implementation of Youth Quality of Life Instrument-Research Version (YQOL-R) Among Chinese Adolescents with Different Weight Status

Purpose

This study implemented the individualized Youth Quality of Life Instrument-Research Version (YQOL-R) to estimate the quality of life (QoL) among Chinese adolescents with three different Body Mass Index (BMI) levels. The study aims to explore and provide a reference for developing individualized QoL (IQoL) measurements in China.

Methods

The sample consisted of 822 aged 11-18 from nine schools. The data collection included all participants' primary characters (age, sex, annual household income, parental education, and recruitment community) and their self-report QoL. Precisely, based on the generic measurement of YQOL-R, we developed IQoL measurements by asking adolescents' perceived five most important things to them (IQOLimportance) and the aspects they most want to change (IQOLchange) from 19 facets, respectively. The one-way analysis of variance (ANOVA) was applied to compare total and subscale scores of IQOLimportance, IQOLchange, and YQOL-R among adolescents with three different weight status. Also, the data analysis used multivariable linear regression modeling to test the effects on scores of IQOLimportance and IQOLchange.

Results

Overall, the obese adolescents identified "Having good physical health" as the most important (54.03%) and most like-to-change (42.65%); in contrast, the normal-weight group ranked "Being myself" as the top facet of IQOLimportance (52.42%) and "Having good friends" as the top facet of IQOLchange (43.12%). The obese adolescents' reported IQOLimportance scores are significantly lower than those of the normal-weight group (P=0.039). However, there is no significant difference in IQOLchange score among the three weight-status groups. The multivariable linear regression models indicated that adolescents who are girls (P=0.035), have higher educated fathers (P=0.049), and are overweight/obese (P=0.041) self-reported worse IQOLimportance score; yet, the girls (P=0.023) and older adolescents (P=0.004) answered lower IQOLchange scores. In addition, adolescents who had higher educated mothers (P=0.047; 0.023) and responded with higher total YQOL-R scores (P<0.001; <0.001) reported higher IQOLimportance and IQOLchange scores.

Conclusion

In the current study, although the self-reported YQOL-R scores from different weight status did not present a significant difference, the obese group reported a statistical trend towards lower IQOLimportance scores than the normal-weight and overweight adolescents. These findings emphasize that IQOLimportance and IQOLchange could capture adolescents' perspectives with different weight statuses about their lives, which are unique as complementary health outcomes accompanying YQOL-R in health surveys and interventions among Chinese adolescents.

Weight discrimination, BMI, or weight bias internalization? Testing the best predictor of psychological distress and body dissatisfaction

OBJECTIVE

This study aimed: (1) to compare psychological distress (PD) and body dissatisfaction (BD) in terms of BMI, weight bias internalization (WBI), and weight discrimination (current and past); (2) to assess the best predictor of PD and BD and assess the relationships with weight discrimination, BD, and WBI.

METHODS

The sample consisted of 1283 participants across all BMI categories, recruited through the internet voluntarily. People with obesity were the most predominant (26.1%). Experiences of weight-based discrimination were reported by participants across all BMI categories, and they were more prevalent in people with obesity.

RESULTS

People with obesity, those with WBI, and those who faced current and past weight discrimination reported higher PD and higher BD. However, WBI was the best predictor after controlling for BMI, WBI, and current and past weight discrimination. Mediation analyses revealed that the relationship between weight discrimination and BD through WBI was significant, as was the relationship between weight discrimination and WBI through BD.

CONCLUSIONS

These results stressed the importance of WBI in PD and the role of weight discrimination in WBI and BD. Hence, there is a need to better understand how WBI is formed and to design effective interventions to reduce it.

Muscularity teasing and its relations with muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating in Chinese adult men

Despite increasing research on weight teasing and other forms of appearance teasing, muscularity teasing, which occurs when an individual is victimized due to low muscularity, has not yet received research attention. Given the solid evidence of positive relations between weight teasing and thinness-oriented body dissatisfaction and disordered eating, we aimed to tap into muscularity teasing and examine its relations with muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating (e.g., rigid dietary rules for enhancing muscularity). A sample of 500 Chinese men, aged 18 - 62 years, were recruited online, and they competed questionnaires assessing muscularity teasing, muscularity bias internalization, muscularity-oriented body dissatisfaction, and muscularity-oriented disordered eating. Correlation analyses showed that muscularity teasing was significantly related to muscularity bias internalization (r = 0.55, p < .001), muscularity-oriented body dissatisfaction (r = 0.50, p < .001), and muscularity-oriented disordered eating (r = 0.38, p < .001). Structural equation modelling indicated that muscularity bias internalization and muscularity-oriented body dissatisfaction, as concurrent mediators, fully mediated the relationships between muscularity teasing and muscularity-oriented disordered eating. Findings extend existing knowledge in appearance teasing research to encompass muscularity teasing in order to better understand the etiology of muscularity-oriented body dissatisfaction and muscularity-oriented disordered eating.

"I was bullied for being fat in every situation, in every outfit, at every celebration": A qualitative exploratory study on experiences of weight-based oppression in Qatar

Introduction

Weight-based oppression (WBO) has been documented as a widespread phenomenon in Western countries and is associated with a range of psychological, physiological, and behavioral harms. Research on weight-based oppression is largely absent from the Arab region.

Methods

We conducted a qualitative exploratory study using semi-structured in-depth interviews to examine the internalized attitudes, values, and beliefs related to body weight, and experiences of external weight-based oppression of 29 staff, faculty, and students at Qatar University.

Results

Thematic analysis revealed six major themes on the characteristics of internalized WBO, and the nature, timing, source, extent, and impact of external WBO. WBO was regarded as so common in the Arab culture as to be normative, with damaging exposure to WBO beginning in early childhood.

Conclusion

WBO in the Arab region is an important and unrecognized public health issue. Programs to reduce WBO should be developed in all sectors.

Obesity stigma and its impact on health: A narrative review

Weight stigma and weight bias are pervasive in our society and are based on wrong assumption that obesity derives basically from a lack self-discipline and personal responsibility, obviating recent evidence showing that obesity is a prevalent, complex, progressive, and relapsing chronic disease that results from the interaction between behavioural, environmental, genetic, and metabolic factors. This narrative review provides an overview of recent research on this problem, mainly focused on the negative impact of weigh stigma on health. Overall, recent evidence shows that weight stigma can contribute to worsening obesity-related problems and creating additional barriers to effective obesity care and prevention. In addition, a brief description of some of the most important international initiatives to address the weight stigma is provided.

Body Weight, Weight Self-Perception, Weight Teasing and Their Association with Health Behaviors among Chinese Adolescents-The Shanghai Youth Health Behavior Survey

Weight-related status has been associated with the physical and psychological health of adolescents. This cross-sectional study evaluated three different kinds of weight-related statuses (Body Mass Index (BMI), weight self-perception and weight teasing from others) among Chinese adolescents and identified their associations with health risk behaviors (lack of healthy dietary behavior, unhealthy dietary behavior, binge eating behavior, lack of physical activity (PA), sedentary behaviors (SB) and sleep disturbance). A stratified random cluster sampling method was used to select 10,070 students aged 11−18 years old from schools in Shanghai. Self-reported questionnaires were collected, weight-related statuses were divided into three categories and six specific health risk behaviors were classified into two groups: positive or negative. Overall, 27.82% of the adolescents were classified as being overweight and obese (35.61% of boys and 18.21% of girls), 43.45% perceived themselves as too heavy and 30.46% experienced weight teasing in the past. Among overweight or obese participants, 50.55% have been teased about their weight, and 77.48% perceived themselves as too heavy. Weight perception and weight teasing were significantly associated with health risk behaviors rather than the actual body weight status based on BMI, especially regarding binge eating behavior (body weight status (BMI): p > 0.05, underweight perception: OR = 1.18, 95%CI 1.03−1.34; weight teasing for more than once a year: OR = 2.00, 95%CI 1.76−2.27). In addition, weight perception and weight teasing were significantly associated with health risk behaviors, mainly in normal and overweight/obese groups but not in underweight groups. Weight teasing and weight self-perception play an independent and stronger role than actual body weight in the health behaviors of adolescents. This calls for more attention and intervention to reduce peer bullying and stigmas on weight among adolescents.

Teasing and Internet Harassment among Adolescents: The Mediating Role of Envy and the Moderating Role of the Zhong-Yong Thinking Style

Extant research studies have documented that teen victims of traditional bullying are more likely to be perpetrators of Internet harassment. Teasing is a typical form of verbal bullying, but, unfortunately, its link with Internet harassment perpetration has rarely been investigated to date. Therefore, this study constructed two moderated mediation models to explore the relation between weight-related/competency-related teasing (the two main types of teasing) and Internet harassment, and whether these associations are mediated by envy and moderated by the Zhong-Yong thinking style. A total of 1811 Chinese adolescents (M_age = 13.22 years, SD = 0.97) were investigated to examine the two models. The results clarified that: (1) weight-related/competency-related teasing was positively predictive of adolescent Internet harassment; (2) envy acted a partially mediating role in the associations between weight-related/competency-related teasing and Internet harassment; (3) the Zhong-Yong thinking style not only moderated the link between weight-related/competency-related teasing and envy, with the effect being more profound for a high-level Zhong-Yong thinking style possessed by adolescents, but also moderated the direct link between competency-related teasing and Internet harassment, with the relation being more potent when the level of Zhong-Yong thinking style was low. Nevertheless, the direct link between weight-related teasing and Internet harassment was not moderated by the Zhong-Yong thinking style. These findings are important to comprehend the psychological mechanisms linking weight-related/competency-related teasing to Internet harassment, and provide some enlightenment for preventing and intervening in adolescent Internet harassment perpetration.

"Negative Things That Kids Should Never Have to Hear": Exploring Women's Histories of Weight Stigma in Physical Activity

Scholars have proposed that cumulative experiences of anti-fat bias and stigma contribute to detrimental physical activity experiences, as well as social and health inequities. The objective of this research was to explore how enacted weight stigma experiences are constructed and impact women's physical activity experiences long term. Eighteen women who identified as having had negative experiences related to their body weight, shape, or size in physical activity contexts participated in semistructured interviews. Using reflexive thematic analysis, four themes were identified: (a) norms of body belonging, (b) distancing from an active identity, (c) at war with the body, and (d) acts of resistance. These findings deepen understandings of how historical experiences of weight stigma can have longstanding consequences on physical activity cognitions, emotions, and behaviors. To equitably promote physical activity, it is imperative that movement spaces (e.g., fitness centers, sport organizations) both target anti-fat stigma and adopt weight-inclusive principles.

Do weight perception and bullying victimization account for links between weight status and mental health among adolescents?

Background

The purpose of this study was to explore whether the way youth perceive their weight and their experiences of bullying victimization account for the increased risk of depression and anxiety symptoms, and poor psychosocial well-being, associated with overweight/obesity in a large sample of Canadian secondary school students. We also explored if associations differed by gender.

Methods

We used cross-sectional survey data from year 7 (2018–19) of the COMPASS study. The sample included 57,059 students in grades 9–12 (Secondary III-V in Quebec) at 134 Canadian secondary schools (Alberta, British Columbia, Ontario, Quebec). First, multiple regression models tested associations between body mass index (BMI) classification and mental health outcomes (anxiety [GAD-7] and depression [CESD-10] symptoms, and psychosocial well-being [Diener’s Flourishing Scale]). Second, weight perception and bullying victimization were added to the models. Models were stratified by gender and controlled for sociodemographic covariates and school clustering.

Results

When weight perception and bullying victimization were added to the models, obesity BMI status no longer predicted internalizing symptoms and flourishing scores relative to normal-weight BMIs. Students with ‘overweight’ or ‘underweight’ perceptions, and experiences of bullying victimization in the past month, reported higher anxiety and depressive symptomatology, and lower flourishing levels, in comparison to students with ‘about right’ weight perceptions and without experiences of bullying victimization, respectively, controlling for BMI status. Results were largely consistent across boys and girls.

Conclusions

Results suggest perceptions of weight and experiences of bullying independently contribute to differences in mental health outcomes by weight status among youth. Continued efforts targeting weight-based bullying and weight bias, and the promotion of body size acceptance and positive body image, may help reduce the risk of mental illness and poor mental health among adolescents.

Psychometric Properties of the Persian Version of the Teasing Questionnaire 23

The current study was a cross-sectional research and aimed to investigate the factor structure, internal consistency, and validities of the Persian version of the Teasing Questionnaire-Revised (TQ-R). Forward and backward translations of the TQ-R were performed; face and content validities were determined based on comments by a sample of psychology students and specialists. Using the cluster sampling method, 290 participants were recruited, and 201 valid data (M_age = 23.53, SD = 3.53, 64.2% men) were analyzed. The factor structure was assessed by confirmatory and exploratory factor analysis (EFA). The result of the confirmatory factor analysis(es) did not confirm the proposed three, four, and five-factor models. EFA revealed four factors with 23 items, explaining 52.03% of the total variance. The internal consistency of the Persian version of Teasing Questionnaire 23 was in the excellent range (α = 0.92), and its expected associations with external correlates (e.g., depression and anxiety) supported the measure’s convergent validity. The findings indicated that the Persian version of the TQ-R has sound psychometric properties and can be used as a valid and reliable tool in research and clinical outcomes.

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.

Weight misperception and psychological symptoms from adolescence to young adulthood: longitudinal study of an ethnically diverse UK cohort

BACKGROUND

To evaluate the association between weight misperception and psychological symptoms in the Determinants of young Adults Social well-being and Health (DASH) longitudinal study.

METHODS

A longitudinal sample of 3227 adolescents, in 49 secondary schools in London, aged 11-16 years participated in 2002/2003 and were followed up in 2005/2006. A sub-sample (N = 595) was followed up again at ages 21-23 years in 2012/2013. An index of weight misperception was derived from weight perception and measured weight. Psychological well- being was measured using the Strengths and Difficulties Questionnaire at 11-16 years and the General Health Questionnaire at 21-23 years. Associations with weight misperception was assessed using regression models, adjusted for socio-economic and lifestyle factors.

RESULTS

White British males and females were more likely than ethnic minority peers to report accurate perceptions of measured weight. At 11-13y, 46% females and 38% males did not have an accurate perception of their measured weight. The comparable figures at 14-16y were 42 and 40%. Compared with male adolescents, more females perceived themselves as overweight or were unsure of their weight but measured normal weight, and this was more pronounced among Indians, Pakistanis and Bangladeshis. At 14-16y, more males perceived themselves as underweight but measured normal weight, and this was more pronounced among Indians. Compared with those who had an accurate perception of their normal weight, a higher likelihood of probable clinically-relevant psychological symptoms was observed among those who measured normal weight but perceived themselves to be underweight (females Odds Ratio (OR) = 1.87 95% CI 1.03-3.40; males OR = 2.34 95% CI 1.47-3.71), overweight (females only OR = 2.06 95% CI 1.10-3.87), or unsure of their weight (males only OR = 1.61 95% CI 1.04-2.49). Among females, the association was driven by internalising rather than externalising symptoms. An accurate perception of overweight was associated with higher psychological symptoms in adolescence and early 20s. Ethnic specific effects were not evident.

CONCLUSION

Weight misperception may be an important determinant of psychological symptoms in young people, with an accurate perception of normal weight status being protective. Culturally targeted interventions should be considered to promote healthy perceptions of body image.

The importance of language in engagement between health-care professionals and people living with obesity: a joint consensus statement

Obesity is a chronic condition that requires long-term management and is associated with unprecedented stigma in different settings, including during interactions with the health-care system. This stigma has a negative effect on the mental and physical health of people with obesity and can lead to avoidance of health care and disruption of the doctor-patient relationship. Considerable evidence exists to suggest that simply having a conversation about obesity can lead to weight loss, which translates into health benefits. However, both health-care practitioners and people living with obesity report apprehension in initiating this conversation. We have collaborated with stakeholders from Obesity UK, physicians, dieticians, clinical psychologists, obesity researchers, conversation analysts, nurses, and representatives from National Health Service England Diabetes and Obesity. This group has contributed to the production of this consensus statement, which addresses how people living with obesity wish to have their condition referred to and provides practical guidance for health-care professionals to facilitate collaborative and supportive discussions about obesity. Expert stakeholders consider that changes to language used at the point of care can alleviate the stigma of obesity within the health-care system and support improved outcomes for both people living with obesity and for the health-care system.