Are K-12 school environments harming students with obesity? A qualitative study of classroom teachers

Tackling obesity while preventing obesity stigma

Obesity is a significant public health problem. Prevalence is rising in children and young people, with lifelong health impacts and implications for paediatric clinical practice. Obesity stigma is increasingly acknowledged as a problem within health services. Health professionals can inadvertently contribute to this stigma, which is harmful and in itself can promote weight gain. A complex web of factors contributes to obesity, and a simplistic approach exclusively focused on personal responsibility, diet and exercise is unhelpful. A more nuanced, sensitive and informed approach is needed, with careful use of language and non-judgemental partnership working.

"It's Not the Stereotypical 80s Movie Bullying": A Qualitative Study on the High School Environment, Body Image, and Weight Stigma

BACKGROUND

Schools are crucial for preventing negative health outcomes in youth and are an ideal setting to address weight stigma and poor body image. The current study sought to examine and describe the nature of weight stigma and body image in adolescents, ascertain aspects of the school environment that affect body image, and identify recommendations for schools.

METHODS

We conducted 24 semi-structured interviews with students at 2 high schools in 2020. Qualitative data were analyzed using inductive coding and an immersion/crystallization approach.

RESULTS

Students did not report weight discrimination or harmful body image messaging from teachers or administrators. Physical education (PE) class and dress codes were 2 instances where covert weight stigma appeared. The most common forms of peer weight stigma reported were weight-based teasing and self-directed appearance critiques. Students recommended that schools eliminate dress codes, diversify PE activities, address body image issues in school, and be cognizant of teasing within friend groups.

CONCLUSIONS

Weight stigma presents itself in unique ways in high school settings. Schools can play a role in reducing experiences of weight stigma and negative body image. Weight-related teasing within friend groups was common and may not be captured in traditional assessments of bullying. More nuanced survey instruments may be needed.

Weight stigma in children and adolescents: Recommendations for practice and policy

ABSTRACT

Weight stigma is the devaluation of a person because of excess body weight. Individuals who experience stigmatization are at increased risk for adverse physical and psychological health outcomes. This article provides an overview of weight stigma and the implications for nursing practice and policy.

Links between obesity, weight stigma and learning in adolescence: a qualitative study

BACKGROUND

Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap.

METHODS

We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically.

RESULTS

We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the 'right' friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them.

CONCLUSIONS

Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

Association between selected individual and environmental characteristics in relation to health behavior of Brazilian adolescents

OBJECTIVE

The study investigates the evolution of healthy behaviors (healthy eating and regular physical activity) in Brazilian adolescents during 2012 and 2015, and its associations with self-assessment of body weight and adoption of weight control attitudes, in the context of diverse household features, school environments, and regional characteristics.

METHODS

Two cross-sectional surveys of Brazilian adolescents attending the ninth grade in 2012 and 2015 were gathered comprising a national sample. Data from 209,601 completed surveys were analyzed using robust error estimates of ordinary least squares regressions.

RESULTS

Results showed that there was a decrease in the frequency of healthy foods consumption and recommended physical activity level between 2012 and 2015. The regression analyses revealed that healthy eating and physical activity were significantly higher for adolescents with normal weight perception (i.e., did not perceive themselves to have either low or excess body weight) and for adolescents who were male, were members of middle socioeconomic stratum families, and had mothers with college degrees. In addition, healthy eating was significantly higher for adolescents who did not wish to lose weight, did not watch TV while eating, went to public schools, and lived with both parents. Ethnic differences varied based on region, with healthy eating being significantly higher among black/mulato/indigenous adolescents in the South and Southeast regions, but significantly higher among white/yellow adolescents in the North region.

CONCLUSIONS

Ethnic and gender-related differences were identified in health behaviors and attitudes towards weight control of Brazilian adolescents. Findings indicate the relevance of individual characteristics combined with the influence of social networks for the adoption of healthy behaviors among adolescent students.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series without intervention.

Weight Stigma in Youth: Prevalence, Consequences, and Considerations for Clinical Practice

PURPOSE OF REVIEW

This review summarizes recent evidence on weight stigma experienced by youth with overweight or obesity. We examine the prevalence and sources of weight-based victimization targeting youth, consequences of these stigmatizing experiences for their psychological and physical health, and considerations for addressing weight stigma in clinical practice and pediatric care.

RECENT FINDINGS

Weight stigma is highly prevalent among youth with high body weight, who are targets of weight-based victimization from peers, parents, and teachers. These experiences place youth at risk for psychological distress (primarily depressive symptoms, low self-esteem, and suicidal ideation), worse social and academic outcomes, and adverse physical health consequences including maladaptive eating behaviors, lower physical activity, substance use, and weight gain. Healthcare professionals and clinicians have important roles to play in efforts to help reduce weight stigma and support youth with obesity. Fundamental to these efforts is the use of supportive, compassionate, and non-stigmatizing communication with youth and their families.

A qualitative investigation of body weight and weight loss-related attitudes of mothers and fathers in the context of food insecurity

PURPOSE

To examine attitudes about body weight and weight loss among low-income parents of young children experiencing household food insecurity.

METHODS

One-on-one interviews were conducted with 25 dyads of cohabitating low-income mothers and fathers who lived with their child aged 2.5-10 years old. Basic inductive analysis was conducted using NVivo to identify emerging themes related to body weight.

RESULTS

Three main themes emerged including (1) weight loss as a "Blessing in Disguise," (2) trouble with losing weight, and (3) the impact of compromised diet quality. Some differences existed in themes between mothers and fathers, but both placed value on weight loss resulting from food insecurity.

CONCLUSION

This research underscores the importance of sufficient nutrition assistance for limited resource families. A lack of money for food was a barrier towards maintaining a healthy weight but the value our culture places on weight loss even in times of despair was undeniably present.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Are Feminine Body Weight Norms Different for Black Students or in Black Schools? Girls' Weight-Related Peer Acceptance across Racialized School Contexts

Adolescent girls with overweight or obesity are less socially integrated than their thinner peers. We examine racial-ethnic differences in girls' weight-related friendship patterns, especially noting Black-white distinctions given their different norms about the ideal feminine form. We also test whether schools with more Black students see diminished weight-related differences in peer integration for all girls and/or for Black girls. Using 1994-1995 data from the National Longitudinal Study of Adolescent to Adult Health, we predict the number of friendship nominations girls receive conditional on their weight status, race-ethnicity, and school's racial composition. Both white and Black girls with overweight or obesity are less integrated than their thinner peers regardless of the school's Black enrollment rate. Hispanic girls with overweight are more integrated than white girls with overweight, particularly in schools with low Black enrollments. The relative consistency of girls' weight-related friendship patterns demonstrates the ubiquity of dominant feminine thinness norms.

School Wellness Environments: Perceptions Versus Realities

The U.S. Department of Agriculture Final Rule on School Wellness Policy requires schools to self-evaluate wellness policies and environments. To understand the utility of this information, this study evaluates the validity of school-reported wellness information against directly observed data. Wellness leaders at 10 Midwestern elementary schools completed a questionnaire spanning nine school wellness settings. School-reported information was compared against a direct observation protocol. Percent agreement and κ statistics were used to assess agreement between school reporters and direct observation. Overall percent agreement between reporters and direct observation was 77.1%. Agreement ranged from 67.3% (Lunchroom Environment) to 92.0% (School Wellness Policies) across the nine categories. κ results showed that 65.7% of the items demonstrated fair or better reporter agreement. The results provide preliminary support for the utility of schools' self-reported wellness information. Facilitation of independent reporting on wellness environments by school leaders will contribute to broader applications for school wellness programming.

Weight Bias in Educational Settings: a Systematic Review

PURPOSE

To conduct a systematic literature review of empirical peer-reviewed published studies on the prevalence of weight bias among students, pre-service, and in-service teachers and its impact on the educational experiences and health of students from kindergarten to postsecondary settings.

METHODS

Keywords were searched on three main concepts, (i) weight bias/stigma, (ii) obesity/overweight, and (iii) education, within eight databases. Our search yielded 8323 individual records, of which 45 studies satisfied our inclusion criteria.

RESULTS

Most studies were conducted in K-12 school settings (n = 41), were quantitative in design (n = 37), and used student samples (n = 18). Weight bias is prevalent in educational settings, among peers at school as well as pre-service and in-service teachers, and negatively impacts students' health and educational experiences.

CONCLUSION

These results highlighted the impact of weight bias in creating inequity for students with obesity as well as several underexamined areas, such as weight bias in postsecondary settings and attitudes among teachers and pre-service teachers. Innovative strategies to address weight bias in educational settings are needed.

Cardiorespiratory fitness and academic performance association is mediated by weight status in adolescents: DADOS study

The aim of our study was to examine the mediation effect of weight status on the association between cardiorespiratory fitness (CRF) and academic performance (AP). Two hundred sixty-nine adolescents (140 boys) aged 13.9 ± 0.3 years old from the DADOS study were included in this cross-sectional analysis. CRF was assessed by the 20-m shuttle run test and estimated maximum oxygen uptake was used in the analysis. AP was assessed through the final academic grades and the Science Research Associates Test of Educational Abilities for assessing reasoning, verbal, and numeric abilities. Weight status was assessed by body mass index (kg/m²). Boot-strapped mediation procedures were performed and indirect effects (IE) with confidence intervals (CI) not including zero were considered statistically significant. Mediation analysis revealed that weight status acted as a mediator of the relationship of CRF with reasoning ability (IE = 0.039; CI = 0.001; 0.091) and the final grades in Math (IE = 0.011; CI = 0.002; 0.025), Language (IE = 0.013; CI = 0.004; 0.027), and GPA (IE = 0.011; CI = 0.003; 0.023).

CONCLUSIONS

Our data show that the influence of CRF on academic performance is mediated by weight status in adolescents. We suggest that our data could be considered by educators, families, and policy makers, so that active lifestyles might be promoted when designing programs aimed to improve AP among adolescents. What is Known: • Academic performance is associated with both, cardiorespiratory fitness and weight status. • The role of weight status in the association between cardiorespiratory fitness and academic performance is poorly understood. What is New: • We support the scarce research investigating the mediating role of weight status as mechanism in the association between fitness and academic performance in youth. • Previous knowledge is expanded by suggesting that cardiorespiratory fitness is related to weight status which in turn may positively influence academic performance in adolescents.

Longitudinal Associations Between Childhood Obesity and Academic Achievement: Systematic Review with Focus Group Data

PURPOSE

The purposes of this study were to review the evidence on longitudinal associations between child and adolescent obesity and academic achievement and to provide perceptions of adolescents with obesity and their parents on this topic.

RECENT FINDINGS

Synthesis of 31 studies (from 17 cohorts) suggested that relationships between obesity and academic achievement are not well established, except for adolescent girls' maths attainment, potentially mediated by both weight-related bullying and executive cognitive functions. Focus groups with adolescent girls with obesity confirmed experiences of psychosocial distress at school particularly during Physical Education. Adolescents perceived that obesity was not related to academic achievement directly, but by their attitude to school. Interventions are warranted to promote psychosocial wellbeing and cognitive abilities linked to academic achievement in adolescent girls with obesity. Physical Education should be a positive experience for children and adolescents with obesity.