The Development of Body Image and Weight Bias in Childhood

Young children's choices and thoughts about pro-social behaviour towards others with overweight

OBJECTIVES

This study aimed to investigate weight bias within young children's pro-social choices between characters who differed in body size.

METHODS

Seventy-six children aged 4-6 years read stories asking them to choose who they would first help, share with, comfort, and steal from, between a healthy weight and child with overweight. They also selected the one character they would most like to play with. Children's reasoning for these choices was recorded and analysed.

RESULTS

The character with overweight was helped first in only a third of the choices made. Children chose the characters with overweight more often as the target for anti-social action. In friendship selections, children overwhelmingly rejected the characters with overweight. However, weight bias was not prominent in the reasons children gave for the choices. Most children were not negative about body shape, weight or appearance. Similarly, in friendship choices, these were mostly expressed positively to the character chosen. Only a small minority of children were explicitly negative about the character with overweight.

CONCLUSIONS

A better understanding of weight bias acquisition and variation between children will benefit those working in health care and educational settings. Future research should link with developmental theory, such as on social categorization and theory of mind.

Negative familial weight talk and weight bias internalization in a US sample of children and adolescents

BACKGROUND

Negative familial weight talk may contribute to higher weight bias internalization in pre- and early adolescents (hereafter referred to as children) and may differ by gender, weight status, and race and ethnicity.

OBJECTIVE

Examine the relationship between negative familial weight talk and weight bias internalization and examine differences by gender, weight status, and race and ethnicity.

METHODS

We cross-sectionally analysed 5th-7th graders (10-15 years old) living in Massachusetts (n = 375, 52.3% girls, 21.3% BMI ≥85th percentile, 54.8% non-Hispanic White). Negative familial weight talk frequency during the past 3 months was self-reported and discretized as 'never,' 'occasionally' (1-9 times) and 'often' (>9 times); the Modified Weight Bias Internalization Scale assessed weight bias internalization. Generalized linear models estimated the relationship between negative familial weight talk and weight bias internalization and sub-analyses estimated the relationship across gender, weight status, and race and ethnicity. Results are summarized as ratios of means (RoM).

RESULTS

Children experiencing negative familial weight talk occasionally (RoM = 1.12, p = 0.024) and often (RoM = 1.48, p < 0.001) had significantly higher weight bias internalization than children who never experienced it. In sub-analyses, experiencing negative familial weight talk often was associated with higher weight bias internalization among girls (RoM = 1.66, p < 0.001), boys (RoM = 1.32, p = 0.007), children with BMI <85th percentile (RoM = 1.44, p = 0.007) and BMI ≥85th percentile (RoM = 1.39, p = 0.001), and non-Hispanic White children (RoM = 1.78, p < 0.001), but not Hispanic (RoM = 1.25, p = 0.085) or non-Hispanic Black children (RoM = 1.20; p = 0.31).

CONCLUSIONS

Frequent negative familial weight talk was associated with higher weight bias internalization across gender and weight status and in non-Hispanic White children only.

"Shape bias" goes social: Children categorize people by weight rather than race

Children tend to categorize novel objects according to their shape rather than their color, texture, or other salient properties-known as "shape bias." We investigated whether this bias also extends to the social domain, where it should lead children to categorize people according to their weight (their body shape) rather than their race (their skin color). In Study 1, participants (n = 50 US 4- and 5-year-olds) were asked to extend a novel label from a target object/person to either an object/person who shared the target's shape/weight, color/race, or neither. Children selected the shape-/weight-matched individual over the color-/race-matched individual (dobjects  = 1.58, dpeople  = 0.99) and their shape biases were correlated across the two domains. In Study 2, participants (n = 20 US 4- and 5-year-olds) were asked to extend a novel internal property from a target person to either a person who shared the target's weight, race, or neither. Again, children selected the weight-matched individual (d = 1.98), suggesting they view an individual's weight as more predictive of their internal properties than their race. Overall, results suggest that children's early shape bias extends into the social domain. Implications for weight bias and early social cognition are discussed. RESEARCH HIGHLIGHTS: Preschoolers extend novel labels based on people's weight rather than their race. Preschoolers infer internal features based on people's weight rather than their race. Shape biases are present, and correlated, across the social and object domains.

Self-Objectification, Disordered Eating and Sexual Orientation in Men

The interplay between disordered eating, depressive symptoms and self-objectification differs between genders and sexual orientations, and merits further study in homosexual and heterosexual men. We examined disordered eating, depressive symptoms and self-objectification in a sample of Israeli heterosexual and homosexual men. Participants were 215 men aged 19-65, 108 of whom were classified by the Kinsey scale as being heterosexual and 107 as homosexual. They completed online measures of self-objectification, disordered eating and depressive symptoms. Heterosexual men reported lower levels of disordered eating and self-objectification than homosexual men, however the difference in depressive symptoms was not statistically significant. Correlations between disordered eating, self-objectification and depressive symptoms when controlling for age, BMI and number of children were all significant, with similar patterns of association for heterosexual and homosexual men. Self-objectification partially mediated the association between sexual orientation and disordered eating. However, contrary to our hypothesis, sexual orientation (homosexual/heterosexual) did not moderate the association between disordered eating and self-objectification. The tendency of homosexual men towards self-objectification is linked to unhealthy eating habits. Self-objectification helps explain the propensity of homosexual versus heterosexual men to develop disordered eating and possibly eating disorders. It should therefore be targeted in prevention and in therapy.

A conceptual framework on body representations and their relevance for mental disorders

Many mental disorders are accompanied by distortions in the way the own body is perceived and represented (e.g., eating disorders, body dysmorphic disorder including muscle dysmorphia, or body integrity dysphoria). We are interested in the way these distortions develop and aim at better understanding their role in mental health across the lifespan. For this purpose, we first propose a conceptual framework of body representation that defines this construct and integrates different perspectives (e.g., cognitive neuroscience, clinical psychology) on body representations. The framework consists of a structural and a process model of body representation emphasizing different goals: the structural model aims to support researchers from different disciplines to structure results from studies and help collectively accumulate knowledge about body representations and their role in mental disorders. The process model is reflecting the dynamics during the information processing of body-related stimuli. It aims to serve as a motor for (experimental) study development on how distorted body representations emerge and might be changed. Second, we use this framework to review the normative development of body representations as well as the development of mental disorders that relate to body representations with the aim to further clarify the potential transdiagnostic role of body representations.

Automatic pro-thin/anti-fat biases can develop without previous visual exposure to body shapes

Endorsement of the thin beauty ideal increases risk for future body dissatisfaction and eating disorders among women. Visual-based media is theorized to be a central pathway through which the thin ideal is internalized. This internalization process results in formation of automatic pro-thin and anti-fat attitudes. However, it is often difficult to separate the contribution of visual-based media and other forms of communication in the creation of such attitudes. Using a novel auditory implicit association test, we show that women with congenital blindness with no previous exposure to body shapes develop automatic pro-thin and anti-fat attitudes to the same extent as sighted women. This result was replicated in studies conducted in two countries involving a combined total of 62 women with blindness and 80 sighted women. Results suggest that internalization of the thin ideal can occur without visual exposure to images of the thin beauty ideal or visual exposure to one's own body.

Body Image and Lifestyle Behaviors in High School Adolescents

This secondary data analysis study aimed to examine the associations between 1) body size perception (BSP) and body size dissatisfaction (BSD) and 2) lifestyle behaviors and BSP and BSD in adolescents. The study pooled cross-sectional data from two studies (n = 301) performed in adolescents. Weight and height were measured, while lifestyle behaviors and perceived actual and desired body size variables were self-reported. Linear regression analysis assessed the contribution of sex and zBMI to BSP and BSD scores. Pearson's correlation explored associations between BSP and BSD. Cohen's effect sizes compared satisfied and dissatisfied adolescents within the underestimators subgroup. A positive association between BSP and BSD scores was observed among girls living with normal-weight and overweight/obesity only (r = 0.26; p ≤ 0.001 and r = 0.38; p < 0.05, respectively). Underestimators who were satisfied with their body size showed a moderate effect size for a lower zBMI, a small effect size for lower screen time, and higher sleep duration compared to dissatisfied underestimators. Underestimation was associated with more body size satisfaction in adolescent girls with normal weight and overweight/obesity, suggesting a protective effect of underestimation. These findings support the hypothesis that body size satisfaction and underestimation in adolescents is associated with healthier lifestyle behaviors.

Physical activity interventions for the mental health of children: A systematic review

OBJECTIVE

This systematic review explored the effectiveness of using physical activity (PA) interventions to enhance psychological well-being and reduce psychological ill-being (e.g., anxiety and depression) in children aged six to 11 years old from the general population.

METHODS

Electronic databases were searched for studies published between January 2005 and June 2020: Web of Science, ProQuest Psychology Journals, PsycINFO, Pub Med, ASSIA, CINHAL PLUS, SPORTDiscus, EMBASE and Wiley Online Library. Search terms included 'physical activity intervention', 'psychological well-being' and 'child*'. After removing duplicates, 11 390 studies were independently screened by two authors based on inclusion/exclusion criteria and assessed for risk of bias.

RESULTS

A total of 23 studies were narratively synthesized and categorized into four domains: Quality of Life (QOL), body image, self-esteem and psychological ill-being. Evidence was provided for the impact of PA interventions in improving QOL, body image and self-esteem. Despite the positive effect on psychological well-being, evidence for a reduction in the frequency and severity of symptoms associated with psychological ill-being in children is less clear.

CONCLUSIONS

Reviewed studies support the use of PA interventions in enhancing the psychological well-being of children in school and community settings. More research is warranted to understand the impact of PA interventions on reducing psychological ill-being in children from the general population.

Changes in self-other boundaries modulate children's body image attitudes

One's own face is a key distinctive feature of our physical appearance, yet multisensory visuo-tactile stimulation can alter self-other boundaries, eliciting changes in adult's self-face representation and social cognition processes. This study tested whether changing self-face representation by altering self-other boundaries with the enfacement illusion modulates body image attitudes toward others in 6-11-year-old children (N = 51; 31 girls; predominantly White). Across all ages, congruent multisensory information led to stronger enfacement (η²_p = 0.06). Participants who experienced a stronger enfacement illusion showed preference for larger body size, suggesting increased positive body size attitudes. This effect was stronger in 6-7-year-olds compared to 8-9-year-olds. Thus, blurring self-other boundaries successfully modulates self-face representation and body image attitudes toward others in children. Our results suggest that increased self-resemblance through self-other blurring resulting from the enfacement illusion may reduce social comparisons between self and other and result in positive body size attitudes.

Lifestyle Risk Factors for Overweight/Obesity in Spanish Children

Childhood obesity is one of the main public health concerns in Europe. The aim was to identify possible risk factors associated with overweight/obesity in Spanish preschool and school-age children. The sample (1075 (50.7% girls) children aged 3 to 12) is part of the project 'Alimentando el Cambio' whose objective is to promote healthy lifestyles in schools. Child height and weight were measured, and parents filled out questionnaires related to the children's lifestyle. There was a positive and significant association between sweetened beverage consumption and body mass index (BMI) z-score in both sexes and age groups. There was a negative and significant association between BMI z-score and dairy products in girls of both age groups. There was also a protective effect of regular nut consumption on overweight/obesity in girls 6-12 y. Night-time sleep during weekdays showed a negative association with BMI z-score for older boys and girls. A positive and significant association was found between total screen time and BMI z-score during weekdays. Regarding emotional well-being and self-esteem, having girls 6-12 y laughing and feeling happy and good about themselves in the last week was a protective factor against overweight/obesity. Childhood obesity prevention efforts may benefit from targeting these key risk factors.

The metabolic conditioning of obesity: A review of the pathogenesis of obesity and the epigenetic pathways that "program" obesity from conception

Understanding the developmental origins of health and disease is integral to overcome the global tide of obesity and its metabolic consequences, including atherosclerotic cardiovascular disease, type 2 diabetes, hyperlipidemia, and nonalcoholic fatty liver disease. The rising prevalence of obesity has been attributed, in part, to environmental factors including the globalization of the western diet and unhealthy lifestyle choices. In this review we argue that how and when such exposures come into play from conception significantly impact overall risk of obesity and later health outcomes. While the laws of thermodynamics dictate that obesity is caused by an imbalance between caloric intake and energy expenditure, the drivers of each of these may be laid down before the manifestation of the phenotype. We present evidence over the last half-century that suggests that the temporospatial evolution of obesity from intrauterine life and beyond is, in part, due to the conditioning of physiological processes at critical developmental periods that results in maladaptive responses to obesogenic exposures later in life. We begin the review by introducing studies that describe an association between perinatal factors and later risk of obesity. After a brief discussion of the pathogenesis of obesity, including the systemic regulation of appetite, adiposity, and basal metabolic rate, we delve into the mechanics of how intrauterine, postnatal and early childhood metabolic environments may contribute to adult obesity risk through the process of metabolic conditioning. Finally, we detail the specific epigenetic pathways identified both in preclinical and clinical studies that synergistically "program" obesity.

A new model to guide identity-focused multidisciplinary rehabilitation for children and young people following acquired brain injury: I-FoRM

A complexity of biological, psychological, environmental and systemic factors influences a child's adaption after acquired brain injury (ABI), all of which transform as the child matures. Multidisciplinary rehabilitation teams are challenged by balancing family system needs and the child's needs, whilst promoting the child's functional skills in difficult or unappealing tasks. This paper presents the conceptual basis for a model for use in childhood ABI neurorehabilitation to address these challenges. A non-systematic narrative review of literature pertinent to integrated neurorehabilitation of pediatric ABI was conducted. Contemporary models of adult and pediatric psychosocial adaptation involving identity following ABI were reviewed. Key findings were then synthesized with models of pediatric resilience and self-concept development. The resulting model describes a cyclical adaptation process whereby the child learns experientially about their self and their world after ABI. Processes of identity development play a central role - particularly emotive processes of self-evaluation - by influencing the child's motivation for participation, tolerance for challenge, self-regulation and emerging self-awareness. The model directs clinicians to use the psychosocial processes of identity development to enhance the child's willingness and capacity to engage in the daily challenges of rehabilitation. Further systematic development and evaluation of the model is needed.

"We're categorized in these sizes-that's all we are": uncovering the social organization of young women's weight work through media and fashion

Background

For decades, dominant weight discourses have led to physical, mental, and social health consequences for young women in larger bodies. While ample literature has documented why these discourses are problematic, knowledge is lacking regarding how they are socially organized within institutions, like fashion and media, that young women encounter across their lifespan. Such knowledge is critical for those in public health trying to shift societal thinking about body weight. Therefore, we aimed to investigate how young women’s weight work is socially organized by discourses enacted in fashion and media, interpreting work generously as any activity requiring thought or intention.

Methods

Using institutional ethnography, we learned from 14 informants, young women aged 15–21, in Edmonton, Canada about the everyday work of growing up in larger bodies. We conducted 14 individual interviews and five repeated group interviews with a subset (n = 5) of our informants. A collaborative investigation of weight-related YouTube videos (n = 45) elicited further conversations with two informant-researchers about the work of navigating media. Data were integrated and analyzed holistically.

Results

Noticing the perpetual lack of larger women’s bodies in fashion and media, informants learned from an early age that thinness was required for being seen and heard. Informants responded by performing three types of work: hiding their weight, trying to lose weight, and resisting dominant weight discourses. Resistance work was aided by social media, which offered informants a sense of community and opportunities to learn about alternative ways of knowing weight. However, social media alleging body acceptance or positivity content often still focused on weight loss. While informants recognized the potential harm of engagement with commercial weight loss industries like diet and exercise, they felt compelled to do whatever it might take to achieve a “normal woman body”.

Conclusions

Despite some positive discursive change regarding body weight acceptance in fashion and media, this progress has had little impact on the weight work socially expected of young women. Findings highlight the need to broaden public health thinking around how weight discourses are (re)produced, calling for intersectoral collaboration to mobilize weight stigma evidence beyond predominantly academic circles into our everyday practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13607-w.

Gender Typicality, Pressure to Conform to Gender Norms, and Anti-Fat and Appearance Stereotypes in Girls

This mixed-methods study investigated the relation among gender identity (i.e., self-perceived gender similarity to girls and boys; self-perceived parental and peer pressure to conform to gender norms) and stereotyping about weight (i.e., anti-fat stereotypes), weight change, and appearance in 83 girls ages 6-9 (M_age = 7.60 years, SD = .85; 65% White, 16% Mixed/Other, 11% Black, 8% Latina) in the U.S. Stereotypes about weight change were assessed with open-ended responses (i.e., qualitatively), and the rest of the constructs were assessed with closed-ended responses (i.e., quantitatively). There was a positive association between pressure from parents to conform to gender norms and appearance stereotypes, and between pressure from peers and negative stereotypes about the fat and thin figures. Girls who were more gender typical, or more similar to girls, were more likely to endorse appearance stereotypes. There was no significant relation among stereotypes about weight change and gender identity. Many girls deemed the fat figure as unattractive, physically restrained, unhealthy, and likely to be bullied and believed that the fat figure should change back to look like a thinner figure. Most girls were aware that exercising, eating healthy, and dietary restriction can lead to weight loss and that food consumption and lack of exercise can lead to weight gain. Findings suggest that certain aspects of weight (anti-fat) and appearance stereotypes are closely linked to gender identity in girls, whereas other aspects of weight stereotypes (e.g., stereotypes about weight change) are so pervasive that they are common in most girls, regardless of their gender identity.

Assessment of Actual Weight, Perceived Weight and Desired Weight of Romanian School Children-Opinions and Practices of Children and Their Parents

Objective: Children and parental awareness regarding weight is linked to the development and management of overweight and obesity. The aim of this study is to assess the actual weight, perceived weight, and desired weight of Romanian school children. Methods: A cross-sectional study was conducted in 2019 in seven schools from two counties of Romania and included 880 pupils aged between 10 and 15 years old and 665 parents. We administrated confidential questionnaires to the participants, and we measured children’s weight and height during school activities. Results: A total of 61.0% of pupils had normal weight, 7.4% were underweight, and 31.6% were overweight or obese. A total of 66.7% of normal weight children, 56.5% of overweight children, and 40% of underweight children perceived their weight accurately. Regarding parents, a majority correctly appreciated the weight of their normal weight children and only a third appreciated correctly the body weight of their underweight and overweight children. Factors such as body mass index, gender, weight related behaviors, parents’ estimation about their children’s weight, discussions of weight topics inside family, and bullying, cyberbullying and exclusion from groups were associated with misperceptions. Conclusion: The study provides useful information for health education activities targeting both children and their parents regarding appropriate body weight management of children.

Perceptions of the Body and Body Dissatisfaction in Primary Education Children According to Gender and Age. A Cross-Sectional Study

Body image (BI) is a trending topic of study since health problems derived from a negative perception of the body are increasing and affecting people of all ages, with an increasing incidence among children from the age of eight. The objective of this study was to evaluate the current perception of the body against the desired body and the degree of body satisfaction of Galician primary education students. A total of 355 students (167 boys (47%)) between 9 and 12 years old participated (mean = 10.53; SD = 0.84). Sociodemographic data (sex, age, height, and weight) were collected, and the Figure Rating Scale was used. There are statistically significant differences between boys and girls in the current perceived figure (p = 0.003) and in the desired figure (p < 0.001). Depending on age, the differences were in current (p = 0.010) and desired (p = 0.021) body perception. In conclusion, boys perceive themselves as having a larger figure than girls do, but this perception is far from reality according to the body mass index. For the desired figure, both boys and girls want to be slimmer, but girls want a slimmer figure. Regarding age, the current perceived figure size increases with age as it increases in those students dissatisfied with their body.

Self-regulatory processes in early childhood as predictors of Hispanic children's BMI z-scores during the elementary school years: Differences by acculturation and gender

Over the last decade, longitudinal research has shown that children's general, top-down self-regulation during early childhood is negatively associated with children's weight status in elementary school. The samples in these previous studies have been primarily White, and no study to date has examined this issue in a sample of Hispanic children from low-income families-a population at high risk for childhood obesity. The present study followed 130 Hispanic children over a time period of three to just under five years, examining the degree to which multiple measures of general, top-down self-regulation, along with a measure of appetite regulation (eating in the absence of hunger), predicted children's BMI z-scores in the early elementary school years. Results showed that children's ability to delay gratification in the preschool years was negatively associated with later BMI z-scores and that children's eating in the absence of hunger was positively associated. In separate models by gender, these relationships were significant only for girls. Moreover, analyses run separately for children of mothers low or high on acculturation showed that the relationship between delay of gratification and later BMI z-scores was significant only for children whose mothers were low on acculturation. Possible socialization and environmental factors contributing to these findings are considered.

Can Parental Body Dissatisfaction Predict That of Children? A Study on Body Dissatisfaction, Body Mass Index, and Desire to Diet in Children Aged 9-11 and Their Families

Body image has been associated with self-care and the assumption of either healthy habits or poor diets and eating disorders. As a vital element in the formation of a positive body image, the role of the family in childhood has been highlighted by a few studies. This study aimed to assess whether children’s body dissatisfaction could be predicted by their parents’ body dissatisfaction, body mass index (BMI), and approach to change. The sample consisted of 581 participants (366 parents and 215 children). The following instruments were used: anthropometric data, the Brief Scale of Body Dissatisfaction for Children, the IMAGE questionnaire (approach to change and drive for muscularity subscales), and the Eating Disorder Inventory-2 (body dissatisfaction and drive for thinness subscales). The results indicated that 19% of children, 22.8% of mothers, and 70.2% of fathers were overweight or obese. The multiple regression models developed for boys and girls explained 60 and 57% of the variance in body dissatisfaction, respectively. Several variables attributable to the mother (higher approach to change, higher drive for thinness, and higher BMI) and to the boys themselves (drive for muscularity, approach to change, and having a high BMI percentile) predicted a higher level of body dissatisfaction. For girls, only variables regarding themselves (approach to change, age, and BMI percentile) explained their body dissatisfaction. Relationships with the traits of the father were not detected for both models. The influence of sociocultural factors on the construction of gender and the negative consequences of mothers’ dieting for aesthetic purposes, on the development of children’s body image, are discussed.

Weight stigma and media: An examination of the effect of advertising campaigns on weight bias, internalized weight bias, self-esteem, body image, and affect

While some media perpetuate weight stigma and an ideal of thinness, certain advertising campaigns, such as Aerie Real and Dove Real Beauty, have attempted to promote body acceptance. The current study evaluated the influence of exposure to these campaigns on weight bias, internalized weight bias (IWB), self-esteem, body image, and affect relative to exposure to a campaign perpetuating the thin ideal and a documentary on weight stigma. 475 female participants were randomized to one of five conditions: Aerie, Dove, Victoria's Secret, an HBO documentary, or control (i.e., neutral video clip). Participants completed measures of weight bias, IWB, self-esteem, body image, and affect one week prior to and immediately after watching the assigned video clip. Results showed positive effects of the Aerie and Dove campaigns on women. While global measures of weight bias and IWB were unchanged, women who viewed the Dove and Aerie campaigns reported significantly improved self-esteem and positive affect. Further, women found the campaigns to have positive, uplifting, and empowering messages. Aerie's and Dove's acceptance-promoting advertising campaigns positively influenced self-esteem and mood, and they are potential tools for weight bias reduction. Advertisements and media have the potential to impact weight-based attitudes in society.

Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study

OBJECTIVE

To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children.

DESIGN

Regional cohort study.

SETTING

Oppland County, Norway.

METHODS

At the routine school entry health assessment at 5-6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child's neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate.

PARTICIPANTS

We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined.

MAIN OUTCOME MEASURES

SDQ subscale and Total Difficulties Scores.

RESULTS

The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis.

CONCLUSIONS

The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.

Is Weight Bias Evident in Peer Interactions Between Young and Older Children?

OBJECTIVE

This study aimed to investigate whether weight bias is apparent in young and older children's interactions during a paired reading activity.

METHODS

One hundred seventy-two children (57% girls) read a book in which the main character, "Alfie," was portrayed either as average weight or as having obesity. Younger children (mean = 6.1 years) were paired with a same-sex older child (mean = 9.5 years). Questions within and at the end of the story prompted discussion. Children's conversations were analyzed according to valence (emotional tone). Nonverbal behavior was noted via observation.

RESULTS

Pairs of children reading about the Alfie character with obesity made significantly more negative and fewer positive comments when offering story completions. Just one pair of boys spoke about him being "fat." There was no evidence that older children passed negative attitudes to younger children. Covertly expressed weight bias was more common. There was more frequent laughter while reading about the character with obesity, and two pairs made nonverbal reference to Alfie's appearance.

CONCLUSIONS

Covert weight bias was apparent in the interactions of some of these children, but overt weight bias was rare. There is a need to establish a better chronology of children's awareness of, and attitudes toward, obesity and how they are acquired.

Linking body esteem to eating disorders among adolescents: A moderated mediation model

This study explored the roles of social appearance anxiety and emotional intelligence in the relationship between body esteem and eating-disorder risk among adolescents. A total of 2509 high-school students were sampled to participate in the study. Statistical methods mainly involved descriptive statistics, Bootstrapping, and structural equation modeling analyses. The results showed that social appearance anxiety partially mediated the relationship between body esteem and eating-disorder risk among adolescents; meanwhile, emotional intelligence moderated the effects of body esteem on social appearance anxiety and eating-disorder risk among adolescents.

Leading by example: Development of a maternal modelling of positive body image scale and relationships to body image attitudes

The aims of this study were to develop a measure, the Role Modelling of Body Image (Attitudes and Behaviors) Questionnaire (RMBI-Q), to determine maternal perceptions of their body image role modelling in front of their children, and to evaluate how role modelling differs with demographic characteristics to identify characteristics of mothers who may require assistance in being a positive role model. Participants were a community-based sample of 887 mothers who provided demographic information and completed the RMBI-Q, Body Appreciation Scale (BAS-2), and a measure of dietary restraint (DEBQ) in an online questionnaire. Exploratory factor analysis revealed one 7-item factor for the RMBI-Q. Confirmatory factor analysis revealed that removal of an item was necessary for model fit, and thus, a 6-item version of the RMBI-Q was evaluated. Good internal consistency, test-retest reliability, content validity, and convergent validity were found. Higher scores on the RMBI-Q correlated with greater maternal body appreciation and lower dietary restraint. More positive role modelling was reported by mothers with lower body mass index and younger children. The RMBI-Q is useful for assessing maternal modelling of positive behaviors that may improve children's body image. Findings highlight avenues for body image interventions for mothers.

Weight stigma and its impact on paediatric care

PURPOSE OF REVIEW

This review aims to evaluate current research findings relevant to weight stigmatization, to acknowledge the deleterious impact it has on the health of the paediatric population and to provide insight to optimize future guidelines for the treatment of individuals with overweight and obesity.

RECENT FINDINGS

Obesity prevalence continues to rise in the USA with estimates in children from ages 2-19 years of 18.5%, an all-time high. With the increase in obesity, there has been a concomitant increase in weight stigma, which affects both youth and general population across varied levels of socioeconomic status and body sizes.

SUMMARY

Weight stigma is a contributing phenomenon to the current obesity epidemic, as individuals with stigmatized experiences (weight-based teasing, bullying, victimization) have increased risks for acquiring adverse health outcomes that encompass the physical, behavioural and psychological. Weight stigma can also lead affected individuals to internalize such experiences which decrease their overall quality of life. Sources of stigma may come from peers, family, educators, media, as well as healthcare professionals, as highlighted in this review. Efforts to establish prevention and treatment strategies for weight stigma may generate further traction to help improve global obesity rates. VIDEO ABSTRACT.

Low body esteem and dietary restraint among 7-year old children: The role of perfectionism, low self-esteem, and belief in the rewards of thinness and muscularity

Body image concerns and dietary restraint have been shown to emerge among young children (aged 5 to 8 years). However, to date, little is known regarding the way in which individual characteristics and endorsement of sociocultural appearance ideals are associated with these concerns and behaviors in this age group. The aim of the current study was to examine perceived rewards of thinness and muscularity as a mediator of the relationships between personality traits (perfectionism and self-esteem), and body esteem and dietary restraint among 7-year-old children. Participants were 261 children, Mage (SD) = 7.46 (0.32), assessed during interview on a range of scales measuring variables of interest. Findings revealed that, with the addition of direct pathways leading to dietary restraint, the model was a good fit to the data. Furthermore, multi-group analyses revealed no gender differences. These results highlight the role of children's individual personality characteristics as well as the degree to which they uphold thin and muscular appearance ideals in body image and eating concerns in 7 year olds. Additional efforts should be made to engage this age group with prevention resources and to target personality characteristics as well as beliefs in the rewards of appearance ideals.

Psychological predictors of body image attitudes and concerns in young children

We aimed to examine cross-sectional and longitudinal relationships between psychological characteristics, body size, and body image outcomes in 6- to 7-year-old children. Participants were 202 children (91 boys, 111 girls) assessed when 6 and 7 years old. Body image-related variables, body mass index, and psychological characteristics were assessed. Cross-sectionally in the total sample, lower self-esteem was associated with greater body dissatisfaction, internalization of appearance ideals, and rewards of muscularity. Greater perfectionism was associated with greater body dissatisfaction, dietary restraint, drive for muscularity, and rewards of thinness and muscularity. Prospectively, internalization and socially prescribed perfectionism at 6 predicted greater body dissatisfaction at 7; higher perfectionism predicted greater rewards of thinness; higher perfectionism and lower self-esteem predicted greater rewards of muscularity; and lower self-esteem and smaller perceived body size predicted higher internalization. Exploratory gender specific analyses suggest that self-esteem may play a greater role in the development of body image attitudes in girls than boys, while perfectionism appears to increase boys' vulnerability to perceive greater rewards from thinness. Findings support the inclusion of psychological characteristics in etiological models of early body image development, and highlight perfectionism, internalization of appearance ideals, and self-esteem as potential targets for preventative interventions in this age group.

Achieving body confidence for young children: Development and pilot study of a universal teacher-led body image and weight stigma program for early primary school children

Negative body image attitudes develop in early childhood and there is a need for school-based resources during the early school years, but no teacher-delivered curriculum-based resources exist to mitigate these attitudes in young children. Achieving Body Confidence for Young Children (ABC-4-YC), a universal body dissatisfaction and weight stigma prevention program, was developed and then delivered in a pilot study. Fifty-one 5- to 8-year-old children completed pre- and post-intervention interviews assessing body image attitudes, and seven teachers provided feedback. Significant improvement in body esteem and positive teacher feedback were found. The results provide preliminary support for ABC-4-YC to improve children's body image attitudes, but extensive evaluation is needed.

The role of weight teasing and weight bias internalization in psychological functioning: a prospective study among school-aged children

Weight-related teasing is a widespread phenomenon in childhood, and might foster the internalization of weight bias. The goal of this study was to examine the role of weight teasing and weight bias internalization as mediators between weight status and negative psychological sequelae, such as restrained eating and emotional and conduct problems in childhood. Participants included 546 female (52%) and 501 (48%) male children aged 7-11 and their parents, who completed surveys assessing weight teasing, weight bias internalization, restrained eating behaviors, and emotional and conduct problems at two points of measurement, approximately 2 years apart. To examine the hypothesized mediation, a prospective design using structural equation modeling was applied. As expected, the experience of weight teasing and the internalization of weight bias were mediators in the relationship between weight status and psychosocial problems. This pattern was observed independently of gender or weight status. Our findings suggest that the experience of weight teasing and internalization of weight bias is more important than weight status in explaining psychological functioning among children and indicate a need for appropriate prevention and intervention approaches.