Longitudinal associations among change in overweight status, fear of negative evaluation, and weight-related teasing among obese adolescents

The relative importance of social anxiety facets on disordered eating in pediatric obesity

PURPOSE

Children with obesity demonstrate increased risk for eating disorders and internalizing psychopathology. Research in adults indicates unique facets of social anxiety differentially relate to eating pathology. These associations remain understudied in pediatric samples. The current study evaluated associations between social anxiety and disordered eating, and tested the relative importance of distinct social anxiety constructs-fear of negative evaluation, social anxiety in general situations, and social anxiety in new situations-for disordered eating in weight-loss treatment-seeking youth with obesity.

METHODS

One-hundred and thirty-five youth (M_age 12.6 years; Range 8-17 years; M_BMIz = 2.6) from a multidisciplinary outpatient pediatric obesity clinic completed questionnaires assessing dimensions of social anxiety and the Children's Eating Attitudes Test (ChEAT). Dominance analyses were used to evaluate the relative importance of social anxiety facets associated with ChEAT subscales.

RESULTS

Social anxiety subscales did not correlate with Dieting scores. Dominance analyses indicated Fear of Negative Evaluation (FNE) evinced complete dominance, thus, emerging as the most important predictor relative to other social anxiety components for Body/Weight Concern and Food Preoccupation. General dominance weights for FNE accounted for more than twice the shared and unique variance, relative to other independent variables within the Body/Weight Concern and Food Preoccupation models, respectively.

CONCLUSIONS

Unique facets of social anxiety differentially relate to disordered eating in youth with obesity. Findings suggest nuanced assessment of anxiety constructs, such as FNE, in pediatric obesity treatment settings may aid in identifying youth at risk for disordered eating attitudes and behaviors.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Weight-Related Teasing of Adolescents Who Are Primarily Obese: Roles of Sociocultural Attitudes Towards Appearance and Physical Activity Self-Efficacy

Adolescents who are obese are at risk for being teased about their appearance with the concomitant negative psychological sequelae. Identifying modifiable variables associated with teasing could inform pediatric weight-management interventions. Characterizing society's role in the victimization of these at-risk individuals could guide anti-bullying programs for schools and broader public health efforts. This study aims to examine novel societal and cognitive factors associated with weight-related teasing frequency. Participants were adolescents (N = 334) being evaluated for a hospital-affiliated weight-management program. The outcome was perceived weight-related teasing frequency. Predictors were sociocultural awareness and internalization of appearance-related attitudes, physical activity self-efficacy, and psychological functioning. Multivariate regressions controlled for demographics and body mass index (BMI) z-scores with separate regressions testing interactions of BMI z-scores with all predictors. In adjusted analyses, higher physical activity self-efficacy and fewer depressive symptoms related to lower teasing frequency. Interactions indicated that less awareness/internalization of sociocultural attitudes towards appearance, more positive body image, and higher self-esteem related to lower teasing frequency regardless of BMI. Targeted interventions and public health campaigns should be developed and tested for adolescents that improve body image with promotion of diverse views about attractiveness, bolster confidence in overcoming physical activity barriers, and identify and treat mood symptoms.

The Impact of School Bullying on Physical Activity in Overweight Youth: Exploring Race and Ethnic Differences

BACKGROUND

About one third of youth in the United States are overweight or obese and African American youth are at an increased risk for pediatric overweight and obesity as well as their complications. Physical activity has been identified as one determinant of overweight and obesity, and school bullying has been found to be associated with decreased physical activity. Guided by the Transactional Stress and Coping Model, this study examines how school bullying might impact the physical activity of white and African American healthy weight and overweight youth.

METHODS

Existing, nationally representative, and complex survey data (N = 4509) from the 2005-2006 United States Health Behavior in School-Aged Children (HBSC) were analyzed using multiple group structural equation modeling to evaluate study questions.

RESULTS

Support for the hypothesized model was found such that bullying negatively impacted physical activity by way of increasing internalizing symptoms. Possible evidence for parental support, but not peer support, as a protective factor was also found. Results were generally similar for all groups, though some differences are discussed.

CONCLUSION

School bullying is a risk factor for reduced physical activity, regardless of race-ethnicity and weight. Implications for school health professionals are discussed.

Intergenerational Transmission of Parent Encouragement to Diet From Adolescence Into Adulthood

BACKGROUND

Although previous cross-sectional research has revealed potential harmful outcomes associated with parent encouragement to diet, it is unclear whether these effects are long lasting and whether they are transmitted to the next generation. The main aim of the current study was to examine longitudinal associations between exposure to parent encouragement to diet in adolescence and weight-related and emotional health outcomes in adulthood and to examine whether intergenerational transmission of encouragement to diet occurs.

METHODS

This is a longitudinal, population-based study (ie, Project Eating and Activity in Teens and Young Adults) of socioeconomically and racially and/or ethnically diverse adolescents managed into adulthood and/or parenthood (n = 556; mean age = 31.4; 64.6% female). Surveys and anthropometrics were completed at school by adolescents in 1998-1999 and surveys were completed online in 2015-2016 by young adults.

RESULTS

Experiencing parent encouragement to diet as an adolescent was significantly associated with a higher risk of overweight or obesity, dieting, binge eating, engaging in unhealthy weight control behaviors, and lower body satisfaction 15 years later as a parent, after adjusting for sociodemographics and baseline measures of the outcomes (P < .05). Additionally, intergenerational transmission of encouragement to diet occurred and resulted in parents being more likely to report other weight-focused communication in the home environment.

CONCLUSIONS

Exposure to parent encouragement to diet as an adolescent had long-term harmful associations with weight-related and emotional health outcomes in parenthood and was transmitted to the next generation. It may be important for health care providers to educate parents about the potential harmful and long-lasting consequences of engaging in encouragement to diet with their children.