Cause and effect beliefs and self-esteem of overweight children

Social anxiety and weight interact with body salience to affect experiences of social exclusion

BACKGROUND

Individuals at a higher weight experience greater victimization and exclusion by peers, and limited research suggests that the salience of one's body image may increase negative emotional reactions to social rejection. Additionally, social exclusion is related to higher levels of social anxiety (SA). We examined how body salience interacts with SA and weight to predict anxiety, self-esteem, and negative affect following social rejection.

METHODS

Participants were undergraduate women (N = 186). We explored the interactive effects of SA, body mass index (BMI), and body salience (i.e., face versus body photo condition) on emotional response to exclusion in a social ostracism paradigm, Cyberball. BMI and self-reported SA were collected at baseline. One week later, participants played Cyberball and reported state affect, anxiety, and self-esteem before and after the game.

RESULTS

The 3-way interaction of BMI, SA, and photo condition did not significantly predict post-exclusion state measures. Photo condition moderated the relationship between SA and post-exclusion anxiety and between BMI and post-exclusion anxiety.

CONCLUSIONS

Those with higher SA were particularly anxious following exclusion if their bodies were visible to others. Additionally, those with lower BMI experienced greater anxiety after exclusion when their body was visible than those with higher BMI.

Obesity in childhood, socioeconomic status, and completion of 12 or more school years: a prospective cohort study

OBJECTIVES

Children with obesity achieve lower educational level compared with normal-weight peers. Parental socioeconomic status (SES) impacts both a child's academic achievement and risk of obesity. The degree to which the association between obesity and education depends on parental SES is unclear. Therefore, the primary aim is to investigate if individuals with obesity in childhood are less likely to complete ≥12 years of schooling, independently of parental SES. The secondary aim is to study how weight loss, level of education and parental SES are associated.

DESIGN

Nationwide prospective cohort study.

SETTING

Swedish national register data.

PARTICIPANTS

Children aged 10-17 years, recorded in the Swedish Childhood Obesity Treatment Register, and aged 20 years or older at follow-up were included (n=3942). A comparison group was matched by sex, year of birth and living area (n=18 728). Parental SES was based on maternal and paternal level of education, income and occupational status.

PRIMARY OUTCOME MEASURE

Completion of ≥12 years of schooling was analysed with conditional logistic regression, and adjusted for group, migration background, attention deficit disorder with or without hyperactivity, anxiety/depression and parental SES.

RESULTS

Among those with obesity in childhood, 56.7% completed ≥12 school years compared with 74.4% in the comparison group (p<0.0001). High parental SES compared with low SES was strongly associated with attained level of education in both children with and without obesity, adjusted OR (^aOR) (99% CI)=5.40 (4.45 to 6.55). However, obesity in childhood remains a strong risk factor of not completing ≥12 school years, independently of parental SES, ^aOR=0.57 (0.51 to 0.63). Successful obesity treatment increased the odds of completing ≥12 years in school even when taking parental SES into account, ^aOR=1.34 (1.04 to 1.72).

CONCLUSIONS

Individuals with obesity in childhood have lower odds of completing ≥12 school years, independently of parental SES. Optimised obesity treatment may improve school results in this group.

Responding positively to "children who like to eat": Parents' experiences of skills-based treatment for childhood obesity

This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.

Mobile phone addiction in Tibetan and Han Chinese adolescents

PURPOSE

To compare mobile phone addiction (MPA) patterns between Tibetan and Han adolescents in China.

DESIGN AND METHODS

The study was carried out in two provinces of China. The Mobile Phone Addiction Scale (MPAS) was used to assess MPA.

FINDINGS

Seven hundred and five Tibetan and 606 Han students participated in the study. The MPAS total score was 24.4 ± 11.4 in the whole sample; 27.3 ± 10.8 and 20.9 ± 11.2 in Tibetan and Han students, respectively. Quality of life (QOL) in the physical, psychological, social, and environmental domains was negatively associated with MPA.

PRACTICE IMPLICATIONS

Compared with Han students, Tibetan students were found to have more severe MPA. Given its negative impact on QOL, appropriate measures for the prevention of MPA should be developed, particularly for Tibetan middle school students.

A mixed methods analysis of maternal response to children's consumption of a palatable food: differences by child weight status

BACKGROUND

Little is known about how mothers respond to their child eating palatable foods.

OBJECTIVES

The objectives of the study are to examine maternal behaviours when children are presented with a large portion of energy-dense palatable food in an experimental setting and to examine differences by child weight status.

METHODS

Mother-child dyads (N = 37) (mean child age 70.8 months) participated in a videotaped eating protocol with cupcakes. Anthropometrics were measured. Videos were analysed using discourse analysis and were reliably coded for the presence or absence of the most salient theme. Analysis of variance examined theme presence by child and mother weight status.

RESULTS

Mothers disavowed responsibility for their child's eating. Mothers were observed to roll their eyes at the child, throw their hands up in exasperation and distance themselves both physically and emotionally when the child ate the cupcakes voraciously or with high enjoyment. Mothers of children with obesity (vs recommended weight) engaged in more counts of disavowal (p = 0.01).

CONCLUSIONS

Mothers of children with obesity distanced themselves from their child, seeming to disavow responsibility for the child's eating of 'junk food'. Mothers may respond to their child's seemingly gluttonous eating by disavowing responsibility due to the stigma of being a parent of a child with obesity.

The Impact of Workplace Health Promotion Programs Emphasizing Individual Responsibility on Weight Stigma and Discrimination

Over time, there has been a steady increase of workplace health promotion programs that aim to promote employees' health and fitness. Previous research has focused on such program's effectiveness, cost-savings, and barriers to engaging in workplace health promotion. The present research focuses on a downside of workplace health promotion programs that to date has not been examined before, namely the possibility that they, due to a focus on individual responsibility for one's health, inadvertently facilitate stigmatization and discrimination of people with overweight in the workplace. Study 1 shows that the presence of workplace health promotion programs is associated with increased attributions of weight controllability. Study 2 experimentally demonstrates that workplace health promotion programs emphasizing individual rather than organizational responsibility elicit weight stigma. Study 3, which was pre-registered, showed that workplace health promotion programs emphasizing individual responsibility induced weight-based discrimination in the context of promotion decisions in the workplace. Moreover, focusing on people with obesity who frequently experience weight stigma and discrimination, Study 3 showed that workplace health promotion programs highlighting individual responsibility induced employees with obesity to feel individually responsible for their health, but at the same time made them perceive weight as less controllable. Together, our research identifies workplace health promotion programs as potent catalysts of weight stigma and weight-based discrimination, especially when they emphasize individual responsibility for health outcomes. As such, we offer valuable insights for organizations who aim to design and implement workplace health promotion programs in an inclusive, non-discriminatory way that benefits all employees.

The Ethics of Making Patients Responsible

In their daily clinical work, healthcare professionals generally apply what seems to be a double standard for the responsibility of patients. On the one hand, patients are encouraged to take responsibility for lifestyle changes that can improve their chances of good health. On the other hand, when patients fail to follow such recommendations, they are not held responsible for the failure. This seeming inconsistency is explained in terms of the distinction between task responsibility and blame responsibility. The double standard for responsibility is shown to be epistemologically rational, ethically commendable, and therapeutically advantageous. However, this non-blaming approach to patient responsibility is threatened by proposals to assign lower priority in healthcare to patients who are themselves responsible for their disease. Such responsibility-based priority setting requires that physicians assign blame responsibility to their patients, a practice that would run into conflict with the ethical foundations of the patient–physician relationship. Therefore, such proposals should be rejected.

Affective Responses to Intermittent Physical Activity in Healthy Weight and Overweight/Obese Elementary School-Age Children

Background: The purpose of this study was to examine the acute effects of intermittent physical activity (2-min bouts of varying intensities) on psychological mood and enjoyment in elementary school-age children and to examine the effect of weight status on these psychological outcomes. Methods: A total of 39 children (healthy weight, n = 26; overweight/obese, n = 13) completed 4 experimental conditions in random order, which consisted of 8 hours of sitting interrupted with 20 two-minute low­-, moderate-, or high-intensity activity breaks or 20 two-minute screen-time breaks. Mood was assessed using the Feeling Scale immediately following each break. Enjoyment was assessed using the Physical Activity Enjoyment Scale immediately following 10 and 20 breaks. Results: Mood was significantly higher during the sedentary versus active conditions (P < .01). Overweight/obese children reported lower mood scores compared with healthy weight children at the initiation of the low- (P < .05) and high-intensity conditions (P < .001) but experienced improvements in mood throughout the day in all 3 active conditions (P = .02). Enjoyment was significantly higher after completing the active versus sedentary conditions (P = .02). Conclusion: These findings suggest that both healthy weight and overweight/obese children felt better immediately after engaging in screen-time breaks but subsequently rated the activity breaks as more enjoyable compared with screen-time breaks.

Obesity in Children and the 'Myth of Psychological Maladjustment': Self-Esteem in the Spotlight

PURPOSE OF REVIEW

There are contrasting views regarding the psychological well-being of children with obesity. Responding to limitations of existing evidence, Jane Wardle in 2005 argued for a 'myth of psychological maladjustment'. This review looks again at self-esteem.

RECENT FINDINGS

The different characterisations of self-esteem each offer value. Global self-esteem is reduced in nearly all studies of youth with obesity. Dimensional self-esteem reveals physical appearance, athletic and social competence as the most affected areas, confirmed by research that has operationalised low self-competence. Children with obesity are also more likely to be victimised by their peers, generally and for their fatness. Victims who bully others appear to preserve some aspects of self-esteem. A relatively small proportion of youth with obesity has low self-esteem, but those with severe and persistent obesity are especially compromised. Weight loss is only weakly associated with improved self-competence suggesting the value of resilience and asset approaches to improving well-being.

Peer victimization in adolescence: The nature, progression, and consequences of being bullied within a developmental context

Since Dan Olweus's seminal work on bullying in the 1970's (Olweus, 1978), there has been a concerted effort by investigators to identify the confluence of factors that contribute to peer victimization and its role in psychosocial development. Although the cause and consequences of peer victimization may include underlying, age-invariant processes, the manifestation of these factors is, in part, driven by the developmental stage being studied. Thus, a comprehensive understanding of peer victimization requires an explicit developmental perspective. This paper examines how peer victimization in adolescence is unique from other developmental periods. Changes in the nature of peer victimization, associated risk factors, the contexts in which victimization is experienced, and the psychosocial outcomes affected are addressed. A primary focus is how maturational processes and interpersonal contexts characteristic of adolescence contribute to changes in victimization, with the objective of informing future research directions and the development of effective interventions.

Cross-sectional study showed psychosocial variables, gender and family involvement played an important role in an adolescent weight management programme

AIM

This study aimed to investigate the psychosocial gains perceived by overweight adolescents attending a 12-week weight management programme and to analyse gender-specific differences.

METHODS

A quantitative cross-sectional study was conducted with a sample of 70 overweight adolescents aged between 12 and 18 (52.9% girls), evaluated at baseline and at week 12 using anthropometric measurements and self-reported questionnaires. We analysed gender-specific differences related to body self-esteem, social life, relationships with their family, physical comfort, health responsibility, perceived benefits of the intervention, self-efficacy and adherence. We further investigated whether the variables at week 12 would predict changes in their body mass index.

RESULTS

While weight had a greater impact on the body self-esteem of girls, both at baseline and week 12, boys reported higher self-efficacy and adherence as well as a greater perception of the benefits of the intervention at week 12. The body mass index change was positively associated with body self-esteem, relationships within the family and self-efficacy and adherence.

CONCLUSION

Gender specifics and the role of psychosocial variables must be taken into account during weight management programmes for adolescents, and it is important to include the family throughout the entire process.

Predictors and determinants for weight reduction in overweight and obese children and adolescents

INTRODUCTION

Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. This multicenter non-randomised trial aimed to identify parameters and determinants of long-term weight reduction.

PATIENTS AND METHODS

A total of 143/159 overweight and obese children and adolescents (90 %) completed the prospective multicenter trial (age 13.9±2.4 years, BMI 31.2±5.4kg/m², BMI-SDS 2.51±0.57). During a 6-week rehabilitation period the patients participated in a structured treatment and teaching program (STTP). Following in-patient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, standardized questionnaires to assess socio-demographic and socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress management, social support, actual body shape).

RESULTS

66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.53±0.09mm (range 0.40 to 0.80); 15% of the patients showed normal range values (< 0.45mm), 40% a slightly elevated (≥ 0.45 to ≤ 0.50mm) and 45% an elevated (> 0.50mm) thickness. After the inpatient treatment lasting 40.4±4.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.52±3.94 (0.4 to 13.3) kg (p<0.01) that was accompanied by a reduction in body fat mass. Using multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square=0.53): well-being (β=-0.543), resilience (β=0.434), and sense of coherence (β=0.315).

CONCLUSION

The different parameters (i. e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs.

Emotional Implications of Weight Stigma Across Middle School: The Role of Weight-Based Peer Discrimination

This study considered the emotional consequences of weight stigmatization in early adolescence by examining the effects of weight-based peer discrimination across middle school. Sampled across 26 urban middle schools, 5,128 youth (52% girls) with complete body mass index data at sixth or 7th grade were included: 30% Latino, 21% White, 14% East/Southeast Asian, 14% Multiethnic, 12% African American/Black, and 9% from other specific ethnic groups. About one third of the sample reported at least one weight-discrimination incident at 7th grade. Controlling for sixth-grade adjustment, perceptions of weight-based peer discrimination at 7th grade were stronger predictors of body dissatisfaction, social anxiety, and loneliness (and somatic symptoms for girls but not boys) at 8th-grade than 7th-grade body mass index. Moreover, heavier body stature during the 1st year in middle school was associated with increased body dissatisfaction by the end of middle school in part due to weight-related disrespectful, exclusionary, and demeaning treatment by peers. Weight-based peer discrimination helps us understand one of the stigmatizing mechanisms underlying the relation between heavy body stature and the progression of emotional problems in early adolescence.

Self-concept, Self-esteem and Body Weight in Adolescent Females

Eighty girls aged 12.8 (0.6) years, completed self-concept, depression and anxiety scales over three years and had their height and weight measured. All nine self-concept domains were lower in the Highest BMI group, compared to the Lower BMI group and this trend was stable over three years. Highest BMI girls were substantially lower than population norms on all nine scales. Over three years, the Physical Appearance and Close Friendship scores of Highest BMI girls decreased compared to Lower BMI girls. This pattern was similar for all of the other self-concept domains. Several aspects of early adolescent girls' self-image may be adversely influenced by a heavy weight status.

The Social and Emotional Lives of Overweight, Obese, and Severely Obese Children

This study examines inter- and intrapersonal problems associated with being overweight among one thousand one hundred sixty-four 6- to 7-year-olds (49% boys) in 29 rural schools. Socioemotional data include child self-reports, peer sociometrics, and teacher reports. Results support the hypothesis that children with weight problems struggle socially and emotionally, and extend current understanding of child obesity by demonstrating that problems appear early, are evident in a community sample, can be identified using standard sociometric methods, and are worse among children with severe obesity. Sociometric status difference between levels of obesity were also found. Although obese children were neglected by peers, severely obese children were rejected.

Effectiveness analysis of an internet-based intervention for overweight adolescents: next steps for researchers and clinicians

BACKGROUNDS

The development of effective strategies for the management of overweight in adolescence is a well recognized need. The current study investigates the effectiveness of an e-therapeutic platform (Next.Step) which aims to promote weight management skills and the adoption of health-promoting behaviours among overweight adolescents.

METHODS

We conducted a randomized clinical trial with a sample of 80 adolescents. The control group followed the standard intervention. The experimental group was invited to access the platform during 12 weeks in addition to the standard intervention.

RESULTS

Although there was no change in the primary outcomes (body mass index and percentage of fat mass), the results suggest that the program is associated with an improvement in the 'positive perspective of life' and 'benefits perceived from the intervention', which have been identified as relevant factors for an effective weight management.

CONCLUSIONS

Our findings provide little support for the effectiveness of internet-based weight management programs as an add-on to the standard intervention.

TRIAL REGISTRATION

NCT01904474.

Obesity Stigmatization and the Importance of the Research of A.J. Stunkard

Obese individuals face weight-based stigmatization and discrimination in virtually all areas of life. These stigmatizing experiences can lead to detrimental psychological, physical, and societal consequences and may further perpetuate the increasing prevalence of obesity. A. J. Stunkard was one of the first medical professionals to identify and address the serious ramifications of obesity stigmatization on both individual and societal levels. Throughout the last half-century, Stunkard contributed numerous findings and publications to the field of obesity stigmatization. His work laid the foundation and direction for important areas of current research, such as the cultural influences on weight bias, stigmatization among healthcare professionals, weight stigma among children, and the internalization of weight bias by obese individuals. His contributions have had an important influence on the current directions of these fields.

Identification of Predictors for Weight Reduction in Children and Adolescents with Overweight and Obesity (IDA-Insel Survey)

INTRODUCTION

Worldwide, overweight and obesity are known as posing serious health risks. Successful methods of prevention and therapy for overweight and obesity have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction.

PATIENTS AND METHODS

In total 143/159 children and adolescents (90%) with overweight and obesity completed the prospective, multicenter trial (age 13.9 ± 2.4 years, BMI 31.2 ± 5.4 kg/m², BMI-SDS 2.51 ± 0.57). During a six-week rehabilitation patients participated in a structured treatment and teaching program (STTP). Following the inpatient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, and standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress-management, social support, and actual body shape).

RESULTS

66% of the children and adolescents showed non-normal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. Mean thickness of carotid intima-media was 0.53 ± 0.09 mm (range, 0.40-0.80); 15% of the patients showed a normal range (<0.45 mm), 40% slightly elevated (0.45-0.50 mm) and 45% an elevated (>0.50 mm) thickness. After an inpatient treatment lasting 40.4 ± 4.1 (range, 28-49) days, children and adolescents reached a mean weight reduction of 5.52 ± 3.94 (0.4-13.3) kg (p < 0.01) accompanied by a reduction of body fat mass. Performing multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): Well-being (β = -0.543), resilience (β = 0.434) and intrafamilial conflicts (β = 0.315).

CONCLUSION

The different parameters (i.e., resilience, intrafamilial conflicts, structured daily schedule) have demonstrated their utility and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting.

Attitudes Toward Physical Activity According to Weight Status Among Schoolchildren in Sousse, Tunisia

AIM

To investigate differences in attitude toward physical activity in normal-weight, overweight, and obese adolescents.

MATERIALS AND METHODS

We conducted a cross-sectional survey carried out in 2009/2010. It concerned randomly selected schoolchildren of colleges of Sousse in seventh and ninth grade. The sample was composed of 4003 schoolchildren. A questionnaire was used to evaluate habits and perception of physical activity, and we took anthropometric measurements of height and weight.

RESULTS

Among schoolchildren who performed a recommended level of physical activity, there was no significant difference in perceptions according to weight status. However, among those who did not practice physical activity, obese participants had significantly less positive perception. Overweight and obesity significantly increase the risk of negative perception of physical activity practice among participants who do not do the recommended level of physical activity. However, this association becomes non significant among those who practice recommended level of physical activity. The same findings were observed after adjustment by age and sex.

CONCLUSION

Negative attitudes among inactive children may favor the development of a vicious circle perpetuating physical inactivity among normal-weight and overweight children.

Type 2 diabetes in youth

Since the 1990s, concerns about a global obesity epidemic have flourished. These concerns regarding obesity are expressed in popular culture and scientific literature and emphasize both weight and weight loss when defining health and well-being. As a result scholars are now calling attention to a "shadow epidemic" of weight stigma that is shown to have harmful physiological and psychological impacts in youth. In tandem with "globesity" concerns, there has been a similar concern expressed over the epidemic of type 2 diabetes, which some have termed "diabesity." Although there is less known about diabetes stigma, the topic has much overlap with obesity stigma. In this narrative review we discuss the related problems of obesity and type 2 diabetes stigma, with an emphasis on issues specific to youth, as relevant. Drawing from literature on weight bias, critical weight studies, and Health at Every Size (HAES), we highlight pedagogical approaches to address obesity stigma and their implications to redress the problem of type 2 diabetes-related stigma in health care.

Peers and Obesity during Childhood and Adolescence: A Review of the Empirical Research on Peers, Eating, and Physical Activity

Obesity during childhood and adolescence is a growing problem in the United States, Canada, and around the world that leads to significant physical, psychological, and social impairment. In recent years, empirical research on factors that contribute to the development and maintenance of obesity has begun to consider peer experiences, such as peer rejection, peer victimization, and friendship. Peer experiences have been theoretically and empirically related to the “Big Two” contributors to the obesity epidemic, eating and physical activity, but there has not been a comprehensive review of the extant empirical literature. In this article, we review and synthesize the emerging theoretical and empirical literatures on peer experiences in relation to: (a) eating (food consumption and food selection); and (b) physical activity, during childhood and adolescence. A number of limitations and issues in the theoretical and empirical literatures are also discussed, along with future research directions. In conclusion, we argue that the involvement of children and adolescents’ peer networks in prevention and intervention efforts may be critical for promoting and maintaining positive behavioral health trajectories.

Imitation of snack food intake among normal-weight and overweight children

This study investigated whether social modeling of palatable food intake might partially be explained by the direct imitation of a peer reaching for snack food and further, assessed the role of the children's own weight status on their likelihood of imitation during the social interaction. Real-time observations during a 10-min play situation in which 68 participants (27.9% overweight) interacted with normal-weight confederates (instructed peers) were conducted. Children's imitated and non-imitated responses to the confederate's food picking movements were compared using a paired sample t-test. In addition, the pattern of likelihood of imitation was tested using multilevel proportional hazard models in a survival analysis framework. Children were more likely to eat after observing a peer reaching for snack food than without such a cue [t₍₆₇₎ = 5.69, P < 0.0001]. Moreover, findings suggest that children may display different imitation responses during a social interaction based on their weight status (HR = 2.6, P = 0.03, 95% CI = 1.09–6.20). Overweight children were almost twice as likely to imitate, whereas normal-weight children had a smaller chance to imitate at the end of the interaction. Further, the mean difference in the likelihood of imitation suggest that overweight children might be less likely to imitate in the beginning of the interaction than normal-weight children. The findings provide preliminary evidence that children's imitation food picking movements may partly contribute to social modeling effects on palatable food intake. That is, a peer reaching for food is likely to trigger children's snack intake. However, the influence of others on food intake is a complex process that might be explained by different theoretical perspectives.

Obesity, Labeling, and Psychological Distress in Late-Childhood and Adolescent Black and White Girls

The stigma of childhood obesity has the potential to affect psychological development during the early life course, but few studies examine whether experiencing stigma in childhood and adolescence has lasting ramifications for mental health during the transition to adulthood. Integrating modified labeling theory with a life course perspective, this study examined how obesity at different ages affects psychological distress in late adolescence using longitudinal data on black and white girls. We tested whether parent or friend labeling mediates this relationship and whether distal effects on psychological distress are further mediated through proximal distress using data from the National Growth and Health Study (n = 2,379). Findings showed significant proximal and distal effects of obesity on psychological distress through both parent and friend labeling among white girls. Distal effects on psychological distress were also mediated by proximal psychological distress. Among black girls, there were no distal effects, suggesting weight-based stigma is more consequential for white girls compared to black girls.

The relationship between weight status and psychopathology in adolescence: The role of social support

This study evaluated the differences between normal-weight and overweight adolescents in psychopathology, social support and emotional competences, and the role of social support in the relationship between psychopathology and weight. We examined a clinical group of 83 overweight/obese adolescents, a community group of 82 overweight/obese adolescents, and 205 adolescents with normal weight. No differences were found in psychopathology and emotional skills. Compared to healthy peers, however, the overweight/obese community group was less satisfied with their friendships, and the clinical group was less satisfied with their intimate support and social activities. Social support mediates the relationship between weight and psychopathology.

Childhood obesity: effects on children's participation, mental health, and psychosocial development

Obesity and being overweight in a child significantly affects his or her healthy development hence there is an understandable focus in the occupational therapy literature on the physical health and difficulties in motor function related to obesity. However, this emphasis somewhat overshadows the psychosocial issues of growing-up obese or overweight. The objective of this paper is to apprise readers of the salient multiple psychosocial sequelae associated with childhood obesity including weight bias and victimization. A conceptual systems framework that supports a multifaceted approach to the occupational and developmental challenges on a population and/or individual level is discussed.

Weight discrimination and bullying

Despite significant attention to the medical impacts of obesity, often ignored are the negative outcomes that obese children and adults experience as a result of stigma, bias, and discrimination. Obese individuals are frequently stigmatized because of their weight in many domains of daily life. Research spanning several decades has documented consistent weight bias and stigmatization in employment, health care, schools, the media, and interpersonal relationships. For overweight and obese youth, weight stigmatization translates into pervasive victimization, teasing, and bullying. Multiple adverse outcomes are associated with exposure to weight stigmatization, including depression, anxiety, low self-esteem, body dissatisfaction, suicidal ideation, poor academic performance, lower physical activity, maladaptive eating behaviors, and avoidance of health care. This review summarizes the nature and extent of weight stigmatization against overweight and obese individuals, as well as the resulting consequences that these experiences create for social, psychological, and physical health for children and adults who are targeted.

'Do I care?' Young adults' recalled experiences of early adolescent overweight and obesity: a qualitative study

OBJECTIVE

Individual behaviour change to reduce obesity requires awareness of, and concern about, weight. This paper therefore describes how young adults, known to have been overweight or obese during early adolescence, recalled early adolescent weight-related awareness and concerns. Associations between recalled concerns and weight-, health- and peer-related survey responses collected during adolescence are also examined.

DESIGN

Qualitative semi-structured interviews with young adults; data compared with responses to self-report questionnaires obtained in adolescence.

PARTICIPANTS

A total of 35 participants, purposively sub-sampled at age 24 from a longitudinal study of a school year cohort, previously surveyed at ages 11, 13 and 15. Physical measures during previous surveys allowed identification of participants with a body mass index (BMI) indicative of overweight or obesity (based on British 1990 growth reference) during early adolescence. Overall, 26 had been obese, of whom 11 had BMI99.6th centile, whereas 9 had been overweight (BMI=95th-97.9th centile).

MEASURES

Qualitative interview responses describing teenage life, with prompts for school-, social- and health-related concerns. Early adolescent self-report questionnaire data on weight-worries, self-esteem, friends and victimisation (closed questions).

RESULTS

Most, but not all recalled having been aware of their overweight. None referred to themselves as having been obese. None recalled weight-related health worries. Recollection of early adolescent obesity varied from major concerns impacting on much of an individual's life to almost no concern, with little relation to actual severity of overweight. Recalled concerns were not clearly patterned by gender, but young adult males recalling concerns had previously reported more worries about weight, lower self-esteem, fewer friends and more victimisation in early adolescence; no such pattern was seen among females.

CONCLUSION

The popular image of the unhappy overweight teenager was not borne out. Many obese adolescents, although well aware of their overweight recalled neither major dissatisfaction nor concern. Weight-reduction behaviours are unlikely in such circumstances.

Weight-based victimization: bullying experiences of weight loss treatment-seeking youth

OBJECTIVE

Few studies have comprehensively examined weight-based victimization (WBV) in youth, despite its serious consequences for their psychosocial and physical health. Given that obese and treatment-seeking youth may be highly vulnerable to WBV and its negative consequences, the current study provides a comprehensive assessment of WBV in a weight loss treatment-seeking sample.

METHODS

Adolescents (aged 14-18 years; N = 361) enrolled in 2 national weight loss camps were surveyed. An in-depth assessment of WBV was conducted by using an online survey, in which participants indicated the duration, typical locations, frequent perpetrators, and forms of WBV they had experienced.

RESULTS

Findings indicate that 64% of the study participants reported WBV at school, and the risk of WBV increased with body weight. Most participants reported WBV enduring for 1 year (78%), and 36% were teased/bullied for 5 years. Peers (92%) and friends (70%) were the most commonly reported perpetrators, followed by adult perpetrators, including physical education teachers/sport coaches (42%), parents (37%), and teachers (27%). WBV was most frequently reported in the form of verbal teasing (75%-88%), relational victimization (74%-82%), cyberbullying (59%-61%), and physical aggression (33%-61%). WBV was commonly experienced in multiple locations at school.

CONCLUSIONS

WBV is a prevalent experience for weight loss treatment-seeking youth, even when they are no longer overweight. Given the frequent reports of WBV from adult perpetrators in addition to peers, treatment providers and school personnel can play an important role in identifying and supporting youth who may be at risk for pervasive teasing and bullying.

Strategies to address weight-based victimization: youths' preferred support interventions from classmates, teachers, and parents

Weight-Based Victimization is a frequent experience for adolescents who are overweight or obese, and is associated with numerous psychosocial and physical consequences for those who are targets of victimization. Assessing targets` preferences for different types of support and intervention has been absent in the context of weight-based victimization, but is needed to help inform potential interventions, motivate action, and identify strategies to help adolescents cope with experiences of weight-related teasing or bullying. Adolescents (14-18 years, N = 361, 40 % female, 71 % Caucasian) enrolled in national weight-loss camps completed an on-line survey. Participants who reported previous experiences of weight-based victimization were surveyed about their preferred interventions from peers, friends, teachers, Physical Education (PE) teachers/coaches, and parents. Participants indicated their preferences for specific strategies pertaining to target support, bullying intervention and prevention (e.g., inclusion in peer activities, confronting the bully, telling an adult, and improving anti-bullying policies). Friends (66 %) and peers (58 %) were the most highly preferred intervention agents followed by teachers (55 %), PE teachers/coaches (44 %), and parents (43 %). Participants who experienced more weight-based victimization expressed increased desire for intervention. The frequency of victimization, social support from friends and family, and perceived likelihood and helpfulness of intervention significantly influenced participant preferences for certain types of intervention, although preferences were generally consistent across participants' characteristics. The current study is the first to document youth's preferences for interventions in response to weight-based victimization. The findings have important implications for encouraging appropriate intervention and informing bystanders, which may help to reduce the prevalence, recurrence, and consequences for youth who are targets of weight-based teasing or bullying.

Psychological effects of dance-based group exergaming in obese adolescents

BACKGROUND

In order to attract obese adolescents who are often reluctant to engage in traditional exercise, new forms of physical activity are needed.

OBJECTIVES

The purpose of the study was to investigate the impact of dance-based exergaming on a diverse sample of obese adolescents' perceived competence to exercise, psychological adjustment and body mass index (BMI).

METHODS

A diverse sample of 40 obese adolescents was randomized to either a 10-week group dance-based exergaming programme or a wait-list control condition. Baseline and follow-up measures included adolescent self-reported psychological adjustment and perceived competence to exercise, and maternal report of adolescent psychological adjustment and anthropometric measures.

RESULTS

Compared with controls, participants in the dance-based exergaming condition significantly increased in self-reported perceived competence to exercise regularly and reported significant improvement in relations with parents from baseline to end-of-treatment. Maternal report of adolescent externalizing and internalizing symptomatology also decreased from baseline to end-of-treatment. No pre-post differences in BMI were seen within or between conditions.

CONCLUSIONS

Results support the positive impact of dance-based exergaming on obese adolescents' psychological functioning and perceived competence to continue exercise.

[Factorial study of the psychopathological factors of morbid obesity in the adolescent]

BACKGROUND

The prevalence of paediatric obesity is high in most countries. Added to this, the degree of paediatric obesity is also on the rise. It is however to be noted that although the psychological causes of the problem are well known, they remain difficult to assess. Facing the great number of adolescents suffering from severe obesity, who are looking for treatment and failing to find one, this survey aims at facts-finding and analyses of the psychological and psychopathological origin and associated severity of obesity, and of the parameters that can lead to a successful treatment.

METHODS

This survey has been carried out among 125 adolescents suffering from grade 2 obesity. To lose weight, the adolescents were treated during 1 year at the boarding dietary department of the "Institut Médical Pédiatrique Clairs-Vallons" in Belgium. The evaluation consists in a type CFTMEA-R-2000 psychopathological diagnosis including previous traumatic factors, taking into consideration the information regarding weight, weight evolution over one year and a quality assessment of the compliance of the patient with the treatment. These data have been submitted to the SPADN statistical program in order to carry out an analysis taking into account the various connections.

RESULTS

Our results have underlined that the severity of the obesity in our population can be coupled with pathological family environment factors such as mental illness, care deficiencies, child abuse and, as a result, the presence of a psychopathological diagnosis. The same can be said in cases of lesser compliance with the treatment by the patient and his family, although in the short term the weight loss is greater. Likewise, a less severe obesity and a better compliance with the treatment can be coupled with the absence of both psychopathological diagnosis and pathological family environment.

CONCLUSION

In our sample population, the psychological and psychopathological factors tend to be linked with a more severe obesity, and less good compliance with the treatment on both individual and family accounts. As a result, obesity could be considered as a way for the patient to adapt him/herself or compensate in front of traumatic family experiences. The isolation from the family seems therefore indispensable for any change in the adolescent, but then raises the problem of long term care after hospitalisation. If obesity is an adaptation process, the loss of weight could then have deeper psychological implications, implying a more complex follow-up of the patient.

Stigmatized Students: Age, Sex, and Ethnicity Effects in the Stigmatization of Obesity

OBJECTIVE

To assess the stigmatization of obesity relative to the stigmatization of various disabilities among young men and women. Attitudes across ethnic groups were compared. In addition, these findings were compared with data showing severe stigmatization of obesity among children.

RESEARCH METHODS AND PROCEDURES

Participants included 356 university students (56% women; mean age, 20.6 years; mean BMI, 23.3 kg/m2; range, 14.4 to 45.0 kg/m2) who ranked six drawings of same-sex peers in order of how well they liked each person. The drawings showed adults with obesity, various disabilities, or no disability. These rankings were compared with those obtained through a similar procedure with 458 fifth- and sixth-grade children.

RESULTS

Obesity was highly stigmatized relative to physical disabilities. African-American women liked obese peers more than did African-American men, white men, or white women [F(1,216) = 4.02, p < 0.05]. Overweight and obese participants were no less stigmatizing of obesity than normal weight participants. Adults were more accepting than children of their obese peers [t(761) = 9.16, p < 0.001].

DISCUSSION

Although the stigmatization of obesity was high among participants overall, African-American women seemed to have more positive attitudes toward obesity than did white women, white men, or African-American men. Participants' weight did not affect their stigmatization of obesity: obese and overweight adults were as highly stigmatizing of obesity as non-overweight adults. Such internalized stigmatization could help to explain the low self-esteem and poor body image among obese young adults. However, adults seemed to have more positive attitudes about obesity than children. An understanding of the factors that limit the stigma of obesity among African-American women could help efforts to reduce stigma.

Boys' and girls' weight status and math performance from kindergarten entry through fifth grade: a mediated analysis

This study tests a mediated model of boys' and girls' weight status and math performance with 6,250 children from the Early Childhood Longitudinal Study. Five data points spanning kindergarten entry (mean age=68.46 months) through fifth grade (mean age=134.60 months) were analyzed. Three weight status groups were identified: persistent obesity, later onset obesity, and never obese. Multilevel models tested relations between weight status and math performance, weight status and interpersonal skills and internalizing behaviors, and interpersonal skills and internalizing behaviors and math performance. Interpersonal skills mediated the association between weight status and math performance for girls, and internalizing behaviors mediated the association between weight status and math performance for both sexes, with effects varying by group and time.

The nature, occurring contexts, and psychological implications of weight-related teasing in urban physical education programs

This study examined the nature, occurring contexts, and psychological implications of weight-related teasing in urban physical education programs. Semistructured interviews were conducted with 47 participants from a large urban school district. Data were analyzed using inductive analysis and constant comparisons. Most overweight adolescents experienced many different types of teasing in physical education. Victims of teasing felt hurt and experienced uncomfortable feelings due to social comparisons. Overweight students who were not teased reported a variety of reasons. Teachers lacked awareness of and strategies to handle teasing of overweight students. There is a need to implement preventive policies and rules to eliminate weight-related teasing and create inclusive physical education environments.

Influence of peers and friends on children's and adolescents' eating and activity behaviors

Obesity during childhood and adolescence is a growing problem in the United States, Canada, and around the world that leads to significant physical, psychological, and social consequences. Peer experiences have been theoretically and empirically related to the "Big Two" contributors to the obesity epidemic, unhealthy eating and physical inactivity. In this article, we synthesize the empirical literature on the influence of peers and friends on youth's eating and physical activity. Limitations and issues in the theoretical and empirical literatures are also discussed, along with future research directions. In conclusion, we argue that the involvement of children's and adolescents' peer networks in prevention and intervention efforts may be critical for promoting and maintaining positive behavioral health trajectories. However, further theoretical and empirical work is needed to better understand the specific mechanisms underlying the effects of peers on youth's eating and physical activity.

Teasing and social rejection among obese children enrolling in family-based behavioural treatment: effects on psychological adjustment and academic competencies

OBJECTIVES

The first objective was to determine the prevalence of psychological maladjustment (emotional and behavioural problems), low academic competencies and teasing/social rejection among obese Icelandic children enrolling in a family-based behavioural treatment. A second objective was to explore the degree to which teasing/social rejection specifically contributes to children's psychological adjustment and academic competencies when controlling for other variables, including demographics, children's physical activity, parental depression and life-stress.

METHODS

Participants were 84 obese children (mean body mass index-standard deviation score=3.11, age range=7.52-13.61 years). Height and weight, demographics and measures of children's psychological adjustment, academic competencies, teasing/social rejection and physical activity were collected from children, parents and teachers. Parental depression and life-stress was self-reported.

RESULTS

Over half the children exceeded cutoffs indicating concern on at least one measure of behavioural or emotional difficulties. Children endorsed significant levels of teasing/social rejection, with almost half acknowledging they were not popular with same-gender peers. Parent reports of peer problems were even higher, with over 90% of both boys and girls being rated by their parents as having significant peer difficulties. However, rates of low academic competencies as reported by teachers were not different from those of the general population. In regression analyses controlling for other variables, self-reported teasing/social rejection emerged as a significant contributor to explaining both child psychological adjustment and academic competencies.

CONCLUSIONS

The results indicate that among obese children enrolled in family-based treatment, self-reported teasing/social rejection is quite high and it is associated with poorer psychological adjustment as well as lower academic competencies. Parent reports corroborate the presence of substantial peer difficulties, supporting the need to address peer relations with overweight children both in clinical practice and in public health interventions.

The views of young children in the UK about obesity, body size, shape and weight: a systematic review

BACKGROUND

There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues.

METHODS

We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings.

RESULTS

We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth.

CONCLUSIONS

Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue.

Impaired mental rotation performance in overweight children

Overweight children seem to have cognitive impairment. Since there is a relationship between motor and visual-spatial ability and because of the reduced motor abilities of overweight children we assumed that these children might show an impaired mental rotation performance. Sixteen overweight children (10 years of age) and 16 control children (10 years of age) were matched by age, gender, and socio-economic status. Each participant completed a general intelligence test, a motor test, and a chronometric mental rotation test. The results show differences in both motor ability and mental rotation accuracy. Overweight children made more errors when the rotation task was difficult compared to normal weight children. This study gives a clue to overweight children's problems in spatial cognitive tasks.

Ensuring children eat a healthy diet: a theory-driven focus group study to inform communication aimed at parents

The Theory of Planned Behavior (TPB) served as a framework for analyzing focus group transcripts (N = 43) focused on parents' perceptions of the challenges of ensuring their children eat a healthy diet. The results suggest that parents consider their beliefs and behaviors as individuals within a society, within families, within cultures, as inheritors of family traditions, and as parents who influence or fail to influence the attitudes and behaviors of their children. The results showed the particular salience of factors related to the TPB concepts of perceived norms and control. Approaches to building theory-driven nursing interventions are suggested.