Prejudice against obesity among 10-year-olds: a nationwide population-based study

Body norms and normative bodies in Highland Guatemala

OBJECTIVES

The concept of bionormalcy highlights the potential tensions between bodies defined clinically as normal or healthy, bodies that are normative (frequent) within a population, and bodies defined within a given social context as abnormal or devalued. Theories of resource scarcity predict preferences for larger bodies should deviate from what is biologically normative (i.e., most frequent) or clinically defined as healthy. Using the case of adult women in a Guatemalan community with chronically low food security, we test how food scarcity shapes individual views of smaller, larger, and clinically categorized normal bodies.

METHODS

Participants were 102 women from a community in the Central Highlands of Guatemala. Using the Stunkard figure scale and a word elicitation task, participants attributed positive and negative characteristics to male and female silhouettes clinically defined as underweight, normal, overweight, mildly obese, and obese. Mixed-effects models were used to compare attribution scores for figures relative to the clinically normal silhouette.

RESULTS

Silhouettes deviating from the clinically defined normal BMI category on both sides are stigmatized to varying degrees. Food insecurity exacerbates the degree of stigma, while also relatively preferencing overweight bodies.

CONCLUSIONS

In this pilot study, women exhibit a preference for body sizes that fall within the clinical normal and overweight categories and stigmatize bodies outside this range, but in distinct ways. We suggest the attachment of stigma to small and large bodies are not mirror processes, and require more detailed testing to untangle the likely complex ecological and social explanations.

Attitudes and Self-Perception of 10- to 14-Year-Old Students Toward Obese Children

This cross-sectional study was carried out to investigate the self-perception of primary school students aged 10-14 and their attitudes toward obese children (n = 693). There was a weak, positive, and highly significant correlation between the mean scores for the overall Attitude Toward Obese Children Scale, the Self-Perception Profile for Children Scale, and the Acceptance of Obese Peers subscale (p = .000). There was a weak, positive, and highly significant correlation between all the subscales except for the Rejection of Obese Peer and Social Acceptance and Athletic Competence subscales (p < .01). Self-perception in adolescence is effective throughout life in terms of community mental health. Therefore, it is of great importance to carry out education and awareness-raising studies in schools to gain students positive attitudes and behavior toward individuals with different characteristics.

Thin idealization and causal attributions mediate the association between culture and obesity stereotypes: An examination of Chinese and American adolescents

Few studies have examined age or cultural differences in the stereotypes adolescents have of persons with obesity. The present research explored the hypotheses that American adolescents have more negative obesity stereotypes than Chinese adolescents and that the effects of culture are mediated by weight attributions and thin idealization. Participants (N = 335; 181 female; M age = 14.83 years, SD = 1.57 years) completed measures of thin idealization and causal attributions and made generalizations from and attributions of stereotypical personality characteristics to obese figures. Not only did stereotypes differ between countries, but generalizations of negative characteristics from obese figures increased with age. In addition, American adolescents more firmly endorsed the 'thin ideal' and were more likely to attribute obesity to internal causes that Chinese adolescents. As anticipated, between-country differences in stereotyping were mediated by thin idealization and causal attributions. Findings are discussed in terms of the 'doctrine of the mean', social identity theory, and dual-process theories. Statement of Contribution The development of obesity stereotypes has been the subject of a number of recent studies. Although scarce, research on adolescents' obesity stereotypes indicates that the strength of these stereotypes increases with age and that these increases are mediated by thin idealization and causal attributions. The current research adds to this growing literature that differences between Chinese adolescents' and American adolescents' obesity stereotypes - in terms of the assignment of stereotypical traits to people with obesity and the generalization of negative traits from an individual person with obesity to people with obesity as a group - are mediated by thin idealization and attributions about obesity's causes. The research also indicates that (1) age differences in obesity stereotyping vary as a function of the method used to measure stereotypes, (2) Chinese adolescents are less likely than American adolescents to attribute obesity to characterological flaws, and (3) American adolescents idealize thinness more than Chinese adolescents.

Inequality and childhood overweight and obesity: a commentary

Statements on childhood overweight and obesity (COO) have focused on different avenues for prevention and treatment, critical stages of the life cycle, including pregnancy and lactation, individual, family, school and community-based interventions, multidisciplinary family programmes and multicomponent interventions. This commentary is concerned with the less-addressed relationship between COO and inequality. It describes current global patterns of inequality and COO and the ways in which those inequalities are linked to COO at micro-level, meso-level and macro-level. It then describes current programmatic approaches for COO inequality, preventive and medical, and considers important pitfalls in the framing of the problem of COO and inequality. It ends with describing how childhood and adolescent overweight and obesity prevention and treatment programmes might be formulated within broader socio-political frameworks to influence outcomes.

Stigmatization of Overweight and Obese Peers among Children

Children get involved in social categorization. Thus, they are able to stigmatize peers as well as to show in-group favoritism theorized by Tajfel and Turner (1986). Moreover, according to Aboud's Cognitive-Developmental Theory (1988, 2003) the intensity of children's stereotypes and negative attitudes toward socially devalued group members changes with age, in line with their cognitive development. In our Western society, which addresses especially females with the message that thinness is beauty, self-efficacy, power, and success, being overweight or obese is one of the most socially devalued and stigmatized conditions among children. Thus, overweight and obese children are more likely to be personally and socially devalued compared to their average size peers. Starting with these theoretical reflections, the objectives of this mini-review are to examine if: (1) obese children show in-group favoritism and thus show less anti-fat attitudes than their thin and normal weight peers; (2) fat stigma is more prevalent toward overweight and obese girls than toward boys; (3) the intensity of weight-related stigma changes with the cognitive development of children.

Is subjective perception of negative body image among adolescents associated with bullying?

Adolescents' body image dissatisfaction has an adverse effect on peer relationships. It may lead to changes in behaviour (aggressive or passive) and consequently to bullying behaviour. Our aim was to assess the association between body image dissatisfaction and involvement in bullying and whether this differs by gender. We used data from the Slovak part of the 2010 Health Behaviour in School-aged Children study. The final sample comprised 8050 adolescents aged 11 to 15 years old (mean age 13.57), less than half of whom were boys. The association between self-reported body image and involvement in bullying was determined using multinomial logistic regression. We found a significant association between body dissatisfaction and involvement in bullying. Adolescents dissatisfied with their bodies because due to feeling overweight were more likely to become passive or reactive victims. Self-reported thinness was found to be significantly associated with bully-victims only in boys.

CONCLUSION

Adolescent body dissatisfaction is strongly associated with bullying behaviour. Our findings point out the importance of incorporating at schools different types of intervention programmes supporting positive self-perceptions of adolescents and reducing bullying behaviour.

A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention

The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self-esteem and self-worth, negative emotions, negative self-belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho-emotional overload, triggering a cascade of weight gain-inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up-regulation, low-grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.

Attitudes towards obesity in the Swedish general population: the role of one's own body size, weight satisfaction, and controllability beliefs about obesity

This study examined the associations of different socio-demographic and psychological factors with attitudes towards obesity. Individuals with different weight status (N=2436) were drawn from an annual population-based survey in Sweden, and data on attitudes towards obesity (ATOP) and predictor variables were assessed in 2008. The strongest predictor of ATOP was controllability beliefs about obesity (β=0.83). Thus, greater controllability beliefs about obesity predicted more negative attitudes. Sex and weight satisfaction were also independently associated with ATOP. However, there was no, or only a weak, association between weight satisfaction and ATOP among individuals with normal weight or overweight. And the higher the weight satisfactions of individuals with obesity, the more positive were their attitudes. It seems that stigma-reduction strategies in the general public should address the uncontrollable factors in the aetiology of obesity. However, more research is needed to understand the underlying causes of people's attitudes towards obesity.

Adolescent Friendships, BMI, and Physical Activity: Untangling Selection and Influence Through Longitudinal Social Network Analysis

Bioecological theory suggests that adolescents' health is a result of selection and socialization processes occurring between adolescents and their microsettings. This study examines the association between adolescents' friends and health using a social network model and data from the National Longitudinal Study of Adolescent Health (N = 1,896, mean age = 15.97 years). Results indicated evidence of friend influence on BMI and physical activity. Friendships were more likely among adolescents who engaged in greater physical activity and who were similar to one another in BMI and physical activity. These effects emerged after controlling for alternative friend selection factors, such as endogenous social network processes and propinquity through courses and activities. Some selection effects were moderated by gender, popularity, and reciprocity.

Bariatric surgery for obese children and adolescents: a review of the moral challenges

BACKGROUND

Bariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process.

DISCUSSION

A wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed.

SUMMARY

Performing bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents.

Is central obesity associated with poorer health and health-related quality of life in primary school children? Cross-sectional results from the Baden-Württemberg Study

BACKGROUND

Childhood obesity and its consequences are a growing threat to national economies and health services. The aim of this study was to determine associations between waist-to-height ratio (WHtR) as a measure of central obesity, and health-related quality of life (HRQoL) and absenteeism of primary school children in the state of Baden-Württemberg, Germany.

METHODS

Cross-sectional data from 1888 first and second grade children (7.1±0.6 years) participating in the baseline measurements of the Baden-Württemberg Study were analyzed. Parents completed questionnaires including a rating of their children's HRQoL using KINDLR and EQ5D-Y VAS. Days of absence because of illness, and number of visits to a physician during the last year of school/kindergarten were asked, as well as the number of days parents took off work to care for their sick child. Anthropometric measurements were taken by trained staff. The Mann-Whitney-U test was used for statistical analysis of differences between WHtR groups. Logistic regression models were used to identify factors associated with sick days.

RESULTS

A total of 158 (8.4%) children were centrally obese (WHtR ≥0.5). These children had significantly more sick days (9.05 vs. 6.84, p < 0.001) and visits to a physician (3.58 vs. 2.91, p < 0.05), but not days of parental absence than other children. According to regression analysis, sick days were also associated with age, migration status, physical activity pattern, maternal health awareness and family education level. Parent-rated HRQoL was significantly lower in centrally obese children for the EQ5D-Y VAS (88.1 vs. 91.6, p < 0.001), and the KINDLR subscales 'school' (79.9 vs. 82.5, p < 0.05) and 'friends' (75.4 vs. 78.3, p < 0.05), but not for the total score.

CONCLUSIONS

Cross-sectional results show higher rates of absence, more visits to a physician and lower HRQoL in children with central obesity. Each missed day at school implies a hazard to academic achievement and each additional visit to a physician is related to higher health care costs. Thus, the negative impact of central obesity is already measurable in primary school children, which emphasizes the urgent need for early delivery of health promotion and targeted prevention.

Weight status at age 18 influences marriage prospects. A population-based study of Swedish men

Background

In a longitudinal population-based study of the relationship between body mass index (BMI) in early adulthood and marital status at 40 years of age, obese men were half as likely to be married compared with men of normal weight. Significant associations between obesity and marital status among men in a longitudinal setting are novel findings.

Methods

The study cohort comprised Swedish men born from 1951 to 1961. Height and weight at age 18 was gathered from the Military Service Conscription Register and information on marital status at 40 years of age was obtained from population registers by record-linkage using the unique personal identification number. The odds ratio (OR) for being married was calculated by polytomous logistic regression analysis adjusting for birth year, intellectual performance, education, country of birth, residential area, socioeconomic position in childhood and adulthood, parental education and muscle strength.

Results

Our study included 486 599 Swedish men. Young men who were obese (BMI≥30.0) at 18 years of age had an OR of 0.49 (95% CI: 0.46–0.52) for being married at 40 years of age compared to normal weight men (BMI: 18.5–24.9). Underweight men (BMI≤18.5) had an OR of 0.84 (0.82–0.86) and overweight men (BMI: 25.0–29.9) had an OR of 0.83 (0.80–0.85) for being married at 40 years of age.

Conclusion

Underweight, overweight and obese men were less likely to be married than their normal weight counterparts. Obese men had the lowest likelihood of being married. Stigmatization and discrimination may partly explain these findings, but further research is needed before firm conclusions can be drawn.

Socio-economic status, forms of capital and obesity

INTRODUCTION

While the relationships among socio-economic status (SES) and obesity are powerful and synergistic, the SES construct is insufficient to describe some of the cultural influences on status production in society, and therefore on obesity production. Socio-economic status has two closely related dimensions. The economic one is represented by financial wealth while the social one can incorporate education, occupational prestige, authority and community standing. These are, however, incomplete explanations for the relationships between societal inequalities and obesity.

DISCUSSION

Cultural factors associated with SES and obesity are examined here by using Bourdieu and Boltanski's theory of practice, which links economic, social and cultural forms of capital (or value) in an overarching category of symbolic capital. These represent categories through which power relationships within society are negotiated. This construct permits a more complete examination of societal stratification and its human biological consequences and amplifiers, since it incorporates the notion of cultural value in different groups of, for example, preferences in body size and shape. The focus is primarily on the USA, although it draws on literature from elsewhere in the industrialized world where appropriate. Differences in obesity rates across major ethnic groups are discussed, because this is an area in which forms of capital differ, and may offer new insights into obesity and factors that predispose to it, as forms of symbolic capital.

Perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents

Background

Thin children are less muscular, weaker, less active, and have lower performance in measures of physical fitness than their normal weight peers. Thin children are also more frequently subjected to teasing and stigmatization. Little is known about thin children's weight perceptions, desired weight and attitudes and behaviours towards food and exercise. The study aimed to compare perceived weight status, desired weight, eating and exercise behaviours and advice received from parents among thin, overweight, obese or normal weight Australian children and adolescents.

Methods

The sample included 8550 school children aged 6 to 18 years selected from every state and territory of Australia. The children were weighed, measured and classified as thin, normal, overweight or obese using international standards. The main outcome measures were perceived and desired weight, weight related eating and exercising behaviours, and advice received from parents.

Results

The distribution of weight status was - thin 4.4%; normal weight 70.7%; overweight 18.3%; and obese 6.6%. Thin children were significantly shorter than normal weight, overweight or obese children and they were also more likely to report regularly consuming meals and snacks. 57.4% of thin children, 83.1% of normal weight children, 63.7% of overweight and 38.3% of obese children perceived their weight as "about right". Of the thin children, 53.9% wanted to be heavier, 36.2% wanted to stay the same weight, and 9.8% wanted to weigh less. Thin children were significantly less likely than obese children to respond positively to statements such as "I am trying to get fitter" or "I need to get more exercise." Parents were significantly less likely to recommend exercise for thin children compared with other weight groups.

Conclusions

Thin children, as well as those who are overweight or obese, are less likely than normal weight children to consider their weight "about right'. Thin children differ from children of other weights in that thin children are less likely to desire to get fitter or be encouraged to exercise. Both extremes of the spectrum of weight, from underweight to obese, may have serious health consequences for the individuals, as well as for public health policy. Health and wellness programs that promote positive social experiences and encourage exercise should include children of all sizes.

Trends in overweight and obesity in Swedish schoolchildren 1999-2005: has the epidemic reached a plateau?

The aim of this review is to synthesize published evidence on the most recent trends in overweight and obesity among Swedish children. Specifically, trends are reported among fourth graders (10-11 years) from six different municipalities between 1999 and 2005. Weights and heights in representative samples of children within each area were measured by school nurses as part of routine school health examinations. Standardized definitions of overweight, obesity and thinness were calculated by methods described by Cole et al. in 2000 and 2007. In Stockholm, obesity prevalence during academic years starting 1999 and 2003 decreased non-significantly from 4.4% to 2.8% in girls, and increased non-significantly from 3.2% to 3.8% among boys. In Gothenburg, comparing academic years starting 2000 and 2004, prevalence of overweight in girls decreased from 19.6% to 15.9% (P < 0.01) while thinness increased from 9.5% to 11.9% (P < 0.05); no significant changes were observed in boys. Finally, the Swedish National Institute of Public Health released figures from Karlstad, Umeå, Västerås and Ystad in 2003-2005 during which time no trends in prevalence could be clearly shown. The stabilized rates are probably a result of regional and local actions that have taken place in many sectors of society, rather than one specific measure or national political action.