"No fat friend of mine": Young children's responses to overweight and disability

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.

A short-form drama series created for the digital media environment: A randomised controlled trial exploring effects on girls' body satisfaction, acceptance of appearance diversity, and appearance-related internalised racism

'Edutainment' micro-interventions are a scalable public health strategy that can challenge media-related body image pressures and race- and weight- based stigma. This study evaluated the impact of viewing a brief, theoretically-informed, short-form drama episode on Black and non-Black adolescent girls' body image, acceptance of diversity of appearance (assessed by acceptance of an individual in a larger body and a Black individual), and appearance-related internalised racism (among Black girls only). The fictional drama depicted characters of diverse body sizes and race/ethnicities, with each episode focusing on a risk or protective factor for body image concerns among adolescent girls (e.g., appearance-related teasing and conversations). Participants (N = 686; 50.4 % Black, 49.6 % non-Black) aged 13-18 (Mage = 15.72 years) were randomly allocated to view either the first episode of this series (focused on social media's unrealistic appearance ideals and strategies to resist pressures) or a non-body-image-related control video. Findings revealed no significant differences in body satisfaction between conditions but significant improvements in the acceptance of appearance diversity among all girls who viewed the body image episode. Black girls who viewed this episode experienced significant improvements to appearance-related internalised racism. Edutainment micro-interventions constitute a promising avenue for promoting acceptance of appearance diversity and reducing appearance-related internalised racism.

A qualitative study exploring the perceptions of health among pre-teen girls from disadvantaged communities in Dublin

There are disparities in health outcomes between youth from higher and lower socioeconomic backgrounds, and girls are especially vulnerable to changes in health-related behaviours as they develop. Therefore, this study explored how girls from disadvantaged communities in Dublin, Ireland, make sense of 'being healthy.' A phenomenological qualitative design was implemented. Three focus groups were conducted (n = 22, 10-12 years) and data were analysed using thematic analysis. Food and physical appearance featured prominently within the girls' definitions of health. Girls and their families from low-SES backgrounds may experience more difficulties with time scarcity as well as environmental barriers to a healthy lifestyle.

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.

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

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Translation, Adaptation and Psychometric Properties of SATAQ-4R for Brazilian Children

BACKGROUND

The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) is one of the most investigated instruments for the evaluation of sociocultural pressure and internalization of the beauty standard, and it is considered to be one of the most robust instruments for this purpose. The most recent version of this questionnaire is the SATAQ-4R, originally designed for adults and teenagers, which has been used in different countries, contexts, and populations. The cross-cultural adaptation and validation of the SATAQ-4R for Brazilian children are appropriate and necessary.

OBJECTIVE

The general objective of this study was to translate, adapt, and verify the psychometric qualities of the SATAQ-4R for Brazilian girls and boys aged between 7 and 11 years old.

METHODS

Study 1 describes the cross-cultural adaptation, from the translation stage to the pretest in children of both sexes (n = 36, M = 8.76, SD = 1.59 years). SATAQ-4R has been demonstrated to be easily understood by Brazilian children. Studies 2 and 3 analyze the psychometric qualities of such an instrument in 566 girls (M = 9.18, SD = 1.23 years) and in 592 boys (M = 9.18, SD = 1.23), respectively. Exploratory and confirmatory factor analyses have been performed with independent samples.

RESULTS

Both instruments presented factor structures composed of five factors, good reliability, and convergent validity.

CONCLUSION

We concluded that SATAQ-4R-Female and SATAQ-4R-Male are useful tools for evaluating the internalization of beauty standards and of sociocultural pressure on Brazilian children.

The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity

Background

Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children.

Objective

The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P.

Methods

This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake).

Results

The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70%). Overall, 95% of the children liked the game very much or much. No group changes were observed at the behavioral level.

Conclusions

The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P.

Trial Registration

ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978

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.

The bigger picture: young children's perception of fatness in the context of other physical differences

BACKGROUND

Negative obesity stereotypes and anti-fat attitudes have been observed in children from age three. It is uncertain whether this is specific to fatness or generalizable to other visible differences.

OBJECTIVES

To determine whether young children base decisions about qualities in others and friendship choices more on fatness than other visible differences between people.

METHODS

Using a personal construct theory approach, 85 children (mean age 5.7, 42 girls) completed a simple repertory grid. The children were asked about differences (constructs) between four illustrations (elements) that showed children as healthy weight, fat, the opposite gender and in a wheelchair. Children were also asked about friendship with the illustrated children and self-image preferences. Their answers were grouped using thematic analysis.

RESULTS

The fat, opposite gender and wheelchair-bound characters were equally chosen by children as different to the standard character. When identifying differences, fatness or body shape was referred to significantly less than gender or being in a wheelchair. Children were more likely to reject an opposite gender character as a friend, or as someone they would like to be, than to reject the fat character. Only one child, themselves overweight, voiced strong anti-fat attitudes.

CONCLUSIONS

Apparent negativity towards fatness is fostered by failure to consider other visible differences and by children's 'like me' peer preferences. It was less desirable in the eyes of most 5-year old girls to be a boy than to be fat. This offers some reassurance to those working to improve children's health literacy in obesity.

PREOCUPAÇÕES E COMPORTAMENTOS RELACIONADOS À APARÊNCIA FÍSICA NA INFÂNCIA: UMA ABORDAGEM QUALITATIVA

A criança elabora mecanismos internos para formação de referências do próprio corpo, desde a tenra idade, tornando-se uma fase da vida relevante para estudiosos. Objetivou-se investigar atitudes relacionadas à imagem corporal sob o ponto de vista de crianças. Esta pesquisa qualitativa descritiva foi conduzida em quatro grupos focais. Participaram 19 crianças (10 meninas e 9 meninos), de 6 a 11 anos (M=8,36±1,42 anos), estudantes de escolas públicas da cidade de Juiz de Fora-MG. Os dados obtidos foram tratados mediante análise de conteúdo categórica. Três categorias emergiram a partir das falas das crianças: preocupações com aspectos específicos do corpo; preocupações com aspectos gerais do corpo; e comportamentos relacionados ao corpo. Conclui-se que as crianças avaliadas apresentaram atitudes que indicam preocupação com o corpo em aspectos gerais e específicos, além de comportamentos relacionados com a imagem corporal. Recomendam-se a elaboração e a adoção de estratégias de terapia e intervenção no sentido de promover uma imagem corporal positiva em crianças.

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.