Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis

OBJECTIVE

Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth.

METHODS

A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined.

RESULTS

Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma.

CONCLUSIONS

Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.

Feasibility and acceptability of a prevention program for eating disorders (Me, You and Us) adapted for young adolescents in Korea

PURPOSE

The aim of this study was to assess the adaptability and acceptability of a prevention program.

METHODS

A total of 169 Korean students (83 boys and 86 girls) with a mean age of 12.3 years from a 6th grade class at an elementary school participated in the study. Mental health social workers delivered Me, You and Us, a school-based body image intervention program originally developed in the UK, through a set of six sessions. The participants were assessed in terms of their body satisfaction and self-esteem before the program, after the program, and at 1-month follow-up. They were also surveyed about their satisfaction and acceptability levels after the program.

RESULTS

At baseline, girls had lower body satisfaction and self-esteem than boys, and their body satisfaction and self-esteem improved after the program. The improved body satisfaction was maintained at the 1-month follow-up. The efficacy of the program on body satisfaction was positively correlated with the frequency of their baseline level of "fat talk." The program was more effective in girls with possible symptoms of an eating disorder at baseline. 93.7% of boys and 77.4% of girls responded that they enjoyed the program.

CONCLUSIONS

The program Me, You and Us was well-accepted by early adolescents in Korea and it can play a role in increasing body satisfaction and self-esteem by reducing "fat talk" in 6th grade students.

LEVEL OF EVIDENCE

Level III, cohort study with intervention.

How is weight stigma related to children's health-related quality of life? A model comparison approach

PURPOSE

Obesity is a highly stigmatizing condition for both adults and children, and both obesity and stigma experiences are negatively related with health-related quality of life (HRQoL). However, the relations among these constructs have been modeled in different and sometimes inconsistent terms in past research, and have been the object of surprisingly few studies in pediatric populations. The present study addresses this gap by comparing, in a sample of preadolescent children, four competing models (i.e., additive, mediation, moderation, and moderated mediation models) accounting for the role of stigma experiences in the concurrent relation between body weight and HRQoL.

METHODS

A community sample of 600 children aged 8-11 years completed the Perception of Teasing Scale to assess weight-based teasing experiences and the PedsQL 4.0 to assess HRQoL. Parent-reported height and weight were used to calculate age- and gender-adjusted zBMI. Log-likelihood test, BIC difference, and Wald test were used for model comparisons.

RESULTS

The mediation model outperformed both additive and moderation models and was found to be equally informative (but more parsimonious) as compared to the moderated mediation account. The same pattern of results was replicated for both global HRQoL and domain-specific quality of life domains (i.e., physical, emotional, social, and scholastic).

CONCLUSIONS

The mediation model provided the best fitting and more parsimonious representation of the relations between body weight, stigma experiences, and HRQoL, meaning that an increased likelihood of experiencing weight-based teasing episodes, rather than excess weight per se, is associated with reduced quality of life in middle childhood.

Correlates of Body Dissatisfaction in Children

OBJECTIVE

To assess body dissatisfaction among children between 9 and 14 years of age and to examine factors (age, sex, body mass index, perceived shape, and self-esteem) associated with wanting a thinner or a larger shape.

STUDY DESIGN

Through at-school questionnaires, 1515 preadolescent children (51.2% girls) were asked to fill out the Culture Free Self-Esteem Inventory and the Contour Drawing Rating Scale (body dissatisfaction). Trained assessors then weighed and measured the students individually.

RESULTS

Overall, 50.5% of girls wanted a thinner shape compared with 35.9% of boys. More boys wanted a larger shape compared with girls (21.1% vs 7.2%). Most of the preadolescents who were overweight or obese were unsatisfied whereas 58.0% of girls and 41.6% of boys who were underweight were satisfied with their body. Results of a multinomial logistic regression revealed that age, sex, body mass index, perceived shape, and self-esteem were significant correlates of the 4 body dissatisfaction contrasts (wanting a slightly thinner, much thinner, slightly larger, and much larger shape) and explained 50% of the variance. An interaction between sex and perceived shape was found, revealing that girls who perceived themselves as having a larger shape were more likely to desire a thinner shape than boys.

CONCLUSIONS

The high prevalence rate of body dissatisfaction among children suggests that current approaches in our society to prevent problems related to body image must be improved. The different results between girls and boys highlight the need to take into account sex differences when designing prevention programs that aim to decrease body dissatisfaction.

Comparison of two measures of weight criticism in youth: associations with physical activity engagement and attitudes, weight status, and health-related quality of life

The objective of this study was to examine the degree to which 2 measures of weight criticism, the Weight Criticism During Physical Activity (WCA) scale and the Perceptions of Teasing Scale (POTS), represent distinct constructs and in what circumstances each is most appropriately used. A community sample of 307 fourth and fifth graders completed these measures, as well as measures of health-related quality of life, physical activity engagement, and attitudes toward physical activity. Body mass index was also calculated. Results of confirmatory factor analysis indicated that the WCA scale and the POTS represented correlated but distinct constructs and related differently to measures of physical activity and weight status. Findings suggested that the WCA scale may be representing criticism regarding athletic competency, not criticism of weight status as described in the literature. The POTS subscales appear to be accurately described and used in the literature.

The Impact of Personal Metaphors and Memorable Interpersonal Communication on Body Satisfaction

Memorable messages about body size can have profound negative psychological and emotional effects on body image and personal health. We found that both men and women recalled more negative than positive memorable messages about their body appearance and size. Participants who reported receiving negative memorable messages also revealed stronger current body dissatisfaction and poorer self-image than participants who reported positive memorable messages. Participants who received negative body comments also described their own body using negative metaphors. Negative memorable messages often occurred in front of third parties who expressed approval for the message, sometimes in the form of laughter. We discuss the mental health consequences of negative messages about body size and the implications for public health campaigns.