Parent-Adolescent Weight Communication: Parental Psychosocial Correlates Among a Diverse National Sample

Parental communication about body weight with their children is common across diverse families. The current study investigates how parents' feelings about their own bodies, beliefs about body weight, history of weight stigma, and weight-related characteristics contribute to the degree to which they talk about weight - both negatively and positively - with their adolescent children. The study sample was comprised of U.S. parents (N = 1936) from diverse racial/ethnic backgrounds with children aged 10-17 years old. Parents completed an online survey with measures assessing their frequency of engaging in negative and positive weight communication with their children, along with several relevant psychosocial factors (i.e. body satisfaction, experienced weight stigma, associative stigma, body appreciation, beliefs about weight controllability, weight bias internalization). Study findings paint a complex picture, including some psychosocial factors (e.g. weight bias internalization) that are related to both more frequent negative and positive weight communication. Notably, higher levels of associative stigma were related to more frequent negative parental weight comments, and less frequent positive weight socialization. Findings can inform healthcare professionals in raising parents' awareness about how their personal beliefs and feelings about their own weight and their child's weight can contribute to how they engage in communication about weight with their children.

Sexual Minority Youth Reporting SOGIE-Based Harassment to Adults at School: The Roles of Experienced Harassment, Outness, Safety, and Adult Support at School

Despite a proliferation of bullying prevention programs in recent time, limited work has investigated support-seeking behaviors in response to elevated bullying levels among sexual minority youth (SMY). To address this gap, the current study examined how harassment targeting SOGIE (sexual orientation, gender identity, and gender expression), sexual identity outness, school safety, and perceptions of teacher/staff support were associated with SMY talking to an adult at school about harassment. A large contemporary national sample of SMY (N = 5538) between the ages 13-18 (Mage = 15.53, SD = 1.33) who experienced at least one form of SOGIE-based harassment in the past year was leveraged for analyses. Hierarchical multivariable logistic regressions revealed more frequent SOGIE-based harassment was associated with greater odds of reporting harassment to school personnel, particularly among SMY who felt safe at school. Findings highlight the need for school-based interventions to foster school safety among SMY who experience peer harassment to promote their reporting of this behavior.

Heterogenous associations between Gender-Sexuality Alliances and LGBTQ adolescents' maladjustment across individual victimization level

Gender-Sexuality Alliances (GSAs), which are student-initiated school clubs for LGBTQ youth and allies, can reduce victimization for lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. This preregistered study identified heterogeneous correlates of GSAs, based on data from an anonymous survey of LGBTQ adolescents aged 13-17 years living in the United States (N = 10,588). In line with the healthy context paradox (Pan et al. [Child Development, 92, 2021, and 1836]), the presence of a GSA exacerbated associations between LGBTQ-based victimization and depressive symptoms, lower self-esteem, and lower academic grades-particularly in transgender youth. Inclusive settings, such as GSAs, might prevent increasing disparities by including tailored strategies to monitor and support more vulnerable, victimized LGBTQ youth.

Parental Communication About Body Weight and Adolescent Health: The Role of Positive and Negative Weight-Related Comments

OBJECTIVE

Research has consistently documented adverse effects of parent weight-related comments on adolescent health. However, little empirical attention has focused on isolating the impact of weight-related comments from mothers versus fathers, and the valence of their comments. The present study examined the extent to which positive and negative weight-related comments from mothers and fathers are related to adolescent health and wellbeing, and whether these associations differ according to adolescent sociodemographic characteristics.

METHODS

Data were collected from a diverse sample of 2032 U.S.-based adolescents aged 10-17 years (59% female; 40% White, 25% Black or African American, 23% Latinx). Online questionnaires assessed perceived frequency of negative and positive weight-related comments from mothers and fathers, as well as four indicators of adolescent health and wellbeing: depression, unhealthy weight control behaviors, weight bias internalization (WBI), and body appreciation.

RESULTS

More frequent negative weight-related comments from parents were associated with poorer adolescent health and wellbeing, while positive comments contributed to lower levels of WBI and body appreciation; these associations were documented regardless of whether mothers or fathers were the source of such comments, and considerable consistency was demonstrated across adolescent sociodemographic characteristics.

CONCLUSION

Findings highlight differences in adolescent health based on how parents discuss their body weight (i.e., negatively or positively), and similarity in associations regardless of whether mothers or fathers are the source of weight communication. These findings reiterate the importance of efforts to educate parents on ways to engage in supportive communication about weight-related health with their children.

Family-based weight stigma and psychosocial health: A multinational comparison

OBJECTIVE

Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US.

METHODS

Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health.

RESULTS

Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (β coefficients = |0.08-0.13|).

CONCLUSIONS

Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.

Parent-child communication about weight: Priorities for parental education and support

BACKGROUND

Approximately 2/3 of parents talk about body weight with their children, which can include negative comments that have adverse health implications for youth.

OBJECTIVES

To identify ways to improve supportive parent-child communication about weight, we assessed parent and youth perspectives of barriers to weight communication, preferences for educational resources and support, and whether perspectives differ across demographic groups and weight status.

METHODS

In Fall 2021, online surveys were completed by two independent, unrelated samples of parents (N = 1936) and youth (N = 2032). Participants were asked about their perceived barriers to talking about weight, and what kinds of information and support would be most useful to them in fostering supportive communication.

RESULTS

Parent and youth-reported barriers to weight communication included discomfort and lack of knowledge about weight, and views that weight does not need to be discussed. Most parents wanted guidance on how to navigate multiple weight-related topics with their children, including promoting positive body image and healthy behaviours, reducing weight criticism, focusing more on health and addressing weight-based bullying. Youth preferences for how their parents can be more supportive of their weight included avoiding weight-related criticism and pressures, increasing sensitivity and encouragement, and emphasizing healthy behaviours rather than weight. Few differences emerged based on sex and race/ethnicity, although several differences emerged for youth engaged in weight management.

CONCLUSION

Parent and youth perspectives indicate a need for education to help parents engage in supportive conversations about body weight. Findings can inform efforts to reduce barriers and increase supportive weight-related communication in families.

"Look beyond the weight and accept me": Adolescent perspectives on parental weight communication

Critical weight communication between parents and their adolescent children is prevalent and harmful. However, research on adolescent perspectives about parental weight communication is limited. The present mixed-methods study aimed to address this gap using inductive thematic analysis of 1743 adolescents' (M_age=14.61 years, SD_age=2.48) preferences regarding parental weight communication in response to an open-ended prompt, and quantitative analyses to examine age, gender, race/ethnicity, and weight-related differences in subthemes. In their responses, adolescents articulated 1) whether and 2) how parental weight communication should-or should not-occur, and 3) what these conversations should entail. We identified 15 subthemes across these categories-the endorsement of which often varied by adolescents' demographic and anthropometric characteristics. For example, some adolescents (especially cisgender girls and transgender/gender diverse adolescents) preferred that their parents talk about weight less often (n = 184), while others (especially multiracial/ethnic or Hispanic/Latinx adolescents) hoped that, if parents were to discuss weight with them, they do so in a manner that was compassionate and respectful (n = 150). Across most subthemes, adolescents described adverse responses (e.g., feeling insecure, embarrassed, or hurt) when parents discussed their weight in non-preferred ways. Collectively, findings can inform interventions to promote more supportive health-focused communication in families.

Patient and Family Perspectives on Terms for Obesity

OBJECTIVES

Parent communication about body weight is a sensitive topic, but limited research has studied youth preferences for words used to talk about their weight with parents. We assessed perspectives of weight-based terminology in 2 racially/ethnically diverse samples of youth and parents.

METHODS

We collected online survey data from 2 panel survey samples between September and December 2021: youth aged 10 to 17 years (n = 2032) and parents of youth aged 10 to 17 years (n = 1936). Participants rated 27 different terms and phrases to describe body weight; parents reported on their usage of this terminology and youth reported their preferences for and emotional responses to terminology. Patterns were examined across sex, race/ethnicity, sexual orientation, and weight status.

RESULTS

Youth reported preferences for words such as "healthy weight" and dislike of terms such as "obese," "fat," and "large," which induced feelings of sadness, shame, and embarrassment. Differences in youth preferences and emotional reactions were present across sex, sexual orientation, race/ethnicity, and weight status. This included a general pattern of lower preference ratings among girls (versus boys) and sexual minority (versus heterosexual) youth, and stronger preferences for words such as "thick" or "curvy" among racial/ethnic minority, sexual minority, and higher-weight youth. Use of most weight terms was higher among fathers compared with mothers, and by Hispanic/Latinx parents compared with white and Black/African American parents.

CONCLUSIONS

Our findings underscore diversity of youth preferences and the need for individualized approaches that support effective parent and youth communication by using their preferred terms when discussing weight-related health.

Motivations for engaging in or avoiding conversations about weight: Adolescent and parent perspectives

BACKGROUND

Little is known about parent and adolescent motivations for engaging in weight communication.

OBJECTIVES

To assess parent and adolescent motivations for engaging in, or avoiding, weight communication, and whether these reasons differed across sex, race/ethnicity, weight, and engagement in weight management.

METHODS

Independent samples of parents (N = 1936) and unrelated adolescents (N = 2032) completed questionnaires assessing their agreement with different reasons they engage in, or avoid, parent-adolescent weight communication, using 7-point Likert scales (strongly-disagree to strongly-agree).

RESULTS

Parents, irrespective of sex, race/ethnicity, and child's weight status, expressed stronger motivations for engaging in weight communication in order for their child to feel good about his/her weight and body size compared to being motivated because a health professional raised their child's weight as a concern. Adolescent motivations for weight communication with parents stemmed from health concerns and worry about their weight; avoidance stemmed from feeling embarrassed, upset, or not wanting to obsess about weight. Differences emerged across sex and race/ethnicity but were most pronounced by weight status and weight management.

CONCLUSION

Parents and adolescents have different motivations for engaging in or avoiding weight communication. Protecting adolescents' emotional wellbeing and body esteem are viewed as reasons for both engaging in or avoiding weight communication.

Weight-based cybervictimization: Implications for adolescent health

BACKGROUND

Despite the ubiquity of cybervictimization among youth, attention to weight-based cybervictimization is scarce.

AIMS

This study assessed the prevalence of electronic forms of weight-based peer victimization (i.e., cybervictimization) and its associations with adolescent health, as indicated by somatic symptoms, stress, depression, and sleep trouble.

MATERIALS & METHODS

A cross-sectional survey was conducted online with a community sample of 452 adolescents aged 11-17 years old (M_age  = 14.91 years).

RESULTS

Thirty-three percent of adolescents reported at least one experience of weight-based cybervictimization, with elevated rates among those with overweight (45%) and obesity (60%). Weight-based cybervictimization was associated with higher levels of somatic symptoms (β = 0.24; p < 0.001), stress (β = 0.22; p < 0.001), depression (β = 0.27; p < 0.001), and sleep trouble (β = 0.20; p < 0.001); these associations were consistent across adolescent weight status.

DISCUSSION AND CONCLUSION

Findings suggest that the health implications of weight-based victimization extend to the electronic context, and underscore the importance of addressing weight-based cybervictimization in antibullying initiatives to support healthy adolescent well-being.

A Comprehensive Examination of the Nature, Frequency, and Context of Parental Weight Communication: Perspectives of Parents and Adolescents

Research suggests that many parents make comments about their child’s weight, which is associated with negative adolescent health outcomes. Gaps in this literature include an underrepresentation of fathers, limited knowledge regarding positive versus negative parental weight comments and differences across race/ethnicity, and adolescent preferences for parental weight communication. The present study addressed these research gaps through a comprehensive investigation of two diverse samples of U.S. parents (n = 1936) and adolescents (n = 2032), who completed questionnaires about their experiences and perspectives of parental weight communication. Positive weight comments from parents were more frequent than negative comments, though both were commonly reported across sex, race/ethnicity, and weight status. In general, boys, fathers, Latino/a parents and adolescents, and adolescents with a high BMI and/or engaged in weight management reported more frequent parental weight-talk. Parent–adolescent weight communication occurred both in-person and digitally, and across daily life contexts. Although the majority of parents communicated positive messages of body diversity and respect, 44% and 63% of adolescents said they never want their mothers and fathers, respectively, to talk about their weight. Adolescents were offered circumstances that would increase their comfort level in having these conversations. Findings have implications for health professionals working with families to promote supportive health communication at home.

Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The Protective Role of Friendships

The continuing COVID-19 pandemic enables assessment of the adaptability of young adults to non-normative stressors threatening their social-emotional wellbeing. Focusing specifically on a developmentally critical social challenge of restricted in-person contact, the goal of the current study was to examine the role of friendships in alleviating social-emotional problems. Data were collected via online surveys from an ethnically diverse sample (n = 1557) of 20 to 24-year-olds (62% cisgender female, 31% male, 7% gender diverse or gender questioning) in spring of 2021. Longitudinal data from an earlier time point involving an age-normative social challenge (transition out of high school) were used as a comparison. The comparisons between the transition from high school and the pandemic showed that whereas social anxiety and depressive symptoms increased, loneliness decreased. Participants also reported having slightly more friends and rated the overall quality of their friendships as somewhat higher. Regression analyses revealed that a greater number of friends over time and greater satisfaction with friend electronic communication during the pandemic were most robustly related to lower social and generalized anxiety as well as depressive symptoms, over and above earlier social-emotional wellbeing and a number of relevant correlates. Loneliness was protected by higher quality of friendships, greater contact with friends, as well as more frequent and satisfying electronic communication with friends. The results suggest that although young adults are facing emotional challenges during the continued pandemic, they are also able to adapt by keeping in touch with friends to decrease subjective sense of isolation. The findings have novel intervention implications to reduce loneliness.

Developmental changes in the frequency and functions of school-related communication with friends and family across high school: Effects on college enrollment

As postsecondary education is an increasingly important developmental milestone for adolescents, it is critical to identify supports that help prepare youth for college. Building on evidence highlighting the role of parental input and guidance, the current study investigates how within-person changes in adolescent school-related communication (i.e., frequency of talking about school and educational planning) with friends and family across high school contribute to college preparedness and subsequent enrollment. Capitalizing on a diverse adolescent sample (N = 4,495), longitudinal analyses across high school showed that school-related communication with friends increased, but remained relatively stable with family, from Grades 9-12 (approximately ages 15-18 years). Parallel process latent growth curve modeling demonstrated that steeper increases in school-related communication with friends independently predicted college enrollment, consistently across racial/ethnic and parental education groups. Moreover, within-person changes in friend and family school-related communication across high school interacted in a compensatory fashion to predict grade point average and perceived college readiness at 12th grade. At a time of growing need for independence from parents, the findings highlight the positive developmental function of friends in helping adolescents reach a critical educational milestone. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Policies to address weight discrimination and bullying: Perspectives of adults engaged in weight management from six nations

OBJECTIVE

Across the world, it remains legal to discriminate against people because of their weight. Although US studies demonstrate public support for laws to prohibit weight discrimination, multinational research is scarce. The present study conducted a multinational comparison of support for legislative measures to address weight discrimination and bullying across six countries.

METHODS

Participants were adults (n = 13,996) enrolled in an international weight-management program and residing in Australia, Canada, France, Germany, the UK, and the US. Participants completed identical online surveys that assessed support for antidiscrimination laws and policies to address weight bullying, demographic characteristics, and personal experiences of weight stigma.

RESULTS

Across countries, support was high for laws (90%) and policies (92%) to address weight-based bullying, whereas greater between-country variation emerged in support for legislation to address weight-based discrimination in employment (61%, 79%), as a human rights issue (57%), and through existing disability protections (47%). Findings highlight few and inconsistent links between policy support and sociodemographic correlates or experienced or internalized weight stigma.

CONCLUSIONS

Support for policies to address weight stigma is present among people engaged in weight management across Westernized countries; findings offer an informative comparison point for future cross-country research and can inform policy discourse to address weight discrimination and bullying.

Reducing Educators' Weight Bias: The Role of School-Based Anti-Bullying Policies

BACKGROUND

Educators' negative weight biases toward students with high body weight have been well-documented. The present investigation examined whether inclusion of body weight in school anti-bullying policies is associated with lower levels of weight bias among educators.

METHODS

Data on explicit weight bias was collected from a sample of secondary school teachers and principals in the United States (N = 246) and examined in relation to the presence of weight-related language in each participant's school district anti-bullying policy.

RESULTS

The results indicate that, although educators on average make negative judgments about individuals with high weight, these biases were lower for educators whose school district anti-bullying policy included enumeration of body weight. Notably, this association did not hold when policies enumerated "appearance."

CONCLUSIONS

The study findings suggest that the explicit mention of "weight" in school anti-bullying policies may represent a feasible mechanism to reduce explicit weight bias among U.S. secondary school educators.

School Safety Among Sexual and Gender Minority Adolescents: Implications for Eating and Weight Control Behaviors

BACKGROUND

Unhealthy weight control and disordered eating behaviors are prevalent among adolescents who identify as a gender and/or sexual minority (SGM). The current study examined how perceptions of school safety contribute to reduced negative weight control and eating behaviors across adolescents with diverse sexual and gender identities.

METHODS

Data on perceptions of school safety, as well as negative weight control and disordered eating behaviors (ie, binge eating, eating to cope), were drawn from a large national sample of SGM secondary school students (ie, grades 7-12; N = 17,112; LGBTQ National Teen Survey).

RESULTS

Differences in negative weight control and disordered eating behaviors emerged as a function of gender identity and sexual orientation. School safety was significantly associated with fewer negative weight control behaviors (B = -0.30, p < .001), reduced binge eating (B = -0.19, p < .001), and less eating to cope (B = -0.21, p < .001). Despite slight variation in the strength of these associations, the protective effects of school safety were significant across sexual and gender identities.

CONCLUSIONS

Findings suggest that efforts to support feelings of school safety among SGM students are likely to have positive implications for eating and weight-related behaviors, and emphasize the need for interventions to promote climates of safety and inclusion within the school setting.

International comparisons of weight stigma: addressing a void in the field

BACKGROUND/OBJECTIVES

Despite substantial evidence documenting weight stigma toward people with higher body weight, international comparative studies are lacking in this field. The few studies that have compared weight stigma across different countries focus on explicit weight-biased attitudes rather than people's experiences of weight stigma. The present study conducted a multinational systematic comparison of weight stigma in six countries to assess experiences and interpersonal sources of weight stigma.

SUBJECTS/METHODS

Adults (N = 13,996) enrolled in WW International (formerly Weight Watchers), residing in Australia, Canada, France, Germany, the UK, and the US completed identical online anonymous surveys in the dominant language for their country. Surveys assessed their history of experiencing weight stigma, the onset of stigmatizing experiences and associated distress from stigma in different time periods, and interpersonal sources of weight stigma.

RESULTS

More than half of participants (55.6-61.3%) across countries reported experiencing weight stigma. Participants with higher BMI were significantly more likely to report weight-stigmatizing experiences than individuals with lower BMI. In all countries, weight stigma experiences were most frequent in childhood and adolescence, with associated distress highest during these time periods. Participants in Germany reported a higher frequency of weight stigma across their whole life, but lower distress associated with stigmatizing experiences, compared to participants in the other five countries. High percentages of participants in each country experienced weight stigma from family members (76.0-87.8%), classmates (72.0-80.9%), doctors (62.6-73.5%), co-workers (54.1-61.7%), and friends (48.8-66.2%).

CONCLUSIONS

Weight stigma is prevalent for adults actively engaged in weight management across different Western countries. There were more similarities than differences in the nature, frequency, and interpersonal sources of people's experiences of weight stigma across the six countries in this study. Findings underscore the need for multinational initiatives to address weight stigma and interventions to support individuals engaged in weight management who experience weight mistreatment.

Adolescents' Exposure to and Experiences of Weight Stigma During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic has increased attention to the proliferation of pediatric obesity amidst significant changes in weight-related health functioning (e.g., compromised physical activity, limited food access, increased stress). The present cross-sectional study investigated adolescents' feelings about their bodies and perceived changes in weight stigma from peers, parents, and social media during the pandemic.

METHODS

Four hundred fifty-two adolescents (11-17 years old) completed an online survey during the Fall of 2020. Measures assessed perceived changes in exposure to weight stigmatizing social media content (stress eating jokes, weight gain memes) and experiences of weight stigma (weight-based bullying, teasing, hurtful comments) by parents and peers, as well as body dissatisfaction, during the COVID-19 pandemic. Weight status and gender were examined as individual difference variables.

RESULTS

The majority (53%) of adolescents reported increased exposure to at least one form of weight stigmatizing social media content during the pandemic. Additionally, pandemic-related increases in body dissatisfaction were prevalent (41%), especially among girls with higher body mass index (≥85th percentile; 67%). On average, the extent to which adolescents experienced weight-based mistreatment from parents and peers remained consistent with their pre-pandemic experiences.

CONCLUSIONS

Overall, these findings highlight changes in the social messages that adolescents receive about their bodies, as well as their subjective body satisfaction, during the pandemic. Results underscore the need for healthcare providers and mental health professionals to be aware of the potential rise in weight stigma during the pandemic, and encourage families and schools to engage in supportive, rather than stigmatizing, weight-related communication with youth.

Adolescent academic worries amid COVID-19 and perspectives on pandemic-related changes in teacher and peer relations

Despite recognition of the potential impact of the COVID-19 pandemic on secondary schooling experiences, little empirical evidence has captured adolescents' perspectives on the extent of academic and social disruption resulting from the pandemic. The present study examined adolescents' academic worries amid the COVID-19 pandemic and their perspectives on pandemic-related changes in teacher and peer relations. Participants were 452 adolescents (55% female) between the ages of 11 and 17, who completed online surveys asking them about their worries about their schoolwork and educational futures, perceived support from teachers, and perceptions of electronic (cyber) bullying during the pandemic. Results indicated that COVID-related academic worries pertaining to motivation to focus on and complete schoolwork were most frequent. High school students and female students reported heightened academic worries compared to middle school students and male students. In addition, the majority of adolescents indicated decreased support from teachers during the COVID-19 pandemic, including more than two-thirds (69%) who reported reduced communication with teachers. Adolescents perceived relative consistency in electronic (cyber) bullying throughout the pandemic, and a third of students indicated that cyberbullying has become more of a problem and increased in frequency during this time period. Perceived changes in cyberbullying were consistent across grade level and gender. Findings emphasize the psychosocial implications of the COVID-19 pandemic on adolescents' secondary schooling experiences and underscore the importance of bolstering social resources to minimize the short- and long-term impact of the pandemic on students' academic functioning. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parental Contributors to the Prevalence and Long-term Health Risks of Family Weight Teasing in Adolescence

PURPOSE

Weight teasing from family members is common during adolescence. However, little is known about parental factors that increase adolescents' risk for family weight teasing and its adverse health sequelae. Using multi-informant data from adolescents, mothers and fathers, the current longitudinal study examined how parental concerns about their child's weight and their own weight contribute to family weight teasing in adolescence and its long-term health consequences.

METHODS

Data were collected in the population-based Project EAT 2010-2018 (Eating and Activity over Time) study, following a longitudinal cohort of young people (N = 2,793). Parental weight concerns for their adolescent and themselves were reported by mothers (N = 2,298) and fathers (N = 1,409) at baseline and examined as a predictor of family weight teasing in adolescence as well as a moderator of family weight teasing effects on health eight years later.

RESULTS

Mothers' and fathers' concerns about their child's weight, as well as mothers' dieting frequency, increased the likelihood of adolescents experiencing family weight teasing. Longitudinal analyses revealed that adolescents teased about their weight by family had higher levels of stress (β = .21, 95% confidence interval [CI] = .09-.33) and substance use (β = .16, 95% CI = .04-.28), and lower self-esteem (β = -.16, 95% CI = -.28 to -.05) in young adulthood.

CONCLUSIONS

Findings highlight parent weight concern, particularly concern for their child's weight, as a risk factor for family weight teasing. These findings underscore the importance of encouraging parental attention to health, rather than weight, in family-based treatment and public health initiatives.

Eating and Exercise-Related Correlates of Weight Stigma: A Multinational Investigation

OBJECTIVE

Weight stigma is prevalent across the world. However, little is known about whether and how the harmful health consequences of weight stigma may vary across countries. The current study examined the association between experiences of weight stigma and multiple eating and exercise-related indicators among a large, multinational sample of adults.

METHODS

Adults enrolled in an international weight management program residing in Australia, Canada, France, Germany, the United Kingdom, and the United States completed identical Web-based surveys in the dominant language for their country. Participants (N = 13,996) reported on their personal experiences of weight stigma and health, including eating behaviors, attitudes toward exercise, and perceived stress.

RESULTS

More than half of all participants in each country reported experiencing weight stigma. Participants who had experienced weight stigma reported engaging in more eating to cope, gym avoidance, and self-monitoring behaviors, as well as higher levels of stress and reduced eating self-efficacy. These associations were documented over and above sociodemographic characteristics and BMI and did not vary across countries.

CONCLUSIONS

Study findings document uniform health-related correlates of weight stigma within a multinational context and underscore the need for global initiatives to curtail weight stigma in order to support population health.

The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

BACKGROUND/OBJECTIVES

Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries.

METHODS

Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors.

RESULTS

Among participants who reported a history of weight stigma (56-61%), two-thirds of participants in each country reported experiencing weight stigma from doctors. Across all six countries, after accounting for demographics, BMI, and experienced stigma, participants with higher internalized weight bias reported greater healthcare avoidance, increased perceived judgment from doctors due to body weight, lower frequency of obtaining routine checkups, less frequent listening and respect from providers, and lower quality of healthcare. Additionally, experienced weight stigma (from any source) was indirectly associated with poorer healthcare experiences through weight bias internalization, consistently across the six countries.

CONCLUSIONS

Weight stigma in healthcare is prevalent among adults actively engaged in weight management across different Western countries, and internalized weight bias has negative implications for healthcare even after controlling for BMI. The similar findings across all six countries underscore the negative consequences of weight stigma on healthcare behaviors and experiences, and emphasize the need for collective international efforts to address this problem.

Prevalence and correlates of weight bias internalization in weight management: A multinational study

Weight bias internalization (WBI) is an understudied form of internalized stigma, particularly among treatment-seeking adults with overweight/obesity. The current study surveyed 13,996 adults currently engaged in weight management in the first multinational study of WBI. From May to July 2020, participants in six Western countries completed the Modified Weight Bias Internalization Scale (WBIS-M) and measures of weight change, health behaviors, psychosocial well-being, and health-related quality of life (HRQOL). Participants were majority white, female, middle-aged, and categorized as having overweight or obesity based on body mass index. Results showed higher mean WBIS-M scores among participants in the UK, Australia, and France than in Germany, the US, and Canada. Across all countries, and controlling for participant characteristics and experiences of weight stigma, WBIS-M scores were associated with greater weight gain in the past year. Participants with higher WBIS-M scores also reported poorer mental and physical HRQOL, less eating and physical activity self-efficacy, greater engagement in eating as a coping strategy, more avoidance of going to the gym, poorer body image, and greater perceived stress. Few interaction effects were found between experiences and internalization of weight stigma. Overall, the current findings support WBI as a robust correlate of adverse weight-related health indices across six Western countries. Prospective and experimental studies are needed to determine directionality and causality in the relationship between WBI and poor health outcomes.

•

Differences in weight bias internalization (WBI) were found between six Western countries.

•

WBI was associated with weight gain in the past year across countries.

•

WBI was associated with adverse weight-related health indices across countries.

•

Associations with weight and health were stronger for WBI than weight stigma experiences.

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.

Weight Stigma as a Predictor of Distress and Maladaptive Eating Behaviors During COVID-19: Longitudinal Findings From the EAT Study

Background

Weight stigma is common for people with obesity and harmful to health. Links between obesity and complications from COVID−19 have been identified, but it is unknown whether weight stigma poses adverse health implications during this pandemic.

Purpose

We examined longitudinal associations between prepandemic experiences of weight stigma and eating behaviors, psychological distress, and physical activity during the COVID-19 pandemic in a diverse sample of emerging adults.

Methods

Participants (N = 584, 64% female, mean age = 24.6 ± 2.0 years, mean body mass index [BMI] = 28.2) in the COVID-19 Eating and Activity over Time (C-EAT) study were cohort members of the population-based longitudinal study EAT 2010–2018. Weight stigma reported by participants in 2018 was examined as a predictor of binge eating, eating to cope, physical activity, depressive symptoms, and stress during COVID-19. Data were collected via online surveys during the U.S. outbreak of COVID-19 in 2020.

Results

Prepandemic experiences of weight stigma predicted higher levels of depressive symptoms (β = 0.15, p < .001), stress (β = 0.15, p = .001), eating as a coping strategy (β = 0.16, p < .001), and an increased likelihood of binge eating (odds ratio = 2.88, p < .001) among young adults during the COVID-19 pandemic but were unrelated to physical activity. Although associations remained after accounting for demographic characteristics and BMI, the magnitude of longitudinal associations was attenuated after adjusting for prior levels of the outcome variables.

Conclusions

Young adults who have experienced weight stigma may have increased vulnerability to distress and maladaptive eating during this pandemic. Public health messaging could be improved to support people of diverse body sizes and reduce the harmful consequences of weight stigma.

Gay-Straight Alliances: A Mechanism of Health Risk Reduction Among Lesbian, Gay, Bisexual, Transgender, and Questioning Adolescents

INTRODUCTION

Adolescents who identify as a sexual or gender minority are vulnerable to multiple health disparities because of stigma-based peer harassment. Given that sexual and gender minority adolescents may be bullied for several stigmatized identities that may exacerbate health risk, it is important to examine factors that can simultaneously reduce multiple forms of targeted victimization among sexual and gender minority adolescents. This study examines whether variation in health risk across sexual and gender minority adolescents who attend schools with versus without a gay-straight alliance can be explained by lessened bias-based bullying across a broad scope of stigmatized identities and attributes.

METHODS

Data on school-based gay-straight alliances, bias-based bullying, and health risk indicators were collected from the LGBTQ National Teen Survey (n=17,112; mean age=15.57 [SD=1.27] years) and analyzed in 2019. Multiple mediation analysis was conducted using latent variable structural equation modeling.

RESULTS

The majority (73%) of sexual and gender minority adolescents were bullied for stigmatized identities other than those related to their gender or sexual orientation. Compared to schools without a gay-straight alliance, student reports of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexual orientation) were lower at schools with gay-straight alliances, which in turn attenuated adverse health outcomes (i.e., stress, sleep problems, depression, and unhealthy weight control behaviors).

CONCLUSIONS

Sexual and gender minority adolescents experience multiple forms of bias-based bullying, which independently heighten health risk, and this study extends previous work on gay-straight alliances to highlight a wider range of potential positive contributions to adolescent health.

Engagement Norms Buffer Academic Risks Associated with Peer Rejection in Middle School

The current study examined school variations in academic engagement norms and whether such norms affect those most susceptible to peer influence. We presumed that behaviors associated with perceived popularity make norms salient and are most likely to affect socially marginalized (rejected) youth. Focusing on differences across 26 middle schools, the main aim was to test whether academic engagement norms moderate the association between peer rejection and subsequent academic difficulties. The U.S. public school sample included 5,991 youth (52% girls): 32% Latino/a, 20% White, 14% East/Southeast Asian, 12% African American, and 22% from other specific ethnic groups. Multilevel models were used to examine whether engagement norms moderated the association between sixth grade peer rejection and changes in grade point average (GPA) and academic engagement across middle school (i.e., from sixth to eighth grade). Consistent with our contextual moderator hypothesis, the association between peer rejection and academic engagement was attenuated-- and in the case of GPA eliminated-- in schools where higher engagement was a salient norm. The study findings suggest that the behaviors of popular peers affect those on social margins, and that academic difficulties are not inevitable for rejected youth.

Correction to: Bias-Based Bullying and School Adjustment among Sexual and Gender Minority Adolescents: The Role of Gay-Straight Alliances

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Bias-Based Bullying and School Adjustment among Sexual and Gender Minority Adolescents: The Role of Gay-Straight Alliances

Adolescents identifying as sexual and/or gender minorities face many challenges at school due to stigma-based peer harassment. This study examined the extent to which sexual and gender minority adolescents experience bias-based bullying across a range of stigmatized identities and attributes, as well as the potential of gay-straight alliances (GSAs, also referred to as gender-sexuality alliances) to reduce simultaneously multiple forms of bias-based bullying, and in turn support school adjustment. Using a United States sample of diverse sexual and gender minority adolescents (N = 17,112; M_age = 15.57, SD_age = 1.27), multiple mediation analyses indicated lower levels of multiple forms of bias-based bullying (based on body weight, gender, religion, disability, gender typicality, sexuality) at schools with versus without GSAs, and in turn higher perceived school safety, as well as higher grades and reduced school suspension (due to less weight- and sexuality-based bullying). The findings shed light on the broad-reaching stigma-reduction potential of GSAs.

Peer rejection as a precursor of romantic dysfunction in adolescence: Can friendships protect?

INTRODUCTION

Using a prospective longitudinal design across six years, the current study investigated whether adolescents' experiences of peer rejection across middle school increased their risk of maladaptive (aggressive and unsupportive) behaviors in high school romantic relationships. Additionally, friendship quality following the transition to high school was examined as a potential protective factor.

METHODS

The sample consisted of 1,987 ethnically diverse youth (54% female; M_age = 17.10) who were romantically involved at eleventh grade. Peer rejection (based on peer nominations) was assessed at four time points across three years in middle school. Students reported on their friendship quality in ninth grade and their aggressive (e.g., shouting; hitting) and supportive (e.g., listening; helping) behaviors towards a romantic partner in eleventh grade.

RESULTS

Results demonstrated that adolescents who were increasingly rejected by peers during middle school were more likely to behave aggressively towards their romantic partners in high school. Friendship quality at the beginning of high school moderated prospective links from rejection to support, such that escalating middle school peer rejection predicted less supportive romantic behaviors only among youth with low-quality friendships at ninth grade. These patterns were documented over and above the effects of sex, ethnicity, socioeconomic status, and students' aggressive behavior at the beginning of middle school.

CONCLUSIONS

Together, the findings suggest that 1) increasing peer rejection during middle school may spiral into later romantic relationship dysfunction and 2) supportive friendships across a critical school transition can interrupt links between peer and romantic problems.

The Effects of Middle School Weight Climate on Youth With Higher Body Weight

This study examines whether social-emotional difficulties associated with higher body weight vary across schools as a function of the school's weight climate. Weight climate, characterized by weight-policing, was assessed indirectly by examining how strongly self-reported weight predicts victim reputation within 26 ethnically diverse middle schools. Social-emotional indicators included self-reported loneliness, school belonging, and self-esteem. In schools with stronger weight-policing at seventh grade, loneliness was intensified by eighth grade among both girls (n = 2,101) and boys (n = 1,985) with higher weight. Similar effects were found for low self-esteem among girls. Additionally, boys-regardless of their weight-reported lower sense of belonging in schools with stronger weight-policing. The study offers a new method to estimate school weight climate, and the findings provide insights for interventions.

Cross-class friendship and academic achievement in middle school

Academic achievement disparities based on parental education are robust during the middle school years. The current study examined whether cross-class friendship (i.e., reciprocal relationships between peers with different levels of parental education) decrease class-based achievement differences during a developmental phase when friends are particularly important. Relying on a sample of 4,288 sixth grade students (M = 12.03 years) from 26 ethnically diverse middle schools, multilevel analyses were conducted predicting seventh-grade grade point average, standardized achievement test scores, and teacher-rated academic engagement. The associations between parental education and academic achievement were reduced when students had at least 1 cross-class friendship at sixth grade. The findings are discussed in terms of how socioeconomic diversity of school-based friendships can level the academic playing field. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Body weight and academic achievement: The role of weight diversity in urban middle schools

The current study was designed to examine one possible weight stigma-reduction mechanism: school-level weight diversity. It was hypothesized that greater weight diversity among same-sex peers at school would attenuate the negative association between weight and academic achievement. Across 26 urban public middle schools, 5,991 sixth-grade students (52% girls) were included: 12% African American/Black, 14% East/Southeast Asian, 30% Latino, 21% White, and 23% from other specific ethnic groups. Weight diversity was estimated as the likelihood that two randomly selected students would be from different weight categories, using Simpson's index. Standardized achievement test scores and grade point average (GPA) were used to assess academic achievement. Consistent with our contextual moderator hypothesis, high levels of weight diversity at school served a protective function. The negative association between body mass index (BMI) and achievement test scores, as well as GPA (girls only) was nonsignificant at schools with high levels of weight diversity. The study results offer a potential explanation for inconsistent findings regarding body weight and achievement, and a novel methodological approach to capture weight diversity in ways that provide new insights for school-based interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Quality and Stability of Cross-Ethnic Friendships: Effects of Classroom Diversity and Out-of-School Contact

Cross-ethnic friendships are linked to a range of positive outcomes in adolescence, but have been shown to be lower quality and less stable than same-ethnic friendships. The current study examined how classroom diversity and out-of-school contact contribute to these relational differences between cross-and same-ethnic friendships. Multilevel analyses were conducted on a sample of 9,171 classroom-based friends nested within 4,333 ethnically diverse sixth grade students (54% female; 32% Latino, 20% White, 14% East/Southeast Asian, 12% African American, 14% Multiethnic, 8% Other ethnic). Consistent with the hypotheses, lower ethnic diversity in classes shared by friends and lack of home contact (as opposed to electronic) contributed to relational differences between cross- and same-ethnic friendships. The findings suggest that while diverse classrooms enable youth to bond across ethnic groups, connecting outside of school is critical for the relational quality and longevity of cross-ethnic friendships.

Friendless Adolescents: Do Perceptions of Social Threat Account for Their Internalizing Difficulties and Continued Friendlessness?

Adolescents who lack friends at school are at risk of internalizing difficulties. This study examined a social-cognitive mechanism underlying friendlessness and internalizing difficulties (i.e., depressive symptoms, social anxiety, low self-esteem). We tested whether perceived social threat (i.e., peer victimization, sense of unsafety, and peer misconduct) mediates the association between friendlessness and increased internalizing difficulties across middle school. Latent variable structural equation modeling was used to test the model among an ethnically diverse sample of 5,991 (52% female) adolescents. The results demonstrate that friendless sixth-grade students perceived their school environment as more threatening by seventh grade, which in turn, increased internalizing difficulties from sixth to eighth grade. Perceptions of threat also predicted friendlessness at the end of middle school.

Losing and gaining friends: Does friendship instability compromise academic functioning in middle school?

Extending past research on the academic benefits of having close friends in early adolescence, the study examines how instability of friendships (i.e., losses and gains of friends) is related to academic engagement and performance in middle school. The sample was drawn from a longitudinal study of ethnically diverse youth across 26 middle schools (N = 5991). The results demonstrated that over two thirds of friends were either lost or gained during the first year in middle school. When controlling for friendship network size, both friendship losses and gains were concurrently associated with lower academic engagement and performance at spring of sixth grade. Moreover, higher overall instability during the first year in middle school was related to lower academic engagement in seventh grade, which in turn, predicted lower grade point average (GPA) by the end of middle school. The findings suggest that friendship instability captures a disruptive social process that can compromise academic functioning in middle school.

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.