Weight Stigma Research: Rebecca Puhl, PhD

BEDA promotes cultural acceptance of, and respect for, the natural diversity of sizes, as well as promoting a goal of improved health, which may or may not include weight change.  The views expressed by our featured bloggers are their own.

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Dr. Rebecca Puhl is the Deputy Director of the Rudd Center for Food Policy and Obesity at Yale University. As a Senior Research Scientist, she coordinates research and policy efforts aimed at reducing weight bias and improving the quality of life of children and adults affected by obesity.

Dr. Puhl received her Ph.D. in Clinical Psychology from Yale University. She has conducted research on weight bias for 13 years and has published numerous studies about weight-based bullying in youth, weight bias in health care and the media, interventions to reduce weight bias, and the impact of weight stigma on emotional and physical health.

Dr. Puhl has testified in state legislative hearings on weight bias, routinely provides expertise on this issue to State Departments of Health and national health organizations, and has developed evidence-based trainings to reduce weight bias that have been implemented in medical facilities across the country. Dr. Puhl has served on the governing Council of The Obesity Society, and is on the Board of Directors for the Obesity Action Coalition. For more information on Dr. Puhl’s work, please visit www.yaleruddcenter.org

 

Weight Based bullying: A Pervasive Problem in Need of Multiple Remedies

As part of weight stigma awareness week, we must raise awareness of those who are most vulnerable to weight bias and its consequences: youth. Children and adolescents are frequent targets of teasing, bullying, and victimization because of their weight. There is considerable research on this topic, all of which points to the conclusion that this is a serious problem in need of effective remedies. Here’s what we know about the prevalence of weight-based bullying, its consequences, and what can be done to address this important issue: 

1) Weight-based bullying is highly prevalent in the school setting. 

As early as preschool, children who are overweight are vulnerable to weight bias. They are viewed as mean, ugly, and undesirable playmates by their peers compared to thinner preschoolers. By elementary school, these children are negatively stereotyped because of their weight and face lower acceptance from their peers. In fact, children in grades 3-6 who are obese are more likely to be bullied by their classmates compared to thinner peers, regardless of their gender, race, social skills, or academic achievement. The likelihood of being bullied is 63% higher for an obese child compared to a thinner peer. By middle school, teasing is more prevalent, upsetting, and longer lasting for children who are overweight.

By high school, not surprisingly, the picture becomes worse. In a recent study, we surveyed over 1500 high school students and asked them what they perceive to be the most common reason that students are teased and bullied at school. As depicted below, students reported weight-based teasing to be the most common form of teasing and bullying at school.

Image 1In this study we also asked students what types of weight-based teasing and bullying they witnessed toward their overweight peers. As shown below, we found that multiple forms of weight-based bullying were observed in the school setting, at alarming rates. For example, 92% of students witnessed their overweight peers being made fun of, 85% saw them being teased specifically during physical activities (like gym class), 67% observed them being excluded from activities, and over half witnessed these students being verbally threatened and physically harassed.

Image 2In addition to reports by students that weight-based bullying is a common problem at school, educators share similar concerns. In 2011, the National Education Association conducted a nationwide study on bullying in which thousands of educators across the country were surveyed and asked what type of bullying they perceived to be most problematic at school. Weight-based bullying was viewed to be the most problematic form of bullying by teachers, as illustrated below:

Image 3Thus, we can see from research that both students and teachers agree that weight-based bullying is a serious problem at school. 

2) Youth experience weight-based teasing from multiple sources

What complicates this situation further, is that youth are vulnerable to weight-based victimization from many sources – not just their peers. Although peers appear to be the most common perpetrators of weight bias, research also indicates that trusted adults, such as teachers and parents, may be perpetrators. Research shows that parents often communicate weight-based stereotypes to their children, and that children report being teased by parents and siblings about their weight.

As a recent example of the many sources of weight bias that youth may confront, we conducted a study with 361 adolescents who were enrolled in weight-loss camps, and asked them about their experiences of weight-based bullying. 64% of adolescents had experienced weight-based victimization, most of whom had been experiencing this for over a year. While 90% of these adolescents reported experiencing weight-based bullying from their peers, 42% reported being victimized about their weight by sports coaches or physical education teachers, 27% from classroom teachers, and 37% from parents.

Image 4Of note, adolescents who had lost weight and were no longer overweight or obese, were still at risk for weight-based teasing and bullying. This tells us that youth may be vulnerable to weight-based victimization at diverse body weights, and in both the school and home settings.

3) Weight-based bullying poses many consequences for youth

Weight-based teasing and bullying has concerning effects on emotional well-being. Youth who are teased about their weight experience poorer body image, lower self-esteem, social isolation, and higher risk of depression and anxiety. Obese youth who experience weight-based victimization from peers have been shown to be two to three times more likely to engage in suicidal thoughts and behaviors. Eisenberg and colleaguesfound that 51% of girls who were targets of weight-based teasing from peers and family members had thought about committing suicide, compared to 25% of those who had not been teased. Among boys, 13% who were teased by family members about their weight reported attempting suicide compared to 4% who were not teased.

Social relationships are also negatively affected by weight bias. Obese children are liked less and rejected more often by peers than thinner students. A large-scale study assessed over 90,000 adolescents from the National Longitudinal Study of Adolescent Health and reported that overweight adolescents were more likely to be socially isolated and less likely to be nominated by their peers as friends than average-weight students. Other research with a sample of over 9000 adolescents found that obese students spent less time with friends than thinner peers, after controlling for variables such as grade level, race, and socioeconomic status. Academic functioning may also be affected by weight bias, as many students who experience weight-based bullying report that their grades are harmed as a result of these experiences, and that they avoid going to school in order to escape the bullying.

Finally, experiencing weight-based teasing may lead to disordered eating and unhealthy weight control behaviors.  As an example, overweight youth who are teased about their weight are more likely to engage in unhealthy weight control and binge-eating behaviors compared to overweight youth who are not targets of weight-based teasing. Prospective research has demonstrated that weight-based teasing predicted binge eating at 5 years of follow-up among both male and female adolescents, even after controlling for other factors. In addition, we know from research that students who are teased about their weight in gym class often cope by avoiding physical activity.

Thus, weight-based bullying can have a devastating effect on the quality of life of children and adolescents. These youth are at risk for adverse consequences affecting their emotional, social, and academic functioning, as well as their physical health.

4) Multiple strategies are needed to reduce weight-based bullying

Although it’s clear from research that weight-based bullying is a pervasive problem that impairs the lives of youth, little has been done to try to remedy this problem. The general issue of bullying in the United States has received considerable attention in recent years by researchers, educators, the media, and even the federal government. Unfortunately, weight-based bullying has been primarily absent in these discussions and efforts. This needs to change. Body weight needs to be on the radar and part of the national discourse about bullying.  

We can achieve this through multiple strategies.

On the school level, we need to ensure that school-based anti-bullying policies include protections for students of diverse body sizes. We also need educators to treat the importance of weight bias as seriously as other forms of bias in the school setting (e.g., race, religion, sexual orientation). Educators can also teach youth about the ways in which the media promotes weight bias, and about the complex and multiple causes of body weight, so that students understand that genetic, biological, environmental, and behavioral factors all contribute to a person’s weight. In school-based health curriculum or obesity prevention programs, we can also help reduce weight-based bullying by focusing on health, rather than being thin or achieving a certain body size. The goal for all children is improved health through physical activity and healthy eating, regardless of their body weight.

At home, parents need to look for signs that their child may be getting teased or bullied about their weight, and offer emotional support to their child and seek assistance from their child’s school to address the problem. Parents also need to be mindful of their own assumptions and attitudes about body weight, and avoid disparaging remarks about weight and making judgmental and criticizing comments to their child. Parents are important models for their child’s view of the world, and need to model acceptance of diverse body sizes, healthy eating and exercise behaviors, and respect for all individuals regardless of their body weight.

More broadly, efforts to reduce weight-based bullying may require changes to the legal landscape. Although almost every state in this country has an anti-bullying law, only a few mention ‘body weight’ as a characteristic that is vulnerable to bullying. It’s not clear whether current laws offer adequate protection to these students, and it may be helpful to strengthen these laws to offer clearer protections to youth who are bullied about their weight.

To learn more about weight-based bullying and efforts to address this problem, please visit www.yaleruddcenter.org

 

 

References of Research Studies Cited

 Bradshaw CP, Waasdorp TE, O’Brennan LM, Gulemetova M. Findings from the National Education Association’s nationwide study of bullying: Teachers’ and education support professionals’ perspectives. National Education Association, 2011.

Eisenberg ME, Neumark-Sztainer D, Story M. Associations of weight-based teasing and emotional well-being among adolescents. Archives of Pediatric Adolescent Medicine 2003;157:733-8.

Falkner N, Neumark-Sztainer D, Story M, et al. Social, educational, and psychological correlates of weight status in adolescents. Obesity Research 2001;9:32-42.

Haines J, Neumark-Sztainer D, Eisenberg ME, et al. Weight teasing and disordered eating behaviors in adolescents: Longitudinal findings from Project EAT (Eating Among Teens). Pediatrics 2006;117:209-15.

Keery H, Boutelle K, van den Berg P, et al. The impact of appearance-related teasing by family members. Journal of Adolescent Health 2005;37:120-7.

Neumark-Sztainer D, Falkner N, Story M, et al. Weight-teasing among adolescents: Correlations with weight status and disordered eating behaviors. International Journal of Obesity 2002;26:123-31.

Puhl, R. M., Peterson, J. L., & Luedicke, J. (2013). Strategies to address weight-based

victimization: Youths’ preferred support interventions from classmates, teachers, and parents. Journal of Youth and Adolescence, 42, 315-327.

Puhl, R. M., Peterson, J. L., & Luedicke, J. (2012). Weight-based victimization: A comprehensive assessment of weight-loss treatment-seeking youth. Pediatrics. DOI 10.1542/peds.2012-1106

Puhl, R.M., & Luedicke, J. (2012). Weight-based victimization among adolescents in the school setting: Emotional reactions and coping behaviors. Journal of Youth and Adolescence. 41, 27-40. 

Puhl RM, Luedicke J, Heuer C. Weight-based victimization toward overweight adolescents: Observations and reactions of peers. Journal of School Health 2011;81:696-703.

Strauss RS, Pollack HA. Social marginalization of overweight children. Archives of Pediatric Adolescent Medicine 2003;157:746-52.