Download 1 RESEARCH PAPER The Consequences of the Stigmatization of

Running Head: RESEARCH PAPER
The Consequences of the Stigmatization of Fat Children and Adolescents
Alison Maffucci
Westmont College
Author’s Note
Alison Maffucci, Department of Psychology, Westmont College
I want to thank my roommates for dealing with me and for my dietitian who got me
interested in the stigmatization of weight.
Correspondence regarding this essay should be addressed to Alison Maffucci, Westmont
College, 955 La Paz Road MS #2000, Santa Barbara, CA 93108 (APA 2012). Email:
[email protected]
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Abstract
The prevalence of overweight and obese children is increasing in the United
States. While there are legitimate health concerns associated with obesity, body size
stigmatization has clear negative consequences for overweight children. This high
rate of obesity might suggest that weight tolerance would actually increase, but
evidence in recent years indicates that weight bias remains widespread and is
worsening. As obesity becomes a national public health priority, it is important for
our society to understand the nature of weight stigma and its effect on youth.
 A stigmatized child possesses an attribute or
characteristic that is linked to a devalued social identity
and is ascribed stereotypes or other deviant labels that
increase vulnerability to status loss, unfair treatment,
prejudice, and discrimination.
 Children are described at risk for overweight if their body
mass index is within the range to the 85-94th percentile
and overweight if their BM! Isa t the 95th percentile or
higher.
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Introduction
As childhood obesity and overweight rates continue to rise, an increasing
number of young people are vulnerable to the social consequences of obesity. There
is reason to be concerned about the vulnerability of so many children to the
negative social, emotional, and physical consequences of obesity.
In the culture of the United States, thinness symbolizes attractiveness, power,
and self-control, while unfortunately people who are not thin are assumed to be
indulgent, lazy, and lacking in self-discipline. Even children internalize this cultural
message and place great importance on being thin, and many even desire thinner
bodies even if they fall within normal weight ranges.
Overweight and obese children and adolescents are the targets of societal
stigmatization in multiple aspects of their lives. Research suggests that overweight
and obese youths are victims of bias and stereotyping by peers, educators, and even
their own parents and family members. Fat children are increasingly excluded,
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treated differently, and viewed as flawed. Stigmatization does not only affect
psychological well being, but also damages social relationships, academic success,
and can trigger destructive behaviors.
This piece defines weight stigma as negative weight related attitudes and beliefs
that are manifested by stereotypes, bias, rejection, and prejudice toward children
and adolescents because they are overweight or obese.
Anti-Fat Attitudes in Youth
Negative attitudes towards obese youth develop in children, probably
because this bias remains socially acceptable in our culture. Children are not afraid
of becoming fat due to the health risks associated with obesity, but because they
have an early awareness that having a fat body is socially unacceptable in our
culture. Research shows that stereotypes towards obese children begin as young as
three years old, where preschoolers report their overweight peers as mean, stupid,
ugly, unhappy, lazy, and undesirable friends. Attitudes worsen as children enter
elementary and middle school, with obese peers being described as ugly, selfish,
lazy, stupid, and dishonest.
There have been numerous studies that have documented children’s negative
attitudes towards obese and overweight individuals. A standard technique for
assessing anti-fat attitudes is to note reactions to figures of various body sizes, from
very thin to very fat. Research shows that children hold the most negative attitudes
toward the overweight figures. In a 1961 study, Richardson, concluded that ten to
eleven year olds rate overweight children as the least likable. In a 2003 replication
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of this study, weight stigma has even worsened among children, which means that
our anti-fat attitudes are only getting worse.
Children like overweight peers less and wish to interact with them less than
average weight peers. Given the stigmatization of overweight and obese youth, these
children will suffer through more negative peer interactions and fewer
opportunities for developing social skills and supportive social relationships.
The acceptability of fat prejudice and much of the hostility directed toward
fat people is supported by the belief that fat people can become thin if they really
wanted. Children’s perceptions of the controllability of weight might be related to
body size stigmatization and their friendship selections based on body size. It is
possible that children characterize overweight individuals more negatively than
those with other physical attributes, because they see this condition as the fault of
the overweight person. Tiggemann and Anesbury found that 8-12 year old children
on average believed that obesity was controllable, and that the more strongly the
children held this belief, the more strongly they held negative stereotypes about
overweight individuals.
Weight Bias and Peer Teasing
Teasing is a widely documented source of psychological distress and is
considered the most psychologically harmful type of peer victimization. Being
teased because of one’s weight or appearance is related to negative body image and
weight concerns in children and adolescents. One-quarter of girls and 12 percent of
boys who were teased reported attempting suicide compared to those who were not
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teased. Weight bias can be expressed verbally, through physical aggression, or
through social exclusion.
Nearly all children are teased, but some may have a higher likelihood of
experiencing chronic teasing. In elementary school, the likelihood of being bullied is
63 percent higher for an obese child compared to a healthy weight child.
Approximately one-third of overweight girls and one-fourth of overweight boys
report being teased by peers at school, while 60 percent of girls and boys who are
obese report victimization.
The National Education Association conducted a study that aimed to figure
out the different types of weight-based victimization that students experience in
school. In a survey of 1555 overweight and obese adolescents, 92% report being
made fun of, 91% report being called names, 85% report being teased during
physical activity, 71% report being teased in the cafeteria, and 76% felt ignored and
avoided. In middle school, weight related teasing elicits the most negative emotional
reactions compared to teasing for other reasons. Michael Loewy, a psychology
professor at the University of North Dakota says in his essay Working with Fat
Children in Schools: “It is amazing that so many fat children survive adolescence,
given the hatred and meanness directed at them.”
Compared to average weight children, obese children report to be teased at
least three times more often. Chronic teasing may lead to social isolation, since there
exists correlations of degree of weight related teasing with weight concerns,
loneliness, and liking of sedentary and isolative activities. Data from 90,118
adolescents in the National Longitudinal Study of Adolescent Health found that
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overweight adolescents were more likely to be socially isolated and were less likely
to be chosen by their peers as friends.
Weight Bias in Education
Peers are not the only sources of weight stigmatization in the educational
setting. Anti-fat beliefs are concerning because even teachers exhibit biased
attitudes. Teacher biases can influence student academic outcomes and
performance, and student self-perceptions.
Research shows that educators report having lower expectations for
overweight students and that they believe overweight students have worse social,
reasoning, physical, and cooperation abilities than non overweight students. This
means that weight bias within educational institutions may prevent obese
individuals from achieving the same educational goals as their normal weight peers.
For fat students, the school experience is one of ongoing prejudice and
socially acceptable discrimination. Obese students have been found to have lower
college acceptance rates and are encouraged less from their high school counselors
to even apply to college. Perceived or actual bias and discrimination from teachers
has negative effects on the students’ well being.
Teacher bias may also make overweight students less likely to participate in
activities that draw additional attention to their weight, such as physical education
class. Getting teased about being overweight often occurs during times when
children are engaging in physical activities. Bauer and colleagues found that middle
school students reported receiving negative comments from teachers about their
athletic abilities that in turn led them to avoid participating in PE classes.
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Overweight youth often report that weight based teasing is ignored by PE teachers.
If teachers themselves have high levels of anti-fat bias, then they may not stop
weight based teasing when it occurs in their classes.
Due to weight based teasing, students report that their grades are harmed
and that they avoid school. In a random sample of 1071 public school students,
being overweight predicted poorer school performance. In school setting, students
who are overweight or obese can face harassment and ridicule from peers, as well
as negative attitudes from teachers and other educators. At the college level, some
research shows that qualified overweight students, particularly females, are les
likely to be accepted to college than their normal weight peers.
BMI Screening in Schools
In 2003, Arkansas was the first state to require schools to chart its students’
Body Mass Index. Three years later, the state’s percentage of overweight school
children remained the same. Miriam Berg, president of the National Council on Size
and Weight Discrimination says, “Weighing children regularly does not help them
become thin.” Berg is opposed to the promotion of weight loss as public policy
because: 1) it targets fat kids and promotes discrimination against them, 2) it
teaches kids that fatness should be avoided at all costs, resulting in dangerous diet
practices and eating disorders, and 3) it ignores the nutritional, exercise, and health
needs of kids who are average weight or thinner on average. The medical
community is doing a disservice to thin kids by focusing solely on kids who are
overweight.
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In a study assessing if BMI screening in schools is helpful or hurtful, the
Center of Disease Control concluded that there was insufficient evidence to
recommend that schools conduct BMI screening and report these results to the
parents. The US Department of Agriculture/ Agriculture Research center
investigated the adequacy of using BMI to assess the weight of children in a
multiethnic population. Their conclusion was that 17% of children with normal
percentages of body fat were incorrectly classified as at risk of overweight or
overweight. There is concern that schools are falsely mislabeling a large number of
children based on the BMI screening. It is critical to understand that obesity
prevention and health promotion programs can actually harm one aspect of health
while attempting to improve another.
According to a policy statement on Prevention of Pediatric Overweight and
Obesity (2004) by the American Academy of Pediatrics, BMI has its limits as an
accurate measurement of obesity. Children grow unevenly, often gaining weight
before growing in height. Some children are also more muscular due to physical
activity and genetic factors, so despite a lean body mass, their weight and BMI are
higher.
John S. Martinez School in New Haven, Connecticut, was one of the first
elementary public schools in its district to rid its campus of all junk food. The
schools health clinic monitors each child’s health and weight loss. The eighth
graders say that the schools efforts to keep them thin have increased their fear
rather than reduced their weight. The messages being received by our youth is lose
weight to get healthy, which contributes to anxiety and depression. Health
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education messages that focus on the negative impact of dietary fat, overweight, and
weight control are likely to make young people feel worse about their bodies and
themselves in general. Child obesity prevention programs and untested health
education messages have the potential to further stigmatize fat children and
perpetuate the current prejudicial beliefs.
Even Parents Tease
Parents who hold their own anti-fat attitudes want to protect their children
from the discrimination that fat people experience, however, parental
encouragement of their children to be within socially acceptable weight limits can
be detrimental to the child. Research shows that parental modeling of excessive
weight concern and disordered eating is related to higher weight concern in their
children. Parental teasing and concern for their child’s body shape has been found to
be detrimental to a child’s psychological wellbeing.
Many parents worry about their children’s weight in elementary school.
Parents may ridicule the child’s eating habits, force their child to diet, insult them, or
shame them into losing weight. Research shows that 47 percent of overweight girls
and 34 percent of overweight boys report weight victimization from their own
family.
There have been a number of studies the address the relationship between
reported parental attempts to control children’s food intake and the amount of food
children actually eat. Mothers who are concerned about their child’s weight are
more likely to restrict their child’s eating. Fisher and Birch found that when mothers
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tried to control their daughters’ food intake, when the daughters were given free
access to the restricted foods, the daughter increased her food intake.
In the only study examining the reaction of parents to a BMI report card, a
significant number of parents responded to the news that their children were
overweight by putting the children on calorie-restricting diets. Limiting calorie
intake in children before puberty is problematic because it stunts growth in height,
and also leads to behavioral problems, such as sneaking food, hiding food, and
overeating.
It is in the home where food and fat will be experienced for the growing and
developing child. Children’s perceptions of parental pressure to maintain a low body
weight, increases the likelihood of weight dissatisfaction and eating disorders. In
addition parental concern about their child’s weight and body image is significantly
correlated with children’s tendency to hold stereotypical views about fat people,
which continues the prevalence of the stigma and fear of fat.
Weight Bias and Emotional Well-Being
We live in a society where messages depict fatness as unhealthy and also
unsightly and immoral. Overweight people feel undesirable, unattractive, and
devalued by society’s standards. Weight bias has a range of negative consequences
for children and adolescents who are overweight and obese. Emotional
consequences of bias include increased vulnerability to depression and anxiety,
lower self-esteem, and poor body image. In addition, research shows that obese
youth who are victimized by their peers are more likely to engage in suicidal
thoughts and behaviors than overweight children who are not victimized. There is
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reason to be concerned about the vulnerability of so many children to the negative
social and emotional consequences of the overweight and obese stigma.
Experiences of weight bias and stigma have harmful psychological and social
consequences, such as isolation or withdrawal. Studies have demonstrated that
when children internalize the bias, they are more likely to binge eat in response to
stigma. Obese children of both sexes report having low self esteem, and exhibit high
rates of extreme dieting, disordered eating, and skipping breakfast, as well as
greater levels of emotional distress and lower expectations of their educational
futures.
The sense that one has been treated unfairly in public places can have
negative consequences for sentiment and emotional health. Obese groups score
lower in physical and general self-esteem scales compared to control groups, and
there is a high prevalence of psychiatric disorders in obese groups. In the study
done by_______ 70 percent of the participants met the criteria for at least one of the
DSM-IV diagnosis. The rate of anxiety disorders seems to be higher in obese children
and adolescents in in-patient settings for binge eating, than in other chronic
diseases.
Adolescents frequently struggle with their self-esteem and want to be
accepted by their peers, and are especially vulnerable if they happen to be heavier
than most in their class. Children and adolescents are battered by ruthless pressure
to be thin at a time when fitting in is of most concern. Heavier children report more
psychological and weight related distress. Depression is associated with weight
related teasing and also with children’s report of body size dissatisfaction. In a study
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researching_________, obesity was significantly related to depression among 15 and
17 year olds and also related to experiences of shame.
The prejudices against fat people are perceived and internalized by children.
Turning around fat discrimination is an important part of helping our overweight
children achieve and maintain a healthy weight, because a society intolerance of fat
bodies makes overweight or at risk overweight children even fatter. Overweight
children who are teased are more likely to engage in unhealthy weight control and
binge eating behaviors. There is also evidence to suggest that obese children are less
likely to engage in physical activity because of weight stigma.
In a sample of over 2,000 overweight and obese women, Phil concluded that
weight related stress and dissatisfaction explains a large portion of obesity’s effect
on health. 79 percent of the sampled women indicated that they coped with the
weight stigma by eating more food. Discrimination against overweight children by
other children and adults often pushed children to isolate and eat more and exercise
less.
Discrimination for their Own Good
Having too much excess weight is linked to ill health and mortality. Long lists
of diseases are associated with obesity and overweight: heart disease, cancer,
hypertension, lipid-dysregulation, type 2 diabetes, and many others, but overlooked
entirely is the impact obesity may have on health through its social consequences.
Societal weight bias and discrimination may be linked to important health outcomes
that the medical and scientific fields have failed to consider.
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Childhood obesity has been identified as a major threat to children’s health in
the USA. The number of Americans classified as obese has increased and is
described by the media and medical community as an obesity crisis. A third of
Americans are obese and another third are overweight. In California, statistics show
that one in three adolescents age 9-11 are at risk of or are already overweight.
Obesity is associated with diabetes, heart disease, cancer, high blood pressure, and
sleep apnea. 60 percent of overweight children have developed at least one
cardiovascular risk factor (i.e. high blood pressure, lipid levels, or impaired glucose
tolerance) and 20 percent of over-weight children have two or more of these.
Despite the alarm, most intervention and treatment is viewed at the individual level.
Excess weight has a pervasive effect on a host of bodily systems: metabolism,
endocrinology, respiration, musculoskeletal integrity.
It is not uncommon to hear that stigma is beneficial because it serves as an
incentive for people to avoid gaining weight and helps motivate overweight people
to diet. However, their remains no evidence that weight teasing directed at children
is a positive motivator to lose weight. Our society has declared a war on fat, “with no
study to demonstrate even the possibility of long-term successful weight loss, but
backed by a 50 billion dollar per year weight loss industry, this war is both under
researched and overfunded.” Fat children are the most innocent of society’s victims.
Politicians are reacting with legislation: BMI report cards sent home to
parents, removal of soft drinks and junk food from schools, banning trans fats in
restaurants, and requiring fast-food chains to display the caloric content of their
food. Americans are actually enjoying longer lives and better health than ever
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before. The claim that four out of five of us have serious health risks because of a
number on a scale further stigmatizes fat people and contributes to a culture that
fears fat. Several researchers have argued that weight should be less of a public health
priority. A 2005 study by scientists at the Centers of Disease Control and Prevention
(CDC) suggested that it is only after BMI reaches 35 that there is a meaningful increase
in mortality and that people in the overweight category actually have the lowest rate of
mortality.
Dr. David Satcher warns that obesity may soon pass tobacco as the chief
cause of preventable deaths in the United States. Obesity is claimed to be the world’s
number one health problem, with the potential to reduce life expectancy by ten
years or more (Fox). About 60 percent of adults in this country are overweight or
obese, as are nearly 13 percent of children. (New York Times 2001a: 2)
In April 2004, researchers from the Centers for Disease Control and
Prevention released a report in the prestigious Journal of the American medical
Association estimating that obesity was killing 400,000 Americans a year. This
resulted in public health officials using these numbers in the news and in congress
declaring obesity as a major threat to the American public. However, the
researchers from the Centers for Disease Control did not record to see if the weight
of each person was a factor in his or her death. Real morbidity/mortality
correlations with weight have often been contradictory with its findings. There have
been cases were being fat protects against disease and heavier people live longer.
It is assumed that the increase in child obesity has occurred because of an
increase in caloric intake, however, data has not confirmed this assertion. The claim
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that obese children and adolescents consume more calories than their normalweight peers conflicts with several studies, which indicate there being no difference
in total energy intake between the two groups.
In the Bogalusa Heart Study that followed the health and nutrition of children
in Bogalusa, Louisiana since 1973 noted that total caloric intake for ten-year-old
children remained virtually unchanged from 1973-1988. The U.S. Department of
Agriculture’s National Food Consumption Surveys and Continuing Survey of Food
Intake by Individuals indicates a downward trend in the mean energy intake for the
general population from 1965-1991, but an increase in the caloric intake for the
years 1994 and 1995. This data reveals that childhood obesity increased for many
years without an increase in caloric intake.
The hypothesis that decreased caloric expenditure in the population is a
significant contributor to the current obesity epidemic remains unproven. Richard
Klein, a well-known critic of the war on fat, pointed to the growing awareness of our
culture on dieting and rigid exercise is the root cause of the fat explosion of our
country. Turning around fat discrimination is an important part of helping our
overweight children achieve a healthy weight. A society obsessed with thinness and
that is intolerant of fat bodies, makes overweight children even fatter.
Health is not a number and is problematic when linked with weight. The
assumption that fat people are unhealthy is so ingrained in our society. Healthy dayto-day practices should be emphasized regardless to whether a person’s weight
changes. Increasingly, even medical researchers are acknowledging that excess body
weight is harmful for health not solely on a physiological basis but in part because of
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the stress associated with enduring an unfavorable social trait. Psychological
distress and discrimination affect our physical health. The social stigma of obesity
worsens the cycle of poor eating and poor exercise routines. If perceived
discrimination adds extra health challenges to the ones that already obese and
overweight children face, it is possible that the internalization of the weight stigma
explains the exacerbation of the effects. Encouraging children of all sizes toward
emotional health and a sense of self-worth encourages physical health. It is
important to practice healthy habits no matter how much you weigh.
Conclusion
Successful efforts to prevent and reduce childhood obesity and overweight
should be programs to reduce weight stigma. Discrimination against overweight
children by other children and adults often pushes them to eat more and exercise
less. And numerous studies document how fat kids, victims of discrimination and
bullying, often respond by withdrawing from peers or becoming bullies themselves.
"I believe if a child is eating a nutritionally balanced diet and
is active, if he or she has a higher BMI [body mass index], it
doesn't matter," says Schwartz.
Schwartz routinely hears people say, "If only fat people worked
harder, they would lose weight." But she and others challenge
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the hysteria surrounding the global "obesity epidemic," which
defines 17 percent of children age 2 to 19 as overweight.
Paul Campos, author of The Obesity Myth, argues that
Americans are, in general, only 15 pounds heavier than they
were 20 years ago. It is public health standards, not our bodies,
that have changed, becoming more rigid in defining the
majority of Americans as "overweight."
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