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. 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 in Youth: Prevalence, Consequences, and Considerations for Clinical Practice.

OBJECTIVES Children with obesity achieve lower educational level compared with normal-weight peers. Parental socioeconomic status (SES) impacts both a child's academic achievement and risk of obesity. The degree to which the association between obesity and education depends on parental SES is unclear. Therefore, the primary aim is to investigate if individuals with obesity in childhood are less likely to complete ≥12 years of schooling, independently of parental SES. The secondary aim is to study how weight loss, level of education and parental SES are associated. DESIGN Nationwide prospective cohort study. SETTING Swedish national register data. PARTICIPANTS Children aged 10-17 years, recorded in the Swedish Childhood Obesity Treatment Register, and aged 20 years or older at follow-up were included (n=3942). A comparison group was matched by sex, year of birth and living area (n=18 728). Parental SES was based on maternal and paternal level of education, income and occupational status. PRIMARY OUTCOME MEASURE Completion of ≥12 years of schooling was analysed with conditional logistic regression, and adjusted for group, migration background, attention deficit disorder with or without hyperactivity, anxiety/depression and parental SES. RESULTS Among those with obesity in childhood, 56.7% completed ≥12 school years compared with 74.4% in the comparison group (p<0.0001). High parental SES compared with low SES was strongly associated with attained level of education in both children with and without obesity, adjusted OR (aOR) (99% CI)=5.40 (4.45 to 6.55). However, obesity in childhood remains a strong risk factor of not completing ≥12 school years, independently of parental SES, aOR=0.57 (0.51 to 0.63). Successful obesity treatment increased the odds of completing ≥12 years in school even when taking parental SES into account, aOR=1.34 (1.04 to 1.72). CONCLUSIONS Individuals with obesity in childhood have lower odds of completing ≥12 school years, independently of parental SES. Optimised obesity treatment may improve school results in this group.

https://bmjopen.bmj.com/content/bmjopen/11/3/e040432.full.pdf

Obesity in childhood, socioeconomic status, and completion of 12 or more school years: a prospective cohort study.

Childhood obesity is, according to the WHO, one of the most serious challenges of the 21st century. More than 100 million children have obesity today. Already during childhood, almost all organs are at risk of being affected by obesity. In this review, we present the current knowledge about diseases associated with childhood obesity and how they are affected by weight loss. One major causative factor is obesity‐induced low‐grade chronic inflammation, which can be observed already in preschool children. This inflammation—together with endocrine, paracrine, and metabolic effects of obesity—increases the long‐term risk for several severe diseases. Type 2 diabetes is increasingly prevalent in adolescents and young adults who have had obesity during childhood. When it is diagnosed in young individuals, the morbidity and mortality rate is higher than when it occurs later in life, and more dangerous than type 1 diabetes. Childhood obesity also increases the risk for several autoimmune diseases such as multiple sclerosis, Crohn's disease, arthritis, and type 1 diabetes and it is well established that childhood obesity also increases the risk for cardiovascular disease. Consequently, childhood obesity increases the risk for premature mortality, and the mortality rate is three times higher already before 30 years of age compared with the normal population. The risks associated with childhood obesity are modified by weight loss. However, the risk reduction is affected by the age at which weight loss occurs. In general, early weight loss—that is, before puberty—is more beneficial, but there are marked disease‐specific differences.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/joim.13547

Pediatric obesity—Long‐term consequences and effect of weight loss

Weight Bias and Stigma: Impact on Health.

Purpose This study aimed to determine the beliefs, attitudes, and phobias of nursing students about obese individuals. Design and method This descriptive and cross-sectional study involved 658 students from the nursing department of a Turkish university. Data collection tools were the Fat Phobia Scale (FPS), Turkish Attitudes toward the Obese Persons Scale (T-ATOP), and Turkish Beliefs about Obese Persons Scale (T-BAOP). Findings Students had moderate levels of fat phobia and attitudes towards obese individuals and they believed obesity is controlled by individuals. Practical implications Fat phobic attitudes of nursing students should be prevented and positive beliefs and attitudes should be developed.

Perceptions of nursing students about individuals with obesity problems: Belief, attitude, phobia

Background Weight bias is a pervasive problem for adolescents in school contexts. Despite evidence of negative attitudes towards students who are overweight, comparatively little research has examined whether teachers provide biased assessments of student work. Aims The purpose of this study was to experimentally test whether middle and high school teachers unfairly assess students who are overweight and perceive them to be less competent. Sample Participants included 133 teachers from first-ring suburban middle and high schools (Mteaching experience = 16 years; 38% male). Methods Teachers evaluated the quality of a bogus student essay assignment accompanied by photographs that portrayed the student as either not overweight or overweight. Weight bias was assessed by having teachers grade the essay and provide perceptions of student sufficiency (perceived effort, need for tutoring, and overall success in school). Opinions about bias in grading for other teachers and self were also assessed. Results Essays for students who were overweight were judged to be similar in structural quality, but were assigned lower grades compared to their healthy weight counterparts. Further, teachers estimated that students who were overweight put forth more effort, needed more remedial assistance, and had lower overall grades in school. Teachers' beliefs about grading bias showed low levels of supposed bias among other teachers and a significantly lesser degree for themselves. Conclusions This study confirms prior research on anti-fat attitudes and provides new evidence of biased attitudes in school settings.

Anna E. Phillips

Papers

Weight bias and grading among middle and high school teachers