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.

The healthy body image (HBI) intervention: Effects of a school-based cluster-randomized controlled trial with 12-months follow-up.

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.

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.

Weight bias and grading among middle and high school teachers

Purpose. Research has documented an inverse relationship between body mass index (BMI) and school achievement but has failed to empirically explain it. We tested whether this association among adolescents can be explained in part by student engagement. Methods. A self-report survey about health and school behaviors was completed by 196 high school students; BMI and achievement data were obtained from school records. Three forms of engagement were assessed: behavioral, presenteeism, and affective. Associations of engagement with BMI and achievement were examined, and mediation analyses were conducted. Results. The simple relationship between BMI and achievement was confirmed and demonstrated that BMI was negatively related to academic achievement. Higher BMI was also significantly correlated with lower classroom participation. Mediation tests showed the significant relationship between BMI and achievement was reduced after accounting for behavioral engagement but not affective engagement. Conclusions. These novel findings shed light on why heavier students often experience lower academic achievement. Intervention studies targeting barriers to classroom engagement among overweight and obese youth are needed so that their academic potential is not compromised.

/pdf/school-engagement-in-relation-to-body-mass-index-and-school-5ahhg3gcla.pdf

School Engagement in Relation to Body Mass Index and School Achievement in a High-School Age Sample

Valid and reliable assessments are difficult to administer in PK–12 physical education due to a lack of resources. In this article, we discuss a collaborative model that may mutually benefit studen...

Kristin E. Finn

Papers

Weight bias and grading among middle and high school teachers

School Engagement in Relation to Body Mass Index and School Achievement in a High-School Age Sample

A Model for Collaboration to Ensure Feasibility and Effectiveness of Fitness Testing in a PK-12 Physical Education Setting.