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Keywords:

  • adolescents;
  • stigma;
  • psychosocial

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References

Objectives: The purpose of this research was to examine the social, educational, and psychological correlates of weight status in an adolescent population. It was hypothesized that obese adolescents would differ on psychological, social, and educational variables compared with their non-overweight peers.

Research Methods and Procedures: In this cross-sectional study, a population-based sample of 4742 male and 5201 female public school students in the 7th, 9th, and 11th grades responded anonymously to a classroom administered questionnaire. Body mass index was calculated from self-reported height and weight and categorized into four classes of weight status: underweight (<15th percentile), average weight (15th to 85th percentile), overweight (>85th to 95th percentile), and obese (>95th percentile). The questionnaire also included questions about social experiences, psychological well-being, educational experiences, and future goals. Associations of weight status with social, psychological, and educational variables and future goals were explored.

Results: After adjustment for grade level, race, and parental socioeconomic status, obese girls, when compared with their average weight counterparts, were 1.63 (95% confidence interval [CI]: 1.16, 2.30) times less likely to hang out with friends in the last week, 1.49 (95% CI: 1.12, 1.98) times more likely to report serious emotional problems in the last year, 1.79 (95% CI: 1.20, 2.65) times more likely to report hopelessness, and 1.73 (95% CI: 1.21, 1.98) times more likely to report a suicide attempt in the last year. Obese girls were also 1.51 (95% CI: 1.09, 2.10) times more likely to report being held back a grade and 2.09 (95% CI: 1.35, 3.24) times more likely to consider themselves poor students compared with average weight girls. Compared with their average weight counterparts, obese boys were 1.91 (95% CI: 1.43, 2.54) times less likely to hang out with friends in the last week, 1.34 (95% CI: 1.06, 1.70) times more likely to feel that their friends do not care about them, 1.38 (95% CI: 1.08, 1.76) times more likely to report having serious problems in the last year, 1.46 (95% CI: 1.05, 0.03) times more likely to consider themselves poor students, and 2.18 (95% CI: 1.45, 3.30) times more likely to expect to quit school. Compared with average weight boys, underweight boys were 1.67 (95% CI: 1.30, 2.13) times more likely to report hanging out with friends in the last week, 1.22 (95% CI: 1.01, 1.49) times more likely to report disliking school, and 1.40 (95% CI: 1.06, 1.86) times more likely to consider themselves poor students.

Discussion: Associations of weight status with social relationships, school experiences, psychological well-being, and some future aspirations were observed. Among girls, the pattern of observations indicates that obese girls reported more adverse social, educational, and psychological correlates. Obese as well as underweight boys also reported some adverse social and educational correlates. These findings contribute to an understanding of how adolescent experiences vary by weight status and suggest social and psychological risks associated with not meeting weight and body shape ideals embedded in the larger culture.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References

As the obesity epidemic in this country continues to grow, so too does concern about the costs and consequences of obesity (1) (2, 3, 4, 5, 6). The prevalence of overweight among U.S. youth is 22%, which is an all-time high (7). At the same time, youth, especially girls, are frequently dieting to lose weight or prevent weight gain (8, 9, 10, 11, 12). This is due, in part, to the awareness among youth of the social prestige bestowed on those who are thin and meet body shape ideals (13, 14, 15).

Among adults in industrialized countries, research demonstrates adverse social and economic correlates of obesity (16). Obese adults are more likely to live in poverty, are less educated, less likely to earn as much income and less likely to date or marry than their non-overweight counterparts (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27). Recently, social scientists observed in prospective studies that obesity is antecedent to adverse social and economic outcomes (26, 27).

Results from several studies demonstrate that obese people are often severely stigmatized (28, 29, 30, 31, 32, 33, 34) and are frequently stereotyped as ugly, stupid, mean, and lazy (30, 31, 32, 33, 34, 35). One study revealed that when children were presented with pictures of children with a range of physical characteristics, including disabilities, the picture representing the obese child was one of the least liked and least likely to be considered a potential playmate by the children in the study (29). In addition to the observation that the obese child, whether male or female, is negatively stereotyped, findings also indicate that the thin boy is sometimes negatively stereotyped (30, 36). Results do not support a similar finding among girls (31).

There are inconsistent findings regarding associations between global self-esteem and obesity, although this may be due in part to methodological limitations (37). Some investigators found modest inverse associations of global self-esteem with weight status (38, 39, 40) but others found no associations between self-esteem and weight status (15, 27, 41, 42, 43). In contrast, self-esteem specific to physical appearance was more consistently found to be inversely associated with obesity (12, 44, 45). A few studies demonstrated modest differences of other global psychological concerns (emotional well-being, suicidal ideation, and peer concerns) between overweight and non-overweight adolescents (46, 47).

With regard to academic success, one study of youth in Thailand demonstrated that overweight adolescents, but not children, on average had a significantly lower grade point average than their non-overweight counterparts (48). However, relatively little is known about the social and economic experiences associated with weight status among youth.

The purpose of this study was to explore the social, educational, and psychological correlates of weight status in a diverse and representative sample of youth. We selected these measures because they reflect important themes in the lives of adolescents, such as their relationships with family and friends, how they feel about themselves, school, and future aspirations. We hypothesized that obese adolescents would fare less well on psychological, social, and educational variables than their non-overweight peers. We also explored among adolescents whether their future goals varied by weight status. Based on results from previous research (46), we did not expect future goals to differ according to weight status.

Research Methods and Procedures

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References

Study Population

The study population was a representative sample of 7th, 9th, and 11th grade students in Connecticut. Students responded to a 1995 to 1996 statewide survey of adolescent health. The study obtained a response from ∼83% of the selected student population. Approximately 5% of these responses were excluded because of missing or invalid information. For the purposes of these analyses, data for an additional 825 students were excluded because of missing information about height and weight or for inappropriately high values for body mass index (BMI) (>50) or inappropriately low values for BMI (<10). The final sample included 5201 females and 4742 males in 7th, 9th, and 11th grades (Table 1). Students were from diverse ethnic/racial backgrounds. About one-fourth (24%) of the males and 13% of the females met or exceeded the 85th percentile age- and gender-specific BMI values from the National Health and Nutrition Examination Survey I (49, 50), which were the criteria for defining overweight in this study.

Table 1.  Demographic characteristics of the sample
 FemaleMale
 N%N%
Total520152.3474247.7
Race    
African American53710.53908.3
Hispanic3907.63277.0
Asian/Pacific Islander1132.21322.8
Other/Multi/Native American4128.03768.0
White368471.7346673.9
Grade    
7th grade179534.5175437.0
9th grade195937.7168135.5
11th grade144727.8130727.5
Parental SES    
Low income3857.42545.4
Low/middle income225443.3180238.0
High/middle income136526.3132728.0
High income92517.898020.6
Unknown income2725.23798.0
Weight status    
Underweight88817.261012.9
Average weight361969.8298163.0
Overweight4588.875716.0
Obese2204.23828.1

Study Design

This study used a sophisticated sampling design to obtain a representative sample of students in Connecticut public schools. In Connecticut, there are nine Educational Reference Groups (ERGs) that are used by the state to assess and compare student achievement across school districts, controlling for socioeconomic level. The ERGs were based on statistical models using 1990 census tract information (e.g., family income, parental level of education and occupation, percentage of single family homes, percentage of homes where English is a second language, etc.) to create socioeconomic gradations. The nine ERGs were crossed with the state's five Service Delivery Areas to ensure a geographically and socioeconomically representative sampling base. Schools were selected from this sample base and students within selected schools were invited to participate. Surveys were completed anonymously. The sampling design and survey development are described in greater detail elsewhere (8).

Measures

A 225-item questionnaire was administered to students in classroom settings. All responses to the survey were anonymous and self-reported. The measures used in these analyses are presented in Table 2 and are briefly described below.

Table 2.  Description of measures and coding
VariableMeasureResponsesCoding
Social factors   
Feel mom doesn't careHow much do you feel your mother cares about you?1 (not at all), 2 (a little), 3 (somewhat), 4 (quite a bit), 5 (very much)1,2 vs. 3,4,5
Feel dad doesn't careHow much do you feel your father cares about you?1 (not at all), 2 (a little), 3 (somewhat), 4 (quite a bit), 5 (very much)1,2 vs. 3,4,5
Feel friends don't careHow much do you feel your friends care about you?1 (not at all), 2 (a little), 3 (somewhat), 4 (quite a bit), 5 (very much)1,2 vs. 3,4,5
Did not hang out with friends last weekIn the past week, have you hung out with friends (at the mall, their house, etc.)?1 (no), 2 (yes, once), 3 (more than once)1 vs. 2,3
Psychological factors   
HopelessnessDuring the past 12 months, have you ever felt so sad, discouraged, or hopeless that you wondered if anything was worthwhile?1 (not at all), 2 (a little bit), 3 (some, enough to bother me), 4 (quite a bit), 5 (extremely so, to the point that I've almost given up)4,5 vs. 1,2,3
Problems in last yearDuring the past 12 months, have you had any serious personal, emotional, or mental health problems?1, 2, 3 (yes), or 4 (no)1,2,3 vs. 4
Attempted suicideHave you tried to kill yourself during the past 12 months?1 (no), 2 (yes, once), 3 (yes, more than once)2,3 vs. 1
Educational factors   
Dislike schoolHow do you feel about going to school?1 (I don't like school at all), 2 (I don't like school very much), 3 (I like school about half the time), 4 (I like school most of the time), 5 (I like school all the time)1,2 vs. 3,4,5
Trouble with studentsSince school started this year, how often have you had trouble getting along with other students?1 (never), 2 (a few times), 3 (once a week), 4 (almost every day)2,3,4 vs. 1
Trouble with teachersSince school started this year, how often have you had trouble getting along with your teachers?1 (never), 2 (a few times), 3 (once a week), 4 (almost every day)2,3,4 vs. 1
Poor student (compared with others)Compared with other students your age, what kind of student are you?1 (near the bottom), 2 (below the middle), 3 (average), 4 (above the middle), 5 (one of the best)1,2 vs. 3,4,5
Expect to quit schoolDo you expect to drop out of school?1 (no, I plan to finish school), 2 (yes, I'm flunking out), 3 (yes, I'm bored at school), 4 (yes, I need money to support me or my family), 5 (yes, I have (will have) a child to support), 6 (yes, since my school is not safe), 7 (yes, since I won't be able to get a job even if I finish school), 8 (yes, other reasons)2–8 vs. 1
Held back a gradeHave you ever repeated a grade or been held back a grade?1 (yes), 2 (no)1 vs. 2
Future goals   
Expect not to finish collegeWhat is the most education you expect to finish?1 (less than high school), 2 (high school), 3 (vocational-technical degree—after high school), 4 (associates degree—2-year program in business, cooking, etc.), 5 (college degree—4-year program), 6 (graduate or professional), 7 (not sure)5,6 vs. 1,2,3,4,7
Expect to be successful in workOn a scale from “no chance” to “it will happen,” what do you think the chances are you will be successful in the work you choose?1 (no chance), 2 (some chance), 3 (about 50–50), 4 (pretty likely), 5 (it will happen)5 vs. 1,2,3,4
Expect to earn a middle income by age 30On a scale from “no chance” to “it will happen,” what do you think the chances are you will have a middle-class family income by age 30?1 (no chance), 2 (some chance), 3 (about 50–50), 4 (pretty likely), 5 (it will happen)5 vs. 1,2,3,4
Social Factors.

Five questions addressed the student's feelings about relationships with friends and family members. Four questions assessed students’ perceptions of how much they felt that their mother, father, and friends cared about them. There was also a measure of social contact with peers assessing whether participants had socialized with their friends in the last week.

Psychological Factors.

These three measures included assessment of emotional well-being, hopelessness, and suicide attempt within the past 12 months.

Educational Factors.

Six questions were used to assess students’ educational experiences. These included measures of liking school, getting along with teachers and students, self-assessment of academic performance, expectations of finishing high school, and whether students had ever repeated a grade.

Future Goals.

Three questions were used to measure students’ future goals regarding educational aspirations, financial success, and occupational success.

Weight Status.

Students’ self-reported height and weight were converted into BMI units (kg/m2). Students were then classified into four groups based on their BMI: underweight (<15th percentile), average weight (15th to 85th percentile), overweight (>85th to 95th percentile), and obese (>95th percentile). Cutoff values for these four groups were based on the reference data for age-and gender-specific BMI from National Health and Nutrition Examination Survey I data (49, 50).

Covariates.

Covariates include grade level (7th, 9th, or 11th), race, and family socioeconomic status (SES). Race was dichotomized as white vs. other due to small group sample size for African Americans, Hispanics, Asian/Pacific Islanders, and others (multiracial, Native American, or other racial heritage). Family SES was based on participants’ reports of parental education and occupation status. There were four categories: high (mother or father had professional training beyond a 4-year college and currently works full time); middle-high (mother or father graduated from a college and currently works full or part time or is retired, or mother or father had professional training beyond college and currently works part time or is retired); middle-low (mother or father graduated from high school but not from college and currently works full or part time or is retired); and low (parents did not graduate from high school, or graduated from high school but are not currently working for reasons other than retirement). Questions were asked separately for each parent and the maximum value of either mother's or father's categorical measure was used. Due to the large number of participants who did not report the educational or occupational status of either parents, an “unknown category” for family SES was also created (N = 651).

Data Analysis

Unadjusted associations were examined by cross-tabulations between weight status (independent variable) and the dependent variables. Observed χ2 values were used to test for differences in each dependent variable across the four weight status categories. Analyses adjusted for grade level, race, and parental SES were conducted using logistic regression because all dependent variables were dichotomous. One model was generated for each of the dependent variables. These models were used to examine the odds of the dependent variable (e.g., held back a grade) according to the specified weight status (obese, overweight, or underweight) compared with those of average weight, independent of the effect of potential confounders (such as parental SES, race, and grade). School was included as a random effect to reflect the two-stage sampling design of this study. To conduct all analyses, SAS Release 6.12 (SAS Institute, Cary, NC) was used (51). The logistic regressions were implemented via the GLIMMIX macro (52), which allowed for the introduction adjustment for the second-level random effect, school. The GLIMMIX macro implements the Generalized Linear Mixed Model and is appropriate for data with a non-normal error distribution and multiple random effects.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References

Results from the unadjusted analyses showing the number and frequency for each dependent variable according to each gender-specific weight category are presented in Tables 3 and 4. Univariate analyses show that among girls, the prevalence of negative social, educational, and psychological reports tended to be the greatest among those who were obese. For example, among the obese girls, 22% had not hung out with friends in the last week, 15% reported feelings of hopelessness, 42% reported emotional problems, 19% reported attempted suicide in the past year, 42% reported experiencing trouble getting along with other students, 12% perceived themselves as below average students, 27% reported being held back a grade, and 35% expected not to finish college (Table 3).

Table 3.  Associations between weight status and social, psychological, school, and future aspiration variables among adolescent females
 UnderweightAverage weightOverweightObese  
 N%N%N%N%Observed* χ2 valuep value
  • *

    Test for equality of prevalence across the four weight status categories (observed value compared with the theoretical χ2 distribution based on 3 df).

Relationships with friends and family          
Feel mom doesn't care839.73159.05512.62411.46.90.074
Feel dad doesn't care14517.358116.89522.34823.713.20.004
Feel friends don't care15418.152915.19421.54621.818.5<0.001
Did not hang out with friends last week11713.444712.47310.74721.718.3<0.001
           
Psychological          
Hopelessness718.02797.8429.33315.015.10.002
Problems in the last year25229.3115932.715134.59242.214.00.003
Attempted suicide9210.537910.55812.84219.117.1<0.001
           
School          
Dislike school16118.262617.38017.53616.60.50.912
Trouble with students31235.7112431.216636.59141.618.1<0.001
Trouble with teachers24528.0100427.815534.16027.37.90.047
Poor student (compared with others)617.01935.4347.52612.019.2<0.001
Expect to quit school222.5802.3102.252.30.30.962
Held back a grade15117.353214.89621.05927.133.0<0.001
           
Future          
Expect not to finish college26930.682022.812627.77634.737.2<0.001
Expect to be successful in work41647.7168446.722750.310648.42.30.507
Expect to earn a middle income by age 3011013.249314.06213.93013.80.40.949

The univariate analyses reveal a different pattern of results among boys. Among boys, the greatest prevalence of negative social, educational, and psychological experiences was reported by underweight and obese boys. For example, 17% of underweight boys and 18% of obese boys reported not hanging out with friends in the last week. One-fourth of underweight boys and 30% of obese boys reported serious emotional problems, 8% of underweight boys and 9% of obese boys attempted suicide in the past year, and 27% of underweight boys and 27% of obese boys reported being held back a grade. With respect to future expectations, 37% of underweight boys and 33% of obese boys reported expecting not to finish college (Table 4).

Table 4.  Associations between weight status and social, psychological, school, and future aspiration variables among adolescent males
 UnderweightAverage weightOverweightObese  
 N%N%N%N%Observed* χ2 valuep value
  • *

    Test for equality of prevalence across the four weight status categories (observed value compared with the theoretical χ2 distribution based on 3 df).

Relationships with friends and family          
Feel mom doesn't care6811.72498.7709.74712.810.20.017
Feel dad doesn't care11320.041014.411215.66919.014.20.003
Feel friends don't care18632.475926.521429.712333.815.20.002
Did not hang out with friends last week10417.230810.49012.06918.336.1<0.001
           
Psychological          
Hopelessness355.81244.2324.3246.35.90.118
Problems in the last year14324.766222.917423.511029.78.90.030
Attempted suicide508.41715.8516.8349.09.70.022
           
School          
Dislike school19632.584928.620527.210828.64.90.179
Trouble with students29048.7122941.434145.416944.413.00.005
Trouble with teachers22137.2102834.726835.414036.81.90.600
Poor student (compared with others)7412.32568.68711.64712.514.50.002
Expect to quit school294.8933.2385.2287.520.3<0.001
Held back a grade16126.659120.016622.210126.518.5<0.001
           
Future          
Expect not to finish college22537.184528.622930.412533.219.2<0.001
Expect to be successful in work27346.2137546.435647.216944.60.70.872
Expect to earn a middle income by age 3010017.548316.512216.46818.10.90.820

Adjusted models were created to account for the possible influence of confounding variables such as grade, race, and parental social class, as well as the random effect of school. In these models, odds ratios were generated and in all cases the reference group was average weight adolescents (Table 5).

Table 5.  Odds ratios of social, psychological, and educational variables and future goals
 Girls Boys
 OR95% CI OR95% CI
  1. OR, odds ratio; 95% CI, 95% confidence interval.

  2. Average weight group is the reference group.

  3. Models are adjusted for grade, race, and parental SES.

Relationships with friends and family
Feel mom doesn't care  Feel mom doesn't care  
Obese1.14(0.73, 1.78)Obese1.39(0.99, 1.94)
Overweight1.33(0.97, 1.82)Overweight1.09(0.83, 1.44)
Underweight1.14(0.87, 1.48)Underweight1.30(0.97, 1.74)
Feel dad doesn't care  Feel dad doesn't care  
Obese1.20(0.85, 1.69)Obese1.22(0.91, 1.64)
Overweight1.17(0.90, 1.50)Overweight1.03(0.81, 1.30)
Underweight1.06(0.86, 1.31)Underweight1.36(1.07, 1.74)
Feel friends don't care  Feel friends don't care  
Obese1.19(0.84, 1.69)Obese1.34(1.06, 1.70)
Overweight1.24(0.97, 1.60)Overweight1.13(0.94, 1.35)
Underweight1.26(1.02, 1.54)Underweight1.22(1.00, 1.49)
Did not hang out with friends last week  Did not hang out with friends last week  
Obese1.63(1.16, 2.30)Obese1.91(1.43, 2.54)
Overweight1.15(0.87, 1.51)Overweight1.16(0.91, 1.49)
Underweight1.00(0.80, 1.26)Underweight1.67(1.30, 2.13)
Psychological
Hopelessness  Hopelessness  
Obese1.79(1.20, 2.65)Obese1.47(0.93, 2.31)
Overweight1.09(0.77, 1.65)Overweight0.98(0.65, 1.46)
Underweight1.03(0.77, 1.36)Underweight1.33(0.89, 1.99)
Problems in last year  Problems in last year  
Obese1.49(1.12, 1.98)Obese1.38(1.08, 1.76)
Overweight1.07(0.87, 1.33)Overweight1.02(0.84, 1.24)
Underweight0.95(0.80, 1.13)Underweight1.17(0.95, 1.45)
Attempted suicide  Attempted suicide  
Obese1.73(1.21, 1.98)Obese1.45(0.98, 2.13)
Overweight1.08(0.80, 1.46)Overweight1.06(0.76, 1.47)
Underweight0.91(0.71, 1.16)Underweight1.19(0.85, 1.67)
School
Dislike school  Dislike school  
Obese0.89(0.61, 1.30)Obese1.00(0.78, 1.27)
Overweight1.03(0.79, 1.33)Overweight0.93(0.77, 1.11)
Underweight1.13(0.93, 1.37)Underweight1.22(1.01, 1.49)
Trouble with students  Trouble with students  
Obese1.18(0.88, 1.58)Obese1.00(0.80, 1.25)
Overweight0.97(0.79, 1.21)Overweight1.11(0.94, 1.31)
Underweight1.00(0.84, 1.18)Underweight1.06(0.88, 1.28)
Trouble with teachers  Trouble with teachers  
Obese0.80(0.59, 1.10)Obese0.99(0.79, 1.25)
Overweight1.15(0.93, 1.43)Overweight0.98(0.82, 1.16)
Underweight0.87(0.73, 1.04)Underweight0.95(0.79, 1.15)
Poor student  Poor student  
Obese2.09(1.35, 3.24)Obese1.46(1.05, 2.03)
Overweight1.29(0.88, 1.89)Overweight1.36(1.05, 1.76)
Underweight1.26(0.93, 1.70)Underweight1.40(1.06, 1.86)
Expect to quit school  Expect to quit school  
Obese0.83(0.34, 2.01)Obese2.18(1.45, 3.30)
Overweight0.83(0.44, 1.59)Overweight1.54(1.07, 2.22)
Underweight1.03(0.64, 1.65)Underweight1.16(0.77, 1.75)
Held back a grade  Held back a grade  
Obese1.51(1.09, 2.10)Obese1.22(0.94, 1.56)
Overweight1.16(0.90, 1.50)Overweight1.04(0.85, 1.28)
Underweight1.18(0.96, 1.46)Underweight1.21(0.98, 1.50)
Future
Expect not to finish college  Expect not to finish college  
Obese1.41(1.04, 1.90)Obese1.15(0.90, 1.46)
Overweight1.08(0.86, 1.36)Overweight1.01(0.84, 1.21)
Underweight1.35(1.14, 1.61)Underweight1.32(1.08, 1.60)
Expect to be successful in work  Expect to be successful in work  
Obese0.97(0.73, 1.29)Obese0.90(0.72, 1.12)
Overweight1.09(0.89, 1.33)Overweight1.03(0.87, 1.21)
Underweight0.98(0.84, 1.15)Underweight0.93(0.77, 1.11)
Expect to earn a middle income by age 30  Expect to earn a middle income by age 30  
Obese1.01(0.67, 1.50)Obese1.14(0.86, 1.51)
Overweight1.01(0.76, 1.35)Overweight1.00(0.80, 1.24)
Underweight0.94(0.75, 1.18)Underweight1.06(0.83, 1.35)

After adjustment for covariates, compared with the average weight girls, obese girls were 1.63 times more likely to report not hanging out with friends, 1.79 times more likely to report feelings of hopelessness, 1.49 times more likely to report serious emotional problems, and 1.73 times more likely to have attempted suicide. They were 2.09 times more likely to perceive themselves as below average students and 1.51 times more likely to report having been held back a year. Interestingly, underweight girls were 1.26 times more likely than average weight girls to report feeling that friends care not at all or little about them. Both obese and underweight girls were more likely to expect not to finish college than their average weight counterparts. Among girls, there were no statistically significant associations of weight status with feeling mother or father does not care, disliking school, experiencing trouble with students or teachers, expecting to quit high school, and expecting to be successful in work and earn a middle income by 30 years of age.

Compared with their average weight counterparts, underweight boys were more likely to report feeling their father and friends care not at all or little about them. Obese boys were also more likely than average weight boys to report feeling that their friends care not at all or little. The obese boys were 1.91 times more likely and the underweight boys were 1.67 times more likely than their average weight counterparts to report not hanging out with friends in the last week. With respect to psychological factors, obese boys were 1.38 times more likely than average weight boys to report serious emotional problems. Underweight boys were more likely to dislike school, yet the obese and overweight boys were more likely to report expecting to quit school. The obese, overweight, and underweight boys were all more likely than average weight boys to think of themselves as below average students; however, underweight boys were more likely to expect not to finish college. Among boys, there were no statistically significant associations of weight status with feeling mother does not care, feelings of hopelessness, attempted suicide, experiencing trouble with students or teachers, being held back a grade, and expecting to be successful in work and earn a middle income by 30 years of age.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References

An interesting pattern of results emerged that revealed adverse social, educational, and psychological correlates and future goals associated with weight status. There were more and stronger associations for obese girls compared with their average weight counterparts than for obese boys compared with their average weight counterparts. However, there were also adverse social and educational correlates and future goals for the underweight boys compared with average weight boys.

To the extent that stereotypes influence behaviors that in turn influence interpersonal relationships, these results are consistent with observations reported in the literature that anti-fat stereotypes have adverse consequences for obese adolescents (33, 53, 54, 55, 56, 57). Results also revealed adverse social outcomes for underweight boys, and these observations are consistent with the lesser investigated phenomenon of anti-thin stereotypes for males (30, 36). Examination of social, school, and psychological variables suggests that the quality of some of these relationships and experiences is related to body weight. Curiously, among girls, underweight students were more likely than average weight girls to report feeling that their friends cared not at all or little about them, but the obese girls were more likely than average weight girls to report that they did not hang out with friends in the last week. The term “hanging out” can be interpreted in more than one way. We have interpreted it as being a proxy measure for socializing with peers. However, hanging out may be interpreted differently. For example, it could have a negative connotation suggesting that youth are hanging out instead of being involved in other activities. Based on our interpretation, these observations suggest that the obese girls are less likely to have as many social contacts with friends, or may in fact have fewer friends but despite this fact, they feel that these friends care. However, both obese and underweight boys reported not hanging out with friends in the last week and feeling that their friends care little or not at all about them. Furthermore, underweight boys were more likely to report feeling that their fathers and other adults cared little or not at all. The experiences of underweight boys are poorly understood, but these results suggest underweight boys may have more negative social experiences during adolescence than their average weight counterparts.

Obese girls were more likely than average weight girls to think of themselves as poorer students and report being held back a year in school. One must use caution when interpreting these results because the data are cross-sectional and it is not possible to determine whether the students were obese when they were held back. We were surprised that the prevalence of youth who reported being held back a grade or having to repeat a grade was 18.9% (16.3% among girls and 21.8% among boys). Among boys, the school experience according to weight status is less clear. There is an inconsistency in the pattern of results revealing that educational experiences may be poorer for obese, overweight, and underweight boys compared with the average weight males, but for different reasons. Although there was no information on grade point average in this study, these results are consistent with those reported in the study by Mo-Suwan et al. (48) that demonstrated an inverse association of weight with academic performance in adolescents.

Other studies exploring associations between obesity and psychosocial concerns among youth have found mixed results. For example, in a study of >30,000 adolescents, Neumark-Sztainer et al. (46) found strong positive associations between obesity and weight-specific concerns and behaviors (e.g., body dissatisfaction and unhealthy weight control behaviors). However, associations of obesity with global psychological concerns such as emotional wellbeing, suicidal ideation, peer concerns, and future job concerns were minimal. Similar results were found in a study of >10,000 Native American youth (47). The stronger associations found between weight status and suicide attempts in this study may be due to different populations or different measures. In the Minnesota Adolescent Health Survey (46) and the study of Native American Youth (47), suicide ideation was assessed, whereas in this study, we assessed suicide attempts in the last year. Suicide ideation is a less specific measure and may account for the higher prevalence ranges (11.5% to 30.0%) reported in these other two studies (46, 47). The present study expands on this body of literature in that associations were examined between weight status and a broader range of individual psychosocial and educational factors.

Despite the pattern of observations found in the present study, it is also important to note that in many cases, there were no differences between weight status and social and school experiences and future goals. Compared with their average weight counterparts, obese students as a group appear to be more likely to have negative social experiences, believe they are poor students, and expect to quit school but also appear to have functional family relationships and aspirations for occupational and economic success.

Adverse outcomes are not inevitable for obese adolescents and adults (58). Stunkard and Mendelson (59) Allon (60), and others (A. Mellin, D. Neumark-Sztainer, M. Story, M. Ireland, M. Resnick, unpublished observations) compared diet and exercise behaviors between overweight and non-overweight youth and explored these associations with family connectedness, parental expectations, parental monitoring, and psychosocial variables among overweight youth. They found that positive familial relationships attenuate the adverse associations. In this context, the observation that obese girls and boys were not more likely to report feeling that their mothers and fathers did not care is encouraging. Certainly more work is needed in this area, and prospective studies may assist in clarifying the temporality of these associations.

Strengths of this study include the large, racially and economically diverse population-based sample of youth, the anonymity of data collection, and the use of a comprehensive survey tool. The limitations of this study must also be considered. All measures were self-reported and consequently subject to reporting bias. For example, participants may have underestimated or overestimated their actual weight and height and this could attenuate or accentuate the observed associations (61). If many participants incorrectly reported their height and weight, these errors would be expected to influence the results. To protect against this, participants with suspiciously large or small BMIs were excluded from analyses. This study is cross-sectional; therefore, it is impossible and incorrect to make causal inferences of the observed associations. Furthermore, the results are correlational, and residual confounding is always a possibility. Despite these limitations, this cross-sectional study reveals interesting interrelationships of weight status with psychological, social, and school variables that corroborate results from stereotype studies and studies of social and economic consequences of obesity among adults.

Careful consideration is made in articulating the implications of these findings. Building on these cross-sectional associations, there is a need to understand why some obese adolescents or underweight boys have more negative social and educational problems and whether these differential experiences are a cause of psychological problems. Is emotional distress among obese students and among underweight males a result of negative social interactions? What kinds of protective factors buffer against distress and suicide attempt among those who are otherwise considered high risk because of their weight status? Considering the epidemic of obesity among youth, these issues are timely and may be meaningful in promoting positive social and educational experiences for all young people, as well as designing sensitive strategies for preventing and treating obesity.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References

The Voice of Connecticut Youth Survey was funded by a grant from the Connecticut Department of Health, Division of Family Health (Hartford, CT). N.F. was supported in part by National Heart, Lung, and Blood Institute Training Grant T32-HL0779 and by Grant DK50456 from the National Institute of Diabetes and Digestive and Kidney Diseases. We thank Peter Hannan for his contributions to this work.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Research Methods and Procedures
  5. Results
  6. Discussion
  7. Acknowledgments
  8. References