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Abstract

  1. Top of page
  2. Abstract
  3. Methods and procedures
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

Objective: To assess whether weight-related teasing is associated with weight control behaviors, disordered eating thoughts and behaviors, and psychological comorbidities in overweight adolescents.

Methods and Procedures: A sample of 46 male and 84 female adolescents completed a survey assessing teasing frequency, sources of teasing (peers and family), weight control behaviors, disordered eating thoughts and behaviors, depression, anxiety, anger, and self-esteem.

Results: Frequent teasing by both family and peers was associated with greater disordered eating thoughts and behaviors, depression, anxiety, anger, and decreased self-esteem. The more that adolescents were bothered by peer and family teasing, the more often they reported a greater value on thinness, higher levels of anxiety, lower self-esteem, and their self-assessment was influenced by their weight and shape. Higher levels of teasing frequency and being bothered by teasing were related to greater odds of adolescents endorsing severe levels of binge eating behaviors and depressive symptomolgy.

Discussion: Overweight adolescents teased about their weight are at risk for disordered eating thoughts and behaviors and psychological morbidities. Health-care providers should involve parents and youth in discussing teasing concerns. Furthermore, parents, schools, and communities should consider enacting policies to decrease or prohibit teasing. Future research is needed to further explore relationships between teasing and psychological functioning.

Teasing among youth, particularly overweight youth, is a prevalent concern related to a variety of health risks. One national study estimates that teasing or emotional bullying is reported by one in four children (1). Teasing can encompass a broad array of targeted negative commentary such as joking and name calling, which is often accompanied by acts of social aggression such as exclusion, being singled out, and being laughed at. A specific type of teasing, being teased about one's weight, is also very common, and is reported by 26% female and 22% male adolescents (2). Research has shown that adolescents who are overweight are at a greater risk of being teased about their weight from peers and family members than average weight adolescents (2). This is particularly salient as overweight adolescents are at increased risk for disordered eating behaviors (3), low self-esteem (4), and depression (5). Research shows that frequent weight-teasing was reported by 45% of overweight adolescent girls and 50% of overweight adolescent boys, compared to 19% of average weight girls and 13% of average weight boys (2). Considering the high prevalence of weight-teasing in overweight adolescents, and the increased risk for psychological comorbidities, it is important to examine the impact of teasing on psychological and behavioral functioning in youth.

Few studies have specifically looked at the psychological and behavioral impacts of weight-related teasing. Eisenberg and colleagues found that weight-related teasing was associated with psychological comorbidities both cross-sectionally and longitudinally in Project EAT (eating among teens) (6,7). In the cross-sectional analysis of ∼4,500 adolescents, weight-teasing was related to depressive symptoms and suicidal ideation (7). As the number of sources of teasing increased to include both peers and family members, the proportion of respondents who reported emotional health concerns increased. The follow-up longitudinal study on ∼2,500 adolescents found that weight-teasing in adolescence predicted poorer emotional well-being in early adulthood through two mechanisms: ongoing weight-teasing and the early impact of teasing on emotional health (6). Two other studies investigated this relationship, but have studied younger children. One study with 6th through 8th grade students found that teasing was significantly associated with disordered eating, clinical levels of depression, and low self-esteem (8). Additionally, a longitudinal study of 6–12-year olds found that boys, but not girls, had higher eating disorder scores when they reported being teased about their weight (9). Both studies suggest a significant relationship between teasing psychological variables and disordered eating; however, these studies cannot be extrapolated to an adolescent population because of their focus on middle school aged children.

The aforementioned literature describes the relationship of teasing on the general population of children and adolescents but does not distinguish the effects on overweight adolescents. Fewer studies exist with regard to teasing in overweight adolescents. One such study found that weight-based teasing was associated with disordered eating (2). Three other studies that evaluated teasing in overweight adolescents also suggested that teasing is associated with poorer emotional well-being, but of these three, one study included only females (10) and the others included middle school students, but not older adolescents (11,12). Therefore, further study is warranted on the relationship between weight-related teasing among overweight adolescents and a range of weight control behaviors, disordered eating thoughts and clinical levels of disordered eating, and psychological morbidities. More research is needed to clarify the role of teasing in adolescent health and well-being.

The purpose of this study was to provide a detailed description of the risks associated with weight-based teasing among overweight adolescents. By using clinical measures of depression, binge eating behaviors and validated measures of anxiety, anger, and self-esteem, this study builds upon previous research by providing a stronger foundation to understand the effects of teasing on overweight adolescents. By examining both healthy and unhealthy weight control behaviors (HWCB and UWCB), this study broadens the scope of previous research. This study addressed the following research questions: is weight-related teasing associated with HWCB and UWCB, disordered eating thoughts and behaviors, and psychological morbidities? Additionally, is the relationship altered by the frequency of teasing, the source of teasing, and the extent to which an adolescent is bothered by the teasing? We hypothesize, based on similar findings with younger adolescents and within the general population, that a greater frequency, number of sources, and extent to which adolescents are bothered by weight-related teasing will be significantly related to a greater utilization of UWCB, more disordered eating thoughts and behaviors, and higher levels of psychological morbidities. We also predict that overweight adolescents who are teased will report using fewer HWCB.

Methods and procedures

  1. Top of page
  2. Abstract
  3. Methods and procedures
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

Participants

Data were collected as part of the Successful Adolescent Weight Losers Project (SAL), a cross-sectional study designed to assess adolescents’ thoughts, feelings, and behaviors associated with being overweight and weight loss. Adolescent males and females were recruited from the community using a variety of methods: direct mailing, newspaper advertisements, radio public service announcements, internet postings, flyers, and professional referrals. Two groups were specifically recruited; overweight adolescents who lost 10 lbs and maintained the weight loss for 3 months, and overweight adolescents who had not lost weight. Adolescents were paid $50 for their participation. Study procedures were approved by the University of Minnesota Human Subjects’ Committee.

Adolescents (N = 130) ranging in age from 12 to 20 years (mean = 15.2) completed the survey and had their height and weight measured. The sample consisted of 65.5% females and a fairly diverse racial and ethnic composition (58.4% white, 13.6% black, 0.8% Hispanic, 2.4% Asian, 7.2% American Indian, 3.2% other, and 14.4% mixed). Most adolescents were overweight (BMI 85–95th percentile for age and gender = 38%; BMI > 95th percentile = 62%) (ref. 13).

Measures

Adolescents completed the Successful Adolescent Weight Losers survey, a 73-item self-report instrument designed to assess adolescent behaviors and feelings related to weight and weight loss. The survey included standardized assessment tools as well as additional items designed by the study team. Measures included in the survey were: the Eating Disorder Examination Questionnaire (EDE-Q) (14), the Center for Epidemiological Studies Depression Scale for Children (15,16), Spielberger State-Trait Personality Inventory (17), Rosenberg Self-Esteem Scale (18,19), and weight control behaviors and items about teasing adapted from the Project EAT survey (3,20).

Anthropometric measures. Height and weight measurements were taken by trained research staff using standardized equipment and procedures (21). Cutoff points for gender- and age-specific and BMI percentile values and were based on reference data from the Centers for Disease Control and Prevention growth charts (13).

Weight control behaviors. Participants were asked to report on 32 strategies (yes/no) used in the past year to reduce or maintain their weight, adapted and expanded upon from Project EAT (3). These items were compiled into four scales using factor analysis: HWCB, UWCB, other dietary changes (ODC), and behavior changes. HWCB included the following items: eat fewer calories, increase exercise, increase fruits and vegetables, no snacking, eat less high-fat food, eat less junk food, watch less TV, drink less soda, drink more water, walk more, less computer and video games, do different kinds of exercise, and weigh self (α = 0.81). UWCB included fasting, skipping meals, taking laxatives, diuretics, diet pills or vomiting, and demonstrated moderate reliability (α = 0.70). ODC included eating less meat, eating fewer carbohydrates, using liquid diet supplements, eating more protein, following the Atkins Diet, and following the South Beach Diet (α = 0.65). Behavior changes included attending a weight loss group, writing down food eaten, working with a professional (nutritionist, physician, etc.), eating a certain amount of calories, counting calories, and following a structured diet (Weight Watchers, Jenny Craig, etc.) (α = 0.61). Interestingly, the factor analysis differentiated the organized weight loss programs. ODC included the Atkins and South Beach Diets as well as individual behaviors that are associated with these diets. ODC is distinguished in the factor analysis from the behavior change factor which included diets such as Jenny Craig and Weight Watchers along with writing down food and calorie counting.

Disordered eating thoughts and behaviors. Individual items were included from the EDE-Q pertaining to binging (14). The EDE-Q has previously demonstrated acceptable levels of reliability in detecting disordered eating thoughts and behaviors among late adolescent females (occurrence ϕ coefficient = 0.62; frequency Pearson r = 0.68) (refs. 22,23,24). The EDE-Q binge eating items have also been shown to correlate highly with the EDE (sensitivity = 0.65; specificity = 0.48), the current gold standard in assessment of eating disorders (25). Participants were asked whether they felt afraid of losing control while eating, had eaten in secret, binged, lost control while eating, and both binged and felt a loss of control while eating in the past 28 days. Severe binge eating behaviors were identified in participants who endorsed eight or more binges in the past month with loss of control.

Depression. Depression was measured using the Center for Epidemiological Studies Depression Scale for Children. Previous studies have demonstrated that the Center for Epidemiological Studies Depression Scale for Children has sufficient reliability and validity with adolescents in the community (α = 0.85) (ref. 16). Participants were asked to respond on a Likert scale about the extent to which they felt bothered by things, felt down, were happy, and felt like crying in the past week. Scores were summed to create an overall depression score (range: 0–60). Severe depressive symptoms was classified as 15 or higher (15,16).

Anger and anxiety. The Spielberger State-Trait Personality Inventory provided measures of anger and anxiety. The items in the State-Trait Personality Inventory are based upon the State-Trait Anxiety Inventory and State-Trait Anger Expression Inventory which have both shown strong reliability among adolescents and adults (anger: r = 0.87; anxiety α = 0.90) (17). Previous analysis of the State-Trait Personality Inventory suggests strong reliability among college age males and females (anger: females α = 0.82, males α = 0.85; anxiety: females α = 0.85, males α = 0.82) (refs. 17,25). Subjects were asked on a 4-point Likert scale to say how often they feel a certain way. Anger (range: 10–40) was assessed with 10 items such as: “I have a fiery temper.” Anxiety (range: 8–32) was a modified scale that included eight items, and participants responded to questions such as, “I feel nervous and restless.” Scores were summed to create overall anxiety and anger scores.

Self-esteem. The Rosenberg Self-Esteem Scale was used to measure adolescent self-esteem with 10 items on a 4-point Likert scale. The self-esteem scale has demonstrated strong reliability with adolescents (0.92) (refs. 18,19). Participants were asked to indicate how strongly they agree or disagree with statements such as, “At times I think I am no good at all.” Scores were summed to create the self-esteem scale (range: 0–30).

Weight-related teasing. Items that assessed teasing were adapted from Thompson et al. (20) and the Project EAT survey (3). Frequency of teasing was assessed by asking how often subjects are teased about their weight with response options that ranged from “never” to “at least once a week.” In addition, participants were asked if they had ever been teased about their weight by peers and if so, the extent to which it bothered them. They were also asked if they had been teased by family members and the extent to which it bothered them. Responses ranged from “not at all” to “very much.” A scale was created from the teasing items to measure the number of sources of teasing. It ranges from no teasing (0) to teasing by peers or family (1) to teasing by peers and family (2).

Data analysis

Data were analyzed using SPSS (14.0) (SPSS, Chicago, IL). Linear regression assessed whether increases in the frequency of teasing and being bothered by teasing were related to changes in levels of weight control behaviors, disordered eating thoughts and behaviors, and psychological morbidities. Logistic regression was used to assess the odds of adolescents experiencing severe levels of depression and binge eating behaviors because of increased frequency and sources of teasing.

Results

  1. Top of page
  2. Abstract
  3. Methods and procedures
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

Among the sample, 19% of participants reported never being teased about their weight, 33% reported being teased by either peers or family, and 48% reported being teased by both peers and family. No statistically significant differences in number of sources of teasing were detected for gender (P = 0.72), race (P = 0.09), age (P = 0.53), weight (P = 0.36), BMI (P = 0.39), BMI percentile (P = 0.14), or between the weight loss and comparison groups (P = 0.06). Participants reported a mean level of teasing frequency of “a few times a year” (mean = 1.53, s.d. = 1.44). On average, participants reported that they were bothered by peer teasing “somewhat” (mean = 1.62, s.d. = 1.10), and a similar mean was reported for the extent to which they were bothered by family teasing (mean = 1.54, s.d. = 1.13).

Because of concerns of UWCB and HWCB contributing to outcomes, analyses were conducted to determine if they varied by weight loss and comparison group. No statistically significant group differences were found for UWCB. Weight loss participants reported utilizing a greater number of HWCB than the comparison group (WL = 7; C = 6; P = 0.01). Additionally, analysis was conducted to determine if weight loss or comparison group membership should be accounted for when looking at the relationship between teasing and the dependent variables of interest. Results suggest that teasing did not vary by group membership; therefore, it was not controlled for in the analyses.

Regression results suggest that a greater number of UWCB (P = 0.04) and ODC (P = 0.01) is associated with a greater number of teasing sources (see Table 1, first column). A greater number of teasing sources is also associated with more days that participants felt afraid of losing control of their eating (P = 0.02) and ate in secret (P = 0.01). Weight and shape assessment influenced how participants felt about themselves when there were more teasing sources (P < 0.001). Among the psychological variables, higher depression (P < 0.001), anger (P = 0.03), and anxiety (P ≤ 0.001) scores are associated with a greater number of teasing sources.

Table 1. . Linear regressions examining associations between teasing and weight control behaviors, disordered eating, and psychological well-being among overweight adolescents; beta (b) and s.e.
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Frequency of teasing was significantly associated with disordered eating thoughts and behaviors, as well as psychological morbidities (see Table 1, second column). The more often participants reported being teased during the year, the more often they reported eating in secret (P < 0.001), binging (P = 0.03), being afraid of losing control while eating (P = 0.01), actually feeling out of control while eating (P = 0.02), and both binging and feeling out of control (P < 0.001). A greater frequency of teasing is related to a greater importance on being thin (P = 0.03) and a greater extent to which weight and shape influenced self-assessment (P < 0.001). Additionally, higher depression (P < 0.001), anger (P < 0.001), and anxiety (P < 0.001) and lower self-esteem (P < 0.001) scores are associated with higher teasing frequency.

Being bothered by teasing, whether by peers or family, was associated with disordered eating thoughts and behaviors, as well as psychological morbidities (see Table 1, columns 3 and 4). The greater extent to which participants were bothered by weight-based teasing from either peers or family, the more important thinness was (peers: P < 0.001; family: P < 0.001), the more weight and shape influenced self-assessment (peers: P < 0.001; family: P = 0.01), anxiety levels were higher (peers: P < 0.001; family: P = 0.01), and self-esteem was lower (peers: P < 0.001; family: P = 0.03). Being bothered by peer teasing was associated with feeling out of control while eating (P < 0.001).

Logistic regression results show that a higher frequency of teasing is related to higher odds of severe levels of depression and severe binge eating behaviors (odds ratio = 1.66 and 1.80, respectively). Additionally, the greater the number of sources of teasing (peer or family, peers and family), the greater the odds of experiencing severe levels of depression (odds ratio = 2.42; see Table 2). Associations between being bothered by peer or family teasing and severe binge eating behaviors and depressive symptoms were not statistically significant, but were in the same direction.

Table 2. . Logistic regressions examining associations between teasing frequency and extent to which being bothered by teasing and clinical levels of severe binge eating and depression in overweight adolescents: odds ratios (ORs) and 95% confidence intervals (CIs)
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Discussion

  1. Top of page
  2. Abstract
  3. Methods and procedures
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

This study examined whether weight-related teasing was associated with a range of HWCB and UWCB, disordered eating thoughts and behaviors, and psychological morbidities among overweight adolescents. Findings suggest that teasing is associated with a variety of poor outcomes including: number of sources of teasing, teasing frequency, and whether youth are bothered by the teasing. Overall, this study shows that in overweight adolescents, teasing is associated with deleterious outcomes.

Our results suggest that adolescents teased by one or two sources of teasing, as compared to none, are more likely to use unhealthy and ODC behaviors such as restricting carbohydrates, fasting, taking laxatives, and vomiting. Further, they are no more likely to utilize HWCB such as increasing fruits and vegetables or doing different kinds of exercise. These results suggest that exposure to teasing from one source is associated with risky dieting while two exposures (family and peers) is related to more restrictive eating practices. These findings confirm earlier studies that have shown the link between teasing and unhealthy dieting (2), but expand on these by showing a lack of association with HWCB. In other words, our findings suggest that being teased about one's weight does not appear to motivate overweight adolescents to engage in healthy weight control practices.

Teasing frequency was the only mechanism, of the disordered eating thoughts and behaviors we studied, found to be significantly related to all of the variables tested. The more often adolescents reported being teased; the more likely they were to experience thoughts and feelings associated with eating disorders; such as, being afraid of losing control while eating, eating in secret, binging, and thinness being important. This greater frequency of teasing was also related to higher levels of behaviors such as binging and eating in secret. These results enhance earlier findings (3,8,9) by delineating the specific disordered eating thoughts and behaviors and suggest that weight-related teasing may potentiate the risk of overweight youth developing disordered eating behaviors. The associations between both frequency of weight-teasing and number of sources of teasing, and eating in secret are of potential importance because the act of eating in secret may have implications for many deleterious outcomes related to weight gain, disordered eating, and parent–child relationships.

The associations between different teasing mechanisms and psychological morbidities demonstrated some of the most consistent findings. Teasing frequency was significantly related to all of the psychological variables measured in this study. More sources of teasing were associated with higher levels of depression, anger, and anxiety. Further, results suggest that higher levels of being bothered by weight-related teasing are associated with higher the levels of anxiety and lower self-esteem. Finally, and of particular concern, a greater frequency of teasing was associated with higher levels of depression and severe binge eating behaviors.

Of note, weight-related teasing was extremely prevalent in this study. Of the overweight adolescents in this study, 19% report any teasing, 33% report teasing by either peers or family, while 48% report teasing by both peers and family. The findings, in combination with other studies, demonstrate the high prevalence of weight-teasing (2) and its harmful consequences (6,7). Together, these studies suggest that weight-related teasing is very prevalent and efforts should be made to curb teasing at school and at home.

Interestingly, no significant differences were detected between the weight loss and comparison groups with regard to teasing. One hypothesis is that the majority of participants were still overweight even after weight loss. Another hypothesis is that once young people are identified as a recipient of teasing by peers, it may be difficult to alter that perception despite weight loss. More research is clearly needed to understand the frequency and impact of teasing on overweight teens, even in light of weight loss.

Study limitations should be taken into account in interpreting the findings. The cross-sectional nature of these data does not allow us to determine causality, and the convenience sample can not be extrapolated to a larger population. Additionally, the teasing variables are measured with a single item and therefore do not have the strong psychometric properties of a scale. The utilization of more refined and expansive measures would benefit this area of study. One possibility is to distinguish the severity of the teasing, such as teasing that is accompanied by physical threats vs. other more general comments, in order to differentiate the severity and type of psychological morbidities and disordered eating. Despite these limitations, this study is one of the first, of which we are aware, to look at a range of weight control behaviors and clinical levels of psychological morbidities among overweight adolescents who have been teased about their weight. Our findings demonstrate a significant relationship between weight-related teasing and UWCB, disordered eating thoughts and behaviors, and psychological morbidities. This study, in combination with prior research (6,7,8,9,10,11,12), indicates that weight-related teasing may increase the risk of overweight adolescents developing unhealthy behaviors and psychological morbidities.

This study has a number of interesting implications for future research. Of particular interest is a longitudinal design that can account for factors such as earlier indicators of psychosocial well-being and health risks, thereby allowing for a clearer understanding of the directionality as well as potential mediators and moderators of these relationships. In addition, a longitudinal sample could be used to identify temporal precedence between teasing and psychological and behavioral morbidities. For instance, this data cannot distinguish directionality between teasing and psychological morbidities. Perhaps adolescents who are anxious or depressed are more sensitive to the effects of teasing. It would also be of interest to conduct an intervention study that aims to decrease weight-teasing and examine the impact on behavioral and psychological outcomes among overweight adolescents.

There are also a number of practical implications from this study. Health-care providers should inquire if overweight youth are being teased about their weight, how often, and how bothered they are by it. Our findings further suggest the potential value of not allowing weight-teasing at home. Based on our findings, and those of others (6,7,8), it would be prudent for parents to institute a “no teasing” zone at home, and protect their children from at least one source of teasing. Parents should query their overweight adolescents about teasing, and assist their adolescent in managing teasing if it is occurring. Finally, educators should explore strategies for decreasing weight-teasing in school with consideration to both programmatic and policy interventions.

Acknowledgments

  1. Top of page
  2. Abstract
  3. Methods and procedures
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References

This study was supported by funding from University of Minnesota Children's Vikings Fund. We thank Robyn Birkeland, PhD and Heather Kamrath for their help in developing the Successful Adolescent Weight Losers Surveys; and Marla Eisenberg, PhD and Carol Skay, PhD for their assistance in developing this analysis.

References

  1. Top of page
  2. Abstract
  3. Methods and procedures
  4. Results
  5. Discussion
  6. Acknowledgments
  7. References
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