Childhood Obesity and Weight Stigma: A Public Health Nutrition Approach
Date
2024-04-20
Authors
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Journal ISSN
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Publisher
University of Glasgow
Abstract
Poor understanding of obesity, its causes and consequences contribute to
weight-related stigma in the UK. Children’s understanding of obesity shapes
their views and perceptions towards obesity as a disease, body image, and
weight stigma behaviours. Exploring children’s and adolescents’ knowledge,
perceptions and views of obesity, weight stigma, and nutrition is essential to
establishing effective health promotion programmes that cater to young people’s
needs, understanding and perspectives. Successful programmes also need
continuous monitoring and evaluation, which are currently lacking in the UK.
Perceptions and views around obesity among the public vary in different cultures
and among healthcare professionals. These different perspectives lead to
debates on defining, managing and treating obesity. Weight stigma research in
adults tends to focus on weight stigma due to the poor understanding of obesity
both among the public (especially women of white ethnicity) and healthcare
professionals rather than children and adolescents. This thesis uses systematic
reviews and a mixed-methods approach to explore weight stigma across the age
spectrum, including children, adolescents and adults. Furthermore, the research
investigates children’s and adolescents’ views on obesity and nutrition
knowledge.
Study 1 systematically reviewed existing observational, quantitative and
qualitative studies focusing on the sources, frequency and implications of weight
stigma on children’s and adolescents’ mental health, well-being and eating
behaviours. The Preferred Reporting Items for Systematic Reviews and Meta-
Analyses (PRISMA) were followed for study selection, screening and data
extraction. Synthesis Without Meta-Analysis (SWiM) guidelines were applied to
report the synthesis and results. The Quality Assessment Tool for Observational
Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood
Institute (NHLBI) was used to assess the quality of the included studies. Twenty
observational studies were included in the final text analysis. Synthesised
evidence highlighted that bullying and victimisation play a fundamental role in
developing and perpetuating weight-related stigma. Weight-related bullying was
correlated with participants’ low self-esteem. Most of the included studies
(N=15/20) were of fair quality (average score 5 to 8), although two were of poor
quality (average score 0 to 4), and most of the quality criteria were not met.
One of the main gaps identified during the literature search in Study 1 was
children and adolescents were poorly represented in the studies, with an
overemphasis on white adult women.
After identifying existing gaps in the literature (e.g., the overemphasis on
recruiting white women), Studies 2, 3 and 4 were developed to explore underrepresented
groups and gain a deeper understanding of their views and opinions
of obesity and weight stigma.
Children’s and adolescents’ views and opinions of obesity and nutrition
knowledge were explored in Study 2, using a cross-sectional questionnaire and
phone interviews. The questionnaire was structured in six sections, exploring
sociodemographic characteristics, anthropometric measurements, views and
perceptions of obesity, nutrition knowledge, general health, and eating habits
and lifestyle. Online interviews followed a narrative focusing on obesity
knowledge and experience, obesity perception and the relationship between
nutrition and obesity. Study 2 recruited a total of n=317 participants, 54% boys,
72% White/British, with a median age of 16 years (interquartile range (IQR) 15-
18). There was an overall lack of understanding of obesity and its causes and
consequences. There was also a lack of consensus and agreement about whether
obesity is a sign of disease, a disease, or merely a body shape. There was
agreement that obesity can be a personal responsibility (median=4: likely, IQR 3:
neutral – 4: likely). Food knowledge was low, with 83% correctly answering three
questions or fewer out of six. Although participants reported and believed that
they knew what obesity was, most participants linked obesity to body image and
placed the responsibility of having obesity on the individuals or their parents.
This can lead to increased stigmatising behaviours and isolation of children and
adolescents with obesity. Proper education about obesity is imperative to help
support children in understanding the general concepts behind obesity’s
complexity as a disease.
Study 3 used a cross-sectional questionnaire and phone interviews to explore
weight stigma and its implications on weight stigma attitudes and body image
perceptions in children. In Study 3 (n=667, 62% boys, 70% White/British, median
age 16 years (IQR 15-18)), 50% of participants who experienced weight stigma
had a BMI ≥30 kg/m². Almost two-thirds of participants who experienced weight
stigma (n=259) said it happened at local community places (e.g., clubs, during
extracurricular activities) (n=149, 58%). Over a quarter (n=67,26%) reported that
it was extremely harsh. Participants who self-reported having obesity (n=214)
experienced more weight stigma (n=114, 53%) than those who believed they
have overweight (n=87, 41%) or underweight (n=13, 6%). More than half of the
sample (n=408, 61%) were dissatisfied with their body image. Most participants
who self-reported having obesity were dissatisfied with their body image,
demonstrating a significant relationship between self-reported weight problems
‘underweight, overweight, obesity’ and body image satisfaction levels
‘dissatisfied, neutral and satisfied’". In summary, unsurprisingly, most
participants who reported weight stigma had a BMI ≥30 kg/m2. Interestingly,
more boys than girls who reported experiencing weight stigma believed there
was weight stigma in society.
To better understand the contribution and impact of childhood lived experiences
of weight stigma on adult perceptions and beliefs around overweight and
obesity, Study 4 employed similar methods to Study 3. In Study 4 (n=738, 52%
men, 76% White/British, 39% BMI ≥30 kg/m2, median age=26 years (IQR=24-31)),
less than a quarter of participants had experienced weight stigma as children
(n=154, 21%). More women (n=108/154, 70%) experienced weight stigma during
childhood than men (n=46/154, 30%, p≤0.001). Participants were mostly
undecided about whether obesity is a disease (median=3: undecided, IQR=1:
strongly disagree – 3: undecided). Experiencing weight stigma in childhood was
positively associated with parents reporting their children’s weight stigma
experiences. Parents dissatisfied with their body image (n=62) were more likely
to be dissatisfied with their children’s body image (n=23/62, 37%) than satisfied
(n=17/62, 24%).
Understanding and awareness of obesity are essential in developing public health
strategies and health education programmes that are child-oriented and specific
to children and adolescents regarding location and intervention tools.
The findings in this thesis highlight the negative impact of weight stigma on
children and adolescents' physical and mental health. Moreover, a poor
understanding of obesity was evident in this research. The work of this research
is beneficial in informing programs explicitly targeting the gaps explored and
found.
This thesis attempts to improve the knowledge of public and academic domains
in elements surrounding perceptions, views, and attitudes regarding obesity and
weight stigma, the reasonings behind perceptions, and strategies to address
obesity stigmatising behaviour.
Description
Keywords
Children, Adolescents, Obesity, Weight stigma, Public Health