riicsRevista de investigación e innovación en ciencias de la saludRev. Investig. Innov. Cienc. Salud2665-2056Fundación Universitaria María Cano0002110.46634/riics.268Review articleSocial Stigma of Overweight and Obesity in Primary School Children: A Systematic ReviewEstigma social del sobrepeso y obesidad en niños de escuela primaria: una revisión sistemática0000-0002-1181-6377MenaSara Concepción Maury1*0000-0003-1943-4661PortelaLucia Lomba20000-0002-5244-7328EscobarJuan Carlos Marín30000-0003-1882-9346UreñaOlman Salazar40000-0002-7935-8042PalacioLuz Marina Alonso50000-0001-7223-6547AngaritaVanessa Navarro10000-0001-8780-9627RizzoRosely Rojas1 Facultad de Ciencias de la Educación; Corporación Universitaria Americana; Barranquilla; Colombia.Facultad de Ciencias de la EducaciónCorporación Universitaria AmericanaBarranquillaColombia Facultad de Ciencias de la Educación; Corporación Universitaria Americana; Barranquilla; Colombia.Facultad de Ciencias de la EducaciónCorporación Universitaria AmericanaBarranquillaColombiamaurysara@americana.edu.co Facultad de Educación; Universidad de La Rioja; La Rioja; España.Universidad de La RiojaFacultad de EducaciónUniversidad de La RiojaLa RiojaSpainPrograma de Psicología; Facultad de Ciencias Sociales; Universidad Simón Bolívar; Barranquilla; Colombia.Universidad Simón BolívarPrograma de PsicologíaFacultad de Ciencias SocialesUniversidad Simón BolívarBarranquillaColombiaMinisterio de Educación de Costa Rica; San José de Costa Rica; Costa Rica. Instituto Tecnológico de Costa RicaMinisterio de Educación de Costa RicaSan José de Costa RicaCosta RicaDepartamento de Salud; Universidad del Norte; Barranquilla; Colombia.Universidad del NorteDepartamento de SaludUniversidad del NorteBarranquillaColombiaCorrespondence: Sara Concepción Maury Mena. E-mail: maurysara@americana.edu.coJul-Dec202571a268300820232910202303052024This is an open-access article distributed under the terms of the Creative Commons Attribution LicenseAbstractIntroduction
The World Health Organization established in 2016 that there are more than 43 million overweight and obese children in the world, being one of the most serious public health problems, which affects the physical health of children and brings psychosocial consequences such as social stigma in the school and its social environment.
Objective
Conduct a systematic review of social stigma in overweight and obese children in primary education to design appropriate interventions and prevention programs.
Materials and methods
Systematic review in the PubMed/Medline, ERIC and Google Scholar databases.
Results
Of 1709 scientific articles, 407 were reviewed in full text and 39 were included when meeting the inclusion/exclusion criteria. There are significant differences between boys and girls; social stigmatization affects girls more, due to the internalization of beauty and body image canons based on thinness. An association was found between academic performance and bullying, self-stigma, and social stigma.
Conclusion
Overweight/obese children are more likely to be stigmatized, to be bullied physically rather than relationally, and to be bullied and victimized by their normal weight peers. The acquired stigma derives from a socioculturally penalized image that has consequences on the psychological development of children who are forming their personality and values. It is necessary to propose specific preventive interventions in the school environment to face the consequences of social stigma and improve the development of body image.
ResumenIntroducción
La Organización Mundial de la Salud estableció en el 2016 que hay más de 43 millones de niños con sobrepeso y obesidad en el mundo, siendo uno de los problemas de salud pública más graves, el cual afecta la salud física de los niños y trae consecuencias psicosociales, como el estigma social en la escuela y su entorno social. El objetivo fue realizar una revisión sistemática del estigma social en niños con sobrepeso y obesidad en la educación primaria, para diseñar intervenciones y programas de prevención apropiadas.
Métodos
Revisión sistemática en las bases de datos PubMed/Medline, ERIC y Google Académico (Scholar).
Resultados
De 1709 artículos científicos, se revisaron 407 en texto completo y 31 fueron incluidos al cumplir con los criterios de inclusión/exclusión. Existen diferencias significativas entre niños y niñas; la estigmatización social afecta más a las niñas debido a la internalización de cánones de belleza e imagen corporal basados en la delgadez. Se encontró asociación entre el rendimiento académico y el acoso escolar, el autoestigma y el estigma social.
Conclusión
Los niños con sobrepeso/obesidad tienen mayores probabilidades de ser estigmatizados, de que el acoso sea físico más que relacional y de intimidación y victimización por parte de sus iguales con normopeso. El estigma adquirido se deriva de una imagen penalizada socioculturalmente, que trae consecuencias en el desarrollo psicológico de los niños que están formando su personalidad y sus valores. Es necesario proponer intervenciones preventivas específicas en el ámbito escolar para afrontar las consecuencias del estigma social y mejorar el desarrollo de la imagen corporal.
Keywords:Childhood overweight and obesitysocial stigmaprimary educationpreventioninterventionsystematic reviewPalabras clave:Sobrepeso y obesidad infantilestigma socialeducación primariaprevenciónintervenciónrevisión sistemáticaIntroduction
The global prevalence of overweight and obesity in children and adolescents has increased from less than 1% in 1975 (11 million) to almost 14% (124 million) in 2016 [1,2], representing one of the most serious health problems, with features of pandemic, of the 21st century. These figures continue to rise at a worrying rate, especially in developing countries such as Colombia. The problem lies, above all, in the fact that overweight and obese children maintain this trend in adulthood, which increases the chances of developing, at an early age, Chronic Non-Communicable Diseases (NCDs) such as diabetes and cardiovascular conditions [2].
Evidence [3-8] shows that the increased prevalence of NCDs is associated with unhealthy lifestyles, characterized by sedentarism, inadequate diet, the daily use of information and communication technologies that keep users inactive and the habits acquired since childhood that are maintained into adulthood.
Overweight and obesity in children and adolescents have been defined by the World Health Organization (WHO) as follows:
Overweight is equal to the Body Mass Index (BMI) for age and gender added up to more than one standard deviation above the median established in infant growth patterns, and obesity is equal to BMI for age and gender plus more than two typical deviations above the median established in infant growth patterns [2 p4].
Today, many children grow up in an obesogenic environment that comes to favor and encourage weight gain, mostly because of the availability, affordability and commercialization of unhealthy foods and low energy consumption due to lack of physical activity and sedentary lifestyle, as the time children spend in front of a screen has increased [9,10].
A child’s biological and psychosocial responses to an obesogenic environment may be affected by socio-cultural determinants prior to birth, increasing, as a matter of course, the numbers of obese children. It is therefore necessary to change unhealthy dietary patterns and increase physical activity, while these socio-cultural determinants must be modified [11,12].
Fortunately, the conditions of overweight and obesity are largely reversible, so prevention work is needed that includes education in healthy lifestyles, increase and incentive of physical activity in all school-age children and teaching them proper eating habits. It is also necessary to choose healthy foods for infants and children under the age of five, as it is known that food preferences are established from an early age in the life cycle [2,13].
Lack of education and knowledge about adequate and balanced nutrition, added to the difficulties in the availability and accessibility of healthy food and the promotion, in mass advertisements, of unhealthy drinks and food for children and families contribute to aggravate this problem. In the conditions of globalization, digitization and urbanization that the world is living today, there are few possibilities for physical activity, that would allow the energy expenditure necessary to have an adequate weight [2,3,6].
In Latin America, the prevalence of overweight and obesity also shows figures that reflect the severity of the situation. In 2014, this prevalence was 7.1% in children under 5 years of age. In children between the ages of 5 and 12, it reached standards between 18.9% and 36.9% and, in adolescents, it was 16.6%-35.8%; that is, from 20% to 25% of the total population of children and adolescents in Latin America suffers from overweight and obesity [14].
Mexico ranks first worldwide in childhood obesity (26% for both genders, 4.1 million children between 5 and 12 years) and is second in obesity in adults (the first place belongs to the United States) [15,16]. In Colombia, according to the Third National Survey of the Nutritional Situation [17], the prevalence of overweight and obesity was 24.4% in children between 5 and 12 years of age, the problem being more serious among the population with better socioeconomic situation.
Excess weight in childhood and adolescence represents physiological and biomedical problems and psychosocial consequences and risk factors, such as depression, lower self-esteem, bullying by peers, difficulties in socialization, being associated with negative stereotypes and the development of stigmatizing prejudices and discrimination in the social environment [18-23].
The stigmatization of overweight or obese children and adolescents has been recognized in Western cultures and can range from verbal jokes, such as insults, derogatory comments and mockery, to physical harassment, reflected in blows, kicks or shoves, which, spread over time, can lead to victimization and discrimination. This can result in social exclusion, being ignored or avoided, or becoming the target of rumors, because stigma can arise in subtle ways or manifest itself openly [24], and seems to have increased in today’s society [18-19,24-25].
Stigma is defined as a deeply discrediting attribute, mark or characteristic (real or supposed), usually based on a physical difference or deviation from the social norm, such as a physical deformity, character flaws or aspects related to family history [20,21,26-28], which penalizes the person in his or her social status.
For Goffman [29], there is nothing in the attribute itself that makes it stigmatizing, because an attribute is neither honorable (positive) nor ignominious (negative). What is important is the meaning that the social environment gives to this attribute, by linking it with negative stereotypes. Therefore, stigma is a social construct [22,29,30], a conjunction between the mark, attribute or characteristic and the social stereotypes associated with these, which create a socially devaluative identity, which leads to the loss of status of those who possess it [30].
As for overweight and obesity, Ozuna et al. [19] define stigma as the rejection and social denigration suffered by people who do not meet the prevailing social standards regarding weight and body shape and image, producing negative attitudes, stereotypes, prejudices and discrimination. This of course generates psychosocial affections of great consideration, which add to the health problems that these patients already suffer [19,22,25,31].
Holzemer et al. [32] identified three types of stigma: stigma received, stigma by association and self-stigma, which is the result of internalizing stigmatizing behaviours observed in the community and may relate to other types of stigma and prejudice present in society, such as those associated with ethnicity, economic income, social classes or gender, among others [31-33].
Prejudice, stereotypes, stigma and discrimination are interrelated and mutually reinforcing. It could be said that stigma is the basis of discriminatory actions and behaviour (staging of stigma) and, in turn, is the product of prejudice and stereotypes, that generate actions or omissions in people that harm or deny services or rights to victims [34-39].
On the other hand, it is also important to consider the frustrations with the difficulties of adherence to treatment when a treatment is followed and weight loss is not achieved, and the psychopathological consequences of trying to sustain a diet (effective or not). Children and adolescents in this situation often feel guilty and ashamed and are criticized for their "failure" by their family members, peers and health professionals [8].
Given this scenario, some large-scale efforts have been generated to provide health interventions in areas such as effective nutrition and physical activity, aimed at children and because the school represents the ideal environment for a more rational and rapid strategy that will lead to a greater coverage of this population [40-42]. Evidence [3-8] is currently available to demonstrate the feasibility and effectiveness of educational interventions that are sustainable if regularly integrated into the school curriculum [6].
In countries such as Colombia, there is a normative and political framework that favors the feasibility of such interventions and makes them enforceable (Article 12 of Law 115 of 1994, 2006; Law 1355 of 2009; Law 2120 of 2021), because they advocate training for comprehensive prevention, the promotion and preservation of health and body hygiene, physical education/activity, recreation, sport and adequate use of leisure time, and the promotion of healthy eating environments.
For these reasons, the “Program Generación Vida Nueva" (PGVN) [8] emerged in 2015 as a strategy in the District of Barranquilla, Colombia, to address obesity and overweight in children from 5 to 12 years in the school environment and to promote healthy lifestyles. The PGVN aims to create interventions integrated with the daily educational practice of the 17 participating primary schools (10,000 students) and has developed annual anthropometric activities [43], including the measurement of the Body Mass Index (BMI) and medical checks of overweight or obese children.
By carrying out anthropometric measurements that confirm overweight or obesity, these children have felt discriminated against by their peers and feel different when invited to follow-up and medical, nutritional, physical activity and psychosocial interventions, necessary for their condition. Parents have also said that their sons and daughters bring home this sense of social stigma and have communicated it to schools. Teachers have also noticed the discomfort of these children during classes.
However, at least from this context, there are no known research approaches or studies that show the reality of stigmatization and stereotypes that overweight and obese children are subjected to. The PGVN’s work has shown very accurately the prevalence and comorbidities of this problem, but the psychosocial dimensions are just a reference. In fact, there is little work on stigmatization in Colombia and Latin America.
As a way of approaching this reality, it is proposed to carry out a systematic review that allows knowing the state of research regarding the levels of stigma and discrimination of overweight and obese children in the context of primary schools. The fundamental purposes of this work are two: First, to assist in the planning of research of a quasi-experimental or experimental nature that sensitizes the academic community to the incidence of stigmatization on the mental health of individuals and specifically children; second, appropriate theoretical and practical elements for the design of accompanying and intervention strategies, which will make it possible to face this reality, suffered by many children and adolescents, and thus prevent the emergence of NCDs, such as diabetes, in early stages of their development.
Several hypotheses accompany this systematic review. The first is that overweight and obese children do suffer to some extent from stigmatizations, many of which occur in the educational systems they are part of and are generated by classmates, but also by teachers themselves. The second hypothesis is that the stigmatization suffered by these children has different levels: there is social stigmatization, which is when it comes from some of their peers; institutional stigmatization, the derivative of schools; self-stigmatization, which is that stigma that the same child infringes himself or herself, that is, "As I am fat, then I am clumsy". Finally, one last hypothesis is that stigmatization and its effects can be reduced through educational strategies that can be established within curricular or extracurricular processes.
As a further goal, the research team aims to conduct meta-analytic studies to determine the effects of overweight and obesity in children and youth population in a variety of psychosocial dimensions, including self-concept, self-esteem, learned helplessness, self-discrimination, supported, of course, by statisticians used from controlled studies of the cause-effect type. However, the current state of research, in these subjects, did not allow finding evidence of such studies with sufficient statistical strength to consolidate a meta-analysis.
MethodsStudy design
The research design corresponds to a systematic review, defined by the Cochrane Manual [44] as the gathering of all empirical evidence according to clearly established inclusion and exclusion criteria to answer precise research questions, using systematic and reliable methods to minimize bias, to draw useful conclusions for decision-making. The design followed the PRISMA methodology reflected in Figure 1 [44].
Study search results
Inclusion criteria
All types of primary and secondary research were included, with populations of children and adolescents between 5 and 13 years, studying the characteristics of social stigma associated with the condition of overweight or obesity (measured by the BMI, by questionnaires or by observation) in the context of primary schools and the effects of discrimination, mockery, social stigma, ideal body image and explicit or implicit attitudes towards children’s weight, in addition to studies published in English and/or Spanish by peer-reviewed indexed journals, between 01-01-2010 and 31-03-2021.
Exclusion criteria
Studies with populations that did not meet the given age range, those not conducted in the context of primary schools, added to investigations published before 2010 and after March 2021, as well as those published in languages other than English and Spanish were excluded.
Sources of information
A search was conducted in the Pub Med/Medline, ERIC and Google Scholar databases. Based on the inclusion and exclusion criteria defined, searches were performed with keywords, the descriptors that were selected in DeCS/MeSH, the search equations with Boolean connectors and the filters described in Table 1. The articles were searched in English and Spanish. The selection process of the studies was carried out by two researchers independently and, when they did not come to an agreement, a third researcher intervened to achieve the final selection.
Descriptors and search equations in databases.
Database
Descriptors
Search equations
Filters
Pub Med/Medline
Social stigma, Obesity, Children
((social stigma) AND (obesity)) AND (children)
Last 10 years, from 2010 to 2020, English-Spanish
ERIC (Proquest UNIR)
Social stigma, Obesity, Elementary School
MAINSUBJECT.EXACT("Stereotypes") OR (social stigma) OR discrimination AND (fat prejudice) AND MAINSUBJECT.EXACT("Obesity") AND MAINSUBJECT.EXACT("Elementary School Students")
Scientific journals, 2010-01-01 to 2020-12-31, Elementary Education
Google Scholar (in English)
overweight, obesity, elementary school children prevention, intervention, social stigma, stigmatization, discrimination, prejudice, stereotype
2010-2020, Where words appear throughout the article
Google Académico (Google Scholar in Spanish)
Sobrepeso, obesidad, escuela primaria, estigma social, estigmatización, discriminación, prejuicio, estereotipo
Sobrepeso, obesidad, escuela primaria, estigma social, estigmatización, discriminación, prejuicio, estereotipo.
2010-2020.
Selection of studies, extraction and analysis of data
The studies were coded and classified with a data extraction form according to first author, year of publication, type of study, population, average age, social extraction of the sample, school grade, country of study and results found. An analysis was made of the scope, nature and distribution of the studies included in the review, as well as the content of the data collected; the literature was summarized according to psychosocial risk factors found, and, the results of the studies were classified into categories and subcategories when necessary. Duplicates were eliminated, titles and abstracts and full texts were examined and the studies to be included were defined. A description of the analysis categories found was made and is presented in the Results section.
Evaluation of the methodological quality of the included studies
The evaluation of the methodological quality of the studies was carried out by two researchers, following the criteria of the NewCastle-Ottawa scale of 2010 [45]. When these two researchers disagreed, a third researcher intervened.
Ethical considerations of the research
As this is a systematic review, there is no need for informed consent, nor to apply for permits because a population was not directly affected.
Results
The search in the PubMed/Medline, ERIC, Google Scholar (in English and Spanish) databases yielded 1709 articles. After eliminating duplicates and excluding by titles, there were 407 articles with which summaries and complete articles were read to verify the inclusion criteria. Then, 376 studies were excluded for the reasons described in Figure 1 and 31 articles were included in the study.
The 31 studies covered a population of 24935 children, of whom 49.67 per cent were girls and 50.33 per cent were boys. The mean age ranged from 7.5 to 11.9 years. There was little information, in the studies, on the social extraction of the sample and some did not report on the school grades attended by the children, although these were generally primary school grades. Most of the studies were of a cross-sectional type (14/31), followed by longitudinal studies of a prospective type (5/31) and studies of a correlative type (5/31). We found 3 Randomized Clinical Trials, 1 qualitative study, 1 mixed study (qualitative-quantitative) and 1 inter and intra-subject experimental study. Details and summaries of the results of the included studies are available in the Appendix.
Most of the research was done in the United States (10/31), 3 in Ireland, 3 in Germany, 2 in Spain and 1 in countries such as Italy, Canada, Greece, Hungary, Australia, China and Cuba. The journals that have published such studies mostly belong to the area of health (especially pediatric or obesity; 30/31) and only 1 to the area of education.
Characteristics of social stigma for overweight and obesity in school-age children
Most of the studies (96%) included in this review (30/31) provided information on the characteristics of social stigma for overweight and obesity in school-age children. In terms of content analysis, it was found that children, during primary education, are able to stigmatize their peers and show their favoritism towards certain peers [46]. Overweight and obesity are highly stigmatized conditions in Western society and the message is conveyed, especially to children and women, that thinness means power, success, beauty and self-efficacy [47].
It is for this reason that overweight or obese children are more likely to be stigmatized in an individual or social context compared to their normal weight peers [46-59], which is why they also suffer from bullying [54].
The social stigma of overweight and obesity is frequent and its prevalence among certain age groups and populations, such as school-age children, makes this population more vulnerable [45,56]. Bullying resulting from this stigma affects the well-being, quality of life and academic performance of overweight or obese children in primary school, and the consequences may be lifelong [54].
The levels of evidence of the studies are low (only 1 study was an ACE), so statistics and effect sizes could not be presented, and the variables measured were described, which were mostly performed in a qualitative way.
Weight labelling
29% of the studies included in this review worked with the weight labeling variable. According to the longitudinal study conducted by Hunger and Tomiyama [59], in which anthropometric and weight labelling measurements were made, 57.9% of the participants reported being labeled "fat". Baseline BMI and labeling condition correlated moderately with this result (r = 0.41, P = less than 0.001). In the evaluation of this association 10 years later, labeling remained a significant predictor of overweight or obesity with an OR = 1.66. The OR was 1.62 when it was family members who labeled and 1.40 when it came to other people.
Mustillo et al. [60] found a link between psychological distress experienced from 18 to 21 years and parental and peer labeling due to the stigma of obesity from 9 to 10 years old, especially in white children.
On the other hand, implicit and explicit attitudes associated with negative attitudes towards overweight or obese children are quite widespread and have been shown to be resistant to interventions. These weight-related attitudes were studied in the cross-sectional research of Hutchinson and Mueller [61], where findings indicate that implicit and explicit attitudes towards overweight and obesity are significantly correlated. It was also found that implicit attitudes associated with weight tended to be higher in older children.
Social stigma of overweight and obesity and school harassment
About 23% of the included studies treated school harassment among their variables. For example, the cross-sectional study by Lumeng et al. [52] investigated the relationship between social stigma and harassment as reported by the child, the child’s mother and the teacher. It was noted that 33.9 per cent (teacher’s report), 44.5 per cent (mother’s report) and 24.9 per cent (child’s report) of children had been harassed. We found a significant independent relationship between being obese or overweight and being harassed with a probability ratio of 1.63, 95% CI, 1.18-2.25, after adjusting it according to school grade, gender, race and family income.
On the other hand, the research by Madowitz et al. [62], which performed logistic and linear regressions to evaluate the relationship between the variables of harassment, depression and unhealthy weight control behaviors, found that overweight or obese children who are bullied have significantly higher levels of depression (B=6.1; SE=2.3) and are 5 times more likely to have unhealthy weight management behaviors (OR=5.1, 95% CI, 1.5-17.4) and that teasing associated with excess weight is related with negative psychosocial factors in these children.
The only Latin American study that was part of this review [63], conducted in several municipalities in Cuba, found that Cuban schoolchildren do not accept their overweight or obese peers contextually. In Cuba, obese children are stigmatized to a lesser degree than in America or New Zealand (where the same type of study was conducted), but stigmatization does occur anyway. Children of both genders with little control over their eating habits suffer the greatest consequences of bullying and peer rejection.
Social stigma of overweight and obesity on the part of peers
About half of the studies (48%, 15/31) considered the social stigmatization of overweight and obesity by peers. Regarding the perception of obesity by children and adolescents, in the qualitative study by Amini et al., children of both sexes stated that they did not like overweight and obesity and described them as excess fat and body weight, overeating, devouring, a condition that makes people lazy, ugly and heavy [64]. For their part, obese children considered obesity as a disease or cause of other diseases such as cancer, a stunting; something that will give a short life, that means having deprivations, a barrier to exercise, be agile and for routine activities, for social activities such as public speaking and for progress in life. Overweight or obese children are perceived as objects of ridicule, who are easily angered by taunts, and, adults and peers, expect an obese child to work and try harder because he or she "is strong".
The study by Brixval et al. [51] found that overweight students (OR 1.75, CI 95%, 1.18 -2.61) or obese students (OR 1.98, CI 95%, 0.79-4.95) were more exposed to bullying than their normal weight peers. Likewise, a greater internalization of weight bias (not properly calculating one’s weight considering that one has less weight than real) was associated with more teasing and harassment by peers and lower self-esteem.
The prospective study of Gmeiner and Warschburger [57] found that a considerable weight of the child, the female sex, experiencing teasing, a significant dissatisfaction with own weight, giving great importance to the figure and appearances, high depression scores and low parental education, are predictors of an internalization of Weight bias (a form of self-stigma in which the individual applies negative weight-based stereotypes against him or herself and blames him or herself for his or her condition regardless of actual weight) [63-66].
Likewise, in the research conducted by Kornilaki [67], in which two characters were showed, one with positive qualities (thin figures) and the other with negative (obese figures), to measure weight bias, it was observed that actual body size affected the accuracy of perceived body size: while normal weight children accurately identified their physical proportions, most overweight or obese children tended to underestimate their own weight. However, it was also found that perceived weight accuracy improved with age.
In the cross-sectional study by Gigirey et al. [68], conducted in Santiago de Compostela, Spain, it was found that a rejection of peers who are overweight or obese is produced. In addition, Olsen’s research [55] found that 59% reported their peers teasing their weight and 49% reported that their parents did the same, and these taunts, in turn, are related to eating problems ("binge eating") for emotional reasons.
The longitudinal "Growing Up" study, conducted in Ireland [69], found that children with a BMI indicating overweight or obesity were significantly more likely to be victimized and discriminated against compared to normal weight children. Weight-based teasing was found to be correlated with an increase in weight gain of the victims (33%), compared with peers who did not report it [70] and these experiences can increase the risk of health problems, including weight gain and bullying.
The research by Olsen et al. [55] found that obese children were considered less often as "best friends" and had a lower rating in the level of acceptance by their peers. In addition, they were described by their classmates as more socially withdrawn, with less leadership, with more aggressive-disruptive behavior, less physically attractive, more sick, tired and absent, less athletic and their relationships were different from those of normal weight peers.
Papp and Túry’s research [71] found that there are cultural differences in attitudes towards obesity and that it is worth continuing to explore these differences. Likewise, the study by Bird et al. [72] found that there were improvements in girls' body satisfaction, in issues related to appearance, eating behaviors and knowledge of the subject of the intervention; besides that, there was a significant reduction of cultural appearance ideals. However, none of these changes remained in follow-up 3 months after the intervention.
Body image and social stigma of overweight and obesity
The body image variable was considered by a large percentage of the studies (78%). Brixval et al. [51] found that body image mediates the associations between weight status and exposure to harassment in both boys and girls. Likewise, the study by Damiano et al. [73] found that 34% of overweight or obese girls reported a moderate level of dietary restriction and that most girls were satisfied with their body image, although half of them showed an internalization of the ideal of the slim figure. In addition, exposure to mass media and social media and talk about appearance were found to be the strongest predictors of dietary restriction. It is necessary to consider that the precision about the own weight improves with age, that is, the more children grow, the more they calculate with greater precision their own weight, despite that this indicates overweight or obesity. However, it was also observed that more than half of overweight or obese children stigmatized fat figures or appearances as if they represented other children and not them.
Jendrzyca and Warschburger [74] conducted a study to explore the role of social weight stigma in body image dissatisfaction and its influence on eating behaviors and found that weight status predicted dissatisfaction with one’s own body image, while weight stigma did not have a direct effect on eating disorders.
According to the study by McCormack et al. [53], 40% of overweight or obese children reported that their peers mocked them and 36% that their relatives too did, resulting in lower body satisfaction among children subjected to teasing and harassment compared to children who were not bullied. Research by Reulbach et al. [70] concluded that body image is more associated with victimization, discrimination and bullying than with objective weight classification based on BMI.
In the randomized clinical trial conducted by Ross et al. [75], to measure the effectiveness of the "Y’s Girl" body image program, the results showed that the girls who received the intervention reported an improvement in body image and self-esteem. Therefore, children who grow up with cultural influences that denigrate overweight and favor thinness as an ideal body image, associate people with overweight or obesity, explicitly or implicitly, with a few negative characteristics that have nothing to do with weight [74].
Moreover, in their study, Guardabassi and Tomasetto [76] decided to investigate whether the threat of negative stereotype associated with excess weight influences working memory. Working memory was found to decrease as BMI increased, showing that the threat of the stereotype of being less intelligent because of overweight or obesity arises at early ages and can influence working memory performance.
Self-stigma of overweight and obesity
About 31% of the studies examined self-stigma. The study by Chan et al. [77] found that overweight and obese children have a higher level of self-stigma and this, in turn, was related to more mental health problems, that is, overweight or obesity condition and victimization interact to influence the ratings of kindness and negative emotions. Thus, the state of self-victimization of children influences the ratings of social attraction, kindness and negative emotions.
For example, Olsen et al. [55] found that overweight/obese children perceive themselves more negatively compared to their normal weight peers and that age, gender, race and perceived responsibility affect attitudes towards an overweight or obese companion. The study by Wong et al. [78] found that overweight or obese children develop weight-related self-stigma (p= 0.,003), and tend to have poor quality of life in relation to health, compared to normal weight children, which means that the experience of teasing and self-stigma is more important than the actual state of weight.
Differences between boys and girls
Seventy-nine per cent of the studies considered differences between boys and girls. Several studies [44,45,55,72] were found in which the social stigma of overweight and obesity occurs more frequently among girls than among boys. Also, some research [61,72] showed that the associations between weight status, stigmatization for excess weight, dissatisfaction with body image and eating behaviors present differences according to gender, that is, girls stigmatized obese or overweight peers less than boys.
Some aspects of the prevention of social stigma due to overweight and obesity in school-age children
Several studies found that children included as factors of obesity prevention physical exercise, decrease food consumption in general, increase the consumption of fruits and vegetables, abstain from eating foods rich in calories, limit the time to watch TV and sleep, eat a light dinner and a hearty lunch, visit a nutritionist or dietitian and have a strong will [62,72].
Discussion
The findings indicate that overweight and obese children are more likely to be victims of social stigma and harassment, although this is more physical than relational, and intimidation and victimization on the part of their normal weight peers [44,46-55]. There are several studies [79-80] which confirm the aforementioned, giving rise to psychosocial problems in both the short and the long term [81].
The Strauss study [80] showed that a decrease in self-esteem in overweight or obese children can result in loneliness, sadness, nervousness and depression, and can affect the school performance of these children [75,79,81,82]. Previous experiences (negative perceptions) with overweight or obese individuals or family members can affect children’s attitudes and are important if a negative psychosocial impact on them is to be reduced [67].
These children have problems with their own body image and there's a possibility that they develop eating disorders [82]. Being labeled as "too fat, dumb, dirty, ugly, sloppy, unreliable, lazy, and a liar" during the childhood years can lead to increased chances of presenting overweight or obesity a decade later [57] because it augments obesogenic stress that triggers negative coping behaviors such as overeating [81].
The child labeled as "fat" is affected in his or her identity and this determines his or her behaviors, producing negative feelings that, in turn, lead him or her to overeat, falling into a vicious circle difficult to overcome and presenting a greater risk of suffering isolation, taunts, intimidation, insults, to the point of physical and not just relational aggression [81].
It is necessary to recognize the importance of using anthropometric measurements, such as BMI, from very early ages, to identify overweight/obese children and propose effective interventions to prevent and treat their excess weight, including psychosocial factors, such as the social stigma of this condition [79,83], and to develop positive coping behaviors and education in healthy lifestyles.
On the other hand, the review by Bautista Diaz et al. [83] found that within the family and in the school, health services and work environments, overweight discrimination is promoted and accepted on a daily basis, and as if it were normal. Instead, these should be environments from which social support and understanding would be expected.
The internalization of attitudes of rejection towards obese or overweight people is established from very early ages, where the family environment influences in this direction, in addition to the school environment, through the relationship with peers. In Mexico, it has been found that almost 70% of school peers associated overweight or obesity with negative characteristics such as "bad, dumb, loose, clumsy, with lack of discipline" [83]. Tiggerman and Barrett [84] found that children between the ages of 7 and 13 rated overweight children as less attractive (94%), less popular (81%) and lazier (86%) than normal weight children.
Other studies have identified that the subject of Physical Education at the basic and secondary school levels represents an aversive situation for students with excess weight, who expect to be accepted and respected by peers and the group [68,83]. Prejudices and negative attitudes towards excess weight have also been found in teachers, especially in those of physical activity, who have the prejudice that this condition means lower skills and lower performance in students [70,83].
The stigma of overweight or obesity stems from a socio-culturally determined image that is accepted and fulfilled by members of society (that thinness is beauty and means success) and, consequently, individuals suffering from this condition are marked by different prejudices that lack rational foundations [18,23-25,31,54,81,82,84-89]. These beliefs and attitudes are acquired during childhood and, by not being questioned, in adulthood end up becoming prejudices and stereotypes.
The experiences of being mocked, discriminated against and harassed due to body image have consequences for the psychological development of children, since childhood is a period where personality and values are formed that will endure throughout life [82]. Overweight/obese people tend to feel guilty and responsible for their condition, considering that they caused it to themselves, having to fight against habits that prevail in society, such as fast-food consumption and sedentarism, but it is this same society that judges and punishes them [81,86].
In Latin America there are few studies on this subject and it is necessary to develop more research on this condition and its particularities, especially considering that Mexico ranks first in the world in overweight children and young people and that 20 to 25% of the total population of Latin American children and adolescents suffer from overweight and obesity [14]: to this extent, we must respond to this phenomenon.
The included studies were published in health journals (30/31) and not in journals around education, which is indicating that the subject needs to be developed from an educational point of view, since the school environment is a day-to-day environment, in which many children are experiencing social stigma and ridicule from their school peers because of their excess weight.
In Colombia, normative and political foundations have been proposed to address the problem. This can be verified by revising Law 2120 of 2021 [8,90]; but action is missing in schools, as well as the development of scientific evidence of the intervention and prevention of this problem.
Implications, limitations and prospectiveImplications for practice
There are studies aimed at reducing bullying derived from the social stigma of overweight and obesity that have short-term effectiveness, but studies are needed to verify their effectiveness in the long term. The studies show significant differences according to gender, body image, self-stigma, socioeconomic level, age of the subjects evaluated, and even race. It is advisable to consider that the stigma associated with weight can change with the growth and cognitive development of children.
While interventions that include physical activity and healthy eating are abundantly supported by scientific evidence, research on psychosocial factors of the stigma of overweight and obesity are less common. It is necessary to do more research in this regard and define common standardized measures, in evaluating study results, so that they can be comparable to each other. More experimental studies are needed to test the size of the effect of this social stigma on bullying and what could be the possible moderating factors of this effect.
Limitations and prospective
Search terms on the topic should be expanded because there are many more related terms that provide necessary and complementary information to understand the phenomenon as "Victimization, prejudice, physical and relational harassment, bullying, stigmatization of weight, Internalization of Weight Bias, fat label, self-stigma, intimidation, ridicule, mockery". There are very few experimental studies on the subject. The review shows that there is a relationship between social stigma and different psychosocial consequences, such as stress, obesogenic stress, depression, difficulty in relationship with peers, poor academic performance, low self-esteem, low satisfaction with one’s own body image and self-stigma, among others. It was also found that there is a relationship between the condition of excess weight in childhood and the possibility of being obese in the future, so it is necessary to measure the effects of all these relationships to propose new interventions, improve existing ones and make programmes to prevent overweight and obesity during childhood and adolescence, which are effective in the short term, but also in the long term.
Conclusions
First, it is emphasized that the objectives of the study were met and that we were able to compare the hypotheses related in the introduction to the results obtained in the 31 articles included in the present review. The results indicate that overweight or obese children must be supported to fight against different barriers to lose weight, especially psychosocial and socio-cultural barriers, such as social stigma derived from the environment.
Overweight and obese children are more likely to be exposed to social stigma, harassment, intimidation and victimization by their normal weight peers. It was also noted that children are at risk of weight gain due to teasing, harassment and social stigma and their consequences, engaging in a vicious cycle that needs to be broken. Therefore, interventions are needed to address the consequences of bullying and improve the body image of overweight/obese children.
The study shows that it is necessary to propose interventions aimed at children with normal weight to teach them empathic behaviors and altruistic and prosocial conducts towards their overweight peers, in order to reduce, for the latter, a negative psychosocial impact which would lead, inter alia, to lower motivation to exercise, lack of emotional coping to decrease overeating, and even other effects such as poor academic performance, depression, low self-esteem, obesogenic stress, which weighs heavily on overweight or obese children.
Western society presents idealizations of thinness from a very early age that cause prejudice and discrimination towards overweight and obesity, this condition being associated with negative characteristics that do not even have to do with weight, generating a higher level of self-stigma and mental health problems.
The social stigma of overweight and obesity is prevalent and certain age groups and populations, such as school children, may be more vulnerable than others. Therefore, it is important to identify external factors, correlations, categories and moderators of this stigmatization to propose interventions that are effective in reducing the negative impact that this age group suffers.
The multicausal and multidimensional origin of obesity needs an analysis of responsibility from individuals, family and society in general, since apart from the physiological consequences, psychosocial consequences on self-concept, self-esteem, obesogenic stress and body image can lead to more dangerous results than biomedical comorbidities themselves. It is important to improve the well-being and quality of life of these children, who feel socially devalued, through psycho-educational interventions.
Health professionals and primary school teachers should train in non-stigmatizing approaches to overweight and obesity, learning unbiased language and using empathic counseling techniques, such as motivational interviews. In addition, family inclusion and participation should be considered to improve this environment as well.
Healthy lifestyle interventions that promote regular physical exercise, healthy and balanced nutrition and an education in values (altruistic and empathetic prosocial behaviors and positive coping), would help reduce the global indicators of childhood overweight and obesity, combating the psychosocial problems that arise from this condition. The mission of the school should not only be the provision of healthy food but education in healthy lifestyles, installed in early childhood, to be taken to adulthood.
Acknowledgements
We thank the English translator Camila Andrea Salcedo Maury from Barranquilla, Colombia.
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Maury Mena, Sara Concepción; Lomba Portela, Lucia; Marín Escobar, Juan Carlos; Salazar Ureña, Olman; Alonso Palacio, Luz Marina; Navarro Angarita, Vanessa; Rojas Rizzo, Rosely. (2025). Social Stigma of Overweight and Obesity in Primary School Children: A Systematic Review. Revista de Investigación e Innovación en Ciencias de la Salud. 2025;7(1):1-37. e-v7n1a268. https://doi.org/10.46634/riics.268
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Financing:
None. The authors declare that they did not receive specific funding for this research.
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The content of this article is the sole responsibility of the authors and does not represent an official opinion of their institutions or the Revista de Investigación e Innovación en Ciencias de la Salud.
Authors’ contribution
Conceptualization, data curation, formal analysis, fund acquisition, research, methodology, project management, resources, software, monitoring, validation, visualization, writing, original draft, review and editing.
Conceptualization, fund acquisition, project management, supervision, visualization.
Data curation, acquisition of funds, resources, supervision, visualization, writing, original draft, revision and editing.
Muestra, sexo, etnia, grado escolar, nivel socioeconómico
Edad promedio
País del estudio
Instrumentos utilizados
Síntesis de resultados
1
Amini et al. 2014 [64]
estudio cualitativo, técnica de análisis de contenido
27 niños (11 niños, 16 niñas); 5º grado
10-11 años
Irán
Debates en 4 grupos focales (DGF), sobre barreras para perder peso, etiquetado del peso, estigma social sobrepeso u obesidad
Surgieron nueve temas en tres categorías principales. Las barreras para perder peso incluyeron barreras ambientales, psicológicas y fisiológicas. La categoría de componentes de la intervención incluyó la mejora de la nutrición, la promoción de la actividad física, el apoyo social y la educación. El entorno y la ejecución de la intervención se incluyeron en la categoría de condiciones de intervención. Los niños propusieron un enfoque de componentes múltiples para el desarrollo de una intervención. Mencionaron la mejora de la nutrición y la actividad física, el apoyo social y la educación como principales elementos de una intervención eficaz
2
Bird et al, 2013 [72]
ensayo clínico aleatorizado ECA
98 niños (43 niños y 45 niñas)
10-11 años
Bristol, United Kingdom
Intervención con el programa “Happy Being Me” con grupo control, medidas de satisfacción corporal, factores de riesgo de imagen corporal negativa, conductas alimentarias, autoestima y conocimiento del tema de intervención, al inicio, después de la intervención y en el seguimiento a los 3 meses.
Para las niñas, al inicio no hubo diferencias en el IMC (t = 0,41, gl = 13, p = 0,69, η2 = 0,01; Intervención M = 20,17, DE = 6,31; Control M = 19,11, DE = 3,62), o edad (t = 1,24, gl = 40, p = 0,90, η2 = 0,02; Intervención M = 10,70, DE = 0,47; Control M = 10,68, DE = 0,48) entre las condiciones de intervención y control. Para los niños, al inicio del estudio no hubo diferencias en el IMC (t = 0,61, gl = 16, p = 0,55, η2 = 0,02; Intervención M = 16,30, DE = 1,95; Control M = 16,88, DE = 2,03), o edad (t = 1,48, gl = 44, p = 0,15, η2 = 0,02; Intervención: M = 10,39, DE = 0,50. La participación de las niñas en la intervención resultó en mejoras significativas en la satisfacción corporal, las conversaciones relacionadas con la apariencia, las comparaciones de apariencia, las conductas alimentarias y el conocimiento del tema de intervención después de la intervención, aunque solo se mantuvo el cambio en la satisfacción corporal. También hubo una disminución significativa en la internalización de los ideales de apariencia cultural desde el inicio hasta el seguimiento. La participación de los niños en la intervención resultó en mejoras significativas en la internalización y las comparaciones de apariencia después de la intervención. Sin embargo, ninguno de estos cambios se mantuvo durante el seguimiento después de tres meses. No hubo mejoras en el grupo control con el tiempo
3
Brixval et al., 2012 [51]
estudio transversal
4.781 niños
11,13 y 15 años
Dinamarca
Programa “Behavior in School-age Children” HBSC del 2002 que midió el acoso escolar por sobrepeso u obesidad, análisis por género, imagen corporal
En este estudio, el 11,2 % había estado expuesto al acoso entre 2 y 3 veces al mes o más durante los últimos meses. Además, el 8,6% se clasificó como sobrepeso y el 1,1% como obesidad. Los análisis de regresión logística bivariada mostraron que, entre los estudiantes expuestos al acoso escolar, hubo una acumulación estadísticamente significativa de estudiantes con sobrepeso (P< 0,000), de estudiantes de los grados inferiores (P< 0,000), de estudiantes que no consideran que sus cuerpos tengan del tamaño adecuado (P< 0,000) y de estudiantes con clase social familiar más baja (P< 0,000). Esta tendencia también estuvo presente cuando se estratificó por sexo. Además, hubo una acumulación estadísticamente significativa de niñas en tipos de familias no tradicionales entre las niñas expuestas al acoso (P= 0,001). El análisis de regresión logística de la asociación entre la imagen corporal y la exposición al acoso mostró una asociación significativa (P<0,000) con un patrón en forma de U. Los estudiantes que no están satisfechos con su imagen corporal, que se sienten demasiado delgados o gordos, tienen mayores probabilidades de ser acosados. Los estudiantes con sobrepeso y obesidad estaban más expuestos al acoso que sus pares con peso normal. Entre los niños, los odds ratios (OR) para la exposición al acoso fueron de 1,75 (1,18-2,61) en los niños con sobrepeso y de 1,98 (0,79-4,95) en los niños obesos en comparación con los de peso normal. Entre las niñas, las OR correspondientes fueron 1,89 (1,25-2,85) en las niñas con sobrepeso y 2,74 (0,96-7,82) en las niñas obesas. La imagen corporal mediaba completamente las asociaciones entre el peso y la exposición al acoso tanto en niños como en niñas
4
Chan et al., 2019 [77]
estudio correlacional
367, (198 niños, 169 niñas)
8-12 años
Hong Kong
Escala de internalización del sesgo de peso [WBIS]; Cuestionario de autoestigma de peso [WSSQ]) y Condiciones de salud mental (Escala breve de calificación de síntomas [BSRS-5]).
En comparación con los niños no OW (n = 241; 143 niños), los niños OW (n = 114; 55 niños) tenían un mayor autoestigma relacionado con el peso en el WBIS (26,49 ± 8,68 vs. 21,58 ± 7,54; p < 0,001) y puntuaciones WSSQ (26,36 ± 8,98 vs. 21,91 ± 8,71; p < 0,001). No se encontraron diferencias significativas entre los niños OW y no OW en condiciones de salud mental como lo refleja la puntuación BSRS-5 (4,29 ± 4,35 vs. 4,44 ± 4,16; p = 0,761). BSRS-5 se asoció significativamente con el WBIS. Los niños OW tendieron a tener un mayor nivel de autoestigma; aquellos que tenían un mayor nivel de autoestigma relacionado con el peso presentaban más problemas de salud mental
5
Damiano et al., 2018 [50]
estudio piloto para ECA
51 niños
5-8 años
Melbourne, Australia
Programa “Achieving Body Confidence for Young Children”ABC-4-YC, entrevistas sobre estima del cuerpo e imagen corporal
Se encontró una mejora significativa en la estima corporal y comentarios positivos de los profesores. Los resultados brindan apoyo preliminar para que ABC-4-YC mejore las actitudes de imagen corporal de los niños, pero se necesita una evaluación exhaustiva
6
Damiano, et al., 2015 [73]
estudio mixto
111 niñas y 109 madres de las niñas
5 años
Melbourne, Australia
Entrevistas y cuestionarios aurreportados sobre internalización del sesgo de delgadez, restricciones dietéticas por género, apariencia y pares
El 34% de las niñas informaron al menos un nivel moderado de restricción dietética. Si bien la mayoría de las niñas estaban satisfechas con su tamaño corporal, la mitad mostró cierta internalización del ideal de delgadez. La restricción dietética de las niñas se correlacionó con un sesgo de peso que favorecía cuerpos más delgados y una mayor internalización del ideal de delgadez, exposición a los medios y conversaciones sobre apariencia con sus pares. La exposición a los medios y las conversaciones sobre la apariencia fueron los predictores más fuertes de la restricción dietética
7
McNamara, et al., 2020 [48]
Protocolo de estudio experimental inter e intrasujetos
176 niños, 92 niños, 84 niñas; 4º, 5º, 6º grado
9-12 años
Irlanda
Programa “Growing Up in Ireland”, cuestionarios sobre contexto del stigma social por sobrepeso u obesidad
Los datos permitieron examinar simultáneamente múltiples factores de varios niveles de la vida del niño y su entorno (familia, barrio, escuela, periodo de tiempo), mientras que el diseño longitudinal permitió trayectorias que cambian con el tiempo para ser modelados
Los resultados mostraron que hay rechazo hacia compañeros con sobrepeso y obesidad, generando burlas y otras conductas negativas que pueden desembocar en acoso escolar. La práctica regular de ejercicio físico, una dieta equilibrada y una educación en valores podrían contribuir decididamente a disminuir los altos índices de obesidad infantil y mitigar, de cierta forma, los problemas que se derivan
9
Gmeiner y Warschburger, 2020 [57]
estudio de cohorte prospectivo
1463 niños (707 niños, 756 niñas); diferentes niveles socioeconómicos
6-11 años
Brandemburgo, Alemania
Tres mediciones: estado del peso objetivo WBI, burlas relacionadas con el peso e insatisfacción corporal.
Un nivel educativo más bajo de los padres, un mayor peso del niño, el género femenino, la experiencia de burlas, una mayor insatisfacción corporal, una mayor relevancia de la figura y puntuaciones más altas de depresión fueron predictivos de puntuaciones más altas del WBI. La insatisfacción corporal (sólo para las niñas) y la relevancia de la propia figura (ambos géneros) mediaron la asociación entre autoestima y WBI; no se observaron diferencias relacionadas con el peso
10
Gray et al., 2011 [47]
estudio cualitativo transversal
157 niños
7-17 años
Gainesville, Fl., USA
Entrevistas sobre victimización entre pares por estigma social del sobrepeso u obesidad
Se ofrecen direcciones futuras para abordar la victimización entre pares y su impacto en el funcionamiento psicológico conductual y social de los niños con sobrepeso y obesidad y las limitaciones de la literatura existente y resaltar áreas potenciales de investigación que pueden proporcionar información para el desarrollo de intervenciones efectivas para la victimización de los jóvenes obesos
11
Guardabassi et al., 2020 [76]
estudio transversal
176 niños
6-11 años
Bologna, Cesena, Italia
Tarea de memoria de trabajo sobre estereotipos del peso
La memoria de trabajo disminuyó a niveles crecientes de IMC en la condición que amenazaba el estereotipo, mientras que la relación entre el peso corporal y la memoria de trabajo fue nula cuando se eliminó el diagnóstico de la tarea. Este efecto no fue moderado por las experiencias directas de los niños con la estigmatización basada en el peso o por su respaldo personal al estereotipo de obesidad sobre la inteligencia. La vulnerabilidad a la amenaza de estereotipos relacionados con el peso surge temprano en la vida y puede contribuir a los déficits de memoria de trabajo en niños con obesidad
12
Hunger y Tomiyama, 2014 [59]
estudio longitudinal
2.379 niñas, 1213 negras, 1166 blancas;
10-19 años
USA
Antropometría, Cuestionario sobre etiquetado del peso. Análisis de regresión logística
El l 57,9 % (n = 1188) de los participantes informaron haber sido etiquetados. Las niñas negras reportaron más etiquetado de peso que las niñas blancas (χ21 = 16.13, P < .001), aunque esta diferencia fue pequeña (φ = 0.089). El IMC inicial y el estado de etiquetado del peso estuvieron moderadamente correlacionados (r = 0,41, P < 0,001). Los análisis de regresión logística evaluaron la asociación entre el etiquetado inicial y la obesidad 10 años después. Ajustando el IMC inicial, los ingresos del hogar, la educación de los padres, la raza y la edad de la menarquia, ser etiquetado como "demasiado gordo" a los 10 años siguió siendo un predictor significativo de obesidad a los 19 años (odds ratio = 1,66). El odds ratio fue de 1,62 cuando los miembros de la familia fueron la fuente del etiquetado y de 1,40 cuando la fuente no fueron miembros de la familia. Estos efectos no fueron mediados por la raza
13
Hutchinson y Mueller, 2018 [61]
estudio transversal
84 niños
4-7 años
Canadá
Medición de actitudes explícitas frente al peso y Prueba de asociación implícita
Las medidas de actitudes explícitas frente al peso se correlacionaron significativamente. Las actitudes implícitas relacionadas con el peso tendían a ser mayores en los niños mayores. Las actitudes explícitas e implícitas relacionadas con el peso no estaban relacionadas entre sí. Se discuten las implicaciones de las intervenciones para reducir las actitudes negativas relacionadas con el peso
14
Jendrzyca y Warschburger, 2016 [74]
estudio prospectivo
1486 (773 niños, 713 niñas)
6-11 años
Potsdam, Alemania
Cuestionarios sobre estigma frente al peso, insatisfacción corporal y conductas alimentarias al inicio y después de 1 año
Las asociaciones entre el estado de peso, el estigma del peso, la insatisfacción corporal y las conductas alimentarias difirió según el género. La experiencia del estigma del peso en las niñas condujo a una alimentación externa y restringida un año después, mientras que en los niños no se observó tal asociación. La insatisfacción corporal medió la asociación entre el estigma del peso y las conductas alimentarias restringidas en las niñas, mientras que, en los niños, la insatisfacción corporal influyó directamente en las conductas alimentarias restringidas. En ambos géneros, el estado de peso predijo la insatisfacción corporal y los trastornos alimentarios, mientras que el estigma del peso no tuvo un efecto directo sobre los trastornos alimentarios. Los resultados sugieren que las intervenciones que involucran el estigma del peso deberían ser parte de los programas de prevención de los trastornos alimentarios y se deberían considerar vías específicas de género
15
Kornilaki, 2015 [67]
estudio transversal
414 niños
5-8 años y 9-10 años
Creta, Grecia
Lectura de viñetas breves con personajes con cualidades positivas y negativas y asociación con figuras delgadas, promedio y obesas. IMC
El tamaño corporal real afectó la precisión del tamaño corporal percibido. Si bien la mayoría de los niños promedio identificaron correctamente su tamaño corporal, la mayoría de los niños con sobrepeso y obesidad tendieron a subestimarlo. La precisión de la percepción del tamaño corporal mejoró con la edad. El sesgo de obesidad no se relacionó con el tamaño corporal real de los niños sino con el percibido: aquellos que se percibían a sí mismos como más pesados exhibían menos sesgos
Ecuaciones de estimación generalizadas para evaluar la relación entre el estado de peso del niño y las probabilidades de ser acosado según el niño, la madre y el maestro
El 33,9%, el 44,5% y el 24,9% de los niños sufrieron acoso según los informes del maestro, la madre y los niños, respectivamente. Hubo una asociación independiente significativa entre ser obeso y ser acosado (odds ratio: 1,63 [intervalo de confianza del 95%: 1,18-2,25]). La relación entre ser obeso y ser acosado fue atenuada pero no eliminada por todas las covariables excepto el género. La relación no fue mediada por ninguna de las covariables
17
Madowitz et al., 2012 [62]
estudio correlacional
80 niños obesos, 58,8% niñas; 28,37% caucásicas
10 años
Minneapolis, USA
Regresiones logísticas y lineales para medir burlas, depresión y desórdenes alimenticios
Los niños objeto de burlas por parte de otros niños tuvieron niveles significativamente más altos de depresión (B = 6,1 [SE = 2,3]) y cinco veces más probabilidades de presentar desórdenes alimenticios (OR = 5,1 [CI = 1,5-17,4]). Los niños que afirmaron que las burlas de sus compañeros les molestaban presentaron niveles significativamente más altos de depresión (B = 2,3 [SE = 0,8]). La frecuencia de las burlas relacionadas con el peso se asoció significativamente con la depresión (B = 2,5 [SE = 0,8]), al igual que el número de fuentes de las burlas (B = 4,6 [SE = 1,5]). No se encontraron relaciones significativas entre las burlas familiares y la depresión o los desórdenes alimenticios
18
McCormack et al., 2011 [53]
estudio transversal multicéntrico, estudio piloto
148 niños
11-12 años
Saint Paul, MN, USA
Análisis de datos secundarios, cuestionario sobre burlas d ellos pares, satisfacción corporal, efectos a largo plazo de las burlas por sobrepeso u obesidad, IMC
El 40% de los niños informó que sus compañeros se burlaban de ellos y el 36% informó que sus familiares se burlaban de ellos por su peso. Más niños con sobrepeso/obesidad informaron haber sido objeto de burlas por parte de sus compañeros (P<0,01) y miembros de la familia (P<0,05) que los niños de peso normal. No se encontraron diferencias significativas entre el estado de peso y el grado en que a los niños les molestaban las burlas. La satisfacción corporal fue menor entre los niños que fueron objeto de burlas por parte de familiares o compañeros que aquellos que no fueron objeto de burlas (P <0,05). Las burlas relacionadas con el peso son un problema para los niños, especialmente aquellos con sobrepeso u obesidad. Se necesitan datos para medir los efectos a largo plazo de las burlas sobre los resultados conductuales y psicosociales en niños racial y étnicamente diversos
19
Mustillo et al., 2013 [60]
estudio longitudinal
2379 niñas
9-10 años
USA
Estudio Nacional de Crecimiento y Salud que midió etiquetado del peso, angustia psicológica debido al etiquetado del peso, diferencias por raza
Se encontraron efectos proximales y distales significativos de la obesidad sobre la angustia psicológica a través del etiquetado tanto de padres como de amigos entre las niñas blancas. Los efectos distales sobre el malestar psicológico estuvieron mediados por el malestar psicológico proximal. Entre las niñas negras, no hubo efectos distales, lo que sugiere que el estigma basado en el peso tiene más consecuencias para las niñas blancas en comparación con las negras
20
Olsen, et al., 2020 [55]
estudio transversal
4º y 5º grado
9-12 años
USA
Modelos de ecuaciones estructurales para examinar las relaciones entre los factores de fondo, las percepciones de responsabilidad y las actitudes de los niños hacia un compañero con sobrepeso
Los niños con sobrepeso fueron percibidos de manera más negativa que sus pares con peso normal. La edad, el género, la raza y la responsabilidad percibida de los participantes impactaron las actitudes de los niños hacia un niño con sobrepeso. Sin embargo, los resultados no mostraron que tener experiencia previa como víctima o el IMC de los niños influyera en sus percepciones sobre los niños con sobrepeso. El modelo actual solo representó el 17% de la variación en las actitudes de los niños. Las hipótesis tampoco fueron respaldadas de manera consistente, lo que sugiere que se necesita más investigación sobre las complejas interrelaciones entre las variables que impactan las actitudes sobre el peso. Los hallazgos respaldan la importancia de comprender y abordar las percepciones negativas de los pares sobre los niños con sobrepeso para reducir el impacto psicosocial negativo en estos niños
21
Olvera et al., 2013 [46]
estudio transversal
99 niñas hispanas y afroamericanas y sus madres
9-14 años, 11 años edad media
Houston, USA
Medición de porcentaje de grasa corporal, grasa abdominal y resistencia aeróbica antes y después de la intervención. Análisis de varianza de medidas repetidas
Los hallazgos indicaron reducciones estadísticamente significativas en el porcentaje de grasa corporal (p < 0,001), grasa abdominal (p < 0,001) y minutos de carrera/caminata de 1 milla (p < 0,001)
Cuestionario, clasificación de 6 figuras masculinas y 6 femeninas (1 niño, sano, 1 niño obeso y 4 con discapacidades) para medir las preferencias por figuras delgadas/obesas
Los dibujos que representan la figura del niño sano fueron calificados como los más preferibles y los que representan la figura del niño obeso como los menos preferibles entre los sujetos, independientemente del género y del origen. Sin embargo, las figuras obesas de niñas y niños fueron valoradas significativamente más positivamente por los niños de etnia roma que por los niños húngaros. Existen diferencias en la actitud hacia la obesidad entre los niños de etnia roma y húngaros.
23
Walter y Shenaar-Golan, 2017 [56]
estudio correlacional
107 adolescentes
12-16 años
Israel
4 cuestionarios: demográfico, IMC, escala de inversión corporal e índice de bienestar personal
Los hallazgos indican una correlación positiva y significativa entre el bienestar subjetivo y la imagen corporal. Después de controlar la variable de relación entre padres y adolescentes, la correlación se debilitó, lo que indica que la relación entre padres y adolescentes no tiene ningún efecto sobre el bienestar subjetivo y la imagen corporal de los adolescentes varones. Se encontró que la imagen corporal era un predictor del bienestar subjetivo
24
Reulbach et al., 2013 [70]
estudio longitudinal
8568 niños y sus familias
9 años
Irlanda
Programa “Growing Up in Ireland”, datos estadísticamente reponderados para medir diferencias por género del stigma social por sobrepeso u obesidad, victimización, acoso escolar
Significativamente (P < 0,001) más niñas tenían sobrepeso u obesidad (33,1%: 23,1% sobrepeso y 10% obesidad) que niños (25,2%: 18,3% y 6,9%). Los niños con índice de masa corporal con sobrepeso u obesidad tenían significativamente (P <0,001) más probabilidades de ser víctimas en comparación con los niños cuyo IMC no estaba clasificado como sobrepeso u obesidad. La delgadez clasificada por el IMC no se asoció significativamente con la victimización; sin embargo, la imagen corporal de ser flaco o muy flaco se asoció significativamente (P = 0,015) con ser victimizado. El acoso no se asoció con la clasificación de peso derivada del IMC, pero se asoció significativamente (P <0,001) con la propia descripción del peso del niño
25
Roddy y Stewart, 2012 [54]
estudio transversal
33 niños
6-8 años y 9-13 años
Galway, Irlanda
Prueba de Asociación Implícita IAT, Escalas de calificación Explícitas y Cuestionario de Actividades Compartidas SAQ para medir prejuicios por sobrepeso u obesidad
Los niños de ambos grupos de edad mostraron prejuicios contra sus compañeros con sobrepeso tanto en las medidas implícitas como en las explícitas. Se discuten las implicaciones de estos hallazgos
26
Rodríguez-Ojea, et al., 2011 [63]
estudio transversal
306 niños, 166 niñas, 140 niños; 5º y 6º grado
9-12 años
La Habana, Cuba
Cuestionario, clasificación de 6 figuras masculinas y 6 femeninas (1 niño, sano, 1 niño obeso y 4 con discapacidades) y comparación con resultados de USA y Nueva Zelanda para medir preferencias por figuras delgadas/obesas
Los escolares cubanos estigmatizaron menos a los obesos que sus contrapartes norteamericanos y neozelandeses. La figura del niño “saludable” recibió el rango promedio más elevado en la serie ordenada de los dibujos, mientras que a la figura del niño sentado en la silla de ruedas se le asignó el rango menor. El 88% de los escolares participantes ubicó la figura del niño saludable dentro de las 3 primeras posiciones de la serie, en tanto que la figura del niño obeso fue colocada dentro de las 3 últimas posiciones en el 70.9% de las instancias
27
Ross, et al., 2013 [75]
ensayo clínico aleatorizado ECA
60 niñas; 6º grado
11-12 años
USA
Programa “Y’s Girl” con grupo control, medición inicial y posterior de la imagen corporal, autoevaluación de la estima, factores sobre pares y trastornos alimenticios
En comparación con el grupo de control, las niñas que recibieron la intervención informaron una mejor imagen corporal, una internalización del ideal de delgadez, comparaciones corporales y autoestima en la prueba posterior, una semana después de finalizar la intervención. Además, los cambios en la satisfacción corporal fueron mediados por los niveles iniciales de factores de riesgo. Estos hallazgos brindan apoyo inicial a Y's Girl como una intervención de imagen corporal eficaz y asequible para niñas preadolescentes
28
Schvey et al., 2019 [69]
estudio longitudinal
110 niños; non-Hispanic Black and White Children
11,8 años edad media
USA
Escala de percepción de burlas, IMC
El 53% presentó sobrepeso/obesidad; el 36% eran negros no hispanos; el 55% eran mujeres; Seguimiento medio desde el inicio: 8,5 años. Al ajustar las covariables y las medidas repetidas de IMC o masa grasa, los modelos lineales mixtos revelaron que las burlas basadas en el peso se asociaron con un mayor aumento de IMC y masa grasa durante el período de seguimiento (ps ≤ 0,007). Ajustando las covariables, los jóvenes que reportaron un alto nivel de burlas basadas en el peso (dos desviaciones estándar por encima de la media) experimentaron un aumento del 33 % mayor en el IMC (0,20 kg/m2 adicionales) y un aumento del 91 % mayor en la masa grasa (0,65 kg adicionales). por año en comparación con sus pares que no reportaron burlas basadas en el peso
29
Solbes e Enesco, 2010 [88]
estudio transversal
120 niños, 60 niñas, 60 niños; 1º, 3º, 5º grado
6-11 años
Madrid, España
Entrevistas y medición de actitudes explícitas frente al peso y Prueba de asociación implícita
Se encontraron prejuicios y estereotipos contra los niños con sobrepeso, tanto a nivel explícito como implícito. Sin embargo, hubo diferencias importantes en la intensidad del prejuicio y su curso de desarrollo en función de las tareas y el tipo de medición utilizada para evaluarlo
30
Wong et al., 2019 [78]
estudio correlacional
100 niños y sus padres
6-11 años
Hong Kong, China
Cuestionarios sobre autoestigma por sobrepeso u obesidad y calidad de vida
En comparación con los niños que no eran OW, los niños OW tenían un mayor autoestigma en WBIS (p = 0,003) y WSSQ (p < 0,001); menor Calidad de vida en SMU (p < 0,001) y STU (p < 0,001). Se mostraron correlaciones más significativas con una magnitud más fuerte (r = −0,28 a −0,61) entre el autoestigma y la Calidad de vida en niños OW que en niños no OW. Los niños OW tenían un autoestigma significativamente mayor y una Calidad de vida más baja que los niños que no eran OW en Hong Kong. Se encontraron correlaciones negativas entre el autoestigma y la Calidad de vida en niños OW
31
Zuba y Warschburger, 2017 [87]
estudio prospectivo
1047 niños, 546 niñas, 501 niños
7-11 años
Potsdam, Alemania
Cuestionarios sobre burlas frente al peso, internalización del sesgo de peso, conductas alimentarias y problemas emocionales antes y después de 2 años
La experiencia de burlarse del peso y la internalización del sesgo de peso fueron mediadores en la relación entre el estado de peso y los problemas psicosociales. Esto se observó independientemente del sexo o del peso. La experiencia de burlarse del peso y la internalización del sesgo de peso son más importante que el estado de peso para explicar el funcionamiento psicológico entre los niños e indican la necesidad de enfoques de prevención e intervención adecuados