Experiences of weight teasing in adolescence and weight-related outcomes in adulthood: A 15-year longitudinal study
Introduction
Weight-based teasing and bullying (also called weight-based victimization) have been identified as common experiences for youth, particularly for those with higher body weight (Bucchianeri et al., 2013, Puhl and Latner, 2007, Puhl et al., 2013). Reports from students, parents, and teachers suggest that body weight is viewed to be the most common reason that youth are teased and bullied (Puhl et al., 2015a, Bradshaw et al., 2013, Puhl et al., 2011). Longitudinal research has demonstrated that weight-based teasing is prevalent throughout adolescence, (Haines et al., 2008) and may remain consistent during the transition into adulthood (Haines et al., 2013).
Given high rates of overweight and obesity in youth, (Ogden et al., 2014) and their vulnerability to weight-based victimization, it is critical to identify how these teasing experiences may influence health outcomes, especially weight-related health. While evidence consistently demonstrates links between weight-based victimization and negative health behaviors, disordered eating, and poorer emotional wellbeing, (Bucchianeri et al., 2014, Eisenberg et al., 2003, Lampard et al., 2014, Puhl and Suh, 2015, Juvonen et al., 2016) few studies have examined longitudinal associations between weight-based teasing and health outcomes in adulthood (Hubner et al., 2016). To date, the limited prospective evidence in this area has examined 5–10 year consequences of early experiences of weight-based teasing on emotional wellbeing (e.g., body image, depressive symptoms, self-esteem), disordered eating, or weight-control behaviors in adolescence and early adulthood (Eisenberg et al., 2012, Eisenberg et al., 2006, Haines et al., 2006). This evidence importantly demonstrates that weight-based teasing may have an adverse impact on emotional wellbeing and maladaptive eating patterns that persists into late adolescence and young adulthood. However, important questions remain.
First, it is important to broaden existing knowledge about the long-term implications of weight-based teasing for weight-related health outcomes. In addition to identifying whether early experiences of weight-based teasing predict maladaptive eating behaviors (such as binge eating and unhealthy weight control) further into adulthood, it is important to identify the potential long-term influence of early teasing experiences on other relevant eating behaviors and weight-related outcomes that can affect health, such as eating to cope with emotional distress, unhealthy dieting, and weight status. Cross-sectional evidence has demonstrated links between weight-based victimization and a range of unhealthy behaviors, (Bucchianeri et al., 2014, Puhl and Suh, 2015) while longitudinal work has observed that exposure to general peer-based bullying (not specific to weight) in childhood or adolescence may increase risk for future obesity, (Takizawa et al., 2015, Mamun et al., 2013, Midei and Matthews, 2011) and certain age-related diseases in adulthood (Takizawa et al., 2015). However, it is important to identify longitudinal associations and the direction of causal pathways linking youth experiences of weight-specific victimization to adverse eating behaviors and weight-related outcomes that may persist well into adulthood.
Second, is not known whether experiencing weight-based teasing from peers versus family members differentially affects adverse eating and weight-related outcomes in adulthood. While evidence shows that youth with overweight or obesity are vulnerable to weight-related teasing and stigma from both peers and parents, (Puhl and Latner, 2007, Puhl et al., 2013) it is not clear whether the long-term impact of these experiences is attenuated or worsened depending on the perpetrator of the teasing. Identifying potential differences in long-term outcomes based on the source of early teasing experiences has important implications for targets (e.g., peers, families) and settings (e.g., schools, home) of intervention and prevention efforts to address weight-based victimization.
To address these important and understudied areas, the present study builds upon previous work to examine whether experiences of weight-based teasing in adolescence predict weight status and adverse eating and weight-related health behaviors 15 years later; and whether the source of early weight-based teasing (from peers, parents, or both) differentially affect these outcomes in adulthood. We examined these questions using the most recent (4th) wave of longitudinal data from Project EAT (Eating and Activity in Teens and Young Adults), an ethnically and socioeconomically diverse sample of males and female adolescents followed for 15 years through young adulthood. Several studies using previous waves of data drawn from Project EAT have assessed longitudinal and secular trends in weight-based teasing in adolescence (Haines et al., 2008, Haines et al., 2013) and examined concurrent teasing experiences by family members in adulthood (Eisenberg et al., 2012). However, the long-term health and weight-related outcomes occurring from weight-based teasing in adolescence have not yet been studied, nor have potential differences in these longitudinal outcomes according to the source of weight-based teasing (peers versus family). Examining these questions in the recently completed 4th wave of Project EAT provides an important opportunity to address these gaps in knowledge and contribute novel insights about the nature and potential long-term impact of weight-based teasing experiences in youth.
Section snippets
Study design and population
Data for this study were drawn from Project EAT-IV, a 15-year longitudinal study examining behavioral, psychological, and socioenvironmental factors related to dietary intake and weight-related outcomes in adolescents. The analytic sample includes 1830 participants who responded at baseline (1998–1999) (Neumark-Sztainer et al., 2002a, Neumark-Sztainer et al., 2002b) and in the fourth study wave (2015–2016). The baseline population included 4746 adolescents, drawn from 31 public middle schools
Results
Table 1 presents demographic characteristics of the sample by baseline experiences of weight-based teasing among participants at baseline who were followed 15 years later. There were no age differences at baseline or follow-up regarding teasing experiences reported by participants. At baseline, a higher percentage of adolescent girls (45.1%) reported experiencing weight-based teasing than adolescent boys (37.1%). Weight-based teasing from both peers and family members was reported by 14.5%
Discussion
This study followed a diverse sample of female and male adolescents for 15 years to examine longitudinal associations between early experiences of weight-based teasing and eating and weight-related outcomes as they entered their 30's. Findings showed that weight-based teasing predicted adverse eating and weight outcomes 15 years later, suggesting the importance of prevention work during adolescence aimed at reducing weight-related teasing. Some important differences across gender and the source
Conclusions
Our findings have implications for programs targeting youth bullying and interventions addressing weight-related health. In addition to increasing awareness that weight-based teasing can have negative implications for future health outcomes, our findings suggest the need for broader anti-bullying initiatives that include both the school and family/home environment as targets for intervention. While most anti-bullying efforts occur in schools, weight-based victimization is often absent in
Conflicts of interest
None.
Financial disclosure
This study was supported by Grant Number R01HL116892 from the National Heart, Lung, and Blood Institute (PI: Dianne Neumark-Sztainer). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. S.B. Austin is supported by training grants T71-MC00009 and T76-MC00001 from the Maternal and Child Health Bureau, Health Resources and Services Administration, U.S.
Acknowledgments
The authors would like to thank Nicole Larson for her input and reviews of previous drafts of this manuscript.
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