Today's post, by Nan Feyler, is one in a series of contributions by members of an expert panel intended to expand the breadth of The Public's Health. Feyler, chief of staff for the Philadelphia Department of Public Health, holds law and master of public health degrees, and is a former executive director of the AIDS Law Project of Pennsylvania.
By Nan Feyler
The recent report of drops in the rates of obesity and severe obesity in Philadelphia's public school children is good news. Not only has the overall obesity rate dropped nearly 5 percent, the greatest decline is in African American male and Hispanic female students who are among those at highest risk of obesity. While it is too soon to be certain what caused these declining numbers, for the past several years the School District of Philadelphia, the city health department's Get Healthy Philly campaign, and non-profits like The Food Trust have focused on a public health strategy to create a healthier food environment in schools.
At the same time, for overweight and obese children the school environment can feel lonely, hostile and unsafe because of teasing, bias and unchecked bullying.
Students report that weight is among the most common reasons that their peers are bullied. In one national study, 84 percent of adolescent students surveyed saw overweight students being called names, being teased in a mean way, and teased during physical activities. Over two-thirds reported observing overweight and obese peers being excluded, ignored, avoided, teased in the cafeteria, and targetted by negative rumors. The majority of students observed verbal threats and physical threats.
While peers are the most common perpetrators, teachers and parents also contribute to stigmatizing obese and overweight children. Teachers, including physical education teachers, report lower expectations for overweight students compared to thinner students, endorse negative stereotypes or believe that overweight and obese children have family problems. Even at home, children may face critical and negative comments, with significant numbers of overweight and obese children reporting weight-related teasing and criticism from their parents.
The psychological, social and even academic consequences of weight discrimination for youths are serious. Overweight and obese kids who are teased and bullied are at risk for low self-esteem, depression, social isolation and poor body image. They are two to three times more likely to engage in suicidal thoughts and behaviors compared to overweight peers who are not bullied. They report feeling sad, bad about themselves, angry and sometimes afraid. Weight-based victimization harms school performance, with overweight students reporting that being teased hurts their grades as well as their attendance at school.
Some people believe that stigma is helpful for motivating weight loss - that making it uncomfortable or undesirable to be overweight will somehow help people lose weight. But a body of research - and common sense - disputes this notion. Studies show that youth often cope with teasing about their weight by trying to lose pounds in harmful ways (fasting, diet pills, vomiting, and chronic dieting), binge eating, and avoiding physical activity - all unhealthy behaviors that can actually impede weight loss and potentially reinforce weight gain.
Confronting stigma, bullying and weight bias needs to go hand-in-hand with efforts to reduce the prevalence of obesity nationwide. Underlying weight-related stigma is the belief that being overweight or obese reflects a personal weakness and that people are personally responsible for their weight – they are overweight because they are lazy, unmotivated, lack self-discipline and willpower. For example, in experimental research, high school girls were more favorable toward peers whose excess weight was attributed to a thyroid condition compared to girls whose obesity was not explained. This belies the scientific understanding that obesity is a result of a complex interplay of environmental, genetic, behavioral and social factors, with many significant contributors beyond the control of individuals. There is also considerable scientific consensus – and plenty of anecdotal evidence from dieters around the world - about the challenge of significant long-term weight loss.
Public health campaigns to reduce obesity – and the nation's focus on the costs and consequences of excess weight -- have the potential to further stigmatize people who are obese. It is a tricky balance, where we celebrate success in reducing the prevalence of childhood obesity without blaming or castigating the individual child who is overweight or obese.
Educators, parents and policy makers should be applauded when making a healthier school food environment, but in equal measure they must make sure there are similar expectations and opportunities for children regardless of their body size, intervene promptly to stop weight-based teasing and bullying, and challenge assumptions that marginalize, blame or stigmatize overweight or obese children.