Peer Victimization, Psychosocial Adjustment, and Physical Activity
in Overweight and At-Risk-For-Overweight Youth
Eric A. Storch,1,2 PHD, Vanessa A. Milsom,3 BA, Ninoska DeBraganza,3 MSESS,
Adam B. Lewin,1,3 MS, Gary R. Geffken,1,2,3 PHD, and Janet H. Silverstein,2 MD
1
Department of Psychiatry, University of Florida, 2Department of Pediatrics, University of Florida,
and 3Department of Clinical and Health Psychology, University of Florida
Objective To examine the relationship between peer victimization and child and parent
reports of psychosocial adjustment and physical activity in a clinical sample of at-risk-foroverweight and overweight children and adolescents. Methods The Schwartz Peer
Victimization Scale, Children’s Depression Inventory—Short Form, Multidimensional Anxiety
Scale for Children, Social Physique Anxiety Scale, PACE+ Adolescent Physical Activity Measure,
and Asher Loneliness Scale were administered to 92 children and adolescents (54 females) aged
8–18 years. The youth’s parent/guardian completed the Child Behavior Checklist. Results
Peer victimization was positively related to child-reported depression, anxiety, social physique
anxiety, and loneliness, and parent-reported internalizing and externalizing symptoms. Peer
victimization was negatively related to physical activity. Depressive symptoms and loneliness
mediated the relations between peer victimization and physical activity. Conclusion Recognition
of the magnitude of the problem and the means of evaluating for peer victimization is important
for clinicians who work with overweight youth. Assessing peer experiences may assist in
understanding rates of physical activity and/or past nonadherence to clinician
recommendations.
Key words
children; overweight; peer victimization; physical activity; psychosocial adjustment.
Childhood peer victimization, the experience of being a
target of peers’ aggressive behavior, is increasingly
recognized as a serious and widespread childhood
occurrence (Storch & Ledley, 2005). Recent estimates
suggest that the number of school-age children and adolescents who are targets of overt (e.g., hitting, pushing,
threatening, and insulting) and/or relational (e.g., ignoring, shunning, and spreading rumors) acts of aggression
may be as high as 17–30% (Nansel et al., 2001, 2004;
Storch & Masia-Warner, 2004). Evidence connecting
peer victimization to poor psychosocial outcomes continues to mount. Victims of bullying frequently report
high levels of depression, social anxiety, and loneliness, and
teachers indicate that victims are among the least popular
of their students (Juvonen, Graham, & Schuster, 2003).
A meta-analytic review of cross-sectional studies spanning
two decades found that peer victimization was directly
associated with increased levels of depression (r = .29−.45),
loneliness (r = .25−.32), generalized anxiety (r = .21−.25),
and social anxiety (r = .14−.25) and decreased levels of
global (r = .21−.39) and social self-worth (r = .23−.35)
(Hawker & Boulton, 2000). Such psychological distress
may be the result of internalizing peers’ negative evaluations (Storch, Masia-Warner, Dent, & Klein, 2005).
Peer victimization of children with medical conditions is especially common because of overt characteristics that may serve as aggressors’ targets (Storch et al.,
2004). High levels of peer maltreatment have been
reported among children with endocrine disorders
(Storch et al., 2004), short stature (Sandberg, 1999), and
All correspondence concerning this article should be addressed to Eric A. Storch, PhD, Department of Psychiatry,
University of Florida, Box 100234, Gainesville, Florida 32610. E-mail: [email protected].
Journal of Pediatric Psychology 32(1) pp. 80–89, 2007
doi:10.1093/jpepsy/jsj113
Advance Access publication April 6, 2006
Journal of Pediatric Psychology vol. 32 no. 1 © The Author 2006. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: [email protected]
Peer Victimization
craniofacial abnormalities (Broder, Smith, & Strauss,
2001) and in retrospective studies of adults with stuttering
difficulties (Hugh-Jones & Smith, 1999) and epilepsy
(Wilde & Haslan, 1996). An ever-growing body of literature indicates that chronic peer victimization is common among overweight children and may contribute to
impaired psychosocial functioning. For example, in 416
high-school students, Pearce, Boergers, and Prinstein
(2002) found that both overweight boys and girls
reported elevated levels of overt and relational victimization and were less likely to date when compared with
their normal-weight counterparts. In a study by Sweeting, Wright, and Minnis (2005) involving 2,127 middleschool-aged children, the degree of overweight was associated with depressed mood, low self-esteem, and greater
victimization. Similarly, Young-Hyman, Schlundt, HermanWenderoth, and Bozylinski (2003) revealed that weightbased teasing was negatively correlated with self-esteem
among 117 African-American overweight school-aged
children. Finally, in a school-based sample of 4,746 adolescents, Eisenberg, Neumark-Sztainer, and Story (2003)
found that weight-related teasing was positively associated with thinking about and attempting suicide, even
after accounting for actual body weight. Even more
alarming, recent evidence that indicates peer victimization of overweight children may have a lasting impact on
psychological adaptation. In a study of 115 female adults
with binge-eating disorder that utilized retrospective
recall, Jackson, Grilo, and Masheb (2000) found a childhood history of appearance-related teasing to be positively correlated with body dissatisfaction, depression,
and poor self-esteem.
Although the above studies have made significant
contributions to the understanding of overweight children’s peer relations, there remain several limitations to
the current body of literature. First, most past studies
have relied heavily on the parent report of child psychological functioning. This has led some to suggest that
parental distress and/or psychopathology may account
for higher levels of reported impairment in overweight
children (Zeller, Saelens, Roehrig, Kirk, & Daniels,
2004). Additionally, sole reliance on the parent report of
children’s adjustment may result in artificially inflated
correlations because of shared method variance and/or
underestimations of internalizing symptoms (Grills &
Ollendick, 2002, 2003). Second, although overweight
children report finding chronic peer victimization upsetting, it is important to note that relatively few studies to
date have utilized psychometrically valid measures to
directly relate peer victimization experiences to clinically significant symptoms of psychological distress in
this population. For example, although Neumark-Sztainer,
Story, and Faibisch (1998) and Neumark-Sztainer, Falkner,
and Story (2002) provided rich qualitative information
about stigmatization experiences among overweight
adolescents, neither study used psychometrically sound
measures of psychological adjustment. Third, as only a
limited range of adjustment variables have been examined to date, a more comprehensive assessment of the
social and psychological correlates of peer victimization
is needed. Previous research has paid a great deal of
attention to social physique anxiety, which is anxiety
about one’s physique stemming from socially related factors. However, this research did not examine the multidimensional aspects of anxiety or other adjustment
indices such as depression, loneliness, and behavior
problems. Lastly, most studies of peer victimization
among overweight children have focused solely on the
impact of weight-based teasing, without considering the
full spectrum of behaviors that encompass both overt
and relational acts of aggression (Janssen, Craig, Boyce,
& Pickett, 2004).
Given that the number of overweight and at-risk-foroverweight children and adolescents continues to climb
at an alarming rate (Ogden, Flegal, Carroll, & Johnson,
2002), peer victimization is likely to affect a significant
number of youth (Strauss & Pollack, 2003) that may
affect adjustment and future relationship development
(Feiring & Furman, 2000). Considering the potential
negative impact of peer victimization among overweight
children, it is imperative to identify correlates of psychological distress, as such factors might pose a barrier to
treatment adherence (e.g., physical activity recommendations) and contribute to poor treatment outcomes.
For example, there is some evidence that overweight
children may avoid taking part in activities, such as
physical education classes or sports to avoid weight-related
peer victimization (Faith, Leone, Ayers, Moonseong, &
Pietrobelli, 2002). Indeed, in a study of 576 middleschool students, Faith et al. (2002) found that weight
criticism during physical activity was associated with
negative attitudes toward sports and reduced levels of
physical activity. The stress and anxiety caused by
weight-related teasing may also lead to somatic complaints, which overweight children may use as reasons
to avoid situations likely to result in further victimization (Fekkes, Pijpers, & Verloove-Vanhorick, 2003). It
is also possible that distress linked to peer victimization
contributes to less physical activity participation because of
the impact of the symptoms (e.g., anhedonia may prevent
participation in formerly enjoyable activities). Unfortunately, avoiding participation in social and recreational
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Storch et al.
activities may only serve to further isolate and stigmatize
the overweight child, in addition to affecting the physical
health and quality of life. Thus, clinicians are encouraged
to have a comprehensive understanding of the role that
peer victimization may play in the lives of overweight
children to facilitate optimal medical and psychological
care.
In this report, we assess the cross-sectional relations
among peer victimization and child- and parent-reported
adjustment in a sample of overweight and at-risk-foroverweight children. On the basis of findings in community samples, we predicted that (a) peer victimization
would positively correlate with child-rated indices of
depression, general anxiety, social physique anxiety, and
loneliness, and parent-rated indices of internalizing and
externalizing behavioral problems; (b) peer victimization would be negatively correlated with physical activity;
and (c) depression, general anxiety, social physique
anxiety, and loneliness would mediate the relationship
between peer victimization and physical activity.
Method
Participants
Participants were 100 children aged 8–18 years
(M = 12.9 ± 2.8) and their parent/guardian, who
attended a scheduled appointment at the University of
Florida Pediatric Lipid Clinic (consent rate 100/121 =
83%). Children who were diagnosed by the attending
physician ( JHS) and clinical psychologist (EAS) with
mental retardation or a psychotic disorder, or who were
unable to read the questionnaire packets, were excluded
from participation. Of the 100 eligible families, 8 were
excluded because of substantial missing data on the
Schwartz Peer Victimization Scale (SPVS) (defined as
one or more items missing). The final sample consisted
of 92 children and adolescents (54 female, 38 male) with
a mean age of 13.0 years (SD = 2.8). In children, body
mass index (BMI) for age is recommended to assess
overweight and risk for overweight status for children
aged 2–20 years. A BMI in the 85th to <95th percentile is
considered at-risk for overweight, whereas a BMI that is
≥95th percentile is considered overweight (Center for
Disease Control and Prevention, 2000). BMI-for-age was
calculated using height and weight measured once by a
clinic registered nurse at that visit using the Demetech
Physician Medical Health Scale (model RGT-B-200-RT).
The mean BMI-for-age was 37.2 (SD = 8.6). Ninety-eight
percent (n = 90) had a BMI >95th percentile (overweight), with the remaining 2% (n = 2) having a BMI in
the 85th to <95th percentile (at-risk for overweight).
The mean BMI z score calculated from Center for Disease Control and Prevention (2000) norms was 4.6 ±
2.1. Most children were self-identified as Caucasian
(60.9%) followed by African–American (32.6%), Hispanic (4.0%), and ‘other ethnicity’ (2.2%). Of the 92 parents who participated, 84 were the child’s mother, 4
were the child’s father, and 4 were the child’s grandmother. Families were considered to be in the low socioeconomic status range because this clinic serviced
children in families with an income meeting Florida
Medicaid requirements (income less than $25,736).
Measures
Schwartz Peer Victimization Scale
The SPVS (Schwartz, Farver, Change, & Lee-Shin,
2002) is a five-item self-report measure of peer victimization that occurred over the past 2 weeks. Items
focused on overt and relational forms of victimization
consistent with contemporary definitions (Crick &
Grotpeter, 1996). The measure has good internal consistency (a = .75), a stable one-factor structure, and correlated modestly and positively with teacher and peer
reports of victimization (r = .32 and .39, respectively)
and loneliness (r = .64) (Schwartz et al., 2002). Cronbach’s a in this sample was .82.
Children’s Depression Inventory—Short Form
The Children’s Depression Inventory—Short Form
(CDI-S) measures self-reported assessment of depressive
symptoms for school-aged children and adolescents
(Kovacs & Beck, 1977). There are 10 items assessing
statements that best describe the youth’s cognitive, affective, or behavioral symptoms of depression using a 3-point
scale indicating the absence, mild symptoms, or definite
symptoms. Within the extant literature, reliability has
been good, with Cronbach’s a ranging from .71 to .89,
and test-retest coefficients range from .74 to .83 with
various samples. Considerable support for the construct
validity of this measure has also been reported (e.g.,
Craighead, Smucker, Craighead, & Ilardi, 1998; Kovacs,
1992). Cronbach’s a for this sample was .84.
Asher Loneliness Scale
The Asher Loneliness Scale (ALS) is a 24-item scale that
assessed self-reported loneliness in children and adolescents over the past 2 weeks (Asher, Hymel, & Renshaw,
1984). The ALS was modified such that the 16 items that
focus on feelings of loneliness, social adequacy, and subjective adequacy and subjective estimations of peer status
were included, whereas the remaining eight filler items
that ask about hobbies were excluded to minimize the
time needed to complete the assessment battery. Items
Peer Victimization
are rated on a 5-point scale (1 = never true and 5 = always
true), indicating how true each item was for them. The
ALS has good psychometric properties including good
internal consistency, a stable factor structure, and
convergent validity (Asher & Wheeler, 1985; Bagner,
Storch, & Roberti, 2004). Cronbach’s a for the 16-item
version used in the current study was .91.
Multidimensional Anxiety Scale for Children
The Multidimensional Anxiety Scale for Children
(MASC; March, Parker, Sullivan, Stallings, & Conners,
1997) is a 39-item self-report questionnaire that assesses
symptoms of general, social, and separation anxiety in
children and adolescents. Items are rated on a 4-point
Likert scale (0 = never true about me, 1 = rarely true
about me, 2 = sometimes true about me, and 3 = often
true about me) with higher scores corresponding to
greater anxiety. The internal consistency of the MASC is
excellent (a = .90; March et al., 1997). Test-retest reliability at 3-week and 3-month intervals has been found
to be .88 and .87, respectively (March et al., 1997;
March, Sullivan, & Parker, 1999). The MASC correlates
highly with the Screen for Child Anxiety-Related Emotional Disorders (r = .83), Spence Children’s Anxiety
Scale (r = .86), and Revised Children’s Manifest Anxiety
Scale (RCMAS; r = .72−.76; Dierker et al., 2001; Muris,
Merckelbach, Ollendick, King, & Bogie, 2002) and
weakly with the CDI (r = .19) and the Abbreviated
Symptom Questionnaire (ASQ; r = .07) (March et al.,
1997). Cronbach’s a for this sample was .91.
Social Physique Anxiety
The degree to which youth become anxious to others’
evaluation of their physique was measured by the 12item self-report Social Physique Anxiety Scale (SPA;
Hart, Leary, & Rejeski, 1989). Items were rated on a
5-point Likert-type scale with higher scores indicating
greater social physique anxiety. Sample items include “It
makes me uncomfortable to know others are evaluating
my physique/figure” and “I wish I wasn’t so uptight
about my physique/ figure.” The SPA Scale has shown
adequate construct validity, test-retest reliability (r = .82),
and internal consistency (a = .90; Hart et al., 1989).
Cronbach’s a for this study was .62.
PACE+ Adolescent Physical Activity Measure
This two-item self-report measure assesses physical
activity in youth (Prochaska, Sallis, & Long, 2001).
Children report how many days they were physically
active for at least 60 min per day over the past 7 days,
and how many days they were physically active for at
least 60 min per day over a typical or usual week. The
PACE+ has demonstrated stability (intraclass correlation
cofficient = .77) and convergent validity with other
measures of physical activity (Prochaska et al., 2001).
Cronbach’s a for this study was .92.
Child Behavior Checklist
The Child Behavior Checklist (CBCL; Achenbach, 1991)
is a widely used parent-rated instrument that provides
estimates of internalizing and externalizing symptoms
over the past 6 months. Items are rated on a 3-point
scale (0 = never, 1 = sometimes, and 2 = often or always).
For this study, only the Internalizing and Externalizing
Problem Scales were used. Cronbach’s a for the Internalizing and Externalizing Scales were .92 and .94.
Procedures
The study was approved by the University of Florida
Institutional Review Board. At each child’s regularly
scheduled appointment at a university based clinic for
overweight children, the child and parent/guardian were
approached by a trained research assistant about participating in this study. Written consent was obtained from
caregiver, and assent was obtained from the children
before completing forms. The children independently
completed the SPVS, CDI, ALS, MASC, SPA, and PACE+
in their clinic room, whereas the accompanying caregiver completed the CBCL concurrently. The research
assistant provided instructions for completing measures
and was available to answer questions. It took the children and caregiver approximately 25 min to complete
the study measures. Families were compensated $10 for
their time.
Data Analysis
First, we conducted independent t tests to examine
gender and ethnic differences in indices. Second, to
examine relations among peer victimization, psychosocial adjustment, and physical activity, we computed
Pearson product moment correlations. Third, we tested
mediational models to explore whether depression, general anxiety, social physique anxiety, and loneliness
mediated the relation between peer victimization and
physical activity. Support for mediation would provide a
more comprehensive explanation of the process by
which victimized youth who are overweight fail to perform sufficient physical activity. Baron and Kenny’s
(1986) guidelines for mediation were followed to test a
model of the influence of peer victimization on physical
activity via psychosocial adjustment. The following criteria are necessary for mediation: (I) the predictor
(victimization) is significantly associated with the outcome (physical activity); (II) the predictor is significantly
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Storch et al.
associated with the mediator (psychosocial adjustment
variables); (III) the mediator is associated with the outcome variable (with the predictor accounted for); and
(IV) finally, the addition of the mediator to the full
model reduces the relation between the predictor and
criterion variable to a nonsignificant value. The Sobel
significance test (Sobel, 1988) will be used to examine
the strength of the mediation. If the addition of the
mediator reduced the size of the direct effect but did not
reduce the effect to a nonsignificant value, then the data
suggest partial mediation.
Results
Descriptive Data
No gender differences were identified for study measures with the exception higher Social Physique Anxiety
reported by female participants, t(90) = –2.62, p = .01.
No differences were identified between African and
Caucasian Americans (there was insufficient sample size
to examine differences among other ethnicities).
Cross-sectional relations among peer victimization
and child- and parent-reported adjustment.
Rates of victimization and psychosocial maladjustment are presented in Table I. Pearson product moment
correlations between reports of victimization and both
child and parent reports of psychosocial adjustment are
presented in Table II. Strong, positive correlations were
found between reports of peer victimization and depressive symptoms, general anxiety, social physique anxiety,
loneliness, and internalizing and externalizing behavioral problems. Peer victimization and psychosocial
adjustment variables were not related to age or BMI.
Likewise, differences in the magnitude of relations by
race and gender were not identified, and thus, correlations are presented for the entire group (to examine
whether relations between peer victimization and
psychosocial adjustment vary by age, BMI, and gender,
we conducted separate hierarchical regression analyses
with interaction terms entered in the final step. Interaction terms for all three series of analyses [for age,
BMI, and gender] were nonsignificant, suggesting that
Table I. Percentage of Children in the Study Sample Exceeding Clinical
Cutoffs on Peer Victimization and Psychosocial Adjustment Measures
Index
Schwartz Peer Victimization Scale
Children’s Depression Inventory—Short Form
%
25
7.6
Multidimensional Anxiety Scale for Children
14.1
Social Physique Anxiety Scale
13
Asher Loneliness Scale
16
relations between peer victimization and each psychosocial adjustment variable did not vary by age, BMI, or
gender).
Relations between Physical Activity, Peer
Victimization, and Psychosocial Adjustment
The relationship between physical activity, peer victimization, and psychosocial adjustment was examined in
two ways. First, Pearson product moment correlations
were computed between these variables (Table II). A
modest, inverse relation was identified between the
reports of peer victimization and the levels of physical
activity. Similarly, significant negative correlations were
found between physical activity with both loneliness
and depressed mood. Second, hierarchical linear regressions were computed to assess whether measures of
psychosocial adjustment mediated the relations between
peer victimization and physical activity (Tables III
and IV).
Depression as a Mediator of the Peer
Victimization–Physical Activity Relationship
Results indicated that victimization predicted physical
activity, R2 = .10, F(1, 90) = 10.1, p < .001 (criterion I),
and depressive symptoms, R2 = .16, F(1, 90) = 16.1,
p < .001 (criterion II). In accordance with criterion III,
depressed mood predicted physical activity with the
effects of victimization accounted for in the equation,
R2 = .05, F(1, 90) = 4.8, p < .01. Finally, the relation
between victimization and physical activity was reduced
to ΔR2 = .07, F(2, 89) = 7.3, p < .01, when depressed
mood was accounted for, demonstrating criterion IV for
mediation. The Sobel significance test (Sobel, 1988),
which tests for a decrease in the total effect of the predictor on the criterion after controlling for the mediator,
also supported criterion IV (Sobel z = –2.1, p < .04),
namely that depressive symptoms partially mediated the
relation between victimization and physical activity. The
addition of the mediator reduced the size of the direct
effect but did not reduce the effect to a nonsignificant
value, suggesting partial mediation. As such, peer victimization is predictive of unique variance above and
beyond depressive symptoms, indicating direct and
indirect effects of victimization on physical activity.
Anxiety as a Mediator of the Peer Victimization–
Physical Activity Relationship
Analyses did not support the hypothesis that either
anxiety or social physique anxiety mediates the relationship between peer victimization and physical activity.
Although criteria I and II were substantiated, the third
Peer Victimization
Table II. Pearson Correlation Coefficients Among Study Variables
Peer
victimization
Peer victimization
CDI-S
1.0
CDI-S
MASC
.40***
1.0
MASC
SPA
CBCL
internalizing scale
ALS
CBCL
externalizing scale Physical activity
.42***
.37***
.63***
.30**
.45***
−.32**
.34***
.49***
.53***
.29**
.38**
−.23*
.39***
.43***
.28**
.18
−.17
.44***
.23*
.24
−.12
.45***
.52***
−.33***
1.0
SPA
1.0
ALS
1.0
CBCL internalizing scale
1.0
−.19
.70***
CBCL externalizing scale
−.22*
1.0
Physical activity
Mean (SD)
1.0
9.4 (3.5)
12.9 (3.1) 41.0 (18.7) 33.0 (7.4) 31.8 (13.6)
16.6 (12.5)
14.2 (12.1)
5.7 (3.6)
ALS, Asher Loneliness Scale; CBCL, Child Behavior Checklist; CDI-S, Children’s Depression Inventory—Short Form; MASC, Manifest Anxiety Scale for Children;
SPA, Social Physique Anxiety.
*p < .05. **p < .01. ***p < .001.
Table III. Mediation Regression Predicting Physical Activity as Mediated by Depressive Symptoms
Step
Predictor variable(s)
R2
ΔR2
F
b
−.32**
Step I: peer victimization and physical activity
—
Peer victimization
.10
—
10.1**
Step II: peer victimization and mediator
—
Peer victimization
.16
—
16.1***
Step III: mediator and outcome
—
Depressive symptoms
.05
—
4.7*
−.23*
Step IV: peer victimization and physical
1
Depressive symptoms
.052
—
4.8*
−.20*
2
Peer victimization
.128
.076
7.3*
−.30*
.40***
activity with mediator in the model
All standardized regression coefficients are from the final block of the regression.
*p ≤ .05. **p < .01. ***p < .001.
Table IV. Mediation Regression Predicting Physical Activity as Mediated by Loneliness
R2
ΔR2
F
b
Peer victimization
.10
—
10.1**
−.32**
—
Peer victimization
.065
—
6.2*
.25*
—
Loneliness
.07
—
6.2*
.25*
1
Loneliness
.011
—
10.8**
−.30**
2
Peer victimization
.013
.02
2.1
Step
Predictor variable(s)
Step I: peer victimization and physical activity
—
Step II: peer victimization and mediator
Step III: mediator and outcome
Step IV: peer victimization and physical
activity with mediator in the model
−.06
All standardized regression coefficients are from the final block of the regression.
*p ≤ .05. **p < .01.
criterion for mediation was not upheld. The relation
between the mediator and outcome was not preserved
when the predictor was accounted for in the equation.
Loneliness as a Mediator of the Peer
Victimization–Physical Activity Relationship
Data from regression analyses are presented in Table IV.
Resulted supported criteria I and II for mediation are
peer victimization significantly predicted physical activity, R2 = .10, F(1, 90) = 10.1, p < .001, and loneliness,
R2 = .39, F(1, 90) = 57.9, p < .001. The path between the
mediator and the criterion variable was also verified
with the effects of peer victimization accounted for in
the equation supporting criterion III for mediation, R2 = .11,
F(1, 90) = 10.8, p < .001. Finally, the relation between
peer victimization and physical activity was reduced to
ΔR2 = .02, F(1, 89) = 2.1, p = .15, when loneliness was
accounted for, demonstrating criterion IV for mediation.
The Sobel test (z = –3.0, p < .002) provides further support for criterion IV, indicating that loneliness fully
mediates the relation between peer victimization and
physical activity.
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Discussion
This study examined the relations among peer victimization, psychosocial adjustment, and physical activity in
at-risk-for-overweight and overweight children and
adolescents. Overall, peer victimization was negatively
associated with physical activity and positively associated
with self-reports of depressive symptoms, anxiety, loneliness, and social physique anxiety, and parent reports of
internalizing and externalizing behavior problems.
Although the cross-sectional nature of this study does
not provide causal information regarding these relationships, such findings may reflect the distressing nature of
peer victimization. Chronically victimized children and
adolescents may internalize the content of peer attacks,
resulting in greater distress and avoidance of social
interactions that are expected to have a high probability
for victimization (Storch et al., 2004). Positive relations
between peer victimization and externalizing behavior
may reflect victims’ acting out to defend themselves and/
or act in ways that divert peers’ attention from their
physical appearance (e.g., act as the class clown). Externalizing symptoms may also represent the overt manifestation of depression and anxiety that is linked to
negative peer relations.
Consistent with data suggesting a positive link
between peer victimization and social avoidance (see
Hawker & Boulton, 2000, and Storch & Ledley, 2005,
for reviews), we found that peer victimization was negatively related to physical activity. In relation to youth
who are overweight or at risk, victimized youth may
avoid activities that are not always closely supervised,
such as physical education class or after school sports,
where victimization frequently occurs (Frey et al.,
2005). Peer aggression directed at overweight youth
may reduce the intrinsic reinforcement inherent to
many activities and may make youth fearful of involvement (Faith et al., 2002). Unfortunately, if overweight
children are nonadherent to physical activity recommendations because of peer victimization, their likelihood of losing weight relies solely on their adherence to
dietary recommendations, reducing the chance of significant weight loss. Thus, addressing peer victimization
may be clinically useful in designing interventions to
increase physical activity in at-risk-for-overweight and
overweight children.
Mediational analyses shed further light on the relationship between peer victimization and physical activity by highlighting the role of depression and loneliness.
Depression and loneliness related to peer victimization
(and/or other factors not examined in this study) may
contribute to lower rates of physical activity as a function
of decreased motivation to be physically healthy because
of diminished mood, depression-related fatigue, or a
poor social-reinforcement history for exercise. Another
possibility is that dysphoric interpretations of peer interactions and other stimuli (e.g., ability) may contribute
to future avoidance of physical activity. Given that
depression and loneliness exacerbate the difficulty that
overweight youth have engaging in exercise, addressing
these psychological barriers to physical activity should
be a primary goal of therapeutic interventions.
These findings have important clinical implications,
particularly when one considers the deleterious outcomes (e.g., type 2 diabetes, insulin resistance, hypertension, lipid problems, sleep apnea, and steatohepatitis;
Bray, 2004; Dietz & Robinson, 2005) and poor quality
of life (Schwimmer, Burwinkle, & Varni, 2003) associated with being overweight in childhood. First, children
with significant depression or who are excessively lonely
may require psychotherapeutic or psychotropic treatments to address these problems. However, it is not
clear that addressing these symptoms would be entirely
effective in increasing physical activity rates should
problematic peer relationships persist. Empirically supported school-based programs such as the Social Skills
Group Intervention (DeRosier, 2002, 2004) can target
peer victimization in the environment in which it
occurs. Such programs should include staff training on
dealing with aggressors and victims, focus on reducing
opportunities for peer victimization to occur, develop an
“antibully” school climate (e.g., publicize school-wide
rules and hold discussions), and maintain firm consequences for aggressors (e.g., meetings with parents and
suspension from sports teams) (Eisenberg & Aalsma,
2004). Additionally, the depression and loneliness that
many overweight youth experience may serve to hinder
the effectiveness of peer bullying programs. Addressing
and treating these symptoms of peer victimization
among overweight youth via psychological and psychiatric
treatment is essential.
Second, clinicians should consider the impact of
peer victimization and problem-solve with overweight
youth and their parents to maximize adherence to physical activity recommendations. It is not surprising that
many youth avoid engaging in events with a high risk of
peer victimization; for youth who are overweight, such
events may include attending physical education and
participating on school or community sports teams.
With this information in mind, it may prove fruitful for
clinicians to discuss the methods of countering bullying
and help the youngster problem-solve ways to exercise
without risking being bullied.
Peer Victimization
This study is not without limitations. First, the
cross-sectional nature of this research prevents the directionality of the relationships from being established.
Although causation is inferred by these mediational
findings, the present data are limited by their self-report
and cross-sectional nature and thus should be interpreted with these considerations in mind. Given this,
longitudinal studies using multiple informants (e.g.,
child, peer, parent, and teacher) are needed to establish
true causal connections among variables. Furthermore,
as this is the first study to test the mediating role of psychosocial adjustment indices in the relation between
peer victimization and physical activity, replication with
independent samples is necessary. Second, these data
suggest that peer victimization is associated with many
negative consequences in overweight youth. Left
unanswered is the question whether peer victimization
is primarily a result of “being different” by virtue of
greater body mass or other factors. For example, other
factors such as social skill deficits secondary to inattention or disruptive behavior may account for peer victimization. Third, although we had a heterogeneous sample
in terms of ethnicity, all youth were treatment seeking
and were from a relatively small community. Therefore,
these findings may not generalize to children and
adolescents from other geographic regions or those who
are not pursuing treatment for weight management.
Fourth, the self-report nature of most instruments may
be vulnerable to the potential confounds of response
bias and shared method variance. Fifth, we measured
physical activity on a two-item self-report scale.
Although this measure has sound psychometric properties,
youth may have misreported physical activity. Future
studies should include more thorough assessments of
this construct. Lastly, the mediational models only
accounted for modest amounts of variance. Numerous
other variables that were not examined in this study may
also contribute to this model. For example, parental attitudes toward nutrition and physical activity likely explain a
significant portion of the variance in the model, as do
other environmental correlates of overweight status.
Thus, a significant amount of variance remains to be
explained by variables other than peer victimization.
In sum, peer victimization is a commonly occurring
childhood problem that may significantly affect the psychosocial adjustment and clinical care of overweight
youth. Our findings highlight the importance of assessing
social functioning in understanding barriers to weight loss
and past nonadherence to clinician recommendations.
Future research should address the causal association
between peer victimization and adjustment and physical
activity, as well as other deleterious outcomes that may
result from negative peer experiences.
Received July 21, 2005; revision received December 30,
2005, February 2, 2006, March 1, 2006, and March 6,
2006; accepted March 7, 2006
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