Weight-related Criticism and Self-perceptions among Preadolescents
Timothy D. Nelson,1 PHD, Chad D. Jensen,2 MA, and Ric G. Steele,2 PHD, ABPP
1
Department of Psychology, University of Nebraska-Lincoln, and 2Clinical Child Psychology Program,
University of Kansas
All correspondence concerning this article should be addressed to Timothy D. Nelson, PhD, Department
of Psychology, University of Nebraska-Lincoln, 319 Burnett Hall, Lincoln, NE, 68588-0308, USA.
E-mail: [email protected]
Received February 5, 2010; revisions received April 14, 2010; accepted April 19, 2010
Objective To examine the relationships among weight-related criticism (WRC), body size perceptions, and
body size dissatisfaction among a sample of preadolescent children. Method A community sample of
382 fifth and sixth graders (M age ¼ 10.8) completed measures of WRC, nonweight-related criticism
(NWRC), body size perceptions, body size dissatisfaction, and general self-esteem. Body mass index for each
participant was collected during a standard school assessment. Results WRC was a significant and
unique predictor of body size perceptions and body size dissatisfaction, controlling for actual BMI percentile
and NWRC. Weight status moderated these relationships, with significant effects for WRC found only in the
overweight group. NWRC was a significant predictor of self-esteem. Discussion The results suggest that
WRC is specifically and uniquely associated with preadolescent children’s body self-perceptions beyond its
association with general, nonweight-related victimization. Prevention efforts may be needed to limit WRC and
its potentially harmful effects.
Key words body size dissatisfaction; body size perceptions; pediatric obesity; peer victimization;
weight-related criticism.
Introduction
Peer victimization is a common problem with potentially
serious consequences for victimized youth. Estimates suggest that up to 30% of children in the United States have
been involved in bully–victim interactions (Nansel et al.,
2001), and chronic victimization has been linked to a variety of physical and mental health problems (Fekkes,
Pijpers, Fredriks, Vogels, & Verloove-Vanhorick, 2006;
Hawker & Boulton, 2000; Juvonen, Graham, & Schuster,
2003; Nishina, Juvonen, & Witkow, 2005; van der Wal, de
Wit, & Hirasing, 2003). Peer victimization is especially
common for overweight youth (see Gray, Kahhan, &
Janicke, 2009, for review), with some research suggesting
that overweight children are teased more frequently and
more chronically than their nonoverweight peers
(Hayden-Wade et al., 2005). Recently, researchers have
begun to focus on weight-related criticism (WRC), which
is a specific type of peer victimization in which the child’s
weight or body size is the subject of the teasing (Libbey,
Story, Neumark-Sztainer, & Boutelle, 2008). WRC may be
an especially important form of victimization with specific
effects on children’s psychosocial well-being, health behaviors, and self-perceptions. Research attention to this construct has increased in recent years, particularly in studying
adolescents; however, research on the effects of WRC in
preadolescents remains limited and an important area for
investigation (Gray et al., 2009).
Emerging evidence suggests that WRC can have a significant effect on psychosocial functioning. Eisenberg and
colleagues found that peer and family WRC significantly
predicted higher levels of depression, suicidal ideation, and
suicide attempts among adolescents in both cross-sectional
(Eisenberg, Neurmark-Sztainer, & Story, 2003) and
longitudinal (Eisenberg, Neumark-Sztainer, Haines, &
Journal of Pediatric Psychology 36(1) pp. 106–115, 2011
doi:10.1093/jpepsy/jsq047
Advance Access publication May 19, 2010
Journal of Pediatric Psychology vol. 36 no. 1 ß The Author 2010. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.
All rights reserved. For permissions, please e-mail: [email protected]
Weight-related Criticism
Wall, 2006) investigations. Similarly, Libbey and colleagues
(2008) reported that frequent peer and family WRC was
associated with higher levels of depression, anxiety, and
anger in a sample of adolescents. These findings complement research demonstrating a significant relationship between general peer victimization and higher levels of
internalizing problems, externalizing problems, and loneliness among overweight youth (Storch et al., 2007).
Further, general peer victimization has been linked to
lower quality of life among overweight youth using both
parent- and child-report measures (Janicke et al., 2007).
Recent evidence has also suggested that WRC may be negatively associated with important health behaviors.
Hayden-Wade and colleagues (2005) found that WRC
was associated with a greater preference for isolative and
sedentary behaviors, and Jensen and Steele (2009) reported
that the interaction between WRC and body dissatisfaction
predicted lower levels of vigorous physical activity among
girls. Other research has linked WRC to unhealthy dieting
behavior (Thompson et al., 2007) and binge-eating
(Neumark-Sztainer et al., 2002) among adolescents.
Gender differences have been reported for body image concerns (Phares, Steinberg, & Thompson, 2004) and WRC
(Faith, Leone, Ayers, Moonseong, & Pietrobelli, 2002),
with girls reporting higher levels of both in community
samples. Further, Phares et al. (2004) found that WRC
was more strongly related to depression among girls than
among boys.
In addition to emerging evidence for WRC’s associations with psychosocial functioning and health behaviors,
it is possible that WRC may influence youth
self-perceptions. An individual’s view of oneself, in general,
and one’s body, specifically, can be influenced by social
factors and interactions (Clark & Tiggemann, 2008).
Within this context, teasing about one’s weight may negatively alter a child’s self-perception. In fact, recent studies
have found that WRC is associated with lower self-esteem
among adolescents (Eisenberg et al., 2003, 2006; Libbey et
al., 2008). In addition to this effect on global self-view,
WRC criticism may have more specific effects on an individual’s view of his or her body. Hayden-Wade et al. (2005)
found that WRC was negatively correlated with confidence
in one’s physical appearance. Similarly, recent studies have
suggested a link between WRC and dissatisfaction with
specific body parts (e.g., waist and thighs) among adolescents (Eisenberg et al., 2003; Thompson et al., 2007).
Beyond unhappiness with particular body parts, we believe
that WRC may have a specific effect on individual youth
perceptions of one’s own body size as well as the discrepancy between one’s perceived size and ideal size (i.e., body
size dissatisfaction); however, research in this area is
lacking.
The potential effect of WRC on youth self-views, both
global (e.g., self-esteem) and specific (e.g., perceptions of
one’s body size; body size dissatisfaction), may have important implications for psychosocial and health outcomes.
For example, diminished youth self-views could partially
mediate the association between WRC and negative clinical
(e.g., depression and anxiety) and health behavior (e.g.,
physical inactivity and eating problems) outcomes (i.e.,
WRC leads to diminished self-views which, in turn, negatively affect psychosocial and health outcomes). Previous
research focusing on general (i.e., nonweight-related) peer
victimization has found evidence for self-perceptions as a
mediator of the victimization-internalizing relationship in a
longitudinal investigation (Troop Gordon & Ladd, 2005).
Similarly, Adams and Bukowski (2008) found that
self-concept mediated the effect of peer victimization on
depressive symptoms and increases in BMI among obese
female adolescents. With regard to body-related perceptions, Gilliland and colleagues (Gilliland et al., 2007)
found that body size dissatisfaction was associated with
higher levels of internalizing problems and negative affect
among youth. Further, Dalton, Johnston, Foreyt, and Tyler
(2008) reported that body dissatisfaction predicted poorer
response to pediatric weight management treatment. Taken
together, these studies suggest that factors that contribute
to negative self-perceptions may play an important role in
the emotional and physical health of youth.
Study Goal and Hypotheses
The primary goal of this study was to build upon previous
literature to examine the relationship between WRC and
self-view in a sample of preadolescents. We investigated
both specific associations of WRC with body perceptions
(i.e., perceived body size and body size dissatisfaction) and
more global self-view (i.e., self-esteem). Further, we compared the association of WRC to that of non-weight-related
criticism (NWRC) to determine whether WRC is a unique
predictor above and beyond the impact of more general
forms of victimization. By examining both WRC and
NWRC in the same study, we can compare their relative
effects on youth self-view, informing whether WRC is an
important target for intervention by itself or merely a manifestation of more general forms of victimization.
We made several a priori hypotheses related to the
relationship between WRC and self-view constructs. First,
we expected significant and specific associations of WRC
with both individual body size perceptions and body size
dissatisfaction (both negative relationships). Second, we
expected the relationship between WRC and these body
107
108
Nelson, Jensen, and Steele
perception constructs to be stronger than the association
with the more general victimization construct (i.e.,
NWRC). We hypothesized that the experience of frequent
teasing specifically targeting one’s weight or body would be
associated with more (negative) attention toward one’s
body. Third, we expected that the associations between
WRC and body size perceptions and body size dissatisfaction would be observed primarily among overweight youth
(i.e., a significant weight status WRC interaction would
be found). We hypothesized that WRC would be both
more prevalent and more potent among overweight youth
who may be especially sensitive to criticism of their bodies.
Finally, we expected that WRC would significantly negatively relate to global self-view, as measured by self-esteem;
however, we expected to find a similar effect for NWRC on
this construct.
The current study was designed to add to the existing
literature on WRC in several important ways. First, we
sought to build upon previous research in this area with
adolescents by examining WRC in a preadolescent sample.
Second, this study utilized both objective weight data (i.e.,
BMI) and more subjective measures of body perceptions to
examine the effects of WRC on body perceptions controlling for one’s actual weight. Third, our study examined
both WRC and NWRC in the same model, allowing for
the comparison of the unique effects of each. Finally,
this study examined both body-related perceptions and
more general self-perceptions to determine if the effects
of WRC are specific to body perceptions of if they generalize to overall self-esteem. Given the potential clinical implications of these self-perceptions, the results of this study
should be relevant to understanding the consequences of
WRC and considering interventions with preadolescents
who are frequent targets of this form of victimization.
Methods
Participants
A sample of 382 participants was recruited through a
Midwestern public school district. Eligibility criteria for
participation in the investigation included (a) the child
was enrolled in either fifth or sixth grade, (b) the student
spoke and read English, and (c) the child’s parent or custodial caregiver provided informed consent for participation. All students meeting these criteria were deemed
eligible regardless of weight status, sex, or ethnicity.
Approximately 54% of the sample was male, and the
mean age of the participants was 10.8 years (SD ¼ 0.65).
The ethnic composition of the sample was as follows: 6.6%
African American, 5.8% Asian, 59.2% European American,
9.7% Hispanic, 6.3% Native American, 10% Other, and
2.1% Biracial. Comparison to school district ethnic percentages (8% African American, 4% Asian, 72%
European American, 5% Hispanic, 4% Native American,
7% Multi-Racial) suggests that this sample was generally
representative of the school district at large. Because parents did not complete study measures, information regarding the SES of individual participants was not available.
However, the school district reported that 43.3% of children attending the six schools sampled qualified for free
and reduced lunch. The agregate school district percentage
of children eligible for free and reduced lunch was 32.1%.
Using body mass index (BMI) percentiles for age, 14.4% of
participants were classified as obese (BMI percentile 95),
18.4 % were considered overweight (BMI percentile 85
and <95), 65.4% were normal weight, and 1.8% were
underweight (BMI percentile <5). The cumulative percentage of children classified as overweight or obese was
32.8%, which is consistent with national estimates
(Ogden, Carrol, Curtin, Lamb, & Flegal, 2010).
Procedures
Information about the study and consent forms were sent
to the parents of all children in the fifth and sixth grades of
six selected elementary schools. In order to encourage children to return the consent forms, a prize was awarded to
classes in which 80% of children or more returned signed
consent forms, regardless of whether parental consent or
nonconsent was indicated. Specifically, classes with a consent form return rate of 80% or higher received a 15-min
visit from the school mascot of the second and third authors’ academic institution. Of the 602 consent forms sent
home to parents, 474 (79%) were returned. Of the returned consent forms, 401 (84%) indicated consent for
participation. Of the 401 forms indicating consent, 382
children (95%) completed study measures. Participating
children completed the study measures in their regular
classrooms. Research assistants read each measure aloud
to the students to eliminate reading comprehension as a
confounding factor in study procedures. Additional research assistants were available to ensure participant understanding of directions and compliance with
instructions. These procedures were approved by the
Human Subjects Committee at the University of Kansas.
Measures
Weight-related Criticism
This construct was measured using the 6-item
Weight-related Teasing subscale of the Perceptions of
Teasing Scale (POTS; Thompson, Cattarin, Fowler, &
Fisher, 1995), The Weight-related Teasing subscale asks
questions about the child’s experiences with weight-related
Weight-related Criticism
criticism from kindergarten until the present (e.g., ‘‘People
made jokes about you being too heavy;’’ ‘‘People called you
names like ‘Fatso’ ’’). Children are asked to rate the frequency with which they have encountered teasing since kindergarten on a five point scale from 1 (never) to 5 (very often).
Thompson and colleagues demonstrated good reliability
for the Weight-related Teasing subscale in the measure’s
original development among young adults (a ¼ .88). More
recently, investigations with overweight pediatric samples
have confirmed this scale’s excellent reliability (a ¼ .88;
Stern et al., 2007). The reliability of the scale in our
sample was also excellent (a ¼ .88).
Nonweight related Criticism
General, or nonweight-related, criticism was measured
using the Teasing about Abilities/Competency subscale of
the Perceptions of Teasing Scale (POTS; Thompson et al.,
1995). These five items assess general teasing (e.g., ‘‘People
laughed at you because you didn’t understand something;’’
‘‘People teased you because you didn’t get a joke’’).
Estimates of internal consistency for this scale were excellent in both the measure’s initial development (a ¼ .84;
Thompson et al., 1995) and in our sample (a ¼ .80).
Eisenberg and colleagues (2006) reported strong test–retest
reliability of the POTS over a 5-year longitudinal study.
Evidence for the construct validity of the POTS with preadolescents has been provided through confirmatory factor
analyses supporting the two factor structure of the measure
(corresponding to the two subscales used in this study;
Jensen & Steele, in press).
Body Size Perception and Body Dissatisfaction
Body size perception and body size dissatisfaction were
measured using a pictorial scale displaying seven figure
drawings of children (both male and female) along a continuum from 1 (extremely thin) to 7 (obese; Collins, 1991).
Children were asked to use the scale appropriate to their
respective sex to identify their current body size and their
ideal body size. This commonly used measure was validated among preadolescent children (M age ¼ 8 years; Collins,
1991) with accuracy reported to increase with age.
Adequate test–retest reliability was reported for actual
self and ideal self (respectively, r ¼ .71, r ¼ .59).
Criterion-related validity was assessed by comparing
figure selection with BMI (r ¼ .37, p < .05; Collins,
1991). Consistent with Collins’ original method, children’s
response to the prompt ‘‘which picture looks most like
you’’ indicated body size perception while the difference
between actual and ideal (‘‘which picture shows how you
want to look’’; actual minus ideal) body size was used to
indicate body size dissatisfaction. Positive scores indicated
a desire to be thinner while negative scores suggested a
desire to be larger.
Self-esteem
Self-esteem was assessed using a five-item measure composed of items drawn from two well-established self esteem
scales (i.e., Coopersmith Self-Esteem Inventory and
Rosenberg Self-Esteem Questionnaire; Nesdale &
Lambert, 2007). Children were presented with positive
statements related to personal and social self-esteem
(e.g., ‘‘I think that I am easy to like’’) and were asked to
rate the degree to which they agreed with each statement
on a scale from 1 (not at all) to 5 (a lot). Total self-esteem
was calculated by summing the scores on the 5 items,
giving a range of scores from 5 (low self-esteem) to
25 (high self-esteem). This scale was validated with
children ranging from 8 to 10 years old and has demonstrated good internal consistency (a ¼ .81; Nesdale &
Lambert, 2007). The internal consistency of the measure
in the current sample was good (a ¼ .78).
Body Mass Index
Participants’ height (in) and weight (lbs) were collected by
school nurses as part of a routine district-mandated health
assessment conducted during the first quarter of the
academic year. This information was provided to study
personnel by the school district for all consenting participants. Using height and weight values, BMI was calculated
for each individual according to the following formula:
weight (lb)/[height (in)]2 703 (Centers for Disease
Control and Prevention [CDC], 2007a). Conversion
of height and weight values to BMI percentiles was performed using a SAS program provided by the CDC (CDC,
2007b).
Analysis Plan
To examine the relationships between WRC and child
self-perceptions, we conducted a series of hierarchical multiple regressions, using body size perception, body size
dissatisfaction, and self-esteem as the dependent variables
in separate analyses. For each analysis, a demographic set,
comprised of age and gender, was entered on the first step
to control for their effects. On the second step, child BMI
percentile was entered to control for the child’s actual body
size in predicting the child’s perception of his/her body
size. WRC and NWRC were entered on the third step to
examine both the set effect of victimization as well as the
unique contributions of each type of victimization. Finally,
on the fourth step, we entered a set of multiplicative interaction terms, including gender WRC and BMI WRC, to
test for gender and BMI as possible moderators of the
109
110
Nelson, Jensen, and Steele
hypothesized relationship between WRC and the dependent variables. If a significant interaction was found, the
interaction was probed by splitting the sample and
re-running the analyses. In the case of BMI, the split was
made at the 85th percentile, resulting in an overweight
group (85th percentile, encompassing overweight and
obese participants using CDC definitions) and a nonoverweight group ( <85th percentile, encompassing healthy
weight and underweight participants using CDC
definitions).
actual BMI. The interaction terms were entered on the
fourth step, and only the BMI WRC term was significant,
p < .001, indicating that BMI is a moderator of the
WRC-body size perception relationship. Therefore, the
sample was split based on weight status (into overweight
and nonoverweight groups; see Analysis Plan section for
description) to probe the interaction. Follow-up analyses
indicated that WRC was a significant predictor of body size
perception in the overweight group only (b ¼ .30, p < .01,
for the overweight group vs. b ¼ .05, p > .05, for the nonoverweight group).
Results
Preliminary Analyses
WRC and Body Size Dissatisfaction
Means and standard deviations of the variables are presented by gender in Table I. Bivariate correlations are presented for the overweight and nonoverweight groups in
Table II. Children in the overweight group reported significantly higher levels of WRC, t(375) ¼ 6.38, p < .001,
but not NWRC, t(373) ¼ 1.02, p > .05. Children in the
overweight group also perceived their body sizes to be
larger, t(378) ¼ -9.07, p < .001, and reported greater
body size dissatisfaction, t(374) ¼ 8.12, p < .001, than
their nonoverweight peers. Overweight and nonoverweight
children did not differ on mean self-esteem, t(379) ¼
1.29, p > .05.
WRC and Body Size Perceptions
In the analysis for body size perception, the demographic
set, entered on the first step, did not account for a significant amount of variance, F(2, 371) ¼ .95, p > .05. BMI
percentile, entered on the second step, accounted for a
significant amount of variance, b ¼ .51, R2 ¼ .255,
p < .001, with heavier children perceiving themselves to
be larger. The victimization set on the third step accounted
for a significant amount of unique variance in body size
perception, R2 ¼ .037, p < .001, but only WRC was a
significant unique predictor, b ¼ .19, p < .001, with children who were more frequently the targets of WRC perceiving themselves to be larger even after controlling for
In the analysis for body size dissatisfaction, the demographic set was entered on the first step and did not account for a significant amount of variance, F(2, 367) ¼
1.21, p > .05. BMI percentile, entered on the second
step, predicted a significant amount of variance, b ¼ .46,
R2 ¼ .211, p < .001, with heavier children reporting
greater body size dissatisfaction. The victimization set, entered on the third step, accounted for a significant amount
of unique variance, R2 ¼ .054, p < .001, but only WRC
was a significant unique predictor of body size dissatisfaction, b ¼ .21, p < .001, with children who were more frequently the targets of WRC reporting greater
dissatisfaction. The interaction terms were entered on the
fourth step, and only the BMI WRC term was significant,
p < .01. The sample was split into overweight and nonoverweight groups to probe the interaction, and WRC was a
significant predictor in the overweight group only (b ¼ .22,
p < .05, for the overweight group vs. b ¼ .08, p > .05, for
the nonoverweight group).
WRC and Self-esteem
For self-esteem, neither the demographic set, F(2, 371) ¼
.20, p > .05, nor BMI percentile, b ¼ .01, R2 ¼ .00,
p > .05, accounted for a significant amount of variance.
The victimization set, entered on the third step, accounted
for a significant amount of variance, R2 ¼ .029, p < .01,
but only NWRC uniquely predicted self-esteem, b ¼ .13,
Table I. Means and Standard Deviations of Variables by Gender
Boys
Variable
Minimum
Maximum
Girls
M (SD)
Minimum
Maximum
M (SD)
WRC
6.00
25.00
6.84 (2.24)
6.00
25.00
7.45 (3.36)
NWRC
5.00
23.00
8.26 (3.25)
5.00
25.00
8.87 (3.85)
3.76 (.96)
Body size perception
1.00
6.00
3.82 (.90)
1.00
7.00
2.00
3.00
0.28 (.69)
2.00
4.00
0.39 (.82)
Self-esteem
5.00
25.00
19.71 (4.12)
7.00
25.00
19.97 (3.77)
BMI
1.40
99.80
67.88 (27.21)
1.00
99.70
61.85 (28.62)
Body size dissatisfaction
Weight-related Criticism
Table II. Bivariate Correlations among the Overweight Group (Above the
Diagonal) and Non-Overweight Group (Below the Diagonal)
WRC
1
NWRC
–
.47***
2
.27***
3
.08
.11
4
.22***
.17**
5
.19**
–
.10
Body size
perception
Body size
dissatisfaction
Self-esteem
Table III. Summary of Regression Results
Variable
Step 1 (Demographics)
Age
.36***
.14
.15
.22*
.27**
Gender
.66***
.22*
Step 2 (BMI)
.51***
.13*
–
.18*
.17**
–
*p < .05; **p < .01; ***p < .001.
p < .05, with children who were more frequently victimized reporting lower levels of self-esteem. Neither of the
interaction terms was significant. A summary of all regression results is available in Table III.
Consistent with our hypotheses, this study found that
WRC had a significant effect on preadolescent perceptions
of their own bodies. Specifically, higher levels of WRC were
associated with larger perceived body size and greater body
size dissatisfaction, even after controlling for BMI percentile. As expected, WRC was a stronger predictor of body
perceptions than NWRC. The effect of WRC was specific to
body perceptions and did not generalize to more global
self-perceptions as measured by self-esteem. Further, the
relationship between WRC and body perceptions was moderated by preadolescent weight status, with significant effects found only among overweight youth, a subset of the
population that is likely more susceptible to this form of
victimization.
The findings of this study complement and expand
upon previous research on WRC in several ways. First,
this study extends investigations of WRC among adolescents (Eisenberg et al., 2003, 2006; Thompson et al.,
2007) to a preadolescent sample. The finding that frequent
teasing related to one’s weight is associated with body perceptions at a relatively early age suggests that children may
be sensitive to such criticism even prior to the often
self-image-focused period of adolescence. In fact, preadolescence is a time when body image concerns begin to
emerge for many youth (see Ricciardelli & McCabe,
2001, for review), and body-specific criticism from peers
could further contribute to these concerns.
Second, the current study expands previous research
by investigating body size perceptions while controlling for
objective anthropomorphic data (i.e., BMI). An individual’s
perception of his or her own body is a complex interaction
between the objective physical reality and socially influenced perceptions. The results of this study suggest that
R2
b
.005
.09
.07
.07
.05
.10
.03
.02
.00
.51***
WRC
.07
.02
.19***
NWRC
.01
.01
.03
.04
.06
.03
.18
.07
.12*
.01
.00
.46***
.06
.01
.21***
.02
.01
.07
Age
.10
.31
.02
Gender
.23
.41
.03
.00
.01
.01
.12
.15
.08
.06
.08
.13*
BMI percentile
.255***
Step 3 (Peer criticism)
.037***
DV ¼ Body size dissatisfaction
Step 1 (Demographics)
Age
Gender
.007
Step 2 (BMI)
BMI percentile
Discussion
SE B
DV ¼ Body Size Perception
.41***
–
B
.211***
Step 3 (Peer criticism)
WRC
NWRC
DV ¼ Self-esteem
.017*
Step 1 (Demographics)
.001
Step 2 (BMI)
BMI percentile
.000
Step 3 (Peer criticism)
WRC
NWRC
.029**
*p < .05; **p < .01; ***p < .001.
peer criticism about one’s weight may be one important
social factor that affects how preadolescents interpret the
physical reality of their bodies. By controlling for objectively obtained BMI in our analyses, we attempted to separate
the relative contributions of physical reality and specific
social interactions to preadolescent body perception formation. Beyond controlling for BMI, our finding that weight
category (i.e., overweight vs. normal weight) moderated the
association between WRC and self-perceptions (particularly body dissatisfaction) underscores the validity (and
clinical significance) of these findings. Specifically, children
who are clinically overweight (i.e., BMI >85th percentile)
seem to be uniquely vulnerable to the negative effects of
WRC on body perceptions. In the context of Fox and
Farrow’s (2009) findings, our results may indicate a recursive cycle in which overweight children exposed to WRC
and who evidence compromised self-perceptions are at increased risk for various forms of subsequent victimization.
Further (perhaps longitudinal) research clarifying the directionality of influence among these variables is clearly
needed.
111
112
Nelson, Jensen, and Steele
Third, this study directly compared the effects of WRC
and NWRC in predicting self-perceptions, finding that
WRC had a specific effect on body-related perceptions
above and beyond the effect of NWRC. This finding suggests that the potential effects of WRC on body perceptions
go beyond those of more general forms of criticism and
that WRC may be an important area for further
consideration.
Our findings indicated that NWRC was associated
with our measure of self-esteem, but that (in contrast to
our stated hypothesis) WRC was not. As noted by Fox and
Farrow (2009), children with obesity are more consistently
shown to have lower self-esteem vis-à-vis their physical
appearance. Similarly, in the quality of life literature, obesity has been associated not only with health-related quality of life in general, but also with physical functioning
quality of life more specifically (Tsiros et al., 2009). In
contrast, there may be more variance associated with
global self-esteem among obese samples; particularly
those that comprise children that are not treatment seeking
(Wardle & Cooke, 2005). Since our measure of self-esteem
was more global in nature (i.e., not specific to physical
appearance), our results may reflect a compartmentalization of self-esteem (Harter, 1999, 2005). With such a view,
WRC might be expected to be associated with
physical-appearance-related self-esteem, and perhaps not
related to more global measures. Further, physical appearance self-esteem might have a more specific effect on health
behaviors such as physical activity and diet (Jensen &
Steele, 2009; Stockton et al., 2009) than global self-esteem.
Given the variance across studies examining associations
between overweight/obesity and self-esteem in youths
(Wardle & Cooke, 2005), further investigation of these
associations is necessary.
It is also worth noting that cultural factors may influence the relationships between weight status, body perceptions, and weight-related criticism. For example, Tyler and
colleagues (Tyler, Johnston, Dalton, & Foreyt, 2009) found
that, among a sample of African-American girls, BMI was
not associated with body esteem. This finding suggests that
an individual’s weight status, as well as teasing related to
one’s weight status, is interpreted through a cultural lens
and individual perceptions might differ considerably based
on the child’s cultural context. Further research is needed
to better understand how culture, body perceptions, and
WRC interact in youth.
Clinical Implications
As indicated above, this study suggests that WRC, although
a form of peer victimization, may be a unique and important predictor of body perceptions among preadolescent
children. WRC may affect body perceptions from a relatively early age which, in turn, may lead to other negative
psychosocial and health outcomes. Youth who develop
more negative perceptions of their bodies as a result of
WRC may be at increased risk for the numerous problems
that have been linked to body dissatisfaction, such as internalizing problems (Gilliland et al., 2007), disordered
eating (Stockton et al., 2009), and further victimization
(Fox & Farrow, 2009). Also, because body dissatisfaction
has been shown to predict poorer outcomes in a pediatric
weight management program (Dalton et al., 2008), the
negative perceptions that result from WRC may inhibit
important efforts to address the weight problems that led
to the peer criticism in the first place.
Given the potential consequences for both negative
body image and associated problems, WRC appears to be
an appropriate target for prevention, early identification,
and intervention efforts. Research on programs targeting
WRC is limited and suggests that the few programs that
have been examined have produced limited results (see
Gray et al., 2009, for review). Effective programs would
likely require efforts to intervene with both the victimized
child and the broader social context within which victimization occurs. Prevention efforts might include programs
that aim to alter the school climate, similar to those attempting to promote a bullying-free school environment
(Fonagy et al., 2009), with a special emphasis on WRC.
Early identification of children who are targets of frequent
and chronic WRC may also be important in reducing ongoing WRC and its potentially harmful effects. Finally, intervention for children who have been victims of WRC may
focus on helping them develop effective coping strategies to
buffer against potential negative effects on self-perception
and health behaviors.
Limitations
Several limitations of this study should be noted. First, this
investigation utilized only cross-sectional data, so we
cannot determine the direction of influence between peer
criticism and self-perceptions. Second, longitudinal studies
are needed to address the potential long-term consequences of WRC on both body perceptions and associated
problems. These investigations might include not only
measures of self-perceptions, but also other outcomes potentially related to WRC such as quality of life. Third, because body size perceptions were measured using a series
of pictures depicting children with different body sizes, we
were unable to directly compare preadolescent reports of
their perceived body size with their actual size (as measured by BMI percentile). Therefore, we were unable to
determine whether children’s perceptions were distorted
Weight-related Criticism
by WRC or, instead, that the criticism merely drew attention to the physical reality for overweight youth. Future
studies may attempt to address this issue by more directly
measuring misperceptions of body size. Finally, our measure for body size perception consisted of a single item,
and our measure for body size dissatisfaction was calculated using only two items. Future research may benefit from
more in-depth measures of body size perception and dissatisfaction using several items to taps various aspects of
these constructs.
Conclusion
WRC is an emerging and potentially important construct,
especially for overweight youth. This study provides preliminary evidence for a specific effect of this form of victimization, beyond that of general peer victimization, on
preadolescent body self-perceptions. Additional longitudinal research is needed to further explore both the potential
short-term and long-term effects of WRC on youth
health-related cognitions, behaviors and outcomes.
Conflicts of interest: None declared.
References
Adams, R. E., & Bukowski, W. M. (2008). Peer victimization as a predictors of depression and body mass
index in obese and non-obese adolescents. Journal of
Child Psychology and Psychiatry, 49, 858–866.
Centers for Disease Control and Prevention. (2007a).
Body mass index formula. Retrieved September 10,
2009 from http://www.cdc.gov/healthyweight/asses
sing/bmi/childrens_bmi/childrens_bmi_formula.html.
Centers for Disease Control and Prevention. (2007b). A
SAS program for the CDC growth charts [Computer
Software Macro]. Retrieved September 7, 2009 from
http://www.cdc.gov/nccdphp/dnpa/growthcharts/
resources/sas.html.
Clark, L., & Tiggemann, M. (2008). Sociocultural and
individual psychological predictors of body image in
young girls: A prospective study. Developmental
Psychology, 44, 1124–1134.
Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International
Journal of Eating Disorders, 10, 199–208.
Dalton, W. T., Johnston, C. A., Foreyt, J. P, & Tyler, C.
(2008). Brief report: Weight dissatisfaction, weight
status, and weight loss in Mexican-American
Children. Journal of Pediatric Psychology, 33,
673–677.
Eisenberg, M. E., Neumark-Sztainer, D., Haines, J.,
& Wall, M. (2006). Weight-teasing and emotional
well-being in adolescents: Longitudinal findings from
Project EAT. Journal of Adolescent Health, 38,
675–683.
Eisenberg, M. E., Neurmark-Sztainer, D., & Story, M.
(2003). Associations of weight-based teasing
and emotional well-being among adolescents.
Archives of Pediatric and Adolescent Medicine, 157,
733–738.
Faith, M. S., Leone, M. A., Ayers, T. S., Moonseong, H.,
& Pietrobelli, A. (2002). Weight criticism during
physical activity, coping skills, and reported physical
activity in children. Pediatrics, 110, 23–31.
Fekkes, M., Pijpers, F. I., Fredriks, A. M, Vogels, T.,
& Verloove-Vanhorick, S. P. (2006). A prospective
cohort study on the relationship between bullying
and health-related symptoms. Pediatrics, 117,
1568–1574.
Fonagy, P., Twemlow, S. W., Vernberg, E. M., Nelson, J.
M., Dill, E. J., Little, T. D., & Sargent, J. (2009). A
cluster randomized controlled trial of child-focused
psychiatric consultation and a school systemsfocused intervention to reduce aggression.
Journal of Child Psychology and Psychiatry, 50,
607–616.
Fox, C. L., & Farrow, C. V. (2009). Global and physical
self-esteem and body dissatisfaction as mediators of
the relationship between weight status and being a
victim of bullying. Journal of Adolescence, 32,
1287–1301.
Gray, W. N., Kahhan, N. A., & Janicke, D. M. (2009).
Peer victimization and pediatric obesity: A review of
the literature. Psychology in the Schools, 46, 720–727.
Gilliland, M. J., Windle, M., Grunbaum, J. A.,
Yancey, A., Hoelscher, Tortolero, S. R.,
& Schuster, M. A. (2007). Body image and children’s
mental health related behaviors: Results from the
healthy passages study. Journal of Pediatric
Psychology, 32, 30–41.
Harter, S. (1999). The cognitive and social construction of
the developing self. New York: Guilford.
Harter, S. (2005). Self-concepts and self-esteem, children
and adolescents. In C. B. Fisher, & R. M. Lerner
(Eds.), Encyclopedia of applied developmental science
(Vol. 2, pp. 972–977). Thousand Oaks, CA: Sage.
Hawker, D. S., & Boulton, M. J. (2000). Twenty years’
research on peer victimization and psychosocial maladjustment: A meta-analytic review of cross-sectional
studies. Journal of Child Psychology and Psychiatry, 41,
441–455.
113
114
Nelson, Jensen, and Steele
Hayden-Wade, H. A., Stein, R. I., Ghaderi, A., Saelens, B.
E., Zabinski, M. F., & Wilfley, D. E. (2005).
Prevalence, characteristics, and correlates of teasing
experiences among overweight children vs. non-overweight peers. Obesity Research, 13, 1381–1392.
Janicke, D. M., Marciel, K. K., Ingerski, L. M.,
Novoa, W., Lowry, Sallinen, B. J., & Silverstein, J. H.
(2007). Impact of psychosocial factors on quality of
life in overweight youth. Obesity, 15, 1799–1807.
Jensen, C. D., & Steele, R. G. (in press). The Perceptions
of Teasing Scale: Validation and role in predicting
attitudes toward physical activity in preadolescent
children. Children’s Health Care.
Jensen, C. D., & Steele, R. G. (2009). Brief report: Body
dissatisfaction, weight criticism, and self-reported
physical activity in preadolescent children. Journal of
Pediatric Psychology, 34, 822–826.
Juvonen, J., Graham, S., & Schuster, M. A. (2003).
Bullying among young adolescents: The strong, the
weak, and the troubled. Pediatrics, 112, 1231–1237.
Libbey, H. P., Story, M. T., Neumark-Sztainer, D. R.,
& Boutelle, K. N. (2008). Teasing, disordered eating
behaviors, and psychological morbidities among overweight adolescents. Obesity, 16, S24–S29.
Nansel, T. R., Overpeck, M., Pilla, R. S., Ruan, W. J.,
Simons-Morton, B., & Scheidt, P. (2001). Bullying
behavior among US youth. Journal of the American
Medical Association, 285, 2094–2100.
Nesdale, D., & Lambert, A. (2007). Effects of experimentally manipulated peer rejection on children’s negative affect, self-esteem, and maladaptive social
behavior. International Journal of Behavioral
Development, 31, 115–122.
Neumark-Sztainer, D., Falkner, N., Story, M., Perry, C.,
Hannan, P. J., & Mulert, S. (2002). Weight-teasing
among adolescents: Correlations with weight status
and disordered eating behaviors. International Journal
of Obesity and Related Metabolic Disorders, 26,
123–131.
Nishina, A., Juvonen, J., & Witkow, M. R. (2005). Stick
and stones may break my bones, but names will
make me feel sick: The psychosocial, somatic, and
scholastic consequences of peer harassment. Journal
of Clinical Child and Adolescent Psychology, 34, 37–48.
Ogden, C. L, Carroll, M. D., Curtin, L. R., Lamb, M. M.,
& Flegal, K. M. (2010). Prevalence of high body
mass index in US children and adolescent,
2007–2008. Journal of the American Medical
Association, 303, 242–249.
Phares, V., Steinberg, A. R., & Thompson, J. K. (2004).
Gender differences in peer and parental influences:
Body image disturbance, self-worth, and psychological functioning in preadolescent children. Journal of
Youth and Adolescence, 33, 421–429.
Ricciardelli, L. A., & McCabe, M. P. (2001). Children’s
body image concerns and eating disturbance: A
review of the literature. Clinical Psychology Review, 21,
325–344.
Stern, M., Mazzeo, S. E., Gerke, C. K., Porter, J. S.,
Bean, M. K., & Laver, J. H. (2007). Gender,
ethnicity, psychosocial factors, and quality of life
among severely overweight, treatment-seeking
adolescents. Journal of Pediatric Psychology, 32,
90–94.
Stockton, M. B., Lanctot, J. Q., McClanahan, B. S.,
Klesges, L. M., Klesges, R. C., Kumanyika, S.,
& Sherrill-Mittleman, D. (2009). Self-perception and
body image associations with body mass index
among 8-10-year-old African American girls. Journal
of Pediatric Psychology, 34, 1144–1154.
Storch, E. A., Milson, V. A., DeBraganza, N., Lewin, A.
B., Geffken, G. R., & Silverstein, J. H. (2007).
Peer victimization, psychosocial adjustment, and
physical activity in overweight and at-risk-foroverweight youth. Journal of Pediatric Psychology, 32,
80–89.
Thompson, J. K., Cattarin, J., Fowler, B., & Fisher, E.
(1995). The Perception of Teasing Scale (POTS): A
revision and extension of the Physical AppearanceRelated Teasing Scale (PARTS). Journal of Personality
Assessment, 65, 146–157.
Thompson, J. K, Shroff, H., Herbozo, S., Cafri, G.,
Rodriguez, J., & Rodriguez, M. (2007). Relations
among multiple peer influences, body dissatisfaction,
eating disturbance, and self-esteem: A comparison of
average weight, at risk of overweight, and overweight
adolescent girls. Journal of Pediatric Psychology, 32,
24–29.
Troop Gordon, W., & Ladd, G. W. (2005). Trajectories
of peer victimization and perceptions of self
and schoolmates: Precursors to internalizing and
externalizing problems. Child Development, 76,
1072–1091.
Tsiros, M. D., Olds, T., Buckley, J. D., Grimshaw, P.,
Brennan, L., Walkley, J., . . . Coates, A.M. (2009).
Health-related quality of life in obese children and
adolescents. International Journal of Obesity, 33,
387–400.
Weight-related Criticism
Tyler, C., Johnston, C. A., Dalton, W. T., & Foreyt, J. P.
(2009). Relationships between weight and body
dissatisfaction, body esteem, and teasing in African
American Girls. Journal of Black Psychology, 35,
125–132.
van der Wal, M. F., de Wit, C. A., & Hirasing, R. A.
(2003). Psychosocial health among young victims
and offenders of direct and indirect bullying.
Pediatrics, 111, 1312–1317.
Wardle, J., & Cooke, L. (2005). The impact of obesity
on psychological well-being. Best Practice and
Research: Clinical Endocrinology and Metabolism,
19(3), 421–440.
115