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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 4  |  Page : 133-138

Weight stigma, coping strategies, and mental health among children with overweight


Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

Date of Submission17-Jun-2019
Date of Decision23-Jun-2019
Date of Acceptance15-Jul-2019
Date of Web Publication18-Oct-2019

Correspondence Address:
Dr. Chung-Ying Lin
Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom
Hong Kong
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_26_19

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  Abstract 


Introduction: Obesity/overweight (hereafter, overweight indicates both obesity and overweight) is an important health issue that is gaining growing interest worldwide. One health issue for children with overweight is stigma. The aims of this study were (1) to detect the impact of stigma on mental health and (2) to probe the effects of positive and negative coping on the mental health of children with overweight. Methods: The author conducted a secondary data analysis using two waves of data from the Taiwan Education Panel Survey (TEPS): the first wave in 2001 and the second wave in 2003. A group of junior high school students (in the 7th grade in the first wave; n = 2612; nmale = 1171) was used for data analysis. Items in the TEPS were categorized into the following five variables: mental health (nine items), stigma from peers (three items in relationship with peers and four items in bullying experience), stigma from parents (four items), positive coping strategies (six items in increasing social activities and two items in increasing self-study activities), and negative coping strategies (five items). Results: The overweight group experienced more peer stigma than the normal-weight group. Bullying experience, stigma from parents, and self-study activities were significantly correlated to mental health in both groups. The overweight group demonstrated stronger negative relationships between bullying events, negative strategies, and mental health than the normal-weight group; a weaker negative relationship was shown between stigma from parents and mental health. Conclusion: Stigma and negative strategies could endanger mental health among children with overweight.

Keywords: Child, coping, mental health, obesity, stigma


How to cite this article:
Lin CY. Weight stigma, coping strategies, and mental health among children with overweight. Soc Health Behav 2019;2:133-8

How to cite this URL:
Lin CY. Weight stigma, coping strategies, and mental health among children with overweight. Soc Health Behav [serial online] 2019 [cited 2019 Nov 17];2:133-8. Available from: http://www.shbonweb.com/text.asp?2019/2/4/133/269506




  Introduction Top


Obesity/overweight (hereafter, overweight indicates both obesity and overweight) is an important health issue that is gaining growing interest worldwide. The negative impact of overweight has been found on physical health, mental health, and quality of life.[1],[2],[3],[4],[5],[6],[7],[8] Unfortunately, the prevalence of overweight is high worldwide.[9] Although the prevalence of overweight in some countries has increased, in some – especially high-income countries – the overweight prevalence has plateaued.[9] With the high (and possibly increasing) prevalence, the issues relating to children with overweight should be taken care of by health-care providers. Specifically, children with overweight have a higher risk of developing physical diseases, such as cardiovascular disease, type II diabetes, and hypertension, than their peers with normal weight.[10] In addition, children with overweight usually have worse physical functioning than their normal-weight peers.[8] In terms of mental health, some researches suggest that children with overweight have low self-esteem, depression, and anxiety.[1],[11] Furthermore, being bullied or teased by peers is often experienced or encountered by children or adolescents with overweight.[12]

Despite the importance of physical functioning among children with overweight, their psychosocial functioning should not be ignored.[11],[13] Thus, understanding stigmatization among children with overweight is needed for health-care providers because it is considered a cause of poor mental health.[14],[15] Research suggests that children with overweight are easily stigmatized by educators, parents, and peers.[16] Some educators, especially physical educators, may believe that children with overweight are less likely to succeed, are more emotional, and are more likely to have family problems than children with normal weight. In addition, one study showed that nearly half of the teachers believed that obesity is often caused by neglect or lacking love.[16] These teachers further agreed that most people feel uncomfortable when they interact with people with overweight. Parents – particularly parents of children with overweight – consider that children with overweight have negative characteristics (e.g., laziness); therefore, the parents may endorse stereotypes toward children with overweight.[17] Peers may dislike children with overweight the most compared with children with different types of disability (e.g., amputee, scarred face, or wheelchair bound).[18],[19]

Unfortunately, when children with overweight grow up, such stigmatization toward overweight may not vanish if they keep their overweight status. One study investigated 318 adults with overweight and found that 61.4% experienced their worst stigma experiences in adulthood.[20] This finding indicated that children with overweight are likely to suffer stigma through their maturation if they do not change their weight status. Furthermore, some policies launched in school settings (e.g., body mass index [BMI] screening) may further strengthen the effects of stigma on children with overweight.[21] Indeed, this type of policy (e.g., monitoring and screening the weight status of a child) may help school educators or health professionals better understand the health condition of children with overweight; it is argued that such screening practices may hurt the self-esteem of children with overweight and may result in their low motivation toward physical activity or social interaction.[22]

Because children with overweight are likely to encounter stigma, they usually develop their own coping strategies to defend themselves in dealing with the encountered stigma. Research has found that children with overweight share some similar coping strategies to children with normal weight, including drawing, excess eating and excess drinking, playing a game, and saying “I am sorry,” when they face stress.[23] Research also suggests that some children with overweight use aggressive and fighting behavior as one of their coping strategies.[24] Therefore, children with overweight may adopt positive (e.g., drawing and reading) or negative (e.g., fighting and excess eating) strategies to cope with the encountered stigma. Thus, detecting the effects of positive and negative coping styles on mental health among children with overweight is important. Specifically, positive coping strategies (e.g., exercising) may result in improved physical and mental health,[25] whereas negative strategies (e.g., inactivity) may subsequently impair physical and mental health.[16]

The purposes of this study were (1) to detect the impact of stigma from parents and peers on the mental health of children with overweight and (2) to probe the effects of the positive and negative coping strategies for their mental health that children with overweight use.


  Methods Top


Data

The author analyzed data from the research project entitled “Taiwan Education Panel Survey (TEPS).”[26] Three waves of investigation in the TEPS, which used random stratified sampling by city/country and public/private schools, have been conducted and released. After excluding missing data, those participants (n = 2612) who participated in both the first (conducted in 2001) and the second wave (conducted in 2003) were used for analysis. The details of the TEPS can be found elsewhere.[27] In brief, all participants and their parents agreed to participate in the TEPS and gave their consents. The ethics approval of the present study was not required because the data analyzed were from the existing TEPS dataset.

All the participants were in the 7th grade in the first wave and 9th grade in the second wave. The author used their BMI in the 7th grade to classify them into the following two groups: normal-weight group (boys: BMI = 17.0–22.0; girls: BMI = 17.0–22.2, n = 2086) and overweight group (boys: BMI >22.0; girls: BMI >22.2, n = 526).

Measures

Mental health, stigma, coping strategies, and environmental settings were considered in this study. The author used the items from the first wave to assess stigma, coping strategies, and environment and the items from the second wave to assess mental health. Thus, the temporal association may somewhat indicate the causality of stigma, coping strategies, and environment on mental health. The following three categories describe the items for each variable.

Mental health contains nine items rated on a 4-point Likert-type scale. The nine items together explained 42.57% of the underlying construct with satisfactory internal consistency (Cronbach's α =0.829). All the items were asked in negative wordings; thus, all the items were reversely coded to make a higher score that represents better mental health. The nine items shared the same item stem of “Since the eighth grade, how often do you have the following feelings?” The item descriptions were as follows: (1) do not want to interact with others; (2) feel upset; (3) want to yell, crash things, or fight; (4) feel shaking, nervous, or distracted; (5) feel lonely; (6) cannot sleep well and easily wake up or have nightmares; (7) feel headache, weak, or tremor in extremities; (8) are angered by others; and (9) feel regret and self-blaming.

Stigma contains two sources: one from peers and another from parents. In stigma from peers, two domains of relationship with peers and bullying experience were adopted. In the relationship with peers, three items rated on a 3-point Likert-type scale were used; together, they could explain 61.89% of the underlying construct with acceptable internal consistency (Cronbach's α = 0.689). All the items were asked in positive wordings; thus, all the items were reversely coded to make a higher score that represents a higher level of stigma. In bullying experience, four items rated on a 4-point Likert-type scale were used; together, they could explain 47.34% of the underlying construct with a decent internal consistency (Cronbach's α = 0.520). All the items were asked in negative wordings; thus, a higher score represented a higher level of stigma. In stigma from parents, four 4-point Likert-type items were used; together, they could explain 47.33% of the underlying construct with acceptable internal consistency (Cronbach's α = 0.626). All the items were asked in negative wordings; thus, a higher score represented a higher level of stigma.

The item stem of the relationship with peers in the stigma from peers was “How do others think about you?” The item descriptions were as follows: (1) popular among classmates; (2) good at sports; and (3) fond of by teachers. The item stem of the bullying experience in the stigma from peers was “From the beginning of the semester, how often did the following descriptions happen?” The item descriptions were as follows: (1) someone stole my properties; (2) someone wanted to sell drugs to me; (3) someone threatened me; and (4) someone robbed me. The item stem of the stigma from parents was “What is the relationship between you and your parents?” The item descriptions were as follows: (1) I argue with my father; (2) I argue with my mother; (3) I can be supported by my father; and (4) I can be supported by my mother.

Coping strategies included both positive and negative strategies. In positive strategies, increasing social activities and increasing self-study activities were included. In increasing social activities, six items rated on a 4-point Likert-type scale were used; together, they could explain 51.70% of the underlying construct with excellent internal consistency (Cronbach's α = 0.800). All the items were asked in positive wordings; thus, a higher score represented more participation in social activities. In the increasing self-study activities, two items rated on a 4-point Likert scale were used; together, they could explain 56.00% of the underlying construct. Both items were asked in positive wordings; thus, a higher score represented more participation in self-study activities. In negative strategies, five items rated on a 4-point Likert-type scale were used; together, they could explain 63.53% of the underlying construct with excellent internal consistency (Cronbach's α = 0.819). All the items were asked in negative wordings; thus, a higher score represented more usage of negative strategies.

The item stem of the increasing social activities in the positive strategies was “Since this semester, how often have you done the following activities?” The item descriptions were as follows: (1) listened to pop music; (2) listened to classical music; (3) visited gallery or museum; (4) visited technology or computer exhibition; (5) visited bookstore or library; and (6) serviced the community. The two items of the increasing self-study activities in the positive strategies were “How long do you exercise, listen to music, and watch TV every day?” and “How long do you read biography, economic books, or books of technology information every week?” The item stem of the negative strategies was “During the semester, how often did you do the following things?” The item descriptions were as follows: (1) dropped a class; (2) fought in the school and argued with teachers; (3) smoked, drank, or ate betel nut; (4) ran away from home; and (5) stole or crashed others' properties.

Statistical analysis

The significance level was set at 0.05 in all statistical analyses, including independent t-test, Pearson's correlation, Spearman's correlation, and Fisher's t-to-Z tests. Independent t-tests were used to test the differences of mental health, relationship with peers, bullying experience, stigma from peers, stigma from parents, positive coping strategies, and negative coping strategies between the two groups. Pearson's correlations and Spearman's correlations were used to test the relationships among the aforementioned variables. All the correlation coefficients between the two groups were tested by Fisher's t-to-Z tests.


  Results Top


Demographic data are presented in [Table 1]. Significant differences were found in relationship with peers (P < 0.001), bullying experience (P = 0.042), increased self-study activities (P = 0.036), and negative strategies (P = 0.048) between the two groups, whereas no significant differences were found in mental health, stigma from parents, and increased social activities [Table 1]. The overweight group experienced more peer stigma than the normal-weight group. In other words, children in overweight group had worse relationship with peers and were bullied more than the children in normal-weight group. In addition, children with overweight showed less self-study activities and used more negative strategies than normal-weight children.
Table 1: Demographic data, mental health stigma, and coping

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[Table 2] indicates that bullying experiences, stigma from parents, and self-study activities were significantly correlated to mental health in both groups. Negative strategies were significantly correlated to mental health in the overweight group but not in the normal-weight group. After comparing the correlation coefficients between the two groups, the author found that the levels of relationship between the two groups were statistically significantly different in bullying experience (Z = 9.153; P < 0.001), stigma from parents (Z = 7.916; P < 0.001), self-study activities (Z = 35.144; P < 0.001), and negative strategies (Z = 28.435; P < 0.001). Specifically, the overweight group demonstrated stronger negative relationships between bullying events, negative strategies, and mental health than the normal-weight group, whereas a weaker negative relationship was shown between stigma from parents and mental health.
Table 2: Correlations between stigma, coping, and mental health

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  Discussion Top


Children with overweight did not appear to have worse mental health than the normal-weight children; however, the children with overweight received more levels of stigma among their peers as previous research suggested.[16],[18],[19],[28] In addition, the study results demonstrate that children with overweight used less positive strategies but more negative strategies than normal-weight children. Not surprisingly, consistent with the study conjectures, the impact of stigma and coping strategies on mental health was found in children with overweight as previous research had shown.[16] The study findings are partly aligned to previous studies that suggested that stigma influences the mental health of children with overweight.[1],[8],[16] The study findings demonstrate that different types of stigma result in different outcomes: bullying experience and stigma from parents influence the mental health of children with overweight, whereas a poor peer relationship does not impact their mental health. Although both bullying experiences and poor peer relationships are embedded in the same concept of stigma from peers, they have different levels in terms of intensity, and their impacts may differ. Specifically, the feeling of threat from being bullied is stronger than from an unfriendly relationship, such as isolation or dislike. As a result, the author suggests that children with overweight may be capable of handling negative impacts from unfriendly relationship; however, they have difficulty in coping with the negative impacts from bullying experiences.

Stigma from parents was found both in children with overweight and in those with normal weight. Surprisingly, the impact of stigma from parents on the mental health of normal-weight children was greater than the impact on the mental health of children with overweight. One possible reason is that the stigma from parents was toward academics instead of toward overweight. Given that most of the parents in Taiwan focus on academic performance and force their children to obtain good grades among all academic subjects,[29] the author postulated that the stigma from parents was toward academic performance rather than toward weight status for both groups.

Studies have pointed out that positive strategies are good for the mental health of children with overweight;[25],[30] however, such positive impacts were not found in the present study. Two reasons could explain the finding that there were no benefits of positive strategies for the mental health among children with overweight. First, children with overweight in the study did not perceive the advantages from their positive strategies. In contrast, some studies [25],[30] have suggested that children with overweight benefit from their positive strategies (e.g., by increasing caloric consumption and decreasing body fat). Second, no rapport was established when children with overweight used positive strategies. Thus, despite the finding that positive strategies are recommended for children with overweight as their coping strategies, positive feedback should be accompanied by stressing the advantages of positive strategies. The author also found that using more negative strategies caused worse mental health. Therefore, health-care providers should assist children with overweight in reducing the use of negative strategies and enhancing the use of positive strategies.

There are some limitations in this study. First, because this study was analyzed using a secondary dataset, the author cannot confirm that the stigma and adapting strategies assessed in this study came solely from the participants' overweight status. Second, all the measures were conducted using self-reports. Thus, the common biases resulting from self-reports (e.g., recall bias and social desirability) are threats to the findings of this study. Third, the generalizability of the findings may be limited because all the participants were junior high school students. Therefore, it is unclear whether younger children (e.g., aged <10 years) and older adolescents (e.g., aged >15 years) share the same conditions that the author found in the specific sample (i.e., 7th-grade students). Fourth, the items used to assess mental health, stigma, and coping were not from a standardized questionnaire. Therefore, the reliability and validity of these underlying constructs that the author assessed in this study may be questionable. However, the author at least verified some degrees of validity (using exploratory factor analysis) and reliability (using internal consistency) for all the studied constructs.


  Conclusion Top


The present study suggests that stigma and negative strategies could endanger the mental health among children with overweight. Health-care providers should thus try to reduce the stigma toward children from their peers. Health-care providers may also want to help children with overweight develop more positive coping strategies and avoid using negative strategies when they need to cope with stigma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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