Weight Labeling and Obesity: A Longitudinal Study of Girls Aged 10 to 19 Years

Letters RESEARCH LETTER Weight Labeling and Obesity: A Longitudinal Study of Girls Aged 10 to 19 Years Anti-obesity efforts that rely on stigmatizing weight (eg, using harsh language or stereotypical portrayals of over- weight individuals) may impede health promotion efforts, as weight stigma is often negatively related to behavior change and thus seems unlikely to result in weight loss. 1 Indeed, considerable research underscores the detrimental effects of weight stigma on the physical health and well-being of chil- dren and adolescents, 2 and nationally representative, longi- tudinal data show weight-based discrimination is associated with weight gain among older individuals. 3 Although the childhood weight stigma literature frequently examines overt and often malicious behaviors (eg, bullying), stigma pro- cesses can begin when an individual experiences weight labeling. 4 By labeling someone as overweight, the negative stereotypes, status loss, and mistreatment associated with this label may now be applicable to the individual. Recent research suggests that the negative psychological effects of weight stigma can begin when one is simply labeled as “too fat” by others. 5 However, the relationship between weight labeling and weight gain remains unknown. Thus, we exam- ined if weight labeling during childhood was related to the likelihood of having an obese body mass index (BMI) nearly a decade later. Methods | Sample . The National Heart, Lung, and Blood Insti- tute Growth and Health Study followed up girls who self- identified as black (n = 1213) or white (n = 1166) from age 10 years until age 19 years. Extensive study information is avail- able at https://biolincc.nhlbi.nih.gov/static/studies/nghs /Protocol.pdf. The National Heart, Lung, and Blood Institute Growth and Health Study protocol was approved by institu- tional review boards at all 3 sites (University of California, Berkeley; University of Cincinnati; and Westat/Group Health Association, Rockville, Maryland). The University of Califor- nia, Los Angeles Institutional Review Board provided human subjects approval for the current study. The child provided writ- ten assent and a parent/guardian provided written informed consent until the child became 18 years old, at which point she provided written informed consent. Measures. A parent or guardian provided income and educa- tion information at baseline. Certified staff conducted anthro- pometry and collected information on pubertal timing and weight labeling. Weight labeling was assessed by asking par- ticipants, “Have any of these people told you that you were too fat?” followed by a list that included father, mother, brother, sister, best girlfriend, boy you like best, any other girl, any other boy, and teacher. Participants reporting “yes” to any item were considered “labeled.” Results | Participants without BMI data at age 19 years (n = 317) were excluded from analyses. These participants did not dif- fer in baseline BMI, weight labeling, or race but had slightly lower levels of household income and parental education. At baseline, 57.9% (n = 1188) of participants reported being la- beled. Black girls reported more weight labeling than white girls (χ 21 = 16.13, P < .001), although this difference was small (φ = 0.089). Baseline BMI and weight labeling status were mod- erately correlated (r = 0.41, P < .001). Logistic regression analy- ses (Table) evaluated the association between baseline label- ing and obesity 10 years later. Adjusting for baseline BMI, household income, parental education, race, and age at men- arche, being labeled “too fat” at age 10 years remained a sig- nificant predictor of obesity at age 19 years (odds ra- tio = 1.66). The odds ratio was 1.62 when family members were the source of labeling and 1.40 when nonfamily members were the source. These effects were not modulated by race. Discussion | Being labeled “too fat” in childhood was associ- ated with higher odds of having an obese BMI nearly a decade later. Importantly, this relationship was independent of ini- tial BMI and thus not attributable simply to participants’ ob- jective weight at baseline. These data provide novel evidence that the relationship between weight stigma and weight gain may begin early in life; these findings also demonstrate that this relationship can emerge even for a seemingly innocuous Table. Results of Logistic Regression Analyses Predicting Obesity Status at Age 19 Years From Baseline Weight Labeling a Source of Labeling, OR (95% CI) Predictor Model 1: Anyone Model 2: Family Baseline BMI Model 3: Nonfamily Race Parental education Household income Age at menarche Baseline labeling jamapediatrics.com Abbreviations: BMI, body mass index; OR, odds ratio. a The pattern of results was the same when modeling both weight labeling and BMI as continuous variables; these full results are available from the authors. JAMA Pediatrics Published online April 28, 2014 Copyright 2014 American Medical Association. All rights reserved. Downloaded From: http://archpedi.jamanetwork.com/ by a University of California - Los Angeles User on 04/28/2014 E1