May 4, 2010 — Obese children are more likely to be bullied than their nonobese peers regardless of sex, race, socioeconomic status (SES), social skills, or academic achievement, according to a University of Michigan study published online May 3 in Pediatrics. This suggests that they are being bullied because of their weight and not for other reasons.
Julie Lumeng, MD, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, and colleagues found that obese children were almost twice as likely to be bullied (odds ratio, 1.8) than their peers who were not obese based on their unadjusted analysis. Children who were overweight were 1.2 times more likely to be bullied than children who were not overweight.
In adjusted analysis, researchers found obese children were still 1.6 times more likely to be bullied than nonobese children and overweight children 1.1 times more likely to be bullied than their normal weight peers. "The association was partially attenuated but not eliminated by the child's race, family SES, school demographic profile, social skills, and academic achievement," the study authors write.
The greater likelihood of obese children being bullied was equally strong among males and females, whites and other races, and poor and not poor, as well as across schools of all types of demographic profiles and across the 10 US study sites participating in the study. The association between bullying and obesity was "equally strong" across the spectrum of social skills and academic achievement. Similar trends were seen for children who were overweight, but results did not reach statistical significance.
"The main reason we were uncertain that there would be an association between obesity and bullying is that obesity is so much more common now — in some communities, 1 out of 4 children is obese — so obese children are not really outliers anymore, which is why we asked, is the association between obesity and bullying really true," Dr. Lumeng told Medscape Psychiatry.
"And while we thought we could make this association go away, no matter what subgroup we looked at or what we controlled for, it was still true, and not only was it true but there was a strong association between obesity and the risk of being bullied to the point where being obese by far outstripped other risk factors for being bullied, including being male and being a low-income child," she added.
Bullying Common
The study included 821 children in the third, fifth, and sixth grades who were participants in The Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development — a longitudinal study focusing on child behavior and development.
Participants were recruited at birth beginning in 1991 and are representative of the demographics of each of the 10 participating study sites.
Height and weight were measured during study visits in the third, fifth, and sixth grades by standard protocol. An 18-item questionnaire developed by longitudinal study investigators was administered to the children, whereas a 43-item questionnaire was administered to both teachers and mothers. In grade 3, investigators found that 14.6% of the children were overweight and 17.3% were obese.
Slightly more than half of the cohort was male, whereas 18.9% were races other than white. The mean income-to-needs ratio again in grade 3 was 4, whereas the mean social skills rating system scores were 105.2 by mothers and 101.9 by teachers. Mean Woodcock-Johnson Psycho-Educational Battery–Revised scores were 110.7 in reading and 115.9 in math.
The study showed that teachers reported that 33.9% of the children in grade 6 had been bullied. On the basis of parental reports, 44.5% of the same children had been bullied, whereas 24.9% of the children themselves reported having been bullied in the same grade.
Table. Odds Ratios for Being Bullied According to Various Risk Factors
| Risk Factor | Unadjusted Model | Adjusted Model |
| Obese | 1.85 | 1.63 |
| Overweight | 1.26 | 1.13 |
| Male | 1.45 | 1.38 |
| Lowest quartile income-to-needs ratio | 1.80 | 1.16 |
| Race (other than white) | 1.68 | 0.68 |
Interventions Needed
Interventions that address bullying within schools are badly needed, as are interventions that address obesity at the individual and community level, the researchers note.
"Despite the increase in childhood obesity prevalence, the stigmatization of obese children remains pervasive," they write, "[and] because the bullying of obese children seems to be rooted in negative perceptions of obesity by other children, future research might consider evaluating approaches to modifying those perceptions."
As to what practitioners may do to help mitigate the negative effects of being bullied, Dr. Lumeng suggested they should try and elicit a history of bullying when caring for obese children.
"We know that bullying has a big impact on a child's well-being, and what this study suggests is that physicians should take a history of bullying when treating an obese child in order to assess its potential impact on their well-being," she said.
She also feels that physicians should counsel parents not to use the fact that their child is being bullied to coerce a child into losing weight.
"Some parents think that their child will be motivated to lose weight because of the bullying, but obesity is really complicated, and what leads to obesity is not easy to solve because if it were no adult would be obese," Dr. Lumeng said.
"So when children are struggling with obesity, your first response should be to empathize and tell them that it's not right that others are saying the things they are or doing the things they are because, otherwise, they may reinforce the bad feelings the child is already experiencing from being bullied."
The study was supported in part by the American Heart Association Midwest Affiliate Grant-in-Aid to Dr. Lumeng. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 3, 2010.
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Cite this: Obesity Makes Children a Target for Bullying - Medscape - May 04, 2010.
