School can be tough on kids who have overweight or obesity. They're often cruelly teased and bullied. And this type of bullying may lead to long-term consequences, according to a study published Thursday in the journal Pediatric Obesity.
The study, conducted by researchers at the Uniformed Services University of the Health Sciences in Bethesda, Md., and the National Institutes of Health, found that making fun of kids for their weight is linked to increased weight gain well into adulthood — and the more teasing that kids and teens experience, the more weight they may gain.
"There's this school of thought that says [weight-based] teasing might have a motivating effect on youth," says study author Natasha Schvey, assistant professor of medical and clinical psychology at the Uniformed Services University. "This study shows that that's not only not true but that teasing might increase weight gain over time."
To assess the link between teasing and weight gain, the authors recruited 110 children and young teens (average age was about 12 years) who were either overweight themselves or who had two parents with overweight. Having parents with overweight classifies children as at risk for being affected by overweight or obesity later in life.
During their first visit, the kids were asked to report whether they had been made fun of based on their size. Among participants with overweight, 62% reported they had been teased about their weight at least once, while 21% of straight-size, at-risk participants reported they had been.
The researchers followed up with these kids for an average of 8.5 years, some for up to 15 years.
Whether they had overweight at the study's start or not, those who reported being teased often for their weight gained 33% more body mass, on average, and 91% more fat per year than their peers who weren't teased.
Schvey cautions that the study was observational and could not directly determine cause and effect. "But we can say weight-based teasing was significantly linked with weight gain over time," she says.
Other research has shown that the stigma associated with overweight or obesity contributes substantially to negative health effects, including increased body dissatisfaction, which may lead to unhealthy coping mechanisms like binge eating.
Teasing can also lead to increased levels of the stress hormone cortisol, which can stimulate appetite, and increase risk for depression and anxiety — both of which contribute to disordered eating. It also may drive kids away from physical activities like sports and gym classes, where they risk getting made fun of for their size.
People affected by overweight or obesity bear an outsize burden of stigma and shame in the U.S. and elsewhere, says Stephen Pont, associate professor of pediatrics at the University of Texas at Austin's Dell Medical School, who works with patients affected by overweight or obesity.
"In the Western world, weight shaming is very common," he says. "Folks who are larger are often picked on in cartoons, in TV shows and commercials. Sometimes it's meant in a positive way, but when we talk to our patients, [they say] it makes them feel bad."
Unlike many other studies, though, the new study assessed whether being teased about their weight during the pivotal window of childhood affected people's weight over time and into their adult years.
"I really do think this is an area that needs more attention," says Rebecca Puhl, deputy director for the Rudd Center for Food Policy & Obesity at the University of Connecticut (Puhl previously taught Schvey). "This is contributing to poor health, bottom line."
Puhl also notes that the finding that over 60% of kids with overweight in the study were bullied shows how common this is for youth. "What [this] is telling us is that we need to do a better job protecting adolescents from weight-based teasing," she says.
For instance, while most public schools in the U.S. have anti-bullying policies in place, many do not contain provisions against weight-based teasing or bullying.
Parental support for taking action against weight-based teasing is high: In another study Puhl conducted, at least 81% of parents endorsed school-based policies addressing this type of bullying.
Not just peers, but also parents, teachers and even health care providers tease kids about their weight, the study notes. If these adult figures are truly serious about helping kids with obesity or overweight, Puhl says, they should be finding ways to reduce teasing — and teach kids strategies to cope with and transcend the insults when they happen.
"Clinicians and pediatricians need to be paying attention to this issue," Puhl says.