Sunday, September 7, 2014

Calling girls fat: Does it help?

Obesity is linked to several fatal and debilitating health conditions and is increasing in prevalence annually in the United States. Despite expensive and wide-reaching efforts to intervene by replacing vending machine goods with sugar-free and “healthy” choices, rates of obesity appear to only be getting worse. In fact, according to the CDC, approximately 18% of children aged 6-11 are obese (as of 2012) compared with 8% in 1980. So far, interventions have focused on stigmatizing obesity by reminding people that obesity is bad, and then trying to motivate weight loss behavior in the wake of that stigma. Unfortunately, several studies have shown that stigma has the opposite effect and actually increases behaviors that maintain obesity such as over-eating and not exercising.

Luckily, clinical and health psychologists have been busy exploring what we are doing wrong in the fight against obesity. For example, Jeffrey Hunger, a doctoral student at UCSB and Dr. Janet Tomiyama at UCLA recently published the results of a study asking:

Does labeling a child as “too fat” during childhood reduce their chances of being obese as adults?

To answer this question, they recruited 2,379 10-year-old females from Maryland, Ohio, and California. The parents of these girls provided information on parent education and family income, while each girl was evaluated for her weight, height, pubertal status and asked a simple question: “Have any of these people told you that you were too fat?” The girls were then given a list of people including their father, mother, brother, sister, best girlfriend, boy you like best, any other girl, any other boy, teacher, and reported on whether any of these people had ever “labeled” them as “too fat.”

The girls returned to complete the study by being weighed and measured when they were 19 years old. They found that girls who had been “labeled” as “too fat” at age ten were significantly more likely to be obese at age 19. In fact, girls who had anyone label them as “too fat” at age ten had an odds ratio of 1.66 of being obese at age 19. This means that for every additional person that called these 10-year old girls fat, their likelihood of being obese increased by 66%.

I know what you’re thinking. Aren’t the kids who are labeled as “too fat” when they are young more likely to be overweight later in life anyway? Yes, but Mr. Hunger and Dr. Tomiyama thought of that too. This finding is after controlling for each child’s family income, parent education, BMI, race, and pubertal timing at age 10. This means that there is likely a unique contribution to a young girl’s risk of being obese that is conferred by being labeled as “too fat” by a family member, peer, or friend as young as age 10. Whoa!

What was also very informative for me was the result broken down by family members vs non-family members. There have been several campaigns in the media focusing on bullying and negative peer influences on healthy development. One might think that being called “too fat” at school would be far more damaging than being called “too fat” at home. However, that wasn’t the case here. Girls who were labeled by a non-family member at age 10 had an odds ratio of 1.4 of being obese at age 19. This means that for every person who labeled the girl at age 10, her risk of being obese at age 19 increased by 40%. In comparison, girls who were labeled by a family member at age 10 had an odds ratio of 1.62 of being obese at age 19. This means that for every parent or sibling who labeled the girl at age 10, her risk of being obese at age 19 increased by 62%. In other words, being labeled as “too fat” by a family member is much worse than being labeled by a peer.

This was obviously not an experimental study, so keep in mind that there is no way to infer that being labeled “too fat” causes obesity later in life for these girls. Also, I wonder whether these findings are an under-estimation of the effect of labeling young girls. The question each girl was asked was very specific, “Have any of these people told you that you were too fat?” Many of the ways girls are “labeled” as “too fat” occurs in less explicit ways and I wonder whether any of that is being captured here.

The bottom line is that the evidence presented in this study is certainly enough to suggest that creating stigma around obesity is not helping our cause, if our goal is to reduce its incidence. As we move forward a greater emphasis should be placed on obesity prevention that reduces stigmatization and promotes self-efficacy instead. Instead of telling a child that they are fat, tell them that they are good at something active, teach them to enjoy playing outside, and model healthy eating habits. If you choose to drink water with meals, they will too; if you choose to drink soda, guess what?

Hunger, J.M. & J.A. Tomiyama (2014). Weight Labeling and Obesity: A Longitudinal Study of Girls Aged 10 to 19 Years. JAMA Pediatrics, 10(1), 49-57.

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