Background

Though 2/3 of US adults and nearly 1/3 of US children have overweight or obesity, weight stigma and social pressures regarding weight are common. Many with overweight or obesity ascribe these negative ideas to themselves, resulting in internalized weight bias (IWB). In adults, IWB has been shown to be associated with psychosocial problems; however, less is known about children. We aimed to describe IWB in children with overweight and obesity and to study the association of children’s IWB with peer teasing, self-esteem, and their parents’ IWB.

Methods

We surveyed children ages 9-18 with overweight or obesity (BMI ≥ 85th percentile for age and gender) and their parents in four general pediatric clinics. Children completed the Weight Bias Internalization Scale-Youth (WBIS-Y), Rosenberg Self-Esteem Scale, and Perception of Teasing Scale. Parent surveys included the Weight Bias Internalization Scale-Modified (WBIS-M). Chi-square and t-tests were used to examine associations between categorical and continuous variables, respectively. Multivariate linear regression was used to identify correlates of WBIS-Y.

Results

Of 111 child participants, 56.1% were male and mean age was 13.6 years; 39.4% were white, 44.2% black, and 10.6% Hispanic. Of 111 parents, 13.1% had healthy weight and 85.2% had overweight or obesity. The median WBIS-Y score was 2.8 out of 7. Higher IWB was associated with more peer teasing (OR=0.39(95% CI 0.09, 0.68), p=0.011) and lower self-esteem (-0.17(-0.22, -0.12), p<0.001). Child age, BMI z-score, and parent IWB were not associated with IWB in children.

Conclusions

Internalized weight bias in children is similar across ages and races or ethnicities. Children who have experienced more teasing by peers or who have lower self-esteem are more likely to have a higher IWB. The connection between teasing, self-esteem, and IWB and their development in children is an area for future research. However, increasing child BMI z-score and parent IWB do not correlate with higher child IWB.