Short communicationThe stigmatization of obesity in children. A survey in Greek elementary schools
Introduction
Obesity is a major medical problem, not only in adults, but also in children and adolescents (Sorof & Daniels, 2002). According to the World Health Organization prevalence of overweight and obesity is increasing worldwide at a significant rate (WHO, 2000). Approximately, 22 million children less than 5 years old across the world are overweight (Deckelbaum & Williams, 2001). Studies in Greece have revealed an increased prevalence of overweight and obese individuals among Greek children (Krassas, Tzotzas, Tsametis, & Konstantinidis, 2001; Mamalakis, Kafatos, Manios, Anagnostopoulou, & Apostolaki, 2000; Tokmakidis, Kasambalis, & Christodoulos, 2006). In fact, Greece has one of the highest levels of childhood obesity in Europe (Lissau et al., 2004).
The effects of obesity on childhood are not only physical, but also psychological with the latter being the most widespread issue. The commonest medical consequences of obesity in children are early maturation, increased blood lipids, diabetes mellitus, hypertension, pseudotumor cerebri and sleep apnea (Dietz, 1998, Melidonis et al., 2006). With regards the psychological effects of obesity, overweight and obese children and adolescents usually become targets of societal stigmatization and systematic discrimination (Dietz, 1998; Puhl & Latner, 2007). According to Puhl and Latner (2007) weight stigma refers to negative weight-related attitudes and beliefs, which are manifested by stereotypes, bias, rejection, and prejudice towards overweight or obese individuals. Two decades ago, Parker and Asher (1987) reported that young persons, who are stigmatised for their weight, might fail to achieve normal social developmental competencies. More recent findings (Morrissette & Taylor, 2002) support Parker and Asher’s report, showing that obese children often face peer rejection, isolation, humiliation, and hostility during a time in their lives when acceptance and development of social skills are critical.
Overweight and obese children are vulnerable to weight stigma from other sources, in addition to that from peers. Educators, parents and even health professionals (Neumark-Sztainer, Story, & Harris, 1999; Neumark-Sztainer et al., 2002; Schwartz, Chambliss, Brownell, Blair, & Billington, 2003; Tiggemann & Wilson-Barrett, 1998; Wardle, Volz, & Golding, 1995) have been reported to stigmatise obese children.
Studies conducted in the early 1960s revealed high degrees of discrimination towards the obese among elementary school students (Goodman, Dornbusch, Richardson, & Hastorf, 1963; Maddox, Back, & Liederman, 1968; Richardson, Goodman, Hastorf, & Dornbusch, 1961). Latner and Stunkard (2003) replicated the Richardson et al. (1961) study on stigma in childhood obesity and found that the stigmatization of obesity by children has increased since the 1960s, although western societies have placed greater emphasis on the acceptance of human diversity.
A considerable number of Greek studies have investigated dietary habits and prevalence of overweight and obese individuals among Greek children (Karayiannis, Yannakoulia, Terzidou, Sidossis, & Kokkevi, 2003; Manios et al., 2007; Piperakis, Papadimitriou, Zafiropoulou, Piperakis, & Zisis, 2007; Roma-Giannikou, Adamidis, Gianniou, Nikolara, & Matsaniotis, 1997). However, no research on stigmatization of obesity in children has been ever conducted up to now in Greece. It is, therefore, our aim to bridge this significant gap and explore Greek elementary school students’ attitudes towards obesity in an effort to record the situation in Greece, compared to that of other countries.
Section snippets
Participants
A total of 1861 Greek students were recruited from 45 primary schools in Central Greece representing a mixed socioeconomic group. Of those, 934 (50.2%) were girls and 927 (49.8%) were boys. All participants, aged between 10 and 11 years, were of Greek origin and attended fifth grade (mean age = 10.93, S.D. = 0.35). Prior to their participation, their body mass index (BMI) was calculated based on anthropometric measures.
Body mass index
BMI was calculated as body weight divided by body height squared (kg/m2).
Results
Table 2 shows frequencies and percentages of participants in each of the six ranking positions. The majority of the participants (81.4%) ranked the “healthy child” figure first or second. On the contrary, the “obese child” figure was ranked last or second last by more than half of the participating sample (56.4%). A significant agreement on the rank order across participants, as shown by Kendall’s coefficient of concordance [W(5) = 0.27, p < 0.005] was found.
The “healthy child” figure was given the
Discussion
Obesity appears to elicit a very strong stigma. Stigmatised individuals are vulnerable to serious psychological and social effects (Puhl & Brownell, 2003). The fact that Greece has one of the highest levels of childhood obesity in Europe (Lissau et al., 2004), should give rise to serious concerns regarding not only the physical but also the psychological health of Greek children.
The present study aimed at investigating Greek elementary school students’ acceptance or disapproval of obesity with
Acknowledgments
We would like to thank Prof. J.D. Latner for her invaluable advice and for providing us with the figures used in this study.
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