Susan M. Peters

Weight- and race-based bullying: Health associations among urban adolescents

Stigma-based bullying is associated with negative mental and physical health outcomes. In a longitudinal study, surveys and physical assessments were conducted with mostly Black and Latino, socioeconomically disadvantaged, urban students. As hypothesized, greater weight- and race-based bullying each was significantly indirectly associated with increased blood pressure and body mass index, as well as decreased overall self-rated health across 2 years, through the mechanism of more negative emotional symptoms. Results support important avenues for future research on mechanisms and longitudinal associations of stigma-based bullying with health. Interventions are needed to reduce stigma-based bullying and buffer adolescents from adverse health effects.

Shift-and-Persist: A Protective Factor for Elevated BMI Among Low- Socioeconomic-Status Children

Low socioeconomic status (SES) is associated with many adverse health outcomes, including childhood overweight and obesity. However, little is understood about why some children defy this trend by maintaining a healthy weight despite living in obesogenic environments. The objective of this study is to test the hypothesis that the psychological strategy of “shift‐and‐persist” protects low‐SES children from overweight and obesity. Shift‐and‐persist involves dealing with stressors by reframing them more positively while at the same time persisting in optimistic thoughts about the future.

Emotional Health Predicts Changes in Body Mass Index (BMI-z) Among Black and Latino Youth

Childhood obesity is a complex and multifaceted health problem linked to elevated risk for chronic diseases, such as diabetes, cancer, hypertension, and cardiovascular disease.1,2 Although research has increased dramatically in the past 2 decades, questions regarding factors driving overweight and obesity remain, particularly among youth of color who experience disproportionate rates of obesity and comorbid health conditions.3 Adolescence is a critical period in the developmental trajectory,4 in part because overweight and obese adolescents are more likely to remain overweight and/or obese in adulthood.3 Overweight and obesity have been associated with adverse symptoms and intra- and interpersonal psychological, social, and emotional issues that continue into adulthood, including depression and anxiety, social withdrawal, feeling worthless, lower self-esteem, and behavioral problems.5–7 Poor mental health may lead to increases in weight due to fluctuations in appetite, obesogenic behaviors (eg, overeating) to cope with negative mood, sedentary behavior, and increased isolation.8 Chronic stress or experiences of discrimination may also influence physiology and behaviors that affect weight gain.9 On the other hand, increased body mass index (BMI) could result in adverse emotional outcomes over time due to weight-based stigma, bullying, or poor self-esteem.5,6 The few longitudinal studies that have examined the association between emotional health and physical health outcomes have primarily taken a narrow focus of mental health symptoms (e.g., only examining depression)10 or behavioral concerns (e.g., conduct).11 Physical outcomes, including BMI, were often collected by self-report12 and/or retrospectively.13 Furthermore, they have been limited to predominantly White samples of older adolescents or adults.12,13 Persistent racial and ethnic disparities in overweight and obesity further complicate research as well as clinical prevention and intervention efforts. Black and Latino youth experience disproportionate levels of overweight and obesity beginning as early as preschool and are more likely to remain obese as adults compared with Whites.14 Blacks and Latinos also are at disproportionate risk for multiple negative health conditions associated with overweight and obesity, such as diabetes.14,15 Reasons for such disparities remain poorly understood and understudied. Although emotional health has been associated with weight in both adults and youth,16 prior research has been limited to cross-sectional studies.17 Longitudinal, prospective designs are critical to explicate the association between emotional health and BMI among Black and Latino youth. The primary objective of this study is to examine whether negative emotional symptoms prospectively predict increases in BMI z-scores (BMI-z) across 2 years among a sample of predominantly Black and Latino, urban youth. We hypothesize that more negative emotional symptoms measured at baseline (grades 5 and 6) would predict increases in BMI-z scores 2 years later. Results can inform programs and interventions aimed at reducing obesity in youth of color.

Associations of Neighborhood and School Socioeconomic and Social Contexts With Body Mass Index Among Urban Preadolescent Students

OBJECTIVES We examined independent and synergistic effects of school and neighborhood environments on preadolescent body mass index (BMI) to determine why obesity rates nearly double during preadolescence. METHODS Physical measures and health surveys from fifth and sixth graders in 12 randomly selected schools in New Haven, Connecticut, in 2009 were matched to student sociodemographics and school- and residential census tract-level data, for a total of 811 urban preadolescents. Key independent variables included school connectedness, neighborhood social ties, and school and neighborhood socioeconomic status. We estimated cross-classified random-effects hierarchical linear models to examine associations between key school and neighborhood characteristics with student BMI. RESULTS Greater average connectedness felt by students to their school was significantly associated with lower BMI. This association was stronger among students living in neighborhoods with higher concentrations of affluent neighbors. CONCLUSIONS How schools engage and support students may affect obesity rates preferentially in higher-income neighborhoods. Further research should explore the associations between multiple environments to which children are exposed and obesity-related behaviors and outcomes. This understanding of the multiple social-spatial contexts that children occupy has potential to inform comprehensive and sustainable child obesity prevention efforts.

Children's report of lifestyle counseling differs by BMI status.

BACKGROUND This study examined whether childrens report of receiving weight, nutrition, and physical activity counseling from their clinicians differs by their BMI status and identified factors associated with higher rates of counseling. METHODS Physical assessments and health surveys were collected from a school-based sample of 959 5(th) and 6(th) grade students. Multivariate logistic regression analysis was used to examine how lifestyle counseling differs by BMI status, adjusting for race, gender, socioeconomic status, co-morbidities, site of care provider, and age. RESULTS Healthy weight children reported receiving the least amount of lifestyle counseling, with nearly one-quarter reporting none at all. Overweight children were no more likely than their healthy weight peers to report receiving weight and nutrition counseling. As expected, obese children were approximately two times more likely to report being counseled on their weight, nutrition, or physical activity as compared to healthy weight children (all p values at least <0.01). However, 23.9% of obese children reported receiving no counseling about their weight. After adjusting for BMI and all other confounding factors, for each lifestyle topic, Hispanics were at least 1.84 times more likely than whites to report being counseled (all p values at least <0.05). Blacks were at least 1.38 times more likely than whites to report being counseled (all p values at least <0.05). Girls were at least 1.38 times more likely than boys to report being counseled (all p values at least <0.05). CONCLUSION Although lifestyle counseling is universally recommended, many children report not receiving counseling. Despite clinical indications for more intensive counseling, overweight children report similar counseling rates as their healthy weight peers. Furthermore, a substantial proportion of obese children report not receiving lifestyle counseling. Future research should examine how lifestyle counseling can more effectively reach all children.

Adolescents Who Visit the Emergency Department Are More Likely to Make Unhealthy Dietary Choices: An Opportunity for Behavioral Intervention

To identify health behaviors that may be amenable to brief screening and intervention among children in the emergency department (ED), we described the prevalence of health behaviors known to contribute to childhood obesity among middle school students who used the ED recently. Participants included 1590 5th, 7th, and 8th grade students who completed health surveys in 2011. Multivariate logistic regression was used to examine the association between health behaviors and ED use. Children who used the ED reported more unhealthy dietary behaviors, including greater consumption of energy-dense foods such as fried chicken, french fries, and ice cream (OR 1.20, 95% CI 1.06–1.37), fast food (OR 1.07, 95% CI 1.00–1.14) and sugar-sweetened beverages (OR 1.24, 95% CI 1.14–1.35). There was no association with fruit and vegetable consumption, physical activity, or screen time. Unhealthy dietary behaviors are associated with ED use in a low-resource urban population of middle school students.