Very overweight teens face a social world of stigma, discrimination, and isolation because of their body size, reveals an analysis of their views, published in the online journal BMJ Open.
And they have to overcome many other additional barriers to lose weight, making it especially hard for them to shed the pounds, the findings suggest.
The latest figures suggest that roughly two out of ten 11 to 15 year olds in England are classified as obese. But evidence on what young people think about larger body size is hard to come by.
The researchers therefore scanned 18 research databases in the fields of health, public health, education, social science and social care; 54 relevant websites; and six key journals, looking for published data on young people's views of body size.
They focused on UK teens between the ages of 12 and 18, all of whom had taken part in in-depth or semi-structured interviews and/or focus groups, between 1997 and 2010. They excluded any research dealing only with eating disorders.
They found 30 relevant studies, involving just over 1400 12-18 year olds. Young people had talked about three main areas: general and societal perceptions of differing body sizes; what it was like to be overweight; and what it was like to try and lose excess weight.
The analysis revealed that young people of all body sizes in the UK predominantly felt that the social implications of a large body size were more important than the health consequences.
In general, young people thought that individuals were responsible for their own body size. They associated excess weight with negative stereotypes of laziness, greed, and a lack of control. And they felt that being overweight made an individual less attractive and opened them up to bullying and teasing.
Young people who were already overweight tended to blame themselves for their size. And those who were classified as very overweight said they had been bullied and physically and verbally assaulted, particularly at school. They endured beatings, kickings, name-calling, deliberate and prolonged isolation by peers, and sniggering/whispering.
Some young people described coping strategies, such as seeking out support from others. But the experiences of being overweight included feeling excluded, ashamed, marked out as different, isolated, ridiculed and ritually humiliated. Everyday activities, such as shopping and socializing, were difficult.
Overweight young people described others' responses to their appearance as a key factor in loss of confidence, anxiety, loneliness and depression, and a vicious circle of subsequent comfort eating and further weight gain.
The level of ridicule they faced made it hard for them to take part in exercise to lose weight, but so too did breathlessness on exertion and other complications of overweight, such as asthma.
And the ready availability of calorie dense foods, poor dietary advice, and constant pressure to lose weight were cited as other barriers to achieving a healthy weight.
Few studies asked young people what would help them cope better with these pressures, but less judgemental responses from health professionals, and the support and encouragement of family and friends were seen as important.
"The perspectives of young people in the UK, when synthesized across the spectrum of body sizes, paint a picture of a stigmatizing and abusive social world," write the authors.
And they add: "Approaches that merely educate and admonish individuals about lifestyles and being overweight are not only insufficient but also potentially counterproductive."
- R. W. Rees, J. Caird, K. Dickson, C. Vigurs, J. Thomas. 'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK. BMJ Open, 2014; 4 (4): e004404 DOI: 10.1136/bmjopen-2013-004404
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