Exposure to Negative Weight Talk From Family Members Is Associated With Weight Bias Internalization in Children

Abstract

ObjectivesFrequent exposure to negative familial weight talk (NFWT), such as teasing or critical comments about weight from family members, may contribute to weight bias internalization (WBI) in children. WBI entails applying negative weight-based stereotypes to oneself and results in self-devaluation. Higher levels of WBI are linked to adverse outcomes, such as low self-esteem and disordered eating. We examined the association between NFWT exposure and WBI in a diverse sample of children from the Greater Boston Area. MethodsBaseline data on 137 parent-child dyads were analyzed. Children, 9–14yo, completed six items measuring NFWT frequency on a 6-point Likert scale (“never” to “almost every day”) from parents, siblings, and other household family members. Responses were converted to times in the past 3 months, summed, and dichotomized as < 9 times vs. ≥9 times. Children completed the WBI Scale–Modified indicating their agreement with applying negative weight-based statements to themselves on a 6-point Likert scale (“strongly disagree” to “strongly agree”). Responses were averaged and the mean WBI score was dichotomized as “low” (<3.0) versus “moderate-high” (≥3.0). ResultsOver half (52%) of the children were girls and 30% had overweight/obesity (BMI > 85th percentile). Half of the parents were non-Hispanic white. The mean child WBI score was 2.1 (SD = 0.9) and 15% had moderate-high levels of WBI. The median NFWT frequency was 0 (IQR = 6.0) and 25% reported NFWT ≥ 9 times. Children exposed to NFWT ≥ 9 times were 8.2 times more likely to have moderate-high levels of WBI than children exposed to NFWT < 9 times in the past 3 months (prevalence ratio = 8.2, 95%CI = 3.4 to 20.0, P < 0.001, by log binomial regression adjusted for child weight and parent race/ethnicity). ConclusionsFamily members appear to be a salient source of weight stigma in children. Exposure to NFWT as little as 3 times per month was significantly associated with moderate-high levels of WBI in this diverse sample of children. More research is needed to understand the impact of NFWT on child WBI, such as differences across racial/ethnic groups, by source (i.e., parents versus siblings), and across the lifespan. Funding SourcesNational Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Drug Abuse of the National Institutes of Health.