Understanding childhood weight bias: Laying the foundation for promoting positive body image

Tingting Xu; Yuan He; Sarah Savoy

doi:10.37291/2717638X.202671727

Authors

Tingting Xu Stephen F. Austin State University https://orcid.org/0000-0003-2939-769X
Yuan He Stephen F. Austin State University https://orcid.org/0000-0001-9758-592X
Sarah Savoy Stephen F. Austin State University https://orcid.org/0000-0003-4378-7950

DOI:

https://doi.org/10.37291/2717638X.202671727

Keywords:

Weight bias, Body image, Early childhood, Cultural context, The tripartite model

Abstract

This study interviewed 131 kindergarten children in China regarding their perspectives on body size-related bias and associated behavioral tendencies using a case study design. Results showed that body satisfaction was prevalent among this group of young children. Similar to studies conducted in Western cultures targeting young children, body weight bias was evident among this group of Chinese kindergarteners with a strong preference for thinner body types, regardless of their genders. Qualitative findings indicated that weight bias could influence children's behaviors, with a tendency to select friends who either share similar body sizes or have slimmer body types. Meanwhile, children with higher body weight may be perceived as a “protector” prototype, a distinctive discovery and contribution to current literature. Findings also suggested a significant peer influence on body size perception, with family members also playing a role. However, the absence of media influence in the current study highlights the need to reconsider the tripartite model’s applicability in non-Western cultural contexts and distinct age groups, offering a unique contribution to the body image literature with young children.

References

Anderson-Fye, E. P. (2004). A “Coca-Cola” shape: Cultural change, body image, and eating disorders in San Andrés, Belize. Culture, Medicine, and Psychiatry, 28, 561-595. DOI: https://doi.org/10.1007/s11013-004-1068-4

Anderson-Fye, E. P. (2011). Body image in non-western cultures. In T. F. Cash & L. Smolak (Eds.), Body image: A handbook of science, practice, and prevention (2nd ed., pp.244-252). The Guilford Press.

Andrew, R., Tiggemann, M., & Clark, L. (2016). Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Developmental Psychology, 52(3), 463- 474. DOI: https://doi.org/10.1037/dev0000095

Baker, A. E. (2005). Body, self, and society: The view from Fiji. University of Pennsylvania Press.

Burmeister, J. M., Zbur, S., & Musher-Eizenman, D. (2016). Active versus inactive portrayals of children with obesity. Stigma and Health, 1(2), 101. DOI: https://doi.org/10.1037/sah0000016

Brylinsky, J. A., & Moore, J. C. (1994). The identification of body build stereotypes in young children. Journal of Research in Personality, 28(2), 170-181. DOI: https://doi.org/10.1006/jrpe.1994.1014

Blüher, M. (2019). Obesity: Global epidemiology and pathogenesis. Nature Reviews Endocrinology, 15(5), 288-298. DOI: https://doi.org/10.1038/s41574-019-0176-8

Carels, R. A., Young, K. M., Wott, C. B., Harper, J., Gumble, A., Oehlof, M. W., & Clayton, A. M. (2009). Weight bias and weight loss treatment outcomes in treatment-seeking adults. Annals of Behavioral Medicine, 37(3), 350-355. DOI: https://doi.org/10.1007/s12160-009-9109-4

Clark, L., & Tiggemann, M. (2006). Appearance culture in nine‐to 12‐year‐old girls: Media and peer influences on body dissatisfaction. Social Development, 15(4), 628-643. DOI: https://doi.org/10.1111/j.1467-9507.2006.00361.x

Collins, M. E. (1991). Body figure perceptions and preferences among preadolescent children. International Journal of Eating Disorders, 10(2), 199-208. DOI: https://doi.org/10.1002/1098-108X(199103)10:2<199::AID-EAT2260100209>3.0.CO;2-D

Cramer, P., & Steinwert, T. (1998). Thin is good, fat is bad: How early does it begin?. Journal of Applied Developmental Psychology, 19(3), 429-451. DOI: https://doi.org/10.1016/S0193-3973(99)80049-5

Damiano, S. R., Gregg, K. J., Spiel, E. C., McLean, S. A., Wertheim, E. H., & Paxton, S. J. (2015). Relationships between body size attitudes and body image of 4-year-old boys and girls, and attitudes of their fathers and mothers. Journal of Eating Disorders, 3, 1-10. DOI: https://doi.org/10.1186/s40337-015-0048-0

Department of Health & Social Care. (2022). Better health childhood obesity. https://www.nhs.uk/healthier-families/

Dittmar, H., Halliwell, E., & Ive, S. (2006). Does barbie make girls want to be thin? The effect of experimental exposure to images of dolls on the body image of 5- to 8-year-old girls. Developmental Psychology, 42(2), 283–292. DOI: https://doi.org/10.1037/0012-1649.42.2.283

Dohnt, H. K., & Tiggemann, M. (2005). Peer influences on body dissatisfaction and dieting awareness in young girls. British Journal of Developmental Psychology, 23(1), 103-116. DOI: https://doi.org/10.1348/026151004X20658

Durso, L. E., & Latner, J. D. (2008). Understanding self‐directed stigma: development of the weight bias internalization scale. Obesity, 16(S2), S80-S86. DOI: https://doi.org/10.1038/oby.2008.448

Faragó, F., & Savoy, S., Xu, T., & He, Y. (2023). Body weight representation in children's picturebooks. Contemporary Issues in Early Childhood, 26(2). DOI: https://doi.org/10.1177/14639491231215387

Fu, L. G., Wang, H. J., Li, X. H., Yang, Y. D., Sun, L. L., & Ma, J. (2014). Analysis on the correlation of body image dissatisfaction and body shape parameters among children and adolescents. Chinese Journal of Child Health Care, 22(11), 1174–1178.

Flannery-Schroeder, E. C., & Chrisler, J. C. (1996). Body esteem, eating attitudes, and gender-role orientation in three age groups of children. Current Psychology, 15, 235-248. DOI: https://doi.org/10.1007/BF02686880

Gondoli, D. M., Corning, A. F., Salafia, E. H. B., Bucchianeri, M. M., & Fitzsimmons, E. E. (2011). Heterosocial involvement, peer pressure for thinness, and body dissatisfaction among young adolescent girls. Body Image, 8(2), 143-148. DOI: https://doi.org/10.1016/j.bodyim.2010.12.005

Harriger, J. A., Calogero, R. M., Witherington, D. C., & Smith, J. E. (2010). Body size stereotyping and internalization of the thin ideal in preschool girls. Sex Roles, 63, 609–620. DOI: https://doi.org/10.1007/s11199-010-9868-1

Harriger, J. A., & Trammell, J. P. (2022). First do no harm: Measuring weight bias beliefs in preschool-age children. Body Image, 40, 176-181. DOI: https://doi.org/10.1016/j.bodyim.2021.12.005

Harriger, J. A., Schaefer, L. M., Thompson, J. K., & Cao, L. (2019). You can buy a child a curvy Barbie doll, but you can’t make her like it: Young girls’ beliefs about Barbie dolls with diverse shapes and sizes. Body Image, 30, 107-113. DOI: https://doi.org/10.1016/j.bodyim.2019.06.005

Harrison, K. (2000). Television viewing, fat stereotyping, body shape standards, and eating disorder symptomatology in grade school children. Communication Research, 27(5), 617-640. DOI: https://doi.org/10.1177/009365000027005003

Harrison, K., & Hefner, V. (2006). Media exposure, current and future body ideals, and disordered eating among preadolescent girls: A longitudinal panel study. Journal of Youth and Adolescence, 35, 146-156. DOI: https://doi.org/10.1007/s10964-005-9008-3

Harrison, S., Rowlinson, M., & Hill, A. J. (2016). “No fat friend of mine”: Young children's responses to overweight and disability. Body Image, 18, 65-73. DOI: https://doi.org/10.1016/j.bodyim.2016.05.002

Harter, S. (1999). The construction of the self. Guilford Press.

Helfert, S., & Warschburger, P. (2011). A prospective study on the impact of peer and parental pressure on body dissatisfaction in adolescent girls and boys. Body Image, 8(2), 101-109. DOI: https://doi.org/10.1016/j.bodyim.2011.01.004

Heatherton, T. F. (2011). Body image and gender. International Encyclopedia of the Social & Behavioral Sciences, 1282-1285. DOI: https://doi.org/10.1016/B0-08-043076-7/03856-0

Himmelstein, M. S., & Puhl, R. M. (2019) Weight-based victimization from friends and family: implications for how adolescents cope with weight stigma. Pediatric Obesity, 14, e12453. DOI: https://doi.org/10.1111/ijpo.12453

Holt, K., & Ricciardelli, L. A. (2002). Social comparisons and negative affect as indicators of problem eating and muscle preoccupation among children. Journal of Applied Developmental Psychology, 23(3), 285-304. DOI: https://doi.org/10.1016/S0193-3973(02)00108-9

Holub, S. C., Tan, C. C., & Patel, S. L. (2011). Factors associated with mothers’ obesity stigma and young children's weight stereotypes. Journal of Applied Developmental Psychology, 32, 118–126. DOI: https://doi.org/10.1016/j.appdev.2011.02.006

Hutchinson, N., & Calland, C. (2019). Body image in the primary school: A self-esteem approach to building body confidence (2nd ed.). Routledge. DOI: https://doi.org/10.4324/9780429198694

Jones, D. C. (2001). Social comparison and body image: Attractiveness comparisons to models and peers among adolescent girls and boys. Sex Roles, 45, 645-664. DOI: https://doi.org/10.1023/A:1014815725852

Jones, D. C., & Crawford, J. K. (2005). Adolescent boys and body image: Weight and muscularity concerns as dual pathways to body dissatisfaction. Journal of Youth and Adolescence, 34, 629-636. DOI: https://doi.org/10.1007/s10964-005-8951-3

Jordan, J. V., & Hartling, L. M. (2002). New developments in relational–cultural theory. In M. Ballou & L. S. Brown (Eds.), Rethinking mental health and disorder: Feminist perspectives (pp. 48–70). Guilford Press.

Kawamura, K. Y. (2011). Asian American body image. In T. F. Cash & L. Smolak (Eds.), Body image: A handbook of science, practice, and prevention (2nd ed., pp.229-243). The Guilford Press.

Kim, H., & Han, T. I. (2021) Body image concerns among South Korean kindergarteners and relationships to parental, peer, and media Influences. Early Childhood Education Journal, 49, 177–184. DOI: https://doi.org/10.1007/s10643-020-01059-z

Kornilaki, E. (2014). Peer acceptance of obese preschool children. In Proceedings of the XVI European Conference on Developmental Psychology (pp.121-123). Medimond International Proceedings.

Latner, J. D., & Stunkard, A. J. (2003). Getting worse: The stigmatization of obese children. Obesity Research, 11(3), 452-456. DOI: https://doi.org/10.1038/oby.2003.61

Lennon, S. J., & Johnson, K.K.P. (2021). Men and muscularity research: A review. Fash Text 8, 20. DOI: https://doi.org/10.1186/s40691-021-00245-w

Levine, M. P., & Harrison, K. (2004) Media’s role in the perpetuation and prevention of negative body image and disordered eating. In J. K. Thompson (Ed.), Handbook of eating disorders and obesity (pp. 695–717). Wiley.

Lowes, J., & Tiggemann, M. (2003). Body dissatisfaction, dieting awareness and the impact of parental influence in young children. British Journal of Health Psychology, 8(2), 135-147. DOI: https://doi.org/10.1348/135910703321649123

Lunde, C., Frisén, A., & Hwang, C. P. (2006). Is peer victimization related to body esteem in 10-year-old girls and boys?. Body Image, 3(1), 25-33. DOI: https://doi.org/10.1016/j.bodyim.2005.12.001

Markus, H. R., & Hamedani, M. G. (2020). People are culturally-shaped shapers: The psychological science of culture and culture change. In Kitayama S., Cohen D. (Eds.), Handbook of cultural psychology (2nd ed., pp. 11–52). Guilford Press.

Miles, M. B. & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd Ed.). Sage.

ObamaWhiteHouse. (2017). Let’s move. https://letsmove.obamawhitehouse.archives.gov/

MOE. (2001). 幼儿园教育指导纲要（试行）. [Guidelines for Kindergarten Education]. http://www.moe.gov.cn/srcsite/A06/s3327/200107/t20010702_81984.html

Paxton, S. J., & Damiano, S. R. (2017). The development of body image and weight bias in childhood. Advances in Child Development and Behavior, 52, 269-298. DOI: https://doi.org/10.1016/bs.acdb.2016.10.006

Pearl, R. L., & Puhl, R. M. (2018). Weight bias internalization and health: a systematic review. Obesity Reviews, 19(8), 1141-1163. DOI: https://doi.org/10.1111/obr.12701

Perez, M., Kroon Van Diest, A. M., Smith, H., & Sladek, M. R. (2018). Body dissatisfaction and its correlates in 5-to 7-year-old girls: A social learning experiment. Journal of Clinical Child & Adolescent Psychology, 47(5), 757-769. DOI: https://doi.org/10.1080/15374416.2016.1157758

Phares, V., Steinberg, A. R., & Thompson, J. K. (2004). Gender differences in peer and parental influences: Body image disturbance, self-worth, and psychological functioning in preadolescent children. Journal of Youth and Adolescence, 33(5), 421-429. DOI: https://doi.org/10.1023/B:JOYO.0000037634.18749.20

Pont, S. J., Puhl, R., Cook, S. R., Slusser, W. (2017). Stigma experienced by children and adolescents with obesity. Pediatrics, 140 (6), e20173034. DOI: https://doi.org/10.1542/peds.2017-3034

Puhl, R. M. (2022). Weight stigma, policy initiatives, and harnessing social media to elevate activism. Body Image, 40, 131-137. DOI: https://doi.org/10.1016/j.bodyim.2021.12.008

Puhl, R. M., & King, K. M. (2013). Weight discrimination and bullying. Best Practice & Research Clinical Endocrinology & Metabolism, 27(2), 117-127. DOI: https://doi.org/10.1016/j.beem.2012.12.002

Puhl, R. M., Luedicke, J., & DePierre, J. A. (2013). Parental concerns about weight-based victimization in youth. Childhood Obesity, 9(6), 540-548. DOI: https://doi.org/10.1089/chi.2013.0064

Puhl, R. M. & Latner J. D. (2007). Stigma, obesity, and the health of the nation's children. Psychological Bulletin, 133(4), 557–580. DOI: https://doi.org/10.1037/0033-2909.133.4.557

Puhl, R. M., Lessard, L. M. (2020). Weight stigma in youth: Prevalence, consequences, and considerations for clinical practice. Current Obesity Report, 9, 402–411. DOI: https://doi.org/10.1007/s13679-020-00408-8

Puhl, R. M., Luedicke, J. (2012). Weight-based victimization among adolescents in the school setting: emotional reactions and coping behaviors. Journal of Youth and Adolescence, 41, 27–40. DOI: https://doi.org/10.1007/s10964-011-9713-z

Puhl, R. M., Wall, M. M., Chen, C., Bryn Austin, S., Eisenberg, M.E., Neumark-Sztainer, D. (2017). Experiences of weight teasing in adolescence and weight-related outcomes in adulthood: A 15-year longitudinal study. Preventive Medicine, 100, 173–179. DOI: https://doi.org/10.1016/j.ypmed.2017.04.023

Rand, C. S., & Resnick, J. L. (2000). The “good enough” body size as judged by people of varying age and weight. Obesity Research, 8(4), 309–316. DOI: https://doi.org/10.1038/oby.2000.37

Ricciardelli, L. A., & McCabe, M. P. (2001). Self-esteem and negative affect as moderators of sociocultural influences on body dissatisfaction, strategies to decrease weight, and strategies to increase muscles among adolescent boys and girls. Sex Roles, 44, 189-207. DOI: https://doi.org/10.1023/A:1010955120359

Rich, S. S., Essery, E. V., Sanborn, C. F., DiMarco, N. M., Morales, L. K., & LeClere, S. M. (2008). Predictors of body size stigmatization in Hispanic preschool children. Obesity, 16, S11–S17. DOI: https://doi.org/10.1038/oby.2008.446

Richardson, S. A., Goodman, N., Hastorf, A. H., & Dornbusch, S. M. (1961). Cultural uniformity in reaction to physical disabilities. American Sociological Review, 26 (2), 241–247. DOI: https://doi.org/10.2307/2089861

Rodgers, R., & Chabrol, H. (2009). Parental attitudes, body image disturbance and disordered eating amongst adolescents and young adults: A review. European Eating Disorders Review, 17, 137–151. DOI: https://doi.org/10.1002/erv.907

Ruble, D. N. (1983). The development of social comparison processes and their role in achievement-related self-socialization. In E. T. Higgins, D. N. Ruble, & W. W. Hartup (Eds.), Social cognition and social development: A sociocultural perspective (pp. 134-157). Cambridge University Press.

Ruble, D. N., Eisenberg, R., & Higgins, E. T. (1994). Developmental changes in achievement evaluation: Motivational implications of self‐other differences. Child Development, 65(4), 1095-1110. DOI: https://doi.org/10.2307/1131307

Sands, E. R., & Wardle, J. (2003). Internalization of ideal body shapes in 9–12‐year‐old girls. International Journal of Eating Disorders, 33(2), 193-204. DOI: https://doi.org/10.1002/eat.10121

Schousboe, K., Visscher, P. M., Erbas, B., Kyvik, K. O., Hopper, J. L., Henriksen, J. E., ... & Sørensen, T. I. A. (2004). Twin study of genetic and environmental influences on adult body size, shape, and composition. International Journal of Obesity, 28(1), 39-48. DOI: https://doi.org/10.1038/sj.ijo.0802524

Schur, E. A., Sanders, M., & Steiner, H. (2000). Body dissatisfaction and dieting in young children. International Journal of Eating Disorders, 27(1), 74-82. DOI: https://doi.org/10.1002/(SICI)1098-108X(200001)27:1<74::AID-EAT8>3.0.CO;2-K

Shomaker, L. B., & Furman, W. (2009). Parent—adolescent relationship qualities, internal working models, and attachment styles as predictors of adolescents’ interactions with friends. Journal of Social and Personal Relationships, 26(5), 579-603. DOI: https://doi.org/10.1177/0265407509354441

Smolak, L. (2004). Body image in children and adolescents: Where do we go from here? Body Image, 1, 15–28. DOI: https://doi.org/10.1016/S1740-1445(03)00008-1

Smolak, L. (2011). Body image development in childhood. In Cash, T. F. & Smolak, L. (Eds), Body image: A handbook of science, practice, and prevention (2nd ed., pp 67-75). The Guilford Press.

Smolak, L., & Levine, M. P. (2001). Body image in children. In J. K. Thompson, & L. Smolak (Eds.), Eating disorders and obesity in youth: Assessment, prevention and treatment (pp. 41–66). American Psychological Association. DOI: https://doi.org/10.1037/10404-002

Spiel, E. C., Paxton, S. J., & Yager, Z. (2012). Weight attitudes in 3- to 5-year-old children: Age differences and cross-sectional predictors. Body Image, 9, 524-527. DOI: https://doi.org/10.1016/j.bodyim.2012.07.006

Spiel, E. C., Rodgers, R. F., Paxton, S. J., Wertheim, E. H., Damiano, S. R., Gregg, K. J., & McLean, S. A. (2015). ‘He's got his father's bias’: Parental influence on weight bias in young children. British Journal of Developmental Psychology, 34(2), 198-211. DOI: https://doi.org/10.1111/bjdp.12123

Tiggemann, M. (2012). Sociocultural perspectives on body image. Encyclopedia of Body Image and Human Appearance, 2, 758-765. DOI: https://doi.org/10.1016/B978-0-12-384925-0.00120-6

Tiggemann, M. (2019). Relationships that cultivate positive body image through body acceptance. In T. L. Tylka & N. Piran (Eds.), Handbook of positive body image and embodiment (pp. 214-222). Oxford University Press. DOI: https://doi.org/10.1093/med-psych/9780190841874.003.0021

Tiggemann, M., & Anesbury, T. (2000). Negative stereotyping of obesity in children: The role of controllability beliefs. Journal of Applied Social Psychology, 30(9), 1977-1993. DOI: https://doi.org/10.1111/j.1559-1816.2000.tb02477.x

Tiggemann, M., & Slater, A. (2014). NetTweens: The internet and body image concerns in preteenage girls. The Journal of Early Adolescence, 34(5), 606-620. DOI: https://doi.org/10.1177/0272431613501083

Tiggemann, M., & Wilson‐Barrett, E. (1998). Children's figure ratings: Relationship to self‐esteem and negative stereotyping. International Journal of Eating Disorders, 23(1), 83-88. DOI: https://doi.org/10.1002/(SICI)1098-108X(199801)23:1<83::AID-EAT10>3.0.CO;2-O

Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance. American Psychological Association. DOI: https://doi.org/10.1037/10312-000

Tylka, T. L. (2018). Overview of the field of positive body image. In E. A. Daniels, M. M. Gillen, & C. H. Markey (Eds.), Body positive: Understanding and improving body image in science and practice (pp. 6-33). Cambridge University Press. DOI: https://doi.org/10.1017/9781108297653.002

van den Berg, P., Thompson, J. K., Obremski-Brandon, K., & Coovert, M. (2002). The tripartite influence model of body image and eating disturbance: A covariance structure modeling investigation testing the mediational role of appearance comparison. Journal of Psychosomatic Research, 53(5), 1007-1020. DOI: https://doi.org/10.1016/S0022-3999(02)00499-3

van Geel, M., Vedder, P., & Tanilon, J. (2014). Are overweight and obese youths more often bullied by their peers? A meta-analysis on the correlation between weight status and bullying. International Journal of Obesity, 38(10), 1263-7. DOI: https://doi.org/10.1038/ijo.2014.117

Vygotsky, L. S., & Cole, M. (1978). Mind in society: Development of Higher Psychological Processes. Harvard University Press.

Wadden, T. A., Brown, G., Foster, G. D., & Linowitz, J. R. (1991). Salience of weight‐related worries in adolescent males and females. International Journal of Eating Disorders, 10(4), 407-414. DOI: https://doi.org/10.1002/1098-108X(199107)10:4<407::AID-EAT2260100405>3.0.CO;2-V

Wang, H. (2021). The somatic turn in the aesthetics and its significance—A cross-cultural perspective. Academic Journal of Humanities & Social Sciences, 4(6), 66-70. DOI: https://doi.org/10.25236/AJHSS.2021.040611

Wang, Y., Cao, R., Peng, X., Zhang, L., Zhang, Z., & Fu, L. (2022). Association between body image dissatisfaction and body anthropometric indices among Chinese children and adolescents at different developmental stages. Frontiers in Public Health, 10, 926079. DOI: https://doi.org/10.3389/fpubh.2022.926079

World Health Organization. (2024). World obesity day 2024 - obesity & youth: Young people catalyzing change. https://www.who.int/news-room/events/detail/2024/03/04/default-calendar/world-obesity-day-2024-obesity-youth-young-people-catalyzing-change

Worobey, J., & Worobey, H. S. (2014). Body-size stigmatization by preschool girls: In a doll's world, it is good to be “Barbie”. Body Image, 11(2), 171-174. DOI: https://doi.org/10.1016/j.bodyim.2013.12.001

Xu, T. & He, Y. (2022). Body size perceptions among normal-weight kindergarten children in China. International Journal of Early Childhood, 54, 245–259. DOI: https://doi.org/10.1007/s13158-021-00300-z

Xu, T., He, Y., Faragó, F., & Savoy, S. (2024). Positive body image-related strategies in children’s Picturebooks. Early Childhood Education Journal, 52, 1447-1458. DOI: https://doi.org/10.1007/s10643-023-01543-2

Xu, T., & Nerren, J. (2017). Investigating young children’s perceptions of body size and healthy habits. Early Childhood Education Journal, 45, 499–507. DOI: https://doi.org/10.1007/s10643-016-0786-x

Yin, R. (1994). Case study research: Design and methods (2nd ed.). Sage.

Zhang, Y., Li, T., Yao, R., Han, H., Wu, L., et al. (2020). Comparison of body-image dissatisfaction among Chinese children and adolescents at different pubertal development stages. Psychology Research and Behavior Management, 13, 555–562. DOI: https://doi.org/10.2147/PRBM.S242645