continued Why overweight children are more likely to have 'frenemies'
For the new Plos One study, de la Haye and her colleagues analyzed data on 504 children from 28 separate primary education classrooms in the Netherlands. The data, collected between 2001 and 2002, came from an ongoing nationwide research project called the Tracking Adolescents' Individual Lives Survey.
The data included questionnaire responses in which the children indicated who their best friends were in the classroom as well as the classmates they disliked in their class. The height and weight of each child were also included in the data and used to calculate each child's body mass index.
The researchers found that overweight children not only were less likely overall to be nominated as a friend than their non-overweight classmates, they were 1.65 times more likely to be disliked.
"We see examples of where there's overweight kids who will say 'Yeah, this person is my friend,' and that person has actually said, 'No, I actually dislike (the overweight kid),' " de la Haye said.
"This negative social environment is important to address because it can have a negative impact on overweight children's mental health and because it is a barrier to overweight kids adopting healthy habits," she said, adding that stigmatizing obesity does not motivate children to lose weight. "Overweight kids who experience peer rejection and social isolation are likely to exercise less, have greater food intake and have fewer positive role models for healthy habits and a healthy weight."
The new study had limitations, since it involved a sample of only Dutch children and examined friendships within a classroom and not outside of a school setting.
"This is really the first study that's looked at the 'dislike' relationships with that," de la Haye said. "We need to do a little more work to see if this would generalize to kids in the US; what we expect is that it would. ... Weight-based stigma seems to be something that's very common across countries."
Dr. Eliana Perrin, lead author of a separate study published last month in the journal Pediatrics, said children might carry an implicit bias toward their overweight peers, which could lead to unreciprocated friendships and bullying.
"Implicit bias probably does explain part of why children with obesity are more likely to be bullied," said Perrin, chief of the division of primary care in the department of pediatrics at Duke University School of Medicine.
"But it's important to realize that some children also have explicit bias and are conscious of the fact that they'd prefer a friend who is thin or would actively exclude a child with obesity from a sports team," she said.
'It's something that's learned pretty early'
The new Pediatrics study involved 114 children, 9 to 11 years old, in the Durham, North Carolina, area. The children were shown images of other children, of various weight sizes, for 350 milliseconds. Then they were shown a meaningless fractal image for 200 milliseconds and were asked to rate the abstract fractal image as "good" or "bad."