The relationship between weight stigma, body imag, self-esteem, risk of disordered eating, and weight loss behaviours in adolescents from the birth to twenty cohort: Soweto-Johannesburg

Abstract

Introduction: Overweight and obese adolescents are at risk of weight related stigmatization, which has been associated with unhealthy weight loss behaviours, and adverse psychosocial factors including poor body image, low self-esteem and the risk of disordered eating. Obesity in childhood increases the risk for adult obesity and the risk of related physical (cardiovascular diseases, diabetes, cancers) and psychosocial (poor body image, low self-esteem, depression and unhealthy weight loss behaviours) morbidity and mortality, which have been found to track from childhood to adulthood. Adolescent obesity is a growing public health concern in South Africa where a National strategy to address this concern has been formulated. Research examining weight related stigmatization in adolescent obesity while prolific in high-income countries has been minimal in South Africa. The study aimed to examine the relationship between weight stigma, body image, self-esteem, risk of disordered eating and weight loss behaviours in urban adolescents aged 13 from the Birth to Twenty cohort in Soweto-Johannesburg. Methods: A secondary data analysis was conducted of data from an urban sample of boys and girls from the Birth to Twenty cohort in Soweto-Johannesburg at 13 years of age. Measures from the 13-year questionnaire used included questions on weight loss attempts, reasons and methods together with weight stigma (Beliefs About Obese Persons (BAOP) and a disability rating task), body image (body-esteem scale), Rosenberg Self-Esteem scale, EAT26 (disordered eating risk) measures and body mass index. Some socio-demographic characteristics of participants collected at enrolment into the study were also included. Bivariate and multivariate analyses were conducted to test for associations between the outcome measure (weight loss) and socio-demographic characteristics and weight stigma, body image, self-esteem and disordered eating risk. Results: High weight stigma was significantly associated with weight loss attempts in girls (aOR 20.1, 95% CI 4.3-94.0, p<0001). Overweight and obese girls were significantly more likely to have attempted weight loss as compared to the reference group (aOR 5.5, 95% CI 1.2-8.5, p<0.001) and (aOR 12.9, 95% CI 4.7-9.0, p<0.001). Poor body image in girls was significantly associated with weight loss (aOR0.4, 95% CI 0.2-0.9, p=0.036). Furthermore, girls who had attempted weight loss were 2.5 times more likely to be at risk for disordered eating (aOR 2.5, 95% CI 1.4-4.5, p=0.002). High socio-economic status in girls was significantly associated with weight loss attempts (aOR 2, 95% CI 1.0-3.9, p=0.040). No significant associations were found for weight stigma and body image in relation to weight loss for boys. Overweight and obese boys were about 11 and 13 times more likely to have attempted weight loss compared to those in the normal or underweight category (aOR 10.9, 95% CI 6.0-19.7, p<0.000 and aOR 13.4, 95% CI 5.5-32.5, p<0.001). Weight loss was more likely to have been attempted by 90% of boys with low self-esteem (aOR 0.9, 95% CI 0.9-1.0, p<0.047). More girls than boys tried to lose weight (20.5% and 13.1% respectively). Primary reasons for weight loss were to look better (about 27.5% and 28.7% of boys and girls respectively) and their clothes were too tight (20.2% of girls and13.7% of boys). More boys (19.6%) than girls (12.9%) wanted to lose weight as they saw themselves as too fat compared to friends. More boys than girls tried to lose weigh to be healthy (16.7% and 14.6% respectively). Exercise for weight loss was the primary method chosen (74.2% boys and 49.4% of girls). Dietary restriction (eating less, skipping meals or eating one meal per day) was the favoured weight loss method by more girls (25%) than boys (17.8%). Conclusion: This analysis found an association between weight loss behaviours and weight stigma, body image and risk for disordered eating in girls even while adjusting for BMI. The only associations with weight loss behaviours found in boys, were for BMI and self-esteem. The findings highlight the need for further investigation into weight stigma as internalised and overtly experienced and the association with unhealthy weight loss behaviours in adolescents.