As early as first grade, children with severe obesity are more likely to be ostracized

The study was conducted by researchers at Oklahoma State University, the University of Arkansas for Medical Sciences, the University of North Carolina-Greensboro, and West Virginia University. It appears in the journal Child Development. While most prior research has used stories about hypothetical obese peers to determine how obese children are treated, this study collected information from multiple sources about real children in different weight groups.

In this study, children were considered overweight if they had a body-mass index (BMI) for their age at or above the 85th percentile, obese if they had a BMI for their age at or above the 95th percentile, and severely obese if they had a BMI for age at or above the 99th percentile. Children were considered to be of healthy weight if their BMI for age was between the 5th and 85th percentile.

"Severe obesity is a clear psychosocial risk for children, even as early as 6 years old," notes Amanda W. Harrist, professor of child development at Oklahoma State University, who led the study. "Children who are ostracized, as occurred with the severely overweight children in our study, suffer great harm, with feelings of loneliness, depression, and aggression, and these children are more likely to skip school and drop out later."

Researchers looked at 1,164 first graders from 29 rural schools in Oklahoma to examine the social and emotional lives of obese children. Children lived in 20 towns in eight counties with adult obesity rates of 28% to 41% and came from mostly low-income, White families; about a fifth of the students were from American Indian families.

The more overweight the children were, the worse the consequences, the study found. Severely obese children were teased more than overweight children. The study found that obese children weren't mentioned by peers when children were asked whom they liked to play with most and least. Severely obese children were actively rejected by their peers; they were frequently mentioned as their least favorite playmates and rarely mentioned as the most favorite. In terms of emotional health, severely obese children had more symptoms of depression than children who were overweight and of healthy weights. Furthermore, compared with overweight children, both severely obese and obese children had more physical symptoms (e.g., complaints of pain and visits to the school nurse) that may have been the result of stress or psychological concerns.

The study's authors say that being teased and rejected by peers and being depressed as a result may exacerbate children's struggles with weight over time. For example, obese children engage in emotional eating to deal with the pain of rejection, or they may avoid physical play with peers to avoid teasing, both behaviors that would lead to additional weight gain.

"Intervention or prevention efforts should begin early and target peer relationships," suggests Glade L. Topham, associate professor of marriage and family therapy at Oklahoma State University, a coauthor of the study. "Interventions addressing the behavior of peer groups can limit exclusion and teasing, and help students form friendships."