Teasing and HRQOL Among Treatment-seeking Overweight Youth
Teasing and HRQOL Among Treatment-seeking Overweight Youth
Numerous negative psychosocial correlates of overweight and obesity in childhood and adolescence have been identified, including increased teasing. Moreover, research has demonstrated significant reductions in HRQOL among overweight and obese youth compared to normal-weight peers. The primary aim of this investigation was to examine the longitudinal associations between perceived teasing experiences and HRQOL among children and adolescents who are overweight or obese. Consistent with previous studies, results from this investigation suggest that child-reported teasing and HRQOL are correlated across three measurement periods spanning 15 months. However, results from latent regression analyses did not support the hypothesis that teasing would predict subsequent HRQOL. Rather, findings suggest that HRQOL negatively predicts teasing at two prospective time periods. Furthermore, the correlations between these constructs remained consistent (and relatively high) across a 15-month time period, suggesting stability in teasing and HRQOL over time.
Overall, our findings contribute to the literature on the health-related correlates of peer-victimization and WRT. Consistent with previous reports (Schwimmer, Burwinkle, & Varni, 2003; Stern et al., 2007), our findings confirm associations between teasing and HRQOL. However, our study is unique in its choice of sample (i.e., overweight and obese children participating in weight management programs), and in its longitudinal measurement of relevant constructs. Correspondingly, this study was able to advance the literature by demonstrating the stability of teasing over time, as well as the stability of the associations among teasing and HRQOL. Despite increases in HRQOL over time (reported previously, Steele et al., 2011), associations between HRQOL and teasing remained significant. This finding may underscore the robust association between teasing and QOL, as well as the risk for teasing despite weight control treatment.
Hypothesized predictive relationships between teasing and HRQOL were examined to provide further information about directionality of influence. Previous cross-sectional studies have inferred that higher levels of teasing predict poorer quality of life outcomes (e.g., Janicke et al. 2007). One of the express aims of this study was to test this assumed predictive relationship. Contrary to the study hypothesis and in contrast with the previously assumed direction of influence, teasing did not significantly predict HRQOL at subsequent time periods. Although this null finding does not provide definitive evidence that this predictive relationship is not possible, this study casts doubt on the previously inferred, and possibly intuitive, direction of influence in the teasing–HRQOL relationship for overweight and obese youths.
Next, this study sought to evaluate the hypothesis that HRQOL would significantly predict teasing at subsequent measurement occasions. Study results supported this hypothesis at both prospective time intervals. This is perhaps the most interesting study finding, particularly because HRQOL has predominantly been conceptualized as an outcome variable in previous investigations (e.g., Janicke et al., 2007). Consistent with the Dyadic Theory of peer victimization, our study results suggest that psychosocial deficits consistent with poorer quality of life are likely to represent social weaknesses that increase risk for teasing. This may be an important area for future research, particularly because significant variability in HRQOL exists among overweight and obese youths (Williams et al., 2005). Moreover, findings from this study provide evidence that improving children's adaptive functioning may decrease the frequency and psychological impact of teasing, suggesting that increasing HRQOL may discourage teasing among overweight youth. A similar pattern has been demonstrated in studies examining self-esteem among overweight children. For example, Jelalian et al. (2006) demonstrated that an intervention incorporating peer-based social skills training improved overweight children's self-esteem, even in the absence of weight loss. It is conceivable that increasing children's HRQOL (e.g., social skills training, increasing physical competencies) may not only lead to primary benefits of improved health but salutary effects on teasing.
Study results also provide support for the longitudinal stability of both teasing and HRQOL constructs among treatment-seeking overweight youth. Specifically, latent regression analyses demonstrated that earlier teasing and HRQOL predicted later levels for both constructs. Furthermore, these regression coefficients remained consistent over the three measurement occasions spanning 15 months. These findings provide additional support to previous Investigations, which have reported longitudinal stability in both teasing and HRQOL for overweight and obese youth (e.g., Eisenberg, Neumark-Sztainer, Haines, & Wall, 2006).
Although improvements in physical health are often the ultimate goal of weight management intervention, numerous investigators have suggested that diminished HRQOL is the most prevalent and immediate consequence of obesity in childhood (Wallander, Taylor, Grunbaum, Franklin, Harrison, Kelder, & Schuster, 2009). Results from the present study provide additional support to this thesis, suggesting that improvements in HRQOL may lead to decreased risk for teasing.
In contrast to study results employing child-reported HRQOL, parent-reported teasing was not highly correlated with HRQOL at any of the measurement occasions. This result contradicts Janicke and colleagues' (2007) finding that child-reported peer victimization correlated with parent-reported HRQOL. However, this discrepancy may be a result of differences between measured peer victimization constructs: Janicke et al. measured peer victimization generally (including physical aggression) while this study limited its scope to teasing about weight and ability. Moreover, this discrepancy may not be surprising given the reported inconsistencies between parent- and child-reported HRQOL in the larger literature (Cremeens et al., 2006; Zeller & Modi, 2006). Predictive regressions between parent-reported HRQOL and child-reported teasing were nonsignificant. As mentioned previously, correlations at the three measurement intervals were small and only the Time 2 correlation reached statistical significance. As might be expected given this lack of association, none of the hypothesized longitudinal predictive regressions were significant. Because youth-reported teasing was used in both models, these discrepancies are likely attributable to differences in self- and parent-reported HRQOL discussed previously.
Several methodological limitations to the present study should be noted.
First, the use of a passive longitudinal design does not allow causal inferences to be drawn because this methodology does not allow for isolation of independent variables nor does it control potential confounding variables. Thus, causality can only be implied using the present study design (Farrell, 1994; Little et al., 2007). An experimental test of an intervention engendering increased HRQOL with appropriate control would be necessary to confirm a causal relationship with HRQOL predicting teasing. Moreover, because of the specific study sample, the results of this study are generalizable only to treatment-seeking overweight and obese youths. Additionally, the wide age range of participants (ages 7–17) may have masked age-related differences in study variables. Finally, the existing literature suggests that peer victimization/teasing and the impact of these experiences vary across gender and ethnic/racial groups. Results of the current study should not be generalized outside of the specific demographic groups represented in the study sample.
Results from this study suggest that interventions designed to improve HRQOL outcomes may reduce teasing among overweight and obese youth. Although quality of life is most often conceptualized as an outcome variable, this study provides evidence that poor physical and psychosocial functioning (e.g., mood problems, social interaction difficulties, physical limitations, and school problems) are risk factors for later teasing. Moreover, results suggest that interventions leading to improved HRQOL may reduce teasing. In general, multi-component pediatric weight management programs have proven to be the most effective currently available method for improving HRQOL among overweight youth, although specific mechanisms behind this improvement (i.e., which components lead to change) are unclear (Lamanna, Kelly, Stern & Mazzeo, 2010). Future interventions for overweight youth and experimental studies of their effectiveness could target more proximal/functional variables associated with HRQOL even more so than weight reduction as critical outcomes.
Discussion
Numerous negative psychosocial correlates of overweight and obesity in childhood and adolescence have been identified, including increased teasing. Moreover, research has demonstrated significant reductions in HRQOL among overweight and obese youth compared to normal-weight peers. The primary aim of this investigation was to examine the longitudinal associations between perceived teasing experiences and HRQOL among children and adolescents who are overweight or obese. Consistent with previous studies, results from this investigation suggest that child-reported teasing and HRQOL are correlated across three measurement periods spanning 15 months. However, results from latent regression analyses did not support the hypothesis that teasing would predict subsequent HRQOL. Rather, findings suggest that HRQOL negatively predicts teasing at two prospective time periods. Furthermore, the correlations between these constructs remained consistent (and relatively high) across a 15-month time period, suggesting stability in teasing and HRQOL over time.
Overall, our findings contribute to the literature on the health-related correlates of peer-victimization and WRT. Consistent with previous reports (Schwimmer, Burwinkle, & Varni, 2003; Stern et al., 2007), our findings confirm associations between teasing and HRQOL. However, our study is unique in its choice of sample (i.e., overweight and obese children participating in weight management programs), and in its longitudinal measurement of relevant constructs. Correspondingly, this study was able to advance the literature by demonstrating the stability of teasing over time, as well as the stability of the associations among teasing and HRQOL. Despite increases in HRQOL over time (reported previously, Steele et al., 2011), associations between HRQOL and teasing remained significant. This finding may underscore the robust association between teasing and QOL, as well as the risk for teasing despite weight control treatment.
Hypothesized predictive relationships between teasing and HRQOL were examined to provide further information about directionality of influence. Previous cross-sectional studies have inferred that higher levels of teasing predict poorer quality of life outcomes (e.g., Janicke et al. 2007). One of the express aims of this study was to test this assumed predictive relationship. Contrary to the study hypothesis and in contrast with the previously assumed direction of influence, teasing did not significantly predict HRQOL at subsequent time periods. Although this null finding does not provide definitive evidence that this predictive relationship is not possible, this study casts doubt on the previously inferred, and possibly intuitive, direction of influence in the teasing–HRQOL relationship for overweight and obese youths.
Next, this study sought to evaluate the hypothesis that HRQOL would significantly predict teasing at subsequent measurement occasions. Study results supported this hypothesis at both prospective time intervals. This is perhaps the most interesting study finding, particularly because HRQOL has predominantly been conceptualized as an outcome variable in previous investigations (e.g., Janicke et al., 2007). Consistent with the Dyadic Theory of peer victimization, our study results suggest that psychosocial deficits consistent with poorer quality of life are likely to represent social weaknesses that increase risk for teasing. This may be an important area for future research, particularly because significant variability in HRQOL exists among overweight and obese youths (Williams et al., 2005). Moreover, findings from this study provide evidence that improving children's adaptive functioning may decrease the frequency and psychological impact of teasing, suggesting that increasing HRQOL may discourage teasing among overweight youth. A similar pattern has been demonstrated in studies examining self-esteem among overweight children. For example, Jelalian et al. (2006) demonstrated that an intervention incorporating peer-based social skills training improved overweight children's self-esteem, even in the absence of weight loss. It is conceivable that increasing children's HRQOL (e.g., social skills training, increasing physical competencies) may not only lead to primary benefits of improved health but salutary effects on teasing.
Study results also provide support for the longitudinal stability of both teasing and HRQOL constructs among treatment-seeking overweight youth. Specifically, latent regression analyses demonstrated that earlier teasing and HRQOL predicted later levels for both constructs. Furthermore, these regression coefficients remained consistent over the three measurement occasions spanning 15 months. These findings provide additional support to previous Investigations, which have reported longitudinal stability in both teasing and HRQOL for overweight and obese youth (e.g., Eisenberg, Neumark-Sztainer, Haines, & Wall, 2006).
Although improvements in physical health are often the ultimate goal of weight management intervention, numerous investigators have suggested that diminished HRQOL is the most prevalent and immediate consequence of obesity in childhood (Wallander, Taylor, Grunbaum, Franklin, Harrison, Kelder, & Schuster, 2009). Results from the present study provide additional support to this thesis, suggesting that improvements in HRQOL may lead to decreased risk for teasing.
In contrast to study results employing child-reported HRQOL, parent-reported teasing was not highly correlated with HRQOL at any of the measurement occasions. This result contradicts Janicke and colleagues' (2007) finding that child-reported peer victimization correlated with parent-reported HRQOL. However, this discrepancy may be a result of differences between measured peer victimization constructs: Janicke et al. measured peer victimization generally (including physical aggression) while this study limited its scope to teasing about weight and ability. Moreover, this discrepancy may not be surprising given the reported inconsistencies between parent- and child-reported HRQOL in the larger literature (Cremeens et al., 2006; Zeller & Modi, 2006). Predictive regressions between parent-reported HRQOL and child-reported teasing were nonsignificant. As mentioned previously, correlations at the three measurement intervals were small and only the Time 2 correlation reached statistical significance. As might be expected given this lack of association, none of the hypothesized longitudinal predictive regressions were significant. Because youth-reported teasing was used in both models, these discrepancies are likely attributable to differences in self- and parent-reported HRQOL discussed previously.
Limitations
Several methodological limitations to the present study should be noted.
First, the use of a passive longitudinal design does not allow causal inferences to be drawn because this methodology does not allow for isolation of independent variables nor does it control potential confounding variables. Thus, causality can only be implied using the present study design (Farrell, 1994; Little et al., 2007). An experimental test of an intervention engendering increased HRQOL with appropriate control would be necessary to confirm a causal relationship with HRQOL predicting teasing. Moreover, because of the specific study sample, the results of this study are generalizable only to treatment-seeking overweight and obese youths. Additionally, the wide age range of participants (ages 7–17) may have masked age-related differences in study variables. Finally, the existing literature suggests that peer victimization/teasing and the impact of these experiences vary across gender and ethnic/racial groups. Results of the current study should not be generalized outside of the specific demographic groups represented in the study sample.
Implications
Results from this study suggest that interventions designed to improve HRQOL outcomes may reduce teasing among overweight and obese youth. Although quality of life is most often conceptualized as an outcome variable, this study provides evidence that poor physical and psychosocial functioning (e.g., mood problems, social interaction difficulties, physical limitations, and school problems) are risk factors for later teasing. Moreover, results suggest that interventions leading to improved HRQOL may reduce teasing. In general, multi-component pediatric weight management programs have proven to be the most effective currently available method for improving HRQOL among overweight youth, although specific mechanisms behind this improvement (i.e., which components lead to change) are unclear (Lamanna, Kelly, Stern & Mazzeo, 2010). Future interventions for overweight youth and experimental studies of their effectiveness could target more proximal/functional variables associated with HRQOL even more so than weight reduction as critical outcomes.
