Teasing Is Toxic When Obese Kids Are Targets

The research on weight-based teasing appeared in the same issue with other studies related to mental health implications of obesity in children and teens. These included studies on social marginalization of overweight children, body satisfaction in children after dietary counseling for atherosclerosis prevention, and a longitudinal evaluation of adolescent depression and adult obesity (see box).

Fassler told Psychiatric News, “It is helpful the articles were published in a pediatrics journal, because so many of these kids are seen by pediatricians and primary care physicians. They may receive little if any mental health treatment. Part of the challenge is to work with colleagues in primary care to enhance the awareness of the association between childhood and adolescent obesity and mental health problems.”

Experts agree that whether obesity precedes behavioral problems in children or vice-versa—or whether the two work to compound each other—is a question research has barely begun to answer.

At Under the Rainbow/Child and Adolescent Behavioral Health, an outpatient clinic of Mt. Sinai Hospital in Chicago, the number of overweight children and teens with behavioral problems has prompted clinicians there to seek funding for the expansion of programs to address the problem specifically and to study the most effective interventions.

“Our interest in this work has stemmed from the high number of overweight kids we treat for low self-esteem, depression and other mood disorders, abuse or neglect, social anxieties, and posttraumatic stress disorder,” said Richard Macur Brousil, Ph.D., in an interview. “It is usually difficult to ascertain whether there is a causal effect between the obesity and the behavioral symptoms, but since the behavioral issues are the reason for the referral, that is usually our treatment focus. But since there appears to be a link between the two, it makes sense that we address both in treatment. As of now, that happens in a hit-or-miss manner.”

Brousil and colleagues hope to expand programs at the clinic to include therapy groups for children who are aged 6 to 18 and have been identified as overweight. Children would receive one of two interventions—either an educationally based intervention providing nutritional and dietary information or a more traditional group-therapy intervention in which children would explore shared issues related to their weight.

Nearly all of the children served by Under the Rainbow are on public aid, and the social and psychological pathologies encountered by clinicians are many. Regardless of whether obesity is a consequence or a cause of behavioral problems, Brousil believes the problem calls for a multidisciplinary approach involving psychiatry, social work, pediatrics, nutrition, and, in cases of children with diabetes, endocrinology.

“In so many hospitals the professionals refer patients to each other but never talk to each other,” Brousil said. “We say, ‘This kid’s fat; send him to nutrition.’ I would like to see more professional networking.”

Such an approach would appear to be necessary given the confluence of factors that affect, and are affected by, obesity. Peers, siblings, and parents—all these contribute to the complex psychosocial web; ultimately, experts say, responsibility for the national epidemic of overweight children widens to include the entire society and culture.

“Predominantly, kids become overweight because our society is structured to create overweight,” Christoffel, of Children’s Memorial, said. “Recreation is sedentary, transportation is sedentary. We don’t cook at home, but eat fast foods full of fat in large portions. If you were to design a society to foster obesity, ours is the society you would come up with.”