Weight-Based Disparities in Youth Mental Health: Scope, Social Underpinnings, and Policy Implications

Abstract

Weight-based disparities in mental health impair the well-being of youth with overweight and obesity, who comprise a growing majority of young people in the United States. This review summarizes research regarding the extent of weight-based disparities in youth mental health and describes the social underpinnings of these disparities across contexts. Youth with high weight face frequent stigmatization (e.g., bullying, victimization, negative judgment), particularly in the school setting. Weight-based disparities in youth mental health emerge not because of high body weight itself, but because of the stigma associated with having high body weight. As such, policy actions need to address weight stigma. Empirical evidence can inform sound policies to reduce the stigma experienced by youth with high weight in order to support equitable mental health outcomes for youth with diverse body sizes.

Bias‐based bullying, self‐esteem, queer identity pride, and disordered eating behaviors among sexually and gender diverse adolescents

“…Accordingly, cisgender girls and transgender/gender diverse adolescents with BMIs in the 5th-85th percentiles may engage in more disordered eating behaviors than cisgender boys in the same BMI category (Romito et al, 2021). Cultivating more weight-inclusive (e.g., school wellness programs that emphasize health rather than weight) and genderinclusive school norms (e.g., using adolescents' chosen name and correct pronouns regardless of how a person's body conforms to gender expectations) may help mitigate these disparities (Lessard & Lawrence, 2022;Pollitt et al, 2021;Russell et al, 2018;Vantieghem & van Houtte, 2020) et al, 2015;Lessard & Lawrence, 2022;Saewyc et al, 2014) and establishing gender and sexuality alliances (Gower et al, 2020;Lessard et al, 2020) are two low-cost strategies found to reduce bias-based bullying, and may help mitigate disordered eating disparities among singly and multiply marginalized youth.…”

“…Accordingly, cisgender girls and transgender/gender diverse adolescents with BMIs in the 5th‐85th percentiles may engage in more disordered eating behaviors than cisgender boys in the same BMI category (Romito et al, 2021). Cultivating more weight‐inclusive (e.g., school wellness programs that emphasize health rather than weight) and gender‐inclusive school norms (e.g., using adolescents' chosen name and correct pronouns regardless of how a person's body conforms to gender expectations) may help mitigate these disparities (Lessard & Lawrence, 2022; Pollitt et al, 2021; Russell et al, 2018; Vantieghem & van Houtte, 2020). To illustrate, evidence suggests that some transgender/gender diverse adolescents engage in disordered eating behaviors to prevent or delay pubertal development and/or cope with gender‐related distress, gender dysphoria (Coelho et al, 2019; Roberts et al, 2021; Romito et al, 2021), but that body image and disordered eating may improve when their gender identity is affirmed consistently (Roberts et al, 2021; Testa et al, 2017).…”

“…Findings are consistent with prior work implicating bias‐based bullying in disordered eating and other health risk behaviors (Himmelstein et al, 2019a; Reisner et al, 2014; Russell et al, 2012), and highlight the importance of school‐based efforts to reduce bias‐based bullying by peers. Enumerating characteristics that can heighten adolescents' vulnerability to victimization (e.g., LGBTQ identity, high body weight) in anti‐bullying policies (Kull et al, 2015; Lessard & Lawrence, 2022; Saewyc et al, 2014) and establishing gender and sexuality alliances (Gower et al, 2020; Lessard et al, 2020) are two low‐cost strategies found to reduce bias‐based bullying, and may help mitigate disordered eating disparities among singly and multiply marginalized youth.…”

Dose-Dependent Association Between Body Mass Index and Mental Health and Changes Over Time

“…Higher weight not only carries risks of physical diseases, like cardiovascular disease and type 2 diabetes, but also affects current and future mental health . This issue is increasingly critical as the growing rates of overweight and obesity in adolescence often extend into early adulthood …”

Weight discrimination, BMI, or weight bias internalization? Testing the best predictor of psychological distress and body dissatisfaction

“…Previous studies have found that being young, being female, living in a non-Western area, and having obesity are potential risk factors for developing depression or depressive symptoms [7]. However, other studies have not found a relationship between weight status and mental health [8,9]. Nevertheless, the few meta-analyses of longitudinal studies have revealed a bidirectional relationship between depression and obesity [10,11].…”