Obesity as a Determinant of Two Forms of Bullying in Ontario Youth (2)

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Original Article
Obes Facts 2011;4:000–000 Published online: December 6, 2011
DOI: 10.1159/000335215
Obesity as a Determinant of Two Forms of Bullying in
Ontario Youth: A Short Report
Atif Kukaswadiaa Wendy Craigb Ian Janssena,c William Picketta,d
a Department of Community Health and Epidemiology,
b Department of Psychology,
c School of Kinesiology and Health Studies, Queen’s University,
d Clinical Research Center, Kingston General Hospital, Kingston, ON, Canada
Keywords Introduction
Behavior · Childhood obesity · Obesity ·
Overweight · Social determinants · Physical bullying · Interpersonalviolenceisacontemporaryadolescenthealth
Relational bullying · Violence problem,andnovelresearchisrequiredtoexamineitsdeter-
minants.Antisocialbehaviorscanbeestablishedasearlyas
Summary pre-adolescenceorevenpreschool,andmaymanifestinvari-
Objective: Obesity can have negative effects in terms ousformsofbullying.Bullyingisacommonprobleminthe
of stigma and discriminatory behavior. Past cross-sec- Canadianschoolsystem;ofparticularconcernarephysical
tional analyses have shown that overweight and obese andrelationalformsofbullyingduetotheirhighprevalence
youths are more likely to be involved in bullying. Here, amongmalesandfemales[1].
we examine such relationships in a longitudinal analysis. Thephysicalappearanceofchildrenisoneofmanypossi-
Study outcomes were self-reports of: i) physical bullying bledeterminantsofbullyingexperiences[1].Anindividual’s
victimization and perpetration and ii) relational bullying appearanceaffectshowothersreactandrespondtothemin
victimization and perpetration. Methods: Participants socialcontexts.Internalizationofthesebehaviorscouldthen
were administered the Health Behaviour in School-Age leadtoperpetrationofbullying[2].Analogously,the‘Obesity
Children Survey in 2006 and then again in 2007, and in- StigmaApproach’suggeststhatweight-basedstigmaplaces
cluded 1,738 youths from 17 Ontario high schools. Rela- overweightandobeseyouthsatriskofanti-socialhealthout-
tionships between adiposity and each of the four forms comes;thesefindingshavebeensupportedbypastcross-sec-
of bullying were evaluated using multi-level analyses. tionalanalyses[1].
Results: Excess adiposity was shown to precede bully- Weexploredthetemporalsequencebetweenadiposity
ing involvement in this study. Obese and overweight statusandreportsofbullyinginasampleofhighschool
males reported 2-fold increases in both physical and students.Baseduponpriorcross-sectionalresearch[1],we
relational victimization, while obese females reported hypothesizedthatmaleswhoareobeseatbaselinewouldbe
3-fold increases in perpetration of relational bullying. morelikelytobecomevictimsandperpetratorsofphysical
Among those free of bullying at baseline (2006), signifi- bullyingandthatobesefemaleswouldbemorelikelytobe
cant increases in perpetration of relational bullying were relationallyvictimized.Intheory,increasedadipositywould
reported by obese females in 2007 relative to normal- makeobeseyouthstargetsforphysicalbullying;however,
weight females (14.8 vs. 3.8% among normal-weight increasedadipositywouldalsohelpthoseinvolvedinphysi-
girls; p = 0.02). Conclusions: Findings are congruent with calbullyingdominatetheirpeersatkeydevelopmentalstages
previous cross-sectional studies and confirm that obese oflife,possiblyleadingtoincreasedbullyingperpetration.
youths are at increased risk of social consequences Forrelationalbullying,increasedadipositystatusposesno
attributable to their appearance. advantage,butyouthscouldstillbevictimizedfornotmeet-
ingphysicalideals[2].
©2011S.KargerGmbH,Freiburg AtifKukaswadia,M.Sc.
1662-4025/11/0046-••••$38.00/0 DepartmentofCommunityHealthandEpidemiology,Queen’sUniversity
Fax+497614520714 Kingston,ON,Canada,K7L3N6
[email protected] Accessibleonlineat: Tel.:+1613549-6666,Fax+1613533-6686
www.karger.com www.karger.com/ofa [email protected]
Material and Methods Table 1. Resultsofrepeatedmeasuresmulti-levellogisticregression
analysesexaminingadiposityasariskfactorforbullying
Survey and Study Population
Typeofbullying Adjustedriskratioa
HealthBehaviourinSchool-AgedChildren (HBSC)isaninternational
surveyconductedinaffiliationwiththeWorldHealthOrganization[3]. normalweight overweight obese
The2006CanadianHBSCinvolved186schoolsand9,672students[3]. OR OR(95%CI) OR(95%CI)
TheQueen’sUniversityResearchEthicsBoardapprovedthestudy.Con-
sentwasalsosoughtfromtheschoolboardandeachindividualschool. Males
Thestudyusedanactiveconsentprocedureforacquiringparentalcon- Physical
sent,inwhichparentsorguardiansweresentlettersaskingforconsent.  Victimization 1.00 1.09(0.56–2.10) 2.07(0.85–5.02)
Finally,thechild’sconsenttoparticipateinthestudywasacquired.Ap-  Perpetration 1.00 1.10(0.61–2.00) 1.71(0.70–4.18)
proximately74%ofstudentsinthesampleparticipated,andonly10%of Relational
studentsdeclinedtoparticipateorspoiledthequestionnaire.Othernon-  Victimization 1.00 1.24(0.72–2.14) 2.11(0.95–4.70)
participantswerestudentswhofailedtoreturntheparentalconsentform,  Perpetration 1.00 1.11(0.63–1.96) 0.99(0.35–2.75)
whodidnotreceiveparentalconsent,orwhowereabsentonthedaythe
surveywasadministered. Females
17schoolsinOntarioagreedtoaspecialfollow-upstudyin2007.Of Physical
these,16schoolsweresurveyedagainin2007(onewithdrewduetoastu-  Victimization 1.00 0.24(0.03–1.80) 1.32(0.28–6.24)
dentdeath),making2,031studentsavailableforlongitudinalanalyses.  Perpetration 1.00 0.41(0.05–3.20) 1.52(0.17–13.3)
Thepresentstudyfocusedonthese2,031students:291werefurtherex- Relational
cludedbasedonmissingheightandweightdata(n=271),nodateofbirth  Victimization 1.00 0.73(0.40–1.32) 1.76(0.77–4.03)
information(n=15),orimplausiblechangesinheightsorweights(n=5),  Perpetration 1.00 1.29(0.58–2.86) 2.98(1.03–8.61)
leavingafinalsampleof1,738students(85.6%).
aAdjustedriskratioscontrolforscreentime,age,self-esteemandfamily
affluencescore.
Survey Methods
BMI and Obesity Classification
InordertocalculateBMI(kg/m2),heightsandweightswereprovidedby
self-report.Participatingchildrenwereclassifiedasnormalweight,over- Results
weightorobesebasedoninternationalcut-offsdevelopedbyColeetal.[4].
Amongmales,approximately2-foldincreasesintheoddsof
Bullying
bullying involvement were observed among obese parti-
TheHBSCbullyingquestionsweredevelopedoriginallybySolbergand
Olweus[5]andhavebeenshowntoprovideaccurateestimatesofpreva- cipants for both physical victimization and perpetration,
lence.Childrenwereaskedquestionsaboutbothperpetrationandvictimi- though neither of these represented significant increases
zationofbullyingbehavior,withresponsecategoriesrangingfrom:‘never’ (p>0.10).Asimilareffectwasobservedfortheoddsofrela-
to‘greaterthanonceaweek’.Asperexistingprecedents[5],bullyingin-
tionalvictimizationamongmales(p=0.07).Overweightand
volvementwasdichotomized(atleast2or3timespermonthornot).
obesefemalesreported1.29(0.58–2.86)(p=0.53)and2.98
Twospecificformsofbullyingwereinvestigated.Physicalbullying
perpetrationwasassessedthroughasinglequestion:‘Ihit,kicked, (1.03–8.61)(p=0.04)timestherelativeoddsofrelationalbul-
pushed,shovedaround,orlockedanotherstudent(s)indoors.’Twoques- lyingperpetrationrespectively,andthistrendapproached
tionswereaskedaboutrelationalbullyingperpetration:i)‘Ihavekept significance(p=0.06).Nootherstatisticallysignificanttrends
anotherstudent(s)outofthingsonpurpose,excludedhimorherfrommy
wereidentifiedamongfemales(table1).
groupoffriends,orcompletelyignoredhimorher,’andii)‘Ispreadfalse
Amongmaleswhodidnotengageinbullyingatbaseline
rumoursaboutanotherstudent(s)andtriedtomakeothersdislikehimor
her.’Affirmationofeitherorbothoftheserelationalbullyingquestions (2006),nostatisticallysignificantincreasesintheincidenceof
indicatedrelationalbullyingperpetration.Analogousquestionswerealso perpetrationorvictimization(anytype)wereobservedby
usedtoassessvictimizationbythetwoformsofbullyingforatotaloffour BMIclass.Amongfemales,significantdifferenceswerefound
measuresofbullyinginvolvement.
forrelationalperpetration,withhigherlevelsreportedfor
obese(14.8%)versusoverweight(2.0%)andnormal-weight
Statistical Analyses
Arepeatedmeasuresmulti-levellogisticregressionmodelwasemployedto (3.8%)respondents(p=0.02).
quantifyassociationsbetweenadiposityandbullyinginvolvement.Thiswas
performedusingSASversion9.1.3andthePROCGLIMMIXprocedure
(SASInstituteInc.,Cary,NC,USA).Themulti-levelmodelconsistedof
Discussion
threelevels:i)withinstudents,ii)betweenstudentsandiii)between
schools,andsimultaneouslyaccountedforclusteringattheschoollevel.
Potentialconfoundersincludedscreentime,age,ameasureofself-esteem, Thisstudyconfirmedthatobesemalesandfemalesexperi-
andsocioeconomicstatus(measuredviafamilyaffluencescore)whichwere enceincreasesinoddsofvictimizationduetotwomajorforms
selectedbaseduponpriorliteratureandbackwardseliminationprocesses. ofbullying.Inaddition,obesefemalesreportedincreasesin
Adescriptivesubanalysiswasconductedamongchildrenwhowere
relationalperpetration.Ourfindingsarecongruentwithpre-
freeofthebullyingoutcomeofinterestatbaseline.Incidentcasesofeach
viouscross-sectionalstudies[1,6]andconfirmthatobesechil-
typeofbullyingin2007wereidentifiedandcomparedwithbaselineadi-
positylevels;Fisher’sExactTestwasusedinthesecomparisons. drenareatriskforsocialconsequencesattributabletotheir
ObesityandBullyinginCanadianYouth ObesFacts2011;4:000–000
appearance,consistentwithLerner’sTheoryofPlannedBe- standers,andprovidingsupportforvictims[11].Targeting
havior,andtheWeightStigmaApproach[2,7].Theseviews thoseatparticularlyhighriskforbullyinginvolvementmay
aboutobesechildrenmaytranslateintonegativeattitudesand increasetheeffectivenessofinterventionsaswellasdecreas-
behaviorstowardsthem. ingnegativepsychosocialconsequencesofbullyinginvolve-
Ourstudyfindingsareimportantasincreasedinvolvement ment.Particularfocusshouldbepaidtoschoollevelinterven-
inbullyingisassociatedwithotherformsofinterpersonalvio- tions,usingtechniquessimilartothosecombatingracismand
lenceaschildrengrowanddevelop.Victimizationduetobul- genderdiscrimination,inordertoreducetheprevalenceof
lyingcanleadtoengaginginandbeinginjuredfromphysical weight-basedteasing.Stigmatizingbehaviorsdirectedtowards
fightsandweaponcarryingforself-defense[8].Thosewhodo theobeseneedtobedecreased.Thepromotionofenviron-
notretaliatedirectlymaystillmanifestotheradverseconse- mentswhereallbodytypesareacceptedisoneavenueby
quences,includingsocialanxietyordepression[9].These whichthispsychologicallydamagingbehaviorcanbereduced
relationshipsmayhavelong-termhealthandsocialconse- andpotentiallyeliminated.
quences,especiallyduringcriticalperiodsofthelifecourse.
Importantgenderdifferenceswereobservedinourfind-
ings.Boysaremuchmorelikelytobebulliedphysicallywhile Conclusion
girlsaremoretypicallyinvolvedinrelationalbullying.This
maybeattributabletoperpetratorstargetingthatwhichis Interpersonalviolencecanaffectthehealthydevelopmentof
importanttotheirpeergroup,withboysvaluingphysical childrenastheytransitiontoadulthood.Ourstudydemon-
dominanceovertheirpeersandgirlsvaluingclose,intimate stratestheimportanceofphysicalappearanceasadetermi-
relationships.Interventionsaimedatsuchdifferenceshave nantofbullyingexperiencesamongCanadianyouths.This
shownmixedreceptivenesstoanti-bullyinginterventionsby researchaddstothegrowingbodyofliteraturethatshows
gender,withsomestudiesshowingnodifferencesfollowing thatexcessadiposityhasconsequencesbeyonddirectphysical
interventions[10]andothersfavoringeithergirls[11]orboys health.
[12].However,cleardifferencesexistinbullyingexperiences
bygender.
Thisstudyhasseveralstrengths.First,thestudywaslongi- Human Subjects Approval Statement
tudinal,incontrasttomostexistingstudieswhicharecross-
sectional[1,6].Second,pastlongitudinalresearchhasonly TheQueen’sUniversityGeneralResearchEthicsBoardapprovedthe
CanadianHBSCsurveyprotocol.Consenttoparticipatewassoughtat
beenconductedinyoungerchildren(ages7.5–8.5years)[13]
theschoolboard,school,parentalandstudentlevels.
andalsoolderadolescents(ages15–20years)[14].Results
fromalloftheseresearchcontextsareconsistent.Hence,
obeseyouthsmayfacebullyingexperiencesthroughoutkey
Acknowledgements
developmentalperiods.
Limitationsofthisstudywarrantcomment.Thesample
HBSCisaWorldHealthOrganization/EuropeanRegioncollaborative
sizeavailablewassmall,withfewincidentcasesofbullying study.InternationalCoordinatorofthe2005–2006study:CandaceCurrie,
occurring.Thislimitedourabilitytoconductaconventional UniversityofEdinburgh,Scotland;DataBankManager:OddrunSamdal,
UniversityofBergen,Norway.TheCanadiandatabankmanagerisMat-
cohortanalysis.Thetimeperiodunderobservationwasonly
thewKing,Queen’sUniversity,Kingston,Ontario,Canada.Thispublica-
1yearandperhapshadinsufficientlatencytoobserveeffects.
tionreportsdatasolelyfromtheprovinceofOntarioinCanada(Principal
Theassessmentwasbasedonself-report,andwhileextensive
Investigators:Dr.WilliamBoyceandDr.WilliamPickett).
validationworkhasbeenperformedself-reportbiasisstillan ThestudywassupportedbyresearchagreementswiththeCanadian
issue.Ourfindingsmaythereforeunderestimatethetrueas- InstitutesofHealthResearch(operatinggrant:2004MOP-CHI-128223-C)
andthePublicHealthAgencyofCanada(contract:HT089–05205/001/
sociationbetweenBMIstatusandbullyingbehavior.These
SS)thatfundstheCanadianversionoftheHealthBehaviourinSchool-
limitationsmaycollectivelyaffectthegeneralizabilityofthe
agedChildrensurvey.
studytootheryouthpopulations.
School-basedanti-bullyinginterventionshavebeenshown
tobeeffectiveoverall[10,15],despitegenderdifferencesin
Disclosure Statement
receptiveness.Theseinterventionshavefocusedonincreasing
awarenesssurroundingbullyingbehaviors,empoweringby- Noconflictsofinterestdeclared.
ObesFacts2011;4:000–000 Kukaswadia/Craig/Janssen/Pickett
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