To examine the role of blame as a mediator of the relationships between perceiver age and gender and children's acceptance of an overweight peer.
Cross-sectional study of children's perceptions of their overweight peers using structural equation modeling.
Two hundred and ninety-one children between the ages of 3 and 11 years.
Children viewed a videotape of a same-sex peer, dressed to appear overweight, interacting with an adult. After viewing the videotape, children responded to items assessing their perceptions of the child's social and emotional traits and how much the child was to blame for being overweight.
Confirmatory factor analysis indicated that the traits loaded on a single factor, acceptance. Results of analyses for our structural equation model indicated that as blame increased, acceptance of the peer decreased. The relationships between gender and blame and gender and acceptance were not significant. Children were categorized into three age groups (3–4, 5–8 and 9–11 years) to examine the influence of age. Children between 5 and 8 years of age were less likely to blame the model compared with younger and older children.
Preschoolers reported the lowest acceptance, indicating a need for intervention for children in this age range. Furthermore, it will be important to conduct longitudinal studies to determine the influence of interventions as the child passes through different developmental stages.
Approximately 14–17% of children and adolescents in the United States of America are overweight.1 The percentage of children in European countries who are characterized as either overweight (body mass index greater than the 85th but less than the 95th percentile) or obese (body mass index greater than or equal to the 95th percentile) ranges from 8.6 to 30.6%.2 Mounting evidence depicts overweight as a public health problem that is being addressed through media, research and interventions.3, 4, 5 Those who are overweight face health risks such as elevated blood pressure and increased risk of developing type 2 diabetes.6, 7 Children who are overweight may also cope with social marginalization,8 receive low levels of social support from classmates9 and report being teased or bullied more often than average weight children.10 Weight-related teasing and bullying during childhood is linked to psychological problems in children, such as depression.6, 11
Although research12 has shown that children tend to be less accepting of overweight peers, researchers are still uncovering the reasons for its occurance. It is important to determine the factors that influence children's acceptance to inform the design of interventions and research. For this study, we proposed that children's perceptions of blame for the child's weight status would influence their acceptance of an overweight peer. Our acceptance factor reflects children's perceptions of different social and emotional characteristics of same gender models dressed to appear overweight. Children also provided their opinions regarding how responsible the model was for his or her weight status.
Children who perceive a child as being to blame because he or she is overweight may also have negative opinions about the child's other characteristics. If this occurs, then one could assume that attributions regarding perceived responsibility or blame for weight status would influence children's acceptance of peers who are overweight.13, 14, 15, 16 On the other hand, if children report that their overweight peers are not responsible for being overweight, they may be sympathetic toward and more accepting of the child. In this study, children reported their views regarding how much a model, dressed to appear overweight, was to blame for his or her weight status. On the basis of findings from other studies,17, 18 we expected that children in our study who reported that the model was to blame for being overweight would report lower acceptance of the model compared with those who did not believe that the model was to blame for being overweight.
Studies assessing children's opinions of overweight peers typically fall into one of three categories: assessing children's opinions of line drawings,19 their opinions of videotaped interactions or presentations,12 or studies assessing the social and psychological functioning of peers who are overweight.9 What these different types of studies have in common are results showing that children are relatively less accepting of overweight children than they are of average weight children. For instance, researchers have shown that children are less accepting of and provide negative trait ratings for line drawings of obese and chubby peers.19, 20, 21, 22 These analog studies offer the benefit of experimental control, because other characteristics that influence children's acceptance—such as gender and race23 of the child who is being judged—can be controlled. On the other hand, the generalizability of findings from studies using line drawings has been questioned, as these stimuli are drawings and thus are removed from children's judgments of peers in real world settings.24
As a result, studies using videotaped presentations of models may provide a more realistic assessment of children's opinions. For instance, Bell and Morgan12 presented children with a videotape of a child in a ‘fat suit’ and at his regular weight, which was in the average range. Children rated their opinions of traits for each child, and their findings showed that children were more accepting of the normal weight as opposed to the child dressed in a ‘fat suit.’ We adapted our methods for presenting an overweight child from those developed by Bell and Morgan.12 We dressed two models, a boy and a girl, to appear overweight using bags of sand wrapped in bunting and affixed to their clothing. The models reported that they felt overweight, which we believe increased the realism of the videotaped interaction between the models and an adult female. Using the analog method allowed us to match gender and race of the models to the children who were viewing the videotaped interactions, which allowed us to examine the effect of gender and age of the perceivers on their acceptance of the child.
Some researchers have reported that boys are more accepting,22, 25, 26 whereas others have reported that girls are more accepting of their overweight peers.12, 27 Other studies have not found a gender difference.20, 21 Findings of the aforementioned studies are difficult to assess, because these studies used children in different age ranges and did not control for the influence of developmental level on children's perceptions. Lehmkuhl25 assessed the effect of gender on judgments of children in our sample. The study by Lehmkuhl25 focused on examining whether gender moderated the relationship between age and children's acceptance and willingness to be friends with the model comparing boys' and girls' ratings for the overweight model and the model at his or her normal weight. In contrast to the study by Lehmkuhl,25 we focused on determining whether blame mediated boys' and girls' acceptance of the overweight model, and our acceptance variable reflected children's perceptions of the overweight model's traits. Nevertheless, findings by Lehmkuhl25 indicated that boys were less accepting compared with girls; thus, we expected this same relationship to be confirmed in our study.
Research regarding the influence of age of the perceivers on their acceptance of children who are overweight is also equivocal. Some researchers have found that younger children are more accepting,20, 21, 25 whereas others have found that older children are more accepting.28 Other studies have found a curvilinear relationship, namely, that children in early adolescence (grades 6–9) were more accepting of their overweight peers than their older (twelfth grade) or younger (kindergarten through fifth grade) counterparts.19 Assessment of developmental differences in children's opinions is important; understanding differences in opinions for children in different age ranges will provide more knowledge regarding the developmental stages that are most appropriate for the implementation of interventions to improve children's attitudes.
Using a path model, this study extends the literature by examining the relationships among gender, age, blame (i.e. is, attribution of responsibility for weight status) and acceptance of an overweight child. The aims of this study were fourfold: (1) determine whether the social and emotional traits reflected a single, unidimensional factor-acceptance, (2) examine whether children who blamed the model for his or her weight status would be less accepting of the model, (3) assess the relationship between gender of the perceivers and acceptance, mediated by blame related to weight status and (4) discover whether the relationship between age of the perceivers and judgment was mediated by children's perceptions of blame related to weight status. On the basis of earlier research,25 we hypothesize that girls will attribute less blame for weight status compared with boys and that this, in turn, will improve their acceptance of the child. We also hypothesize that age will have a curvilinear relationship with blame and, through the effects of age on blame, a curvilinear relationship with acceptance.19, 25 We used three age groups: preschoolers (ages 3–4 years), children in early elementary school (ages 5–8 years) and children in late elementary school (ages 9–11 years). We anticipate that young children (ages 3–4 years) and preadolescents (ages 9–11 years) will report more blame for weight status, which in turn will be related to a lower acceptance of the models, than will children who are between 5 and 8 years of age.
Materials and methods
The 291 children in this study were 146 boys and 145 girls between the ages of 3 and 11 years (M=6.31, s.d.=2.45). (Children aged 12 and 13 years, who had viewed the overweight model and were in the larger sample, were initially considered for inclusion in data analyses for this study. However, because of the small numbers of participants in these age ranges (n=14), and the fact that their responses seemed to differ greatly from the other age ranges, the age range for this study was limited to 3–11-year olds). They were a subsample of children participating in a larger study in which children provided their opinions about average weight and overweight models.25, 29 A Caucasian boy and girl participated as models for the videotapes. Both children were 7 years of age. A university-based institutional review board approved this study. Parental consent and child assent were required for study participants and for the models.
Stimulus videotapes showed either the boy or girl dressed to appear overweight either playing cards or kicking a ball. Given that children often prefer to interact with the same gender children,28 children viewed models of the same gender.
It is noteworthy that Lehmkuhl25 conducted a study to verify that children judged the model as being overweight. She showed children the videotapes of the same gender model dressed to appear overweight and at his or her regular weight. Results of this study indicated that the children judged the models dressed to appear overweight as heavy compared with when they were not in costume.
Children viewed their assigned videotape and then completed questions assessing their views of the child's attributes. Questions were developed from a review of literature on children's acceptance of peers with physical differences.12, 30, 31, 32 Children provided ratings for several traits, (Table 1). Children also rated how much they thought the model was to blame for being overweight. Children provided their ratings on four-point scales with smiley faces and bars to assist them in understanding the scale. For trait ratings, higher ratings were equivalent to more positive opinions (for example, 1=not happy and 4=very happy), whereas for blame ratings, higher ratings were equivalent to the attribution of more blame (for example, 1=not to blame and 4=very much to blame).
All interviews took place in a room separate from the classroom. Elementary school-age children read and completed questions independently. Children recruited from preschools completed individual interviews and a research assistant or the third author read the questions to them. After this, the child received a small prize (for eg., stickers) and the research assistant debriefed the child and requested that they not discuss the study with other children.
Statement of ethics
We certify that all applicable institutional and governmental regulations regarding the ethical use of human volunteers were followed during the research.
Using a reflective measurement model and confirmatory factor analysis, six traits were assessed to determine if they reflected a single underlying factor, ‘acceptance.’ Next, a path model that included the measurement model of acceptance—a structural equation model (SEM)—was used to examine our study hypotheses, and this model is presented in Figure 1. To test the curvilinear relationships between age and blame and age and acceptance, age was aggregated into three age categories and dummy coded.
Confirmatory factor analysis
A confirmatory factor analysis was conducted using LISREL software33 to determine whether the six traits loaded on a single underlying factor rather than on different constructs. The error terms of the positively worded items were allowed to covary, representing the measurement error of affirmation bias.34 A model loading on a single factor, which we termed acceptance, was determined to be a good fit of the data, χ2 (d.f.=6, N set to 200)=10.88, P⩾0.09. In this type of measurement model, a loading represents the square root of an item's reliability as a measure of acceptance. In SEM, we use the observed items to measure our latent variable. One quality of such a latent variable is that it is treated as measuring acceptance with perfect reliability. Thus, the path coefficients testing the hypotheses are corrected for the bias owing to the measurement error of the acceptance factor. The Cronbach's α, assessing the reliability of a composite constructed from the items, would be 0.733.
The means and standard deviations for the six traits measuring acceptance and for blame, as well as the loadings of the six items reflecting acceptance, are presented in Table 1.
Means for the traits were fairly high; they ranged from 2.9 to 3.5 and indicated that the children rated the attributes reflecting acceptance fairly positively. The average for blame was also high (1.2), suggesting that children were likely to view the child as being responsible for being overweight.
Structural equation model
Our hypothesized model (see Figure 1) provided a good overall fit, χ2 (d.f.=26, N set to 200)=32.25, P>0.185, SRMR=0.038. Once a good fit was determined, the model was re-run to carry out the statistical testing with the actual N (N=291; Figure 2) (The covariance matrix for variables in our structural model is available from the second author). The coefficients in Figure 2 and Table 2 below are β-values, that is, standardized coefficients.
Our results indicated that blame was significantly related to acceptance, such that children who were more likely to blame the child for being overweight were less accepting of the child (β=−276). This corroborates our hypothesis.
We hypothesized that boys would attribute more blame to the overweight and, indirectly through this effect on blame, would be less accepting of the overweight than would be girls. However, our hypotheses that gender would directly or indirectly influence acceptance were not supported.
Our findings showed significant direct relationships of age group on blame and on acceptance, and a small indirect effect of age on acceptance mediated through blame (Table 2).
The numbers in Table 2 are standardized β-coefficients. Although their statistical meaning is not intuitive when a multinominal variable is involved, they do correspond to differences in averages. For example, consider the top left number in the table that equals 0.128. It indicates that a standard deviation increase on a measure coded 0 for the middle age group and on 1 for the young age group corresponds to the children between 3 and 4 years of age having an average blame that is 0.128 of a s.d. higher than children between 5 and 8 years of age. Whether directly estimated (direct effects) or derived (indirect and total effects), the value of β-values suggests that they are comparable, and reflect the degree of relationship. As we have noted, with nominal variables, they also correspond to differences in averages. The β-value of −0.2 (−0.195 in Table 2) indicates that the average blame among children between 9 and 11 years of age is lower than the average among those between 5 and 8 years.
The indirect effects of age on acceptance are small, with only one achieving statistical significance. It showed a higher acceptance among the middle than among the oldest age group. Finally, the total effects echo the direct effects of age on acceptance, indicating that the size of the direct effects is much more powerful than the indirect effects of age. We must conclude that blame does not account for the relationship between age and acceptance.
Our study results suggested that the children were less likely to attribute positive traits to the model if they blamed him or her for being overweight. This finding is consistent with earlier literature13, 14, 17, 18 and with the logic of attribution theory.15 Furthermore, our findings indicated that children's ratings of the target child's social and emotional traits reflected a single factor. This suggests that we could have assessed opinions about the models' characteristics by asking a single question, such as ‘How much do you accept this child?’ Unfortunately, blame did not mediate the relationship between gender and acceptance or age and acceptance; thus, our two other hypotheses were not confirmed. Several interesting findings for the influence of age on blame and age on acceptance were uncovered. For example, preschool-age children were more likely to blame the model for his or her weight status compared with the older children in our sample. Children in our middle age group, who were between the ages of 5 and 8 years, were more accepting of the model than were children in our oldest age group, who were between the ages of 9 and 11 years.
The relationship between age and acceptance appeared to be a linear rather than a curvilinear relationship. It may be that children in the older age groups were more positive because they were able to understand that a physical attribute, such as weight, is not representative of all of a child's social and emotional characteristics.21 On the other hand, a curvilinear relationship might have been discovered had we included middle and high school-age youth in our sample, as Richardson19 reported that children in high school were likely to have negative opinions about an overweight peer.
Being in the youngest age group also had a modest direct downward pressure on acceptance. As mentioned, preschoolers were also more likely to blame the models for their weight status. Consequently, the preschool period may be an ideal time for interventions designed to improve children's acceptance of peers who are overweight. Interventions for children in this age range should also address ways to reduce young children's perceptions of responsibility for weight status. There are several ways to address the issue of responsibility for weight status. Very young children may not have perspective-taking skills and thus may need to be taught that blaming an overweight child may hurt his or her feelings. Another notion is to teach preschoolers to view others' traits as being separate entities, such that perceptions of one trait (i.e., weight status) do not necessarily influence perceptions of other traits (i.e., intelligence). When young children are able to view a peer as having strengths, such as being fun to play with or smart, they may be less likely to generalize a negative opinion about one characteristic, in this case being overweight, to other characteristics. Hence, if some traits are viewed as assets, and similar in nature to the characteristics of children who are of average weight, then their perceptions of a child who is overweight may improve.
Our results did not support the idea that girls would have more positive attitudes than would boys.22, 25, 26 This may have occurred because concepts such as blame and acceptance are ‘gender neutral’ terms. Researchers who have found gender differences may have done so because they did not control for effects related to the children's ages, as we did in this study. Nevertheless, we recommend conducting additional studies, using qualitative and quantitative methods, to answer this question. Quantitative measures may be useful in assessing the relative importance of blame for weight status and the relative importance of other social and emotional traits for boys and girls. It may be that if we assessed physical traits, such as agility and speed, we would have discovered that boys held more negative opinions compared with girls. We specified the items that children rated for this study; if we had used qualitative methods, such as interviews with open-ended questions, we might have discovered that children reported different reasons for acceptance or for the lack thereof.
It is noteworthy that children's ratings of the traits contributing to the acceptance factor were fairly positive (see Table 1). Moreover, results of our factor analysis indicated that those traits that we considered to be ‘more positive’ (for example, happy, smart, nice) had higher loadings than did the negative traits (for example, worried, angry, sad) on ‘acceptance.’ This might lead one to conclude that children in our sample were more likely to view the model positively, which is encouraging. Increasing our understanding of whether traits with positive connotations are more descriptive of children's views than those that are negative is another area for future research.
Several factors limited the generalizability of our findings. For example, this study included only white children as participants and models, and thus our results reflect opinions of one racial group. Research has suggested that children who are black hold more accepting attitudes toward peers who are overweight;26, 35 and thus, more research with children in different racial groups is needed. Furthermore, it may be that our hypotheses were a better fit for children between 5 and 8 years of age, because they were closer in age to the models. The 7-year-old models may have appeared more overweight to children between the ages of 3 and 4 years than to the older children in our sample, because the model was both taller and more physically developed than were age peers. Alternatively, the 7-year-old models may have appeared large to children between the ages of 9 and 11 years, because the child looked unusually short compared with most children in their age range. In addition, this study was an analog study, and is subject to the limitations of this type of research. For example, the children might have thought that the videotaped interaction was unrealistic, which may have influenced their ratings of the models' traits. Finally, our model was overweight rather than obese. Age and gender of the perceiver may operate differently if the target child is obese. In future studies, it will be important to compare children's perceptions of peers who represent a range of weight statuses, from being very thin to being obese.
In summary, our results suggested that children who blamed the models for being overweight were more likely to be less accepting of the model, reporting more negative trait perceptions. Assessing children's perceptions of responsibility for the weight status of peers who are overweight may be one method of identifying children who would benefit from interventions to improve their attitudes or simply ways to encourage children's acceptance of everyone's differences and the appropriate timing of those interventions. Our results also showed that negative attitudes toward overweight peers were more salient for young children between the ages of 3 and 4 years. Teaching young children that, although a peer is overweight, he or she has many other traits in common with them may emphasize similarities rather than differences between children, resulting in positive attitudes about overweight peers.36 Research assessing whether this notion has ‘added’ value, beyond the influence of other components of an intervention, will determine whether similarities between children is a key component of interventions to improve their perceptions of peers who are overweight.
Conflict of interest
The authors declare no conflict of interest.
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We thank the research assistants who assisted with data collection for this study.
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Cite this article
Iobst, E., Ritchey, P., Nabors, L. et al. Children's acceptance of a peer who is overweight: relations among gender, age and blame for weight status. Int J Obes 33, 736–742 (2009). https://doi.org/10.1038/ijo.2009.52
- pediatric overweight
- peer acceptance
- gender influences
- age influences
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