Received: 20 September 2018
Revised: 13 March 2019
Accepted: 28 March 2019
DOI: 10.1111/ijpo.12534
WILEY pediatricobesity
ORIGINAL RESEARCH
The role of weight stigma in parental weight talk
Ellen V. Pudney1,2
|
Mary S. Himmelstein2
1
Department of Human Development and
Family Sciences, University of Connecticut,
Mansfield, Connecticut
Correspondence
Ellen Pudney, MS, RD, Rudd Center for Food
Policy and Obesity University of Connecticut,
One Constitution Plaza, Suite 600, Hartford
06103, CT.
Email: ellen.pudney@gmail.com
Rebecca M. Puhl1,2
Summary
Background:
2
Rudd Center for Food Policy and Obesity,
University of Connecticut, Hartford,
Connecticut
|
Many parents engage in “weight talk” with their child, such as encour-
aging their child to lose weight or making comments about their own weight or
others' weight. What parents say to their children about weight can affect children's
well‐being, yet little is known about parental characteristics that may be at play
regarding this common practice.
Objectives:
This study examined the role of weight stigma in parental weight talk,
and whether internalized weight bias mediates the relationship between parents'
experiences of weight stigma and weight‐based conversations and comments.
Methods:
A sample of 453 parents (Mage = 35.07) with children 2 to 17 years old
(Mage = 8.76) completed surveys measuring parental experiences with weight stigma,
weight bias internalization, and frequency of different types of parental weight talk.
Mediations were tested via the PROCESS macro.
Results:
Independent of controls (parent BMI, child BMI percentile, parent and
child sex, parent and child age, race, income, and education), experienced weight
stigma was indirectly associated with greater frequency of weight‐based conversations (β = .08) and comments about oneself (β = .08) and others (β = .04) via parents'
internalized weight bias.
Conclusions:
These findings offer novel insights for understanding parental weight
talk and can inform pediatric providers working with families on weight‐related
issues.
K E Y W OR D S
communication, obesity, parent, weight bias, weight stigma, weight talk
1
|
I N T RO D U CT I O N
without reference to weight (child‐centred health conversations),
impersonal/indirect weight comments about oneself or others (paren-
Body weight is an emotionally charged issue for many children and
1
tal weight comments), and weight criticism/teasing of their children.5
adolescents, especially during periods of physical growth when soci-
Data from a national sample of adolescents in the United States
etal values of physical appearance become more salient. What parents
suggest that approximately one‐third of parents engage in conversa-
say to their children about body weight can play an important role in
tions about weight with their child.6 Weight conversations are most
children's body esteem and physical well‐being.2-4 “Parental weight
common amongst parent/child dyads of the same sex, of adolescents
talk” is a general term that has been used to describe weight‐related
categorized as overweight, and of adolescents of Hispanic/Latino
communication by parents with their children, such as parental
and Asian/Hmong descent.6 Evidence further suggests that parental
encouragement of their child to lose or maintain weight (child‐centred
weight comments may also occur frequently, especially from mothers;
weight conversations), encouragement to exercise/eat healthy
one study found that 27% of mothers reported “often or very often”
Pediatric Obesity. 2019;e12534.
https://doi.org/10.1111/ijpo.12534
wileyonlinelibrary.com/journal/ijpo
© 2019 World Obesity Federation
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commenting on their own weight, while 13% of mothers reported
literature documenting weight stigma as a prevalent problem with
often commenting on others' weight.3 Weight‐focused conversations
associated health consequences. Approximately 40% of adults report
and comments from parents can occur in families regardless of the
experiencing weight stigma, such as weight‐based teasing, unfair
weight status of the child, but children and adolescents categorized
treatment, or discrimination.14,15 These experiences are associated
as overweight or with obesity tend to report more negative emotional
with maladaptive eating behaviours, decreased physical activity,
reactions in response to words parents use to describe their weight,
depression, low self‐esteem, and body dissatisfaction.16,17 Further-
compared with those classified at a normal weight.7 Children and
more, weight stigma can also be internalized, which involves apply-
adolescents with higher body weight also have increased vulnerability
ing negative weight‐based stereotypes to themselves and blaming
to stigma, bullying, and victimization because of their weight,8,9
themselves for their own weight status—a construct known as
not just at school from peers,10 but also at home from family
weight bias internalization.18-21 Thus, while experienced weight
members.11 Thus, parental comments about weight could potentially
stigma refers to weight‐based prejudice, stereotyping, and unfair
exacerbate negative implications for the emotional well‐being of these
treatment that people confront in extrinsic situations (such as being
children who may already feel stigmatized and distressed because of
stereotyped or treated unfairly in the workplace or by peers), weight
their weight.
bias internalization involves directing stigma inwardly on to oneself;
Furthermore, weight conversations and comments have important
an intrinsic process of self‐stigma in that people apply negative
implications for both physical and mental health. Previous work dem-
weight‐based stereotypes to themselves.18,21 Although these two
onstrates child‐centred weight conversations, such as encouraging a
constructs are highly correlated, weight bias internalization is
child to change their behaviours for the purpose of managing their
uniquely associated with poor emotional and physical health out-
weight, are associated with body dissatisfaction amongst college‐aged
comes,22,23 the effects of that can occur independent of experienced
women, particularly when the encouragement comes from the girl's
weight stigma.24-26 In some cases, internalizing weight bias may have
12
Amongst adolescent girls, both maternal and paternal
more negative ramifications for health than experienced stigma
weight conversations are associated with the use of unhealthy weight
alone.24-26 For example, recent research has found that weight bias
control behaviours (eg, skipping meals, vomiting) and binge eating
internalization partially mediates the effect of experienced weight
mother.
2
when the encouragement comes from the mother. Greater frequency
stigma on exercise behaviour,26 and that feeling concerned about
of mothers commenting on their own weight or the weight of others is
stigma mediates the relationship between body mass index (BMI)
associated with feelings of low self‐worth and depressive symptoms
and self‐reported health, even when controlling for perceived weight
amongst their daughters.3 Frequency of parental comments about
discrimination.27
their own weight is associated with adolescent use of extreme weight
Given the prevalence and consequences of experienced weight
control behaviours.2 In contrast, parental conversations with children
stigma, internalized weight bias in adults, and recent qualitative evi-
that focus on healthy eating or being physically active, without talking
dence suggesting that parental experiences of weight‐based stigma
about body weight, have no evidence for associations with negative
might influence child‐centred weight conversations,13 examining the
health ramifications and may instead help prevent disordered eating
relationships between experienced weight stigma, internalized weight
behaviours.4,5
bias, and parental weight talk is warranted. It may be that parents who
Although this emerging evidence suggests that parental weight talk
experience weight stigma, but do not internalize these experiences,
is prevalent and that weight‐focused comments and conversations
avoid talking about weight with their child because of heightened con-
from parents are potentially harmful for children's mental and physical
cerns about the effects of weight talk on their child's well‐being.
health, little is known about why some parents engage in this practice
Alternatively, parents who experience weight stigma, and internalize
more than others. In one qualitative study, parental engagement in
these experiences, might choose to engage in weight talk with their
weight‐focused conversations or teasing stemmed from several moti-
child to encourage their child to lose weight in order to avoid being
vations, including a health professional's opinion about their child's
the target of weight‐based teasing. The direction of these relation-
health, the parent's own concern for their child's health, and parental
ships is unclear and has not been studied, but identifying whether,
attempts to protect their child from being teased about their weight
and to what extent, weight stigma plays a role in parental weight talk
by others.13 Parents who avoided weight conversations/teasing with
could offer important insights about strategies to improve parent‐child
their children emphasized their own negative past experiences with
communication on this issue. To begin to address these research gaps,
weight conversations/teasing (and not wanting to repeat these expe-
the present exploratory study had the following aims: (a) examine the
riences for their child) and wanting their child to be respectful of
relationship between parental experiences of weight stigma and the
others' body sizes.13 This qualitative evidence highlights a potential
frequency of their engagement in different forms of parental weight
role of parental weight‐based stigma in influencing child‐centred
talk, (b) examine the relationship between weight bias internalization
weight conversations and the need for further research to examine
amongst parents and the frequency of their engagement in different
the relationship between parental experiences of weight stigma and
forms of parental weight talk, and (c) assess the extent to that weight
weight talk.
bias internalization mediates the relationship between parents' experi-
Weight stigma has been neglected in research on parental
weight talk with children, which is surprising given the substantial
enced weight stigma and the frequency of engagement in different
forms of parental weight talk.
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2
TABLE 1
METHODS
|
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Sample characteristics
Range
M
SD
35.07
8.19
Parent age (years)
N
453
Parent BMI
452
15
64
27.21
6.88
explore parental communication and comments around weight. Of the
Child age (years)
453
2
17
8.76
4.98
597 participants who entered the survey, 37 did not meet the eligibil-
Child BMI percentile
0
100
65.64
33.95
2.1
|
Participants
A total sample of 597 adults (age 18 years or older) were surveyed to
ity criteria of having at least one child between the ages of 2 and
451
20
N
%
17 years living with them. Participants were also excluded for missing
Parent sex
demographic or anthropometric data (eg, sex, height, and weight;
Male
184
40.6
Female
269
59.4
Male
242
53.4
Female
211
46.6
352
77.7
n = 35), skipping greater than 75% of the questions (n = 32), being
pregnant (n = 1), or entering a biologically impossible height or weight
for themselves or their child (n = 39), resulting in a final sample of 453
participants.
Sociodemographic characteristics of the sample are presented in
Table 1. Study participants consisted of 184 men and 269 women
Child sex
Race/ethnicity
(41% and 59%, respectively). The mean age of parents was 35.07 years
White, non‐Hispanic, non‐Latino
(SD = 8.19, range 20‐65), while the mean age of their children was
Black or African American
37
8.2
8.76 years (SD = 4.98, range 2‐17). Seventy‐eight percent of the sam-
Asian or Pacific Islander
28
6.2
23
5.1
or Pacific Islander, 5% Latino/Hispanic, and 3% who indicated “Other”
Latino, Hispanic,
or Mexican‐American
racial categories. The mean BMI of parents was 27.21 (SD = 6.88).
Other
13
2.9
64
14.1
$25 000‐$49 999
140
30.9
$50 000‐$74 499
112
24.7
$75 000‐$99 999
70
15.5
$100 000‐$124 999
31
6.8
$125 000 or more
36
7.9
ple was White, followed by 8% Black or African American, 6% Asian
Using guidelines of the Centers for Disease Control, 31% of parents
were classified as overweight (almost identical to the US average of
31.8%) and 25% were classified as having obesity (lower than the US
average of 39.8%).28 Using BMI percentile guidelines from the Centers
for Disease Control, 15% of the reported children were classified as
overweight and 27% were classified as having obesity (higher than
US rates of obesity of 18.5% for children ages 2‐19 years).28
2.2
|
Household income
(US dollars, annually)
Under $25 000
Education
Procedures
High school/GED, or less
Data were collected from March to April 2016 via an online survey
29
that was advertised on Mechanical Turk (MTurk).
The survey was
advertised as a “Parent Survey on Communication about Weight.”
Participants were compensated $1.50, which is a rate typical of other
58
12.8
Some college or
technical/vocation degree
203
34.6
College graduate or higher
238
52.6
Parent BMI category
MTurk studies of similar length.30 In addition to being a parent of a
Underweight
12
2.6
child between the ages of 2 and 17 years living at home, parameters
Normal weight
189
41.7
were restricted to participants living in the United States. Participants
Overweight
138
30.5
Obese
113
24.9
40
8.8
provided informed consent and participation was anonymous and voluntary. All procedures were approved by the University of Connecticut institutional review board.
Child BMI percentile category
Underweight
Normal weight
Overweight
2.3
|
Measures
Participants completed self‐report measures to assess demographic
characteristics, anthropometrics for both parent and child, parental
weight talk (conversations and comments), experienced weight
stigma, and internalization of weight bias. These measures are
described below.
65
Obese
218
48.1
69
15.2
124
27.4
Abbreviations: BMI, body mass index; GED, General Educational
Development.
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2.3.1
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these items,3 the “very often” response category was combined with
Demographics
“often,” resulting in a score ranging from 1 to 4 for both questions.
Participants answered questions regarding their age, sex, race, education, household income, and their child's sex and date of birth, from
2.3.5
|
Experienced weight stigma
which we calculated the child's age.
Experienced weight stigma was measured with two (yes/no) questions
2.3.2
|
in that participants answered whether they had ever been teased or
Anthropometrics
treated unfairly because of their weight.34 Participants were coded
Participants reported height and weight for themselves and their child.
Parental BMI was calculated from self‐reported height and weight.
While continuous BMI was used in regression analyses, BMI status
was stratified into weight categories in accordance to guidelines from
31
the Centers for Disease Control
as having experienced weight stigma if they answered “yes” to either
of these questions.
2.3.6
|
Weight bias internalization
(see Table 1). Child BMI percentiles
were calculated using the children's BMI group calculator from the
Centers for Disease Control, which accounts for age and sex.31
Internalized weight bias was assessed using the modified weight bias
internalization scale (WBIS‐M), which measures the extent to which
people apply negative weight‐based stereotypes to themselves and
blame themselves for their weight status.19-21 The 10‐item version
2.3.3 | Child‐centred weight and health
conversations
of the WBIS‐M was used, which is appropriate for individuals of
diverse body weight categories and aligns with recent research
recommending that the first item be dropped from the original
Child‐centred weight and health conversations were measured using a
11‐item scale.20 Participants were asked to indicate their level of
six‐item scale.6,32 Two out of the six questions assessed frequency of
agreement with statements such as “I don't feel that I deserve to have
child‐centred health conversations by asking parents how often in the
a really fulfilling social life because of my weight.” Participants
past year they had a conversation with their child(ren) about (a)
responded using a seven‐point Likert scale ranging from “strongly
healthy eating habits and (b) being physically active. The remaining
disagree” to “strongly agree,” where higher scores indicate greater
four questions assessed frequency of child‐centred weight conversa-
weight bias internalization. Reponses to the 10 questions were aver-
tions by asking parents how often in the past year they had a conver-
aged resulting in an overall score from 1 to 7 (Cronbach's α = .95).
sation with their child about his/her weight or size and told their child
that he/she weighs too much, should eat differently, or exercise in
order to lose weight or to keep from gaining weight. Participants
responded using a five‐point Likert scale ranging from “never or
rarely” to “almost every day,” where higher scores represent a greater
frequency of conversations. Reponses to the two health conversation
questions were averaged, and the responses to the four weight conversation questions were averaged resulting in an overall score from
1 to 5 for each subscale (health conversations Cronbach's α = .89;
weight conversations Cronbach's α = .83).
2.4
|
Statistical analysis
All analyses were performed using SPSS Statistics version 25.
To establish baseline relationships, we calculated bivariate Pearson
correlations amongst the following variables: weight bias internalization, experienced weight stigma, the four parental weight talk measures, parental BMI, and child BMI percentile. To examine the first
and second aim of the study, we conducted four linear regression
models that assessed experienced weight stigma and weight bias
internalization as separate predictors of the four forms of parental
2.3.4
|
Weight comments about oneself and others
weight talk, while controlling for parental BMI, child BMI percentile,
parent and child sex, parent and child age, race, household income,
Parental comments about their own weight and others' weight were
and education. To address the third aim of the study, the regression
measured with two items previously tested in samples of parents of
models that were significant at the 0.05 level were further tested for
children under the age of 18 years.3,33 Parents responded to the fol-
mediation using the PROCESS macro for SPSS.35 We ran three sepa-
lowing questions: “Thinking about your child(ren) who you consider
rate mediation models to examine whether weight bias internalization
to be [underweight/about the right weight/overweight], how often
mediated the relationship between experienced weight stigma and
do you talk about your own weight, shape, or size with your chil-
child‐centred weight conversations, parental comments about oneself,
d(ren)?” and “… how often do you make comments about other peo-
and parental comments about others. Using the PROCESS macro, we
ple's weight, shape, or size with your child(ren)?” Participants
conducted a mediation analysis using bootstrap sampling with 5,000
responded using a five‐point Likert scale ranging from “never” to “very
replications, which constructs a 95% confidence interval (CI) for the
often,” where higher scores indicated a greater frequency of com-
indirect effect of the independent variable (experienced weight
ments. Similar to previous research using these questions,3 a low fre-
stigma) on the dependent variables (the various forms of weight talk)
quency of parents in our sample reported using either form of weight
via weight bias internalization. The presence of an indirect effect
commentary “very often.” To align with prior research practices using
was determined if the results of the CI did not contain zero.35 As with
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the regression models, we adjusted the mediation models for parental
TABLE 3
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Correlations between key study variables
BMI, child BMI percentile, parent and child sex, parent and child age,
1
2
3
4
5
6
7
race, household income, and education.
1. Weight bias
internalization
3
RESULTS
|
2. Experienced
stigmaa
.45***
3.1 | Relationship between parental weight stigma
and weight talk
3. Child‐centred
weight
conversations
.23*** .04
Mean scores on the primary measures are shown inTable 2. The average
4. Child‐centred
health
conversations
.06
5. Comments
about self
.28*** .20*** .47*** .24***
6. Comments
about others
.10*
7. Parent BMI
.44*** .37*** .07
8. Child BMI
percentile
.11*
score on the WBIS‐M was 2.91 (SD = 1.59, range 1‐7). Correlations
between the main variables are shown in Table 3. Weight bias internalization was correlated with experienced stigma (r(442) = .45, P < .001)
and both weight bias internalization and experienced stigma were correlated with parental BMI (r(445) = .44, P < .001; r(442) = .37, P < .001).
Parental experiences of weight stigma were not associated with
child‐centred weight conversations (β = .02, P = .690), child‐centred
health conversations (β = .09, P = .102), or parental weight comments
about others (β = .06, P = .248), after adjusting for parental BMI, child
BMI percentile, parent and child sex, parent and child age, race, household income, and education. Experienced weight stigma was associated with parental weight comments about oneself (β = .15,
P = .003) after adjusting for the control variables.
Greater weight bias internalization amongst parents was associ-
.10*
.05
0.06
.38***
.43*** .12*
.05
.17*** .04
.62***
.17*** .05
.15*** .13** .18***
Abbreviation: BMI, body mass index.
a
Variable is binary.
*P < .05.
**P < .01.
***P < .001.
ated with a greater frequency of child‐centred weight conversations
amount of variance in each dependent variable (all P's < .001). The
(β = .24, P < .001), parental weight comments about oneself
model assessing child‐centred health conversations did not account
(β = .29, P < .001), and parental weight comments about others
for a significant amount of variance in child‐centred health conversa-
(β = .13, P = .017) after adjusting for the control variables. Weight bias
tions, so coefficients were not interpreted. Across the three significant
internalization was not associated with child‐centred health conversa-
mediation models, experienced weight stigma was indirectly associated
tions (β = .06, P = .261) after adjusting for the control variables.
with greater frequency of child‐centred weight conversations
(Bootstrapped CI: 0.07, 0.22), as well as parental weight comments
3.2
talk
|
Mediational models assessing parental weight
about oneself (Bootstrapped CI: 0.10, 0.27), and others (Bootstrapped
CI: 0.01, 0.15) through weight bias internalization (Figure 1). Parents'
experienced weight stigma was significantly associated with greater
As depicted in Table 4, the mediation models assessing child‐centred
weight bias internalization in all three models (β = 0.32, P < .001).
weight conversations, parental weight comments about oneself, and
Additionally, weight bias internalization was associated with an
parental weight comments about others explained a significant
increased frequency of child‐centred weight conversations (β = .26,
P < .001), parental weight comments about oneself (β = .26, P < .001),
TABLE 2
and parental weight comments about others (β = .12, P = .034).
Primary measures
Several consistent relationships emerged between parental weight
Range
N
M
SD
Min
Max
Cronbach's
Alpha
WBIS‐M
445
2.91
1.59
1.00
7.00
.95
conversations (β = .28, P < .001), parental weight comments about
Child‐centred weight
conversations
442
1.70
0.83
1.00
4.75
.83
themselves (β = .24, P < .001), and parental weight comments about
Child‐centred health
conversations
441
3.13
1.17
1.00
5.00
.89
centred weight conversations (β = .11, P = .024) and made more fre-
Weight comments
about oneself
440
2.26
1.01
1.00
4.00
Weight comments
about others
439
1.95
0.90
1.00
4.00
talk variables and control variables (see Table 4). Across all three
models, child age was positively associated with child‐centred weight
others (β = .25, P < .001). Fathers, in this sample, had more child‐
quent comments about others (β = .11, P = .023), relative to mothers.
No effect of parent sex emerged for conversations about parent's own
weight. Child BMI percentile had a small but significant positive rela-
Abbreviation: WBIS‐M, modified weight bias internalization scale.
tionship with child‐centred weight conversations (β = .13, P = .005),
comments about parent's own body weight (β = .10, P = .026), and
comments about others (β = .11, P = .026).
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TABLE 4
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Predictors of parental weight talk
Weight conversations
R2
df
F
P
0.16
11, 425
7.28
<.001
B
Weight bias internalization
SE
β
t
P
Bootstrapped 95% CI
0.13
0.03
0.26
4.80
<.001
0.08
0.19
Experienced stigma
−0.10
0.09
−0.06
−1.19
.233
−0.27
0.07
Parent BMI
−0.01
0.01
−0.07
−1.26
.208
−0.02
0.00
Child BMI %ile
0.00
0.00
0.13
2.80
.005
0.00
0.01
Parent male (ref. female)
0.18
0.08
0.11
2.27
0.024
0.02
0.33
Child male (ref. female)
0.05
0.08
0.03
0.64
0.523
−0.10
0.20
Parent age
0.00
0.01
−0.04
−0.62
.533
−0.02
0.01
Child age
0.05
0.01
0.28
5.03
<.001
0.03
0.07
White (ref. non‐White)
−0.16
0.09
−0.08
−1.82
.070
−0.34
0.01
Income
−0.05
0.03
−0.08
−1.68
.094
−0.11
0.01
Education
−0.06
0.04
−0.08
−1.69
.091
−0.13
0.01
0.08
0.22
Indirect effect of experienced stigma
Health conversations
.14*
0.04
11, 424
1.68
0.04
.08*
.080
Weight bias internalization
0.03
0.04
0.04
0.61
.542
0.10
0.23
Experienced stigma
0.17
0.13
0.07
1.27
.206
−0.06
0.35
Parent BMI
0.00
0.01
−0.01
−0.16
.870
−0.01
0.02
Child BMI %ile
0.00
0.00
0.06
1.16
.246
0.00
0.01
−0.11
0.12
−0.05
−0.94
.348
−0.27
0.34
Parent male (ref. female)
Child male (ref. female)
0.14
0.12
0.06
1.24
.216
−0.07
0.28
Parent age
0.01
0.01
0.08
1.20
.230
−0.01
0.02
Child age
White (ref. non‐White)
Income
Education
Indirect effect of experienced stigma
Comments about oneself
0.19
11, 423
8.90
0.02
0.01
0.10
1.61
.109
0.03
0.07
−0.16
0.14
−0.06
−1.18
.238
−0.48
−0.06
0.01
0.04
0.01
0.25
.802
−0.15
−0.01
−0.01
0.05
−0.01
−0.13
.896
0.02
0.04
0.01
−0.12
0.05
−0.06
0.12
<.001
Weight bias internalization
0.16
0.03
0.26
4.92
<.001
0.10
0.23
Experienced stigma
0.14
0.11
0.07
1.36
.176
−0.06
0.35
Parent BMI
0.00
0.01
0.01
0.10
.920
−0.01
0.02
Child BMI %ile
0.00
0.00
0.10
2.24
.026
0.00
0.01
Parent male (ref. female)
0.16
0.09
0.08
1.68
.094
−0.03
0.34
Child male (ref. female)
0.11
0.09
0.05
1.16
.245
−0.07
0.28
Parent age
0.00
0.01
0.01
0.18
.855
−0.01
0.02
Child age
0.05
0.01
0.24
4.30
<.001
0.03
0.07
White (ref. non‐White)
−0.27
0.11
−0.11
−2.55
.011
−0.48
−0.06
Income
−0.08
0.04
−0.11
−2.26
.024
−0.15
−0.01
Education
−0.03
0.04
−0.04
−0.80
.426
−0.12
0.05
0.10
0.27
Indirect effect of experienced stigma
Comments about others
.17*
0.09
11, 433
3.62
0.04
.08*
<.001
Weight bias internalization
0.07
0.03
0.12
2.11
.036
0.00
0.13
Experienced stigma
0.04
0.10
0.02
0.43
.671
−0.15
0.24
−0.01
0.01
−0.04
−0.64
.523
−0.02
0.01
0.00
0.00
0.11
2.23
.026
0.00
0.01
Parent BMI
Child BMI %ile
(Continues)
PUDNEY ET AL.
---------------------------w•
TABLE 4
LEY~•W•®Ht+t·)·t47 'rat----'~-7 of 11
(Continued)
R2
df
F
P
B
SE
β
t
P
Bootstrapped 95% CI
Parent male (ref. female)
0.21
0.09
0.11
2.29
.023
0.03
0.38
Child male (ref. female)
0.11
0.09
0.06
1.22
.222
−0.06
0.28
−0.01
0.01
−0.07
−1.15
.252
−0.02
0.01
Parent age
Child age
0.05
0.01
0.25
4.21
<.001
0.02
0.07
White (ref. non‐White)
−0.16
0.10
−0.07
−1.52
.128
−0.36
0.05
Income
−0.03
0.03
−0.04
−0.74
.461
−0.09
0.04
0.01
0.04
0.02
0.31
.761
−0.07
0.09
0.01
0.15
Education
Indirect effect of experienced stigma
.07*
0.04
.04*
Note. All models adjust for BMI, child BMI percentile, parent and child sex, parent and child age, race, income, and education. P < .001 is displayed where P
could not be exactly expressed within three decimal points. B = unstandardized regression coefficient, β = standardized regression coefficient. The standard
errors for each indirect effect are bootstrapped.
Abbreviations: BMI, body mass index; CI, confidence interval; SE, standard error.
*Significance is based on the bootstrapped CI not containing zero.
B= 1.04, fi=.32, P<.001
Parent's
Weight Bias
Internalization
B= 0.13,P = .26, P< .001
Parent's
Child-Centered
Experienced
Weight
Conversations
Stigma
c': B = -0.l0,P= -,06, P= ·229
~ - - - - ~ (Bootstrapped CI for indirect effect: 0.08, 0.22) ~ - - - - ~
Parent's
Parent's
B= 1.04, P=.32, P<.001
Weight Bias
Internalization
B=0.17, p=.26, P<.001
Parent's
Weight
Experienced
Comments
Stigma
c': B = 0.14, P= .07, P = .194
About Oneself
~ - - - - ~ (Bootstrapped CI for indirect effect: 0. 10, 0.27) ~ - - - - ~
FIGURE 1
4
|
B= 1.04,fi=.32,P<.001
Weight Bias
Internalization
B = 0.07,P= .12, P= .034
Parent's
Weight
Experienced
Comments
02
695
Stigma
c': B = 0.04, P= - ,P= ·
About Other.;
~----~(Bootstrapped CI for indirect effect: 0.01 , 0.1 5 ) ~ - - - - ~
Mediator models for parental weight talk
DISCUSSION
align with some previous research documenting differing outcomes
when comparing external stigma with internal, self‐stigma, such as
This study is the first to examine the role of parental weight stigma
with exercise behaviours and self‐esteem.25,26 In order to gain a better
(experienced weight stigma and internalized weight bias) in parental
understanding of how experienced and internalized weight stigma
comments and communication about weight. Findings suggest that
may differ in their implications for weight talk, it will be informative
parents' experienced weight stigma was indirectly associated with
for future research to examine parental perceptions of whether their
child‐centred weight conversations and parental weight comments
experiences of weight stigma and/or their internalization of stigma
via parents' internalized weight bias.
are related to their reasons for engaging in weight talk and to assess
These findings show that experienced weight stigma was related
whether certain aspects of parental weight stigma, such as the time
to greater weight bias internalization amongst parents, and that
period of when stigmatization occurred, the source of their stigmatiz-
greater internalization of weight bias in parents was in turn signifi-
ing experiences, and the extent of distress and internalization in
cantly associated with a higher frequency of child‐centred weight con-
response to different types of weight stigma, play a role in their moti-
versations and parental weight comments about oneself and others.
vations for engaging in or avoiding weight talk with their child. Ideally,
Accounting for weight bias internalization in the models eliminated
longitudinal research would be valuable to identify the relationships
the effect of experienced stigma, suggesting that experienced weight
between experienced stigma, internalized weight bias, and engage-
stigma influences child‐centred weight conversations and parental
ment in weight talk over time. Of note, accounting for parental weight
comments indirectly via weight bias internalization. These findings
stigma did not explain a significant amount of the variance in child‐
--~-w1 LEY~•@•t®iiti•]•r41 i
8 of 11
PUDNEY
ET AL.
M f----------------------------
centred health conversations, suggesting that weight stigma may be
greater frequency of weight‐focused conversations and comments as
particularly important in the context of child‐centred conversations
children get older. Moreover, the association between child age and
that focus on body weight rather than health. While pediatric pro-
parental weight talk variables was equally as strong as weight bias
viders may want to encourage all parents to promote healthy lifestyle
internalization for child‐centred weight conversations and for
behaviours in their children, parents who internalize weight bias may
weight‐focused comments that parents made about themselves. Addi-
particularly benefit from encouragement to focus on their child's
tionally, the association between child age and parental weight com-
health behaviours rather than his/her weight, as our findings suggest
ments about others was twice as strong as the relationship between
that these parents may be especially likely to engage in weight‐
parent weight comments about others and weight bias internalization.
focused comments and conversations with their child.
Most of the existing research on parental weight talk has focused
There could be several reasons why greater internalized weight
on adolescents, rather than children of all ages, but a recent study of
bias is related to parental engagement in conversations with their child
2‐ to 17‐year‐old children found child‐centred weight conversations
about their child's weight and the practice of making weight com-
to be more frequent with older children.38 For children going through
ments about themselves or others. Parents who internalize weight
puberty, weight conversations may occur because parents are more
bias may have heightened concerns that their child will be teased
aware of the change in their child's appearance and/or because chil-
about weight and thus be more likely to intervene by talking to their
dren may make more comments about their own body during this
child about his/her weight, eating behaviours, and/or physical activity
developmental period, sparking conversations. Therefore, future
in order to lose weight and avoid potential teasing. Additionally, par-
research should examine patterns and potential motivations for
ents who internalize weight bias may be more likely than those who
weight talk at different stages in child development and whether
do not internalize to be fixated on their own (or others') weight, and
parental weight talk affects children and adolescents differently
in turn be more likely to make weight‐based comments. As it is unclear
depending on their age.
whether parents engage in these behaviours intending to influence
In addition, there was a positive relationship between child BMI
their child or whether they are not cognizant of their intentions, future
percentile and frequency of child‐centred weight conversations,
research should examine parental awareness and intentions of their
parental weight comments about oneself, and parental weight com-
child‐centred communication and potential underlying mechanisms
ments about others. Even though child BMI was not as strong of a pre-
that can help clarify the ways in that experienced weight stigma versus
dictor as child age, our findings do suggest that frequency of child‐
internalized weight bias are related to parental weight talk. Further-
centred weight conversations increase with child BMI. These findings
more, it will be informative to examine the role of other parental char-
align with recent evidence documenting a higher frequency of child‐
acteristics that might be at play in parental weight talk, such as
centred weight conversations in children with a higher BMI,6,39
disordered eating behaviours amongst parents and/or their child.
highlighting the importance of ensuring that children with higher body
In line with a recent policy statement from the American Academy
weight (who are particularly vulnerable to weight stigma36) are not
of Pediatrics (AAP) that aims to raise awareness amongst pediatric
further stigmatized in parent‐child conversations about weight. A
providers about weight stigma in children and adolescents who may
recent study found that some adolescents with higher body weight
be vulnerable to teasing and bullying because of their weight,36 our
felt ashamed and embarrassed by parental weight talk and preferred
findings suggest that it may be additionally useful for pediatric pro-
that parents use neutral terminology when discussing their weight.40
viders to raise awareness about the potential implications of weight
Providers can encourage parents to ask their children about words
stigma in parents, which could contribute to the nature and frequency
or phrases that they would like their parents to avoid. Given the cur-
of weight‐focused communication with their children. Future research
rent findings demonstrating associations between a child's body size
should also explore strategies to prevent and reduce weight bias inter-
and frequency of parental weight comments directed toward oneself,
nalization in parents.
future research should clarify the effect of a child's weight on different
It is important to note that mean WBIS‐M score in this sample
types of parental weight talk.
(M = 2.91) was lower than similar general population samples, which
It is noteworthy that the present findings showed that fathers
typically range from 3.27 to 3.95.18,19,21,24 Despite these lower levels
were more likely than mothers to engage in weight conversations
of internalized weight bias in our sample, we found significant positive
and make comments about others, but there were no differences in
relationships between internalized weight bias and frequency of child‐
mothers' versus fathers' weight comments about themselves. This
centred weight conversations and parental weight comments. Thus, it
finding is contrary to other studies that have documented similar rates
will be informative to examine patterns of weight talk amongst par-
of weight talk between mothers and fathers6 or higher rates of weight
ents with higher levels of internalized weight bias as well as parents
talk from mothers compared with fathers.41,42 While it is beyond the
engaged in weight loss treatment, who may have heightened vulnera-
scope of our study to identify reasons for differences in weight talk
bility to weight stigma.37
between fathers and mothers, one potential explanation for this find-
Our study findings additionally identified consistent relationships
ing could be different perspectives of parents and children. Previous
between several control variables and parental weight talk variables.
studies typically assess parental weight talk from the perspective of
Specifically, we found child age to be a strong positive predictor in
the child, as opposed to the parent,5 but studies that have compared
all three significant models of parental weight talk, suggesting a
reports of parents with those of their children have pointed to
PUDNEY
ET AL.
--------------------------w•
LEY~•W•®Ht+t·)·t47 'rat- - '~-9 of 11
potential differences in frequency of weight talk.2,3 Furthermore, it
Despite these limitations, our study offers several key strengths. This
may be that parental sex affects not just the frequency of weight talk,
is the first study to assess the extent to that parental experiences of
but the topics of these conversations and the sex of the child they
weight stigma and weight bias internalization are associated with parental
engage with. The limited evidence in this area has found that mothers
weight talk. Additionally, the use of multiple measures of parental weight
tend to engage in food‐related weight talk, while fathers tend to com-
talk allowed for an informative description of different components of
ment on specific body parts41; mothers engage in more weight talk
parental weight communication. Finally, the inclusion of parents with chil-
with their daughters, and fathers with their sons6; and appearance
dren ages 2 to 17 years in our sample improves upon previous studies on
43
teasing by fathers can be particularly damaging to their daughters.
parental weight talk that typically target limited age groups of children.
Therefore, it will be informative for future work to assess weight talk
from the perspective of both parents and their child(ren) to better
4.2
|
Conclusion
understand how parental sex plays a role in weight‐focused communication. Survey measures that can capture potential distinctions
Our findings offer novel insights into the unexplored relationship
between mothers and fathers will be key in these efforts to accurately
between weight stigma and parental weight talk. This study suggests
understand these family dynamics, which can in turn inform pediatric
that parents' internalized weight bias mediates the relationship
providers.
between their experienced weight stigma and the frequency of child‐
centred weight conversations and parental weight comments about
oneself and others. Given that these forms of parental weight talk
4.1
|
Limitations
can have harmful effects on child health,3,4 this study offers important
insights about parental factors that may increase these behaviours.
There are several limitations of this study. First, the cross‐sectional
The AAP recommends that pediatricians be aware of weight stigma
nature of this study precludes causal inferences between parental
and its adverse implications for children and adolescents36 and to edu-
weight stigma and their engagement in weight‐based comments
cate parents about the best practices regarding ways to communicate
and/or conversations with their child. It will be informative for future
about weight‐related health with children, such as discouraging dieting
research to assess this relationship longitudinally to help determine
and focusing on healthy eating and physical activity instead of
whether parental weight stigma influences parental weight talk over
weight.49 Our findings suggest that it may be additionally useful for
time and whether education about weight talk from pediatric providers
pediatric providers to be aware of internalized weight bias amongst
affects the incidence of parental weight talk. Second, MTurk is not a
parents and its potential role in parental weight talk.
national panel, and the sample of parents was predominately White
and highly educated, limiting generalizability and indicating the need
for future research to examine more ethnically and economically
diverse samples. Third, measures were self‐reported, including the
ACKNOWLEDGEMENTS
The authors are grateful to Alison Manchester for her assistance in
managing data collection for this study.
height and weight of both parents and their children. Although objective measures of height and weight are ideal, studies show that online
self‐reported heights and weights are a valid alternative to measured
CON F L I C T S OF IN TE RE S T
height and weight.44,45 The survey questions we used to assess paren-
The other authors have indicated they have no financial relationships
tal comments and conversations about weight have been used in stud-
relevant to this article to disclose.
ies with similar populations, but future studies should aim to develop
more comprehensive, validated tools that measure different types of
AUTHOR CONT R IBUT IONS
weight talk from the perspectives of both children and parents. For
R.M.P. conceptualized the study. E.V.P. and M.S.H. carried out data
example, parents might not be fully aware of the extent that they talk
analyses, and E.V.P. wrote the initial draft of the manuscript. All
about weight, and their self‐report could be biased. In examining expe-
authors revised the manuscript, approved the final manuscript as sub-
rienced stigma, we did not assess the frequency, recency, or distress
mitted, and agreed to be accountable for all aspects of the work.
arising from the stigmatizing experiences. While previous longitudinal
research suggests that dichotomous questions (ie, yes/no questions)
ORCID
about the presence versus absence of weight labelling or stigmatizing
Ellen V. Pudney
experiences can inform long‐term associations with maladaptive eating
Mary S. Himmelstein
behaviours and poor weight‐related health,46-48 it will be important for
Rebecca M. Puhl
https://orcid.org/0000-0002-7197-5783
https://orcid.org/0000-0002-3173-1901
https://orcid.org/0000-0003-2340-2486
future research to include more comprehensive measures of stigmatizing experiences (ie, distress, recency, and frequency) to better under-
RE FE RE NC ES
stand the nature and extent of parental experiences with weight
stigma. Finally, because of the few measures available in the literature
to examine internalized weight bias, future studies should continue to
assess the long‐term stability and predictive validity of the WBIS‐M.
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How to cite this article: Pudney EV, Himmelstein MS, Puhl
RM. The role of weight stigma in parental weight talk. Pediatric
Obesity. 2019;e12534. https://doi.org/10.1111/ijpo.12534
