Obesity in Children and Discrimination

Susan Hosman

 

 

Abstract

Obesity in children is a problem in our society that leads to discrimination for individuals as early as preschool, and follows them through adulthood. A convenience sample of 120 college students participated in this study to assess how they evaluated obese children. Surveys were distributed in the following classes: Introduction to Psychology, Sociological Data Analysis, Introduction to Biology, and American Politics. Statistical analysis revealed participants rated pictures of average girl, and average boy, more positively than pictures of obese girl, and obese boy, F (3,116) = 27.32, p <. 001. The attitudes associated with obesity and discrimination should be addressed in order to find a way to stop this behavior that many children face on a daily basis.

Keywords: obesity, children, discrimination, poor body image, depression.


         Obesity is a condition that is not merely shared by adults; obesity is very common in children as well. For many parents the reason behind the growing number of children who are obese is a result of the busy lifestyles they live, the high price of healthier food, and the lack of healthy food choices that are available. When a family consists of two parents who are working full time it is not always possible to find time to prepare a meal. Also, it can be difficult to prepare food that is not only healthy but tasty in the eye of a child.

     Children that are obese are more likely to be diagnosed with diseases and disorders that are generally related to adults (Wabitsch, 2000).  Children are maturing faster than in years past and the self image they develop happens as early as preschool. Parents must be aware of the way that they show acceptance of their own body image if they do not want their children to follow in their footsteps. Furthermore, it is important that adults are aware of their own prejudices towards individuals who are obese including their own children or these children may develop feelings of inadequacy.

     Sigmund Freud developed a theory that infers that as individuals move through life they have specific desires and needs that must be met (Corey, 2009). During the oral stage of our development the pleasure zone is the mouth and young children are consumed with putting everything in their site into their mouth (Corey, 2009). Freud posits that if an individual’s needs are not met during this period in development they will develop greed because they are fixated at this point which may be related to obesity (Corey, 2009).  

     Erik Erikson developed a theory that correlates with Freud’s in that the two theories happen at the same time during an individuals’ lifetime (Corey, 2009). During the stage Erikson entitles “Autonomy vs. shame and doubt” children become more independent which includes feeding themselves (Corey, 2009). If a child is not shown that their caregiver has faith in them that they are capable of doing more for them self the child will develop feelings of shame and doubt in concerns to their eating habits which may affect the person they become and they may either develop an eating disorder or become obese (Corey,2009).

      BMI-Calculator.net (2012) defined body mass index as “a measurement of body fat based on height and weight that applies to both men and women between the ages of 18 and 65 years”.   According to Carr and Friedman (2001), anyone with a BMI exceeding 30 is considered obese, and is confronted with more inequality than the average person. The unfairness that is bestowed upon obese individuals can greatly influence their own self image and seems to have a lasting effect on them. The stigma that overweight men and women are faced with is worse than any other type of discrimination in that it is an acceptable form of behavior in our society (Carr & Friedman, 2005).

     Discrimination is an acceptable form of action towards others that is carried through at times by medical providers who may unknowingly show some bias towards a patient (Carr & Friedman, 2005). This type of bigotry may have negative effects on an obese person because they may not seek care when they are in need (Carr & Friedman, 2005). An article concerning Physical Therapists in some instances viewed obese individuals as lazy, lacking will power and unappealing (Sack, Rigassio Radler, Mairella, Touger-Decker, & Khan, 2009).  Puhl and Heuer (2010) communicated the fact that individuals who are obese are often thought to be responsible for their overall health, and that it is not only acceptable to criticize them it is the norm.

     The Early Childhood Education Journal (1999) discussed two different terms in relation to a person’s body size; overweight, and obese (Jalongo, 1999).  Overweight is defined as a person who weighs more than the typical individual; whereas obesity is defined as an individual with more “adipose tissue or fat” than what society considers the standard (Jalongo, 2005) p96. Overweight and obese individuals are viewed as unmotivated and somehow body size is related to their moral fiber (Jalongo, 2005). Researchers have found that obesity is a subject that is generally not thought of as offensive, and other considerations should be given when taking into account an individual’s overall qualities (Jalongo, 2005).

     Harriger, Calogero, Witherington, & Smith (2010) examined the source of where young women learn to have view of themselves and how this belief is carried with them throughout her lifetime. This study focused on girls rather than boys due to the fact that boys did not appear to have been affected by the ideal body image as early as girls whose focus on this subject begins as early as four years of age.  Questions were asked of preschool girls concerning choosing who they would like as a best friend and describing their weight; in the end the girls chose as their best friends other girls who were thin as their choice for a best friend (Harriger et al., 2010).

     Unfortunately there are many more females who are stuck at what they feel is an ideal weight that they try to control how much they weigh as early as the age of six or seven (Jalongo, 2005). According to The Early Childhood Education Journal it is important to introduce healthy eating habits to children early in childhood because they have not yet learned how to overeat and are not usually overweight until middle school (Jalongo, 2005). According to Sealy (2010), a subject that needs to be explored when considering why so many children are obese in this country is the ability of caregivers to find healthy foods such as fruits and vegetables in their own neighborhood. The number of young people who are now overweight has increased by more than half over the last two decades (Sealy, 2010).  Furthermore, this researcher acknowledged the fact that as a result of weight gain in children there are more health risks that must be addressed such as: “diabetes, asthma, and high cholesterol” in children (Sealy, 2010).

     Obesity may also be attributed to one’s parents’ body shape, for instance if a child has two  parents that have a significant amount of excess body fat they are more likely to become like them (Sealy, 2010). Also, a child who is considered extremely overweight at the age of 18 has a greater risk of dying at a younger age than do their thinner counterparts (Sealy, 2010). The main issue that many parents face is having access to the foods that will ensure a balanced diet for their children (Sealy, 2010).

     In a study concerning childhood obesity and the correlation between convenience and accessibility, parents in three different neighborhoods noted that it all boiled down to where you reside (Sealy, 2010). In areas where Caucasians were in the majority the ability to find choices from the food pyramid such as apples and carrots were not difficult, whereas neighborhoods that consisted of mostly convenience stores where African Americans lived, did not give access to healthy foods that would hinder obesity in children (Sealy, 2010). Caregivers are the most important denominator in concerns to educating their children about the benefits of eating healthy and exercising because without their help children may not develop the right habits that will ensure a healthy lifestyle (Akhtar-Danesh, Dehghan, Morrison, & Fonseka, 2011).

     Another variable that Sealy (2010)  discussed is the fact that the high accessibility of fast food restaurants  which appears to be very well located in neighborhoods where single parents reside may be related to obesity as well (Sealy, 2010).  Several studies suggest that the amount of commercials involving unhealthy food choices plays a large role in why children are obese because of the food choices they make (Akhtar-Danesh et al. 2011; Yu, 2011). Furthermore, the Social Work in Health Care Journal indicated that obesity is a problem for all races, but particularly African Americans and Hispanics where young women appear to have the most weight gain (Sealy, 2010).

     In research by Peters and Jones (2010) there was a strong connection to the way that individuals who are training to become physical education teachers and sports trainers view overweight children. The method used in this study was a questionnaire that gave examples of overweight children’s behavior and personality with the chance for respondents to agree or disagree with how these children are stereotyped due to their appearance. The authors reported findings that suggested that the overall personal opinions of future P.E. teachers and sports trainers were discriminating in that the children who were overweight were perceived as lacking motivation and the capability to be involved in physical activities (Peters & Jones, 2010).

     Because of the early emphasis on how much a person should weigh, many young ladies develop eating disorders at an earlier age than boys (Petrie, Greenleaf & Martin 2010). These authors  considered the significance of the link between whether a person was male or female, who faces more inner battles concerning their weight, and what factors lead up to happiness of one’s own body (Petrie et al, 2010).  The average adolescent male and female have very different ideas when considering an ideal body shape; for young men the standard goal is to possess a body that is “lean and muscular,” whereas the aim for females is to lack a large amount of body fat (Petrie et al. 2010). Young ladies are faced with the demands of becoming more slender, and young men are more concerned with becoming more powerfully built through activities that will assist in the goal of more muscle mass (Petrie, et al. 2010).

     Young women are more interested in how television and magazines implement the perfect body, and young men are much more concerned with looking like a body builder (Petrie et al. 2010).   Bissell and Hays (2011) reiterated the fact that children are indeed affected by what they observe on television as well as the internet. An interesting fact that was noted by Petrie et al (2010) was the idea that a young person considers the standard body to be viewed differently among the sexes due to how far in their development an individual is. A juvenile male appears to embrace the idea of their future development concerning their body due to an increase in height and a change in their overall body structure (Petrie et al. 2010). Whereas young ladies do not celebrate the future changes in their maturity due to the fact that their body transforms in such a manner that includes an overall change in their bone structure (Petrie et al. 2010). In addition, the young women who had higher levels of self confidence, also had an overall contentment with their body when they were not encouraged to change themselves, and the young men were not as overly concerned with their appearance (Petrie, et al. 2010).

    There is much less stigma in individuals who are diagnosed with eating disorders than individuals who are considered overweight or obese ((Jalongo, 2005).  Due to the fact that so many young ladies are extremely concerned with their own self image, anorexia and bulimia occurs much more than in young men (Jalongo, 2005).  Also, so many individuals are fixated with weight gain that there is too much emphasis on the amount that their children should weigh even at an early age (Jalongo, 2005). ). As a result of the prejudice that overweight men and women face it is expected that the percent of individuals who try out for sports is not very high; instead of encouraging young people to get up and move they are discouraged to try new things that are interesting to them (Tang-Peronard & Heitmann, 2010).

     De Bruin, Woertman, Bakker, and Oudejans (2009) compared girls between the ages 13-18 that exercised to lose weight, those who played sports not to change their appearance, and girls who did not play a sport The girls who exercised because of weight issues were found to have more problems with how they felt about themselves and dieted more frequently (De Bruin et al.2009). In addition, the individuals that participated in sports related activities felt better about their appearance because they were exercising in comparison to the individuals that worked out to keep their weight at a manageable number or because of how they looked (De Bruin et al. 2009).

     Previous research has suggested that teens that are judged more harshly because of their weight had more issues with depression and suicide (Taylor, 2011). Of the children who suffer from depression the overweight children list unhappiness with their appearance as a factor and the children who are of average weight refer to bullying as the reason for their discontent (Gibson, Byrne, Blair, Davis, Jacoby, & Zubrick, 2007).  Consequently, girls are often watched more closely than boys in concern to weight because girls are expected to maintain a smaller waistline (Taylor, 2011). The effect of taunting a person due to their weight is harmful and has strong after effects; it does not matter if you are male or female because the sting is there from this kind of behavior (Taylor, 2011).

     Wabitsch (2000) conveyed the point that child obesity is not only related to a form of segregation from other children, it also correlated with other illnesses generally found in adults; an extremely obese child may develop high blood pressure and cardiovascular issues.  Also, obesity is a direct result of other health problems such as sleep apnea, high cholesterol, and diabetes (Wabitsch, 2000). Although it is generally not the case in some instances a child may die from the result of obesity, and it may lead to an earlier death as an adult (Wabitsch, 2000).

     The Society for Nutrition Education (2003) discussed not what causes obesity in children but how to prevent the onset of childhood obesity and how to help children to have better body images. This research indicated that it is important to educate people to the fact that everyone has their own body weight due to biology instead of only genetics. (SNE, 2003).  Also, the researchers established the fact that a person should not focus on a particular number when looking at an individual’s weight but what is the right body shape for them (SNE, 2003) In addition, the committee that put together this research noted that it is essential to show children that there are so many different ways to exercise during play time that a child may not realize (SNE, 2003).        

     In an assessment of 17 studies by Tang-Peronard and Heitmann (2009), it was discovered that the likelihood of an individual facing discrimination correlated best with an individual’s gender, however children with excess body fat were often victims of this behavior as well. The simple act of intolerance related to someone’s weight also correlated with low self esteem, social isolation, depression, and eating disorders (Tang-Peronard & Heitmann, 2009).

      It was reported that the young ladies who were overweight did not have as many friends to find comfort in than young men or girls who were not overweight (Tang-Peronard, & Heitmann, 2009). In addition, the study found that young women who were not the average body size did not have as many opportunities to go out with young men as young women that were of average weight (Tang-Peronard, & Heitmann, 2009).  Teri (1982) discussed the relationship to what causes depression and the type of behavior that followed; adolescents who were depressed included their weight as an immense factor that was somewhat related to how assertive they were.  

     Bybee, and Zigler (1991) discussed the actual self image a person has in comparison to the ideal self image a person would like to have, and the way that a person who does not have the self image they want has more guilt than a person that is satisfied with their self image. Subjects whose idea self image is not their actual, or ideal body image have more issues they contend with such as the rules they follow and the beliefs they live by; the young ladies that had higher goals set for the person they wanted to be had more feelings of guilt (Bybee & Zigler. 1991). The authors made a good point in that the subjects in their research who were not happy with herself had more remorse in who they are (Bybee & Zigler 1991).  Crosnoe (2007) discussed the relationship between obesity, success in school, and future enrollment in college. Research has shown that individuals who were obese were less likely to enroll in college which opens the door for failure concerning earnings and how well a student may perform academically; young men are not affected by the idea that an overweight person is less likely to attend college (Crosnoe, 2007). This research drives home the idea that discrimination from peers continues throughout a person’s life time and may follow them to college (Crosnoe, 2007).

     The current research hypothesized that obese children face more discrimination than children of average weight, and that obese girls face more negative evaluations than obese boys. The independent variable was obesity and the dependent variable was discrimination. Obesity was operationalized through a survey that asked the respondent to answer questions based upon their first emotional response. Children are discriminated against not only by their peers but by adults such as parents, and teachers as well. It is assumed that the characteristics and personality of a child are related to body shape and size.  Findings from this research will include not only that an obese child is discriminated against because of their weight but that gender plays a part when considering who is shown more prejudice.

Method

Participants

     Participants were comprised of 120 college students at a private Midwestern university of various ages, gender, college major, and minor.  There were 53 males (44.2%), and 66 females (55.0%), and 1 outlier that did not answer the demographic information. The mean age was 21.665; the oldest participant was 54, and the youngest participant was 18. The participants were chosen based on the availability of professors and whether the experimenters schedule coincided.  Surveys were distributed in the following classes: Introduction to Psychology, Sociological Data Analysis, Introduction to Biology, and American Politics. Participants were given right to consent as well as the freedom to withdraw from the surveys that were distributed (“Publication Manual,”2010).

Materials

      A convenience sample was used to answer specific questions on a survey developed by the researcher, to measure obesity.  Students were asked to answer questions on one of four surveys that included general questions such as: age, gender, major, and minor. Surveys consisted of 1 of 4 specific pictures of average or obese children and the participants were instructed to answer questions based on their first emotional response. To counterbalance the experiment the participants were only shown one picture of the four. Participants were not informed of the hypothesis for this research in order to avoid demand characteristics. (See Appendix A).

  Procedure

     A survey was developed that consisted of photos, one was of an obese girl, another was a girl of average weight, the third was of an obese boy, and the fourth was of a boy of average weight. The surveys developed by the researcher were field tested during an Experimental Psychology class where they were peer reviewed. Following the evaluation of the surveys the experimenter modified any changes necessary and emailed the documents to her professor for approval. The surveys were then sent to the Institutional Review Board to receive the authorization to distribute to the chosen participants.

     Participants were instructed to answer questions based on their first emotional response to the photo viewed. More detailed questions were comprised of attitudes toward obesity using a Likert scale that ranged from 1: definitely yes-6: definitely no to measure the participants’ responses.      The surveys were distributed in groups of 30 with each classroom receiving only 1 of the 4 photos for their review to assess discrimination related to obesity. For classrooms that had fewer than 30 students extra surveys were distributed at 1828 and the Piper Academic Center computer lounge. Data was analyzed using a one-way ANOVA and an independent t test. To view surveys see appendix.

Results

     This study compared negative versus positive ratings of obese or average children’s photographs in an effort to determine levels of participant prejudice based on obesity. Participants rated one of four pictures (average girl, average boy, obese girl, and obese boy) on attributes such as honesty, health, friendship, kindness, etc.  A composite score was calculated for each participant with a lower score indicating a more negative rating, and a higher score indicating a more positive rating.  A one-way analysis of variance indicated that the average girl ratings (M=60.60, SD =5.19), and average boy ratings (M=61.97, SD= 5.89) were significantly more positive than the obese girl (M= 47.57, SD=9.94), or obese boy (M = 50.40, SD = 8.27).

F (3, 116) = 27.32, p < .001.

This research assessed the hypothesis that the gender of the obese children played a role negatively to the participant’s ratings as well. An independent t test indicated that while obese girls were rated slightly more negatively (M=47.57, SD= 9.94) than obese boys (M=50.40, SD=8.27), findings were not significant. t (119) = 2.833,  p = .075.

 

     ANOVA

 

discrimination

 

Sum of Squares

df

Mean Square

F

Sig.

Between Groups

4687.133

3

1562.378

27.316

.000

Within Groups

6634.733

116

57.196

 

 

Total

11321.867

119

 

 

 

 

Multiple Comparisons

 

Dependent Variable: discrimination

 

(I) picture

(J) picture

Mean Difference (I-J)

Std. Error

Sig.

95% Confidence Interval

      

Lower Bound

Upper Bound

Scheffe

average girl

average boy

-1.36667

1.95271

.921

-6.9064

4.1731

  

obese girl

13.03333(*)

1.95271

.000

7.4936

18.5731

  

obese boy

10.20000(*)

1.95271

.000

4.6602

15.7398

 

average boy

average girl

1.36667

1.95271

.921

-4.1731

6.9064

  

obese girl

14.40000(*)

1.95271

.000

8.8602

19.9398

  

obese boy

11.56667(*)

1.95271

.000

6.0269

17.1064

 

obese girl

average girl

-13.03333(*)

1.95271

.000

-18.5731

-7.4936

  

average boy

-14.40000(*)

1.95271

.000

-19.9398

-8.8602

  

obese boy

-2.83333

1.95271

.553

-8.3731

2.7064

 

obese boy

average girl

-10.20000(*)

1.95271

.000

-15.7398

-4.6602

  

average boy

-11.56667(*)

1.95271

.000

-17.1064

-6.0269

  

obese girl

2.83333

1.95271

.553

-2.7064

8.3731

LSD

average girl

average boy

-1.36667

1.95271

.485

-5.2342

2.5009

  

obese girl

13.03333(*)

1.95271

.000

9.1658

16.9009

  

obese boy

10.20000(*)

1.95271

.000

6.3324

14.0676

 

average boy

average girl

1.36667

1.95271

.485

-2.5009

5.2342

  

obese girl

14.40000(*)

1.95271

.000

10.5324

18.2676

  

obese boy

11.56667(*)

1.95271

.000

7.6991

15.4342

 

obese girl

average girl

-13.03333(*)

1.95271

.000

-16.9009

-9.1658

  

average boy

-14.40000(*)

1.95271

.000

-18.2676

-10.5324

  

obese boy

-2.83333

1.95271

.149

-6.7009

1.0342

 

obese boy

average girl

-10.20000(*)

1.95271

.000

-14.0676

-6.3324

  

average boy

-11.56667(*)

1.95271

.000

-15.4342

-7.6991

  

obese girl

2.83333

1.95271

.149

-1.0342

6.7009

*  The mean difference is significant at the .05 level.

 

 

 Means Plots

 


Discussion

     The current research examined the relationship between obesity in children and discrimination, as well as the role that gender plays when comparing an obese boy vs. an obese girl, and the amount of prejudice shown toward them. It is very surprising that in this day and age this form of judgment is bestowed upon individuals who are viewed as overweight and obese; a more astonishing fact is that this type of behavior is acceptable among many individuals.

     The first hypothesis of this research was that obese children are discriminated against more than the average child; the research in this study indicated that obese children were scored more negatively on a Likert scale than the average child. In concerns to the second hypothesis that girls are judged more significantly than boys when speaking of weight and the amount of negativity they are shown, findings are not significant.

     The results in this research measure up to previous research comparing obesity in children and discrimination. Harriger, Calogero, Witherington, and Smith (2010), explored the relationship among preschool girls and what type of individuals they were most likely to choose for a best friend; a thin girl, or an obese girl. Their findings indicated that preschool girls were found to select thin girls over obese girls as a playmate and as a best friend.  Also, future physical education teachers were found to judge obese children more negatively than average individuals in concern to their ability to participate in physical activities (Peters & Jones, 2010).

     Future research in relation to obesity in children and discrimination would lead this researcher to choose a larger sample size that would not be limited to college students; this examiner would include a wider range of participants such as parents and possibly educators. Also, this study would benefit from the use of pictures in the survey in Appendix A that would be comprised of individuals who were of the same race in order to remove any biases concerning an individual’s character traits and ethnicity. In addition, a potential question for the above mentioned survey would consist of “How do you rate yourself: obese, overweight, somewhat overweight, or average weight?” Moreover, this researcher may make an inquiry from the participants concerning the subject matter of obesity with regards to their own perceived ability to participate in physical activities.

     Obesity in children is a topic that caregivers, and educators must be aware of when speaking of the self esteem and self worth of all individuals not only children. Many individuals have been found to avoid medical care due to the amount of discrimination they have faced in their lifetime (Carr & Friedman, 2005).   Research has shown that individuals who were obese were less likely to enroll in college which opens the door for failure concerning earnings and how well a student may perform academically (Crosnoe, 2007). This research drives home the idea that discrimination from peers continues throughout a person’s life time and may follow them to college (Crosnoe, 2007).

 

Appendix A

The following survey was used in this research as a measure of obesity.

 

Your Gender _____________                                          

Your Age_________________                                   

Major____________________                                                                                                                                                     Minor____________________    

 

Evaluate the child based on your first emotional reaction.

 Child;

1) Is a good student.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes          Yes                Definitely yes  

                                                                                                       

2) Is responsible.

 1                              2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes         Yes                Definitely yes  

 

3) Has lots of friends.       

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes         Yes                Definitely yes  

                                                                                                          

4) Is happy.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes         Yes                Definitely yes  

                                                                                                        

 

 

5) Is energetic.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes         Yes                Definitely yes  

 

6) Is organized.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes         Yes                Definitely yes  

                                                                                                       

7) Is kind.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no          Probably yes          Yes                Definitely yes  

                                                                                                       

8) Respects others.

 1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no           Probably yes          Yes                Definitely yes  

 

9) Is greedy/selfish.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no           Probably yes         Yes                Definitely yes  

                                                                                                        

10) Is lazy.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no           Probably yes         Yes                Definitely yes  

                                                                                                       

 

 

11) Is unsociable.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no           Probably yes          Yes               Definitely yes  

12) Is irresponsible.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no           Probably yes         Yes                Definitely yes  

                                                                                                       

13) Is unkind.

1                               2                        3                              4                               5                    6                  

Definitely no         No                     Probably no           Probably  yes         Yes                Definitely yes  

 

14) Is healthy   

   1                               2                        3                            4                               5                    6                  

Definitely no           No                      Probably no         Probably yes         Yes                Definitely yes                                                                                          

 

 


 

Appendix B

The following pictures were used in the survey for participants to view and select an answer based on their first emotional response.

 

Average Boy                                                   Average Girl                 

Description: http://t2.gstatic.com/images?q=tbn:ANd9GcTb7aDKAQ5Gb30AaAMJCdNLmkRJrFqw50hvyi2gLbfmJ8db-VdB3w     Description: http://t0.gstatic.com/images?q=tbn:ANd9GcSwN4U5VASudwa2P5twHGbRsxoKYoobavBd6mp2VyQVekaAqhRKgxJYAl9O

 

Obese Boy                                                                   Obese Girl

Description: http://t3.gstatic.com/images?q=tbn:ANd9GcTvJs2gsXyMbvDf68cbXdjloF5GKV0H_rd8375epOvCQqzv4kZQ    Description: http://www.worldbulletin.net/resim/250x190/2012/01/18/obez.jpg

                                                                                            

 

 

References

Danesh, N., Dehghan, M., Morrison, K.M., Fonseka, S. (2011). Parents’ perception and attitudes on childhood obesity: A Q-methodology study. Journal of the American Academy of Nurse Practioners, 23, 67-75.

American Psychological Association. (2010). Publication Manual of the American Psychological Association.  (6th ed.). Washington DC: Author.

Bissell, K., Hays, H. (2011). Understanding Anti-Fat Bias in Children: The Role of Media and Appearance Anxiety in Third to Sixth Graders’ Implicit and Explicit Attitudes toward Obesity.  Mass Communication and Society, 14, 113-140. doi: 10.1080/15205430903464592.

BMI. (2012). BMI-Calculator. Retrieved from: http://www.bmi-calculator.net/

Bybee, J.A. Zigler, E. (1991). Self-Image and Guilt:  A Further Test of the Cognitive-Developmental Formulation. Journal of Personality, 59, 732-745.

Carr, D., Friedman, M.A. (2005). Is Obesity Stigmatizing? Body Weight, Perceived Discrimination, and Psychological Well-Being in the United States. Journal of Health and Social Behaviors.46, 244-259.

Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy (8th ed.). United States: Brooks/Cole, Cengage Learning.

Crosnoe, R. (2007). Gender, Obesity, and Education. University of Texas at Austin. Sociology of Education, 80, 241-260.

De Bruin, A.P., Woettman, L., Bakker, F.C., Oudejans, R.R.D. (2009).Weight-Related Sport Motives and Girls’ Body Image, Weight Control Behaviors, and Self-Esteem. Sex Roles, 60, 628-641. doi: 1 0.1 007/s 11199-008-9562-8.

Gibson, L., Byrne, S.M., Blair, E., Davis, E.A., Jacoby, P., Zubrick, S.R. (2008). Clustering of psychosocial symptoms in overweight children. Australian and New Zealand Journal of Psychiatry, 42, 118-125.

Harriger, J.A., Calogero, R.M., Witherington, D.C., Smith, J.E. (2010). Body Size Stereotyping and Internalization of the Thin Ideal in Preschool Girls. Sex Roles, 63,609-620. doi: 10.1007/sI1199-010-9868-1.

Jalongo, M.A. (1999). Matters of Size: Obesity as a Diversity Issue in the Field of Early Childhood. Early Childhood Education Journal, 27, 95-102.

Peters, D.M., Jones, R.J.A., (2010). Future Sport, Exercise and Physical Education Professionals’ Perceptions of the Physical Self of Obese Children. Institute of Sport and Exercise Science, 36-43. UDC 612.3:616.7:37.01-053:6.

Petrie, T.A., Greenleaf, C., Martin, S. (20 l 0). Biopsychosocial and Physical Correlates of Middle School Boys' and Girls' Body Satisfaction. Sex Roles, 63, 631-644.

Puhl, R.M. PhD, Heuer, C. MPH. (2010). Obesity Stigma:  Important Considerations for Public Health. American Journal of Public 1lealth, 100, 1019-1025.

Sack, S., Rigassio Radler, D., Mairella, K.K., Touger-Decker, R., Khan, H. (2009). Physical Therapists’ Attitudes, Knowledge, and Practice Approaches Regarding People Who Are Obese. Physical Therapy, 89, 804-815

Sealy, Y.M. PhD, MPH. (2010). Parents' Perceptions of Food Availability: Implications for Childhood Obesity. Social Work in Health Care, 49,565-580.  doi: I 0.1080/00981381003635353.

Society for Nutrition Education. (2003). Guidelines for Childhood Obesity Prevention Programs: Promoting Healthy Weight in Children. Journal of Nutrition Education and Behavior, 35, 1-4.

Tang-Peronard, J.L. Heitmann, B.L. (2008).  Complications of Obesity: Stigmatization of obese children and adolescents, the importance of gender. Obesity Reviews, 9,522-534.

Taylor, N.L. (2011). "Guys, She's Humongous!” Gender and Weight-Based Teasing in Adolescence. Journal of Adolescent Research, 26, (2) 178-199.   doi: I 0.1177/0743558410371128.

Teri, L. (1982) Depression in Adolescence: It's Relationship to Assertion and Various Aspects of Self­ Image. Journal of Clinical Child Psychology, 11,101-106.

Wabitsch, M. (2000). Overweight and obesity in European children: definition and diagnostic procedures, risk factors and consequences for later health outcome. Eur J Pediatr, 159, 8-13.

Yu, H., (2011). Parental Communications Style’s Impact on Children’s Attitudes Toward Obesity and Food Advertising. The Journal of Consumer Affairs, 45, 87-107.