Assessing weight stigma in school-aged children (grades 1 to 3): a cross-sectional study from Palestine

Obesity is a complex global epidemic. There are multiple causes and complications of obesity, both physical and psychological ones. One challenge that individuals with obesity encounter is the experience of weight stigma. Weight stigma is associated with negative outcomes, including psychological disturbances, eating disorders, weight gain, and avoiding physical activity. Weight stigma is prevalent among different age groups. The main purpose of the study is to explore weight stigma among school-aged children through the development of an image-based questionnaire. This study is conducted as a first step for further educational intervention studies to reduce weight stigma among children.

The study aimed to explore weight stigma in 150 children aged 6 to 9 years through direct interviews conducted by the researcher. Data collection started after the development and validation of a specific image-based questionnaire. Questionnaire development followed an intense literature review. Content validity was ensured by revision from experts in related fields. Reliability was checked by a pilot study, followed by data analysis to calculate Cronbach's alpha. Weight stigma explored through a) stereotypes of others with obesity. b) social preference and rejection of individuals with obesity. c) children's beliefs about weight controllability and judgment towards others with obesity. Based on that, the developed questionnaire was composed of three tasks: the Adjective Attribution Task, the Friendship Selection Task, and the Controllability Task.

In the Adjective Attribution Task, most of the participants attributed negative adjectives to the figure with overweight. In the Friendship Selection Task, figures with overweight were almost rejected as partners and friends, and only one child chose the figure with overweight as a best friend. The Controllability Task revealed a high percentage of judgment beliefs towards figures with overweight.

Our findings indicate that weight stigma is prevalent among school-aged children. This study is the first to provide a tool to explore weight stigma and to offer statistical data that will support future educational interventions. This work is important to reduce weight stigma among children, protect children's psychological status, reduce obesity prevalence, and improve its management.