Background
Adolescent obesity is increasingly prevalent. The International Association for the Study of Obesity (IASO) and International Obesity Task Force (IOTF) report that 40–50 million school-aged children globally are classified as obese. Adolescent obesity has been linked to various physical health problems and tends to persist into adulthood. Besides physical health problems, many adolescents with obesity also experience psychosocial difficulties, such as low self-esteem and depression.
Treatment programs for children and adolescents with obesity mainly target weight-loss by changing dietary habits, physical activity and parental support. These medical treatment programs are usually supplemented with a lifestyle skills training for a longer sustained effect. In spite of this, their long-term effectiveness has nonetheless been disappointing. Some studies have raised poor psychosocial functioning as a potential barrier to implement these weight-loss interventions and achieve lifestyle change. In examining psychosocial functioning of adolescents, not only individual psychopathology but also the context of peer relationships is important. In this context, peer victimization can be a vital contributor to psychosocial malfunctioning. Peer victimization refers to feeling subjected to aggressive acts by other children and is often used synonymously to being bullied, a form of repeated victimization that assumes a power difference between victim and bully. Bullying can be relational, physical, verbal such as teasing, or sexual. It can use traditional face-to-face contact, referred to as traditional bullying, or can employ online communication, referred to as cyberbullying.
Indeed, numerous studies have shown that obese adolescents are especially prone to being traditionally bullied and that this victimization predicts psychosocial difficulties, such as low self-esteem, high depressive symptoms and suicidal ideation. Their appearance, which is considered a sign of laziness and self-indulgence, serves as a justification to bullies in victimizing obese peers. Adolescents are highly sensitive to being victimized based on their weight since an important part of identity development takes place during adolescence and is intertwined with body image and self-esteem. Further negative effects of peer victimization for obese adolescents are observed in reduced sports enjoyment and motivation for physical activity (PA).
Previous research makes a distinction between weight-based teasing during physical activity and outside of physical activity classes. When weight-based teasing occurred during PA, youngsters experienced lower levels of sports enjoyment and of physical activity behaviour. This relation was lessened if the youngsters possessed good problem-solving or avoidant coping skills. When weight-based teasing took place outside of physical activity, it had the opposite effect and seemed to motivate children to increase their exercise levels. Three different mechanisms have been mentioned as possible reasons for lower PA motivation among obese youth. Firstly, avoiding PA has been considered as a coping mechanism to avoid weight-related victimization. Secondly, lower PA motivation may be attributed to poor social reinforcement experiences for physical activity in the past and thirdly, it may be a result of anhedonic feelings and loneliness resulting from victimization.
In sum, obese youth are at increased risk for peer victimization, which heightens their risk of psychosocial problems and physical activity avoidance, and thus lowers the effectiveness of professional and lifestyle weight-loss initiatives.
The recent spreading use of digital communication has given rise to a new form of bullying: cyberbullying. In cyberbullying, bullies intentionally and -often but not necessarily- repeatedly send electronic messages with hurtful content, aiming to cause harm or embarrassment to the victim. Prevalence figures of cyberbullying among youngsters range from 3% to 40%, depending on the definition and measure that is used. The psychosocial impact of being cyberbullied in a general adolescent population is even more devastating than that of bullying through traditional, face-to-face forms of communication.
Adolescents with obesity exhibit more important risk factors for cyber-victimization, such as traditional peer victimization and high computer or internet use, than normal-weight youth. Cyber-victimization can therefore be expected to be highly prevalent among obese adolescents and to cause more psychosocial problems than traditional bullying.
So far, little is known on cyber-victimization among obese adolescents. Cyber-victimization was examined in the US Health Behaviour in School-Aged Children (HBSC) study in 2005–2006. They found no association between cyber-victimization and weight group. In total, 9.9% of the teenagers was cyberbullied, this was 11.8% among obese teens. A more recent study in the US investigated cyber-victimization among adolescents attending a weight-loss program. They reported very high cybervictimization rates among those ever victimized (59% to 61% of those ever victimized were cyber-victimized in the past year), but when estimating the prevalence in the total surveyed sample, cyberbullying represented only between 10 to 12%, similar to the rates found in the US HBSC survey. They did not compare these results with a general population sample and therefore do not provide further insight in cyberbullying prevalence rates among obese youth compared to adolescents who have not experienced weight problems. No data is yet available for cybervictimization experiences among obese youth in other countries than the United States. Cross-national differences may however exist in how cyberbullying is experienced as noted in a recent European cross-national study.
No study so far examined the association between cyber-victimization among obese youth on the one hand and psychosocial malfunctioning and lower sports motivation as barriers to weight-loss effectiveness on the other hand, despite indications that the psychosocial impact of cyber-victimization can be more extensive than that of traditional victimization. In line with the abovementioned results, cybervictimization could be assumed to have a positive effect rather than a negative one on physical activity motivation, since this form of victimization takes place outside of physical education classes. To the best of our knowledge, no study has yet examined the relation between cybervictimization and physical activity motivation. As physical activity is a key component in obesity treatment, understanding whether traditional and cybervictimization pose risks to the effectiveness of weight-control efforts of obese youth are of great importance.
This current study thus aims to investigate the occurrence of traditional and cyber-victimization among obese adolescents and their association with psychosocial functioning and barriers to lifestyle change.
Research questions addressed in this study were: 1) to what extent are obese adolescents victimized by traditional and cyber-aggression, compared to normal-weight adolescents?; 2) to what extent do obese victims of (cyber-) aggression experience psychosocial problems, compared to non-victims?; and 3) is being (cyber-) aggressed related to more barriers and less facilitators for PA and a healthy diet among obese youth, compared to non-victims? We hypothesized that 1) victimization will be higher among obese youth than among normal-weight peers; 2) victimization and especially cyber-victimization will be positively associated with psychosocial problems; and 3) (cyber-)victims will experience more barriers and less facilitators to PA and a healthy diet than non-victims.
Our study findings could help optimize healthy lifestyle interventions and treatment efforts for obese adolescents by a better understanding of barriers to their effectiveness.