Social Standing May Be Linked to Body Mass Index in Teen Girls

Teen girls who perceive themselves as being lower on the social ladder appear more likely to gain weight over the subsequent two years, according to a report in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.1

Between 1999 and 2004, the percentage of American teen girls classified as overweight increased from 14 percent to 16 percent, according to background information in the article. “Children who are overweight experience many health complications but perceive the most immediate consequence of overweight to be social discrimination,” the authors write. “To lessen this health and economic burden, it is important to identify factors that contribute to excess weight gain and the development of obesity.”

Adina R. Lemeshow, S.M., of the Harvard School of Public Health, Boston, and the New York City Department of Health and Mental Hygiene, Bureau of Tobacco Control, and colleagues assessed questionnaires completed by 4,446 girls age 12 to 18 years in 1999. In addition to reporting their height and weight, television viewing habits, diet and other factors, the girls answered the following question: “‘At the top of the ladder are the people in your school with the most respect and the highest standing. At the bottom are the people who no one respects and no one wants to hang around with. Where would you place yourself on the ladder?’” Girls who placed themselves at five or above on the 10-rung ladder were compared with those who ranked themselves at or below four.

The average body mass index (BMI) among participants was 20.8 in 1999 and 22.1 in 2001. In that two-year period, 520 of the girls (11.7 percent) had at least a two-unit increase in BMI. “After adjusting for age, race/ethnicity, baseline BMI, diet, television viewing, depression, global and social self-esteem, menarche, height growth, mother’s BMI and pretax household income, adolescent girls who placed themselves on the low end of the school subjective social status scale had a 69 percent increased odds of having a two-unit increase in BMI during the next two years compared with other girls,” the authors write.

“It is important that researchers consider physical, behavioral, environmental and socioemotional factors that might contribute to the rising prevalence of overweight in adolescents,” they conclude. “Previous research suggests that emotional factors such as depression and low self-esteem and self-perception contribute to the burden of overweight in adolescents. Our study contributes to this body of literature in that, to our knowledge, it is the first to prospectively evaluate the relationship between subjective social status in the school community and change in BMI, and our findings suggest that low school subjective social status may be an important contributor to increases in BMI in girls over time.”

 “Despite the need for urgent action in the obesity epidemic, the health community’s mixed history of success with peer interventions should serve as a story of caution for designing interventions based on incomplete understandings of how adolescents’ health behaviors are shaped by their peers,” write Clea McNeely, M.A., Dr.P.H., and Robert Crosnoe, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, in an accompanying editorial2.

“Future adolescent health research, therefore, should seek to identify the specific ways that peers transmit health-related information and norms to each other in their everyday lives, either through face-to-face contact or through social networking activities on the Internet (e.g., MySpace),” they continue. “The study by Lemeshow and colleagues contributes to this knowledge base, which in the future can be used to consistently harness the power of peers to promote health.”

1. Arch Pediatr Adolesc Med. 2008; 162(1):23-28.  

2. Arch Pediatr Adolesc Med. 2008; 162(1):91-92.