Weight-related bullying, body shaming and addiction: interplay, causes and consequences

Weight-related bullying is a risky way of victimization with serious consequences in terms of Physical and mental health. We aim at exploring substance and alcohol use disorders as possible adverse outcomes.
Accordingly, three hundred forty-four young adults (18-24 years old) were recruited on a voluntary basis from the Adolescent Psychiatric Department and tested with the Mini International Neuropsychiatric Interview and the Weight-Based Teasing Scale.
Sixty subjects suffered from weight-related bullying (19.73%). Males reported significantly higher rates of victimization (p = .04). Subjects with frequent weight-related bullying showed significant higher rates of substance use disorder (p = .048) compared to those who never suffered fat shaming and used mixed substances significantly more frequently (p = .02). 
Women who frequently suffered from weight-related bullying showed a significant higher use of tobacco (> 10 cigarettes/day) compared to women who had never suffered the same kind of abuse and, interestingly, also compared to men who suffered the same abuse with the same frequency (37.5% vs 9.1%; p = .13).
In conclusion, weight-related bullying shows higher incidence of substance use disorder as a serious consequence. Women are more afflicted by that consequence highlighting a gender-oriented outcome even if they suffer weight-related bullying less frequently than men.

BACKGROUND

Many young people experience bullying, especially during their school years. Being victims, particularly if it is chronic, may cause severe adverse consequences such as depression, low self-esteem and reduced personal goals achievement ^1,2.

Bodily characteristics and weight are often objects of bullying ^3,4 with gender-oriented differences. In fact, males are more often afflicted by bullying victimization if thin, while females are bullied if overweight ^5,6. Weight stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change ^4,7,8.

Obese children are more often bullied than non-obese peers, but the female gender is a protective factor for physical abuse compared to verbal while it is a risk factor for relational bullying ^6,9.

Furthermore, weight status is associated with chronic bullying victimization ².

Our research aims at exploring possible consequences of weight-related bullying on substance and alcohol addiction.

METHODS

Sample

Three hundred forty-four young adults (18-24 years old) were recruited on a voluntary basis from the Adolescent Psychiatric Department of the ASST Monza Health Care Trust and the School of Medicine and Surgery of the University of Milan Bicocca, Italy.

They were tested with the Mini International Neuropsychiatric Interview and the Weight-Based Teasing Scale.

Test

Mini International Neuropsychiatric Interview ¹⁰: it is a short diagnostic structured interview to explore 17 disorders according to the DSM-IV and ICD-10 criteria. Administration time is approximately 15 minutes.

Weight-Based Teasing Scale ¹¹: it is a self-administered scale based on 5 questions with a Likert-scale score (never to at least once a week). It explores the frequency of teasing and disrespectful behaviors.

Ethics and consent

Informed consent of the participants was obtained after the nature of the procedures had been fully explained. None of the participants received compensation for their contribution. The investigation was carried out in accordance with the latest version of the Declaration of Helsinki. The study was authorized and approved by the Hospital Ethical Committee.

Statistics

Data was analyzed using SPSS 26 performing Pearson Chi-square test for non-continuous variables; statistical tests were 2-sided and used a significance threshold of p < . 05.

RESULTS

Sample characteristics (Tab. I)

The majority of our sample was composed of female subjects. Students represented the majority of the sample, living with their parents. 40.79% were under psychological or psychiatric treatments (73.39% of them were under psychiatric and psychological care; 29.93% of the total sample). Mostly were affected by personality disorders and mainly treated with antidepressants. Their addiction was reported at the beginning of their treatment, none of the participants developed addiction afterwards.

Weight-related bullying and addiction

Fourty-one subjects (13.49%) were teased, but not frequently, for their weight, while 19 were often bullied regarding their weight (6.25%). Males reported significantly higher rates of victimization with moderate (16.7% vs 11.7%) or high (10.2% vs 4.1%) frequency (p = .04).

People who were often fat shamed didn’t show a significantly higher rate of alcohol use disorder compared to those who were not frequently fat shamed (p = .53) or those who never suffered that type of bullying (p = .81). Instead, they showed significantly higher rates of substance use disorder (p = .048) compared to those who never suffered fat shaming but not significant (p = .23), even if higher, compared to those who were not frequently fat shamed. Subjects who often suffer from body shaming use mixed substances significantly more frequently compared to those who have never experienced that type of bullying (p = .02). Women showed a higher rate of substance use disorder and a lower rate of alcohol use disorder compared to their male peers, even if the difference was not statistically significant (6.1% vs 3.7%; p = .37 and 6.6% vs 11.1%; p = .17) (Tab. II).

Women who frequently suffered from weight-related bullying showed a significantly higher use of tobacco (> 10 cigarettes/day) compared to women who had never suffered the same kind of abuse. Interestingly, female victims of weight-related bullying at high frequency showed higher rates of tobacco use (> 10 cigarettes/day) compared to men who suffered the same abuse with the same frequency (37.5% vs 9.1%; p = .13) (Tab. III).

DISCUSSION

Bullying is a well recognized form of violence with important short and long-term adverse outcomes for victims, including suicide, depression, self-harming and addiction ^{12, 13}. Weight-related bullying is a common issue often considered less serious, but its effects are as severe as in other kinds of bullying ¹⁴.

Our research shows that adolescents and young adults who suffer weight-related bullying develop self-threatening behaviors in terms of substance use disorder. Furthermore, those who are often victims use a mix of illegal substances more frequently than non-victims and such behavior is even more risky for their health, highlighting a more severe clinical picture as a possible outcome. Male subjects are more frequently teased compared to their female peers and this result confirms Literature data ¹⁵.

Interestingly, female victims at high frequency show the worst profile with a higher frequency of substance use disorder and smoking habits compared to their male counterpart, thus suggesting a possible gender-oriented outcome.

Notwithstanding such a worse profile, male victims of weight-related bullying showed adverse consequences as well. In fact, they are more prone to developing alcohol use disorder, demonstrating a risky impact of being victims of this kind of bullying and highlighting a gender distinction of possible adverse outcomes that stimulate the need of in-depth research on this issue.

Strength and limits

This research explores a low examined area in a representative sample of adolescents. Furthermore, it examines gender-oriented consequences, offering a precise risk declination according to the victim’s gender.

Its strength is that, for the first time, this research documents a higher substance use disorder, especially of mixed substances, in victims of weight-related bullying. Female victims show the worst profile in terms of addiction. Possible limitations are linked to the study design, since it is not a multi-center study, thus limiting the generalizability of results despite a huge sample. Moreover, a possible limit is the self-reported measuring of victimization and addiction. Furthermore, even if it was not the main aim of the study, an in-depth analysis of the influence and mediation of different diagnoses on addictive behaviors should be stressed in future research.

CONCLUSION

Weight-related bullying shows important consequences for the victims’ health as higher substance use disorder. Women show the worst outcomes in terms of substance use disorder even if they suffer weight-related bullying less frequently than men, while men report adverse long term consequences in terms of alcohol use disorder highlighting thus highlighting possiblea gender-oriented outcomes.

Conflict of interest

The authors declare no conflict of interest.

Funding

None.

Authors’ contributions

E.d.G. planned the study concept and design, the analysis and interpretation of data, statistical analysis, supervised the study and wrote this manuscript. R.P. contributed to the study design. All authors collected data and contributed to their interpretation. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis

Ethical consideration

Informed consent of the participants was obtained after the nature of the procedures had been fully explained. None of the participants received compensation for their contribution. The investigation was carried out in accordance with the latest version of the Declaration of Helsinki. The study was authorized and approved by the Hospital Ethical Committee Protocol .AD_PER n 982.

Figures and tables

TABLE I. Sample characteristics.

Gender	M			F
	109 (35.86%)			195 (64.14%)
Work activity	Student			Employee			Unemployee
	229 (66.77%)			74 (21.38%)			41 (11.85%)
Marital status	Single			In a relationship			Prefer not to answer
	192 (55.92%)			142 (41.12%)			10 (2.9%)
Housing	Parents’			With peers			Alone
	299 (86.84%)			35 (10,17%)			10 (2.99%)
Psychiatric diagnosis N = 141	MDD	Anx	DOC	PD	ADJ	BD	ED	PTSD
	14 (10 %)	12 (8.6 %)	11 (7.6%)	49 (45%)	37 (26%)	3 (2%)	1(0,4%)	1(0,4%)
Psychiatric drugs N = 112	Antidepressant			Antipsychotic	Benzodiazepine		Mood Stabilizer
	82 (92%)			27(30%)	15 (18%)		23 (26%)
MDD = Major Depressive Disorder; Anx = Anxiety Disorder; DOC = Obsessive-compulsive D.; PD = personality disorders; ADJ = Adjustment D.; BD = Bipolar D.; ED = Eating D; PTSD = Post-traumatic Stress Disorder

TABLE II. Frequency of each substance use according to the frequency of weight-related bullying

	Weight-related bullying
	Never (N = 244)	Sometimes (N = 41)	Often (N = 19)
Cannabis	54(22.13%)	9(21.95%)	6(31.58%)
Sedatives	5 (2.05%)	2(4.88%)
Hallucinogens	2(0.8%)
Cocaine	3(1.2%)	1(2.44%)	1(5.26%)
Opioid	1(0.4%)	1(2.44%)
Stimulants	4(1.64%)
Mixed	1(0.4%)		1(5.26%)
Alcohol Use Disorder	46 (18.8%)	6 (14.7%)	4 (21.2%)
Substance Use Disorder	19 (7.8%)	4 (9.8%)	4 (21.2%)

TABLE III. Frequency of weight-related bullying in genders and addiction

	Male		p	Female		p
	Often (N = 11)	Never (N = 79)		Often (N = 8)	Never (N = 165)
> 10 cigarettes/day	1 (9.1%)	11 (13.9%)	.66	3 (37.5%)	18 (10.9%)	.024
Alcohol use disorder	1 (9.1%)	7 (8.86%)	.98		7 (4.24%)
Substance use disorder		1 (1.26%)			6 (3.6%)