Lower subjective social status is associated with increased adiposity and self-reported eating in the absence of hunger due to negative affect among children reporting teasing distress

Abstract

Objectives

Low social standing and teasing are independently associated with increased body mass index (BMI) and overeating in children. However, children with low social status may be vulnerable to teasing.

Methods

We tested the statistical interaction of subjective social status (SSS) and subjective socioeconomic status (SSES) and teasing distress on BMI, fat mass index (FMI), and eating in the absence of hunger (EAH) in children (M_age = 13.09 years, SD = 2.50 years; 27.8% overweight/obese). Multiple linear regressions identified the main effects of self-reported SSS (compared to peers in school), distress due to teasing, and their interaction on BMI (n = 115), FMI (n = 114), and child- (n = 100) and parent-reported (n = 97) EAH.

Results

Teasing distress was associated with greater BMI, FMI, and child-reported EAH due to negative affect (a subscale of EAH) and total EAH scores. There were no associations of SSS with these outcomes. However, there was an interaction between SSS and teasing distress for BMI, FMI, and EAH from negative affect such that lower SSS was associated with higher BMI, FMI, and EAH from negative affect in the presence of teasing distress. However, there were no main effects or interactions (with teasing distress) of SSES on the outcomes.

Conclusions

These findings suggest that the relationship between lower SSS and increased adiposity and overeating behaviors may be exacerbated by other threats to social standing, such as teasing. Children exposed to multiple social threats may be more susceptible to eating beyond physiological need and obesity than those who experience a single form of perceived social disadvantage.

Introduction

Children who have low social status or experience weight-based teasing are more likely to have obesity and engage in behaviors that promote excess energy intake (e.g., food addiction, emotional eating) (Proffitt Leyva et al., 2020; Puhl & Luedicke, 2012; Rahal et al., 2020b; Rubin et al., 2021; Schvey et al., 2019; Senese et al., 2020). Yet, the interplay of these adverse social experiences on children’s body composition and eating behavior remains understudied. We investigated whether subjective social status (SSS) and teasing distress are independently associated with body mass index (BMI), fat mass index (FMI), and eating in the absence of hunger (EAH) as well as the statistical interaction of SSS and teasing distress on these outcomes.

Influence of subjective social status on body composition and eating behavior

Subjective social status describes one’s perception of their position within the social hierarchy, akin to popularity (Jackman & Jackman, 1973). Subjective social status broadly captures perceptions of personal, social, and cultural capital (Diemer et al., 2013) and is relative to one’s social environment or peers (e.g., community, neighborhood, or school scales). A related construct is subjective socioeconomic status (SSES), which captures perceptions of one’s standing compared to others on resources and opportunities that grant socioeconomic status, such as income, education, and occupational prestige (Adler et al., 2000; Singh-Manoux et al., 2005). Among youths (children and adolescents), lower or declining social standing is associated with higher odds of overweight/obesity (Goodman et al., 2001, 2003). In a longitudinal study of adolescents, lower school SSS was associated with higher odds of obesity five years later (Rahal et al., 2020b). Similarly, individuals who experienced steeper trajectories of declining SSS from adolescence to young adulthood exhibited higher BMIs (Goodman et al., 2015).

These results may partially be explained by the relationship between low subjective social standing and obesogenic eating habits among youths. Lower SSES (perceptions of one’s family as less affluent compared to other families) is associated with lower fruit and vegetable intake, frequency of skipping breakfast, and more severe hyperphagic behaviors, even when controlling for indicators of objective SES or deprivation (Belardinelli et al., 2022; Elgar et al., 2016; Quon & McGrath, 2015; Smith et al., 2023). Similarly, young adults who retrospectively reported experiencing lower socioeconomic status relative to others during childhood consumed more energy regardless of their body’s energy needs (Hill et al., 2016). Although there is limited research directly studying the relationship between SSS (perceived respect and acceptance by peers) and eating behaviors among youths, situations that signal threats to social status such as ostracism and social exclusion by peers have been linked to increased energy intake among children and adolescents (Salvy et al., 2012; Senese et al., 2020).

Studies that have experimentally manipulated low subjective socioeconomic and social status have demonstrated causal relationships between such feelings and responses that may subsequently increase energy intake (Cardel et al., 2016; Cheon & Hong, 2017; Cheon et al., 2018; Lim et al., 2020; Sim et al., 2018). However, there have been limited experimental studies of SSS and eating behaviors among children and adolescents. One study that experimentally manipulated social status among adolescents found that resilience was associated with lower energy intake following the manipulation among those assigned to a high social status condition, but not among those assigned to a low social status condition (Guazzelli Williamson et al., 2021), suggesting that feelings of low social status could disrupt psychological processes that may help regulate increased energy intake.

Influence of teasing on body composition and eating behavior

Negative social experiences, such as social exclusion and teasing are associated with increased BMI and obesogenic eating behaviors in children and adolescents (Puhl & Luedicke, 2012; Puhl et al., 2017; Rubin et al., 2021; Salvy et al., 2012; Schvey et al., 2019; Senese et al., 2020). Although children may be teased on different domains and characteristics across development (Warm, 1997), most prior research on the potential influence of teasing on eating behaviors and body composition among children have focused on weight-based teasing. Children and adolescents who experience weight-based victimization tend to respond in ways that negatively affect their emotional and physical well-being including lower physical activity, higher food consumption, and binge eating (Puhl & Luedicke, 2012; Rubin et al., 2021). In addition, children and adolescents who experience weight-based teasing tend to have higher BMI and fat mass, and weight-based teasing during this age is associated with increased BMI, fat mass, binge eating, eating as a coping strategy, and body dissatisfaction approximately 9 years later (Puhl & Luedicke, 2012; Schvey et al., 2019). Rubin and colleagues (Rubin et al., 2021) indicated that adolescents who reported weight-based teasing had greater emotional eating and EAH and were 3 times more likely to report having recently engaged in loss of control eating.

However, being teased or rejected for characteristics besides one’s weight may also be important to consider, since teasing may generally produce negative affect that promotes excess energy intake. For instance, greater experiences of appearance- and competence-based teasing, but not weight-based teasing, during childhood was associated with lower self-esteem among men and women (Gleason et al., 2000). Likewise, greater reports of childhood teasing related to one’s performance, social behavior, and appearance, as well as total experiences of teasing across many domains, was associated with lower self-esteem and greater anxiety in interpersonal relationships in young adulthood (Ledley et al., 2006). Given bidirectional longitudinal relationships between children’s self-esteem and diet quality (Arvidsson et al., 2017), domain-general teasing may contribute to increased discretionary food intake of children. Similarly, children exposed to experimentally induced social rejection from peers without a specific reason were more motivated to earn food rewards and consumed more energy dense food compared to those who were not rejected by peers (Salvy et al., 2012; Senese et al., 2020).

Although measures of teasing-related experiences typically inquire about the frequency of being teased, the negative affect or distress experienced from teasing may also be important to consider. Frequency of teasing may be irrelevant if such experiences are not interpreted or experienced as harmful or threatening to one’s status. Furthermore, given that excess energy intake in response to negative social experiences may be driven by stress or negative emotions, the impact of teasing may be relatively more important compared to frequency alone. Prior research that has examined impact of teasing on eating behaviors has demonstrated that distress experienced from teasing also predicts disturbances to eating behaviors among adolescents (Fabian & Thompson, 1989), and may be more correlated with measures related to disordered eating, depression, and self-esteem among young adults than frequency of teasing episodes (Thompson et al., 1995).

Interplay of subjective social status and teasing

Despite these findings indicating that both low SSS and teasing may be associated with eating behaviors and body composition of youths, the interplay of low SSS and teasing on these outcomes remains understudied. Youths reporting lower SSS may be more susceptible to the impacts of social stressors like teasing. Lower subjective status is associated with experiencing greater negative affect and lower well-being, independent of the contributions of objective socioeconomic status (Kraus et al., 2013; Tan et al., 2020), which may increase vigilance and reactivity to social threats. Low SSS has been proposed to affect health not only by directly increasing stress, but also by heightening vulnerability to social stressors (Adler et al., 2000). For instance, lower SSES has been associated with greater self-reported fear and physiological reactivity and recovery to a social-evaluative threat among older adolescents, over and above objective socioeconomic measures (Rahal et al., 2020a). Status-related factors, such as having lower perceived status have also been shown to interact with the presence of social-evaluative threats, like being critically judged by others, to influence stress related physiological responses (Cundiff et al., 2016).

Initial studies that have examined the interactions between low SSS and teasing have revealed similar findings. When dyads of young adult friends engaged in an experimental task that involved teasing each other, those who had relatively lower socioeconomic standing than their friends more accurately tracked and experienced hostile emotions of their friend, suggesting greater vigilance to social threat (Kraus et al., 2011). Among adolescents, exposure to greater shaming experiences (i.e., being ridiculed or insulted in front of others) was associated with increased risk for depression among those who reported lower SSS compared to peers (Åslund et al., 2009). However, it remains unclear whether this interaction between low SSS and teasing-related experiences on negative affective outcomes also extends to eating behaviors and body composition.

This link between low subjective status with heightened stress responses to social threats like teasing may contribute to tendencies for emotional eating or eating as a means of coping with social stressors. Among adults, negative affective states like stress and anxiety are associated with increased snack intake, intentions to consume larger food portion sizes, and EAH (Lim et al., 2018; Newman et al., 2007; Rutters et al., 2009). This relationship between stress and EAH has also been observed for children, although results are inconsistent or the effects are moderated by other individual differences (Savard et al., 2022), such as child’s weight status (Miller et al., 2019). Given that youth’s subjective social standing among peers may be one factor that may contribute to eating beyond physiological need and may determine how reactive children are to social stressors, the interaction of low SSS and stress experienced from teasing may be important determinants of EAH and adiposity among children.

Current study

Taken together, the risks produced by low social status and distress due to teasing likely contribute to children’s risk of obesity and eating behaviors that increase energy intake. Eating in the absence of hunger may be an especially relevant eating behavior to examine given that experiences that signal lower or loss of social standing such as teasing, social exclusion, and lower socioeconomic standing are associated with increased snack intake and eating in the absence of energy needs (Hill et al., 2016; Rubin et al., 2021; Salvy et al., 2012; Senese et al., 2020). Furthermore, self/parent-reported measures of EAH for youths include specific subscales to determine whether EAH may specifically be motivated by negative affect, as opposed to external cues or other nonnegative internal states like boredom (Shomaker et al., 2013; Tanofsky-Kraff et al., 2008).

We conducted secondary analyses to test the independent associations of SSS and distress due to teasing, as well as their statistical interaction on BMI, FMI, and EAH in a sample of youths. As an exploratory aspect of the study, we also tested a similar relationship between SSES and teasing distress on these outcomes. Although teasing may be a more meaningful moderator of low SSS’s relationship with the outcomes due to both teasing and SSS reflecting experiences of having lower status on social domains, lower relative socioeconomic status compared to others has also been associated with heightened reactivity to social stressors (Kraus et al., 2011; Rahal et al., 2020a). We expected that lower SSS/SSES and exposure to teasing distress would be independently associated with higher BMI, FMI, and EAH. Additionally, we hypothesized that exposure to teasing distress would moderate the relationships SSS/SSES has with BMI, FMI, and EAH such that the relationship between low SSS/SSES and outcomes would be stronger among participants who experience distress due to teasing.

Methods

Participants

A convenience sample was assembled among participants recruited by an ongoing NICHD clinical study (NCT02390765) initiated in 2015 that longitudinally examines how genes and environment influence health and behavior. Manuscripts focused on other main questions (LeMay-Russell et al., 2019; Rubin et al., 2021; Smith et al., 2023) have used questionnaire data that are also employed in the current manuscript. Youths (8–17 years at baseline) were recruited to participate from the Washington DC metro area if they were cognitively-capable, in good general health, and had a BMI ≥ 5th percentile for age and sex (Kuczmarski et al., 2002). Baseline data and assent/consent were collected during 2 screening visits separated by 16–90 days, and data were subsequently collected annually for up to 6 years. The SSS/SSES measure, which was added to the study in November 2018, was obtained once, at either baseline or year 3 follow-up (Y3). Teasing distress, BMI, FMI, and EAH data were collected at baseline and Y3. Cross-sectional analyses utilized data from baseline or Y3, determined by the study visit at which the participants’ SSS and SSES were measured. Participants were provided $120 for completing the second screening visit (at baseline) and $100 for completing the Y3 visit.¹ The study procedures were approved by the National Institutes of Health Institutional Review Board.

Participants over 18 years (44 participants) or who had missing data for exposures (18 participants) were excluded from analyses. Participants were also excluded if they were missing data for the outcome variables in each analysis, resulting in 4 different sample sizes (BMI: n = 115; FMI: n = 114; EAH child-report: n = 100; EAH parent report: n = 96). By design, potential outliers were not removed from analyses. The full sample (N = 115) was 45% female with an average age of 13.1 years (SD = 2.5). See Table 1 for descriptive statistics.

Measures

Subjective social and socioeconomic status

SSS was measured using the MacArthur Scale of Subjective Social Status—Youth Version (Goodman et al., 2001), which presents participant with two 10-rung ladders. For the measure (ladder) of SSS, the participant is asked to select the rung that best represents their overall standing in their school collectively based on respect, grades (academic performance), and social standing. For the measure (ladder) of SSES, the participant is asked to select the rung that best represents the overall socioeconomic standing of their family in society collectively based on income, education, and occupation. On both the SSS and SSES ladders, higher scores indicate higher SSS, and the scores were treated as continuous variables in analyses. The MacArthur Scale was introduced into the study in 2018; thus, it was not administered to every participant.

Teasing distress

The Perception of Teasing Scale (POTS) (Thompson et al., 1995) measures how often one is teased and how upset one feels because of teasing using 5-point Likert-type scales ranging from 1 (never) to 5 (very often) and 1 (not upset) to 5 (very upset), respectively (α = 0.67). In the current study, teasing distress was determined by dichotomizing the “how upset” responses into distress absence (not upset, response = 1) and presence (at least a little upset, response ≥ 2). This was due to an uneven distribution of ratings of distress when any distress was present. Distress due to teasing was the focus of the analysis rather than the frequency of teasing because distress may more closely capture the negative affect and internalization of social threat produced by teasing. Within POTS, there are separate questions related to weight-based teasing (e.g., people make fun of me because I am heavy) and competence-based teasing (e.g., people say I act dumb). Responses for the 2 types of teasing were combined into a single measure because few children reported distress related to individual teasing types.

Body mass index

Weight and height measurements were used to calculate BMI (kg/m²) among participant youth, which was converted into continuous z-scores (BMIz) for age and sex based on CDC growth standards (Kuczmarski et al., 2002).

Fat mass index

FMI represents the total weight of one’s body fat relative to their height. While BMI does not distinguish body fat mass from lean body mass, FMI directly reflects excess body fat relative to height. Age- and sex-specific reference percentiles and curves for FMI among children and adolescents in the United States has been previously published (Weber et al., 2013). Total body fat mass was determined using dual-energy x-ray absorptiometry using the iDXA system (GE Healthcare, Madison, WI) and converted to kilograms to calculate FMI (kg/m²) as a continuous variable.

Eating in the absence of hunger (child report)

The 14-item Eating in the Absence of Hunger Questionnaire for Children (EAH-C) (Tanofsky-Kraff et al., 2008) measures how often a child starts or keeps eating in response to emotions or external factors using a 5-point Likert-type scale ranging from 1 (never) to 5 (always). The EAH-C was completed by children and includes a total score (α = 0.88) and 3 subscales: negative affect (α = 0.86; e.g., feeling sad), external eating cues (α = 0.79; e.g., food tastes good), and fatigue (α = 0.63; e.g., feeling tired). This measure has exhibited good internal consistency, convergent validity, and temporal stability (Tanofsky-Kraff et al., 2008), and scores were used as continuous variables in analyses.

Eating in the absence of hunger (parent report)

Along with the EAH-C, we employed the Eating in the Absence of Hunger Questionnaire for Children—Parent Report about Child (EAH-P) (Shomaker et al., 2013). The EAH-P allows caregivers to characterize their perceptions of their child’s EAH. As a parallel version of the EAH-C, the EAH-P has a total score (α = 0.89) in addition to the same 3 subscales: negative affect (α = 0.88), external eating cues (α = 0.77), and fatigue (α = 0.73), where used as continuous variables in analyses. Previous research has indicated that caregiver-reported EAH due to external cues may be a better predictor of BMI and fat mass than child-reported external EAH (Shomaker et al., 2013), although caregiver-reported EAH of children is demonstrably different from children’s self-reported EAH (Shomaker et al., 2010). Caregivers perceived their children’s EAH due to negative affect and fatigue more often when their child experienced binge eating episodes compared to caregivers of children with no episodes, indicating that parents may infer their child’s internal experience based on observable eating (Shomaker et al., 2010). The EAH-C may be more sensitive to the internal responses produced by social threats like low social standing and teasing since children are reporting their own eating behaviors and parents are not always privy to their children’s struggles. As such, we included both scales in our analyses.

Analysis

Analyses were conducted using SPSS version 29 (IBM, 2022). To assess potential selection bias of participants who were excluded due to unavailable SSS/SSES data, we performed independent sample t-tests to compare differences in BMI, FMI, EAH-C, EAH-P, and age and a chi-squared test to compare differences in teasing distress and sex for those who were administered the SSS/SSES measures and those who were not.

Statistical interactions between SSS and teasing distress on outcomes of interest were tested using the Process SPSS macro model #1 (Hayes, 2017). SSS was conditioned to low, mean, and high levels. In this model, SSS was entered as the predictor and teasing distress (presence or absence) was the moderator. We identified the main effects of SSS, teasing distress, and their interaction on BMI, FMI, and EAH. Covariates² included the timepoint when SSS was measured for the participant (baseline or Y3), visit age (continuous), and sex (male, female). The same sets of analyses were applied to examine statistical interactions between SSES and teasing distress. Given deviations from normality and heteroscedasticity, confidence intervals for all regression coefficients (i.e., main effects and interactions) were estimated using wild bootstrapping with 5,000 resamples. Wild bootstrapping was used because it produces robust estimates even when assumptions of normality and homoscedasticity are violated (Liu, 1988). Wild bootstrapping involves resampling weighted residuals from the model along with predicted values. Because heteroskedasticity is caused by unequal variance in the residuals, resampling residuals and predicted values provides a more robust estimate of confidence intervals with bootstrapping (Liu, 1988).

Results

Descriptive statistics and correlations

After running an independent samples t-test, we found that there was no difference in SSS between participants who reported teasing distress (M = 7.12, SD = 1.47) and those who did not (M = 7.19, SD = 1.62), t(113) = 0.21, p = .84. Likewise, there was no difference in SSES between participants reporting teasing distress (M = 7.03, SD = 1.11) and those who did not (M = 6.60, SD = 1.27), t(113) = 1.69, p = .09. Spearman's rho correlations between continuous variables are presented in Table 2. EAH subscales and total scores were significantly correlated within an assessment type (i.e., EAH-C total score and EAH-C subscales were correlated). However, none of the EAH-C and corresponding EAH-P subscales were correlated (e.g., EAH-C due to negative affect was not significantly correlated with EAH-P due to negative affect), indicating low correspondence in children- and caregiver-reported EAH.

When comparing participants who were included for analysis from those who were excluded due to unavailable data, we found significant differences only between those who completed the SSS/SSES measures and those who did not for baseline EAH-P due to negative affect (t[293.56] = 2.44; p = .02 without data: M = 1.32, SD = 0.51; with data: M = 1.19, SD = 0.36) and baseline EAH-P total score (t[298.99] = 2.51; p = .01 without data: M = 23.72, SD = 7.26; with data: M = 21.93, SD = 5.30).

Body mass index Z-score

SSS. The model for BMIz was significant (p = .01; see Table 3 for full results of the model). The main effect of SSS was not significant, but there was a significant main effect of teasing distress (b = 2.66; 95% CI: 1.26, 4.09). The interaction term for SSS and teasing distress was significant (b = −0.31; 95% CI: −0.50, −0.11), in which lower SSS was significantly associated with higher BMI only when participants reported distress due to teasing (b = −0.27; 95% CI: −0.44, −0.10; Figure 1).

SSES. The model for BMIz was significant, R² = .15, F(6, 108) = 3.19, p = .006. There was no significant main effect of SSES (b = −0.04; 95% CI: −0.22, 0.13), but there was a main effect of teasing distress (b = 2.57; 95% CI: 0.49, 4.58). There was no statistical interaction between SSES and teasing distress (b = −0.30; 95% CI: −0.60, 0.04). See Table S1 (Supplemental materials) for full results on the main effects of SSES and interactions with teasing distress on the outcomes.

Fat mass index

SSS. The FMI model was significant (p < .01; see Table 3 for full results of the model). There was no significant main effect of SSS, but the main effect of teasing distress was significant (b = 6.17; 95% CI: 2.02, 10.39). The interaction term for SSS and teasing distress was significant (b = −0.66; 95% CI: −1.24, −0.08), such that lower SSS was significantly associated with higher FMI when participants were upset because of teasing (b = −0.57; 95% CI: −1.09, −0.02; Figure 2).

SSES. Although the FMI model was significant, p = .002, there were no main effects or statistical interactions of SSES and teasing distress (ps > .05).

Child-reported eating in the absence of hunger

SSS. The model for the external subscale was not significant (p = .08; see Table 3 for full results of the model), but the models for negative affect (p < .01), fatigue (p = .03), and total score (p < .01) were significant. The main effect of SSS was not significant for negative affect, fatigue, or total score. There was a significant main effect of teasing distress only for negative affect (b = 1.37; 95% CI: 0.46, 2.32) and total score (b = 14.66; 95% CI: 2.18, 27.62). The interaction term for SSS and teasing distress was significant only for the negative affect subscale (b = −0.16; 95% CI: −0.28, −0.04). Lower SSS was associated with greater EAH due to negative affect when participants experienced teasing distress (b = −0.18; 95% CI: −0.28, −0.08; Figure 3).

SSES. The models for EAH due to negative affect, p = .03, fatigue, p = .04, and total EAH scores, p = .03, were significant but there were no main effects or statistical interactions of SSES and teasing distress on any of the subscales or total score of self-reported EAH (ps > .05).

Caregiver-reported eating in the absence of hunger

SSS. The EAH-P external cues subscale, fatigue subscale, and total score models were not significant (ps > .05) (Table 3). The negative affect subscale model was significant (p = .03), although there was no significant main effects or statistical interactions of SSS or teasing distress.

SSES. None of the models examining EAH-P subscales or total scores as outcomes were supported (ps > .05).

Discussion

This analysis found a statistical interaction between SSS and children’s experience of teasing distress on body composition and EAH. Low SSS was associated with greater BMI, FMI, and EAH due to negative affect only when participants experienced teasing distress. Exposure to teasing distress was also independently associated with higher BMI, FMI, EAH due to negative affect, and EAH total score. These results are consistent with previous literature indicating that children exposed to adverse social experiences, such as low SSS, ostracism, and weight-based teasing, tend to have increased BMI, fat mass, and energy intake (Cardel et al., 2016; Pink et al., 2024; Rahal et al., 2020b; Rubin et al., 2021).

However, we did not observe the main effects of SSES or statistical interactions with teasing distress on these outcomes. SSS captures perceived status on social domains relative to peers in one’s proximal school environment, possibly serving as a more salient or meaningful signal of social standing among youths than SSES, which is based on family (rather than personal) standing in a broader societal environment. SSES also involves comparisons of status based on socioeconomic factors, such as income, occupation, and education, which may be less relevant for impressions of status among school-aged youths. Our findings suggest that lower SSS in school, rather than lower subjective standing in general (i.e., SSES), may selectively increase susceptibility of EAH due to negative affect and adiposity to social stressors like teasing. However, it is possible that low subjective status in one domain (either social status or socioeconomic status) interacts with being teased on the same domain to affect these outcomes. For instance, teasing in the domain of socioeconomic status (e.g., ridicule for being “poor”) may exhibit a similar statistical interaction with lower SSES on these outcomes, although we lacked such measures of teasing in the current study.

It is possible that we observed statistical interaction between SSS and teasing distress only for the EAH-C negative affect subscale because negative affect is a common response to social threat. Among adults, negative affect mediates the relationship between lower SSS and poorer health outcomes (O'Leary et al., 2021), and lower SSS has been linked to greater psychological and physiological stress reactivity to social-evaluative threats among adolescents and young adults (Cundiff et al., 2016; Rahal et al., 2020a). Together with these findings, our results suggest that youth who report low SSS and are distressed by teasing may be more susceptible to negative affect or stress that induces eating independent of hunger and adiposity.

However, not all our hypotheses were supported—we did not replicate prior studies indicating that SSS is independently associated with higher BMI (Cardel et al., 2016; Rahal et al., 2020b). Perhaps SSS contributes to BMI when coupled with other social stressors like teasing distress. For EAH-P, none of the scales are correlated with the corresponding EAH-C scales. This indicates that the EAH-P and -C may be capturing different constructs in this sample. It is also possible that caregivers are unaware of the specific motivations that drive their children’s EAH (e.g., caregivers may misinterpret eating due to negative affect for boredom).

These secondary analyses were limited by the relatively small sample size and since they represent secondary analyses for this trial, p-values were not adjusted for multiplicity of tests that were conducted. It is possible that results might differ if all studied participants had overweight or obesity. Thus, results of this study should be considered as hypothesis generating. Since we performed cross-sectional analyses, we are also unable to establish any causal relationships between SSS, teasing distress, and outcomes. Future studies should utilize longitudinal data, mediation analyses, or perform experimental manipulations to determine how multiple adverse social experiences affect eating behaviors among children. Future research should attempt to replicate these results in larger samples, compare effects based on child age, extend our findings to other eating behaviors, and identify the relevance of the findings on eating behavior to longitudinal changes in body composition.

The inclusion of FMI and EAH were strengths of this study. BMI is used more often as an outcome for body composition rather than fat mass in research on social determinants of children’s growth and health. Yet, FMI is a more predictive screening tool for metabolic status compared to BMI (Liu et al., 2013). Likewise, we were able to operationalize EAH in 2 ways by utilizing child- and caregiver-reported EAH.

These findings have multiple broader impacts. They provide support for a conceptual model that low SSS may exacerbate the negative effects of social stressors, like teasing, on health outcomes, such as obesogenic eating behaviors and adiposity. Researchers should consider the interplay of vulnerabilities to different forms of perceived social disadvantage when examining the effect of social experiences on children’s body composition and eating behaviors. Likewise, clinicians should consider the interplay of multiple, rather than individual, social stressors, when assessing children who may be at risk for overweight/obesity or practices for weight management. Researchers and clinicians could readily incorporate a measure of SSS into these initiatives since it can be measured intuitively among children with a single item. Recent research has shown that 8.5-year-old children who are more socially anxious and exhibit greater stress-related responses to threats to social status, such as ostracism by peers, consume more energy from subsequent snacks and prospectively have higher BMI’s around age 10 (Pink et al., 2024). When considered with the current findings, prevention and intervention strategies to address eating or weight-related issues among youths should focus on the impact of multiple social threats. This could be done by efforts that promote greater inclusivity and social support, while lower teasing and bullying in youths’ social environments, such as schools. Although not specific to teasing, some initiatives to reduce bullying in schools have been effective (Silva et al., 2017). Another complementary approach may be to bolster youths’ socio-emotional skills to better manage stress related to low subjective status and other peer-related social adversities. Research on adults has shown that greater ability for reappraisal (reframing negative/adverse experiences in a positive light) may downregulate the effects of low SSS on negative affect and ultimately mitigate its effects on poorer health outcomes (O’Leary et al., 2021), although further research is needed on how such affective regulation strategies could be applied to low SSS and among children.

Footnotes

Supplementary material

Supplementary material is available online at Journal of Pediatric Psychology (https://dbpia.nl.go.kr/jpepsy/).

Data availability

Data available on request.

Author contributions

Bobby K. Cheon (Conceptualization [lead], Data curation [equal], Formal analysis [lead], Funding acquisition [equal], Investigation [equal], Methodology [lead], Project administration [equal], Supervision [equal], Writing—original draft [equal], Writing—review & editing [equal]), Meegan R. Smith (Conceptualization [supporting], Data curation [lead], Formal analysis [equal], Investigation [equal], Project administration [equal], Writing—original draft [equal], Writing—review & editing [equal]), Julia M.P. Bittner (Conceptualization [supporting], Investigation [supporting], Methodology [supporting], Writing—review & editing [equal]), Lucy K. Loch (Data curation [supporting], Investigation [supporting], Project administration [supporting] writing—review & editing [equal]), Hannah E. Haynes (Data curation [supporting], Investigation [supporting], Project administration [supporting], Writing—review & editing [equal]), Bess F. Bloomer (Data curation [supporting], Investigation [supporting], Project administration [supporting], Writing—review & editing [equal]), Jennifer Te-Vazquez (Data curation [supporting], Investigation[supporting], Project administration [supporting] writing—review & editing [equal]), Andrea I. Bowling (Data curation [supporting], Investigation [supporting], Project administration [supporting], Writing—review & editing [equal]), Sheila M. Brady (Data curation [supporting], Investigation [supporting], Project administration [supporting], Writing—review & editing [equal]), Marian Tanofsky-Kraff (Conceptualization [equal], Investigation [supporting], Writing—review & editing [equal]), Kong Y. Chen (Investigation [supporting], Project administration [supporting], Writing—review & editing [equal]), and Jack A. Yanovski (Conceptualization [equal], Data curation [equal], Funding acquisition [equal], Investigation [equal], Methodology [equal], Project administration [equal], Resources [lead], Supervision [equal], Writing—review & editing [equal]).

Funding

This research was supported by Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (BKC: ZIAHD009004-01656312 and JAY: ZIAHD00641).

Conflicts of interest: J.A.Y. has received grant support unrelated to this article for pharmacotherapy trials for obesity from Hikma Pharmaceuticals, Inc., Soleno Therapeutics, Inc., and Rhythm Pharmaceuticals, Inc, as well as support for basic science studies from Versanis Bio, Inc. No other potential conflicts of interest relevant to this article were reported by the other authors.

Acknowledgments

The authors thank Neil Perkins for consultation on statistical analyses. The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of the National Institutes of Health, United States Department of Health and Human Services, Uniformed Services University of the Health Sciences, Department of Defense, or Metis Foundation.

References