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APA Style:
Almenara, C. A., & Ježek, S. (2015). The source and impact of appearance teasing: An
examination by sex and weight status among early adolescents from the Czech Republic. Journal
of School Health, 85(3), 163–170. https://doi.org/10.1111/josh.12236
AMA Style:
Almenara CA, Ježek S. The source and impact of appearance teasing: An examination by sex and
weight status among early adolescents from the Czech Republic. J Sch Health. 2015;85(3):163-170.
doi:10.1111/josh.12236.
Chicago Style:
Almenara, Carlos A, and Stanislav Ježek. 2015. “The Source and Impact of Appearance Teasing:
An Examination by Sex and Weight Status among Early Adolescents from the Czech Republic.”
Journal of School Health 85 (3): 163–70. doi:10.1111/josh.12236.
IEEE Style:
C. A. Almenara and S. Ježek, “The source and impact of appearance teasing: An examination by
sex and weight status among early adolescents from the Czech Republic,” J. Sch. Health, vol. 85,
no. 3, pp. 163–170, 2015.
doi: 10.1111/josh.12236
Journal of School Health • March 2015, Vol. 85, No. 3 •
• 163
D
R
ESEARCH
A
RTICLE
The Source and Impact of Appearance
Teasing: An Examination by Sex and Weight
Status Among Early Adolescents From the
Czech Republic
C
ARLOS
A.
A
LMENARA
,
PhD
a
S
TANISLAV
J
E
Z
ˇ
EK
,
PhD
b
ABSTRACT
BACKGROUND: Some adolescents are victims of negative appearance-related feedback, and this may have lasting adverse
effects on their self-evaluation. The aim of this study was to examine the frequency and impact of appearance teasing across sex
and weight status.
METHODS: The participants were 570 Czech adolescents (47.9% girls) evaluated at age 13 during the European Longitudinal
Study of Pregnancy and Childhood. Instruments used were body mass index and an adapted version of the Physical Experiences
Survey that measures appearance teasing sources (parents, peers, among others), body part teased, and the impact of teasing.
Chi-square test and multivariate analyses of variance were conducted to compare groups by sex and weight status. Logistic
regression was then used for adjusted analyses.
RESULTS: Girls were more likely to report appearance teasing than boys. Overweight adolescents, both girls and boys, were
more likely to be teased than non-overweight adolescents. Overweight adolescents compared with non-overweight adolescents
reported higher levels of impact of body-related teasing.
CONCLUSIONS: Czech adolescents continue to adopt the societal standards of Western countries, stigmatizing overweight
peers. This may affect more obese adolescents. Future research has to evaluate different sources of appearance-related teasing.
Interventions in schools are suitable for the reduction of appearance-related prejudices.
Keywords: body weight; physical appearance; adolescents; teasing; appearance criticism.
Citation:
Almenara
CA,
Je
z
ˇ
ek
S
.
T
he
source and
i
mpact o
f
appearance
teasing: an examination
b
y
s
ex
and
w
eight
s
tatus
a
mong
early adolescents from the Czech Republic. J Sch Health. 2015; 85: 163-170.
Received on November 28, 2013
Accepted on October 22, 2014
uring adolescence, several domains of functioning
such as academic competence, athletic competence,
physical appearance, peer acceptance, close
friendship,
among others, seem to be integrated to give adolescents
a global sense of self-worth.1 Among
all these domains,
physical appearance and peer
acceptance are
recognized as important ones during
adolescence. Self-
perceived physical appearance (ie,
self-perception of
external appearance) plays a key
role among most
adolescents’ lives because it has been
found to be a more predictive domain of global self-
esteem or overall sense of self-worth.1 In addition,
studies across cultures suggest that peer acceptance
provides adolescents better adjustment in school, and
by contrast negative peer interactions, specifically
peer rejection or exclusion, may represent risk factors
for the development of psychopathology and general
maladjustment.2
Taken together, negative peer interactions empha-
sizing physical appearance may have long-lasting
detrimental effects. For instance, appearance-related
a
Postdoctoral Lecturer, (carlos.almenara@mail.muni.cz), Institute for Research on Children, Youth and Family, Department of Psychology, Faculty of Social Studies, Masaryk University,
Joštova, 10, 602 00 Brno, Czech Republic.
b
Senior Researcher, (jezek@fss.muni.cz), Institute for Research on Children, Youth and Family, Department of Psychology, Faculty of Social Studies, Masaryk University, Joštova, 10,
602 00 Brno, Czech Republic.
Address correspondence to: Carlos A. Almenara, Postdoctoral Lecturer, (carlos.almenara@mail.muni.cz), Institute for Research on Children, Youth and Family, Department of
Psychology, Faculty of Social Studies, Masaryk University, Joštova, 10, 602 00 Brno, Czech Republic.
The authors acknowledge the support of the Central European Longitudinal Study of Pregnancy and Childhood (CELSPAC) (MUNI/M/1075/2013) and the VITOVIN project
(CZ.1.07/2.3.00/20.0184), which is co-financed by the European Social Fund and the state budget of the Czech Republic.
Journal of School Health • March 2015, Vol. 85, No. 3 doi: 10.1111/josh.12236
164
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feedback in the form of negative comments (eg, using
names like ‘‘fatty,’’ ‘‘egghead,’’ or others) is a common
form of verbal harassment in schools,3 and it could
have lasting negative effects on self-evaluation and
consequently on the psychological adjustment and
general well-being of adolescents. Specifically, these
negative comments have been commonly studied
under the name of teasing, which is defined as an
intentional provocation, usually a comment about
a relevant characteristic of the target of the teasing,
done in a playful but ambiguous way through the
combination of humor and aggression.4,5 Among the
negative effects, previous studies have revealed that
appearance-related teasing increases the adolescents’
risk of developing body dissatisfaction6,7 and disor-
dered eating.7 Other studies suggest that teasing can
increase negative affect in girls,8 lower self-esteem
and increase symptoms of depression in boys and
girls.9 Moreover, experiences of being teased about
physical appearance in adolescence tend to predict
appearance-based rejection sensitivity and anxiety
disorders in adulthood.10,11
A limitation of some previous studies is that they
evaluated teasing history by asking adult participants
to recall their previous experiences retrospectively.
Furthermore, most of these findings are limited to
undergraduate women and overweight adults from
English speaking countries. A limited number of
previous studies have been conducted with early
adolescents of both sexes. In addition, there is a claim
to evaluate the impact of teasing at different ages, and
specifically across weight status.12,13 The reason is that
several studies have highlighted the stigma against
overweight people, and especially obese children, who
have been found to be less likable by their peers,14
more likely to be victims of weight teasing15 and
bullying.16 In addition, it has been recommended
to examine the different sources of teasing.7,17 The
experience of teasing could differ not only by sex and
weight status18 but also could vary when considering
different sources such as parents, peers, teachers,
and even when considering different kinds of peers
such as classmates compared with neighborhood
friends.19 Finally, studies across cultures are needed
to help understand the patterns and meanings of peer
interactions.2
Consequently, this study has been conducted to
explore the experience of appearance-related teasing
among Czech adolescents. To our knowledge, this
is the first study of its kind with early adolescents
from the Czech Republic. Specifically, our first goal
is to examine the frequency and impact of teasing
across sex and weight status. Second, to examine
how the frequency and impact of appearance-related
teasing may vary when accounted by different sources
(parents, peers, teachers, among others).
METHODS
Participants
The sample comprised 570 adolescents (273 girls)
from the urban area of Brno, the second largest
city in the Czech Republic. Participants were part
of a broader epidemiological study, the European
Longitudinal Study of Pregnancy and Childhood
(ELSPAC).20 Previous studies using this dataset have
been published elsewhere.21,22
The Czech ELSPAC sample started with all families
having a child born in Brno between March 1991
and June 1992 (N 3859). This original sample
reflected the ethnic homogeneity of contemporary
Czech society, in which less than 3% people were
of ethnic minorities.23 In 1999, a subsample of
800 children (8 years old at that time) was selected
for psychological examinations. This subsample was
examined at age 8, and then biannually from age
11 to 19, with the sample size slowly decreasing due
to attrition. The sample used in this study (N 570)
belongs to the group at age 13. Missing data analysis did
not show any systematic patterns in attrition affecting
the data from age 8 to 13.
Instrumentation
Weight status.
Participants’ weight and height were
self-reported. The body mass index (BMI kg/m
2
)
was then calculated and used to obtain weight
status categories (non-overweight and overweight)
using international cutoff points.
24
In this way, 23
(8.42%) girls and 44 boys (14.81%) were classified
as overweight, a prevalence similar to that one found
among Czech adolescents (13 to 15 years old) in a large
cross-national survey.
25
Teasing about physical appearance.
A scale adapted
from the Physical Experiences Survey (PES)
26
was
used to measure the specific sources of appearance-
related teasing and their impact. The PES was designed
to measure developmental body image experiences
during childhood and adolescence, including open-
ended, Likert-type, and dichotomous responses. For
the purposes of this study, we selected the items
measuring sources of teasing, the impact of teasing,
and the body aspect teased.
To measure sources of teasing, participants were
asked
Did any of the following persons sometimes criticize
your appearance?
— to evaluate 10 different sources of
appearance teasing: mother, father, relatives, teachers,
strangers, siblings, male classmate, female classmate,
male friend, female friend. The answer type was
dichotomous (1 yes, 0 no), and item answers were
aggregated to calculate total prevalence (zero points
indicate that the adolescent has never been teased by
anyone, and more than zero that the adolescent has
been teased by someone). As in the original version,
those participants who indicated they were teased
doi: 10.1111/josh.12236
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were further asked to answer the question:
How did you
feel?
— to measure the impact of the experience(s). A 5-
point Likert-type response from
it mattered a lot to me
to
it did not matter at all to me
was employed. The reliability
estimated by Cronbach’s alpha was 0.86, indicating
adequate internal consistency for this measure.
To measure the body aspect teased, a 4-item
subscale from the PES was used. Participants were
asked Did it ever happen to you that someone criticized
your appearance? with the indication to specify what
aspect of their body was teased, face, height, body
shape, or weight. The answer type was dichotomous
(yes or no). Participants who selected yes were further
asked How did you feel? — to measure the impact of the
experience(s) with a 5-point Likert-type answer from it
mattered a lot to me to it did not matter at all to me. Although
this scale evaluates 4 body parts, we used for this study
the items more relevant to the impact of teasing (body
shape and body weight).27 The reliability estimated by
Cronbach’s alpha was 0.81 for this measure, indicating
adequate internal consistency.
Procedure
Adolescents and their parents were asked to par-
ticipate in individual sessions between May 2004 and
June 2005. During the sessions, various types of mea-
sures, including a structured interview, achievement
and ability tests, pencil-and-paper questionnaires, and
computer-administered questionnaires, were admin-
istered. The data used in this study comes from
computer-administered questionnaires, except for the
number of siblings, which was reported by the parents.
Data Analysis
To examine the differences across sex and weight
status on reported appearance teasing frequencies,
a series of chi-square tests for independence was
performed.
To evaluate further these differences, a series of
logistic regression analyses was conducted to calculate
the likelihood of reporting being teased. Sex and
weight status were introduced as predictors, and
males and non-overweight were the reference groups.
These analyses were adjusted by weight status and
sex, respectively. The interaction between weight
status and sex was not included because it was not
statistically significant in the analyses, and the effect
size was very small.
To examine the effect of sex and weight status
on the impact of teasing levels, a 2-way between-
groups multivariate analysis of variance (MANOVA)
was used. Sex and weight status were introduced as
fixed factors and the 2 kinds of impact by teasing, body-
related teasing and appearance teasing, as dependent
variables.
RESULTS
Teasing Frequency and Sources
In general, we found a large prevalence of teasing
(Table 1). Specifically, 76% of all adolescents in this
sample reported appearance-related teasing. Almost
50% reported body-related teasing, including more
than 33% reporting body shape and body weight
teasing (Table 1). The most cited source of teasing was
by far male classmates (Table 1).
Sex and Weight Status Differences
To evaluate differences across sex and weight status
in reported appearance teasing, chi-square tests of
independence were performed first. Comparing girls
with boys, the former were more likely than the latter
to report appearance teasing (
χ2
[1, N 556] 7.29,
p .007, phi 0.12), whereas boys were more likely
than girls to report body weight teasing (
χ2
[1,
N 542] 4.43, p .035, phi 0.09). Specifically,
girls reported more appearance teasing by their siblings
(
χ2
[1, N 430] 4.36, p .037, phi 0.11) and
female friends (
χ2
[1, N 553] 11.13, p .001,
phi 0.15).
In the group of non-overweight adolescents, girls
were more likely than boys to report appear-
ance teasing (
χ2
[1, N 492] 5.73, p .017,
phi 0.11), including more teasing by female class-
mates (
χ2
[1, N 492] 4.47, p .035, phi 0.10)
and female friends (χ2 [1, N 490] 12.24, p <.001,
phi 0.16). Boys were more likely to report appear-
ance teasing by teachers (χ2 [1, N 493] 6.23,
p .013, phi 0.12).
By contrast, in the group of overweight adolescents,
the only sex difference found was that overweight
boys were more likely than overweight girls to report
body weight teasing (χ2 [1, N 61] 4.31, p .038,
phi 0.30), and overweight girls were more likely
to report appearance teasing by their siblings (χ2 [1,
N 46] 3.99, p .046, phi 0.34), compared with
overweight boys.
When comparing non-overweight with overweight
adolescents, the latter were more likely to report body-
related teasing (
χ2
[1, N 545] 20.51, p
<
.001,
phi 0.20), including both body shape teasing (
χ2
[1, N 546] 21.24, p
<
.001, phi 0.20), and body
weight teasing (
χ2
[1, N 542] 21.53, p
<
.001,
phi 0.20). Although there were no differences by
weight status in the total frequency of appearance
teasing, significant differences emerged when the
sources of appearance teasing were examined.
Specifically, overweight adolescents were more likely
to report being teased by their male classmates
(
χ2
[1, N
=
556]
=
6.66, p
=
.010, phi
=
0.11), sib-
lings (
χ2
[1, N
=
430]
=
5.86, p
=
.015, phi
=
0.12),
and father (
χ2
[1, N
=
550]
=
6.88, p
=
.009,
phi
=
.12).
Journal of School Health • March 2015, Vol. 85, No. 3 doi: 10.1111/josh.12236 166
= = =
=
Table 1.
Frequencies (Percentages Between Parentheses) of Reported Teasing by Sex and Weight Status
Non-Overweight
Overweight
Teasing
Girls
Boys
Total
Girls
Boys
Total
Total
(N = 250)∗
(N = 253)∗
(N = 503)∗
(N = 23)∗
(N = 44)∗
(N = 67)∗
(N = 570)∗
Source
Mother
48 (19.6)
42 (16.9)
90 (18.2)
8 (36.4)
9 (22.0)
17 (27.0)
107 (19.2)
Father
29 (11.9)
28 (11.4)
57 (11.7)
6 (28.6)
9 (22.5)
15 (24.6)
72 (13.1)
Relatives
30 (12.2)
29 (11.7)
59 (12.0)
3 (13.6)
5 (11.9)
8 (12.5)
67 (12.0)
Teachers
7 (2.9)
21 (8.5)
28 (5.7)
4 (18.2)
1 (2.4)
5 (7.8)
33 (5.9)
Strangers
36 (14.7)
39 (15.7)
75 (15.2)
2 (9.1)
6 (14.3)
8 (12.5)
83 (14.9)
Siblings
†
73 (39.2)
61 (30.8)
134 (34.9)
13 (76.5)
12 (41.4)
25 (54.3)
159 (37.0)
Classmate (m)
106 (43.3)
113 (45.7)
219 (44.5)
16 (72.7)
24 (57.1)
40 (62.5)
259 (46.6)
Classmate (f)
74 (30.2)
53 (21.5)
127 (25.8)
8 (36.4)
15 (35.7)
23 (35.9)
150 (27.0)
Friend (m)
32 (13.1)
39 (15.7)
71 (14.4)
4 (18.2)
8 (19.0)
12 (18.8)
83 (14.9)
Friend (f)
46 (18.9)
19 (7.7)
65 (13.3)
4 (18.2)
6 (14.6)
10 (15.9)
75 (13.6)
Any source
195 (79.9)
174 (70.2)
369 (75.0)
21 (95.5)
32 (76.2)
53 (82.8)
422 (75.9)
Body part
Shape
76 (32.2)
67 (27.0)
143 (29.5)
15 (71.4)
22 (53.7)
37 (59.7)
180 (33.0)
Weight
75 (31.8)
89 (36.3)
164 (34.1)
9 (45.0)
31 (75.6)
40 (65.6)
204 (37.6)
Any part
109 (46.2)
113 (45.7)
222 (46.0)
15 (71.4)
33 (80.5)
48 (77.4)
270 (49.5)
m, male; f, female.
∗Percentages may show small incidental missingness.
†Percentages based on respondents who had brothers or sisters.
Likelihood of Being Teased Across Sex and Weight Status
To evaluate these differences further, a series
of logistic regression analyses was performed. The
patterns we found were similar to those outlined
Table 2.
Risk of Appearance Teasing, Comparing Sources and
Body Parts by Sex and Weight Status
Impact of Teasing
Finally, a 2-way between-groups MANOVA was
used to examine the effect of sex and weight sta-
tus on the impact of teasing. MANOVA revealed
no sex effect on the impact of teasing. We found
only a statistically significant difference between non-
overweight and overweight adolescents on the com-
bined impact of teasing variables, F (2, 63) 6.41,
p .003; Wilks’ lambda 0.83; eta squared 0.17.
Considering the 2 impact variables separately, a
difference was found only in impact by body-
related teasing, F (1, 64)
=
6.11, p
=
.016; eta
squared = 0.09, indicating that overweight adolescents
OR, odds ratio; CI, confidence interval; m, male; f, female. Statistically significant
values are in bold.
∗Reference group for sex was males. Analyses were adjusted by weight status.
†Reference group for weight status was non-overweight. Analyses were adjusted
by sex.
‡Based on respondents that had brothers or sisters.
reported higher levels of impact by body-related teas-
ing (mean
=
3.47, SD
=
1.31) than non-overweight
adolescents (mean
=
2.92, SD
=
1.47).
DISCUSSION
The aim of this study was to examine the frequency
and impact of appearance-related teasing, by different
above. Regarding sex differences, girls were more than
1.5 times more likely to report appearance teasing,
compared with boys (Table 2). Specifically, compared
with boys, girls were between 1.5 and almost 2.5
times more likely to report being teased about their
appearance by female classmates, siblings, and female
friends (Table 2).
When compared with non-overweight, overweight
adolescents were up to 4 times more likely to report
body-related teasing, including more than 3.5 times
more likely to report body shape and body weight
teasing (Table 2). Furthermore, they were up to 2.5
times more likely to report father, siblings, and male
classmates as the sources of appearance teasing.
doi: 10.1111/josh.12236
Journal of School Health • March 2015, Vol. 85, No. 3 •
•167
sources (parents, peers, teachers, among others)
and across sex and weight status (overweight and
non-overweight).
Frequency of Appearance-Related Teasing
A noteworthy finding in this study was the large
amount of adolescents who reported appearance
teasing and body-related teasing (76% and 49%,
respectively), including body shape teasing (33%), and
weight teasing (38%). A recent meta-analysis of pre-
vious studies suggests that appearance-related teasing
is a common phenomenon during adolescence across
different cultures.28 For instance, a previous study in
Wales with a sample aged 8 to 13 reported that 78%
of the children and early adolescents have ever experi-
enced unkind nicknames, referring the majority to the
child’s appearance.3 Similarly, epidemiological studies
with adolescents from the United States reported a
prevalence between 20% and 30% of weight teasing
in the previous month.29,30 Nevertheless, it should
be noted that the prevalence of teasing varies by
several methodological reasons.7 In our study, a high
prevalence may be explained by the decomposition
effect of asking separately about different sources of
appearance teasing. However, such an approach leads
to more accurate reporting of prevalence in survey-
research methodology studies.31 In conclusion, given
the limited information, future research is required
to examine the extent of variation in the prevalence
of appearance-related teasing across cultures, as has
been done with bullying victimization prevalence.32,33
Sources of Appearance-Related Teasing
In general, peers (classmates and friends) and
family (siblings and parents) were the most cited
sources reported by adolescents in this sample. These
findings are consistent with the tripartite influence
model34 that proposes that other than media, peers
and parents are major sources of appearance-related
pressures. However, it should be noted that specific
family members (eg, siblings) and specific peers (eg,
classmates) may exert the greatest appearance-related
pressure, as suggested by our results and previous
studies with college women in the United States
recalling appearance-related teasing experiences.26,35
Further research is required to confirm these findings
across cultures and to examine in a greater extent
the role of siblings and specific peers, as well as the
impact of appearance-related feedback coming from
these sources compared with that from other sources.
Sex Differences
Regarding teasing sources, the Czech girls in our
study were more likely to report appearance teasing
by siblings and same-sex peers than boys. Similarly,
previous studies have found that brothers rather than
parents, sisters, or relatives are the most common
source of appearance-related teasing reported by girls
and women in the United States.26,35,36 However, a
study in the same country found that girls compared
with boys were more likely to report appearance
teasing by parents, and there were no sex differences
on reported appearance teasing by peers.37 Taken
together, these findings suggest that the sources
of appearance teasing need to be considered by
future studies. Although it seems that, in general,
appearance-related teasing is common among both
sexes,28 sex differences may emerge when specific
sources are evaluated. Given the few studies to
compare our results with, future research has to
include adolescent boys more frequently and examine
the diverse sources of appearance-related teasing by
sex and across cultures.
Regarding teasing frequency by sex, the Czech girls
in our sample were more likely to report appearance
teasing than boys. In Western countries, previous stud-
ies have found that girls are more involved in general
appearance conversations than boys.1 8 In this context,
girls compared with boys may be more likely to report
appearance-related teasing because they may be more
attuned to these kinds of comments.38 By contrast,
boys compared with girls may be more reluctant to talk
about their body and appearance-related experiences,
placing less emphasis on their appearance and more
on other domains like athletic competence.39 When it
comes to teasing about weight, it seems that adolescent
girls are more likely to report being teased than boys,
a finding observed in Western countries such as the
United States and Spain.38,40,41 Although in our results
more boys than girls reported weight teasing, these
sex differences disappeared when the analyses were
adjusted by weight status. Therefore, independently
of sex, the frequency of body-related teasing in both
sexes reinforce the idea that the Czech Republic is
adopting societal standards of Western countries,42
emphasizing weight as a central component of phys-
ical appearance. However, these assumptions remain
speculative given the limited research evaluating
sex differences on appearance-related teasing among
early adolescents, and specifically among Czech
adolescents. Future research is needed to examine
these sex differences and also to examine potential
social desirability bias or cultural differences.
Weight Status Differences and the Impact of Teasing
Compared with non-overweight adolescents, the
overweight adolescents in this sample were more
likely to report appearance teasing by male classmates,
siblings, and father. Furthermore, we found that
overweight adolescents were more likely to report
body weight and body shape teasing, and this group
Journal of School Health • March 2015, Vol. 85, No. 3 doi: 10.1111/josh.12236
168
was the more likely to be impacted on by it.
Previous studies in the United States have found
that peers and family members are a common
source of appearance- and weight-related teasing,
with parents — especially the father— encouraging
overweight children to control their weight.37,40,43,44
In addition, several studies in Western countries have
found that overweight adolescents are more likely to be
victims of weight teasing.41,45,46 Taken together, these
findings seem to confirm the idea that stigmatization
of overweight adolescents is a widespread problem.47
Previous studies suggest that the teasing experience is
more intense for overweight adolescents,48 could affect
school performance,49 and could be associated to the
development of several other problems that finally
could affect the general well-being of overweight
adolescents.9 For this reason, it is recommended to
increase the awareness about the consequences of
appearance-related teasing and implement strategies
to tackle this problem. Future research might evaluate
different strategies to reduce the impact of appearance-
related teasing.
Limitations
Although our study has strengths, it has also
limitations and the results need to be interpreted
with caution. This is a cross-sectional analysis and
causal inferences cannot be drawn from these data.
Furthermore, not being a national study, the sample is
not representative of the entire adolescent population
of the Czech Republic; however, the participants
belong to the second largest city in the Czech Republic.
Another problem was attrition. Although we did not
find any systematic effects of attrition from age 8
to 13, it is likely that a major part of the dropout
took place before age 8. Well-functioning, responsible,
and less mobile families were more likely to stay
in a study requiring regular (annual) participation.
Additionally, we had a necessity to use self-report
measures that could bias the actual results. However,
we used dichotomous items for prevalence estimates
which are considered suitable for this purpose,50 and
we used self-reported weight and height, which is
considered a simple and valid way to estimate BMI in
epidemiological studies.51
Conclusions
Czech adolescents seem to be continuing to
adopt the societal standards of Western countries,
emphasizing weight-bias and stigmatization against
overweight peers. This may affect more obese Czech
adolescent. Future research has to evaluate different
sources of appearance-related teasing. Interventions
are needed to facilitate positive peer interactions
and reduce appearance-related prejudices. Schools are
suitable for this purpose.
IMPLICATIONS FOR SCHOOL HEALTH
This study has several implications. Considering
that teasing experiences could be part of broader
negative experiences like bullying and victimization,
and considering the psychological consequences of
these experiences,52,53 proper interventions have to
be addressed. Adopting a socio-ecological approach
may be helpful because it considers different lev-
els of intervention.54 From this approach, the school
setting is suitable to deliver preventive initiatives tar-
geting the entire school community, including teach-
ers, children, as well as parents. Several strategies
have been outlined in recent reviews and could be
implemented in schools.
34,55
-
57
Examples of these
strategies are to involve the entire school commu-
nity, including parents, in creating positive family and
school climates with positive and respectful family and
peer interactions,
54
which are essential for preven-
tion efforts. Reducing appearance-related prejudices
and specifically obesity stigmatization, emphasizing
less physical appearance and accepting body shape
diversities,
55
and promoting body acceptance
58
could
help reduce negative appearance-related feedback dur-
ing social interactions. At the individual level, they
could help to not base self-esteem on physical appear-
ance but on other domains,
59
like academic compe-
tence. Given that appearance teasing is widespread and
more subtle and less overt ways of appearance teasing
could persist, intervention initiatives should strength
children’s coping strategies and self-efficacy to buffer
the impact of these experiences, especially among girls
and overweight adolescents.
12,55,60,61
Finally, these ini-
tiatives should be integrated with other initiatives on
health promotion. For instance, integrating the mes-
sage that obesity is caused by several factors and is not
exclusively under personal control.
62
By doing so, an
integrative approach will reduce both the human and
economic cost and increase effectiveness.
63,64
Human Subjects Approval Statement
This study followed the research protocol ethical
recommendations,
20
and its approval was granted
by the institutional ethical board of the Faculty of
Medicine at Masaryk University.
REFERENCES
1.
Harter S. Is self-esteem only skin-deep? The inextricable link
between physical appearance and self-esteem. Reclaim Child
Youth. 2000;9(3):133-138.
2.
Rubin KH, Bowker JC, McDonald KL, Menzer M. Peer
relationships in childhood. In: Zelazo PD, ed.
The Oxford
Handbook of Developmental Psychology
, Vol. 2. New York, NY:
Oxford University Press; 2013:242-275.
3.
Crozier WR, Dimmock PS. Name-calling and nicknames in
a sample of primary school children. Br J Educ Psychol.
1999;69(4):505-516.
doi: 10.1111/josh.12236
Journal of School Health • March 2015, Vol. 85, No. 3 •
•169
¨
4.
Keltner D, Capps L, Kring AM, Young RC, Heerey EA. Just
teasing: a conceptual analysis and empirical review.
Psychol
Bull
. 2001;127(2):229-248.
5.
Shapiro JP, Baumeister RF, Kessler JW. A three-component
model of children’s teasing: aggression, humor, and ambiguity.
J Soc Clin Psychol. 1991;10(4):459-472.
6.
Barker ET, Galambos NL. Body dissatisfaction of adolescent
girls and boys: risk and resource factors. J Early Adolesc.
2003;23(2):141-165.
7.
Menzel JE, Schaefer LM, Burke NL, Mayhew LL, Brannick
MT, Thompson JK. Appearance-related teasing, body dissat-
isfaction, and disordered eating: a meta-analysis.
Body Image
.
2010;7(4):261-270.
8.
Hutchinson DM, Rapee RM, Taylor A. Body dissatisfaction and
eating disturbances in early adolescence: a structural modeling
investigation examining negative affect and peer factors. J Early
Adolesc. 2009;30(4):489-517.
9.
Eisenberg ME, Neumark-Sztainer DR, Haines JI, Wall MM.
Weight-teasing and emotional well-being in adolescents:
longitudinal findings from Project EAT.
J Adolesc Health
.
2006;38(6):675-683.
10.
Butler JC, Doherty MS, Potter RM. Social antecedents and
consequences of interpersonal rejection sensitivity.
Pers Individ
Dif
. 2007;43(6):1376-1385.
11.
Park LE, DiRaddo AM, Calogero RM. Sociocultural influence
and appearance-based rejection sensitivity among college
students. Psychol Women Quart. 2009;33(1):108-119.
12.
Puhl RM, Luedicke
J.
Weight-based victimization among
adolescents in the school setting: emotional reactions and coping
behaviors. J Youth Adolesc. 2012;41(1):27-40.
13.
DePierre JA, Puhl RM. Experiences of weight stigmatization:
a review of self-report assessment measures.
Obes Facts
.
2012;5(6):897-918.
14.
Rancourt D, Prinstein MJ. Peer status and victimization
as possible reinforcements of adolescent girls’ and boys’
weight-related behaviors and cognitions.
J Pediatr Psychol
.
2010;35(4):354-367.
15.
Krukowski RA, West DS, Siddiqui NJ, Bursac Z, Phillips MM,
Raczynski JM. No change in weight-based teasing when school-
based obesity policies are implemented. Arch Pediatr Adolesc Med.
2008;162(10):936-942.
16.
Lumeng JC, Forrest P, Appugliese DP, Kaciroti N, Corwyn
RF, Bradley RH. Weight status as a predictor of being
bullied in third through sixth grades.
Pediatrics
. 2010;125(6):
e1301-e1307.
17.
Thompson JK, Cattarin
J,
Fowler B, Fisher E. The Perception
of Teasing Scale (POTS): a revision and extension of the
Physical Appearance Related Teasing Scale (PARTS).
J Pers
Assess
. 1995;65(1):146-157.
18.
Jones DC, Crawford JK. The peer appearance culture during
adolescence: gender and body mass variations. J Youth Adolesc.
2006;35(2):243-255.
19.
Kerr M, Stattin H, Kiesner
J.
Peers and problem behavior:
have we missed something?. In: Engels RCME, Kerr M,
Stattin H, eds.
Friends, Lovers and Groups: Key Relationships in
Adolescence
. Chichester, England: John Wiley & Sons; 2007:
125-153.
20.
Golding
J.
Research protocol. European Longitudinal Study of
Pregnancy and Childhood (ELSPAC).
Paediatr Perinat Epidemiol
.
1989;3(4):460-469.
21.
Michal
c
ˇ
a
´
kov
a
´
R
,
Lacinov
a
´
L
,
K
yjonkova
H
,
B
ousa
O,
Jelinek
M.
Fears in Czech adolescents: a longitudinal study.
J Early Adolesc
.
2013;33(8):1072-1090.
23.
Czech Statistical Bureau. Population by nationality: as mea-
sured by 1921-2001 censuses. Available at: http://www.czso.
cz/csu/2010edicniplan.nsf/engt/D9003499F9/$File/403210011
7.pdf. Accessed March 3, 2011.
24.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. Establishing a
standard definition for child overweight and obesity worldwide:
international survey. BMJ. 2000;320(7244):1240-1240.
25. Ojala K, Vereecken CA, Valimaa R, et al. Attempts to lose
weight among overweight and non-overweight adolescents: a
cross-national survey.
Int J Behav Nutr Phys Act
. 2007;4:50.
26.
Cash TF. Developmental teasing about physical appearance:
retrospective descriptions and relationships with body image.
Soc Behav Pers Int J. 1995;23(2):123-130.
27. Thompson JK, Fabian LJ, Moulton DO, Dunn ME, Altabe MN.
Development and validation of the Physical Appearance Related
Teasing Scale.
J Pers Assess
. 1991;56(3):513-521.
28. Menzel JE. Appearance-related teasing. In: Cash TF, ed.
Encyclopedia of Body Image and Human Appearance, Vol. 2. London,
England: Academic Press; 2012:783-789.
29. Haines JI, Neumark-Sztainer DR, Hannan PJ, van den Berg
PA, Eisenberg ME. Longitudinal and secular trends in weight-
related teasing during adolescence.
Obesity (Silver Spring)
.
2008;16(Suppl 2):S18-S23.
30. Haines JI, Neumark-Sztainer DR, Perry CL, Hannan PJ, Levine
MP. V.I.K. (Very Important Kids): a school-based program
designed to reduce teasing and unhealthy weight-control
behaviors.
Health Educ Res
. 2006;21(6):884-895.
31. Tourangeau R, Rips LJ, Rasinski K.
The Psychology of Survey
Response
. Cambridge, UK: Cambridge University Press; 2000.
32.
Due P, Holstein BE. Bullying victimization among 13 to 15 year
old school children: results from two comparative studies in
66 countries and regions. Int J Adolesc Med Health. 2008;20(2):
209-222.
33. Cook CR, Williams KR, Guerra NG, Kim TE. Variability in
the prevalence of bullying and victimization: a cross-national
and methodological analysis. In: Jimerson SR, Swearer SM,
Espelage DL, eds.
Handbook of Bullying in Schools: An International
Perspective
. New York, NY: Routledge; 2010:347-362.
34. Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S,
eds.
Exacting Beauty: Theory, Assessment, and Treatment of Body
Image Disturbance
. Washington, DC: American Psychological
Association; 1999.
35.
Rieves L, Cash TF. Social developmental factors and women’s
body-image attitudes. J Soc Behav Personal. 1996;11(1):63-78.
36. Keery H, Boutelle KN, van den Berg PA, Thompson JK. The
impact of appearance-related teasing by family members.
J
Adolesc Health
. 2005;37(2):120-127.
37.
Helfert S, Warschburger P. The face of appearance-related social
pressure: gender, age and body mass variations in peer and
parental pressure during adolescence. Child Adolesc Psychiatry
Ment Health. 2013;7(1):16.
38. Eisenberg ME, Berge JM, Fulkerson JA, Neumark-Sztainer DR.
Weight comments by family and significant others in young
adulthood.
Body Image
. 2011;8(1):12-19.
39.
Ricciardelli LA, McCabe MP, Ridge D. The construction of
the adolescent male body through sport. J Health Psychol.
2006;11(4):577-587.
40. Neumark-Sztainer DR, Falkner NH, Story MT, Perry CL, Hannan
PJ, Mulert S. Weight-teasing among adolescents: correlations
with weight status and disordered eating behaviors.
Int J Obes
Relat Metab Disord
. 2002;26:123-131.
41.
Rojo-Moreno L, Rubio T, Plumed J, et al. Teasing and
disordered eating behaviors in Spanish adolescents.
Eat Disord
.
22.
Je
zˇ
ek
S
,
Lacinov
a
´
L
,
S
ˇ
ir
u
˚
c
ˇ
ek
J
,
M
ichal
c
ˇ
a
´
kov
a
´
R. The
2013;21(1):53-69.
psychological branch of the ELSPAC study: a survey of 15-year-
old
r
espondents.
In:
J
e
zˇ
ek
S
,
Lacinov
a
´
L
,
e
d
s
.
Fifteen-Year-Olds
in Brno: A Slice of Longitudinal Self-Reports
. Brno, Czech Republic:
Masaryk University; 2008:7-11.
42. Krch FD. Being overweight and developing an eating disorder
in the Czech Republic.
Eat Disord
. 1995;3(1):20-27.
43. Puhl RM, Heuer CA. The stigma of obesity: a review and update.
Obesity (Silver Spring). 2009;17(5):941-964.
Journal of School Health • March 2015, Vol. 85, No. 3 doi: 10.1111/josh.12236
170
44.
Wertheim EH, Martin G, Prior M, Sanson A, Smart D. Parent
influences in the transmission of eating and weight related
values and behaviors. Eat Disord. 2002;10(4):321-334.
45. Haines JI, Hannan PJ, van den Berg PA, Eisenberg ME,
Neumark-Sztainer DR. Weight-related teasing from adolescence
to young adulthood: longitudinal and secular trends between
1999 and 2010.
Obesity (Silver Spring)
. 2013;21(9):E428-E434.
46. Puhl RM, Luedicke
J,
Heuer CA. Weight-based victimization
toward overweight adolescents: observations and reactions of
peers.
J Sch Health
. 2011;81(11):696-703.
47. Puhl RM, Latner JD. Stigma, obesity, and the health of the
nation’s children.
Psychol Bull
. 2007;133(4):557-580.
48.
Hayden-Wade HA, Stein RI, Ghaderi A, Saelens BE, Zabinski
MF, Wilfley DE. Prevalence, characteristics, and correlates
of teasing experiences among overweight children vs. non-
overweight peers. Obes Res. 2005;13(8):1381-1392.
49. Krukowski RA, West DS, Philyaw Perez A, Bursac Z,
Phillips MM, Raczynski JM. Overweight children, weight-based
teasing and academic performance.
Int J Pediatr Obes
. 2009;
4(4):274-280.
50. Olweus D. Understanding and researching bullying some critical
issues. In: Jimerson SR, Swearer SM, Espelage DL, eds.
Handbook
of Bullying in Schools: An International Perspective
. New York, NY:
Routledge; 2010:9-33.
51. Fonseca H, Silva AM, Matos MG, et al. Validity of BMI based
on self-reported weight and height in adolescents.
Acta Paediatr
.
2010;99(1):83-88.
52. Copeland WE, Wolke D, Angold A, Costello EJ. Adult psychiatric
outcomes of bullying and being bullied by peers in childhood
and adolescence.
JAMA Psychiatry
. 2013;70(4):419-426.
53. Isaacs
J,
Hodges EVE, Salmivalli C. Long-term consequences of
victimization by peers: a follow-up from adolescence to young
adulthood.
Eur J Dev Sci
. 2008;2(4):387-397.
54.
Hage SM, Romano JL, Conyne RK, et al. Best practice guidelines
on prevention practice, research, training, and social advocacy
for psychologists. Couns Psychol. 2007;35(4):493-566.
55. Haines JI. Weight-related teasing and anti-teasing initiatives
in schools. In: O’Dea JA, Eriksen M, eds.
Childhood Obesity
Prevention: International Research, Controversies, and Interventions.
New York, NY: Oxford University Press; 2010:363-379.
56.
Puhl RM, Peterson JL, Luedicke
J.
Strategies to address weight-
based victimization: Youths’ preferred support interventions
from classmates, teachers, and parents. J Youth Adolesc.
2013;42(3):315-327.
57.
Espelage DL, Poteat VP. School-based prevention of peer
relationship problems. In: Altmaier EM, Hansen JIC, eds. The
Oxford Handbook of Counseling Psychology. New York, NY: Oxford
University Press; 2012:703-722.
58. Stice E, Shaw HE, Marti CN. A meta-analytic review of eating
disorder prevention programs: encouraging findings.
Annu Rev
Clin Psychol
. 2007;3:207-231.
59. Armitage CJ. Evidence that self-affirmation reduces body
dissatisfaction by basing self-esteem on domains other than
body weight and shape.
J Child Psychol Psychiatry
. 2012;
53(1):81-88.
60. Lu L, Kao S-F, Chang T-T, Lee Y-W. Individual differences
in coping with criticism of one’s physical appearance among
Taiwanese students.
Int J Psychol
. 2009;44(4):274-281.
61.
Seiffge-Krenke I, Persike M, Karaman NG, et al. Stress with
parents and peers: how adolescents from six nations cope with
relationship stress. J Res Adolesc. 2013;23(1):103-117.
62.
Rukavina PB, Li W. Adolescents’ perceptions of controllability
and its relationship to explicit obesity bias. J Sch Health.
2011;81(1):8-14.
63. Domitrovich CE, Bradshaw CP, Greenberg MT, Embry D,
Poduska JM, Ialongo NS. Integrated models of school-based
prevention: logic and theory.
Psychol Sch
. 2009;47(1):71-88.
64.
Reinke WM, Herman KC, Ialongo NS. Developing and imple-
menting integrated school-based mental health interventions.
Adv Sch Ment Health Promot. 2012;5(3):158-160.
