What do we want to know?
Body size in young people continues to be a public health issue in the UK: young people can experience physical and psychosocial problems as a result of having a large body size, and young people’s attitudes to and beliefs about their bodies, which can include high levels of body dissatisfaction, have also raised concern. Little is known from research about young people’s own perspectives on obesity and body size, shape and weight. And yet young people have a stake in this issue and can contribute valuable insights. This systematic review aims to address this gap and to examine recent research findings from the UK where young people aged from twelve to eighteen provide views about their own body sizes or about the body sizes of others. It complements an earlier review that focuses on the views of children aged 4-11 (read more about this review: Rees et al. (2009) Children’s views about obesity, body size, shape and weight: a systematic review.)
Who wants to know?
This review will inform policy-makers, commissioners, practitioners, advocates and researchers who have a remit to explore policy issues or to promote or conduct research with young people on the topic of obesity.
What did we find?
A total of 30 studies were incorporated into a synthesis. This configured young people’s views into three main groups. Each theme was labelled with a quote provided in one of the included studies:
- General perceptions about different body sizes and society’s responses to them (It’s on your conscience all the time);
- Overweight young people’s beliefs about influences on size and experiences related to their size (If I had the choice, I wouldn’t be this size); and
- Overweight young people’s experiences of trying to lose and maintain weight and their suggestions for action (Make sure, even when it’s hard, you’ve got people there).
The review identified a reasonable amount of recent research into views about obesity among young people in the UK aged between 12 and 18. Very few studies, however, were judged as having made a ‘thorough attempt’ to privilege young people’s own framing of issues in their lives.
The review found that young people discussed larger body sizes in overwhelmingly social terms. An overweight body size was to be avoided for social, rather than health reasons. Among young people with healthy weights, these reasons included not being attractive to others and having fewer friends. Young women and men identified ideals consistently for their own bodies that were very different for the two sexes. Young women were identified as being particularly concerned about body size, but young men’s concerns were also discussed.
The accounts of young people with experience of being obese also made reference to the social nature of size, but the consequences appear far graver. These young people reported how their size had impacted seriously on their ability to socialise with their peers, and had also led to severe and unrelenting size-related abuse and a sense of isolation and of being marked out as being unacceptably different.
Young people also emphasised personal responsibility when talking about body size. Regardless of their own size, they also tended to be judgemental of, and to apportion blame to individuals who are very overweight, identifying this as due to a lack of willpower. And yet overweight young people, when reporting their experiences of trying to lose weight, described a social environment that contains multiple barriers in the way of their success. They described experiences of surveillance and abuse while exercising or attempting to eat healthily, unhelpful food environments at home, and the receipt of unhelpful advice and criticism from others. These young people reported how, as a result, they can withdraw from social contact, avoid school-based physical activity and eat for comfort. Their accounts also described the vicious circle of increased weight gain, guilt and otherwise lowered mood that such strategies can incubate. In contrast, the few, positive accounts of weight-loss attempts emphasised the benefits of contact with others who are going through, or have gone through, similar experiences.
The accounts of young people who have experience of being very overweight included numerous references to emotion and well-being. As well as the feelings of exclusion, shame and lowered mood described above, they reported frustration at the time required for substantial weight loss, and fear that weight might easily rebound. Good mental health was seen as key for substantial weight-loss and having taken active steps to reduce weight was a source of considerable pride, especially when successful.
Young people in the UK had not been asked by researchers to reflect to any great extent on what might help them achieve and maintain a healthy weight. This review suggests, again, that young people will tend to focus on their own behaviour. As well as making more careful efforts to eat healthily and take exercise, young people in this review mentioned the need for them to access their own psychological resources. Only one study in this review included reference to what other people should do. Here, young people, many of whom had experience of trying, and sometimes succeeding, in losing substantial amounts of weight, emphasised how health professionals and others should be less judgemental, and give encouragement and other, practical, forms of support.
What are the implications?
The findings suggest that there is a need:
- for those who run or develop weight reduction initiatives to recognise the physical, psychological and social constraints faced by young participants, to consider how they can reduce stigma, to consider including a component of peer support and social activity, to provide young people with practical skills to support their emotional health and identify patterns of comfort eating, to deliver initiatives over the long-term, and to support weight loss maintenance, and to support parents and health professionals in understanding and responding effectively, and yet sensitively.
- at the policy level, to address weight stigma in society through social interventions, to consider the full range of factors that contribute to obesity, especially those that are social or environmental in nature, and provide opportunities for young people to engage in positive healthy behaviours , and to involve diverse groups of children in the development and evaluation of initiatives.
- for research which explores the social implications of body size with young people in greater depth and actively engages young people in how to address these issues in society, for further research with young men and with young people from minority ethnic and differing socio-economic groups, and research that is influenced more by the young people that participate.
How did we get these results?
The review addressed the following questions:
- What are young people’s views about the meanings of obesity or body size, shape or weight (including their perceptions of their own body size), and what experiences do they describe relating to these issues?
- What are young people’s views about influences on body size?
- What are young people’s views about changes that may help them to achieve or maintain a healthy weight?
We located studies through sensitive searches of a large number of databases, as well as specialist websites and contact with experts. Studies needed to have been produced since 1997 and to collect the views of young people in the UK aged 12 – 18 using used qualitative methods. Reports needed to have described basic aspects of a study’s methods. Included studies were described and quality-assessed by two reviewers independently. A thematic synthesis was conducted to configure the studies’ findings. A consultation was held with young people to explore the credibility of the findings and their possible implications.
This report should be cited as:
Rees R, Caird J, Dickson K, Vigurs C, Thomas J (2013) The views of young people in the UK about obesity, body size, shape and weight: a systematic review. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London. ISBN: 978-1-907345-52-4