Skip to main content
Log in

Investigating the Self-Stigma and Quality of Life for Overweight/Obese Children in Hong Kong: a Preliminary Study

  • Published:
Child Indicators Research Aims and scope Submit manuscript

Abstract

Overweight (OW) children are likely to internalize common weight bias and developed weight-related self-stigma (or self-stigma in short). Also, OW children tended to have poor health-related quality of life (HRQoL) with higher level of self-stigma associated with poorer HRQoL. However, the aforementioned findings have yet been investigated in the East. This study aimed to test the differences of self-stigma and HRQoL between OW and non-OW children, and to examine the correlations between self-stigma and HRQoL in a Hong Kong sample. OW children (n = 50, Mage ± SD = 9.36 ± 1.17) and non-OW children (n = 50, Mage ± SD = 9.73 ± 1.28) completed questionnaires that measure self-stigma (Weight Bias Internalization Scale [WBIS] and Weight Self-Stigma Questionnaire [WSSQ]) and HRQoL (child-reported Kid-KINDL and Sizing Me Up [SMU]). All parents completed parent-reported Kid-KINDL and Sizing Them Up (STU) that measure HRQoL of their children. Compared with non-OW children, OW children had higher self-stigma in WBIS (p = 0.003) and WSSQ (p < 0.001); lower HRQoL in SMU (p < 0.001) and STU (p < 0.001). More significant correlations with stronger magnitude (r = −0.28 to −0.61) were shown between self-stigma and HRQoL in OW children than in non-OW children. This study showed that OW children had significantly higher self-stigma and lower HRQoL than did non-OW children in Hong Kong. Moreover, negative correlations between self-stigma and HRQoL were found in OW children. Future studies may want to investigate whether reducing self-stigma of OW children can improve their HRQoL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Carels, R. A., & Latner, J. (2016). Weight stigma and eating behaviors. An introduction to the special issue. Appetite, 102, 1–2. https://doi.org/10.1016/j.appet.2016.03.001.

    Article  Google Scholar 

  • Census and Statistic Department. (2017). Table E032: Domestic households by household size and monthly household income. https://www.censtatd.gov.hk/hkstat/sub/sp150.jsp?productCode=D5250036. Accessed 14 Mar 2018.

  • Centre for Health Protection. (2015). Healthy weight healthy kids. NCD Watch. http://www.chp.gov.hk/files/pdf/ncd_watch_mar2015.pdf. Accessed 14 Mar 2018.

  • Chan, P. L., Ng, S. S., & Chan, D. Y. (2014). Psychometric properties of the Chinese version of the kid-KINDL-R questionnaire for measuring the health-related quality of life of school-aged children. Hong Kong Journal of Occupational Therapy, 24(1), 28–34. https://doi.org/10.1016/j.hkjot.2014.05.001.

    Article  Google Scholar 

  • Chan, Y., Chan, Y. Y., Cheng, S. L., Chow, M. Y., Tsang, Y. W., Lee, C., et al. (2017). Investigating quality of life and self-stigma in Hong Kong children with specific learning disabilities. Research in Developmental Disabilities, 68, 131–139. https://doi.org/10.1016/j.ridd.2017.07.014.

    Article  Google Scholar 

  • Chang, C.-C., Wu, T.-H., Chen, C.-Y., & Lin, C.-Y. (2016). Comparing internalized stigma between people with different mental disorders in Taiwan. Journal of Nervous & Mental Disease, 204(7), 547–553.

    Article  Google Scholar 

  • Chang, C.-C., Lin, C.-Y., Gronholm, P. C., & Wu, T.-H. (in press). Cross-validation of two commonly used self-stigma measures, Taiwan versions of the internalized stigma mental illness scale and self-stigma scale-short, for people with mental illness. Assessment. https://doi.org/10.1177/1073191116658547.

  • Chen, Y. P., Wang, H. M., Edwards, T. C., Wang, T., Jiang, X. Y., Lv, Y. R., et al. (2015). Factors influencing quality of life of obese students in Hangzhou, China. PLoS One, 10(3), e0121144. https://doi.org/10.1371/journal.pone.0121144.

    Article  Google Scholar 

  • Cheng, C. P., Luh, W. M., Yang, A. L., Su, C. T., & Lin, C. Y. (2016). Agreement of children and parents scores on Chinese version of pediatric quality of life inventory version 4.0: Further psychometric development. Applied Research in Quality of Life, 11(3), 891–906.

    Article  Google Scholar 

  • Ciupitu-Plath, C. (2016). Weight stigma experiences and internalization among boys and girls accessing obesity care in Berlin, Germany (Doctoral thesis, Technical University of Berlin). https://doi.org/10.14279/depositonce-4998.

  • De Onis, M., Blössner, M., & Borghi, E. (2010). Global prevalence and trends of overweight and obesity among preschool children. The American Journal of Clinical Nutrition, 92(5), 1257–1264. https://doi.org/10.3945/ajcn.2010.29786.

    Article  Google Scholar 

  • Durso, L. E., & Latner, J. D. (2008). Understanding self-directed stigma: Development of the weight Bias internalization scale. Obesity, 16(S2), S80–S86. https://doi.org/10.1038/oby.2008.448.

    Article  Google Scholar 

  • Farhangi, M. A., Emam-Alizadeh, M., Hamedi, F., & Jahangiry, L. (2017). Weight self-stigma and its association with quality of life and psychological distress among overweight and obese women. Eating and Weight Disorders: EWD, 22(3), 451–456.

    Article  Google Scholar 

  • Faus, A. L., Turchi, R. M., Polansky, M., Berez, A., & Leibowitz, K. L. (2015). Health-related quality of life in overweight/obese children compared with children with inflammatory bowel disease. Clinical Pediatrics, 54(8), 775–782. https://doi.org/10.1177/0009922814562555.

    Article  Google Scholar 

  • Feng, T., & Abebe, D. S. (2017). Eating behaviour disorders among adolescents in a middle school in Dongfanghong, China. Journal of Eating Disorders, 5, 47.

    Article  Google Scholar 

  • Flint, S. W., Čadek, M., Codreanu, S. C., Ivić, V., Zomer, C., & Gomoiu, A. (2016). Obesity discrimination in the recruitment process: “You’re not hired!”. Frontiers in Psychology, 7, 647. https://doi.org/10.3389/fpsyg.2016.00647.

    Article  Google Scholar 

  • Geliebter, A., & Aversa, A. (2003). Emotional eating in overweight, normal weight, and underweight individuals. Eating Behaviors, 3, 341–347.

    Article  Google Scholar 

  • Hilbert, A., Baldofski, S., Zenger, M., Löwe, B., Kersting, A., & Braehler, E. (2014). Weight Bias internalization scale: Psychometric properties and population norms. PLoS One, 9(1), e86303. https://doi.org/10.1371/journal.pone.0086303.

    Article  Google Scholar 

  • Huang, W.-Y., Chen, S.-P., Pakpour, A. H., & Lin, C.-Y. (2018). The mediation role of self-esteem for self-stigma on quality of life for people with schizophrenia: A retrospectively longitudinal study. Journal of Pacific Rim Psychology, 12(e10), 1–7.

    Google Scholar 

  • Kolotkin, R. L., Zeller, M., Modi, A. C., Samsa, G. P., Quinlan, N. P., Yanovski, J. A., et al. (2006). Assessing weight-related quality of life in adolescents. Obesity, 14(3), 448–457.

    Article  Google Scholar 

  • Latner, J. D., Durso, L. E., & Mond, J. M. (2013). Health and health-related quality of life among treatment-seeking overweight and obese adults: Associations with internalized weight bias. Journal of Eating Disorders, 1(1), 3.

    Article  Google Scholar 

  • Latner, J. D., Barile, J. P., Durso, L. E., & O'Brien, K. S. (2014). Weight and health-related quality of life: The moderating role of weight discrimination and internalized weight bias. Eating Behaviors, 15(4), 586–590.

    Article  Google Scholar 

  • Lee, S., Ho, T. P., & Hsu, L. K. G. (1993). Fat phobic and non-fat phobic anorexia nervosa: A comparative study of 70 Chinese patients in Hong Kong. Psychological Medicine, 23(4), 999–1017. https://doi.org/10.1017/S0033291700026465.

    Article  Google Scholar 

  • Lee, S., Leung, T., Lee, A. M., Yu, H., & Leung, C. M. (1996). Body dissatisfaction among Chinese undergraduates and its implications for eating disorders in Hong Kong. International Journal of Eating Disorders, 20(1), 77–84.

    Article  Google Scholar 

  • Lee, J. S., Mishra, G., Hayashi, K., Watanabe, E., Mori, K., & Kawakubo, K. (2016). Combined eating behaviors and overweight: Eating quickly, late evening meals, and skipping breakfast. Eating Behaviors, 21, 84–88. https://doi.org/10.1016/j.eatbeh.2016.01.009.

    Article  Google Scholar 

  • Lee, C.-T., Tsai, M.-C., Lin, C.-Y., & Strong, C. (2017). Longitudinal effects of self-report pubertal timing and menarcheal age on adolescent psychological and behavioral outcomes in female youths from northern Taiwan. Pediatrics and Neonatology, 58, 313–320. https://doi.org/10.1016/j.pedneo.2016.04.004.

    Article  Google Scholar 

  • Lee, C.-T., Lin, C.-Y., Strong, C., Lin, Y.-F., Chou, Y.-Y., & Tsai, M.-C. (2018a). Metabolic correlates of health-related quality of life among Taiwanese overweight and obese adolescents. BMC Pediatrics, 18, 25.

    Article  Google Scholar 

  • Lee, K., Dale, J., Guy, A., & Wolke, D. (2018b). Bullying and negative appearance feedback among adolescents: Is it objective or misperceived weight that matters? Journal of Adolescence, 63, 118–128. https://doi.org/10.1016/j.adolescence.2017.12.008.

    Article  Google Scholar 

  • Leung, F., Lam, S., & Sze, S. (2001). Cultural expectations of thinness in Chinese women. Eating Disorders, 9(4), 339–350.

    Article  Google Scholar 

  • Lillis, J., Luoma, J. B., Levin, M. E., & Hayes, S. C. (2010). Measuring weight self-stigma: The weight self-stigma questionnaire. Obesity, 18(5), 971–976. https://doi.org/10.1038/oby.2009.353.

    Article  Google Scholar 

  • Lin, K., & Lee, M. (2017). Validating a Chinese version of the weight self-stigma questionnaire for use with obese adults. International Journal of Nursing Practice, 23(4), e12537. https://doi.org/10.1111/ijn.12537.

    Article  Google Scholar 

  • Lin, Y.-C., & Lin, C.-Y. (2017). Minor symptoms talk: How children react to encountered bullying. Child Indicators Research. https://doi.org/10.1007/s12187-017-9505-4.

  • Lin, C.-Y., Su, C.-T., & Ma, H.-I. (2012). Physical activity patterns and quality of life of overweight boys: A preliminary study. Hong Kong Journal of Occupational Therapy, 22(1), 31–37.

    Article  Google Scholar 

  • Lin, C.-Y., Su, C.-T., Wang, J.-D., & Ma, H.-I. (2013). Self-rated and parent-rated quality of life (QoL) for community-based obese and overweight children. Acta Paediatrica, 102(3), e114–e119. https://doi.org/10.1111/apa.12108.

    Article  Google Scholar 

  • Lin, Y.-C., Latner, J. D., Fung, X. C. C., & Lin, C.-Y. (2018a). Poor health and experiences of being bullied in adolescents: Self-perceived overweight and frustration with appearance matter. Obesity, 26(2), 397–404. https://doi.org/10.1002/oby.22041.

    Article  Google Scholar 

  • Lin, Y.-C., Strong, C., Tsai, M.-C., Lin, C.-Y., & Fung, X. C. C. (2018b). Validating sizing them up, a parent-proxy weight-related quality-of-life measure, with community-based children. International Journal of Clinical and Health Psychology, 18(1), 81–89. https://doi.org/10.1016/j.ijchp.2017.10.001.

    Article  Google Scholar 

  • Luppino, F. S., de Wit, L. M., Bouvy, P. F., Stijnen, T., Cuijpers, P., Penninx, B. W., et al. (2010). Overweight, obesity, and depression: A systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry, 67(3), 220–229.

    Article  Google Scholar 

  • Major, B., Tomiyama, A. J., & Hunger, J. M. (2017). The negative and bi-directional effects of weight stigma on health. In B. Major, J. Dovidio, & B. G. Link (Eds.), Oxford handbook of stigma, discrimination and health (pp. 499–520). New York, NY: Oxford University Press.

    Chapter  Google Scholar 

  • Mendo-Lázaro, S., Polo-del-Río, M. I., Amado-Alonso, D., Iglesias-Gallego, D., & León-del-Barco, B. (2017). Self-concept in childhood: The role of body image and sport practice. Frontiers in Psychology, 8, 853. https://doi.org/10.3389/fpsyg.2017.00853.

    Article  Google Scholar 

  • Miri, S. F., Javadi, M., Lin, C.-Y., Irandoost, K., Rezazadeh, A., & Pakpour, A. H. (2017). Health related quality of life and weight self-efficacy of life style among normal-weight, overweight and obese Iranian adolescents: A case control study. International Journal of Pediatrics, 5(11), 5975–5984.

    Google Scholar 

  • Modi, A. C., & Zeller, M. H. (2008). Validation of a parent-proxy, obesity-specific quality-of-life measure: Sizing them up. Obesity, 16(12), 2624–2633. https://doi.org/10.1038/oby.2008.416.

    Article  Google Scholar 

  • Morrison, K. M., Shin, S., Tarnopolsky, M., & Taylor, V. H. (2015). Association of depression & health related quality of life with body composition in children and youth with obesity. Journal of Affective Disorders, 172, 18–23. https://doi.org/10.1016/j.jad.2014.09.014.

    Article  Google Scholar 

  • O'Brien, K. S., Latner, J. D., Puhl, R. M., Vartanian, L. R., Giles, C., Griva, K., et al. (2016). The relationship between weight stigma and eating behavior is explained by weight bias internalization and psychological distress. Appetite, 102, 70–76. https://doi.org/10.1016/j.appet.2016.02.032.

    Article  Google Scholar 

  • Palmeira, L., Pinto-Gouveia, J., & Cunha, M. (2016). The role of weight self-stigma on the quality of life of women with overweight and obesity: A multi-group comparison between binge eaters and non-binge eaters. Appetite, 105, 782–789. https://doi.org/10.1016/j.appet.2016.07.015.

    Article  Google Scholar 

  • Pearl, R. L., & Puhl, R. M. (2016). The distinct effects of internalizing weight bias: An experimental study. Body Image, 17, 38–42. https://doi.org/10.1016/j.bodyim.2016.02.002.

    Article  Google Scholar 

  • Pearl, R. L., Puhl, R. M., & Dovidio, J. F. (2015). Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity. Journal of Health Psychology, 20(12), 1626–1632. https://doi.org/10.1177/1359105313520338.

    Article  Google Scholar 

  • Penny, H., & Haddock, G. (2007). Children's stereotypes of overweight children. British Journal of Developmental Psychology, 25(3), 409–418. https://doi.org/10.1348/026151006X158807.

    Article  Google Scholar 

  • Pierce, J. W., & Wardle, J. (1997). Cause and effect beliefs and self-esteem of overweight children. Journal of Child Psychology and Psychiatry, 38(6), 645–650. https://doi.org/10.1111/j.1469-7610.1997.tb01691.x.

    Article  Google Scholar 

  • Puhl, R. M., & Latner, J. D. (2007). Stigma, obesity, and the health of the nation's children. Psychological Bulletin, 133(4), 557. https://doi.org/10.1037/0033-2909.133.4.557.

    Article  Google Scholar 

  • Ravens-Sieberer, U., & Bullinger, M. (2000). KINDL R questionnaire for measuring health-related quality of life in children and adolescents revised version manual. http://www.kindl.org/english/manual/ Accessed 14 Mar 2018.

  • Rees, R., Oliver, K., Woodman, J., & Thomas, J. (2009). Children’s view about obesity, body size, shape and weight: A systematic review. Journal of Advanced Nursing, 67(5), 954–960. https://doi.org/10.1186/1471-2458-11-188.

    Article  Google Scholar 

  • Reilly, J. (2005). Descriptive epidemiology and health consequences of childhood obesity. Best Practice & Research Clinical Endocrinology & Metabolism, 19(3), 327–341. https://doi.org/10.1016/j.beem.2005.04.002.

    Article  Google Scholar 

  • Roberto, C. A., Sysko, R., Bush, J., Pearl, R., Puhl, R. M., Schvey, N. A., et al. (2012). Clinical correlates of the weight bias internalization scale in a sample of obese adolescents seeking bariatric surgery. Obesity, 20(3), 533–539. https://doi.org/10.1038/oby.2011.123.

    Article  Google Scholar 

  • Schwimmer, J. B., Burwinkle, T. M., & Varni, J. W. (2003). Health-related quality of life of severely obese children and adolescents. JAMA, 289(14), 1813–1819.

    Article  Google Scholar 

  • Shoup, J. A., Gattshall, M., Dandamudi, P., & Estabrooks, P. (2008). Physical activity, quality of life, and weight status in overweight children. Quality of Life Research, 17(3), 407–412.

    Article  Google Scholar 

  • So, H. K., Nelson, E. A., Li, A. M., Wong, E. M., Lau, J. T., Guldan, G. S., et al. (2008). Secular changes in height, weight and body mass index in Hong Kong children. BMC Public Health, 8(1), 320. doi:https://doi.org/10.1186/1471-2458-8-320.

  • Stevanovic, D. (2013). Impact of emotional and behavioral symptoms on quality of life in children and adolescents. Quality of Life Research, 22(2), 333–337. https://doi.org/10.1007/s11136-012-0158-y.

    Article  Google Scholar 

  • Strong, C., Lin, Y.-C., Tsai, M.-C., & Lin, C.-Y. (2017). Factor structure of sizing me up, a self-reported weight-related quality of life instrument, in community children across weight status. Childhood Obesity, 13(2), 111–119. https://doi.org/10.1089/chi.2016.0259.

    Article  Google Scholar 

  • Su, C.-T., Wang, J.-D., & Lin, C.-Y. (2013). Child-rated versus parent-rated quality of life of community-based obese children across gender and grade. Health and Quality of Life Outcomes, 11(1), 206. https://doi.org/10.1186/1477-7525-11-206.

    Article  Google Scholar 

  • Tam, C. K., Ng, C. F., Yu, C. M., & Young, B. W. (2007). Disordered eating attitudes and behaviours among adolescents in Hong Kong: Prevalence and correlates. Journal of Pediatrics and Child Health, 43(12), 811–817.

    Article  Google Scholar 

  • The Government of the Hong Kong Special Administrative Region Press Releases. (October 11, 2016). Hong Kong world obesity day 2016 focuses on childhood obesity. http://www.info.gov.hk/gia/general/201610/11/P2016101100232.htm Accessed 14 Mar 2018.

  • Tomiyama, A. J. (2014). Weight stigma is stressful. A review of evidence for the cyclic obesity/weight-based stigma model. Appetite, 82, 8–15. https://doi.org/10.1016/j.appet.2014.06.108.

    Article  Google Scholar 

  • Vogt Yuan, A. S. (2010). Body perceptions, weight control behavior, and changes in adolescents' psychological well-being over time: A longitudinal examination of gender. Journal of Youth and Adolescence, 39(8), 927–939. https://doi.org/10.1007/s10964-009-9428-6.

    Article  Google Scholar 

  • Wallander, J. L., Taylor, W. C., Grunbaum, J. A., Franklin, F. A., Harrison, G. G., Kelder, S. H., et al. (2009). Weight status, quality of life, and self-concept in African American, Hispanic, and white fifth-grade children. Obesity, 17(7), 1363–1368. https://doi.org/10.1038/oby.2008.668.

    Article  Google Scholar 

  • Williams, J., Wake, M., Hesketh, K., Maher, E., & Waters, E. (2005). Health-related quality of life of overweight and obese children. JAMA, 293(1), 70–76.

    Article  Google Scholar 

  • Wong, Y., & Huang, Y. C. (1999). Obesity concerns, weight satisfaction and characteristics of female dieters: A study on female Taiwanese college students. Journal of the American College of Nutrition, 18(2), 194–200.

    Article  Google Scholar 

  • World Health Organization. (1993). Study protocol for the World Health Organization project to develop a quality of life assessment instrument (WHOQOL). Quality of Life Research, 2(2), 153–159.

    Article  Google Scholar 

  • Xin guang ti pan (n.d.). In ChineseWords.org . http://www.chinesewords.org/idiom/show-11633.html. Accessed 14 Mar 2018.

  • Zeller, M. H., & Modi, A. C. (2009). Development and initial validation of an obesity-specific quality-of-life measure for children: Sizing me up. Obesity, 17(6), 1171–1177. https://doi.org/10.1038/oby.2009.47.

    Article  Google Scholar 

  • Zhang, J., Seo, D. C., Kolbe, L., Lee, A., Middlestadt, S., Zhao, W., et al. (2011). Comparison of overweight, weight perception, and weight-related practices among high school students in three large Chinese cities and two large US cities. Journal of Adolescent Health, 48(4), 366–372. https://doi.org/10.1016/j.jadohealth.2010.07.015.

    Article  Google Scholar 

  • Zuba, A., & Warschburger, P. (2017). The role of weight teasing and weight bias internalization in psychological functioning: A prospective study among school-aged children. European Child & Adolescent Psychiatry, 1–11. https://doi.org/10.1007/s00787-017-0982-2.

Download references

Acknowledgements

We sincerely thank for all the participants, including the children and parent. We also thank the assistance from the following organizations: Buddhist Wong Cheuk Um Primary School and Hong Kong Playground Association.

Funding

This research was supported in part by (received funding from) the startup fund in the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chung-Ying Lin.

Ethics declarations

Conflict of Interests

All the authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, P.C., Hsieh, YP., Ng, H.H. et al. Investigating the Self-Stigma and Quality of Life for Overweight/Obese Children in Hong Kong: a Preliminary Study. Child Ind Res 12, 1065–1082 (2019). https://doi.org/10.1007/s12187-018-9573-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12187-018-9573-0

Keywords

Navigation