Girls who feel unpopular more likely to get fat

By Anne Harding
NEW YORK (Reuters Health) - Adolescent girls who rank themselves at the bottom of the social totem pole are more likely to gain weight over time than their peers with a more positive view of their social standing, new research shows.
Based on these findings, programs aiming to prevent overweight and obesity in teen girls should focus on helping them feel better about themselves, as well as improving their eating and exercise habits, study co-author Adina R. Lemeshow told Reuters Health.
In the study, conducted while Lemeshow was a graduate student at the Harvard School of Public Health in Boston, the researchers followed 4,446 girls aged 12 to 18 for 2 years. All were asked to rank their social standing on a 10-point "ladder," with the bottom being "people who no one respects and no one wants to hang around with" and "people in your school with the most respect and the highest standing" at the top.
The average self-ranking was 7.7, while just 4 percent of the girls ranked themselves at 4 or below. After adjusting for several factors that could influence both social status and weight gain, such as body mass index (BMI) at the study's outset, household income, and self-esteem, the researchers found that the girls who considered themselves to have the lowest social status were 69 percent more likely to have a 2-point increase in BMI over the following 2 years.
This is equivalent to gaining about 11 pounds more than expected, Lemeshow, who now works for the New York City Department of Mental Health and Hygiene, said in an interview.
"For girls, it could be useful to have programs that focus on personal skills or how to face social problems and challenges" when seeking to prevent obesity, she said.
In an editorial accompanying the study, Drs. Clea McNeely and Robert Crosnoe of Johns Hopkins University point out that low social, political and economic status are known to be fundamental causes of disease.
The current study findings suggest that self-perceived, subjective social status can also lead to illness, they note. But interventions designed to address obesity in the context of social status must be designed carefully, they add.
"Grouping together multiple at-risk youth to deliver some behavioral intervention can make things worse by creating a new peer culture organized around the very behaviors that the intervention was trying to change."
McNeely and Crosnoe call for a better understanding of how teens influence one another's health behavior to ensure that such interventions are effective.
SOURCE: Archives of Pediatrics and Adolescent Medicine, January 2008.