Adolescents in low- and middle-income countries are affected by weight-related stigma, first-of-its-kind study finds

Study of 1,200 young people in Brazil, Indonesia and South Africa shows that the negative impacts of weight-related stigma on mental health is not only a high-income-country issue

RESEARCH TRIANGLE PARK, N.C. — Weight-related stigma is adversely affecting adolescents in low- and middle-income countries, according to a new study from RTI International, a nonprofit research institute, and UNICEF that was recently published in the Journal of Global Health.

The first-ever study looking at how weight-related stigma impacts young people’s lives across several low- and middle-income countries found that stigma was reported most by young people who were affected by overweight and obesity, but being underweight was also associated with stigmatization.

In Brazil, 92.6% of female adolescents affected by overweight and obesity had experienced weight stigma, and in South Africa this proportion was 73.3%, compared to 75.9% of young males in Brazil and 64.7% in South Africa. In Indonesia, 53.8% of male adolescents affected by overweight and obesity reported weight stigma, compared to 46.2% of female adolescents.

Notable proportions of adolescents affected by underweight also reported receiving negative comments about their weight, including 45.7% of young women and 40.9% of young men in South Africa, and 56.3% of Indonesian young men and 37.3% of young women.

“Weight stigma is a well-recognized issue in high-income countries that adversely impacts  the mental well-being of people of all ages, and actually undermines their capacity to undertake health-promoting practices,” said Angie Jackson-Morris, Ph.D., associate director in RTI’s Center for Global Noncommunicable Diseases and director for the project that undertook the research. “Unfortunately, this study confirms that it’s now a problem in low- and middle-income countries and that adolescents of all demographics are affected by it.” 

According to the study – which included interviews with 1,200 young people aged 15-19 in Brazil, Indonesia and South Africa – weight-related stigma manifested in negative weight-related comments from schoolmates and family members in the majority of cases. Girls were subjected to more negative comments than boys, as well as those living in urban areas who reported receiving the most comments, but most adolescents were affected regardless of age, area and gender.

Furthermore, one in five respondents reported that negative weight-related comments adversely affected their mental health and described experiencing anxiety, depression, insecurity, self-doubt and low self-confidence in response. For some, such comments also negatively impacted their eating behavior.

Adolescents surveyed for the study overwhelmingly believed that action should be taken to address weight stigma. Their recommendations included promoting a more inclusive model of health and body image in schools and making environments more supportive of healthy choices.

“Our research indicates that the growing pandemic of overweight and obesity among adolescents in low- and middle-income countries has devastating negative consequences in young people’s mental health – including anxiety and depression,” added Victor Aguayo, Ph.D., UNICEF Global Director for Child Nutrition and Development. “These findings emphasize the importance of preventing obesity from early childhood, supporting children to achieve and maintain a healthy weight, regulating children’s food environments, and promoting a more inclusive model of body image among school-age children and adolescents.”

Nearly 380 million children around the world are affected by overweight and obesity, 75% of whom live in low- and middle-income countries. A global rise in unhealthy food environments, where millions of children don’t have access to healthy food options that support their nutrition requirements for both good physical growth and mental well-being, is fueling this child rights crisis, according to UNICEF.

Focusing on the enabling environments in which children live, learn, eat, meet and play, UNICEF works with governments to prioritize actions for tackling childhood overweight and obesity by creating actions plans, allocating budgets, and designing, implementing and enforcing a core set of food environment regulatory policies in countries.

Read the full study

Related: RTI-led study finds economic impacts of overweight and obesity set to reach 3.3% of global GDP by 2060

About RTI International
RTI International is an independent, nonprofit research institute dedicated to improving the human condition. Clients rely on us to answer questions that demand an objective and multidisciplinary approach — one that integrates expertise across the social and laboratory sciences, engineering and international development. We believe in the promise of science, and we are inspired every day to deliver on that promise for the good of people, communities and businesses around the world. For more information, visit www.rti.org.

About UNICEF
UNICEF works in some of the world’s toughest places, to reach the world’s most disadvantaged children. Across more than 190 countries and territories, we work for every child, everywhere, to build a better world for everyone. Follow UNICEF on Twitter, Facebook, Instagram and YouTube.