Parental Contributors to the Prevalence and Long-Term Health Risks of Family Weight Teasing in Adolescence

Abstract

Purpose:

Weight teasing from family members is common during adolescence. However, little is known about parental factors that increase adolescents’ risk for family weight teasing and its adverse health sequelae. Using multi-informant data from adolescents, mothers and fathers, the current longitudinal study examined how parental concerns about their child’s weight and their own weight contribute to family weight teasing in adolescence and its long-term health consequences.

Methods:

Data were collected in the population-based Project EAT 2010–2018 (Eating and Activity over Time) study, following a longitudinal cohort of young people (N=2,793). Parental weight concerns for their adolescent and themselves were reported by mothers (N=2,298) and fathers (N=1,409) at baseline, and examined as a predictor of family weight teasing in adolescence as well as a moderator of family weight teasing effects on health eight years later.

Results:

Mothers’ and fathers’ concerns about their child’s weight, as well as mothers’ dieting frequency, increased the likelihood of adolescents experiencing family weight teasing. Longitudinal analyses revealed that adolescents teased about their weight by family had higher levels of stress (β=0.21, 95% CI=0.09–0.33) and substance use (β=0.16, 95% CI=0.04–0.28), and lower self-esteem (β=−0.16, 95% CI=−0.28- −0.05) in young adulthood.

Conclusions:

Findings highlight parent weight concern, particularly concern for their child’s weight, as a risk factor for family weight teasing. These findings underscore the importance of encouraging parental attention to health, rather than weight, in family-based treatment and public health initiatives.

Adolescents who experience weight-based teasing are more likely to suffer maladjustment across multiple domains, including declines in physical¹ and psychological² health. Considerable research on adolescent weight teasing has focused on peer victimization in the school setting;^3,4 however, accumulated evidence also indicates that many adolescents face weight teasing within the family context. In fact, retrospective reports from adults with obesity,⁵ as well as reports from adolescents,⁶ indicate that family members are a main source of negative weight talk and teasing. Prevalence estimates across diverse samples suggest that up to half of youth experience weight teasing from family members.^7–10

Family weight teasing during adolescence is particularly concerning given its adverse health effects. Cross-sectional studies indicate that adolescents who experience weight teasing from family members are at elevated risk for emotional distress (e.g., low self-esteem) and are more likely to engage in unhealthy behaviors, such as substance use.^6,7,11–13 Although longitudinal studies of family weight teasing are scarce, growing evidence documents enduring consequences that persist into adulthood. Not only does weight teasing by family members in adolescence increase the likelihood of receiving weight-related comments by family in young adulthood,¹⁴ but adolescent girls teased about their weight by family members engage in more unhealthy eating behaviors and have lower body satisfaction 15 years later, even after controlling for demographic characteristics and weight status.¹ Given the prevalence and harm associated with family weight teasing, it is important to identify whether certain factors within the family microsystem may heighten adolescents’ risk for such mistreatment and magnify (or temper) its adverse health sequelae.

As adolescence is a developmental period of elevated parental pressure and critique regarding appearance,^15,16 parents may play an important role in adolescents’ experiences of family weight teasing. Parents serve as critical socializers throughout adolescence¹⁷ and are likely to set the tone for the acceptability of weight-related (mis)treatment within the family context. Although predictors of parental encouragement to diet have been investigated,¹⁸ little is known about parental predictors of family weight teasing, and studies with multi-informant samples (e.g., both parents and adolescents) are scarce. Qualitative accounts from parents offer initial insights into why families engage (or do not engage) in weight talk and teasing. In particular, among an ethnically diverse, predominantly low-income sample of parents, Berge and colleagues¹⁹ highlighted child-focused weight-related concern, along with parental weight-related factors (e.g., body image) as contributing to family weight teasing. Additionally, given that parental body weight²⁰ and beliefs about weight²¹ contribute to anti-fat attitudes, weight-related characteristics and concerns reported by parents seem particularly important to examine in the context of adolescent-reported weight teasing.

The current study uses longitudinal data to explore how parental weight-related concerns and characteristics differ between adolescents who do versus do not report weight teasing from family members, and whether such factors moderate the longer-term health implications of weight teasing. To enhance generalizability of the findings across a wide range of demographic groups, we rely specifically on a large diverse population-based sample. Extending previous studies that document differential risk for family weight teasing as a function of adolescent demographic⁹ and anthropometric¹⁹ characteristics, we focus on parental factors that are more amenable to change, including child-focused (e.g., parental concern for their child’s weight, restrictive feeding practices) and self-focused (e.g., dieting frequency, body satisfaction) weight concerns and characteristics that were expected to heighten adolescents’ vulnerability to weight teasing at home. In addition, whereas past studies examining parental influence on adolescent eating and weight-related behaviors have relied primarily on adolescents’ perceptions of their parents,^22,23 we instead use multi-informant data (i.e., adolescent-, mother-, father- reports), which uniquely allow for separate examination of the role of mothers and fathers. Furthermore, our longitudinal models assess whether the parent-reported weight factors moderate the long-term health consequences of family weight teasing, captured by indicators of emotional and physical health (i.e., stress, substance use, self-esteem) that can be disrupted due to internalizing and externalzing (e.g., self-medication) coping responses to social mistreatment. Our moderator models were exploratory in nature, with the aim of addressing whether particular underlying motivations of parents (e.g., weight-related concern) may turn up, or dial down, the adverse health sequlae associated with family weight teasing. Understanding parental contributors to family weight teasing of adolescents and its long-term health implications represents a critical first step for the development of family-based and public health interventions that can help families to reduce these harmful behaviors.

Methods

Study Design and Population

EAT 2010–2018 (Eating and Activity over Time) is a population-based, longitudinal study of weight-related health and associated factors in young people (www.sph.umn.edu/research/projects/project-eat/about/#eat-2010). The overall aim of the study is to identify multi-contextual predictors of a broad array of weight-related problems in a diverse, population-based sample of young people as they progressed from adolescence to young adulthood in order to inform more effective interventions. The EAT 2010–2018 study is guided by an ecological framework, including family/home, friend/significant other, school/workplace, and neighborhood environments. Participants enrolled in the EAT 2010 study as adolescents during the 2009–2010 academic year (mean age=14.4±2.0 years) and completed a follow-up EAT 2018 survey in 2017–2018 (mean age=22.0±2.0 years). For EAT 2010, middle and senior high school students at 20 urban public schools (of n=35 schools contacted) in Minneapolis-St. Paul, Minnesota completed classroom surveys during school hours. Additionally, parents/caregivers of adolescents completed a mail/phone survey about weight-related factors within the home environment during the same baseline year of the study. The follow-up EAT 2018 assessment was designed to allow for examining changes in weight-related outcomes along with risk and protective factors as participants progressed through adolescence and into young adulthood. The University of Minnesota’s Institutional Review Board Human Subjects Committee approved all protocols used at each time point.

Adolescent Assessments

Trained research staff administered surveys (EAT 2010 survey, food frequency questionnaire, physical activity questionnaire) and measured adolescents’ height and weight during selected health, physical education, and science classes. Adolescents were given the opportunity to assent only if their parent/guardian did not return a signed consent form indicating refusal to have their child participate. Among adolescents who were at school on the days of survey administration, 96.3% had parental consent and chose to participate (N=2,793). Measurements were completed in a private area (e.g., behind a screen in the back of the classroom or hallway) and surveys were administered during two class periods that were typically 45–50 minutes. Survey items and response options used to assess adolescents’ perceptions of weight teasing are described in Table 1. The test-retest reliability of EAT 2010 survey items were determined over a one week period among 129 adolescents.

Table 1.

Description of adolescent, parent/caregiver, and young adult survey measures

	Sourcea	Survey items or descriptionb
Adolescent perception of family weight teasing	A	Have you ever been teased or made fun of by family members because of your weight? Response options were yes or no;[7] test-retest agreement = 96%.
Parental misperception of adolescent weight status	P	How would you describe your child’s weight? Five response options ranging from very underweight to very overweight;[32] test-retest r=0.84. Parental misperception of weight status was defined by comparing responses to the adolescent’s weight category based on measured body mass index percentile.
Parental concern about adolescent weight	P	How concerned are you about your child’s weight? Four responses ranging from not at all concerned to very concerned; test-retest r=0.68).
Parental encouragement of adolescent to diet	P	To what extent do you encourage your child to diet to control his/her weight? Four responses ranging from not at all to very much;[33] test-retest r=0.68.
Parental feeding practices	P	Modified restriction subscale of the Child-Feeding Questionnaire.[34,35] Six statements (e.g., I have t be sure that my child does not eat too many sweets (candy, ice cream, cake or pastries). Four responses for each item ranging from disagree to agree; responses were averaged to form a scale with Cronbach’s alpha=0.86.
Parent dieting	P	How often have you gone on a diet during the last year? By “diet” we mean changing the way you eat so you can lose weight? Five responses ranging from never to I am always dieting; test-retest r = 0.60.
Parent body mass index	P	Parents self-reported their height (test-retest r=0.95) and weight (test-retest r=0.97), and body mass index was calculated as weight (kg)/height (m)2.
Parent body satisfaction	P	Parents reported their satisfaction with their own weight, body shape, and body build.[36] Five response options for each item ranging from very dissatisfied to very satisfied. Responses to the three items were averaged to form a scale with Cronbach’s alpha=0.90.
Young adult stress	Y	On a scale from one to ten, with one being not stressed at all and ten being very stressed, how would you rate your average level of stress in the past 30 days?[37] Response options ranging from one to ten (test-retest r=0.69).
Young adult substance use	Y	How often have you used the following during the past year (12 months)? Five response options for each form of substance use ranging from never to daily;[38] responses were summed after being coded 0–4. Three forms of substance use were assessed: liquor (test-retest r=0.82), marijuana (test-retest r=0.87), other drugs (cocaine, heroin, meth, etc) (test-retest r=0.78).
Young adult self-esteem	Y	The Rosenberg Self-esteem Scale[39] including six items (e.g., On the whole, I am satisfied with myself). Four response options for each item ranging from strongly disagree to strongly agree. Responses were summed to form a scale with a Cronbach’s alpha=0.81.
Parent and adolescent covariates	P, A	Parent and adolescent gender (male, female; parent test-retest agreement=92%, adolescent test-retest agreement=99%) and race/ethnicity (White, Black or African American, Hispanic or Latino, Asian American, Native Hawaiian or other Pacific Islander, American Indian or Native American, Other; parent test-retest agreement=98–100%, adolescent test-retest agreement=98–100%)c. Adolescent socioeconomic statusd (test-retest r=0.90), and age (test-retest r=0.99).

^aA, adolescent report; P, parent report; Y, young adult report.

^bThe test-retest reliability of adolescent (EAT 2010) survey items was determined over a one-week period among 129 adolescents. The test-retest reliability of parent/caregiver survey items was determined among a subsample of 102 parents/caregivers who completed the survey twice within a period of two weeks. Similarly, for young adult (EAT 2018) survey items, test-retest reliability was examined using data from a subgroup of 112 participants who completed the survey twice within a period of three weeks.

^cIndividuals identifying as “Native Hawaiian or other Pacific Islander”, “American Indian or Native American”, or “Other” were collapsed into a combined “Other Ethnic Group” category given lower prevalence and to facilitate more parsimonious modeling.

^dThe prime determinant of socioeconomic status (SES; low, low-middle, middle, upper-middle, high) was the higher education level of either parent. Subsidiary variables were family eligibility for free/reduced lunch, family receipt of public assistance, and parent employment status.^[40]

Parent/caregiver Survey

Parents/caregivers of adolescent participants were also asked to respond to a survey as part of Project F-EAT (Families and Eating and Activity among Teens) in 2010. A total of 3,709 parents provided informed consent and responded; 2,382 adolescents had at least one parent respond (85.3%) and 1,327 adolescents had two parents respond (47.5%). The parent sample for the current analysis included 2,298 females (mean age=41.3±8.1 years; 93% mothers, 7% stepmothers or other) referred to hereafter as “mothers”, and 1,409 males (mean age=44.2±8.6 years; 87% fathers, 13% stepfathers or other) referred to hereafter as “fathers”. To meet the needs of the culturally diverse population, parents were given the option of responding to a written survey by mail or completing a telephone interview with trained research staff (both with multiple language options). Table 1 describes survey items and response options used to assess parents’ perceptions of adolescent weight, weight-related parenting practices, and parents’ body mass index, body satisfaction, and dieting frequency. A subsample of 102 parents completed the Project F-EAT survey twice in a 2-week period to examine test-retest reliability of survey questions.

Young Adult Assessments

Of the original 2,793 adolescent participants, 410 (14.7%) were lost to follow-up for various reasons, primarily missing contact information at EAT 2010 or no address found at follow-up (n=397). Invitations to participate in the online EAT 2018 survey were mailed to the remaining 2,383 young people and complete surveys were returned by 65.8% of this group for whom contact information was available. All participants were mailed a financial incentive following survey completion. Data collection ran from June 2017 to November 2018. The survey measures of stress, substance use, and self-esteem that were completed by this young adult sample (N=1,568) are described in Table 1. The test-retest reliability of measures was examined using data from 112 participants who completed the survey twice over three weeks.

Analytic Plan

Data were analyzed in Mplus 8.0. All analyses considering parental effects were conducted separately for mothers and fathers because of the potential for differential influence²³ and concerns about multicollinearity when modeled together. Descriptive information regarding adolescent-reported weight teasing and the parent-reported weight variables is provided first. Second, to provide insight into the parental correlates of weight teasing, concurrent associations between the parent-reported weight variables and adolescent-reported family weight teasing were tested using logistic regression (0=no weight teasing, 1=weight teasing). The regression models were run separately for each weight-related independent variable, accounting for parent race/ethnicity (4 dummy coded variables with White coded as the reference group), as well as adolescent age, gender (0=male, 1=female) and socioeconomic status (SES; 4 dummy coded variables with middle SES coded as the reference group). Initial exploratory analyses examining whether the associations between the parent-reported weight variables (separately for mothers and fathers) and weight teasing varied as a function of adolescent gender were tested with two-way interactions; however, the two-way interaction terms (i.e., parent predictor x adolescent gender) were nonsignificant, suggesting that the associations function similarly across male and female adolescents and thus the data were pooled.

Finally, to consider whether the long-term health consequences of experiencing family weight teasing in adolescence depends on parental weight-related concerns and characteristics, longitudinal associations were tested. Specifically, after testing how family weight teasing in adolescence predicts stress, substance use, and self-esteem eight years later in young adulthood, we examined whether the links between weight teasing and health vary as a function of parent-reported child-focused and self-focused weight variables using two-way interactions. All models accounted for child gender, race/ethnicity and SES (dummy coded to align with concurrent analyses). Inverse probability weighting (IPW) was applied to the data to account for missing data, as attrition from EAT 2010 to EAT 2018 did not occur completely at random.^24,25 IPW minimizes potential non-response bias, and thus allows for comparisons to the original school-based sample. Weights for IPW were derived as the inverse of the estimated probability that an individual responded at the two time points based on characteristics reported in 2010, including demographics, past year frequency of dieting, and weight status.

Results

Table 2 presents demographic characteristics for the adolescent and parent samples at baseline. On average, 24% of adolescents reported being teased or made fun of by family members because of their weight.

Table 2.

Sample characteristics in the EAT-2010 and F-EAT-2010 study.

Sample Characteristics	% (N)
Adolescents (n=2793)
Gender
Female	53.2 (1486)
Male	46.8 (1307)
Race/Ethnicitya
White	18.9 (525)
African American/Black	29.0 (808)
Hispanic	16.9 (472)
Asian American	19.9 (555)
Other Ethnic Groupb	15.3 (424)
Socioeconomic Statusc
Low	39.9 (1072)
Low-middle	22.1 (595)
Middle	17.5 (471)
Upper-middle	12.9 (347)
High	7.6 (203)
Grade Leveld
Middle School (Grades 6–8)	46.1 (1287)
High School (Grades 9–12)	53.9 (1502)
Weight Teasing from Family Memberse	24.2 (660)
Mothers (n=2298)
Race/Ethnicityf
White	29.5 (666)
African American/Black	28.3 (639)
Hispanic	16.5 (373)
Asian American	19.9 (449)
Other Ethnic Groupb	5.8 (132)
Fathers (n=1409)
Race/Ethnicityg
White	30.1 (415)
African American/Black	22.5 (310)
Hispanic	18.9 (260)
Asian American	23.9 (330)
Other Ethnic Groupb	4.6 (64)

^a9 missing

^bE.g., Native Hawaiian, Pacific Islander, American Indian or indigenous American

^c105 missing

^d4 missing

^e65 missing

^f39 missing

^g30missing

Parental Correlates of Family Weight Teasing in Adolescence

As shown in Table 3, adolescents were more likely to report weight teasing by family members when mothers and fathers reported higher levels of concern for their child’s weight, more frequent encouragement of their child to diet, greater engagement in restrictive feeding practices (mothers only), and when parents misperceived the weight of their child. In addition, when considering the parental self-focused weight variables, adolescents were more likely to report being teased by family members when mothers reported more frequent dieting; however, this association was non-significant among fathers.

Table 3.

Concurrent associations between parent-reported weight variables and adolescent-reported weight teasing from family members.

	Adolescent Reported Weight Teasing from Family
Parental Predictors	Odds Ratio	95% CI
Mothers
Child-focused
1. Parental misperception of child weight	2.02***	1.64, 2.48
2. Parental concern for child weight	1.42***	1.28, 1.57
3. Parental encouragement to diet	1.37***	1.25, 1.50
4. Restrictive eating parenting practices	1.25***	1.11, 1.41
Self-focused
5. Parent dieting frequency	1.15**	1.06, 1.25
6. Parent BMI	1.02	1.00, 1.03
7. Parent body satisfaction	0.95	0.87, 1.03
Fathers
Child-focused
1. Parental misperception of child weight	1.98***	1.52, 2.58
2. Parental concern for child weight	1.30***	1.14, 1.49
3. Parental encouragement to diet	1.20**	1.06, 1.36
4. Restrictive eating parenting practices	1.11	0.94, 1.30
Self-focused
5. Parent dieting frequency	0.93	0.82, 1.07
6. Parent BMI	1.01	0.98, 1.03
7. Parent body satisfaction	1.00	0.90, 1.11

Note. All regression models were run separately for mothers and fathers, and separately for each parental predictor while controlling for parent race/ethnicity, as well as adolescent age, gender and socioeconomic status. CI = confidence interval. BMI = body mass index.

^***p<.001

^**p<.01

^*p<.05.

Thus, while parent-reported concern about their child’s weight was positively associated with weight teasing regardless of the gender of the parent, dieting frequency of mothers, in particular, increased the likelihood that adolescents were teased about their weight by family members. These associations were documented over and above parent race/ethnicity, as well as adolescent age, gender, and SES. To test the robustness of the findings, we also re-ran the analyses controlling for adolescent BMI percentile. All associations between the parental predictors and weight teasing replicated over and above adolescent BMI in the sensitivity analyses, with the exception of the association between paternal encouragement to diet with weight teasing (which became non-significant).

Longitudinal Health Risks of Family Weight Teasing in Adolescence

As shown in Table 4, adolescents who reported experiencing weight teasing from their family members had higher levels of stress (β=0.21, 95% CI=0.09–0.33) and substance use (β=0.16, 95% CI=0.04–0.28), and lower self-esteem (β=−0.16, 95% CI=−0.28- −0.05), in young adulthood (i.e., eight years later), compared to those who did not experience family weight teasing in adolescence. These associations were retained even after adjusting for adolescent BMI percentile.

Table 4.

Standardized estimates of the interactive effects of adolescent-reported weight teasing and parent-reported weight variables on health outcomes in young adulthood.

	Young Adult Health Outcomes (standardized estimates)
	Stress		Substance Use		Self-Esteem
Weight Teasing from Family Members	0.21**		0.16**		−0.16**
Interactive Effects of Parental Predictors	Mothers	Fathers	Mothers	Fathers	Mothers	Fathers
Child-focused
1. Parental Misperception of Child Weight	0.08	0.06	0.03	−0.04	−0.04	−0.08
Weight Teasing X Misperception of Child Weight	−0.08	−0.09	−0.02	−0.20	−0.09	0.11
2. Parental Concern for Child Weight	0.02	0.04	−0.04	−0.05	−0.04	−0.08
Weight Teasing X Concern for Child Weight	0.02	0.03	−0.03	−0.04	−0.04	−0.03
3. Parental Encouragement to Diet	0.02	−0.07	−0.09**	−0.03	−0.03	−0.03
Weight Teasing X Encouragement to Diet	0.01	0.08*	0.01	−0.01	−0.01	−0.04
4. Parental Restrictive Eating Practices	0.05	0.00	−0.03	−0.06	−0.11**	−0.07
Weight Teasing X Restrictive Feeding Practices	−0.04	0.02	−0.05	−0.02	−0.01	0.02
Self-focused
5. Parental Diet Frequency	0.07*	0.01	0.04	0.05	−0.04	−0.02
Weight Teasing X Parental Diet Frequency	−0.02	−0.01	−0.02	−0.02	−0.03	0.00
6. Parental BMI	0.07	0.07	0.00	0.05	−0.05	0.00
Weight Teasing X Parental BMI	0.00	−0.03	−0.03	−0.01	0.03	0.02
7. Parental Body Satisfaction	−0.13***	−0.02	−0.02	−0.04	0.09*	0.02
Weight Teasing X Parental Body Satisfaction	0.03	0.06	0.01	0.00	−0.01	−0.05

Note. Regression models testing interactive effects of the parental predictors were run separately for each parental weight variable and separately for mothers and fathers while controlling for child gender, race/ethnicity, and socioeconomic status. BMI=body mass index.

^***p<.001

^**p<.01

^*p<.05

Across the 42 weight teasing by parent predictor interactions tested, only one was statistically significant. As such, it was concluded that the associations between weight-related teasing and young adult outcomes did not vary as a function of parental child- or self-focused weight concern. These null findings imply that being teased about weight by family members in adolescence has long-term health consequences regardless of the parent-reported weight variables.

Discussion

Despite the harm associated with family weight teasing during adolescence,^1,6,7,11,12 research examining risk factors for teasing has been limited, and has focused primarily on adolescent characteristics (e.g., gender, race, BMI). In this study, we investigated the role of parental weight-related concerns and characteristics in adolescents’ experiences of weight teasing from family members. The results indicated that parental concerns about their child’s weight, encouragement of their child to diet, and misperceptions of their adolescent’s weight were associated with heightened risk for adolescent exposure to family weight teasing. These associations held for both mothers and fathers, and did not vary as a function of adolescent gender. Dieting frequency of mothers, but not fathers, was also related to increased likelihood of adolescents experiencing family weight teasing. Finally, adolescents who were teased by family members because of their weight had greater levels of stress, substance use, and lower self-esteem in young adulthood (i.e., eight years later), compared to those who were not teased about their weight as adolescents. In general, these longitudinal associations were unrelated to parent-reported weight concerns and characteristics. At a time when life course health trajectories take shape,²⁶ our findings provide a social-developmental perspective on the harm associated with family weight teasing during adolescence.

Although fathers are often neglected in adolescent research,²⁷ the current findings indicate that the consequences of fathers’ weight-related concerns for their child were on par with that of mothers. Presumably, mothers and fathers who are more concerned about their child’s weight, encourage dieting, and restrict their child’s eating are more likely to openly criticize their child because of their weight. Previous qualitative research suggests that many parents directly communicate concerns about their child’s weight or criticism of eating behaviors.¹⁹ Such criticism from parents may set the tone for weight-related communication and (mis)treatment from other family members (e.g., siblings, grandparents). Indeed, over and above BMI and age, siblings are more likely to engage in weight teasing when parents do so.¹² Thus, it will be important for future studies to examine parent-adolescent weight-related communication as a mechanism underlying the associations between parental weight concern and family weight teasing.

Building on the concurrent health consequences of family weight teasing, to the best of our knowledge, these results are the first to document that the negative effects of family weight teasing on self-esteem^7,8 and substance use¹³ are not only concurrent, but endure over time. Thus, in addition to negatively affecting eating behaviors and weight-related health 15 years later,¹ family weight teasing in adolescence appears to also have long-term consequnces for emotional and physical health. Our findings also uniquely document higher levels of stress among young adults who were teased by family about their weight during adolescence. Given that stress has been proposed as a mechanism linking weight stigma and weight gain,²⁸ it is possible that the ongoing stress of family weight teasing accounts in part for higher BMI and obesity among adults who were teased about their weight by family members during adolescence.¹

Finally, the near entirety of non-significant interactive effects in the longitudinal models provide important insight to the pervasive harms of family weight teasing. Specifically, adolescents teased by family members because of their weight reported higher levels of stress, substance use and lower self-esteem during young adulthood, regardless of the parental contributors to such mistreatment. While the health consequences of family weight teasing could be expected to diminish as adolescents transition into adulthood and may come to understand the motivations underlying the teasing (e.g., loving concern, or parent’s own weight-related challenges), this was not the case. Given longitudinal evidence that adolescents who are teased about their weight by family members are more likely to face weight comments by family in young adulthood,¹⁴ it is also possible that the effects of earlier weight teasing are magnified by the continuation of this experience over time. Future longitudinal research parsing out the developmental timing vs life course accumulation of weight teasing could help shed light on adolescence as critical period in the etiology of enduring weight stigma-related health consequences.

Strengths, Limitations and Future Directions

Several design features contributed to the strength of the current study, including longitudinal data using a diverse multiple informant sample. This approach uniquely allowed us to detect both similarities and differences in the influence of mothers and fathers on adolescent-reported family weight teasing without the contribution of shared method variance. In addition, our findings are among the first to shed light on parental factors that may heighten adolescents’ risk of experiencing family weight teasing and are critical to identify in order to help support adolescent health and reduce weight teasing in the home environment.

Study limitations should also be taken into account in interpreting findings and informing further research. First, associations between the parent-reported weight factors and adolescent-reported family weight teasing were assessed at a single time point, and change over time could not be examined for the adverse health outcomes considered here. Thus, neither directionality nor causality can be concluded. Further research is needed to explore how changes in weight-related treatment in the familial context contribute to the development of health problems over time. Second, although adolescent BMI was computed using objective anthropometric assessments, self-reported height and weight data were used to calculate parental BMI when objective measurement would be ideal. Third, the measure of weight teasing was broad (i.e., from family members in general), and therefore we were unable to differentiate the specific source of teasing (e.g., mother, father, siblings, grandparents). Given that siblings are likely to critique one another’s appearance during adolescence,¹² future research with sibling dyads is needed to capture the motivational underpinnings of sibling weight teasing. Relatedly, while the mother and father indicators were purposefully broad to be inclusive of diverse family structures (i.e., split on the basis of parent/guardian gender), the current analyses do not distinguish the influence of biological mothers and fathers from other female and male parents (e.g., step-parents) or guardians (e.g., grandparents). Furthermore, it is important that future research place the current study findings within the broader family context by taking into account, for example, individual differences in parent-child relationships. Given cultural differences in the acceptability and meaning of weight teasing at home,¹⁹ additional studies are also needed to consider how associations between parental weight concerns and family weight teasing may interact with broader community and cultural influences.

Conclusions and Implications

Collectively, the current findings build on a large literature documenting harmful effects of weight teasing, and provide new insights that underscore the importance of addressing weight teasing in the familial context. According to previous work, some parents report engaging in negative weight talk and teasing with their child because of weight concerns expressed by their child’s doctor or health care professional.¹⁹ Thus, our findings suggest that practitioners working with families should be aware that parental weight concerns may increase the likelihood of family weight teasing, which may in turn contribute to long-term health consequences for adolescents.²⁹ Furthermore, our study findings reiterate the importance of guidelines from the American Academy of Pediatrics that encourage clinicians to use sensitive and non-stigmatizing language when communicating with youth and families about weight, and to discuss with parents the potential that weight stigma that may be occurring at home.³⁰ These practices can model appropriate communication behaviors to parents and help increase their awareness of weight teasing and its harmful consequences.

Emphasizing the importance of parents focusing on the health, rather than the weight, of their child is likely critical to reducing weight teasing in the home environment and in turn supporting healthy adolescent outcomes. Similar findings have been documented with regards to parent-adolescent communication, wherein conversations surrounding healthy eating and physical activity without reference to weight, shape, or size are associated with more positive eating-related outcomes among adolescents.³¹ Finally, a greater emphasis should be placed on cultivating inclusive family weight climates given that when parents are motivated to instill tolerance and respect for others, they are less likely engage in weight teasing.¹⁹ As such, family-based interventions and public health initiatives that teach empathy and inclusion are needed to ensure that all adolescents are treated with respect at home regardless of their body weight or size, especially during this developmental period when appearance-related pressures and concerns are particularly salient.