This month’s Journal Watch reminds us of one of the perils of the teenage years, social exclusion, and discusses the impact of weight on developing friendships.

Dr Melissa Stoneham writes:

Being a teenager, or screenager as we now call them, can be tough. I reflect positively on most of my teenage years and fondly remember many healthy friendships. But like most teenagers, I can certainly recall times when I was left out by my friends.

New research has found that this type of ostracising continues to occur and is prominent in overweight young people. It was found that overweight teens were more likely to be denied friendships from their peers that were of normal weight. The study, published in the American Journal of Public Health, found that young people are more likely to socially exclude their peers who are overweight, which makes overweight teenagers on average, have one less friend than those who are considered to be ‘normal weight’.

The study led by Associate Professor David Schaefer from Arizona State University involved analysing data from 58,897 students from 88 middle and high schools that participated in the National Longitudinal Study of Adolescent Health. Using a social networking approach, adolescent participants who averaged 15 years of age, were asked to identify their five closest female friends and five closest male friends. Body mass index was self-reported and participants were categorised as underweight, healthy weight, overweight or obese. They then looked at social network analyses to link different types of friend selection methodologies that students used based on things they had in common, such as extracurricular activities and those who met through mutual friends. This allowed the researchers to isolate the effect of weight status on friend selection.

What they found was that overweight youth were less picky when it came to what weight status categories their friends fell into. This led the researchers to believe that overweight young people reached out to normal weight peers for friendship often and were rejected frequently. The question remains then, do overweight young people turn to overweight peers for friendship? Well the researchers suggest this is what actually happens, but only as their second choice due to the rejection from those who were not overweight.

Similar findings emerged in the literature almost 40 years ago with the use of peer-nomination methods with kindergarten children. This study found a consistent aversion to chubbiness expressed by 86% of the children.

Friendships are important sources of support and companionship when you are a teenager.  Research has indicated that not having or losing friends is associated with higher depression and lower self-worth for young people, which could exacerbate the health problems associated with being overweight. One study in America found that the more overweight a teen is, the lower his or her satisfaction with life will be. The Obesity Action Coalition suggest that at least 30% of girls with excess weight and 24% of boys with excess weight report being teased by peers at school.

Preventing childhood obesity is a top priority for public health in Australia. With around 1 in 4 of our kids overweight or obese, it is important to approach this issue of friend selection with an understanding of the social stigma that young overweight people face. This can often be pervasive and have serious implications for mental and physical health. The influence of not having friends, not fitting in with others or being shunned because of extra weight would have to be a difficult thing to endure during teenage years.

So as we continue to fight the war against obesity, we need to constantly remember that positive support of efforts toward healthy lifestyles and environments are more effective than shaming or victimizing people. Environmental factors, lifestyle preferences and our social and cultural environments play pivotal roles in curbing the rising prevalence of obesity. There is no one silver bullet – the solutions to preventing obesity are always going to be complex and need to steer away from standalone initiatives.

Coherent, comprehensive and integrated solutions including education, role modeling, food security, tax on fast food and sugary drinks, promoting physical activity and reducing exposure to marketing and advertising of unhealthy products are just some of the solutions. With indicators suggesting the health system is already overstretched, we need to act now before the freight train runs right over us.


Using Social Network Analysis to Clarify the Role of Obesity in Selection of Adolescent Friends. David R. Schaefer. Published in the American Jnl Public Health Vol 104, Issue 7; pages 1223-1229.

About JournalWatch

The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.