Measures to reduce weight stigma against children and adolescents with overweight and obesity in the education sector

Research area: Psychological & psychiatric interventions

Duration: Q1 2026 to Q4 2026 (5 PM)
Language: German (with English summary)

 

Background:
According to the World Health Organisation (WHO), 20% of children and adolescents aged five to 19 were suffering from overweight (including obesity) in 2022 [1]. Considering obesity alone, the prevalence in this age group was 8%. Similar numbers were reported in Austria by the Childhood Obesity Surveillance Initiative (COSI), which found an overweight prevalence of 18% in eight- to nine-year-olds, and an obesity prevalence of 16% in boys and 8% in girls in 2022/23 [2]. With even higher prevalence rates in the adult population [1]. Furthermore, higher prevalence rates are observed in adolescents with an immigrant background and in those from a lower socioeconomic background [3, 4].

Weight stigma can be defined as the devaluation of people in society because of their body weight. Weight bias is defined as a negative attitude towards people because of their weight, while weight discrimination occurs when such negative attitudes influence a person’s behaviour [5]. Many adolescents report experiencing discrimination because of their weight, most often from peers or in school [6]. This stigmatisation can manifest itself in bullying, affecting children and adolescents with overweight and obesity more frequently as victims and perpetrators [7, 8]. However, stigmatisation can also be perpetrated by teachers, for example, through poorer school grades for the same level of performance or the belief that pupils with a heavier weight are ‘slower’ [9].

Experiencing weight stigma can have an impact on physical, psychological, and social health. Such experiences can lead to increased body weight during adolescence and adulthood [9, 10]. Furthermore, children and adolescents who experience weight stigma are more likely to suffer from depression and anxiety, and are at a higher risk of self-harm and suicidal behaviour [9].

As school represents a central environment in the lives of children and adolescents, and weight stigma occurs particularly frequently in this setting, this report focuses on this context. Targeted measures in educational settings may therefore offer a promising approach to reducing weight stigma at an early stage and providing lasting protection for the children and adolescents affected.

Project aims:
Due to the high prevalence of weight stigma in schools and its far-reaching consequences, interventions are needed to reduce it. The aim of this project is to provide a systematic overview of scientifically evaluated and/or recommended interventions for reducing weight stigma against children and adolescents in educational settings. The project also aims to assess the effectiveness of these interventions.

Non-aims:
There will be no overview of interventions to reduce weight stigma against children and adolescents in the healthcare sector. This topic was addressed in a report from 2024, which identified no specific literature on this topic for this age group [5].

Based on this background, the following two research questions will be addressed:

Research questions:

1.     Which interventions are used or recommended in scientific studies and guidelines to reduce weight stigma against children and adolescents in educational settings?

2.     How effective are interventions to reduce weight stigma against children and adolescents in educational settings?

Methods:

Recommendations and characteristics of the measures: summary of guidelines, grey literature and published studies

To answer the first research question, we will conduct a systematic literature review of multiple databases for review articles (and, if necessary, primary studies). Additionally, we will perform a targeted manual search for evidence-based guidelines, published consensus and position papers. After selecting the literature, we will extract the intervention characteristics into tables and summarise the results narratively. We will not conduct a quality appraisal of the selected literature, as the focus lies on proposed strategies and not their effectiveness. Study selection and data extraction will be conducted according to the four-eyes principle by two authors (JKK and LG).

Effectiveness of the interventions: systematic review

The search results obtained from the systematic search for the first research question will also be used for the second research question. Whether primary studies are included depends on whether enough systematic reviews can be identified. The study characteristics and effectiveness outcomes of interventions for reducing weight stigma against children and adolescents will be extracted. The quality of the included literature will be appraised. The results will be summarised narratively. Study selection, data extraction and quality appraisal will be carried out by the same authors (JKK and LG) according to the four-eye principle.

Inclusion criteria (PICO):

Population	arget audience for the intervention, e.g. healthcare professionals working in the education sector, educational staff, organisations in the education sector (such as all types of schools) and their management, health and education policymakers Affected population, such as children, adolescents and young adults with overweight or obesity in the education sector, as well as their parents and families. Key words: weight bias/stigma*/discrimination; obesity bias/stigma*/discrimination; fat phobia; anti-weight bias; sizeism
Intervention	Interventions … … that could be used to reduce weight stigma in the education sector, or … to reach a stigma free treatment with children and adolescents with overweight or obesity in the education sector.
Comparison	-
Outcomes	Research question 1: Recommended interventions Intervention characteristics Research question 2: Effectiveness of the interventions in relation to, for example: ·        Implementation of the interventions (adjustment of teaching style, structural changes in the school setting…) ·        Reduction of weight bias within the target population (measured using questionnaires, e.g. Anti-Fat Attitudes Questionnaire (AFA), Fear of Fat Scale, Fat Phobia Scale (FPS), Beliefs About Obese Persons Scale (BAOP)) ·        Experienced weight stigma among the children and adolescents concerned, or their parents (measured using questionnaires, e.g. the 10-item Weight Bias Internalisation Scale – Modified (WBIS-M))
Publication type	Research question 1:  Guidelines and published position of consensus papersa Systematic reviews Research question 2: Systematic reviews or meta-analyses (preferred) Primary studies (alternatively)
Countries	Global North
Languages	German, English and potentially other languages for research question 1a

Notes: ^aDepending on how many guidelines and published position and consensus papers are identified in German or English, additional guidelines or papers in their original language will be included or excluded. If included, the texts will be translated using an online tool.

Timetable:

Period	Tasks
Q1 2026	Scoping and finalisation of the project protocol
Q2 2026	Systematic and manual literature search Literature selection
Q2 2026	Data extraction and quality appraisal
Q2 2026	Writing
Q3 2026	Internal and external review
Q3-Q4 2026	Layout & publication

 

References:

[1]           World Health Organization. Obesity and overweight. 2025 [updated 2025/12/08; cited 04.03.2026]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
[2]           Felder-Puid R. and Teufl L. Childhood Obesity Surveillance Initiative (COSI). Ergebnisbericht O?sterreich 2023. Wien: 2024. Available from: https://jasmin.goeg.at/id/eprint/3844/.
[3]           Felder-Puig R., Teufl L. and Winkler R. Gewichtsstatus und Körperselbstbild von österreichischen  Jugendlichen. HBSC Factsheet 02 aus Erhebung 2021/22. Wien: Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz (BMSGPK), 2023. Available from: https://jasmin.goeg.at/id/eprint/3043/.
[4]           Hoebel J., Waldhauer J., Blume M. and Schienkiewitz A. Socioeconomic Status, Overweight, and Obesity in Childhood and Adolescence. Dtsch Arztebl International. 2022;119(49):839-845. DOI: 10.3238/arztebl.m2022.0326.
[5]           Wolf S. and Kern J. Strategien zur Reduktion von Gewichtsstigmatisierung bei Personen mit U?bergewicht oder Adipositas im Gesundheitswesen. Wien: HTA Austria – Austrian Institute for Health Technology Assessment GmbH, 2024 Report No. 160. Available from: https://eprints.aihta.at/1547/.
[6]           Anastasiadou D., Tárrega S., Fornieles-Deu A., Moncada-Ribera A., Bach-Faig A. and Sánchez-Carracedo D. Experienced and internalized weight stigma among Spanish adolescents. BMC Public Health. 2024;24(1):1743. DOI: 10.1186/s12889-024-19246-7.
[7]           Chen H. and Ye Y. A Three-Level Meta-Analysis on the Relation of Overweight or Obesity to Bullying Behavior Among Youths. Psychology in the Schools. 2025;62(10):3747-3766. DOI: https://doi.org/10.1002/pits.23540.
[8]           Thompson I., Hong J. S., Lee J. M., Prys N. A., Morgan J. T. and Udo-Inyang I. A review of the empirical research on weight-based bullying and peer victimisation published between 2006 and 2016. Educational Review. 2020;72(1):88-110. DOI: 10.1080/00131911.2018.1483894.
[9]           Puhl R. M. and Lessard L. M. Weight Stigma in Youth: Prevalence, Consequences, and Considerations for Clinical Practice. Current Obesity Reports. 2020;9(4):402-411. DOI: 10.1007/s13679-020-00408-8.
[10]         Gmeiner M. S. and Warschburger P. Interrelation between weight and weight stigma in youth: is there evidence for an obesogenic vicious cycle? European Child & Adolescent Psychiatry. 2023;32(4):697-704. DOI: 10.1007/s00787-021-01922-3.