More About Friends and Peers

Attitudes to Obesity

At the International Conference on Childhood Obesity in Portugal, one of the speakers Dr. Pretlow heard was Professor Andrew Hill, who heads the Academic Unit of Psychiatry and Behavioral Sciences at Leeds University. Dr. Hill’s interests include obesity interventions, food cravings, appetite, the influence exerted by families, the media, and peer groups, and the psychology behind all these things.

In his experience, even at the tender age of 5, children of normal weight will shun obese classmates, and the overweight kids are unhappy about it. In a British Medical Association report in 2005, to which Dr. Hill contributed, the psychological consequences of obesity were well documented. That research harked back to a 1961 study in which:

[…] children (aged 10-11 years) were presented with pictures and asked who they would most like to be friends with. The pictures included children with varying ‘handicaps’. The obese child was always ranked last, irrespective of the ranking child’s gender, race, socio-economic status, living environment or disability. This study was repeated in 2001 with the results indicating that social reaction to obese children has worsened since the study 40 years earlier.

The psychological consequences of obesity have become more severe over time, and girls feel them more keenly.

In 2009, Dr. Thomas W. Valente wrote about a study in Los Angeles whose subjects were 617 teenagers, ages 12 to 14. Researchers aimed to discover if overweight teenagers are more likely to have overweight friends, and the answer was yes, twice as likely. Then he mentioned, in rather alarming terms, a large study done among adults which:

[…] indicated that obesity seemed to spread among family and friends like an infectious disease. There are several reasons to believe obesity may spread through adolescent friendship networks similar to the processes described for adults.

Three causes are seen for this, the first being normal adolescent rebellion with its determination to not listen to a thing the grownups say. Also, it’s been proven over and over that people who behave in a certain way tend to pal around with other people who share that behavior. The other factor is more complicated:

Third, adolescent peer groups are formed around shared behaviors (sports, computer games, video games, eating, etc.) that directly or indirectly affect weight status. Conversely, adolescent peer influences may be less salient to weight status because parents control some of their children’s diet and can also restrict or support physical activity opportunities.

So the implications, Dr. Valente says, are twofold. What he calls the “social contagion” of obesity can start at the very young age. And, the social affiliations that cause or result from a person’s obesity status can have long-reaching consequences.

In 2011, a Columbia University study of a school program called HealthCorps showed two things: prevention is better than cure, and:

[…] education and mentoring from such programs targeting obesity and delivered in schools by peers have a significant impact on diet and physical activity… [Y]oung adults respond better to their peers than to doctors or specialists.

Dr. David Katz of Childhood Obesity magazine added a caveat:

Just as importantly, however, they indicate that peer mentoring cannot be the whole solution and thus we all have lots of work left to do to create environments — both in school and out — that foster the wellbeing of our teenage sons and daughters.

This article also says, “the ‘education as a cure’ model was particularly effective for reducing the consumption of calorific fizzy drinks, with a 13 per cent drop among the participants.” That doesn’t fit with what Dr. Pretlow has learned from the message boards at his website, Weigh2Rock. Young people have said over and over that education is not enough, and what they need are coping skills to resist food cravings.

It could be a difficult area to research. Of course, there are learned skills, like focusing on some unpleasant mental image to cancel out the desire for a food treat. But other people just seem able to cope without trying. For instance, there are natural vegetarians, who just never got into eating meat. If you asked one of them what coping skills come into play when a person wants to resist the urge to eat meat, they would simply stare. The craving for meat isn’t part of their world. They don’t fight it, it just isn’t there.

There are people who have no trouble resisting tobacco, and apparently there are people who have no trouble resisting sugar. How? They probably don’t even know.

Your responses and feedback are welcome!

Source: “Professor Andrew Hill,”
Source: “Preventing childhood obesity,”, 06/05
Source: “Adolescent Affiliations and Adiposity: A Social Network Analysis of Friendships and Obesity,”, 03/17/09
Source: “Feature: Youngsters who turn to peer mentoring ‘can fight obesity‘,”, 10/07/11
Image by Richardson.

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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