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Richard S. Strauss, MD; Harold A. Pollack, PhD

Arch Pediatr Adolesc Med. 2003;157:746-752.

Background  Overweight is the most common health problem that faces children and adolescents. Although the correlation among overweight, low self-esteem, and depression is well known, social isolation among overweight children and adolescents has not been studied.

Objective  To investigate social networks of overweight and normal-weight adolescents in a large, nationally representative sample.

Design  Cross-sectional, nationally representative cohort study.

Population  A total of 90 118 adolescents aged 13 to 18 years who were enrolled in the National Longitudinal Study of Adolescent Health, of which a 1:5 subsample was selected for detailed in-home assessment, including height and weight measurements (n = 17 557). Overweight was defined according to body mass index (>95th percentile for age and sex).

Main Outcome Measures  This analysis focuses on the number of friendship nominations each adolescent received from other adolescents. The number of friendship nominations and other social network measures were calculated using statistical software.

Results  Overweight adolescents were more likely to be socially isolated and to be peripheral to social networks than were normal-weight adolescents. Although overweight adolescents listed similar numbers of friends as normal-weight adolescents, overweight adolescents received significantly fewer friendship nominations from others than were received by normal-weight adolescents (mean [SE] number of friendship nominations, 3.39 [0.08] vs 4.79 [0.04]; P<.001). Overweight adolescents were also more likely to receive no friendship nominations than were normal-weight adolescents (odds ratio, 1.71; 95% confidence interval, 1.39-2.20). Decreased television viewing (P<.001), increased levels of sports participation (P<.001), and increased participation in school clubs (P<.001) were associated with significantly more friendship nominations and higher network centrality scores among both overweight and normal-weight adolescents.

Conclusions  Many overweight adolescents are socially marginalized. Such isolation may aggravate the social and emotional consequences of overweight in this age group.

From the Department of Pediatrics, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick (Dr Strauss); and Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Dr Pollack).

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