Overweight and isolated

Abstract

This longitudinal study investigates whether there are particularly salient ages when being overweight is related to problems in interpersonal relationships (i.e., physical, relational, and verbal victimization, lack of friend social support, dating status, and romantic relationship worries). Participants were from a large, six-wave longitudinal study (N = 662, 48% males, M age at T1 = 15.5 years, SD = 1.9 years). We use time-varying effect models to estimate how the associations between weight status and interpersonal problems differ from ages 12 to 28. Gender differences are also investigated. Findings show that youth who are overweight are more likely to experience verbal victimization, feel less supported by their peers, and are less likely to date than youth who are not overweight from mid-adolescence into early young adulthood. Further, females who are overweight are more likely to be physically victimized at ages 15 to 22 than females who are not overweight. The results provide a better understanding of age-related changes in interpersonal problems among youth who are overweight from adolescence into young adulthood.

Keywords

adolescence longitudinal overweight and obesity peer victimization romantic relationships social support time-varying effect model young adulthood

Currently, 29% of boys and girls (ages 2 to 20) and 70% of men and 61% of women (20 years of age and above) are overweight or obese in Canada and the United States (Ng et al., 2014). Adolescents who are overweight or obese often experience weight-based stigma that can have detrimental consequences for their peer relationships and romantic involvement (Puhl & Heuer, 2009; Puhl & King, 2013). However, we know little about the continuities or discontinuities of interpersonal problems for youth who are overweight across the transition to young adulthood; a period when significant, developmentally salient changes in relationships occur. This longitudinal study investigates whether and when weight status is associated with interpersonal problems (i.e., physical, relational, and verbal victimization, lack of friend social support, dating status, and romantic relationship worries). We use an innovative statistical method, time-varying effect models (Tan, Shiyko, Li, Li, & Dierker, 2012), that allows us to identify windows of time in which being overweight is particularly associated with interpersonal problems. Distinguishing age-salient periods of risks could help to target prevention and intervention strategies and improve social support among youth who are overweight.

Adolescence and young adulthood are particularly important periods in which to study interpersonal processes, as relationships in these stages of life set the foundation for accruing and sustaining social support (Furman & Shaffer, 2003). Peer relations tend to be relatively stable in adolescence and are often found in high-school networks. In contrast, young adulthood is a period of notable changes in social networks as youth enter into postsecondary and new employment settings, and establish romantic relationships (Arnett, 2000; Chow, Roelse, Buhrmester, & Underwood, 2012). On the one hand, the transition to young adulthood may reduce interpersonal problems for youth who are overweight by offering new opportunities to select supportive peers and engage in new contexts. On the other hand, interpersonal problems experienced in adolescence and continued stigma related to overweight status may also limit the capacity of youth who are overweight to establish new relationships in young adulthood.

Although the consequences of stigma may be more severe for youth who are obese, exclusive focus on this typically small group (12% of boys and 13% of girls ages 2 to 20; Ng et al., 2014) can overlook the costs for the majority of youth who are overweight, but do not meet criteria for obesity. Considerable research shows both youth who are overweight or obese experience weight-related stigma (Puhl & King, 2013; Tang-Péronard & Heitmann, 2008). In the present study, overweight refers to both overweight and obesity. For children and adolescents (20 years of age and younger), overweight includes youth with a body mass index (BMI) ≥ 85th percentile for age and sex (Centers for Disease Control and Prevention, 2000); whereas, a BMI equal to or above 25kg/m² (or lb/in² × 703) is considered overweight for youth over 20 years of age (Must & Anderson, 2006).

Peer relationships of adolescents who are overweight

Research with adolescents who are overweight shows that, compared to their non-overweight peers, they are less liked by peers, experience more peer victimization, and date less frequently (Pearce, Boegers, & Prinstein, 2002; Strauss & Pollack, 2003). Lack of social support and negative peer interactions may compromise the well-being of adolescents who are overweight at a time when peers are major sources of support. Negative peer relationships also have direct implications for obesity-related behaviors (Salvy & Bowker, 2014). For example, adolescents who are overweight may withdraw from engaging in physical activity to avoid teasing and victimization (Storch et al., 2007). Further, adolescents who are overweight may be ostracized from their peers and befriend youth with similar BMIs, creating social contexts which promote obesity-related behaviors (de la Haye, Robins, Mohr, & Wilson, 2010; Salvy & Bowker, 2014).

Several cross-sectional studies report a positive association between BMI and peer victimization in adolescence (e.g., Janssen, Craig, Boyce, & Pickett, 2004; Pearce et al., 2002). For example, Janssen and colleagues (2004) found that adolescents who are overweight (ages 11 to 16) were more likely to report peer victimization than their normal-weight peers (e.g., ORs = 1.26 −1.91 in ‘ever’ victimized category). In addition to peer victimization, substantial research also shows that adolescents who are overweight experience negative stereotypes, weight-based stigma, and poor peer acceptance and support (for a review, see Puhl & King, 2013). The social network literature also suggests that, compared to adolescents who are overweight, normal-weight adolescents are selective in their friendships and may reject adolescents who are overweight from their peer groups; whereas adolescents who are overweight are less biased in relation to weight status (de la Haye, Robins, Mohr, & Wilson, 2011; Schaefer & Simpkins, 2014). This body of research emphasizes the marginalization of adolescents who are overweight; however, there is little understanding of how these associations change over time.

In contrast to peer and friend relationships, research on the romantic relationships of adolescents who are overweight (ages 12 to 18) is rare. One cross-sectional study (Pearce et al., 2002) found that females who are overweight (≥ 95th percentile) were less likely than their peers to date and all participants who are overweight were less satisfied within their existing relationships compared to their non-overweight peers.

Overall, although research suggests the peer relationships of youth who are overweight are compromised in adolescence, how these relationships fare in young adulthood is unknown. The present study will address gaps in the literature by examining the peer and romantic relationships of youth who are overweight from adolescence to young adulthood.

Peer relationships of young adults who are overweight

Compared to research in adolescence, there is considerably less research on the association between weight status and peer relationships in young adulthood. However, victimization experiences appear to persist into adulthood (Haines, Hannan, Van Den Berg, Eisenberg, & Neumark-Sztainer, 2012; Leadbeater, Thompson, & Sukhawathanakul, 2014). Haines and colleagues (2012) examined changes in weight-based teasing among two age cohorts in the United States (baseline M age = 12.8 and 15.9 years). Youth (N = 2,287) were followed into young adulthood. Weight-related teasing was stable across the transition to young adulthood, except for the younger cohort of males whose rates increased over time (Haines et al., 2012). Leadbeater and colleagues (2014) also mapped the trajectories of physical and relational victimization from adolescence into young adulthood in previous research with the current sample. Physical victimization was low and relatively stable over time and relational victimization was moderate; it remained stable for females but increased among males. How victimization changes for youth who are overweight across this transition is not known.

In contrast to high school, where friends are often limited to school networks, young adults who are overweight may select friends from new and wider social networks allowing for improvements in the quality of their friendship support (Carr & Friedman, 2006). In support of this, two cross-sectional studies with adults over 19 years of age found no relation between weight status and quality of social interactions (Carr & Friedman, 2006; Dierk et al., 2006). However, no research to date has investigated the associations between weight status and friend support longitudinally across the transition to young adulthood.

Research on young adult romantic relationships shows that females who are overweight (≥ 18 years) have more difficulty finding romantic partners and report less satisfaction within relationships compared to normal-weight peers (Puhl & King, 2013; Sheets & Ajmere, 2005). The quality of romantic relationships may also be affected by previous experiences of peer victimization and rejection, along with acceptance of this negative treatment (see Puhl & King, 2013). Research also suggests that young adults who are overweight are rated as less sexually desirable than their normal-weight peers (Chen & Brown, 2005). However, it is unclear when youth who are overweight begin to engage in romantic relationships or how the quality of their relationships may change over time.

The present study

We examine the associations between being overweight and difficulties in peer relationships (i.e., physical, relational, and verbal victimization, and lack of friend social support) and romantic relationships (i.e., dating status and romantic relationship worries) following youth from adolescence into young adulthood. We use time-varying effect models (Tan et al., 2012) to investigate our hypotheses that, compared to non-overweight youth, those who are overweight experience more peer victimization from adolescence into young adulthood (Haines et al., 2012; Pearce et al., 2002) and less friend social support in adolescence (Zeller, Reiter-Purtill, & Ramey, 2008). We also expect that youth who are overweight are less likely to date and be satisfied within relationships in both adolescence and young adulthood compared to their non-overweight peers (Pearce et al., 2002; Puhl & King, 2013). Weight-based stigma can vary for males and females (Fikkan & Rothblum, 2012; Tang-Péronard & Heitmann, 2008); hence, we also examine gender differences in these associations. Research regarding gender differences in the experience of peer victimization and friend support for youth who are overweight is limited (see Midei & Matthews, 2011). However, past research suggests that being overweight is more strongly related to dating status and romantic relationship worries for females than for males in both adolescence (Pearce et al., 2002) and young adulthood (Chen & Brown, 2005; Puhl & King, 2013).

Socioeconomic status (SES) is included as a time-invariant covariate because low SES can influence BMI by reducing the availability of nutritional foods and resources for physical activity, and through limiting parental monitoring of eating behaviors (see Goodman, 2008). Concurrent internalizing symptoms are also included as a time-varying covariate in each of the time-varying effect models, as youth with internalizing symptoms may perceive peer experiences (e.g., victimization) more negatively than those without symptoms (Giletta, Scholte, Engels, & Larsen, 2010).

Method

Participants

Data were taken from the Victoria Healthy Youth Survey, a prospective longitudinal survey which followed youth (N = 662; 48% males) biannually for six waves of data collection, from 2003 (T1) to 2013/2014 (T6) (see Leadbeater, Thompson, & Gruppuso, 2012 for details). At T1, participants ranged in age from 12 to 18 (M age = 15.5 years, SD = 1.9 years); 64% lived with their biological parents; 90% of fathers and 76% of mothers were employed (either part-time or full-time); and 85% identified as Caucasian. Participants were recruited from a medium-sized Canadian city, and demographic variables (i.e., living situation, parental education, and ethnicity) reflect the population from which the sample was drawn (Albrecht, Galambos, & Jansson, 2007).

Attrition was assessed by testing for differences on T1 demographics (age, gender, SES), and T1 assessment of overweight (classification and BMIz score), physical, relational, and verbal victimization, friend social support, dating status, and romantic relationship worries between youth who remained in the study (n = 478) and those who did not participate at T6 (n = 184). Group differences were found for some study covariates: participants who dropped out of the study were more likely to be male than female, χ²(1, 662) = 8.77, p = .003, and had lower levels of mother’s education (SES), F(1, 655) = 14.90, p < .001 (M = 2.55 [CI = 2.33, 2.77] vs. 3.01 [CI = 2.89, 3.13]) at T1. However, no group differences were found for the primary outcome variables in this study.

Procedure

A random sample of 9,500 telephone listings was contacted and 1,036 households with an eligible adolescent (ages 12 to 18) were identified. Of those, 185 parents or guardians and 187 adolescents declined to participate in the study. Informed consent was obtained from the parents and youth themselves. Retention rates were high at all waves of data collection: 87% (T2), 81% (T3), 69% (T4), 70% (T5), and 72% (T6). Further, 53% of participants provided data at all six waves. A trained interviewer administered the survey in the participant’s home or another private location. Items dealing with private topics (e.g., mental health symptoms) were self-report. This portion of the interview was self-administered and placed in a sealed envelope not accessible to the interviewer. Gift certificates were awarded for participation at each interview.

Measures

Overweight

For the first five waves, participants self-reported their weight (in lbs) and height (in inches). Weight and height were converted to metric units (kg and cm). In wave 6, trained interviewers measured participants’ weight (kg) and height (cm). Participants who had moved away or could not be interviewed in-person (28%) provided their weight and height in self-report packages. Adolescent self-reported weight and height have been shown to be accurate (e.g., Goodman, Hinden, & Khandelwal, 2000). Correlations between T5 and T6 BMI were comparable for those who self-reported at both assessments (r = .84) and those who were measured at T6 (r = .81). BMI was calculated using the standard weight(kg) divided by height(m) squared formula. BMIz scores and percentiles adjusted for age and sex based on the Centers for Disease Control (Centers for Disease Control and Prevention, 2000) revised growth charts were computed for youth aged 12 to 20 (Kuczmarski et al., 2000). Youth aged 12 to 20 were then classified as non-overweight (< 85th percentile) and overweight/obese (≥ 85th percentile) categories. Over age 20, youth were classified as overweight if their BMI was equal to or greater than 25kg/m² (or lb/in² × 703) (Must & Anderson, 2006). For additional analyses using BMIz as a continuous predictor, the age-20 reference (Centers for Disease Control and Prevention, 2000) for participants 20 years of age and older was used to maintain continuity in measurement across development (Must & Anderson, 2006).

Peer victimization

The Social Experiences Questionnaire (SEQ; Crick & Grotpeter, 1996) was administered at each wave. Participants rated how often they experienced physical victimization (four items; e.g., “How often do you get pushed or shoved by your peers?”), relational victimization (five items; e.g., “How often do your peers tell lies about you to make others not like you anymore?”), and verbal victimization (one item; “How often do your peers yell at you or call you mean names?”). Responses were provided on a 3-point Likert scale (0 = never, 1 = sometimes, or 2 = almost all the time) and scores were summed with higher scores indicating higher levels of victimization. Only two of the four items for physical victimization were collected at T4 and multiple imputation was used for the missing items. Following Gadermann, Guhn, and Zumbo (2012), reliability estimates (alphas) for these ordinal scales were obtained using polychoric correlations. Alphas ranged from .82 to .92 for physical victimization and .81 to .86 for relational victimization. Due to skewness, victimization was dichotomized into youth who did not experience any victimization (total score = 0) and those who were victimized “sometimes” or “almost all the time” (total score ≥ 1).

Friend social support

The 9-item Perceived Social Support scale from the Friends measure (PSS-FR; Procindano & Heller, 1983) was administered at each wave. Items assessed whether youth feel emotionally supported by their friends, feel they have deep sharing relationships, feel they could go to their friend when feeling down, etc. An example item includes, “I rely on my friends or peers for emotional support.” Responses were provided on a 0 = no, 1 = yes, 2 = don’t know response scale. The “no” and “don’t know” categories were collapsed providing item responses on a binary (0, 1) scale. Total scores were then computed (range 0–9), with higher scores indicating higher levels of friend social support. Alphas (polychoric correlations) ranged from .83 to .90 across waves.

Dating status

At each wave, participants were asked a single item regarding their dating status: “Are you currently involved with someone or going out with someone who is more than just a friend (could be a ‘boyfriend,’ ‘girlfriend,’ or ‘partner’)?” Participants responded either 0 = no or 1 = yes. In addition, participants were asked to indicate in months how long they have been involved with their current partner. The number of youth in current romantic relationships increased over time (22% at T1, 37% at T2, 46% at T3, 61% at T4, 61% at T5, and 65% at T6) and 76% of youth were in a relationship for at least one wave. The average length of relationship ranged from 7.21 (T1) to 41.88 (T6) months.

Romantic relationship worries

Only youth who indicated that they were currently in a romantic relationship responded to questions about romantic relationship worries. Worries about the continuity of one’s romantic relationship were assessed using nine items developed for the Victoria Healthy Youth Survey (Leadbeater, Banister, Ellis, & Yeung, 2008). Youth rated on a five-point Likert scale (0 = never to 4 = always) how often they spent time worrying about specific aspects of relationship continuity (e.g., “Whether he/she is committed to the relationship;” “Whether the relationship will last”). Only three items were collected at T1 and multiple imputation was used for the missing items. Alphas (polychoric correlations) ranged from .67 to .88 across waves.

SES

Mother’s education was rated on a five-point scale from 0 = less than a high school diploma to 4 = finished college or university.

Internalizing symptoms

Internalizing symptoms were assessed using the Brief Child and Family Phone Interview (BCFPI; Cunningham, Boyle, Hong, Pettingill, & Bohaychuk, 2009). The BCFPI includes items based on DSM-IV criteria for child and adolescent mood and anxiety disorders and has demonstrated strong psychometric properties (Leadbeater et al., 2012). The internalizing subscale contains 12 items that assess symptoms of general anxiety (e.g., “Do you notice that you worry about past behavior?”) and depression (e.g., “Do you notice you get no pleasure from usual activities?”). Participants were asked to rate each item on a 3-point Likert scale ranging from 0 (never) to 2 (often). Items were summed. Alphas (polychoric correlations) were high across waves (range = .86 to .93).

Statistical analyses plan

The six waves of data were restructured, so the time metric was age in years. Data for participants at ages 29 and 30 (n = 39) were removed because of inadequate coverage at these ages. Because the number of participants with BMIs that are classified as obese was small across ages (males n ≤ 10; females n ≤ 15; also see Table 2), overweight status was dichotomized as non-overweight (0) or overweight and obese (1). Additional analyses using BMIz scores as a continuous predictor yielded similar patterns of significant findings (see below for further details). Time-varying effect models (Tan et al., 2012) were used to examine the relations between weight status and each of the relationship variables at ages 12 to 28. A benefit of the time-varying effect model is that it does not assume parametric growth (i.e., linear, quadratic) in variables; and allows for associations to fluctuate over time. The time-varying effect model allows for the identification of specific ages when weight status is associated with interpersonal problems. Following the methods specified by Vasilenko and Lanza (2014), we first computed intercept-only models that estimated the rates of overweight by age and gender. Second, we estimated how weight status was associated with physical, relational, and verbal victimization, friend social support, dating status, and romantic relationship worries at each age. Finally, the time-varying effects of interactions between gender and weight status are tested. When interactions were not significant, they are trimmed from the final models (Thompson, Roemer, & Leadbeater, 2015). In each of models, SES is entered as time-invariant covariate and internalizing symptoms as a time-varying covariate. The %TVEM_logistic macro in SAS 9.3 (Li, Tan, Huang, Wagner, & Yang, 2014; TVEM SAS, 2014) was used to calculate the odds ratio of being victimized and of dating status (binary outcomes). The %TVEM_normal macro (Li et al., 2014; TVEM SAS, 2014) was employed in analyses when the outcome was a continuous measure (i.e., friend social support, romantic relationship worries). The time-varying effect model uses all available data for each participant at each time point (Li et al., 2014).

Table 1.
Means and standard deviations (SD) for continuous study variables by gender and age group.

Total sample Males Females

Mean SD N Range Mean SD n Mean SD n F Cohen’s d

Socioeconomic status

2.88 1.38 657 0–4 2.87 1.36 315 2.89 1.39 342 .05 .01

Body mass index

12–13 19.72 3.29 159 12.62–34.44 19.68 3.34 73 19.76 3.27 86 .02 .02

14–15 21.35 3.34 334 13.43–44.72 21.09 2.98 155 21.57 3.62 179 1.69 .14

16–17 22.33 3.08 520 15.60–33.51 22.45 3.17 255 22.21 2.99 265 .80 .08

18–19 23.07 3.54 481 16.14–39.18 23.45 3.68 223 22.74 3.39 258 4.88* .20

20–21 23.59 3.73 435 15.66–40.72 23.77 3.57 195 23.44 3.86 240 .83 .09

22–23 23.98 3.97 400 14.08–46.99 23.96 3.47 181 24.00 4.34 219 .01 .01

24–25 24.59 4.52 370 15.83–50.12 24.89 3.96 172 24.33 4.95 198 1.42 .12

26–27 24.76 4.94 259 14.43–46.11 25.19 3.79 113 24.43 5.67 146 1.52 .15

28–29 25.08 5.40 107 15.61–47.42 26.00 4.79 45 24.42 5.75 62 2.24 .29

Internalizing symptoms

12–13 7.32 3.94 173 0–19 7.07 3.58 80 7.54 4.24 93 .60 .12

14–15 8.48 4.24 343 0–23 7.84 3.93 160 9.03 4.43 183 6.77* .28

16–17 9.31 4.22 526 1–22 8.96 4.19 258 9.65 4.22 268 3.51 .16

18–19 9.81 4.56 485 0–24 9.49 4.38 225 10.08 4.70 260 1.98 .13

20–21 9.50 4.47 436 0–24 9.54 4.30 195 9.48 4.61 241 .02 .01

22–23 9.07 4.66 400 0–24 8.97 4.88 181 9.15 4.48 219 .15 .04

24–25 8.57 4.75 373 0–24 8.52 4.82 173 8.61 4.71 200 .03 .02

26–27 8.32 4.80 259 0–24 7.79 4.65 113 8.73 4.89 146 2.45 .20

28–29 8.67 4.95 110 0–20 8.32 5.07 47 8.94 4.88 63 .42 .13

Friend social support

12–13 6.79 1.96 173 0–9 6.28 1.99 80 7.23 1.82 93 10.72 .50

14–15 6.99 2.00 343 0–9 6.15 2.08 160 7.73 1.61 183 62.46* .86

16–17 7.32 1.78 527 0–9 6.78 1.85 258 7.83 1.56 269 49.01* .61

18–19 7.49 1.62 485 1–9 6.93 1.64 225 7.97 1.45 260 55.92* .67

20–21 7.76 1.63 438 2–9 7.39 1.70 196 8.05 1.52 242 18.75* .41

22–23 7.86 1.64 401 1–9 7.49 1.69 182 8.17 1.53 219 17.90* .42

24–25 7.86 1.63 376 1–9 7.47 1.75 175 8.20 1.43 201 20.04* .46

26–27 7.85 1.66 259 0–9 7.49 1.92 113 8.13 1.37 146 9.93 .39

28–29 7.65 1.89 110 0–9 7.34 2.00 47 7.89 1.79 63 2.29 .29

Romantic relationship worries

12–13 8.27 3.22 15 4–13 8.88 2.59 8 7.57 3.91 7 .60 .40

14–15 10.08 5.32 66 1–25 8.90 4.41 20 10.59 5.64 46 1.41 .32

16–17 9.49 4.61 172 0–30 9.19 4.32 60 10.02 5.11 112 1.26 .17

18–19 11.25 5.99 223 0–29 11.94 6.44 83 10.84 5.69 140 1.78 .18

20–21 11.86 5.81 251 0–27 12.65 5.63 100 11.34 5.88 151 3.11 .23

22–23 11.96 5.88 249 0–29 11.83 5.58 102 12.05 6.10 147 .08 .04

24–25 11.62 5.87 249 1–31 11.52 5.70 102 11.68 6.10 147 .04 .03

26–27 10.74 5.70 184 0–27 10.71 5.48 79 10.76 5.89 104 .004 .01

28–29 11.05 6.48 80 0–30 10.86 6.05 35 11.19 6.85 45 .05 .05

Note. Entries marked with asterisks indicate significant differences between males and females for that age group. p < .05; p < .01; p < .001.

Table 2.
Proportions for dichotomous study variables by gender and age group.

Total sample Males Females

% N % n % n χ²

Overweight^a (obese^b only)

12–13 18.2% (4.4%) 159 23.3% (2.7%) 73 14.0% (5.8%) 86 2.31

14–15 17.4% (4.8%) 334 17.4% (6.5%) 155 17.3% (3.4%) 179 .001

16–17 17.5% (3.3%) 520 19.6% (5.1%) 255 15.5% (1.5%) 265 1.54

18–19 15.8% (4.6%) 481 18.4% (6.3%) 223 13.6% (3.1%) 258 2.09

20–21 23.7% (4.1%) 435 23.6% (3.6%) 195 23.8% (4.6%) 240 .002

22–23 33.0% (8.0%) 400 33.1% (4.4%) 181 32.9% (11.0%) 219 .003

24–25 37.9% (10.6%) 369 42.7% (10.5%) 171 33.8% (10.6%) 198 3.05

26–27 37.1% (11.6%) 259 41.6% (10.6%) 113 33.6% (12.4%) 146 1.76

28–29 43.9% (14.0%) 107 57.8% (11.1%) 45 33.9% (16.1%) 62 6.05*

Physical victimization

12–13 29.5% 173 37.5% 80 22.6% 93 4.61*

14–15 26.8% 343 36.3% 160 18.6% 183 13.58*

16–17 24.9% 527 34.5% 258 15.6% 269 25.14*

18–19 17.7% 485 26.2% 225 10.4% 260 20.74*

20–21 18.9% 435 27.2% 195 12.1% 240 16.03*

22–23 17.3% 400 28.2% 181 8.2% 219 27.65*

24–25 16.4% 372 28.5% 172 6.0% 200 34.11*

26–27 12.0% 259 20.4% 113 5.5% 146 13.38***

28–29 2.7% 110 6.4% 47 0.0% 63 4.13*

Relational victimization

12–13 52.6% 173 52.5% 80 52.7% 93 .001

14–15 44.9% 343 44.4% 160 45.4% 183 .03

16–17 42.3% 527 37.2% 258 47.2% 269 5.40*

18–19 43.5% 485 39.6% 225 46.9% 260 2.66

20–21 43.0% 435 42.6% 195 43.3% 240 .03

22–23 53.8% 400 54.1% 181 53.4% 219 .02

24–25 51.3% 372 57.0% 172 46.5% 200 4.06*

26–27 45.7% 258 48.7% 113 43.4% 145 .70

28–29 49.1% 110 42.6% 47 54.0% 63 1.40

Verbal victimization

12–13 34.7% 173 40.0% 80 30.1% 93 1.86

14–15 25.9% 343 30.0% 160 22.4% 183 2.56

16–17 25.6% 527 29.1% 258 22.3% 269 3.16

18–19 26.4% 485 31.1% 225 22.3% 260 4.81*

20–21 33.1% 435 36.9% 195 30.0% 240 2.33

22–23 40.0% 400 47.5% 181 33.8% 219 7.78

24–25 32.3% 372 40.7% 172 25.0% 200 10.43

26–27 28.6% 259 36.3% 113 22.6% 146 5.84*

28–29 23.6% 110 23.4% 47 23.8% 63 .002

Dating status

12–13 9.2% 173 11.3% 80 7.5% 93 .71

14–15 19.2% 343 12.5% 160 25.1% 183 8.77

16–17 32.9% 526 23.3% 257 42.0% 269 20.74*

18–19 45.8% 485 36.4% 225 53.8% 260 14.72***

20–21 57.3% 438 50.5% 196 62.8% 242 6.70*

22–23 61.5% 400 55.8% 181 66.2% 219 4.54*

24–25 66.8% 376 59.4% 175 73.1% 201 7.92**

26–27 71.7% 258 71.7% 113 71.7% 145 .00

28–29 74.5% 110 76.6% 47 73.0% 63 .18

Note. Entries marked with asterisks indicate significant differences between males and females for that age group.

^aYouth ages 12 to 20 were classified as overweight if their BMI adjusted for sex and age ≥ 85th percentile; youth over age 20 were classified as overweight if their BMI ≥ 25 kg/m² (or lb/in² × 703).

^bYouth ages 12 to 20 were classified as obese if their BMI adjusted for sex and age ≥ 95th percentile; youth over age 20 were classified as obese if their BMI ≥ 30 kg/m² (or lb/in² × 703).

p < .05; p < .01; p < .001.

Table 3.
Within-time correlations between study variables by gender and age group.

Overweight^a Physical victimization Relational victimization Verbal victimization Friend social support Dating status Romantic relationship worries Internalizing symptoms

Ages 12–13 (n = 173)

Overweight^a .15 −.04 −.01 .15 −.11 .18 .06

Physical victimization −.13 .32 .47* .02 .05 .79* .22

Relational victimization −.02 .20 .32** −.08 .02 .57 ^g .26*

Verbal victimization −.12 .43* .39* −.13 .19 .60 .10

Friend social support .06 −.22* −.30 −.30 −.01 −.55 −.11

Dating status .13 .04 −.06 −.10 .17 N/A^b −.05

Romantic relationship worries .08 −.01 −.70^g −.29 .31 N/A^b .18

Internalizing symptoms .21 .33 .17 .28 −.34 .02 −.32

Ages 14–15 (n = 344)

Overweight^a −.05 .08 .15 −.04 −.03 −.09 −.02

Physical victimization .16* .27** .19* −.11 −.13⁽⁺⁾ .15 .25

Relational victimization .02 .33* .27** −.20* .01 .07 .27

Verbal victimization .10 .25 .41* −.10 .04 .07 .23

Friend social support −.13 −.18* −.15* −.09 .16* .05 −.05

Dating status .01 .11^g .03 .11 .08 N/A^b .06

Romantic relationship worries .08 .28** .18 .28 −.03 N/A^b .27*

Internalizing symptoms .13 .40* .42* .35* −.25 .19 .48*

Ages 16–17 (n = 535)

Overweight^a −.05 −.01 .10 −.05 −.20** −.10 .03

Physical victimization .05 .13* .31* .02 .06 .04 .10

Relational victimization .04 .21 .23* −.21 −.07 .07 .25*

Verbal victimization .02 .41* .19 .00^g .01 .03 .10

Friend social support −.08 −.09 −.26* −.19**^g .12 .02 −.14*

Dating status −.04 .07 −.02 .03 .08 N/A^b .04

Romantic relationship worries .06 .24* .16 .28** −.04 N/A^b .32*

Internalizing symptoms −.03 .21* .20 .24* −.24* −.12 .45*

Ages 18–19 (n = 492)

Overweight^a .08 .00 .13 −.02 −.07 −.06 .04

Physical victimization .24* .18 .43^g −.08 .07 −.02^g .06^g

Relational victimization .01 .19 .28 −.03 .12 .21 .28*

Verbal victimization .07 .27^g .29 −.13 −.03 .10 .18

Friend social support −.03 .03 −.15* −.07 .10 −.20 −.16*

Dating status −.06 .04 −.03 .09 .13* N/A^b .05

Romantic relationship worries .13 .39^g .23 .21 −.03 N/A^b .48*

Internalizing symptoms .09 .32^g .33 .21 −.28* −.06 .51*

Ages 20–21 (n = 453)

Overweight^a −.04 −.11 −.05 .03 −.20 −.10 −.04

Physical victimization .10 .29* .35*** .03 −.02^g .03 .16*

Relational victimization .07 .17* .29*** −.10 −.02 .20* .22^g

Verbal victimization .05 .32* .40*** −.02^g −.03 .08^g .09

Friend social support −.01 −.13* −.13* −.21^g .00 −.17 −.14^g

Dating status −.18 .13 −.08 .09 .02 N/A^b −.09

Romantic relationship worries .09 .26 .37* .41^g −.21 N/A^b .55

Internalizing symptoms −.01 .19 .40^g .27 −.35^g −.05 .54

Ages 22–23 (n = 410)

Overweight^a .08 .06 .11 .06 .11 −.06 .05

Physical victimization .07 .21 .36* −.03 .02 .18 .15

Relational victimization −.03 .18 .25^g −.03 −.03 .28 .34*

Verbal victimization −.03 .28* .45^g .15^g −.02 .15 .21

Friend social support .01 −.19 −.22 −.28^g .19 −.06 −.24

Dating status .01 .04 −.07 .00 .00 N/A^b −.25^g

Romantic relationship worries −.07 .14 .30 .22 −.21 N/A^b .41*

Internalizing symptoms −.02 .18 .33* .30* −.31* −.01^g .47*

Ages 24–25 (n = 394)

Overweight^a −.04 −.11 .08 .00 .08 −.05 −.12

Physical victimization .04 .26 .40*** .00 .02 .12 .11

Relational victimization .01 .14* .31* −.24 .08 .32 .32*

Verbal victimization .13 .24 .41* −.17* .00 .28 .21

Friend social support .15* −.11 −.25*** −.13 −.01 −.24* −.19*

Dating status .05 −.08 −.04 −.09 .11 N/A^b −.19*

Romantic relationship worries .06 .25 .31* .29* −.34* N/A^b .54*

Internalizing symptoms −.01 .26 .33* .30* −.31* −.11 .65*

Ages 26–27 (n = 263)

Overweight^a .06 −.18 .04 −.10 −.03 .11 −.07

Physical victimization −.09 .26^g .30 −.08 −.02 .04 .05

Relational victimization .05 .00^g .30** −.21* −.10 .21 .40*

Verbal victimization .08 .27 .37*** .08^g −.14 .07 .15

Friend social support .08 −.07 −.18* −.28^g .00 .00 −.32*

Dating status −.10 .00 −.14 −.14 .23** N/A^b −.19*

Romantic relationship worries .02 .21* .08 .18 −.13 N/A^b .44*

Internalizing symptoms −.06 .12 .33* .28** −.21* −.12 .64***

Ages 28–29 (n = 111)

Overweight^a .05 −.31* .07 .21 −.04 −.05 −.07

Physical victimization N/A^c .13 .27 −.34* −.06 .01 .07

Relational victimization −.01 N/A^c .24 −.53*** −.13 .38* .30*

Verbal victimization .15 N/A^c .22 −.24 −.04 .38* .42**

Friend social support .01 N/A^c −.27* −.07 −.09 −.38* −.25

Dating status −.10 N/A^c .01 .09 .26* N/A^b −.14

Romantic relationship worries −.11 N/A^c .48 .24 .01 N/A^b .56

Internalizing symptoms −.06 N/A^c .47*** .30* −.31* .08 .66***

Note. Upper quadrants = correlations for males; lower quadrants = correlations for females.

^aOverweight (youth ages 12 to 20) = BMI ≥ 85th percentile for sex and age; overweight (youth ≥ 20 years) = BMI ≥ 25 kg/m² (or lb/in² × 703).

^bOnly those in current romantic relationships completed the romantic relationship worries measure.

^cNone of the female participants at ages 28–29 reported experiencing physical victimization.

^gIndicates significant gender difference in magnitude of correlation.

p < .05; p < .01; p < .001.

Consistent with the literature (e.g., Thompson et al., 2015; Vasilenko & Lanza, 2014), the time-varying effect model results are presented in figures (i.e., the number of coefficients estimated as a function of age is too large to report in tables). Odd ratios (for binary outcomes) and unstandardized regression coefficients (for continuous outcomes) are presented on the y-axis. When confidence intervals (95% CI) do not include 1, for odds ratios; or 0, for regression coefficients, the association between the predictor and outcome is significant at that age (p < .05 level; Li et al., 2014).

Results

Descriptive statistics

Descriptive statistics are provided by 2-year age intervals (i.e., ages 12–13, 14–15, 16–17, etc.). Tables 1 and 2 show the descriptive statistics for study variables by age group and gender. With regard to the primary study variables, males and females did not differ in the percentage of youth who are overweight, with the exception of ages 28–29 when more males are overweight than females (Table 2). Males reported consistently more physical victimization than females, as well as more verbal victimization at ages 18–29, 22–23, 24–25, and 26–27 (Table 2). Compared to males, females reported higher proportions of relational victimization at ages 18–19, but males reported higher proportions than females at ages 24–25 (Table 2). Compared to males, females reported higher levels of friend social support across all age groups (Table 1). Finally, more females than males reported being in a current romantic relationship (Table 2) at all age groups with the exception of ages 12–13, 26–27, and 28–29. The within-time correlations by gender are in Table 3.

Rates of being overweight for males and females

Figure 1 shows results for the time-varying effect intercept-only models. Solid black lines represent the estimated percentage of youth who are overweight at each age (in years) between 12 and 28 years. For example, 25% of males and 20% of females were overweight at age 12, whereas 56% of males compared to 36% of females were overweight at age 28. The gray lines show the 95% confidence intervals for the estimated percentage of youth who are overweight. The confidence intervals overlap for females and males up to age 25, indicating rates did not significantly differ for females and males until age 25, after which more males than females are classified as overweight.

Figure 1.
Proportion of youth classified as overweight from age 12 to 28 (n’s range from 76 to 273 across each age), estimated by an intercept-only time-varying effect model.

Associations between being overweight and relationship concerns

Figures 2 to 6 show the results of the analyses examining associations between being overweight and each of the relationship variables. For results involving peer victimization and dating status (i.e., binary outcomes), associations are presented as odds ratios on the y-axis. Confidence intervals not containing 1 indicate a significant association between overweight and the outcome at a particular age (p < .05 level; Li et al., 2014). For results involving friend social support and romantic relationship worries (i.e., continuous outcomes), associations are presented as unstandardized regression coefficients and confidence intervals not containing 0 identify a significant association at a particular age (p < .05 level; Li et al., 2014). The wider confidence intervals at the beginning of the graphs (i.e., Figure 6 for romantic relationship worries), represent sparse coverage of youth in relationships at this time (n’s ≤ 8 for males and females ages 12 to 13).

Figure 2.
Time-varying effects of a) the two-way interaction between overweight and gender on physical victimization from 12 to 28 (n’s range from 76 to 273 across each age; significant at ages 15 to 21), b) overweight on physical victimization for males (nonsignificant), and c) overweight on physical victimization for females (significant at ages 15 to 22). Results are presented in odds ratios; confidence intervals (gray lines) that do not include 1 indicate periods of significance.

Figure 3.
Time-varying effect of overweight on relational victimization from 12 to 28 (n’s range from 76 to 273 across each age; nonsignificant). Results are presented in odds ratios; confidence intervals (gray lines) that do not include 1 indicate periods of significance.

Figure 4.
Time-varying effect of overweight on verbal victimization from 12 to 28 (n’s range from 76 to 273 across each age; significant ages 15 to 21 and ages 25 to 28). Results are presented in odds ratios; confidence intervals (gray lines) that do not include 1 indicate periods of significance.

Figure 5.
Time-varying effect of overweight on friend social support from 12 to 28 (n’s range from 76 to 273 across each age; significant at ages 15 to 17). Results are presented in regression coefficients; confidence intervals (gray lines) that do not include 0 indicate periods of significance.

Figure 6.
Time-varying effect of overweight on dating status (n’s range from 76 to 273 across each age; significant at ages 15 to 21). Results are presented in odds ratios; confidence intervals (gray lines) that do not include 1 indicate periods of significance.

Physical peer victimization

As shown in Figure 2a, there was a significant gender interaction between ages 15 and 21 for physical victimization. Although males in each age group reported consistently higher levels of physical victimization than females (Table 2), males who are overweight were not more likely to experience physical victimization than their non-overweight peers (Figure 2b). In contrast, females who are overweight reported more physical victimization than their non-overweight peers between the ages of 15 and 22. For example, at age 18, females who are overweight were almost three times more likely to report physical peer victimization than their non-overweight peers, OR = 2.93, CI = [1.74, 4.96] at age 18; see Figure 2c. For all youth, internalizing symptoms were related to increased odds of being physically victimized from age 12 to 26.5 (OR’s range = 1.07 to 1.19 from age 12 to 26.5). SES was unrelated to physical victimization.

Relational peer victimization

Youth who are overweight were not more likely than non-overweight youth to experience relational victimization at ages 12 to 28 (see Figure 3). Internalizing symptoms were related to increased odds of being relationally victimized across all ages (OR’s range = 1.16 to 1.21 from ages 12 to 28). SES was negatively related to relational victimization (b = −.06, standard error = .03, p = .042).

Verbal victimization

Youth who are overweight were more likely to experience verbal victimization at ages 15 to 21 and at ages 25 to 28 than youth who were not overweight, e.g., OR = 1.53, CI = [1.11., 2.12] at age 17; see Figure 4. Although males reported higher rates of verbal victimization than females (b = −.53, standard error = .08, p < .001), gender differences in the relation between being overweight and verbal victimization were nonsignificant. Internalizing symptoms were related to increased odds of experiencing verbal victimization across all ages (ages 12 to 28; OR’s range = 1.10 to 1.18). SES was negatively related to verbal victimization (b = −.12, standard error = .03, p < .001).

Lack of friend social support

There was a significant gender interaction briefly between ages 20 and 21; however, upon probing this interaction, the effect at this age period was nonsignificant for both males and females. For the total sample, youth who are overweight reported lower levels of friend social support than non-overweight peers from ages 15 to 17 (e.g., b = −.32, CI = [−.59, −.04] at age 16; see Figure 5). Internalizing symptoms were negatively associated with friend social support across time (b’s range = −.06 to −.15 from ages 12 to 28). SES was positively related to friend social support (b = −.07, standard error = .02, p < .001) and females reported higher levels of friend social support than males (b = .92, standard error = .06, p < .001).

Romantic relationships

Although females in each age group were more likely to be in a relationship than males (b = .56, standard error = .08, p < .001), gender differences in the relation between being overweight and dating status were nonsignificant. As shown in Figure 6, youth who are overweight were half as likely to be in a current romantic relationship between the ages of 15 and 21, e.g., OR = .51, CI = [.36, .71] at age 16, compared to non-overweight youth. However, youth who are overweight reported comparable levels of romantic relationship worries to their non-overweight peers over time (Figure 7). Internalizing symptoms were associated with decreased odds of being in a relationship in young adulthood (OR’s range = −.97 to = −.93 from ages 20 to 27), as well as were positively associated with romantic relationship worries at ages 13 to 28 (OR’s range = .45 to .87). SES was unrelated to dating status and romantic relationship worries.

Figure 7.
Time-varying effect of overweight on dating relationship worries from 12 to 28 (n’s range from 76 to 273 across each age; nonsignificant). Results are presented in regression coefficients; confidence intervals (gray lines) that do not include 0 indicate periods of significance.

Additional analyses using BMIz were conducted to assess whether findings were replicated using BMI as a continuous measure. Findings were similar, suggesting that the results were not driven solely by youth who are classified as obese. For example, increasing BMIz was associated with increased likelihood of physical victimization for females at ages 15 to 19.5 (e.g., OR = 1.51, CI = [1.12, 2.04] at age 17). For all youth, increasing BMIz was related to increased likelihood of verbal victimization at ages 15 to 20 (e.g., OR = 1.19, CI = [1.02, 1.38] at age 17) and decreased likelihood of dating at ages 16 to 22 (e.g., OR = .78, CI = [.67, .90] at age 17). One exception was identified. Whereas friend social support was associated with BMI assessed as a dichotomous variable at ages 15 to 17 (e.g., b = −.32, CI = [−.59, −.04] at age 16; see Figure 5), BMIz was not related to friend social support at this age, but was positively associated at ages 23 to 26 (e.g., b = .14, CI = [.03, .25] at age 25). Given that only a few youth in our sample have very high BMIz (i.e., classified in the obese category) across age (see Table 2), this inconsistency suggests that the association between BMI and friend social support should be viewed with caution and re-examined with a sample that better represents the range of youth at higher levels of BMI.

Discussion

In this study, we found that there are salient age periods during the transition from adolescence to young adulthood when being overweight is related to problems in interpersonal relationships, including physical and verbal victimization, friend social support, and dating status (but not to relational victimization or romantic relationship worries). Because of the small number of youth who are obese in our sample across age, overweight refers to both overweight and obese. We accounted for SES and internalizing symptoms (Giletta et al., 2010) and also tested for gender differences in these associations. Specifically, compared to their non-overweight peers, youth who are overweight or obese were more likely to experience more verbal victimization (at ages 15 to 21 and at ages 25 to 28), experience less friend social support (at ages 15 to 17), and were less likely to date (at ages 15 to 21) than non-overweight youth. Gender differences in these patterns were significant for physical victimization, only. Females, but not males, who are overweight experienced more physical victimization at ages 15 to 22 than non-overweight females.

Physical, relational, and verbal peer victimization

Consistent with research with school-age children (Janssen et al., 2004), our findings show that females who are overweight (but not males) are more likely to experience physical victimization than non-overweight females, especially before age 22. This suggests that physical victimization continues for females who are overweight even as they encounter opportunities to form new relationships after high school (i.e., in postsecondary settings or the workforce). This is particularly alarming as physical victimization typically declines across the transition to young adulthood (Leadbeater et al., 2014). A better understanding is needed of the perpetrators and nature of physical victimization and of contexts that contribute it (e.g., college residences, workplace harassment, job discrimination) within this age period. Some research shows females are more subject to weight stigma than males (Fikkan & Rothblum, 2012; Tang-Péronard & Heitmann, 2008) and the continued social acceptance of this stigma may also reduce the impact of norms regarding physical abuse among young women. Victimized females who are overweight are also at risk for subsequent mental health problems (Adams & Bukowski, 2008; Puhl & Luedicke, 2012); however, the specific types of victimization (i.e., physical) which are more likely to lead to negative affect are rarely identified.

In the current study, despite the fact that males who are overweight or obese reported higher levels of physical victimization than females, they did not experience more physical victimization than non-overweight males. Past research suggests that males who are obese may experience more victimization than those who are overweight only (Janssen et al., 2004; Pearce et al., 2002). Using BMI as a measure of adiposity among males does not take into account muscle mass and may not be as sensitive to delineating overweight status. It may be that some males who are overweight are also more athletic or muscular. The latter may be more popular among their peers and protected against negative peer interactions (Pearce et al., 2002). It is also possible that males who are overweight use their physique to exhibit dominance to protect themselves from physical aggression.

Contrary to expectations, the association between being overweight and relational victimization was not significant at any age. In a previous study using the same sample, rates of relational victimization were moderate and stable for females and increased in males across the transition to young adulthood (Leadbeater et al., 2014). It is possible that relational victimization is commonplace and not unique to youth who are overweight. It is also possible that youth who are obese only (≥ 95th percentile), but not overweight, are at particular risk for relational victimization. For example, Pearce and colleagues (2002) found that females who are obese (≥ 95th percentile), but not overweight, may be at particular risk for relational victimization.

Consistent with previous findings which show weight-based teasing (e.g., name-calling) continues into young adulthood (Haines et al., 2012), we found the relation between being overweight and verbal victimization persisted into young adulthood, particularly at ages 15 to 21, but also from ages 25 to 28 (Figure 4). Verbal victimization may be more common when physical forms of victimization are not socially sanctioned or illegal. Verbal victimization can also be perpetrated casually by peers believing that they are “just joking” and even anonymously by strangers who make stigmatizing comments as passersby’s in public places and hence this type of victimization may persist longer than direct physical- or relationship-based teasing. Verbal victimization may also escalate in contexts including athletic or social events (e.g., parties) where heavy drinking can disinhibit youth from making stigmatizing comments.

Friend social support

Lack of peer support has been widely associated with both negative physiological and mental health consequences (see review by Uchino, 2006). In this study, youth who are overweight reported less emotional support between ages 15 to 17 than peers who are not overweight. These findings were not replicated using BMIz scores and should be viewed with caution. However, lack of friend social support is of particular concern, given the focus of our peer support measure on the presence or absence of emotional support in many circumstances (e.g., problem-solving, moral support, meeting personal needs). Advancing extra-curricular, community, and volunteer activities that promote the inclusion of youth who are overweight and raising awareness among peers about weight-based stigma could help to increase peer support for youth who are overweight (Salvy & Bowker, 2014). Consistent with Dierk and colleagues’ (2006) study of 226 adults aged 19 and over, the association between being overweight and friend social support was not significant after age 17. Having opportunities to choose new sources of support (i.e., work colleagues, friends in post-secondary school settings, romantic partner) may be important in releasing youth from high school networks and reputations (Chow et al., 2012).

Romantic relationships

Consistent with past cross-sectional research (Pearce et al., 2002), in this study, both males and females who are overweight dated less frequently than non-overweight youth at ages 15 to 21. Establishing supportive romantic relationships is a key developmental task in adolescence and young adulthood that can set the foundation for healthy long-term relationships (Furman & Shaffer, 2003). The consequences of delaying the onset of dating compared to one’s peers are not known. Negative consequences may also be minimized by later ages for, and rates of, marriage, and increases in individuals living alone in young adulthood (Statistics Canada, 2012). However, not dating could have negative consequences for self-esteem, increase loneliness, and interfere with support and intimacy in young adulthood, especially as peers begin to date. In this study, youth who are overweight did not report more worries about their current romantic relationship, compared to youth who are not overweight. This suggests that once youth who are overweight enter a dating relationship, they may find support and acceptance in these relationships and they may not worry more than their peers about their partners’ commitment to the relationship. This is consistent with Carr and Friedman’s (2006) finding which showed categories of BMI are not associated with quality of relationships with spouses, but it stands in contrast to past research suggesting that females who are overweight tend to be less satisfied in romantic relationships than their non-overweight peers (e.g., Puhl & King, 2013; Sheets & Ajmere, 2005). Qualitative research on the quality of romantic relationships of youth who are overweight could provide a better understanding of the gains from these relationships.

Future research and limitations

Our sample represents a wide socio-economic group and the percentages of participants who are overweight and obese are comparable to Canadian national statistics showing 21% of adolescents (ages 12–17) and 39% of young adults (ages 18–34) are overweight or obese (Statistics Canada, 2014a, 2014b). However, the generalizability of this study is limited by the primarily Caucasian sample. Large, long-term cohort studies that follow Canadian youth from adolescence through young adulthood are rare. Research is needed to examine weight-based concerns in the relationships of ethnic minority youth where there may be less stigmatization for being overweight (see Puhl & Latner, 2007).

Although weight-based stigma extends to youth who are both overweight and obese (Tang-Péronard & Heitmann, 2008), obese youth were not well represented in our sample. Research shows that there are differences in stigma related to being overweight versus being obese, and youth who are obese may be at particular risks for interpersonal problems (Janssen et al., 2004; Pearce et al., 2002). Our assessment of weight is also limited to BMI and additional assessments of metabolic risks, that include the health or fitness of youth who are overweight, as well as assessments of adiposity, waist circumference, and hypertension, could overcome the limitations of BMI, especially for males (Karelis, 2008).

The victimization measure used in this study is time- and sex-invariant across the transition to young adulthood (Leadbeater et al., 2014); however, the inclusion of additional items that reflect young adult experiences (e.g., victimization in college residences or workplaces) could increase understanding of the nature of this victimization and help to illuminate targets for prevention and intervention. The friend social support measure (e.g., Procidano & Heller, 1983) used in the present study taps friend emotional social support, but does not reflect other dimensions of support (e.g., instrumental or informational support) that may be important (Malecki & Demaray, 2003). For example, best friend and family or mentor relationships may buffer against negative outcomes of weight-based stigma and relationship problems (Bollmer, Milich, Harras, & Maras, 2005; Yeung Thompson & Leadbeater, 2012). Finally, all measures are self-reported which could inflate the associations observed among the variables. Perception biases related to depressive symptoms or negative self-concepts may also inflate reports of relationship problems (Giletta et al., 2010). However, we accounted for the time-varying effect of internalizing symptoms in our models.

Implications

Our findings indicate that youth who are overweight may be struggling with interpersonal problems across the transition from adolescence to young adulthood. Friends, peers, and school personnel (e.g., teachers, physical education instructors/coaches) can be effective supports for adolescents who are overweight (Puhl, Peterson, & Luedicke, 2013). There is a need for high school and post-secondary environments that promote tolerance and inclusivity and prohibit weight-based victimization. Fostering anti-stigma messages (e.g., emphasizing healthy behaviors rather than ideal body types) may also help to reduce victimization of youth who are overweight (Puhl et al., 2013; Salvy & Bowker, 2014). In addition, providing diverse opportunities for physical activities that focus on enjoyment and inclusiveness, rather than competition, could help youth foster positive peer relationships and promote life-long engagement in healthy behaviors (Salvy & Bowker, 2014). These interventions may be most effective in childhood and adolescence when youth begin to establish life-style health attitudes and behaviors. However, opportunities for forming new relationships in young adulthood may serve to diminish some of the peer-related stressors of youth who are overweight in late adolescence. Strategies to reduce weight-based stigma in post-secondary and workplace settings may also be important. Treatments for mental and physical health concerns in youth who are overweight should also consider approaches that consider their peer experiences and help youth to identify and engage with supportive peer networks as they transition out of high school and into new social networks.

	Total sample	Males	Females
Socioeconomic status
	2.88	1.38	657	0–4	2.87	1.36	315	2.89	1.39	342	.05	.01
Body mass index
12–13	19.72	3.29	159	12.62–34.44	19.68	3.34	73	19.76	3.27	86	.02	.02
14–15	21.35	3.34	334	13.43–44.72	21.09	2.98	155	21.57	3.62	179	1.69	.14
16–17	22.33	3.08	520	15.60–33.51	22.45	3.17	255	22.21	2.99	265	.80	.08
18–19	23.07	3.54	481	16.14–39.18	23.45	3.68	223	22.74	3.39	258	4.88*	.20
20–21	23.59	3.73	435	15.66–40.72	23.77	3.57	195	23.44	3.86	240	.83	.09
22–23	23.98	3.97	400	14.08–46.99	23.96	3.47	181	24.00	4.34	219	.01	.01
24–25	24.59	4.52	370	15.83–50.12	24.89	3.96	172	24.33	4.95	198	1.42	.12
26–27	24.76	4.94	259	14.43–46.11	25.19	3.79	113	24.43	5.67	146	1.52	.15
28–29	25.08	5.40	107	15.61–47.42	26.00	4.79	45	24.42	5.75	62	2.24	.29
Internalizing symptoms
12–13	7.32	3.94	173	0–19	7.07	3.58	80	7.54	4.24	93	.60	.12
14–15	8.48	4.24	343	0–23	7.84	3.93	160	9.03	4.43	183	6.77*	.28
16–17	9.31	4.22	526	1–22	8.96	4.19	258	9.65	4.22	268	3.51	.16
18–19	9.81	4.56	485	0–24	9.49	4.38	225	10.08	4.70	260	1.98	.13
20–21	9.50	4.47	436	0–24	9.54	4.30	195	9.48	4.61	241	.02	.01
22–23	9.07	4.66	400	0–24	8.97	4.88	181	9.15	4.48	219	.15	.04
24–25	8.57	4.75	373	0–24	8.52	4.82	173	8.61	4.71	200	.03	.02
26–27	8.32	4.80	259	0–24	7.79	4.65	113	8.73	4.89	146	2.45	.20
28–29	8.67	4.95	110	0–20	8.32	5.07	47	8.94	4.88	63	.42	.13
Friend social support
12–13	6.79	1.96	173	0–9	6.28	1.99	80	7.23	1.82	93	10.72**	.50
14–15	6.99	2.00	343	0–9	6.15	2.08	160	7.73	1.61	183	62.46***	.86
16–17	7.32	1.78	527	0–9	6.78	1.85	258	7.83	1.56	269	49.01***	.61
18–19	7.49	1.62	485	1–9	6.93	1.64	225	7.97	1.45	260	55.92***	.67
20–21	7.76	1.63	438	2–9	7.39	1.70	196	8.05	1.52	242	18.75***	.41
22–23	7.86	1.64	401	1–9	7.49	1.69	182	8.17	1.53	219	17.90***	.42
24–25	7.86	1.63	376	1–9	7.47	1.75	175	8.20	1.43	201	20.04***	.46
26–27	7.85	1.66	259	0–9	7.49	1.92	113	8.13	1.37	146	9.93**	.39
28–29	7.65	1.89	110	0–9	7.34	2.00	47	7.89	1.79	63	2.29	.29
Romantic relationship worries
12–13	8.27	3.22	15	4–13	8.88	2.59	8	7.57	3.91	7	.60	.40
14–15	10.08	5.32	66	1–25	8.90	4.41	20	10.59	5.64	46	1.41	.32
16–17	9.49	4.61	172	0–30	9.19	4.32	60	10.02	5.11	112	1.26	.17
18–19	11.25	5.99	223	0–29	11.94	6.44	83	10.84	5.69	140	1.78	.18
20–21	11.86	5.81	251	0–27	12.65	5.63	100	11.34	5.88	151	3.11	.23
22–23	11.96	5.88	249	0–29	11.83	5.58	102	12.05	6.10	147	.08	.04
24–25	11.62	5.87	249	1–31	11.52	5.70	102	11.68	6.10	147	.04	.03
26–27	10.74	5.70	184	0–27	10.71	5.48	79	10.76	5.89	104	.004	.01
28–29	11.05	6.48	80	0–30	10.86	6.05	35	11.19	6.85	45	.05	.05

	Total sample	Males	Females
Overweight^a (obese^b only)
12–13	18.2% (4.4%)	159	23.3% (2.7%)	73	14.0% (5.8%)	86	2.31
14–15	17.4% (4.8%)	334	17.4% (6.5%)	155	17.3% (3.4%)	179	.001
16–17	17.5% (3.3%)	520	19.6% (5.1%*)	255	15.5% (1.5%)	265	1.54
18–19	15.8% (4.6%)	481	18.4% (6.3%)	223	13.6% (3.1%)	258	2.09
20–21	23.7% (4.1%)	435	23.6% (3.6%)	195	23.8% (4.6%)	240	.002
22–23	33.0% (8.0%)	400	33.1% (4.4%*)	181	32.9% (11.0%)	219	.003
24–25	37.9% (10.6%)	369	42.7% (10.5%)	171	33.8% (10.6%)	198	3.05
26–27	37.1% (11.6%)	259	41.6% (10.6%)	113	33.6% (12.4%)	146	1.76
28–29	43.9% (14.0%)	107	57.8% (11.1%)	45	33.9% (16.1%)	62	6.05*
Physical victimization
12–13	29.5%	173	37.5%	80	22.6%	93	4.61*
14–15	26.8%	343	36.3%	160	18.6%	183	13.58***
16–17	24.9%	527	34.5%	258	15.6%	269	25.14***
18–19	17.7%	485	26.2%	225	10.4%	260	20.74***
20–21	18.9%	435	27.2%	195	12.1%	240	16.03***
22–23	17.3%	400	28.2%	181	8.2%	219	27.65***
24–25	16.4%	372	28.5%	172	6.0%	200	34.11***
26–27	12.0%	259	20.4%	113	5.5%	146	13.38***
28–29	2.7%	110	6.4%	47	0.0%	63	4.13*
Relational victimization
12–13	52.6%	173	52.5%	80	52.7%	93	.001
14–15	44.9%	343	44.4%	160	45.4%	183	.03
16–17	42.3%	527	37.2%	258	47.2%	269	5.40*
18–19	43.5%	485	39.6%	225	46.9%	260	2.66
20–21	43.0%	435	42.6%	195	43.3%	240	.03
22–23	53.8%	400	54.1%	181	53.4%	219	.02
24–25	51.3%	372	57.0%	172	46.5%	200	4.06*
26–27	45.7%	258	48.7%	113	43.4%	145	.70
28–29	49.1%	110	42.6%	47	54.0%	63	1.40
Verbal victimization
12–13	34.7%	173	40.0%	80	30.1%	93	1.86
14–15	25.9%	343	30.0%	160	22.4%	183	2.56
16–17	25.6%	527	29.1%	258	22.3%	269	3.16
18–19	26.4%	485	31.1%	225	22.3%	260	4.81*
20–21	33.1%	435	36.9%	195	30.0%	240	2.33
22–23	40.0%	400	47.5%	181	33.8%	219	7.78**
24–25	32.3%	372	40.7%	172	25.0%	200	10.43**
26–27	28.6%	259	36.3%	113	22.6%	146	5.84*
28–29	23.6%	110	23.4%	47	23.8%	63	.002
Dating status
12–13	9.2%	173	11.3%	80	7.5%	93	.71
14–15	19.2%	343	12.5%	160	25.1%	183	8.77**
16–17	32.9%	526	23.3%	257	42.0%	269	20.74***
18–19	45.8%	485	36.4%	225	53.8%	260	14.72***
20–21	57.3%	438	50.5%	196	62.8%	242	6.70*
22–23	61.5%	400	55.8%	181	66.2%	219	4.54*
24–25	66.8%	376	59.4%	175	73.1%	201	7.92**
26–27	71.7%	258	71.7%	113	71.7%	145	.00
28–29	74.5%	110	76.6%	47	73.0%	63	.18

	Overweight^a	Physical victimization	Relational victimization	Verbal victimization	Friend social support	Dating status	Romantic relationship worries	Internalizing symptoms
Ages 12–13 (n = 173)
Overweight^a		.15	−.04	−.01	.15	−.11	.18	.06
Physical victimization	−.13		.32**	.47***	.02	.05	.79*	.22
Relational victimization	−.02	.20		.32**	−.08	.02	.57 ^g	.26*
Verbal victimization	−.12	.43***	.39***		−.13	.19	.60	.10
Friend social support	.06	−.22*	−.30**	−.30		−.01	−.55	−.11
Dating status	.13	.04	−.06	−.10	.17		N/A^b	−.05
Romantic relationship worries	.08	−.01	−.70^g	−.29	.31	N/A^b		.18
Internalizing symptoms	.21	.33**	.17	.28**	−.34**	.02	−.32
Ages 14–15 (n = 344)
Overweight^a		−.05	.08	.15	−.04	−.03	−.09	−.02
Physical victimization	.16*		.27**	.19*	−.11	−.13⁽⁺⁾	.15	.25**
Relational victimization	.02	.33***		.27**	−.20*	.01	.07	.27**
Verbal victimization	.10	.25**	.41***		−.10	.04	.07	.23**
Friend social support	−.13	−.18*	−.15*	−.09		.16*	.05	−.05
Dating status	.01	.11^g	.03	.11	.08		N/A^b	.06
Romantic relationship worries	.08	.28**	.18	.28	−.03	N/A^b		.27*
Internalizing symptoms	.13	.40***	.42***	.35***	−.25**	.19**	.48***
Ages 16–17 (n = 535)
Overweight^a		−.05	−.01	.10	−.05	−.20**	−.10	.03
Physical victimization	.05		.13*	.31***	.02	.06	.04	.10
Relational victimization	.04	.21**		.23***	−.21**	−.07	.07	.25***
Verbal victimization	.02	.41***	.19**		.00^g	.01	.03	.10
Friend social support	−.08	−.09	−.26***	−.19**^g		.12	.02	−.14*
Dating status	−.04	.07	−.02	.03	.08		N/A^b	.04
Romantic relationship worries	.06	.24*	.16	.28**	−.04	N/A^b		.32*
Internalizing symptoms	−.03	.21***	.20**	.24***	−.24***	−.12	.45***
Ages 18–19 (n = 492)
Overweight^a		.08	.00	.13	−.02	−.07	−.06	.04
Physical victimization	.24***		.18**	.43***^g	−.08	.07	−.02^g	.06^g
Relational victimization	.01	.19**		.28***	−.03	.12	.21	.28***
Verbal victimization	.07	.27***^g	.29***		−.13	−.03	.10	.18**
Friend social support	−.03	.03	−.15*	−.07		.10	−.20	−.16*
Dating status	−.06	.04	−.03	.09	.13*		N/A^b	.05
Romantic relationship worries	.13	.39***^g	.23**	.21*	−.03	N/A^b		.48***
Internalizing symptoms	.09	.32***^g	.33***	.21**	−.28***	−.06	.51***
Ages 20–21 (n = 453)
Overweight^a		−.04	−.11	−.05	.03	−.20**	−.10	−.04
Physical victimization	.10		.29***	.35***	.03	−.02^g	.03	.16*
Relational victimization	.07	.17*		.29***	−.10	−.02	.20*	.22**^g
Verbal victimization	.05	.32***	.40***		−.02^g	−.03	.08^g	.09
Friend social support	−.01	−.13*	−.13*	−.21*^g		.00	−.17	−.14*^g
Dating status	−.18**	.13**	−.08	.09	.02		N/A^b	−.09
Romantic relationship worries	.09	.26**	.37***	.41***^g	−.21**	N/A^b		.55***
Internalizing symptoms	−.01	.19**	.40***^g	.27***	−.35***^g	−.05	.54***
Ages 22–23 (n = 410)
Overweight^a		.08	.06	.11	.06	.11	−.06	.05
Physical victimization	.07		.21**	.36***	−.03	.02	.18	.15
Relational victimization	−.03	.18**		.25**^g	−.03	−.03	.28**	.34***
Verbal victimization	−.03	.28***	.45***^g		.15^g	−.02	.15	.21**
Friend social support	.01	−.19**	−.22**	−.28**^g		.19	−.06	−.24**
Dating status	.01	.04	−.07	.00	.00		N/A^b	−.25**^g
Romantic relationship worries	−.07	.14	.30***	.22**	−.21**	N/A^b		.41***
Internalizing symptoms	−.02	.18**	.33***	.30***	−.31***	−.01^g	.47***
Ages 24–25 (n = 394)
Overweight^a		−.04	−.11	.08	.00	.08	−.05	−.12
Physical victimization	.04		.26**	.40***	.00	.02	.12	.11
Relational victimization	.01	.14*		.31***	−.24**	.08	.32**	.32***
Verbal victimization	.13	.24**	.41***		−.17*	.00	.28**	.21**
Friend social support	.15*	−.11	−.25***	−.13		−.01	−.24*	−.19*
Dating status	.05	−.08	−.04	−.09	.11		N/A^b	−.19*
Romantic relationship worries	.06	.25**	.31***	.29***	−.34***	N/A^b		.54***
Internalizing symptoms	−.01	.26**	.33***	.30***	−.31***	−.11	.65***
Ages 26–27 (n = 263)
Overweight^a		.06	−.18	.04	−.10	−.03	.11	−.07
Physical victimization	−.09		.26**^g	.30**	−.08	−.02	.04	.05
Relational victimization	.05	.00^g		.30**	−.21*	−.10	.21	.40***
Verbal victimization	.08	.27**	.37***		.08^g	−.14	.07	.15
Friend social support	.08	−.07	−.18*	−.28**^g		.00	.00	−.32***
Dating status	−.10	.00	−.14	−.14	.23**		N/A^b	−.19*
Romantic relationship worries	.02	.21*	.08	.18	−.13	N/A^b		.44***
Internalizing symptoms	−.06	.12	.33***	.28**	−.21*	−.12	.64***
Ages 28–29 (n = 111)
Overweight^a		.05	−.31*	.07	.21	−.04	−.05	−.07
Physical victimization	N/A^c		.13	.27	−.34*	−.06	.01	.07
Relational victimization	−.01	N/A^c		.24	−.53***	−.13	.38*	.30*
Verbal victimization	.15	N/A^c	.22		−.24	−.04	.38*	.42**
Friend social support	.01	N/A^c	−.27*	−.07		−.09	−.38*	−.25
Dating status	−.10	N/A^c	.01	.09	.26*		N/A^b	−.14
Romantic relationship worries	−.11	N/A^c	.48**	.24	.01	N/A^b		.56**
Internalizing symptoms	−.06	N/A^c	.47***	.30*	−.31*	.08	.66***

Footnotes

Acknowledgment

We would like to thank our participants for their generosity and Clea Sturgess for her contributions to the manuscript preparation.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by grants from the Canadian Institutes for Health Research (#88476; #79917; #192583; #130500) to Dr. Leadbeater.

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	Total sample				Males			Females
	Mean	SD	N	Range	Mean	SD	n	Mean	SD	n	F	Cohen’s d
Socioeconomic status
	2.88	1.38	657	0–4	2.87	1.36	315	2.89	1.39	342	.05	.01
Body mass index
12–13	19.72	3.29	159	12.62–34.44	19.68	3.34	73	19.76	3.27	86	.02	.02
14–15	21.35	3.34	334	13.43–44.72	21.09	2.98	155	21.57	3.62	179	1.69	.14
16–17	22.33	3.08	520	15.60–33.51	22.45	3.17	255	22.21	2.99	265	.80	.08
18–19	23.07	3.54	481	16.14–39.18	23.45	3.68	223	22.74	3.39	258	4.88*	.20
20–21	23.59	3.73	435	15.66–40.72	23.77	3.57	195	23.44	3.86	240	.83	.09
22–23	23.98	3.97	400	14.08–46.99	23.96	3.47	181	24.00	4.34	219	.01	.01
24–25	24.59	4.52	370	15.83–50.12	24.89	3.96	172	24.33	4.95	198	1.42	.12
26–27	24.76	4.94	259	14.43–46.11	25.19	3.79	113	24.43	5.67	146	1.52	.15
28–29	25.08	5.40	107	15.61–47.42	26.00	4.79	45	24.42	5.75	62	2.24	.29
Internalizing symptoms
12–13	7.32	3.94	173	0–19	7.07	3.58	80	7.54	4.24	93	.60	.12
14–15	8.48	4.24	343	0–23	7.84	3.93	160	9.03	4.43	183	6.77*	.28
16–17	9.31	4.22	526	1–22	8.96	4.19	258	9.65	4.22	268	3.51	.16
18–19	9.81	4.56	485	0–24	9.49	4.38	225	10.08	4.70	260	1.98	.13
20–21	9.50	4.47	436	0–24	9.54	4.30	195	9.48	4.61	241	.02	.01
22–23	9.07	4.66	400	0–24	8.97	4.88	181	9.15	4.48	219	.15	.04
24–25	8.57	4.75	373	0–24	8.52	4.82	173	8.61	4.71	200	.03	.02
26–27	8.32	4.80	259	0–24	7.79	4.65	113	8.73	4.89	146	2.45	.20
28–29	8.67	4.95	110	0–20	8.32	5.07	47	8.94	4.88	63	.42	.13
Friend social support
12–13	6.79	1.96	173	0–9	6.28	1.99	80	7.23	1.82	93	10.72**	.50
14–15	6.99	2.00	343	0–9	6.15	2.08	160	7.73	1.61	183	62.46***	.86
16–17	7.32	1.78	527	0–9	6.78	1.85	258	7.83	1.56	269	49.01***	.61
18–19	7.49	1.62	485	1–9	6.93	1.64	225	7.97	1.45	260	55.92***	.67
20–21	7.76	1.63	438	2–9	7.39	1.70	196	8.05	1.52	242	18.75***	.41
22–23	7.86	1.64	401	1–9	7.49	1.69	182	8.17	1.53	219	17.90***	.42
24–25	7.86	1.63	376	1–9	7.47	1.75	175	8.20	1.43	201	20.04***	.46
26–27	7.85	1.66	259	0–9	7.49	1.92	113	8.13	1.37	146	9.93**	.39
28–29	7.65	1.89	110	0–9	7.34	2.00	47	7.89	1.79	63	2.29	.29
Romantic relationship worries
12–13	8.27	3.22	15	4–13	8.88	2.59	8	7.57	3.91	7	.60	.40
14–15	10.08	5.32	66	1–25	8.90	4.41	20	10.59	5.64	46	1.41	.32
16–17	9.49	4.61	172	0–30	9.19	4.32	60	10.02	5.11	112	1.26	.17
18–19	11.25	5.99	223	0–29	11.94	6.44	83	10.84	5.69	140	1.78	.18
20–21	11.86	5.81	251	0–27	12.65	5.63	100	11.34	5.88	151	3.11	.23
22–23	11.96	5.88	249	0–29	11.83	5.58	102	12.05	6.10	147	.08	.04
24–25	11.62	5.87	249	1–31	11.52	5.70	102	11.68	6.10	147	.04	.03
26–27	10.74	5.70	184	0–27	10.71	5.48	79	10.76	5.89	104	.004	.01
28–29	11.05	6.48	80	0–30	10.86	6.05	35	11.19	6.85	45	.05	.05

	Total sample		Males		Females
	%	N	%	n	%	n	χ²
Overweight^a (obese^b only)
12–13	18.2% (4.4%)	159	23.3% (2.7%)	73	14.0% (5.8%)	86	2.31
14–15	17.4% (4.8%)	334	17.4% (6.5%)	155	17.3% (3.4%)	179	.001
16–17	17.5% (3.3%)	520	19.6% (5.1%*)	255	15.5% (1.5%)	265	1.54
18–19	15.8% (4.6%)	481	18.4% (6.3%)	223	13.6% (3.1%)	258	2.09
20–21	23.7% (4.1%)	435	23.6% (3.6%)	195	23.8% (4.6%)	240	.002
22–23	33.0% (8.0%)	400	33.1% (4.4%*)	181	32.9% (11.0%)	219	.003
24–25	37.9% (10.6%)	369	42.7% (10.5%)	171	33.8% (10.6%)	198	3.05
26–27	37.1% (11.6%)	259	41.6% (10.6%)	113	33.6% (12.4%)	146	1.76
28–29	43.9% (14.0%)	107	57.8% (11.1%)	45	33.9% (16.1%)	62	6.05*
Physical victimization
12–13	29.5%	173	37.5%	80	22.6%	93	4.61*
14–15	26.8%	343	36.3%	160	18.6%	183	13.58***
16–17	24.9%	527	34.5%	258	15.6%	269	25.14***
18–19	17.7%	485	26.2%	225	10.4%	260	20.74***
20–21	18.9%	435	27.2%	195	12.1%	240	16.03***
22–23	17.3%	400	28.2%	181	8.2%	219	27.65***
24–25	16.4%	372	28.5%	172	6.0%	200	34.11***
26–27	12.0%	259	20.4%	113	5.5%	146	13.38***
28–29	2.7%	110	6.4%	47	0.0%	63	4.13*
Relational victimization
12–13	52.6%	173	52.5%	80	52.7%	93	.001
14–15	44.9%	343	44.4%	160	45.4%	183	.03
16–17	42.3%	527	37.2%	258	47.2%	269	5.40*
18–19	43.5%	485	39.6%	225	46.9%	260	2.66
20–21	43.0%	435	42.6%	195	43.3%	240	.03
22–23	53.8%	400	54.1%	181	53.4%	219	.02
24–25	51.3%	372	57.0%	172	46.5%	200	4.06*
26–27	45.7%	258	48.7%	113	43.4%	145	.70
28–29	49.1%	110	42.6%	47	54.0%	63	1.40
Verbal victimization
12–13	34.7%	173	40.0%	80	30.1%	93	1.86
14–15	25.9%	343	30.0%	160	22.4%	183	2.56
16–17	25.6%	527	29.1%	258	22.3%	269	3.16
18–19	26.4%	485	31.1%	225	22.3%	260	4.81*
20–21	33.1%	435	36.9%	195	30.0%	240	2.33
22–23	40.0%	400	47.5%	181	33.8%	219	7.78**
24–25	32.3%	372	40.7%	172	25.0%	200	10.43**
26–27	28.6%	259	36.3%	113	22.6%	146	5.84*
28–29	23.6%	110	23.4%	47	23.8%	63	.002
Dating status
12–13	9.2%	173	11.3%	80	7.5%	93	.71
14–15	19.2%	343	12.5%	160	25.1%	183	8.77**
16–17	32.9%	526	23.3%	257	42.0%	269	20.74***
18–19	45.8%	485	36.4%	225	53.8%	260	14.72***
20–21	57.3%	438	50.5%	196	62.8%	242	6.70*
22–23	61.5%	400	55.8%	181	66.2%	219	4.54*
24–25	66.8%	376	59.4%	175	73.1%	201	7.92**
26–27	71.7%	258	71.7%	113	71.7%	145	.00
28–29	74.5%	110	76.6%	47	73.0%	63	.18