Weight Status and School Bullying Experiences in Urban China: The Difference Between Boys and Girls

Abstract

This article examined the associations between weight status (body mass index [BMI] and perceived weight measures) and school bullying experiences (being bullied and bullying others) of children and adolescents in urban China. A national representative sample (n = 3,675) of all types of pre-college schools from seven Chinese cities was employed for the analysis. Students from all grades in high school, vocational school, middle school, and primary grades 4 to 6 were surveyed. Height, weight, perceived weight status, and experiences of being bullied and bullying others were obtained. The results demonstrated that the objective weight status (BMI) was neither associated with being bullied overall by others nor associated with bullying others, but the subjective/perceived weight status was significantly related to being bullied. Regarding the specific forms of being bullied, underweight (measured by BMI) students were less likely to be cyberbullied, whereas obese (measured by BMI) students were more likely to be cyberbullied. Students who perceived themselves as slightly fat and too fat were more likely to be verbally bullied. Overweight and obese students were more likely to bully others physically and relationally, and the students who perceived themselves as too thin were positively associated with physically bullying others. Moreover, BMI had a role in the involvement in school bullying for boys, whereas perceived weight status had a role in school bullying involvement in girls. These results indicate that school bullying prevention and intervention should consider weight status, as well as gender differences.

Keywords

weight BMI perceived weight gender school bullying China

Introduction

School bullying is a subtype of aggressive behavior among students with the attributes of asymmetric power relationships, repetitiveness, and hostile intentions (Olweus, 2013). It has become a global concern in recent years (UNESCO, 2017, 2019). Children and adolescents involved in school bullying (both being bullied, also called bullying victimization, and bullying others, also called bullying perpetration) are more likely to develop symptoms of internalization (e.g., sleeping problems, headaches, anxiety, low self-esteem, and depression; Chang et al., 2013; Fekkes, Pijpers, & Verloove-Vanhorick, 2004) and external consequences (e.g., tobacco use, suicidal ideation and attempts, and self-harm and violence; Kretschmer et al., 2018; Schneider, O’Donnell, Stueve, & Coulter, 2012). Verbal, physical, relational, and cyberbullying are the four typical forms of bullying behaviors (Waasdorp & Bradshaw, 2015; J. Wang, Iannotti, & Nansel, 2009), while some studies have considered the sexual dimension of bullying to be another type (UNESCO, 2019).

Being overweight and/or obese is the primary reason for youth bullying (Puhl et al., 2016), and weight-related school bullying is highly prevalent among youths due to stigmas regarding weight (Aimé, LeBlanc, & Maïano, 2017). The attribution theory blames overweight individuals for failing to control their weight and, therefore, they are responsible for being overweight (Crandall, 1994). Hence, people may hold negative perceptions of overweight and obese people and feel they are lazy, unmotivated, sloppy, and lack self-discipline (Pearl, 2018). These weight-related negative stereotypes further lead to weight stigmatization, which translates into bullying (Puhl & King, 2013). Moreover, obesity and the prevalence of overweight children and adolescents are becoming global epidemics (World Health Organization, 2000) that lead to many adverse health outcomes such as cancer (Lauby-Secretan et al., 2016), cardiovascular disease, and diabetes (Afshin et al., 2017). Those adverse health conditions, along with the consequences of school bullying, result in additional health risks for overweight and obese students. Therefore, there is a strong need to investigate the correlations between weight status and involvement in school bullying to protect the health and well-being of children and adolescents.

Weight status can be measured either objectively by the body mass index (BMI) or subjectively by body image, the perception of weight status by an individual (Reulbach et al., 2013). BMI measurements are generally classified into underweight, normal weight, overweight, and obese (Liu, Chen, Yan, & Luo, 2016). Subjective weight status (SWS) is commonly assessed on five scales: too thin, slightly thin, suitable size, slightly fat, and too fat (Wilson, Viswanathan, Rousson, & Bovet, 2013). Although the association between BMI and SWS and the experience of school bullying (being bullied and bullying others) have been considerably explored in the literature, the results have not been consistent.

Current findings regarding the correlation between BMI and involvement in school bullying are complicated. Overall, both overweight and obese students, as well as underweight students, are at risk of being bullied compared with normal-weight students. First, most studies have indicated that overweight and obese students were more likely to be bullied. Studies from Ireland (Reulbach et al., 2013), Canada (Janssen, Craig, Boyce, & Pickett, 2004), the Netherlands (Jansen et al., 2014), Denmark (Brixval, Rayce, Rasmussen, Holstein, & Due, 2012), China (Guo et al., 2010), and the United States (Lumeng et al., 2010) suggested that overweight and/or obese students were more likely to be bullied compared with normal-weight students. However, investigations from Seychelles found no significant difference in the probability of being bullied between overweight, obese, and normal-weight students (Wilson et al., 2013). Fewer studies have paid attention to the school bullying experience of underweight students. Investigations from 39 countries in Europe and North America demonstrated that underweight students had higher probabilities of being bullied than normal-weight students than normal-weight students (Lian et al., 2018; C. Wang, Li, Li, & Seo, 2018), although one study from Ireland found no significant association between BMI-classified thinness and being bullied (Reulbach et al., 2013).

Similarly, correlations between BMI and bullying others have been inconsistent. Surveys from the Netherlands (Jansen et al., 2014) and Canada (Janssen et al., 2004) revealed that overweight and obese students were more likely to bully others, whereas a study from China reported that only obese students were more likely to bully others (Liu et al., 2016). However, investigations from the United Kingdom suggested that there were no significant differences in the BMIs of students who bullied others (K. Lee, Dale, Guy, & Wolke, 2018).

Studies using SWS found that SWS was correlated with both being bullied and bullying others and sometimes the effects were even stronger than the correlations with BMI (Lin, Latner, Fung, & Lin, 2018; Reulbach et al., 2013). Compared with the students who perceived themselves as a suitable size, those who perceived themselves as thin or fat had higher risks of being bullied (Brixval et al., 2012; Carey, Wilkinson, Ranjit, Mandell, & Hoelscher, 2018; Lian et al., 2018) or of bullying others (Reulbach et al., 2013). However, some studies found no evidence that SWS was significantly correlated with bullying others (Holubcikova, Kolarcik, Geckova, Dijk, & Reijneveld, 2015) or being bullied (Kaltiala-Heino, Lankinen, Marttunen, Lindberg, & Fröjd, 2016). Currently, no empirical effort has analyzed the correlation between SWS and involvement in school bullying within China. Considering the vital influence of SWS on the involvement in school bullying (Reulbach et al., 2013) and the cultural differences between China and the countries previously studied, there is a strong need to narrow this knowledge gap. Moreover, rare studies have included both BMIs and SWSs in studies investigating weight status and involvement in school bullying and this study can be a valuable supplement to that information.

Weight status may be construed differently by males and females. Due to gender stereotypes in most cultures, females, especially young girls, are more likely to be stigmatized by weight variations from the norm, and thus, boys and girls can demonstrate different patterns of involvement in school bullying in relation to weight status. For example, one study in China revealed that obese girls were more likely to be bullied, whereas obese boys were more likely to bully others (Liu et al., 2016). Another study from the United States found that SWS was only significantly associated with being bullied among boys (Carey et al., 2018). Regarding the specific forms of bullying behaviors, overweight boys in South Korea were more likely to be physically bullied and to physically bully others, but the different BMI categories were not significantly associated with any form of bullying experience (being bullied and bullying others) among girls (Kim, Yun, & Kim, 2016). In the United States, underweight boys were more likely to be physically bullied, whereas underweight girls were more likely to be relationally bullied (J. Wang, Iannotti, & Luk, 2010).

Culture plays a vital role in shaping weight stigmatization and involvement in school bullying. People in countries with individualist cultures tend to have stronger prejudices toward overweight and obese individuals than people from collectivist countries (Crandall et al., 2001). For example, in the United States, where a strong individualist cultural ideology exists (Crandall & Martinez, 1996), people appearing overweight or obese often experience weight-related stigmatization and discrimination (Puhl & Latner, 2007). Compared with American children, the attitude of Japanese (collectivists) children toward obesity is more positive and inclusive (Crystal, Watanabe, & Chen, 2000). Regarding involvement in school bullying, some cultures tend to see the bullying experience as a part of growing up (Maunder & Crafter, 2018), especially for boys. Thus, school bullying patterns and their association with weight status vary across cultures (Kim et al., 2016). However, most of the current investigations have been based on Western countries and Western cultures and there is a lack of information from the more collectivist cultures, like China. Thus, studies from China can widen our understanding of the association between weight status and involvement in school bullying.

In summary, weight status is a leading predictor of involvement in school bullying. BMI and SWS are the usual ways of measuring weight status, and most studies exploring the linkage between weight status and school bullying involvement have only employed one type of measure. Moreover, due to cultural differences regarding weight status and school bullying, countries with different cultures may demonstrate different patterns of weight status and bullying involvement. For example, countries with strong individualist orientations and ones with strong collectivist orientations should have different cultural preferences regarding body shape, hence school bullying. Nevertheless, studies from China are needed because China is a country with an influential collectivist culture and that China has the largest population of obese children in the world (Afshin et al., 2017). Last but not least, due to cultural variations and gender stereotypes and stigmatizations, males and females may experience different associations between weight status and involvement in school bullying. Thus, studies of school bullying and weight status should be gender-sensitive.

Based on the discussion above, we hypothesize the following:

Hypothesis 1: Students who deviate from normal weight are more likely to be bullied.

Hypothesis 1a: Underweight, overweight, and obese students measured by BMI are more likely to be bullied.

Hypothesis 1b: Underweight, overweight, and obese students measured by SWS are more likely to be bullied.

Hypothesis 2: Students who deviate from normal weight are more likely to bully others.

Hypothesis 2a: Underweight, overweight, and obese students measured by BMI are more likely to bully others.

Hypothesis 2b: Underweight, overweight, and obese students measured by SWS are more likely to bully others.

Hypothesis 3: The effect of weight status on the involvement in school bullying exhibits different patterns between girls and boys.

Method

Data and Sampling

Representative national data collected from seven provinces in China during 2016 were employed for the analysis. A stratified sampling method was used for the data collection. First, the capital cities of the seven provinces covering a geographical variety in China were purposively selected. Because there are four types of pre-college schools in China, primary schools, middle schools, high schools, and vocational schools (equivalent to high school but with a focus on technical skills training), one of each type was selected. Within each school, one class from each grade was randomly selected and all the students within the selected class were invited to participate in the study. For students in primary school, only Grades 4 to 6 were selected. Participants in the study were voluntarily recruited. All the surveys were completed independently by the students with the assistance of a research assistant in each class. In total, 3,675 valid questionnaires were collected. Among them, 16.08%, 12.46%, 12.82%, 13.66%, 21.44%, 10.56%, and 12.98% of the respondents were from Beijing (north of China), Gansu (northwest), Guangdong (south), Guizhou (southwest), Hunan (middle), Jiangsu (east), and Liaoning (northeast), respectively (Table 1). Primary school students represented 37.77% of the participants, 27.76% were from middle school, 26.91% were from high school, and 7.56% were from vocational schools.

Table 1.

Participants’ Characteristics and Weight Status (N = 3,675).

Categorical Variables	Frequency	%
Gender (male = 1)	1,772	48.22
Ethnic (minorities = 1)	303	8.24
Boarding school (Yes = 1)	668	18.18
School type
Primary	1,388	37.77
Middle	1,020	27.76
High	989	26.91
Vocational	278	7.56
Living with
Parents	2,693	73.28
One parent	364	9.90
Others	618	16.82
Province
Beijing	591	16.08
Gansu	458	12.46
Guangdong	471	12.82
Guizhou	502	13.66
Hunan	788	21.44
Jiangsu	388	10.56
Liaoning	477	12.98
Objective weight status (BMI)
Normal	2,750	74.83
Underweight	327	8.90
Overweight	276	7.51
Obesity	272	7.40
Missing	50	1.36
Subjective weight status (perceived weight)
Too thin	275	7.48
Slightly thin	565	15.37
Suitable size	1,489	40.52
Slightly fat	1,051	28.60
Too fat	295	8.03
Continuous variables	Range	M (SD)
Father’s education	1-5	2.92 (1.15)
Mother’s education	1-5	2.83 (1.20)
Relation with classmates	1-5	4.27 (0.88)
Relation with teachers	1-5	4.08 (0.95)
Academic performance	1-5	3.25 (1.01)
Perceived socioeconomic status	1-5	3.17 (0.83)

Note. BMI = body mass index.

Measures

Being bullied and bullying others

The school bullying behaviors were categorized as verbal, physical, relational, and cyberbullying based on prior research (J. Wang et al., 2009). The participants were asked, “In the last academic year, have your classmates or peers done any of the following behaviors to you?” Ten specific school bullying behaviors, two verbal, two physical, two relational, and four cyberbullying behaviors, were presented following the question (Supplemental Appendix A; Han, Zhang, & Zhang, 2017). The responses to each item were never, rarely, sometimes, and frequently. Based on the repetitiveness criterion in the definition of school bullying (Olweus, 2013), we recoded sometimes and frequently as being bullied (score = 1) by that specific behavior, whereas never and rarely meant not being bullied (score = 0). If a student experienced any form of bullying behavior within the four categories (verbal, physical, relational, and cyber), he or she was defined as being bullied in that dimension. For example, a student would be defined as a verbal bullying victim when he or she chose sometimes or frequently in any kind of the two verbal bullying behaviors. Otherwise, the student was considered as not being verbally bullied. Being physically bullied, relationally bullied, and cyberbullied was scored the same as being verbally bullied. Furthermore, if a student experienced any of the four categories of bullying, the student was considered to have been bullied. Cronbach’s alphas for being bullied overall, verbally bullied, physically bullied, relationally bullied, and cyberbullied were .86, .44, .65, .54, and .81, respectively.

Similar to being bullied, the behavior of bullying others was also divided into four categories: verbal, physical, relational, and cyberbullying. The same 10 bullying behaviors, as well as the operational methods, were employed. The only difference was the inquiry question used: “In the last academic year, have you done any of the following behaviors to your peers or others?” Cronbach’s alpha test results for overall bullying, verbal bullying, physical bullying, relational bullying, and cyberbullying were .88, .47, .65, .65, and .87, respectively.

Weight status

Two types of weight status measures were used in this study: objective weight status measured by BMI and SWS assessed by self-reported perceived weight status.

BMI was calculated by self-reported height and weight as follows: BMI = weight (kg) / height² (m²) (Kaltiala-Heino et al., 2016). The respondents were classified into four categories: underweight, normal weight, overweight, and obese, according to grade and gender-specified BMI cutoffs suggested by the National Student Physical Health Standard (revised in 2014) from the Ministry of Education of the People’s Republic of China (Ministry of Education of the People’s Republic of China, 2014). The distribution of underweight, normal weight, overweight, and obese respondents was 8.9%, 74.83%, 7.51%, and 7.40%, respectively.

SWS was obtained from the question, “How do you feel about your body weight?” and the answers were too thin (score = 1), slightly thin (score = 2), suitable size (score = 3), slightly fat (score = 4), and too fat (score = 5) (Holubcikova et al., 2015). Of the participants, 7.48% reported themselves as being very thin, 15.37% as slightly thin, 40.52% as suitable size, 28.6% as slightly fat, and 8.03% as too fat.

Control variables

Gender (1 = male, 0 = female), ethnicity (1 = ethnic minority, 0 = ethnic majority [Han]), parents’ education, socioeconomic status, peer relationships, teacher–student relationships, parent–child relationships, academic performance, and school type were included as control variables in the analysis, according to previous studies (Han et al., 2017; B. Lee, Jeong, & Roh, 2018). The parents’ educational levels were assigned numbers ranging from 1 to 5, where illiterate or primary school attendance was assigned 1, middle school 2, high school or equivalent 3, college 4, and graduate school or above 5. The perceived family’s socioeconomic status, relationship with classmates, relationship with teachers, relationship with parents, and perceived academic performance were measured on a 5-point Likert-type scale, with 1 indicating the lowest value and 5 the highest. Moreover, since some of the students lived on campus during the weekdays and not all of them lived with both parents (Ba et al., 2019), we included one dummy variable called boarding (1 = boarding, 0 = not boarding) to indicate whether a student was living on campus. Another nominal variable, called guardian status, comprised three categories: living with parents, living with one parent (father or mother), and living with others (e.g., grandparents, relatives), to indicate who a student lived with most of the time. Geographical variations (city) were also incorporated into the analysis. The characteristics of these control variables are shown in Table 1.

Statistical Analysis

All results were analyzed by Stata/MP 14.0 statistical software. First, we reported the prevalence of being bullied and bullying others by gender and weight status (BMI and SWS). Then, logistic regression was used to analyze the association between weight status and bullying involvement by gender. Odds ratios for the unadjusted (without the controlled variables) and the adjusted results were reported. In total, 50 observations with missing values were automatically dropped from the analysis.

Results

Prevalence of School Bullying by Weight Status

In this study, 26.12% of the students reported being bullied, whereas 9.03% identified themselves as bullies. Verbal bullying was the most common form of bullying. Meanwhile, boys reported higher percentages of being bullied and bullying others than girls (Table 2).

Table 2.

The Prevalence of Bullying Victimization/Perpetration by Gender, BMI, and SWS (in %).

Items	Gender (N = 3,675)				BMI (N = 3,625)					SWS (N = 3,675)
Items	Total	Male	Female	χ² test	Normal	Underweight	Overweight	Obesity	χ² test	Too thin	Slightly thin	Suitable size	Slightly fat	Too fat	χ² test
Being bullied
Overall	26.12	31.04	21.54	p < .001	25.20	30.28	25.36	31.25	p = .048	35.64	27.61	24.71	24.83	26.10	p = .003
Verbal	20.60	25.45	16.08	p < .001	19.45	24.46	22.46	25.74	p = .017	27.27	21.24	19.14	20.08	22.37	p = .036
Physical	11.21	14.28	8.36	p < .001	10.36	14.68	11.59	14.71	p = .025	19.27	12.92	10.81	9.23	9.49	p < .001
Relational	14.97	17.38	12.72	p < .001	14.22	16.51	16.67	17.65	p = .263	21.45	16.11	14.17	13.32	16.61	p = .010
Cyber	8.30	9.88	6.83	p = .001	7.96	7.03	7.97	12.50	p = .058	13.45	8.50	8.19	6.66	9.49	p = .008
Bully others
Overall	9.03	11.85	6.41	p < .001	8.11	12.23	9.42	12.50	p = .012	14.91	9.38	8.66	7.90	8.81	p = .009
Verbal	6.48	8.35	4.73	p < .001	5.56	10.09	7.61	9.19	p = .002	10.18	7.43	6.18	5.52	6.10	p = .062
Physical	3.54	4.57	2.57	p = .001	2.73	5.50	5.43	5.88	p = .001	9.09	3.01	3.36	2.76	3.05	p < .001
Relational	3.73	4.68	2.84	p = .003	3.02	4.59	5.07	6.99	p = .003	7.27	3.89	3.90	2.47	3.73	p = .006
Cyber	2.75	3.72	1.84	p < .001	2.33	3.67	3.62	3.68	p = .207	5.09	3.54	2.48	2.19	2.37	p = .068

Note. BMI = body mass index; SWS = subjective weight status.

The involvement in being bullied according to BMI is reported in Table 2. Obese students had the highest prevalence of being bullied (31.25%), followed by underweight (30.28%), overweight (25.36%), and normal-weight (25.2%) students. Regarding SWS, students who perceived themselves as too thin had the highest incidence of being bullied (35.64%), whereas those who perceived themselves as suitable size had the lowest rates (24.71%). The prevalence of students who perceived themselves as slightly thin, slightly fat, and too fat was 27.61%, 24.83%, and 26.1%, respectively.

The prevalence of bullying others by weight status (both BMI and SWS) is also shown in Table 2. Obese students had the highest overall rate of bullying others (12.5%), followed by underweight (12.23%), overweight (9.42%), and normal-weight (8.11%) students. Moreover, obese students also reported the highest rates of physically, relationally, and cyberbullying others. By SWS, the too-thin group had the highest proportion of bullying others (14.91%), whereas the group who felt slightly fat (7.9%) had the lowest. Specifically, the too-thin group had the highest rates of bullying others in all forms of bullying behaviors (verbal, physical, relational, and cyberbullying).

Associations Between Weight Status and Being Bullied

First, the associations between BMI and being bullied were examined. Compared with normal-weight students, only the obese students had a higher likelihood of being bullied overall (OR = 1.38, p < .05), being verbally bullied (OR = 1.41, p < .05), being physically bullied (OR = 1.76, p < .01), and being cyberbullied (OR = 1.72, p < .05) in the unadjusted model (Table 3). However, no significant associations between BMI and being bullied overall, verbally bullied, physically bullied, or relationally bullied were found among the students when the controlled variables were included. In the adjusted model, underweight students were less likely to be cyberbullied (OR = 0.57, p < .05) than normal-weight students, whereas obese students had a higher probability of being cyberbullied (OR = 1.58, p < .05).

Table 3.

The Associations Between Weight Status (BMI and SWS) and Being Bullied (Logistic Regressions).

Items	Total (3,625)					Male (1,748)					Female (1,877)
Items	Overall	Verbal	Physical	Relation	Cyber	Overall	Verbal	Physical	Relation	Cyber	Overall	Verbal	Physical	Relation	Cyber
Unadjusted models
BMI (normal weight as reference)
Underweight	1.12 (0.15)	1.21 (0.18)	1.15 (0.21)	1.00 (0.17)	0.67 (0.16)	1.18 (0.22)	1.23 (0.24)	1.02 (0.24)	0.91 (0.21)	0.63 (0.20)	1.06 (0.22)	1.23 (0.28)	1.38 (0.38)	1.13 (0.28)	0.75 (0.27)
Overweight	1.04 (0.16)	1.19 (0.19)	1.33 (0.28)	1.25 (0.22)	1.11 (0.27)	1.02 (0.20)	1.14 (0.23)	1.10 (0.29)	1.38 (0.31)	1.15 (0.35)	0.87 (0.21)	1.02 (0.27)	1.36 (0.47)	0.88 (0.27)	0.86 (0.36)
Obesity	1.38* (0.21)	1.41* (0.23)	1.76** (0.35)	1.28 (0.23)	1.72* (0.37)	1.39 (0.28)	1.51* (0.32)	1.64 (0.42)	1.08 (0.27)	1.43 (0.43)	1.17 (0.27)	1.04 (0.28)	1.58 (0.52)	1.44 (0.39)	2.02* (0.64)
SWS (suitable size as reference)
Too thin	1.60** (0.24)	1.49* (0.24)	1.83** (0.34)	1.63** (0.28)	1.86** (0.40)	1.38 (0.25)	1.28 (0.25)	1.61* (0.36)	1.42 (0.31)	1.59 (0.42)	1.73* (0.44)	1.55 (0.44)	1.95* (0.64)	1.88* (0.55)	2.14* (0.80)
Slightly thin	1.17 (0.13)	1.15 (0.14)	1.23 (0.19)	1.19 (0.16)	1.09 (0.19)	1.06 (0.15)	1.03 (0.16)	1.06 (0.21)	1.09 (0.20)	0.97 (0.22)	1.25 (0.22)	1.22 (0.24)	1.42 (0.35)	1.25 (0.27)	1.20 (0.35)
Slightly fat	0.99 (0.10)	1.05 (0.11)	0.79 (0.11)	0.89 (0.11)	0.74 (0.12)	1.09 (0.15)	1.15 (0.17)	1.00 (0.19)	0.98 (0.17)	0.80 (0.18)	1.04 (0.14)	1.13 (0.17)	0.71 (0.15)	0.90 (0.16)	0.78 (0.18)
Too fat	0.98 (0.16)	1.09 (0.19)	0.68 (0.16)	1.09 (0.21)	0.94 (0.23)	0.90 (0.21)	0.99 (0.24)	0.64 (0.21)	0.93 (0.26)	0.73 (0.27)	1.21 (0.27)	1.40 (0.35)	0.85 (0.30)	1.44 (0.38)	1.31 (0.44)
Adjusted models
BMI (normal weight as reference)
Underweight	0.87 (0.13)	0.97 (0.16)	0.87 (0.17)	0.79 (0.14)	0.57* (0.14)	0.84 (0.17)	0.90 (0.19)	0.69 (0.18)	0.64 (0.16)	0.49* (0.16)	0.92 (0.21)	1.10 (0.28)	1.19 (0.35)	1.04 (0.28)	0.75 (0.28)
Overweight	0.96 (0.16)	1.11 (0.19)	1.11 (0.25)	1.17 (0.23)	1.07 (0.27)	1.06 (0.23)	1.23 (0.28)	1.02 (0.29)	1.46 (0.36)	1.22 (0.38)	0.86 (0.23)	1.08 (0.31)	1.29 (0.48)	0.81 (0.27)	0.81 (0.35)
Obesity	1.27 (0.22)	1.24 (0.22)	1.33 (0.29)	1.12 (0.22)	1.58* (0.36)	1.44 (0.32)	1.58* (0.36)	1.38 (0.38)	1.03 (0.28)	1.34 (0.42)	1.19 (0.32)	1.00 (0.30)	1.31 (0.47)	1.42 (0.41)	2.00* (0.66)
SWS (suitable size as reference)
Too thin	1.32 (0.22)	1.14 (0.20)	1.46 (0.29)	1.29 (0.24)	1.49 (0.33)	1.26 (0.26)	1.12 (0.24)	1.45 (0.36)	1.20 (0.28)	1.31 (0.36)	1.40 (0.40)	1.20 (0.38)	1.53 (0.54)	1.44 (0.46)	1.74 (0.67)
Slightly thin	1.11 (0.14)	1.07 (0.14)	1.20 (0.20)	1.14 (0.17)	1.05 (0.19)	1.04 (0.17)	1.00 (0.17)	1.07 (0.22)	1.10 (0.21)	0.96 (0.23)	1.17 (0.23)	1.13 (0.25)	1.41 (0.37)	1.14 (0.27)	1.12 (0.34)
Slightly fat	1.23 (0.13)	1.31* (0.15)	1.01 (0.15)	1.02 (0.13)	0.81 (0.14)	1.13 (0.18)	1.18 (0.19)	1.02 (0.21)	0.95 (0.18)	0.75 (0.18)	1.40* (0.21)	1.61** (0.28)	1.06 (0.25)	1.14 (0.21)	0.89 (0.22)
Too fat	1.55* (0.28)	1.76** (0.34)	1.17 (0.30)	1.64* (0.34)	1.18 (0.30)	1.16 (0.30)	1.27 (0.34)	0.89 (0.31)	1.11 (0.34)	0.78 (0.30)	2.16** (0.54)	2.59*** (0.72)	1.78 (0.66)	2.49** (0.71)	1.89 (0.66)

Note. Due to page limitation, the results of control variables were not reported here and included in Supplemental Appendix B; odds ratios were reported; standard errors in parentheses. BMI = body mass index; SWS = subjective weight status.

p < .05. **p < .01. ***p < .001.

Regarding gender differences, after adjustment for all the control variables, obese boys were more likely to be verbally bullied (OR = 1.58, p < .05) than boys with normal BMI, whereas obese girls were much more likely to be cyberbullied (OR = 2.00, p < .05) than girls with normal BMIs. Also, underweight boys were significantly less likely to be cyberbullied.

In the unadjusted model, students who perceived themselves as too thin by SWS had significantly higher likelihoods of being bullied overall (OR = 1.60, p < .01), verbally bullied (OR = 1.49, p < .05), physically bullied (OR = 1.83, p < .01), relationally bullied (OR = 1.63, p < .01), and cyberbullied (OR = 1.86, p < .01) than the ones who reported themselves as suitable weight. However, none of these significant differences were found when the controlled variables were included. In the adjusted models, students who perceived themselves as too fat had a 55% higher probability of being bullied overall compared with those who perceived themselves as suitable weight. Specifically, in the adjusted models, students who reported themselves as being slightly fat (OR = 1.31, p < .05) and too fat (OR = 1.76, p < .01) were more likely to be verbally bullied compared with those who felt they were with suitable size. Students in the perceived too fat category also had a higher probability of being relationally bullied (OR = 1.64, p < .05).

Gender-specific analyses revealed that the correlations between perceived weight status and being bullied were more common among girls. In the adjusted model, while no significant associations were found in the boys’ group, girls who perceived themselves as too fat were more likely to be bullied overall (OR = 2.16, p < .01), verbally bullied (OR = 2.59, p < .001), and relationally bullied (OR = 2.49, p < .01) compared with girls who perceived themselves as suitable size. Girls who reported themselves as slightly fat were also more likely to be bullied overall (OR = 1.4, p < .05), especially to be verbally bullied (OR = 1.61, p < .01), compared with girls of suitable weight.

Association Between Weight Status and Bullying Others

The associations between BMI and bullying perpetration are reported in Table 4. In the unadjusted models, the obese group had a higher probability of bullying others (OR = 1.77, p < .01), particularly for verbal bullying (OR = 1.95, p < .01), physical bullying (OR = 2.76, p < .001), and relational bullying behaviors (OR = 3.10, p < .001) compared with normal-weight students. Compared with the normal-weight group, the overweight group was more likely to bully others physically (OR = 2.57, p < .01) and relationally (OR = 2.31, p < .01) and the underweight group was more likely to bully others verbally (OR = 1.64, p <.05). After adjustment of the controlled variables, no significant relationships were found between BMI and overall bullying perpetration. Regarding specific bullying behaviors, overweight and obese students were more likely to bully others physically and relationally than normal-weight students.

Table 4.

The Associations Between Weight Status (BMI and SWS) and Bullying Others (Logistic Regressions).

	Total (3,625)					Male (1,748)					Female (1,877)
	Overall	Verbal	Physical	Relation	Cyber	Overall	Verbal	Physical	Relation	Cyber	Overall	Verbal	Physical	Relation	Cyber
Unadjusted models
BMI (normal weight as reference)
Underweight	1.30 (0.25)	1.64* (0.35)	1.37 (0.40)	1.13 (0.34)	1.24 (0.42)	1.18 (0.30)	1.73* (0.48)	1.40 (0.52)	1.02 (0.42)	1.23 (0.54)	1.57 (0.49)	1.54 (0.54)	1.28 (0.60)	1.31 (0.59)	1.24 (0.67)
Overweight	1.30 (0.29)	1.57 (0.40)	2.57** (0.79)	2.31** (0.72)	1.89 (0.69)	1.20 (0.34)	1.63 (0.51)	2.26* (0.87)	3.15** (1.14)	2.42* (0.99)	1.08 (0.43)	1.14 (0.52)	2.34 (1.24)	0.74 (0.56)	0.41 (0.43)
Obesity	1.77** (0.38)	1.95** (0.48)	2.76*** (0.85)	3.10*** (0.90)	1.91 (0.72)	1.95* (0.52)	2.33** (0.71)	2.70* (1.06)	3.95*** (1.42)	2.52* (1.10)	1.17 (0.46)	1.12 (0.52)	2.47 (1.24)	1.70 (0.90)	0.72 (0.57)
SWS (suitable size as reference)
Too thin	1.65* (0.34)	1.39 (0.34)	2.56*** (0.70)	1.68 (0.49)	1.75 (0.63)	1.56 (0.38)	1.29 (0.37)	2.12* (0.73)	1.65 (0.59)	1.22 (0.53)	1.38 (0.55)	1.26 (0.60)	3.24* (1.51)	1.57 (0.84)	3.20 (2.04)
Slightly thin	1.10 (0.19)	1.22 (0.24)	0.92 (0.27)	1.04 (0.27)	1.51 (0.43)	1.00 (0.22)	1.07 (0.27)	0.79 (0.29)	1.04 (0.34)	1.12 (0.40)	1.14 (0.33)	1.42 (0.45)	1.12 (0.50)	1.00 (0.42)	2.46 (1.19)
Slightly fat	0.84 (0.13)	0.85 (0.15)	0.63 (0.16)	0.50** (0.13)	0.80 (0.23)	1.01 (0.21)	0.94 (0.23)	0.90 (0.30)	0.58 (0.20)	0.85 (0.30)	0.80 (0.19)	0.87 (0.24)	0.43 (0.19)	0.44* (0.17)	0.87 (0.44)
Too fat	0.82 (0.21)	0.76 (0.22)	0.53 (0.22)	0.53 (0.20)	0.71 (0.32)	0.62 (0.22)	0.63 (0.25)	0.30 (0.20)	0.42 (0.21)	0.36 (0.24)	1.31 (0.47)	1.10 (0.48)	0.96 (0.51)	0.89 (0.50)	2.45 (1.59)
Adjusted models
BMI (normal weight as reference)
Underweight	1.04 (0.21)	1.34 (0.30)	1.18 (0.35)	0.86 (0.27)	1.12 (0.39)	0.88 (0.23)	1.40 (0.40)	1.14 (0.44)	0.71 (0.31)	1.03 (0.47)	1.34 (0.43)	1.26 (0.46)	1.45 (0.70)	1.17 (0.55)	1.60 (0.92)
Overweight	1.22 (0.29)	1.55 (0.41)	2.33** (0.75)	2.04* (0.67)	1.91 (0.71)	1.32 (0.39)	1.89 (0.61)	2.19 (0.88)	3.24** (1.23)	2.76* (1.15)	1.02 (0.43)	1.08 (0.52)	1.99 (1.12)	0.52 (0.41)	0.34 (0.39)
Obesity	1.43 (0.33)	1.60 (0.41)	1.96* (0.63)	2.29** (0.69)	1.64 (0.64)	1.78* (0.50)	2.14* (0.68)	2.05 (0.85)	3.14** (1.18)	2.36 (1.07)	0.96 (0.39)	0.87 (0.42)	1.79 (0.92)	1.22 (0.67)	0.66 (0.54)
SWS (suitable size as reference)
Too thin	1.32 (0.29)	1.12 (0.29)	2.03* (0.59)	1.30 (0.40)	1.23 (0.46)	1.35 (0.35)	1.09 (0.33)	1.70 (0.62)	1.28 (0.49)	0.86 (0.40)	1.09 (0.45)	0.98 (0.48)	2.67* (1.30)	1.12 (0.61)	2.86 (1.92)
Slightly thin	1.09 (0.20)	1.24 (0.25)	0.92 (0.27)	1.04 (0.28)	1.45 (0.42)	1.03 (0.23)	1.11 (0.29)	0.82 (0.32)	1.05 (0.36)	1.10 (0.41)	1.15 (0.35)	1.47 (0.49)	1.10 (0.53)	0.96 (0.42)	2.22 (1.12)
Slightly fat	1.04 (0.17)	1.06 (0.20)	0.77 (0.21)	0.61 (0.16)	0.81 (0.24)	1.11 (0.24)	1.04 (0.26)	1.00 (0.34)	0.63 (0.22)	0.81 (0.29)	1.04 (0.27)	1.19 (0.35)	0.55 (0.25)	0.62 (0.26)	0.80 (0.42)
Too fat	1.24 (0.33)	1.14 (0.35)	0.70 (0.29)	0.83 (0.32)	0.76 (0.36)	0.80 (0.30)	0.82 (0.34)	0.33 (0.22)	0.51 (0.27)	0.35 (0.24)	2.26* (0.86)	1.99 (0.91)	1.59 (0.90)	2.01 (1.15)	3.25 (2.20)

Note. Due to page limitation, the results of control variables were omitted here and reported in Supplemental Appendix C; odds ratios were reported; standard errors in parentheses. BMI = body mass index; SWS = subjective weight status.

p < .05. **p < .01. ***p < .001.

In terms of gender differences, significant associations between BMI and bullying others were only found in the boys’ group. Overweight boys had higher odds of relational (OR = 3.24, p < .01) and cyberbullying (OR = 2.76, p < .05) and obese boys were more likely to bully others (OR = 1.78, p < .05), especially verbally (OR = 2.14, p < .05) and relationally (OR = 3.14, p < .01). No significant differences were found among the girls’ groups.

In the unadjusted model, analysis of the relationship between SWS and bullying perpetration showed that students who perceived themselves as too thin were more likely to bully others overall (OR = 1.65, p < .05), especially physically (OR = 2.56, p < .001), compared with students who identified themselves as suitable size. However, in the adjusted model, significant differences were only found for physically bullying others (OR = 2.03, p < .05).

The adjusted model results related to gender differences showed no significant association between the different SWS categories and bullying others in the boys’ groups. However, compared with girls who felt they were a suitable size, girls who considered themselves too fat were 2.26 times more likely to bully others overall and those who considered themselves too thin were 2.67 times more likely to bully others physically.

Discussion

This article examined the association between weight status (BMI and SWS) and involvement in school bullying (being bullied and bullying others) according to gender by analyzing a national sample of school-aged children and adolescents in China. To the best of our knowledge, this was the first weight-related school bullying research conducted in a Chinese context that included both subjective (perceived) and objective (BMI) assessments of weight.

Overall, students who deviated from normal-weight status (i.e., underweight, overweight, or obese) were not significantly associated with being bullied overall compared with normal-weight students, although most studies from Western countries reported that overweight and obese youth were at risk for being bullied (Janssen et al., 2004; Lian et al., 2018; Reulbach et al., 2013). One possible reason for the discrepancy may be that China has relatively low proportions of overweight and obese people compared with Western countries (Ng et al., 2014), although the absolute number is significant. Another possible explanation could be that the stigmatization of overweight people in China is not as strong or widespread as in Western cultures. Compared with developed countries, China has only lifted herself from a state of poverty over the last two decades. It is logical to consider that people who have experienced poverty may prefer, or at least not tend to stigmatize, obesity, and such attitudes may affect the next generations (Kim et al., 2016). Therefore, overweight people may not be bullied in a background of weaker stigma because stigmatization was reported to be a link between being overweight and being bullied (Puhl & King, 2013). In addition, China’s collectivist culture may reduce peoples’ negative attitudes toward overweight individuals.

SWS seems to be a better predictor of being bullied than BMI, whereas BMI’s effect was more significant than SWS for bullying others. Regarding being bullied, in the adjusted model, the perception of being too fat, rather than the BMI, was significantly associated with being bullied. Similar observations were found in the United States (Carey et al., 2018) and Seychelles (Wilson et al., 2013). However, concerning bullying others, students with overweight and obese BMIs were more likely to bully others physically and relationally. However, when SWS was used, only the too-thin group was more likely to bully others physically.

Regarding the specific forms of bullying involvement, the correlations between weight status and the types of school bullying varied. For example, overweight and obese BMIs were risk factors for being cyberbullied, as found in previous studies (DeSmet et al., 2014). Meanwhile, overweight and obese students were more likely to bully others physically and relationally. A potential explanation is that overweight and obese students may be physically stronger, enabling them to bully others physically and relationally (Griffiths, Wolke, Page, & Horwood, 2006). In addition, students who perceived themselves as slightly fat and too fat were more likely to be verbally bullied and students in the too fat category were more likely to be relationally bullied. Overweight or obese status can lead to lower self-esteem, depression, and peer isolation, especially in cultures unfriendly to overweight or obese people (Perrin, Boone-Heinonen, Field, Coyne-Beasley, & Gordon-Larsen, 2010; Xie et al., 2003). These factors may make overweight and obese people even more vulnerable to bullying (Giletta, Scholte, Engels, & Larsen, 2010).

Furthermore, the association between weight status and school bullying involvement exhibited gender differences. Consistent with previous findings (Carey et al., 2018), the effects of SWS on being bullied was significant for girls but not for boys in this study. Moreover, the association between bullying others and SWS was significant among girls only. However, BMI mainly affected the involvement of boys in school bullying (both being bullied and bullying others). Gender stereotypes may mediate the linkage between weight status and involvement in school bullying and needs further investigation.

This study had several limitations that should be noted. First, this was a cross-sectional survey and causal relationships between weight status and involvement in school bullying cannot be made. Second, this study only included students from cities in China and investigations including children and adolescents from both urban and rural areas should be conducted in the future because of the substantial urban–rural division in China (Han et al., 2017). Third, although we included BMI as an objective measure of weight status in this study, BMI was calculated by self-reported information rather than measured using standard electronic scales and a stadiometer and thus, a risk of reporting bias may exist (Giletta et al., 2010). Therefore, better measurements of body shape are needed.

Findings from this study can provide three implications for practice. First, students who deviate from normal weight, especially overweight and obese students, have a higher risk of being bullied, as well as bullying others. They can be both victims and perpetrators of school bullying. Nevertheless, the high probability of underweight students bullying others cannot be neglected. Second, school bullying measures and anti-bullying programs should include detailed behaviors of school bullying, rather than one overall measure of bullying. Our study demonstrated that the prevalence, as well as the linkage between weight status and school bullying involvement, varied across different types of bullying behaviors. Third, the linkage between weight status and involvement in school bullying exhibited gender differences. Therefore, anti-bullying interventions should be gender-sensitive, especially for overweight and obese girls.

Conclusion

In conclusion, SWS mattered more than BMI in the association between weight status and being bullied, whereas BMI played a role in more types of bullying perpetration than did SWS. Moreover, overweight and obese students had the highest risks of being involved in school bullying. The associations between weight status (BMI and SWS) and involvement in school bullying (being bullied and bully others) showed different patterns between boys and girls—BMI mainly affected boys’ involvement in bullying others, whereas SWS mainly affected girls’ involvement.

Supplemental Material

Appendices – Supplemental material for Weight Status and School Bullying Experiences in Urban China: The Difference Between Boys and Girls

Supplemental material, Appendices for Weight Status and School Bullying Experiences in Urban China: The Difference Between Boys and Girls by Zepeng Gong, Ziqiang Han, Haibo Zhang and Guirong Zhang in Journal of Interpersonal Violence

Footnotes

Acknowledgements

The authors acknowledge all students, teachers, and staffs who participated in the study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This paper was supported by the National Social Science Foundation of China under grant Emerging Risk, Adaptation of Public Safety System (No. 13AGL009), and the Hunan Province’s 13th Planning Project of Education-School Bullying in New Era: The Reasons, Consequences, and Interventions.

Ethical approval

The study was designed in accordance with the Declaration of Helsinki, and all procedures and instruments were reviewed and approved by the Research Ethics Board of the university that led the investigation. Permission was granted from each school. The participation was wholly voluntary and anonymous.

ORCID iD

Ziqiang Han

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Zepeng Gong is a PhD candidate at the Institute for Disaster Management and Reconstruction/West China School of Public Health and West China Fourth Hospital, Sichuan University, China. He is majoring in epidemiology and health statistics. His research interests include public health, emergency preparedness, and school safety.

Ziqiang Han is a professor at the School of Political Science and Public Administration, Shandong University, China. He is interested in risk, disaster, and emergency management. Recently, he mainly focuses on the topic of comprehensive school safety, emergency preparedness, and behavior decision.

Haibo Zhang is a professor at the School of Government, Nanjing University, China. His research interests include emergency management, public security, and governance.

Guirong Zhang is a professor at the School of Public Administration, Central South University, China. Her research interests include social risk and public policy assessment, and school safety.

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