Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents

Abstract

Obesogenic behaviors have been individually associated with bullying during adolescence. However, physical activity, sedentary behavior, and diet manifest themselves in synergy and even behavioral profiles in which positive and negative behaviors coexist can be more positively associated with psychosocial outcomes. The present study aimed to analyze the association between clusters of obesogenic behaviors and different bullying roles in Brazilian adolescents. This cross-sectional study used data from the Brazilian School-based Health Survey—PENSE, 2015. A total of 100,794 male and female adolescents of the ninth-grade elementary school participated in the study. Students responded to an electronic questionnaire. Clusters of obesogenic behavior consisted of physical activity, exposure to sedentary behavior, and diet, and the different roles in bullying were: participant, victim, bully, and bully–victim. Binary logistic regression with 95% confidence intervals (CI) was used for data analysis (p < .05). Multiple adjustments and complex sampling procedures were employed. Adolescents in the cluster “Health-promoting sedentary behavior and Diet” had reduced chances of participating in bullying (odds ration [OR] = 0.70; 95% CI [0.64, 0.76]), of being a victim (OR = 0.87; 95% CI = 0.76–0.99), and being the bully (OR = 0.65; 95% CI [0.59, 0.71]); and those from the cluster “Health-promoting physical activity and Diet” had reduced chances of participating (OR = 0.81; 95% CI [0.76, 0.87]), being a victim of bullying (OR = 0.86; 95% CI [0.76, 0.98]), being the bully (OR = 0.79; 95% CI [0.72, 0.85]), and being a bully–victim (OR = 0.74; 95% CI [0.61, 0.90]), when compared to those from the “health-risk” cluster in the adjusted analysis. Clusters of obesogenic behavior may reduce adolescent bullying: victim, bully, and bully–victim benefit when exposed to healthier behavioral profiles. The school setting must recognize bullying as a problem and therefore simultaneously promote multi-component interventions to tackle physical activity, sedentary behavior, and eating behavior. Outcomes other than obesity should be acknowledged when promoting obesogenic behaviors.

Keywords

bullying youth violence community violence cultural contexts violent offenders

Introduction

Bullying is characterized by harmful, aggressive, intentional, and recurrent behaviors that involve physical, emotional, and/or psychological violence/harm to individuals who are unable to stop the aggression. Bullying is illustrative of power asymmetry between peers and is a serious social problem (Biswas et al., 2020; Olweus, 2013).

There are different roles in the context of bullying: the bully, the victim, both (bully–victim), and those who witness the practice of bullying. The prevalence of bullying victimization in adolescents from low- and middle-income countries is 35.9% (Smith et al., 2021), suggesting that the number of bullies and adolescents who witness bullying should be even higher. However, in Brazil, bullying perpetration prevalence is lower, with a 7.2% prevalence of victimization and 20.8% perpetration of bullying found in 2012 (Malta et al., 2014), and a 18.3% prevalence of victimization and 4.9% perpetration of bullying in a population-based study conducted with a representative sample of (n = 2,680) schoolchildren in the city of São Paulo, Brazil (Loch et al., 2020).

Recent evidence shows that bullying during adolescence can be positively or negatively influenced by obesogenic behaviors, such as physical activity, exposure to sedentary behavior (García-Hermoso et al., 2020), and eating behavior (Holubcikova et al., 2015; Jackson, 2017; Waasdorp et al., 2019; Zahedi et al., 2014). Engaging in physical activity and decreasing sedentary behavior can foster greater adolescent social encouragement by increasing self-confidence and the ability to solve problems and reducing social isolation, which protects adolescents from bullying (Alfonso-Rosa et al., 2020; Malaeb et al., 2020; Waasdorp et al., 2019). Similarly, a lack of physical activity and excessive screen time can increase the social vulnerability of these adolescents and favor bullying, increasing the probability of being a victim of bullying (Fitzpatrick et al., 2019; García-Hermoso et al., 2020; Rech et al., 2013).

In addition, unfavorable behaviors, such as the consumption of ultra-processed products and soft drinks, are also associated with bullying and violent behavior (Alfonso-Rosa et al., 2020; Holubcikova et al., 2015; Malaeb et al., 2020; Waasdorp et al., 2019; Zahedi et al., 2014). These can also expose adolescents to overweight and obesity, stereotypes recognized in the literature as facilitators of bullying (Koyanagi et al., 2020).

Adolescents’ Lifestyle, Obesogenic Behaviors, and Bullying Perpetration

Obesogenic behaviors have been individually associated with bullying (e.g., physical activity and bullying) (García-Hermoso et al., 2020; Holubcikova et al., 2015; Zahedi et al., 2014), and the World Health Organization recommends that adolescents participate in moderate-to-vigorous physical activity for 60 minutes or more per day for better health (Bull et al., 2020). In addition, international and national physical activity guidelines have recently suggested that meeting physical activity recommendations is vital for school-age children’s and adolescents’ physical, psychological, social, and cognitive health (Brasil, 2021; Piercy et al., 2018).

Physical activity is considered a critical protective factor against bullying (Shah et al., 2019; Turagabeci et al., 2008). Regular physical activity promotes improved physical fitness, motor skills, and provides cognitive and mental health benefits such as increased self-control, self-esteem, and empathy (Biddle et al., 2019). Moreover, the consequences of physical activity are widely associated with a reduction in aggressive and deviant behaviors (Spruit et al., 2016).

A cross-sectional study by Merril and Hanson (2016) found that physically active adolescents who played in sports teams were less likely to be victimized by bullying, possibly because they seemed less vulnerable due to group support and protection. More recent studies have also reported reduced vulnerability due to physical activity context (Shah et al., 2019; Waasdorp et al., 2019). Similar findings have been observed in physical activity programs in school settings. For example, Bleeker et al. (2012), who developed Playworks, a program that aims to provide opportunities for organized play during recess and throughout the school day, found positive reductions in bullying victimization and improvements, including positive attitudes, in the school environment.

The same was also evidenced by Garnett et al. (2016), who observed that in schoolchildren, fewer victims of bullying were more active, including running and walking, than those who were less active. Likewise, the study by Hormazábal-Aguayo et al. (2019), which applied an eight-week preschool physical activity program to Chilean schoolchildren, found a statistically significant reduction in the probability of being physically (odds ratio [OR] = 0.18; 95% confidence interval [CI] [0.04, 0.82]; p = .027) and verbally bullied (OR = 0.13; 95% CI [0.02, 0.97]; p = .046) after the completion of the program.

Structured physical activity programs at school seem to provide motor skills and knowledge, a sense of respect, and body and social awareness. In addition, physical activity programs help adolescents solve problems and favor cooperative attitudes, which may explain the reduction in bullying victimization among schoolchildren who practice regular physical activity (García-Hermoso et al., 2020; Hormazábal-Aguayo et al., 2019). Physical activity may increase adolescents’ confidence in establishing social relationships with peers and promote prosocial attitudes (Bleeker et al., 2012; Hormazábal-Aguayo et al., 2019). However, there is a scarcity of studies that have evaluated the relationship between the habitual practice of physical activity and bullying roles.

Observing sedentary behavior is also important when examining the contribution of both physical activity and sedentary behaviors to children and adolescents’ health (Katzmarzyk et al., 2019). There is evidence that compliance with screen time recommendations is associated with a lower likelihood of being a bullying victim (OR = 0.64; 95% CI [0.46, 0.88]) or aggressor of bullying (OR = 0.64; 95% CI [0.43, 0.96]) (Sampasa-Kanyinga et al., 2014). Limiting sedentary behavior may reduce impulsivity (Guerrero et al., 2019), internalization (e.g., depression, anxiety, somatic complaints), and externalization (e.g., aggression, delinquency) behaviors (Sampasa-Kanyinga et al., 2014), thereby protecting adolescents from bullying perpetration. In addition, meeting sedentary behavior recommendations contributes to adolescents’ greater social encouragement through increased self-confidence, greater ability to solve problems, and reduced social isolation (Alfonso-Rosa et al., 2020; Malaeb et al., 2020; Waasdorp et al., 2019).

Sedentary behavior may also be a consequence of bullying; to avoid distress, adolescents may opt for more solitary activities, such as playing video games, watching television, or using the computer, instead of activities that require socialization (Feldmann et al., 2012; Kuntsche et al., 2006). Thus, excessive screen use is more significant in individuals who experience social isolation, leading to cognitive, physical, and emotional disturbances (Hall-Lande et al., 2007; Leigh-Hunt et al., 2017). Social isolation is an antisocial behavior that increases bullying (Spriggs et al., 2007). On the other hand, friendships are a protective factor against bullying (Fox & Boulton, 2006; Primack et al., 2017).

Good nutrition for young people, for instance, is described in the scientific literature as healthy and prosocial behavior (Merrill & Hanson, 2016; Turagabeci et al., 2008; Waasdorp et al., 2019). However, the mechanisms underlying these associations remain debatable. A healthy diet favors overweight/obesity control, which is related to several social and psychological factors (O’Neil et al., 2014) and cognitive benefits (executive function–inhibitory control, working memory, attention, and planning) (Cohen et al., 2016). Additionally, the literature consistently reports that overweight/obese children and adolescents are more vulnerable to bullying (Koyanagi et al., 2020; van Geel et al., 2014).

An unhealthy diet is associated with bullying perpetration (Alfonso-Rosa et al., 2020; Holubcikova et al., 2015; Malaeb et al., 2020; Waasdorp et al., 2019; Zahedi et al., 2014). The consumption of ultra-processed foods, soft drinks, caffeine, and skipping breakfast is a mechanism associated with bullying perpetration (Farrow & Fox, 2011; Sampasa-Kanyinga et al., 2014). An unhealthy diet can cause deregulation of various perceptual mechanisms of the body, which can affect decision-making. An adequate supply of nutrients, such as folic acid, vitamin B12, and polyunsaturated fat, is valuable for proper central nervous function and influences mood state by synthesizing neurotransmitters such as serotonin (Bamber et al., 2007; Salem et al., 2001). Therefore, low intake of food/nutrients dysregulates the production of neurotransmitters and consequently influences mood.

Consumption of soft drinks and caffeine is also related to nervousness and irritability (Kristjansson et al., 2013; Martin et al., 2008). Psychological distress may be due to artificial coloring, caffeine, and sugar, which can alter blood glucose levels and metabolism (Kristjansson et al., 2013; Tandel, 2011). Thus, evidence shows that adolescents with aggressive behavior tend to consume more soft drinks. In a study in Slovakia, researchers found that nervousness and irritability mediated the association between soft drink consumption and bullying among adolescents (Holubcikova et al., 2015). Skipping breakfast, for instance, can occur due to psychological distress from being bullied, as intense psychological and social suffering can decrease appetite (Sampasa-Kanyinga et al., 2014), suggesting a possible bidirectional association among phenomena.

Research Problem

Despite the evidence from primarily bivariate analysis, it is well known that physical activity, sedentary behavior, and diet manifest themselves in synergy. Adolescents’ behaviors are multi-varied and interact synergistically or compete with one another, combining positive and negative habits (Leech et al., 2014, 2015; Matias et al., 2018).

Clustering studies show that even behavioral profiles in which positive and negative behaviors coexist (e.g., the adolescent practices physical activity and spends many hours in front of the computer) can be more positively associated with psychosocial outcomes (Matias et al., 2019). For example, Iannotti and Wang (2013), evaluating clusters of obesogenic behaviors and their relationship with physical and mental health in adolescents in the United States, found that the cluster with the highest sedentary behavior, the highest proportion of non-healthy diet but meeting (moderately) physical activity criteria, or consuming fruits or vegetables daily, was associated with lower body dissatisfaction.

Since Iannotti and Wang’s (2013) study, little progress has been made in understanding the co-occurrence of these behaviors and their association with psychosocial aspects, such as bullying. To the best of our knowledge, there is no evidence of a relationship between clusters of obesogenic behaviors and different patterns of bullying. Several studies have only examined victims of bullying (Waasdorp et al., 2019), and few have explored factors related to bullies themselves (Méndez et al., 2019; Rech et al., 2013).

Therefore, it is essential to understand (a) the relationships between clusters of obesogenic behaviors and bullying, even when positive and negative behaviors coexist in adolescents’ lifestyles, and (b) whether these relationships influence the different roles played in bullying. This study investigated the association between clusters of obesogenic behaviors and different roles in bullying in a population-based survey of Brazilian adolescents.

Methods

Study Design and Participants

The present study had a cross-sectional design, and data from the “National School-based Health Survey (PeNSE)” conducted in 2015 were used. PeNSE follows the World Health Organization recommendations for student health surveys and aims to investigate students enrolled in the 9th grade of elementary school from urban and rural areas and public and private schools all over Brazil (Sample 1). PeNSE is a partnership between the Brazilian Institute of Geography and Statistics and the Brazilian Ministry of Health. The main objective of PeNSE is to follow the risk and protective factors of the health and lifestyle behaviors of Brazilian students. The PeNSE sampling process represented all geographical areas, capitals, and federal districts of Brazil. From 3,040 schools, 102,301 students were assessed in this study. Of these, 229 students declined to participate in the research, did not report their age or sex, and were not analyzed. The sampling strategy included geographical stratification and multistage selection, as described elsewhere (Oliveira et al., 2017). Ethics committee approval was obtained, and the participation of all participants was approved by the National Committee of Ethics in Research (number 1.006.467/2015).

Measures

The researchers assessed students using an electronic questionnaire. The PeNSE questionnaire was based on the Global School-Based Student Health Survey and the Youth Risk Behavior Surveillance System. PeNSE is in its third edition, and the instrument has been tested and adjusted to make adjustments and determine adequacy.

Cluster Formation

Table 1 shows the three obesogenic behaviors examined in the clustering procedure (leisure-time physical activity, sedentary behavior, and diet). Sedentary behavior was defined by sitting time. Diet was assessed using seven indicators: green salads or vegetables, fruits, deep-fried empanadas, candies, soda, fast foods, and ultra-processed foods. The cluster profiles were previously classified and validated by Matias et al. (2018). A total of 1507 (<1.5% of the total sample) adolescents did not provide valid information about physical activity, sedentary behavior, or diet and were not considered for analysis.

Table 1.

Variables Used in Cluster Formation, Their Questions, Response Options, and How They Were Classified.

Variables	Questions	Answers Range	Classification
Leisure-time physical activity	In the past seven days, how many days did you practice some physical activity like sports, dance, gym exercises, fighting sport, or other activities without considering physical education class?	From none to 7 days in a week	Not applicable
Sedentary behavior	On a regular day, how much time do you spend watching television, playing video games, talking with friends, or in other sitting activities?	From 1 to 9 hours a day	Not applicable
Diet	During the past 7 days, how many times did you eat INDICATORS SPECIFIC EXAMPLES?	From none to 7 days in a week	An exploratory factor analysis was used to identify dietary patterns.

An exploratory factor analysis identified healthy (green salads or vegetables and fruits) and unhealthy (deep-fried empanadas, candies, soda, ultra-processed, and fast foods) food groups. Factor analysis was suitable (Kaiser–Meyer–Olkin measure of sampling adequacy [0.72] and Bartlett’s test of sphericity [p < .001]), and no rotation was required. The factors were extracted based on the screen plot, and items with factor loadings greater than 0.60 were retained. These two factors were entered independently into the cluster analysis. The factor score for each factor was created by summing the observed (days/week) intake of the indicator food items divided by the number of food items.

A two-step cluster procedure was used, and log-likelihood was used as the distance measure to account for congruency between clusters. Leisure-time physical activity, sedentary behavior, and healthy and unhealthy diets were independently included in the model. A combination of three criteria (low Schwarz’s Bayesian Criterion [BIC], high ratio of distance measures, and high ratio of BIC changes), as well as theoretical implications, were used to determine the appropriate number of clusters. The final cluster solution was successfully replicated between younger and older adolescents (Matias et al., 2018).

Three clusters were identified in the 100,794 adolescents. Cluster 1, labeled “Health-promoting sedentary behavior (SB) and diet,” comprised 32.6% of the sample, Cluster 2 (44.9%), labeled “Health-promoting physical activity (PA) and diet,” and cluster 3: “Health-risk” comprised 22.5% of the sample. The health-promoting SB and diet cluster suggested a “positive” behavior for sedentary behavior and unhealthy diet, since the adolescents spent less than 3 hours a day in sedentary behavior and had, on average, less than 2 days/week of an unhealthy diet, despite not being physically active and having only an average of 2.68 days/week of a healthy diet. The health-promoting PA and diet cluster (Cluster 2) was representative of active behavior (physical activity pattern of 4.56 days/week) but combined almost 4 hours/day in sedentary behaviors. Participants within this cluster were reported to have unhealthy (under 3 days/week) and healthy diets (more than 4 days/week). The health-risk cluster (Cluster 3) comprised adolescents that combined an obesogenic profile considering all behaviors, such as excessive levels of SB, unhealthy diet, and lack of physical activity. The silhouette coefficient of 0.40 indicated that the overall model was fair. The clusters are shown in Figure 1. A detailed description of the clustering procedures, validation process, and results can be found elsewhere (Matias et al., 2018).

Figure 1.

Clustering of obesogenic behavior. Brazil School-Based Health Survey among ninth-grade students—PeNSE, 2015 (Sample 1). Cluster 1 = health-promoting SB and diet; cluster 2 = health-promoting PA and diet; cluster 3 = health-risk; SB = sedentary behavior; PA = physical activity.

Bullying Variables

Participants were asked about two aspects: (a) “In the past 30 days, how often have any of your schoolmates bullied, or teased you so much that you were hurt, annoyed, offended, or humiliated?” A 5-point Likert-type scale ranging from “never” to “always” was the response option. Those who responded “always” or “most of the time” were considered victims of bullying (those who were the bully or bully–victim were not considered for this outcome); and (b) “In the past 30 days, have you mocked, bullied, or teased any of your schoolmates so much that they were hurt, annoyed, offended, or humiliated?” Respondents who answered yes were considered bullies, and those who answered no were not considered for this outcome. We also observed those students who were identified as victims and bullies simultaneously, treating an independent outcome as a specific role: the bully–victim (victims and bullies alone were not considered for this outcome); and we classified those who participated in bullying independent of their role (participant vs. nonparticipant).

Covariates

The covariates were sex (male, female), skin color (white, black, yellow, brown, indigenous), age, lives with the mother (yes, no), lives with the father (yes, no), mother’s education (no schooling, elementary school, high school, higher education), number of people in the household, owns a cell phone (yes, no), owns a computer (yes, no), internet access (yes, no), studies full time (yes, no), goes to a boarding school (yes, no), cigarette consumption (last 30 days), alcohol consumption (last 30 days), drug use (last 30 days), sexual intercourse (number of people), condom use in the first (yes, no) and last sexual experience (yes, no), has suffered family aggression (last 30 days), involvement in gun fights (last 30 days), involvement in fights with another type of weapon (last 30 days), wears seat belt when in a car (last 30 days), wears helmet when on a motorcycle (last 30 days), drives a motorized vehicle (last 30 days), has suffered aggression (last 12 months), involvement in fights (last 12 months), body satisfaction (very satisfied, satisfied, indifferent, dissatisfied, very dissatisfied), feelings of loneliness (last 12 months), difficulty sleeping (last 12 months), number of friends, perceived health (very good, good, regular, bad, very bad), and type of school (municipal, state, federal, private).

Statistical Analysis

The participants’ characteristics were described using absolute and relative frequencies with 95% CI for nominal variables and means with standard deviations (SD) for numerical variables. The association between covariates and dependent variables was performed using the Rao-Scott χ² procedure. Binary logistic regression models were used to evaluate the association between exposures (clusters) and bullying roles. The multivariate analysis was chosen because it allowed adjustment for multiple confounders. Furthermore, it respected the qualitative nature of our dependent binary variables, and was simple to implement and interpret. Finally, the study sample size allowed robust adjustments and more reliable interpretations, avoiding type I errors. The adjustments for each outcome are described in Figure 2.

Figure 2.

Adjusted association between clusters of obesogenic behavior and bullying roles. Panel A—participation in bullying; adjusted for sex, skin color, age, lives with the mother, lives with the father, mother’s education, number of people in the household, owns a cell phone, owns a computer, internet access, studies full time, goes to a boarding school, cigarette consumption, alcohol consumption, drug use, sexual intercourse, use of condoms in the first and last sexual intercourse, involvement in gunfights, involvement in fights with another type of weapon, wears a helmet, drives a motorized vehicle, has suffered aggressions, involvement in fights, satisfaction with their body, feelings of loneliness, difficulty sleeping, number of friends, perception of health status, and type of school. Panel B—victim; adjusted for sex, skin color, age, lives with the father, mother’s education, number of people in the household, owns a cell phone, internet access, studies full time, goes to a boarding school, cigarette consumption, alcohol consumption, drug use, sexual intercourse, condom use in the first and last sexual intercourse, involvement in gunfights, involvement in fights with another type of weapon, wears a seat belt, wears a helmet, drives a motorized vehicle, has suffered aggressions, involvement in fights, satisfaction with their body, feelings of loneliness, difficulty sleeping, number of friends, perception of health status, and type of school. Panel C—bully; adjusted for sex, skin color, age, lives with the mother, lives with the father, mother’s education, number of people in the household, owns a cell phone, owns a computer, internet access, studies full time, goes to a boarding school, cigarette consumption, alcohol consumption, drug use, sexual intercourse, condom use in the first and last sexual intercourse, involvement gunfights, involved in fights with another type of weapon, wears a seat belt, wears a helmet, drives a motorized vehicle, has suffered aggressions, involvement in fights, satisfaction with their body, feelings of loneliness, difficulty sleeping, number of friends, perception of health status, and type of school. Panel D—bully–victim; adjusted for sex, skin color, age, lives with the father, mother’s education, goes to a boarding school, cigarette consumption, alcohol consumption, drug use, sexual intercourse, condom use in the first and last sexual intercourse, involvement in gunfights, involvement in fights with another type of weapon, wears a seatbelt, wears a helmet, drives a motorized vehicle, has suffered aggressions, involvement in fights, satisfaction with their body, feelings of loneliness, difficulty to sleep, number of friends, perception of health status, and type of school.

The “Health-risk” cluster was the reference category in the regression models. All covariates, after bivariate prescreening, were individually associated with bullying roles as candidates to be retained in the model; significant predictors (at p-value < 2) were retained. All covariates in a block were entered in a single step into the regression equation. The interaction terms between exposures (clusters) and sex were also tested. When significant interaction effects were observed (p < .05), subgroup analyses were performed to estimate the associations between exposure and bullying roles for each sex stratum (male, female), and the results were expressed as OR and 95% CI. The survey design and weighting were considered in all inferential procedures. The data were analyzed using STATA 15 software (Stata Inc., College Station, TX, USA), except for the cluster procedures, and the significance level was defined as p < .05.

Results

Table 2 shows the sociodemographic characteristics of the included 100,794 students, with an average age of 14.28 years (SD = 0.013). Regarding the roles in bullying, 24.68% (95% CI [24.09, 25.29]) of the adolescents had participated in bullying, 8.91% (95% CI [8.52, 9.33]) of which were victims, 20.78% (95% CI [20.20, 21.37]) were bullies, and 3.14% (95% CI [2.89, 3.41]) were bully victims.

Table 2.

Characteristics of the Participants. PENSE, Brazil 2015 (n = 100,794).

Variables	n	%	95% CI
Sociodemographic characteristics
Sex
Male	48,580	48.62	[47.99, 49.25]
Female	52,214	51.38	[50.75, 52.01]
Skin color
White	33,415	36.26	[35.22, 37.31]
Black	12,642	13.29	[12.78, 13.82]
Yellow	4,525	4.11	[3.87, 4.36]
Brown	46,358	43.03	[42.14, 43.93]
Indigenous	3,765	3.31	[3.08, 3.54]
Type of school
Municipal	287	0.10	[0.04, 0.26]
State	48,785	48.31	[45.01, 51.62]
Federal	30,927	37.00	[34.06, 40.04]
Private	20,795	14,59	[12.64, 16.78]
Lives with the mother
Yes	89,382	89.96	[89.59, 90.33]
No	11,378	10.04	[9.67, 10.41]
Lives with the father
Yes	62,843	63.71	[63.00, 64.40]
No	37,869	36.29	[35.60, 37.00]
Mother’s education
No schooling	5,432	7.28	[6.87, 7.72]
Elementary School*	23,960	35.29	[34.25, 36.34]
High school*	23,957	32.96	[32.14, 33.79]
Higher education*	22,550	24.47	[23.14, 25.85]

Note. n = absolute frequency; % = prevalence; 95% CI = 95% confidence interval.

Represents having started and/or completed the educational level.

Students from the “Health-promoting SB and diet” cluster were 30% less likely to participate in bullying (OR = 0.70; 95% CI [0.64, 0.76]), 17% less likely to be a victim of bullying (OR = 0.87; 95% CI [0.76, 0.99]), and 35% less likely to be a bully (OR = 0.65; 95% CI [0.59, 0.71]) when compared to those from the “health-risk” cluster in the adjusted analysis. Those from the “Health-promoting PA and diet” cluster had a reduced chance of participating in bullying (OR = 0.81; 95% CI [0.76, 0.87]) and being a victim (OR = 0.86; 95% CI [0.76, 0.98]), bully (OR = 0.79; 95% CI [0.72, 0.85]), and bully victim (OR = 0.74; 95% CI [0.61, 0.90]) when compared to those in the “Health-risk” cluster in the adjusted analysis (Figure 2).

Interaction analyses showed that the relationship between clusters and being a victim of bullying differed between males and females. The above protective effect observed for the “Health-promoting SB and diet” cluster and the “Health-promoting PA and diet” cluster did not occur for girls. For boys, those in the “Health-promoting PA and diet” were 24% less likely to be a victim of bullying when compared to adolescents in the “Health-risk” cluster (OR = 0.76; 95% CI [0.64, 0.91]; p = .002). No interaction was found for the bullying role of others.

Discussion

This study aimed to investigate the association between clusters of obesogenic behavior and bullying roles among a representative sample of Brazilian adolescents. Almost a quarter of the population is involved in bullying. When these roles were discriminated, it was observed that most were bullies, and nearly 10% of adolescents were victims of bullying. Exposure to clusters of healthier obesogenic behaviors (regardless of the combination of behaviors) in adolescents has been associated with reduced chances of participating in bullying, being bullied, being a bully, and being a bully victim.

The literature has provided evidence that practicing physical activities, avoiding sedentary behaviors (especially screens), and healthier food choices can possibly indirectly favor adolescents’ socialization and protect against overweight and obesity; healthier behaviors improve confidence in the face of daily activities, promoting better mental health (Hoare et al., 2014) and body image (Matias et al., 2019) among adolescents, which can protect them from bullying circumstances.

The opposite has also been reported in literature (García-Hermoso et al., 2020). Evidence shows that not following recommendations of 60 minutes or more of moderate to vigorous physical activity on weekdays, screen time longer than 2 hours (García-Hermoso et al., 2020; Patte et al., 2020), and unhealthy eating habits (Himmelstein et al., 2019) exposes adolescents to bullying victimization (García-Hermoso et al., 2020). Low engagement in physical activities can contribute to a less confident young person with fewer motor and social skills. Moreover, sedentary behavior, especially screen time, reduces the personal experiences of children and adolescents, contributing to less problem-solving capacity, fewer friends, and loneliness, among other intra- and interpersonal vulnerabilities that contribute to bullying victimization (García-Hermoso et al., 2020).

Regarding the coexistence of behaviors (cluster analysis), we hypothesized that physical activity and sedentary behavior share similar mediators in their relationship with bullying. This is why, even when exposed to screens, when adolescents include physical activities in their daily lives, they might experience protection from bullying. Similarly, even without practicing physical activities, when they are not excessively exposed to sedentary behavior, they can avoid participating in bullying or being victims of bullying.

Studies have shown that healthy eating is accompanied by physical activity and less sedentary behavior (Leech et al., 2014, 2015). Therefore, a healthier diet can help adolescents to control their weight (Landsberg et al., 2010). Healthy eating behavior can prevent young people from avoiding physical activities and increasing sedentary behavior, with a bidirectional effect. Overweight and obese adolescents are more likely to be victims of bullying (Koyanagi et al., 2020; van Geel et al., 2014), and the negative stereotypes associated with obesity, such as laziness, incompetence (Koyanagi et al., 2020), and lack of discipline (Smith et al., 2021), tend to favor bullying.

The protective effects observed in boys and not in girls for bullying victimization may be explained by significant gender differences in bullying characteristics, and lifestyle may not sufficiently protect girls. Previous studies have shown that females use bullying indirectly, opting for verbal aggression, and predominantly attack other girls. In addition, the focus of aggression is related to sexual competition, sexual attractiveness, and aesthetic physical attributes (Vaillancourt, 2013). These results suggest that a girl perceived as a sexual rival can be a victim of bullying (Vaillancourt & Sharma, 2011). Furthermore, in women, sexual attractiveness is related to thinness; therefore, the effects of healthy behaviors can expose girls to an increased chance of bullying victimization.

However, the consequences of bullying differ between the sexes. Girls appeared to be more vulnerable to the harmful effects of bullying. For example, among females, the odds of reporting psychological distress and suicidal ideation increased with exposure to bullying victimization (Kim et al., 2019). Furthermore, there is a positive association between the recurrence of bullying and the presence of obesity and overweight in women (Hammami et al., 2020).

Limitations

Some limitations of this study must be noted. This study was cross-sectional, and causal relationships cannot be assumed. It is also possible that the association between obesogenic behavior and bullying is bidirectional. The adjusted models did not control for weight status, leading to an analysis bias. Additionally, clustering procedures are subject to the biases of different algorithms, and different behavior profiles can be observed for this population using other algorithms. The results of this study are specific to students who attend school; however, in Brazil, school dropout rates are high, so caution in extrapolating the data is necessary. The comparison of our results and clustering procedures with the literature was somewhat constrained because most of the studies are limited to studying bullying victimization.

However, to our knowledge, this is the first study to investigate the relationship between obesogenic behavior and bullying perpetration. Analyses were performed on a representative sample of adolescents, and the formation of clusters was previously validated. Statistical inferences considered multiple adjustments, including indicators of body image, a notable proxy of overweight and obesity in adolescence, which suggests the consistency of the findings.

Implications and Generalizations

Prosocial behaviors can operate positively in different bullying roles, including preventing bullying profiles. These results are relevant from a public-health perspective. Seeing behaviors that mitigate the chances of an adolescent being a bully means possibly preventing young people from being bullied and undoing the entire chain of relationships involved in bullying victimization. Unfortunately, few studies have focused on the different roles of bullying, and most have investigated victims. Correlational studies have focused more on understanding adolescents’ exposure to negative behaviors and their chances of being victims, limiting their understanding, practical sense, and the construction of public policies on the subject.

The school setting must recognize bullying as a problem. School bullying should be highlighted as a risk factor for the internalization and/or externalization of health problems, such as depressive symptoms, poor self-esteem, and violent behavior (Chung et al., 2018; Malaeb et al., 2020). Moreover, these negative consequences have long-term effects on school communities' cultural, social, and individual dynamics (Maunder & Crafter, 2018). Therefore, multicomponent interventions should be promoted to tackle physical activity, sedentary behavior, and eating behavior simultaneously. Recommendations for managing sedentary behavior in the pedagogical projects of Brazilian schools have been recently suggested (Dumith et al., 2021).

However, adolescent behavior literature has mainly focused on “physical” health determinants. Less attention has been paid to adolescents' psychosocial attributes, mental health, and spiritual elements linked to that behavior (Matias & Piggin, 2022). Consequently, schools have adopted a limited view of the importance of promoting health behaviors beyond obesity/cardiovascular/diabetes consequences, albeit for benevolent purposes. Addressing physical activity, sedentary behavior, and diet synergistically as potentially prosocial and pro-health behaviors is significant, since changing behaviors toward better health has an individual and social function (Iannotti & Wang, 2013).

Thus, environmental changes in the school setting should consider lifestyle promotion, for example, by suggesting activities in the general curriculum and physical education classes in which lifestyle is a central subject, creating active opportunities in the school environment, and promoting ongoing health education in the school community. These strategies have recently been identified as effective in promoting physical activity and sedentary behavior in schools located in vulnerable areas of Brazil; however, other “more social” outcomes such as tobacco use and excessive alcohol consumption changes were not observed as effective (Barbosa Filho et al., 2019).

The authors recognize that these social outcomes were not primary goals, which is understandable from a randomized control trial point of view. The problem is, from a sociological point of view, these adolescents were not questioned about their social lives when promoting healthy behavior. Health cannot be disconnected from individuals or their surroundings. Thus, we must start considering that “physical” health discourse should not establish what is primary and secondary in adolescents’ lives. Recent evidence has demonstrated that people may value social messages about behavior change more than discourse on disease prevention (Harris et al., 2022; Williamson et al., 2020). Therefore, tobacco and alcohol use, bullying, sexual health (in broader terms), and mental health must also be a school's primary health goals (Shackleton et al., 2016).

When promoting lifestyle/obesogenic behaviors, researchers have been recently arguing for a broader view of “promoting”; physical activity, for instance, is a complex act, systemically involving political, social, and emotional aspects (Matias & Piggin, 2020). In this sense, our results might contribute to maximizing progress toward school policies to avoid and prevent bullying perpetration and victimization.

Recent comprehensive reviews have found that different types of school programs are effective in reducing both bullying perpetration (≅20% reduction) and victimization (≅15% reduction) (Gaffney et al., 2019). However, most interventions, despite the ecological level tackled, are more educational than experienced, such as increasing awareness and suggesting regulations (Gaffney et al., 2021). The role of education in behavior change is well known in the literature, as it represents an essential, basal, and transversal component within interventions. However, it does not necessarily culminate in a change in behavior. A systematic review of 100 behavior change theories suggested that people change/maintain behaviors when they experience congruence (Kwasnicka et al., 2016). The behavior will be meaningful and accepted when an individual experiences and meets essential human needs (Deci & Ryan, 2000; Matias & Piggin, 2022).

Our results add to the current models of bullying prevention interventions. Physical activity, sedentary behaviors, and dietary habits are experienced; these behaviors possess a latent force that pushes adolescents to recognize themselves, others, and their community (Matias & Piggin, 2022). The recognized intervention components for anti-bullying programs, such as classroom rules, classroom management, informal peer involvement, cooperative group work, and mental health, can be met not only from education but also from an embodied human physical activity experience, whether playing outdoors or avoiding sedentary videogame play (Matias & Piggin, 2022). Physical activity, for example, is recognized as encouraging/provoking group management, supporting and promoting mental health and psychological attributes, minimizing power imbalance, and meeting immediate human needs for positive interaction (Zurita Ortega et al., 2015). Emphasizing an experienced view of behavior change and looking at behaviors that strongly permeate/influence adolescents’ lives might send a more meaningful message to these adolescents to change toward an anti-bullying attitude.

Thus, physical activity, sedentary behavior, and diet are related to how adolescents perceive themselves (Matias et al., 2019). These behaviors impact body image and motor/physical competence, and influence how they perceive themselves and their peers and when they experience feelings of fun, satisfaction, and success in social activities (Rech et al., 2013). Thus, as a consequence of positive obesogenic behaviors, these foundational perceptions facilitate social integration, friendships, and an increase in popularity (Roman & Taylor, 2013).

Furthermore, active adolescents are more likely to partner in different social activities (e.g., team sports), which restricts the possibility of them being bullied by peers at school (Holbrook et al., 2020). However, the opposite is also true. Children and adolescents with fewer motor skills tend to have fewer friends, are likely to be rejected by their peers, are less invited to play and participate in games, are more likely to suffer from depression (Draghi et al., 2020, 2021), and are likely to be bullied at school (Øksendal et al., 2019, 2022).

It is essential to note that bullying is also likely to occur in the physical activity/physical education context (Alfonso-Rosa et al., 2020; García-Hermoso et al., 2020; Jiménez-Barbero et al., 2020). Physical activity contexts allow substantial and sometimes mandatory social interaction with teams, and this social feature can condone school bullying since students with fewer overall skills and worse motor performance are vulnerable targets to bullies (Scarpa et al., 2012). This means that they can suffer intimidation, aggression, exclusion from games, and malicious comments regarding their performance within active contexts. As a result, many children may avoid exposure to physical activity to prevent vexatious situations due to their “poor” motor skills, which increases the social isolation of these young people. Thus, sedentary behavior occurs more frequently.

The above considerations do not diminish the potential for physical activity and physical education to reduce the perpetration of bullying. Through physical activity, bullies can learn to redirect their potential, including motor competence, to leadership skills. With the help of teachers and coaches, they can find positive and healthy ways to gain power and status among their peers (Gonzalez Hernandez & Martínez Martínez, 2018). In addition, victims of bullying can use physical activities to fulfill their psychological needs, such as status and competence, being more self-confident, and discovering new skills (Sibold et al., 2020). Physical activity for this population helps reduce anxiety (Carter et al., 2021) and equalizes relationships with peers (Gonzalez Hernandez & Martínez Martínez, 2018).

Conclusions

Clusters of obesogenic behaviors that carry both negative and positive behaviors can lead to prosocial attitudes and reduce adolescent bullying. Victims, bullies, and bully–victims also benefit when exposed to healthier behavior profiles. Creating social opportunities for young people to synergistically engage in physical activities and be less exposed to sedentary behavior, especially screens, combined with good eating behavior can reduce the chances of an adolescent becoming a bully, ending the social chain of bullying perpetration.

Supplemental Material

sj-docx-1-jiv-10.1177_08862605221132785 – Supplemental material for Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents

Supplemental material, sj-docx-1-jiv-10.1177_08862605221132785 for Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents by Thiago Sousa Matias, Eliane Denise Araújo Bacil, Vanise dos Santos Ferreira Viero, Yohana Pereira Vieira, Laura Silva da Silva, Andressa Munhoz Sá, Cleonice Santos do Amaral and Timothy Gustavo Cavazzotto in Journal of Interpersonal Violence

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Supplemental material, sj-docx-2-jiv-10.1177_08862605221132785 for Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents by Thiago Sousa Matias, Eliane Denise Araújo Bacil, Vanise dos Santos Ferreira Viero, Yohana Pereira Vieira, Laura Silva da Silva, Andressa Munhoz Sá, Cleonice Santos do Amaral and Timothy Gustavo Cavazzotto in Journal of Interpersonal Violence

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Supplemental material, sj-docx-3-jiv-10.1177_08862605221132785 for Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents by Thiago Sousa Matias, Eliane Denise Araújo Bacil, Vanise dos Santos Ferreira Viero, Yohana Pereira Vieira, Laura Silva da Silva, Andressa Munhoz Sá, Cleonice Santos do Amaral and Timothy Gustavo Cavazzotto in Journal of Interpersonal Violence

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Supplemental material, sj-docx-4-jiv-10.1177_08862605221132785 for Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents by Thiago Sousa Matias, Eliane Denise Araújo Bacil, Vanise dos Santos Ferreira Viero, Yohana Pereira Vieira, Laura Silva da Silva, Andressa Munhoz Sá, Cleonice Santos do Amaral and Timothy Gustavo Cavazzotto in Journal of Interpersonal Violence

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Supplemental material, sj-docx-5-jiv-10.1177_08862605221132785 for Clustering of Obesogenic Behaviors Associated With Bullying Roles Among 100,794 Adolescents by Thiago Sousa Matias, Eliane Denise Araújo Bacil, Vanise dos Santos Ferreira Viero, Yohana Pereira Vieira, Laura Silva da Silva, Andressa Munhoz Sá, Cleonice Santos do Amaral and Timothy Gustavo Cavazzotto in Journal of Interpersonal Violence

Footnotes

Declaration of Conflicting Interests

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

Funding

The author(s) received no financial support for the research and/or authorship of this article.

ORCID iDs

Thiago Sousa Matias

Timothy Gustavo Cavazzotto

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Thiago Sousa Matias is a Professor at the Federal University of Santa Catarina, PhD and Masters in Human Movement Science at the Santa Catarina State University, Brazil. As a researcher, became interested in Exercise Motivation in various contexts; and the synergic between obesogenic behaviors associated with psychological health (cluster analysis).

Eliane Denise Araújo Bacil, PhD in Physical Education at the Federal University of Paraná, Master in Public Health at the Federal University of Santa Catarina, Specialist in Physical Education in the area of Physical Activity and Health from the Federal University of Santa Catarina and Full Degree in Physical Education from the Federal University of Pelotas, Brazil.

Vanise dos Santos Ferreira Viero, Master in Public Health from the University of the Extreme South of Santa Catarina (UNESC). Doctoral student (Health Sciences) at the Federal University of Rio Grande, Brazil. Her PhD focuses on evaluating the impact of COVID-19 on the physical and mental health of the adult and elderly population in the far south of Brazil.

Yohana Pereira Vieira, Master in Health Sciences from the Federal University of Rio Grande do Sul. Doctoral student (Health Sciences) at the Federal University of Rio Grande, Brazil. His doctoral research aims to assess the incidence and prevalence of use of health services by patients after COVID-19 infection in the extreme southern population of Brazil during the period 2021 to 2023.

Laura Silva da Silva is a student of the 8th semester of Psychology at the Federal University of Rio Grande, Brazil. CNPq Scientific Initiation Scholarship.

Andressa Munhoz Sá is a Psychologist and Master student (Public Health) at the Federal University of Rio Grande, Brazil. Her research interest is on the intersection between mental health and public health.

Cleonice Santos do Amaral is a Master student (Public Health) at the Federal University of Rio Grande, Brazil. Her research interest is on the intersection between mental health and public health.

Timothy Gustavo Cavazzotto, PhD and Master in Physical Education at the Londrina State University, Brazil. As a researcher, became interested in R programming, biostatistics, physical activity and health, and behavioral epidemiology.

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