Position paper


The Position Paper is based on Chapter 11 Age and Cohort and the article “Children’s Perceptions of Body Size and Healthy Habits”.  Summarize and choose a position based on the material. Chapter 11 is talking about as children develop in modern society, they will be under pressure from their parents, as well as some trends and cultural influences.

Investigating Young Children’s Perceptions of Body Size
and Healthy Habits
Tingting Xu1 • Jannah S. Nerren2
Published online: 22 March 2016
Springer Science+Business Media New York 2016
Abstract Attitudes and biases toward body size perceived as fat and body size perceived as thin are present in
young children (Cramer and Steinwert in J Appl Dev
Psychol 19(3):429–451, 1998; Worobey and Worobey in
Body Image 11:171–174, 2014). However, the information
children have regarding body size and ways to modify
body size might not be accurate, which could lead to
negative health outcomes. To collect information for
developing strategies to prevent such health outcomes, this
study explored children’s perceptions towards body size,
factors they believed contribute to body size differences,
and strategies they indicated as necessary to make changes
in body size. Forty-eight children from 1st grade and 3rd
grade were interviewed. The majority of children were
aware that the quality and quantity of food influences body
size. They expressed similar strategies to change body size;
however, some of their strategies were extremely unhealthy. Children in this group prefer an average body size
rather than the thinnest size body from the selections presented. Information obtained from the study demonstrated
the importance of guiding children to establish appropriate
eating and healthy habits that might ultimately prevent
extreme behaviors and health problems. It is crucial to help
all children realize the importance of maintaining a healthy
body rather than an overly thin body.
Keywords Body size Young children Health Obesity
Childhood obesity has been recognized as one of the most
serious health problems for children in the United States
(Schwartz and Puhl 2003). Children who are obese are
more likely to experience weight-based stereotypes and
bias from others (Puhl and Latner 2007). For example
Cramer and Steinwert (1998) found that 5-year-olds frequently associated mean, or unfriendly characteristics with
‘‘chubby’’ figures. Children believed that overweight children might not have friends to play with (Girlguiding 2007;
Kostanski and Gullone 1999), and they might be less
popular (Dixey et al. 2001). Children who are obese are
more likely to have severe psycho-social problems, such as
depression, and are more likely to experience discrimination (Dietz 1998; Dixey et al. 2001; Friedman and Brownell 1995; Ricciardelli and McCabe 2001; Whitlock et al.
Research studies have been conducted investigating
treatment and prevention of childhood obesity; however,
approaches from these research studies were not consistent
in measuring outcomes or restricted in populations (Luttikhuis et al. 2009; Summerbell et al. 2005), making them
impossible for application. In addition, limited research
studies have been conducted to explore young children’s
own perceptions about body size and ways to modify body
size, which might be essential for designing and implementing interventions. To explain, perception of body size
is a mental construct (Cash 2002), which might be
& Tingting Xu
Jannah S. Nerren
1 Department of Elementary Education, Stephen F. Austin
State University, 2428 Raguet Street, ECRC 209, SFA
Station, P. O. Box 13017, Nacogdoches, TX 75962, USA
2 Office of Assessment and Accountability & Educator
Preparation Program, Stephen F. Austin State University,
McKibben Bldg, Suite 212B, SFA Station,
P. O. Box 13017, Nacogdoches, TX 75962, USA
Early Childhood Educ J (2017) 45:499–507
DOI 10.1007/s10643-016-0786-x
influenced by levels of cognitive development. As children
grow from the pre-operational stage to the concrete operational stage as explained by Piaget (1977), they develop
logical reasoning skills, they begin moving from concrete
to abstract thinking, and they begin to develop an awareness of different features rather than one singular aspect of
an object (Piaget’s concept of centration), for example the
body. However, children moving from the pre-operational
stage to the concrete operational stage might still have
limited abilities for abstract thoughts (Piaget 1977). With
limitations in their cognitive development, children might
demonstrate inadequate reasoning about the body. This
type of inconsistency in reasoning is also found in other
studies focusing on children’s choices of perceived body
size and their actual body size (i.e. Holub 2008; MusherEizenman et al. 2003; Gardner et al. 1999; Truby and
Paxton 2002), in which cognitive development is taken into
account (Tremblay et al. 2011). Additionally, perception of
body size is also found to be associated with later mental
health problems (Haines and Neumark-Sztainer 2006).
Children’s misconceptions towards body size might result
in unhealthy practices that may cause problematic outcomes (Woolsey 1998), potentially making intervention
more difficult. It is indicated by McCabe and Ricciardelli
(2005) that many young children have shown symptoms of
eating disturbance. Such dieting-like behaviors have also
been shown among preadolescent children (Hill et al. 1992;
Hill and Pallin 1998; Hill and Robinson 1991; Schur et al.
2000). Nine-year-old girls have been observed to have selfimposed dietary restrictions, choosing fewer high energy
foods and dietary fiber (Hill and Robinson 1991; Hill et al.
1992). Schur et al. (2000) reported that 16 % of children
aged 8–13 had tried to change their body size either
through food choices or exercising. Therefore, children’s
own perceptions seem to play an important part in altering
the obesity prevention process.
It is necessary to guide children’s healthy habits to
prevent these contrary outcomes, however, at what age
these interventions should be implemented is not clear. It is
critical to consider the developmental stages of children,
and the potential effectiveness of interventions based on
children’s ability to accurately process information connecting healthy habits with a healthy body. With this in
mind, the current study was conducted with children as
young as 7 years old due to the following reasons. First, it
is indicated by Gelman (2009), that children develop rich
knowledge and concepts during the preschool and early
elementary school years. While we know that the early
years are meaningful years in this development, there are
gaps in the literature on children’s early perceptions of
body size and the factors that contribute to healthy body
size and image, particular with children at this young age.
In addition, there are limited research studies targeting
children younger than 8 years old, which might be essential
for early detection of some health problems (Sypsa and
Simons 2008). Therefore, it is meaningful to investigate
perceptions and thought patterns in children at early ages,
and this study seeks to address these deficits in the
The current study explored 1st grade and 3rd grade
children’s perceptions towards body size, their explanations of causes of body size differences, and strategies they
indicated to make changes in body size. We answered three
research questions: (1) What are children’s perceptions
about influential factors on body size? (2) What are children’s views about habits or strategies that contribute to a
healthy body size? (3) What are children’s views about
optimal body size?
Study Design
Since there is limited literature documenting young children’s’ views about body size, the study adopted a mixed
method research design. One-on-one interviews were
conducted with young children from 1st grade and 3rd
grade to explore young children’s perceptions about body
sizes, their explanations of causes of the body size differences, the strategies they indicated to change body size,
and their optimal body size. A one-way analysis of variance (ANOVA) was conducted to examine the significant
differences in optimal body choices between boys and
Data Sources
The participants for the current study were children who
ranged in age from 5 to 8 years old. The participants were
recruited from one charter school and one early childhood
lab school in rural east Texas. The invitation to participate
in this study was sent to parents. Based on the 60 % return
rate of permissions, 48 children participated. Among these
children, there were 22 boys, and 26 girls; 26 of the children were in 1st grade, and 22 were in 3rd grade. They
were from diverse ethnic backgrounds: 77 % White
(n = 37), 8 % Hispanic (n = 4), 4 % African American
(n = 2), 4 % Asian (n = 2), and 2 % American Indian
(n = 1), based on the school administration report.
The body size task included line drawings and open-ended
questions. The line drawings of child-sized figures were
adopted in the instrument developed by Collins (1991).
500 Early Childhood Educ J (2017) 45:499–507
Similar with previous studies that used line drawings
(Brylinsky and Moore 1994; Harriger et al. 2010; Margulies et al. 2008; Musher-Eizenman et al. 2003), this
modified instrument used seven gender-specific drawings
of child figures identical in all ways but with increasing
sizes from the thinnest figure to the heaviest figure, with an
underline label from 1 to 7. Appropriate validity and reliability of using this instrument among children in similar
age range have been documented and reported (Collins
1991; Ricciardelli and McCabe 2001; Vander Wal and
Thelan 2000). This instrument has previously been used in
other research studies among children as young as 5 years
old, and there have been no reported problems with children selecting the appropriate figures (Williamson and
Delin 2001; Shroff et al. 1995). It has been shown to be
reliable for children of various racial backgrounds enrolled
from the first to third grade to use this figures, revealed by
an overall 3-day test–retest reliability coefficients of .71 for
figure selections (Collins 1991). In addition, five openended questions were added. These questions are: (1) There
are seven boys (girls), what do you see? (2) What do you
think makes them different? (3) Which one do you like
best? (4) What would this boy (girl) do if he (she) wants to
become like this boy (girl; Point from figure 1 to 7)? (5)
What would this boy (girl) do if he (she) wants to become
like this boy (girl; Point from figure 7 to size 1)? These
questions were discussed with early childhood professors,
the early childhood lab school director, and teachers in PreK classroom to ensure the language was appropriate for
young children. Based on a small pilot study with eight
preschool children, we found that the children have no
problem answering these questions.
Data Collection
The university’s institutional review board approved this
research. Both the charter school principal and early
childhood lab school director allowed researchers to
approach the parents to provide the permission for their
children to participant in this study. For each child, parental
consent was obtained prior to the one-on-one interviews.
Interviews with children were then scheduled with classroom teachers. During the school hours, the participating
children were interviewed individually in a separate, quiet
place at school assigned by classroom teachers. Children
were required to observe the drawing figures of seven boys
(for male participants) or girls (for female participants).
The children were then asked to answer five questions read
by a graduate research assistant. This research assistant was
trained to conduct interviews with children. She recorded
their answers, and clarified (when necessary) any responses
from the children. Each interview took about 10–15 min to
complete following this procedure. All child interviews
were video-recorded for transcription purposes. One of the
researchers was in charge of recording process.
Data Analysis
The video data were first transcribed and entered in an
electronic document file. Data for individual participants
were organized by numerical codes. The transcribed video
data were then analyzed by following the procedures of
open coding (Strauss 1987). Two researchers went through
the first part of data, color-coded similar responses and
looked for patterns within the data. Matrices were created
that allowed for contrasts, comparisons and allowed the
researchers to note patterns, quotes, and themes as they
emerged (Miles and Huberman 1994). Inter-rater reliability
checks were conducted at the beginning stages of coding.
The ‘‘check code’’ process of inter-rater reliability was
implemented after the data were independently coded by
the researchers (Miles and Huberman 1994). Then, the
researchers added details to the coding scheme and revised
definitions as needed, and had sessions of coding separately. To ensure reliability, 25 % of the transcriptions
were randomly selected and coded by both researchers,
which yield an agreement of 94 %. After the completion of
all data coding, the researchers had discussions about
several categories that had emerged to establish the final
Body Size Influential Factors
The current data demonstrated that the majority of children
were aware of the connection between eating and body
size; food was the major factor indicated by children that
can influence body size. Although children in this group
seemed to take into account both quality and quantity of
food; however, the study revealed that quantity mattered
more to the children. When talking about factors that might
influence body size, children frequently indicated that
eating different amounts of food could influence body size.
Specifically, children associated overweight body size with
excessive eating behaviors and they were most likely to
state that the image of the child at size 7 or 6 (the heavier
point of the spectrum) must eat too much. Likewise, children associated a skinny body size with food restriction and
stated that the image of the child at size 1 (the smallest
point of the spectrum) must barely eat. Some of them stated
that the types of food they ate makes them look differently;
food that contains a lot of sugar would make a body fat. In
addition to associating body size with food, a few children
associated the thinner body image with family socioEarly Childhood Educ J (2017) 45:499–507 501
economic status. One child explained: ‘‘Well if you like see
someone really skinny you will probably think they are
poor and they don’t have any food’’. See examples in
Table 1.
Body Change Strategies
In terms of body change strategies, most children in this
group were aware of means to change body size and they
believed that modification of either food or exercise, or
both can change body size. To reduce body size, children
frequently recommended strategies such as to (1) increase
amount of exercise, (2) eat more fruit and vegetables, (3)
restrict certain type of food such as candy, and (4) reduce
the amount of food intake. To increase body size, children
suggested to eat specific foods (e.g. candy, chocolate) and
decrease the amount of exercise. See example response in
Tables 2 and 3.
Optimal Body Size
There are seven different body sizes in the images used for
this study, increasing from the thinnest (1) to the heaviest
(7). Within this group of 48 children, almost half of children (n = 22, 46 %) in this current study chose body size 4
as the optimal body size, including 15 girls and 7 boys; 9
were in the first grade and 13 were in the third grade.
Eleven children (23 %) chose body size 1 as the optimal
body size. Among these 11 children, there were 5 girls and
6 boys; 10 of them were in the 1st grade and 1 was in the
3rd grade. Some of children (n = 9) chose size 3, in which
4 of them were girls and 5 were boys; 4 of them were in the

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