Children (n=34) aged 7–9 y (mean s.d. age=8.1 (0.7) y) participated in the study. Of the 34 subjects, 19 were girls and 15 were boys. All children (n=78) in the second and third grades of a small private elementary school in New England were recruited for participation with the permission of the school's headmaster, division head, classroomteachers, children's parents and the children themselves. Written consent forms were sent home with children in sealed envelopes. Of these, 37 (47%) were returned giving parental consent for the child's participation, 3 (4%) were returned declining consent for the child's participation, and 38 (49%) were not returned. There was no significant difference in participation rates between boys and girls (P>0.10). Once parental consent was obtained, children were asked in person to give assent. No child declined; however, three children were not run due to time constraints. Subjects' mean (s.d.) body mass index (BMI) was 18.6 (3.5) kg/m2. Two children (6%) had BMIs that fell below the 5th percentile for pre-adolescent children, and one child (3%) had a BMI that fell above the 95th percentile for pre-adolescent children.14 Subjects' socioeconomic status was quite high and ranged from status 1 to 2 on the Hollingshead and Redlich 2 Factor Index of Social Position, indicating that children's parents were predominantly college-educated professionals. Ethnic status was reasonably diverse; 22 children (65%) were Caucasian, 10 (29%) had mixed ethnic backgrounds and 2 (6%) were Asian.
In addition to written consent forms, parents completed a demographic questionnaire that included the child's age, sex, ethnicity, height and weight. Additionally, parents were asked to report the highest level of educational and occupational status within the household from which socioeconomic status was determined.
Based on the methodology used by Staffieri,4,5 each child was presented with a series of black and white illustrations of both boys and girls, one within each of the following weight-status categories: chubby, average and thin, for a total of six illustrations for each child to rate (see Figure 1). The illustrations were prepared by the first author to be uniform on the following dimensions: height, attire (T-shirt and shorts), stance, hair texture and color and facial features. Gender of illustration was indicated by hair length with the drawings of girls indicated by hair that was longer than that of boys (approximately 33% longer). Pilot data indicated that children had no difficulty in differentiating gender by this cue. In addition to varying hair length to produce illustrations of either girls or boys, weight-status was varied to produce illustrations of a chubby, average, or thin child. There were two randomly generated orders for presentation of illustrations. Illustration order was not significantly associated with children's ratings (P-value>0.10).
Children were asked to rate each illustration on a series of nine descriptors. Eight of the nine descriptors were taken from Staffieri.4,5 These included four positive descriptors (kind, best friend, honest, funny) and four negative descriptors (gets teased, lonely, lazy, ugly). The ninth descriptor, ‘fat’ was added to confirm that children perceived and candidly reported differences in the illustrations' weight-status. In order to reduce any impact of explicitly labeling a child as ‘fat’ this descriptor was always presented last in the series of nine. Children rated each illustration on each descriptor on a scale of 1–5 (5=most likely to possess this trait) by circling a number on a scale underneath each descriptor. There were two randomly generated orders for presentation of the first eight descriptors. Descriptor order was not significantly associated with children's ratings (P-value>0.10). The first eight descriptors were combined to create a composite score consisting of the average of the positive descriptors and reversed-scored negative descriptors. Thus, higher scores indicated a more favorable rating. In order to test whether the composite score evenly reflected the contribution of each of the eight items, correlations of each descriptor with the composite score and a stepwise regression of the composite score on each descriptor were completed. All analyses demonstrated balanced and statistically significant associations between each descriptor and the composite score (allP-values<0.001).
Children were tested individually. Children were informed that they would be shown a series of drawings of other kids about their same age and that they would be asked some questions about each kid. Each subject was given a sample question without a drawing. This question was used to explain the five-point rating scale. The sample question was, ‘I might show you a kid and ask ‘How kind do you think this kid is?’ If you think that the kid is very kind, you might circle something at this end of the scale (gesturing to the 4 and the 5). If you think they're not kind at all, you might circle something at this end of the scale (gesturing to the 1 and the 2). If you think they're sort of kind, you might circle one of the numbers in the middle. Do you understand how this scale works?’ At this point, children were asked if they were still interested in participating. Subjects were informed that they could skip any question they did not wish to answer and could discontinue participation at any time. All children chose to complete the study. Finally, children were told that there were no ‘correct’ answers. It was explained that the study was interested in understanding what kids think and that honest answers would be most helpful.
The experimenter (KAK) read each descriptor aloud while presenting the illustration. Children recorded their responses in writing out of the experimenter's view in order to reduce a socially desirable response bias. Response sheets were coded with numbers so that children's anonymous responses could later be joined with their demographic data.
Analyses were conducted with SPSS for Macintosh. A repeated measures ANOVA design was used to assess the impact of variables of interest. Sex of the child making the rating was a between subjects factor. Sex and weight of the illustrations were within subject factors. A P-value of 0.05 was set for statistical significance for ANOVAs. To control for type I errors due to multiple comparisons, Bonferroni corrections were used for post-hoct-tests. Paired and independent t-tests were used as appropriate for post-hoc comparisons.
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