title: The Interplay among BMI z-Score, Peer Victmization, and Self-Concept in Outpatient Children and Adolescents with Overweight or Obesity.
abstract: BACKGROUND
  Research has provided evidence that obesity is associated with peer victimization and low levels of self-concept. No study has examined the relationship between BMI z-score, self-concept in multiple domains, and peer victimization.
  
  
  METHODS
  The aim of the research was to investigate the interplay between BMI z-score, self-concept in multiple domains (physical, athletic, social), and peer victimization, testing direct, mediated, and moderated associations. Eighty hundred fifteen outpatient children and adolescents were consecutively recruited in 14 hospitals distributed over the Italian country. The sample consisted of 419 males and 396 females; mean age 10.91 ± 1.97 years (range 6-14 years) and mean BMI z-score 1.85 ± 0.74 (range -0.97 ± 3.27). Peer victimization and self-concept were assessed with a revised Olweus Bully/Victim Questionnaire and with the Self-Perception Profile for Children. A structural equation model approach was used to determine the associations among variables, testing two competing models.
  
  
  RESULTS
  In both models, path analysis revealed that BMI z-score was directly associated with peer victimization and self-concept in multiple domains. In the first model, peer victimization mediated the relationship between BMI-score and self-concept, whereas in the alternative model, self-concept mediated the relationship between BMI z-score and peer victimization. Interaction analyses revealed that social competence moderated the relationship between BMI z-score and peer victimization and that peer victimization moderated the relationship between BMI z-score and physical appearance.
  
  
  CONCLUSIONS
  Higher levels of BMI z-score are a risk factor for peer victimization and poor self-concept. When high levels of BMI z-score are associated with a negative self-concept, the risk of victimization increases. Preventive and supportive interventions are needed to avoid negative consequences on quality of life in children and adolescents with obesity.
authors.affiliation: 1 Dipartimento di Psicologia, University of Campania "Luigi Vanvitelli," Caserta, Italy .
authors.forename: Dario
authors.initials: D
authors.lastname: Bacchini
authors.affiliation: 2 Dipartimento di Pediatria Specialistica e Sistematica, AORN Santobono Pausilipon , Napoli, Italy .
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Licenziati
authors.affiliation: 1 Dipartimento di Psicologia, University of Campania "Luigi Vanvitelli," Caserta, Italy .
authors.forename: Gaetana
authors.initials: G
authors.lastname: Affuso
authors.affiliation: 3 Servizio di Dietologia Clinica , Ospedale Pediatrico Bambino Gesù IRCCS, Roma, Italy .
authors.forename: Alessandra
authors.initials: A
authors.lastname: Garrasi
authors.affiliation: 4 Centro di Prevenzione Diagnosi e Cura dell'Obesità in Età Evolutiva U.O. Pediatria , Presidio Ospedaliero di Gallipoli, Lecce, Italy .
authors.forename: Nicola
authors.initials: N
authors.lastname: Corciulo
authors.affiliation: 5 SOC Clinica Pediatrica, Azienda Ospedaliero-Universitaria Udine , Udine, Italy .
authors.forename: Daniela
authors.initials: D
authors.lastname: Driul
authors.affiliation: 6 U.O. di Pediatria, Azienda Ospedaliero-Universitaria S. Anna , Ferrara, Italy .
authors.forename: Rita
authors.initials: R
authors.lastname: Tanas
authors.affiliation: 7 Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Seconda Università di Napoli , Napoli, Italy .
authors.forename: Perla Maria
authors.initials: PM
authors.lastname: Fiumani
authors.affiliation: 8 U.O. di Pediatria, Ospedale S. Liberatore , Atri, Teramo and Unità di Neuropsichiatria Infantile, Policlinico di Modena, Modena, Italy .
authors.forename: Elena
authors.initials: E
authors.lastname: Di Pietro
authors.affiliation: 9 U.O.C. di Malattie Metaboliche ed Endocrinologia Pediatrica A.O.U. Policlinico Bari, Bari, Italy .
authors.forename: Sabino
authors.initials: S
authors.lastname: Pesce
authors.affiliation: 10 U.O.S. di Patologia Endocrina Autoimmune, Ospedale Pediatrico Bambino Gesù IRCCS , Palidoro, Roma, Italy .
authors.forename: Antonino
authors.initials: A
authors.lastname: Crinò
authors.affiliation: 11 Dipartimento di Scienze Mediche e Chirurgiche, Unità Operativa di Pediatria, Programma di Endocrinologia Pediatrica, Policlinico Universitario S. Orsola Malpighi , Bologna, Italy .
authors.forename: Giulio
authors.initials: G
authors.lastname: Maltoni
authors.affiliation: 12 Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università di Modena e Reggio Emilia , Modena, Italy .
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Iughetti
authors.affiliation: 13 Laboratorio Sperimentale Ricerche Auxo-Endocrinologiche , Divisione di Auxologia e Malattie Metaboliche, Istituto Auxologico Italiano, IRCCS, Milano, Italy .
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sartorio
authors.affiliation: 14 Clinica Pediatrica , Ospedale F. Del Ponte, Varese, Italy .
authors.forename: Manuela
authors.initials: M
authors.lastname: Deiana
authors.affiliation: 15 U.O.C. di Pediatria, Ospedale Maggiore, Ausl di Bologna, Bologna, Italy .
authors.forename: Francesca
authors.initials: F
authors.lastname: Lombardi
authors.affiliation: 16 Dipartimento di Scienze Motorie e del Benessere, Università degli Studi di Napoli Parthenope , Napoli, Italy .
authors.forename: Giuliana
authors.initials: G
authors.lastname: Valerio
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D058445:Bullying; D002648:Child; D019548:Crime Victims / Q000523:psychology*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010045:Outpatients; D063766:Pediatric Obesity / Q000503:physiopathology / Q000523:psychology*; D010379:Peer Group; D000067074:Peer Influence; D000066550:Physical Abuse; D011788:Quality of Life; D012649:Self Concept; D011795:Surveys and Questionnaires
keywords: bullying; multicentric study; obesity; peer victimization; self-concept; weight-based victimization