Hooper Lab

Weight-related health research rarely views adolescents in larger bodies as experts to inform development of interventions, but this approach has proven crucial to improving outcomes for other health problems. If adolescents in larger bodies continue to be underutilized, they will continue to experience weight stigma at healthcare visits, increasing their likelihood of future weight gain, disordered eating, self-harm behaviors, substance use, healthcare avoidance and other harmful consequences of weight stigma.

This qualitative study has two aims, both focused on medical visits that address nutrition, physical activity, body image or weight:

• AIM 1: Characterize stigmatizing and non-stigmatizing experiences, from the perspectives of 15–21-year-olds with larger bodies and underserved racial and ethnic identities.
• AIM 2: Identify facilitators, barriers and training needs to promote health without simultaneously transmitting stigma to adolescents, from the perspectives of primary care practitioners.

Next steps: Findings from this study will inform co-development of tools and resources for primary care practitioners to support them in providing strengths-based, culturally responsive, body-neutral nutrition-related healthcare for adolescents.

Funders: National Institute on Minority Health and Health Disparities P50MD017342 (PI: Allen) and National Institute of Mental Health T32 MH082761 (PI: Peterson)

Major disparities exist in access to safe, enjoyable, developmentally appropriate, affordable physical activity opportunities for young people. To help address this gap, our team created Move + Thrive, a free, online physical activity video library that aims to support the emotional and physical health of young people. This resource, designed in partnership with youth and adult community advisory boards, emphasizes physical activity for self-care and fun, and avoids body shaming, misleading talk about weight or dieting, product promotions and air-brushed fitness influencers. Our videos purposefully respect diverse gender identities, races, ethnicities, body sizes and fitness levels.

Our team is also investigating:

1. Misleading messages about exercise, nutrition, body image and weight that adolescents encounter during searches for physical activity resources on social media
2. Strengths and vulnerabilities of adolescents as they respond to those messages

Next steps: Build a research team in Indiana that engages young people to address and deconstruct misinformation about nutrition, physical activity, body image and weight on social media and in their communities. We plan to use principles of youth participatory action research, peer health education and digital literacy to guide these next steps.

Hear about our work on the Health Promotion Practice Podcast.

Read more about Move + Thrive.

Funders: National Center for Advancing Translational Sciences UL1TR002494 (PI: Blazer) and National Institute of Mental Health T32 MH082761 (PI: Peterson)

Studies have shown that young people who experience weight stigma are more likely to struggle with depressive symptoms, self-harm behaviors, social isolation, disordered eating behaviors and future weight gain. However, research has mainly been conducted in white, middle- to high-socioeconomic status populations, missing the unique needs of underserved populations.  

Therefore, in Project EAT 2010-2018, an ethnically, racially and socioeconomically diverse cohort of young people, we found:

• Experiencing weight stigma in adolescence was strongly linked with higher weight status and higher rates of disordered eating behaviors, both cross-sectionally and eight years later.
• Weight stigma, disordered eating and higher weight status were more prevalent among young people with underserved racial and ethnic identities and those from low socioeconomic households.
• Weight stigma showed similar associations to disordered eating and higher weight status across ethnic, racial and socioeconomic groups.

Implications:

• Findings reinforce that weight-based mistreatment harms young people’s health and challenges the notion that weight stigma and disordered eating primarily affect affluent, white young people.
• Future research and public policies should address weight stigma and prioritize young people with underserved identities.
• Policies to protect against weight-based mistreatment should include input from young people with these identities.

Read more:

• Weight teasing is a risk factor for disordered eating in young people across demographic groups
• How weight teasing affects health behaviors and weight status among diverse young people

Funders: National Heart, Lung, and Blood Institute R01HL127077 and R35HL139853 (PI: Neumark-Sztainer), National Center for Advancing Translational Sciences TL1R002493 and UL1TR002494 (PIs: Blazer and Fulkerson)

Prior household food insecurity research has focused on young children; however, less is known about how it uniquely affects adolescents. Therefore, we investigated the relationship between household food insecurity and both disordered eating and high weight status in the Project EAT 2010-2018 cohort and found:

• Household food insecurity was associated with greater use of disordered eating behaviors.
• Household food insecurity during adolescence was a risk factor for new onset high weight status and binge eating eight years later.
• 39% of adolescents experienced household food insecurity.
• 43% reported engaging in disordered eating.
• 40% had high weight status.

Implications:

• Research, clinical and public health programs for young people often address food insecurity, disordered eating and high weight status separately.
• Findings indicate these issues are common and interconnected, requiring coordinated approaches.
• Findings reinforce that outcomes such as high weight status are driven by factors beyond an individual’s control, highlighting the need for non-stigmatizing, upstream policy solutions.

Read more:

• Household food insecurity during adolescence is a risk factor for future disordered eating and high weight status in young adulthood
• Food insecurity raised risk for disordered eating in low-income adolescents

Funders: National Heart, Lung, and Blood Institute R01HL127077 and R35HL139853 (PI: Neumark-Sztainer), Health Resources and Services Administration T71MC00006-40-00 (PI: Sieving) and T79MC00007-31-00 (PI: Stang), and National Center for Advancing Translational Sciences TL1R002493 and UL1TR002494 (PIs: Blazer and Fulkerson)

Hooper L, Lebow J, Gewirtz O'Brien JR, Puhl RM, Neumark-Sztainer D. "Partnerships with primary care providers: Opportunities to prevent eating disorders and mitigate their progression in young people.” Eating Disorders. Volume 32, Issue 6. 746-762. 2024. https://doi.org/10.1080/10640266.2024.2394263

Hooper L, Framson C, Donaldson A, Cifra N, Dave S, Weiss AL, Galagali P, Kumar MM. "The American Academy of Pediatrics Guideline for Obesity: An Adolescent Health Perspective." Journal of Adolescent Health. Volume 75, Issue 4. 535-537. October 2024. https://doi.org/10.1016/j.jadohealth.2024.07.006

Hooper L, Puhl R, Eisenberg ME, Crow S, Neumark-Sztainer D. “Weight teasing experienced during adolescence and young adulthood: Cross-sectional and longitudinal associations with disordered eating behaviors in an ethnically/racially and socioeconomically diverse sample.” International Journal of Eating Disorders. Vol 54. Issue 8. 1449-1462. August 2021. https://doi.org/10.1002/eat.23534

Hooper L, Puhl R, Eisenberg ME, Reicks M, Neumark-Sztainer D. “How is weight teasing cross-sectionally and longitudinally associated with health behaviors and weight status among ethnically/racially and socioeconomically diverse young people?” International Journal of Behavioral Nutrition and Physical Activity. Volume 19. Article 71. June 2022. https://doi.org/10.1186/s12966-022-01307-y

Hooper L, Puhl RM, Eisenberg ME, Berge JM, Neumark-Sztainer D. “Can family and parenting factors modify the impact of weight stigma on disordered eating in young people? A population-based longitudinal study.” Journal of Adolescent Health. Volume 73, Issue 1. 44-52. July 2023. https://doi.org/10.1016/j.jadohealth.2023.01.024

Hooper L, Mason SM, Telke S, Larson N, Neumark-Sztainer D. “Experiencing household food insecurity during adolescence predicts disordered eating and elevated body mass index eight years later.” Journal of Adolescent Health. Volume 70. Issue 5. 788-795. May 2022. https://doi.org/10.1016/j.jadohealth.2021.11.026

Hooper L, Telke S, Larson N, Mason SM, Neumark-Sztainer D. “Household food insecurity: Associations with disordered eating behaviours and overweight in a population-based sample of adolescents.” Public Health Nutrition. Vol 23. Issue 17. 3126-3135. December 2020. https://doi.org/10.1017/S1368980020000464

Hazzard VM, Hooper L, Larson N, Loth KA, Wall M, Neumark-Sztainer D. “Associations between severe food insecurity and disordered eating behaviors from adolescence to young adulthood: Findings from a 10-year longitudinal study.” Preventive Medicine. Volume 154. January 2022. https://doi.org/10.1016/j.ypmed.2021.106895

Hazzard VM, Loth KA, Hooper L, Becker CB. “Food insecurity and eating disorders: A review of emerging evidence.” Current Psychiatry Reports. Vol 22. Issue 74. 1-9. October 2020. https://doi.org/10.1007/s11920-020-01200-0

West CE, Hazzard VM, Loth K, Larson N, Hooper L, Neumark-Sztainer D. “The interplay between food insecurity and family factors in relation to disordered eating in adolescence.” Appetite. Volume 189, Issue 1. October 2023. https://doi.org/10.1016/j.appet.2023.106994

Arseniev-Koehler A, Hooper L, Lee H. “Online pro-eating disorder (pro-ED) activity.” Adolescent Medicine: State of the Art Reviews. American Academy of Pediatrics. Vol 25. 553-563. December 2014. https://doi.org/10.1542/9781581108927-online_pro_eating 

Kaja SM, Miller KK, Adler SJ, Hooper L. Helping Teens Move + Thrive: Adolescents’ Preferences for Online Exercise Videos. Health Promotion Practice. Online ahead of print. January 2025. https://doi.org/10.1177/15248399251314423

Miller KK, Hooper L, Kaja SM. “Move + Thrive: Development of an Adolescent Friendly and Inclusive Online Fitness Resource.” Health Promotion Practice. Online ahead of print. April 2024. https://doi.org/10.1177/15248399241245

Espinoza SM, Martin CL, Eisenberg ME, Borowsky IW, McMorris BJ, Hooper L. “Internal and Social Assets, Weight-Based Bullying, Sport, and Activity Among Female Adolescents.” Women in Sport and Physical Activity Journal. Volume 31, Issue 2. 82-91. October 2023. https://doi.org/10.1123/wspaj.2022-0047

Folk A, Hooper L, Hazzard VM, Larson N, Barr-Anderson DJ, Neumark-Sztainer D. “Does weight motivation for exercise predict physical activity levels across the life course from adolescence to adulthood?” Journal of Adolescent Health. Volume 71, Issue 1. 112-118. July 2022. https://doi.org/10.1016/j.jadohealth.2022.02.002

Kramer-Kostecka EN, Kaja SM, Harris V, Quinlivan C, Treacy J, Hooper L, Barr-Anderson DJ, Neumark-Sztainer D. “Conducting Community-Partnered Cardiorespiratory Fitness Assessments with Young Adults Underrepresented in Physical Activity Research: Lessons Learned.” Progress in Community Health Partnerships: Research, Education, and Action. Online ahead of print. June 2024.

Ruedinger E, Evans YN, Pham DQ, Hooper L. “Just-in-Time Strategies to Reduce the Effect of Interviewer Bias During Trainee Recruitment.” Academic Pediatrics. Volume 24, Issue 5. 709-713. July 2024. https://doi.org/10.1016/j.acap.2024.01.020

Hazzard VM, Burnette CB, Hooper L, Larson N, Eisenberg ME, Neumark-Sztainer D. “Lifestyle health behavior correlates of intuitive eating in a population-based sample of men and women.” Eating Behaviors. Volume 46, August 2022. https://doi.org/10.1016/j.eatbeh.2022.101644

Christoph MJ, Järvelä-Reijonen E, Hooper L, Larson N, Mason S, Neumark-Sztainer D. “Longitudinal associations between intuitive eating and weight-related behaviors in a population-based sample of young adults.” Appetite. Volume 160. May 2021. https://doi.org/10.1016/j.appet.2021.105093

Christoph MJ, Hazzard VM, Järvelä-Reijonen E, Hooper L, Larson N, Neumark-Sztainer D. “Intuitive eating is associated with higher fruit and vegetable intake among adults.” Journal of Nutrition Education and Behavior. Volume 52. Issue 3. 240-245. March 2021. https://doi.org/10.1016/j.jneb.2020.11.015

Yoon C, Mason SM, Hooper L, Eisenberg ME, Neumark-Sztainer D. “Disordered eating behaviors and 15-year trajectories in body mass index: Findings from Project Eating and Activity in Teens (EAT).” Journal of Adolescent Health. 2019. Vol 66. Issue 2. 181-188. January 2020. https://doi.org/10.1016/j.jadohealth.2019.08.012

Simone M, Hooper L, Eisenberg M, Neumark-Sztainer D. “Unhealthy weight control behaviors and substance use among adolescent girls: The harms of weight stigma.” Social Science and Medicine. Vol 223. 64-70. July 2019. https://doi.org/10.1016/j.socscimed.2019.05.047

Hahn S, Burnette CB, Hooper L, Wall M, Loth K, Neumark-Sztainer D. “Do weight perception transitions in adolescence predict concurrent and long-term disordered eating behaviors?” Journal of Adolescent Health. Volume 72, Issue 5. 803-810. May 2023. https://doi.org/10.1016/j.jadohealth.2022.12.023

Hooper LE, Foster-Schubert KE, Weigle DS, Sorensen B, Ulrich CM, McTiernan A. “Frequent intentional weight loss is associated with higher ghrelin and lower glucose and androgen levels in postmenopausal women.” Nutrition Research. Volume 30. Issue 3. 163-170. https://doi.org/10.1016/j.nutres.2010.02.002