A young boy visited my consulting room, accompanied by his mother’s friends. His mother had been abroad for some time and had asked them to bring him to the hospital because he had gained excessive weight since she left. He was living with his grandparents.
They were welcomed and offered chairs. The young boy, clearly obese, sat on my right. I greeted him, and he replied, “I am fine.” I asked if he had any concerns, and he said, “No.” However, he kept his head down, avoiding eye contact. I inquired about his grandparents, and he said they were at home and doing well.
I again asked how school was. He responded that it was “just okay,” but this time his voice trembled. I sensed there was an issue at school. When I probed further, it became clear he was being bullied by his classmates. He was called “Obolo,” a fat boy. Apparently, this happened daily, and even the class teacher was sometimes guilty, occasionally calling him Obolo, sometimes just to the class.
I encouraged him to look up, so we chatted, and he did. By then, I could see he was more at ease, made eye contact, and even smiled at my jokes now and then. He told me how his grandparents were also making him unhappy because they restricted him from using his tablets and phone to weekends only. It was also obvious he missed his mother. I later facilitated a reunion with his mother by writing to the embassy. Recently, the mother sent a picture of him, looking very trim and beaming.
An obese early adolescent girl and her mother visited. Her reasons for coming were that she had been experiencing recurrent headaches and abdominal pains. Some episodes occurred at school, and the mother, who was a staff member at the same school, had to be called to pick her up.
They had visited several facilities with the same complaints. During this process, multiple laboratory investigations were conducted, with no apparent cause identified. I asked her and her mother about symptoms that could indicate the cause of her recurrent condition. I examined her but could not find an obvious cause for her ailment.
However, I noticed she did not look happy; she appeared sad. Upon further inquiry, it became clear that she had been bullied by her classmates, especially one girl. She was being referred to as “Obolo.” Even her mother would sometimes use the girl’s body size as an insult if she misbehaved. What was “killing” her was the fact that her classmates said she would not get a boyfriend, let alone a husband. Her mother confirmed that the girl had told her about this, and she was aware of the body-shaming comments from her daughter’s peers.
Another encounter in my consulting room with an adolescent girl in a secondary school boarding house, whose mother had to transfer her to a day school nearer to home. This was because of constant complaints of abdominal, chest pain and headaches.
She had been seen several times by different medical practitioners, including paediatricians. She was of small stature, and because of that, she was constantly being teased by her classmates. That had gotten to her to the point that she was always nervous going to the dining hall or the classroom.
And even though she had wanted to be in that school because of the prestige associated with the school, she could not stand the constant humiliation. Her mother had to find a day school, a private one, in their neighbourhood, which was more expensive.
Not long ago, I saw a 7-year-old boy, again obese, whom his mother brought to me because he had been complaining of severe abdominal pain and headaches for over a month. He was not vomiting, had no diarrhoea, and no fever. He looked unhappy and quiet, and he answered my questions with indifference. On physical checks, the patient’s condition was unremarkable except for the obesity.
I asked the mother about school and whether she had any worries. She said he was not doing well. So, I turned to the boy and enquired about what was happening at school. Was there anything worrying him? He said the friends have been calling him “Obolo,” especially one boy. I asked him, “How was that boy, a senior, or was he taller than him?” He said no, he was in the same class, but short. I then asked, “So what do you also call him?” He said he called him “Shortingo.”
However, his main concern was that some children in his neighbourhood would shout “Obolo, obolo, obolo” whenever they saw him, making fun of him. That made him sad, so he would not go out to play.
I recently received an early morning call from an evidently worried mother, an experienced health practitioner. She wanted to bring her son so I could examine him. Her 9-year-old son, while getting ready for school that morning, complained to her that he was experiencing severe abdominal pain, chest pain, and a headache. That was not the first time.
Mother sometimes received calls from the school to collect him because of these complaints, which could be distressing. She had been seen at various health facilities by medical practitioners of varying experience, and several laboratory investigations, as well as a computed tomography (CT) scan of the brain, had been carried out, but to no obvious conclusion.
A spirometry was also unremarkable. The boy had, on occasions, complained of feeling anxious while getting ready for school. He had also asked for a change of school. I then suggested to her that her son might be suffering from bullying.
But she was reluctant to accept my on-the-spot diagnosis. She said that was not possible because the elder brother was in the same school. She wanted me to see him, examine him, and conduct further studies. I obliged and asked them to come. In the consulting room, I noticed that, unlike the previous children who appeared worried and sad, he was all laughter with me. After the exchange of pleasantries, I asked the mother to excuse me and the nurse to have a private conversation with him.
To my surprise, he asked the nurse to go out as well. He didn’t want her to hear what he wanted to tell me. When I asked him what the problem was, he said he was fine; all the symptoms had resolved. He said he was okay if he was not in school. I volunteered to know the reason for that, what was making him not like school. I asked whether they liked teasing in his class, and who they had been teasing. I asked whether there were bullies in his class.
My approach, if I suspect abuse or bullying, is to make my patients not feel that I think they are weak by asking a general, open-ended question, then narrowing it down to them. He answered, “Yes.” I followed up and queried what the bullies had been doing. He gave me an interesting answer, which I was not really expecting from him, but it also showed me how he had been bullied and the pain he was going through.
He said, “well they do what bullies do.” He was not forthcoming with the answer initially, but he finally said, “They take your lunch money, take your lunch and body-shame you.” I then asked, “So who has been taking your lunch money or your lunch?” He denied it, saying that on one occasion, a senior was about to take his change, but he did not allow him. I then asked what about body-shaming? He then spilt the beans by saying that they had been teasing him that he was too small and too weak to practice basketball or any other sports. They also called him an “elf”; he didn’t like that.
When I finally spoke privately with the mother, she confirmed she was aware of the bullying and had confronted the school authorities, who, in turn, had called the perpetrator to order. So, she believed that had stopped. But she was “hoping” there might be an obvious cause for her son’s complaints, which could lead to a definite treatment.
After completing the necessary investigations, we advise the parents and children. I show them my hand and ask them to describe what the five fingers look like. They respond that each finger is different. I then tell them, “That’s how God created the world”. We are not all the same, so they should accept and love who they are. They should focus on their positive attributes and education. Follow-ups are scheduled, and referrals are made to see a clinical psychologist.
What do these stories teach us?
In all these cases, there are commonalities. Most of them experienced chronic, repetitive somatic (physical) symptoms such as headaches, chest pain, and stomach pain. These symptoms may have stemmed from the constant bullying, name-calling, and body-shaming by their peers, and for some, even their own parents. The schoolteachers also contributed subtly.
These comments have severely affected them. They have become intolerable and have clearly impacted their emotional or mental health and well-being.
For some, their education is at risk. Children are anxious, depressed, and extremely vulnerable, while parents feel confused, distressed, and sometimes helpless. Even for parents with professional experience and knowledge of this phenomenon, they wish their children had a physical condition that could be treated, either with medication or surgery; they simply want peace of mind.
Parents are missing productive work hours because they are constantly called from school to pick up their children and take them to the hospital. For adolescents, this may negatively affect their ability to develop peer relationships and engage socially during a crucial period of their development. Consequently, they may experience substance abuse problems, and unfortunately, some may try to take their lives.
It is therefore important for healthcare professionals to look out for such victims of bullying and address the issues. The school and the community at large should identify perpetrators and victims of bullying and discourage such unhealthy acts.
What is bullying?
According to the World Health Organisation (WHO), bullying is a “multifaceted form of mistreatment characterised by repeated exposure of an individual to physical and/or emotional aggression.” Bullying involves deliberate, largely unprovoked efforts to harm another person. It can be physical or verbal, and can be direct or indirect. Bullying involves repeated negative actions by one or more individuals against another. It also entails an imbalance of physical or psychological power.
Traditional forms of bullying include physical (e.g., hitting, kicking, pushing, forceful possession of someone’s belongings), relational (e.g., teasing, gossip, rumours, social exclusion), and verbal (e.g., name-calling, body-shaming). With the advent of the internet and social media, there is a thriving form of bullying called cyberbullying, which occurs via electronic contact.
Bullying among school children is a persistent issue. The statistics on bullying among overweight and obese children are concerning. In the United States of America, more than a quarter of sixth-grade pupils who are overweight or obese, regardless of gender, reported being bullied. For secondary school students with excess weight, about 60% experienced this harmful behaviour.
In Ghana, little is known about children with excess weight and bullying. However, bullying is common in secondary schools, where around 38-62% of students report having been bullied. The perpetrators are mainly senior students. Traditionally, bullying is seen as an initiation ritual for young students entering secondary schools and also as a form of entertainment for seniors. In contrast, studies on bullying in primary schools are mostly absent.
The relationship between bullying and overweight/obesity has been inconsistent. For instance, some researchers have it that boys with excess weight are more likely to be bullied, while others found that boys with excess weight are perpetrators of bullying. Concerning children who are constitutionally small, boys are more likely to be physically bullied, while girls are more likely to experience gossip and social exclusion.
Effect of bullying on the individual
Studies have shown that school bullying is connected to various physical health issues (e.g., headaches, stomachaches, and pain) and mental health problems (e.g., sleep problems, separation anxiety, low self-esteem, and depression) among children and adolescents.
Furthermore, school bullying behaviours have long-term implications, such as physical health complaints, such as bedwetting, fatigue, and poor appetite in children and adolescents, as well as suicidal thoughts and suicide. Moreover, victims of bullying tend to skip classes more often, perform poorly in academics, avoid school activities, increase substance use, become truant at some point in time, and drop out of school.
How to prevent bullying in school
Preventing bullying and reducing its harmful effects is everyone’s duty within the school community. Staff, teachers, students, and parents all need education on bullying and its impact on victims. School authorities should establish and enforce a zero-tolerance policy that clearly defines bullying, specifies consequences, and outlines reporting procedures, ensuring all staff are trained in these protocols.
Other essential strategies include teaching students about kindness and inclusivity, training staff to intervene promptly, empowering bystanders to report incidents, and maintaining open communication between parents and educators to foster a safe, supportive environment.
Childhood Obesity: A Public Health Concern
Obesity remains a major public health issue worldwide. In 2025, UNICEF reported that obesity had overtaken undernutrition as the most common form of malnutrition globally. One in ten school-age children aged 5-19 is obese. Although the rate of undernutrition has declined from 1% to 9.4% since 2000, obesity in this group has increased from 3% to 9%.
This trend is seen across all regions of the continent, except for sub-Saharan Africa and South Asia. The recent Ghana Demographic and Health Survey 2022 indicates that 2% of children under 5 are overweight. However, among school-aged children, the prevalence of obesity ranges widely from as low as 0.5% to as high as 47%. Girls are more affected than boys, and it occurs more frequently in children attending private schools than in those in public schools.
Childhood obesity is a complex issue. The coronavirus-19 pandemic highlighted how obesity is linked to increased risk of death due to co-existing conditions such as diabetes, metabolic syndrome, cholesterol problems, and respiratory or breathing difficulties, which make individuals more vulnerable to complications of the disease. Several factors—including genetics, environment, metabolism, lifestyle, prolonged screen time (such as watching TV, playing video games, using smartphones, and tablets), and unhealthy eating habits—are thought to contribute to its development.
However, most children with obesity do not have a clear underlying cause. Nonetheless, attention increasingly centres on diet. The shift towards consuming ultra-processed, affordable, energy-dense, and imported foods has displaced traditional diets rich in fruits, vegetables, legumes, and meat in many communities, and has been associated with weight gain among school-aged children.
Regarding screen time, evidence indicates that it contributes to obesity in children and adolescents through several pathways: reduced physical activity, increased eating while viewing screens, exposure to advertisements for unhealthy foods and sugary drinks that influence children’s preferences and buying requests, altered eating habits, and insufficient sleep. The recommended maximum for recreational screen time is 2 hours daily for children aged 5-17.
Spending more than three hours a day in front of screens is associated with a 41% higher risk of obesity. Unfortunately, many working parents, especially mothers, often give these devices to their young children to help manage household chores. You might see a one-year-old being handed a smartphone or tablet to keep them quiet while the mother washes or cooks.
Additionally, pupils and students in well-resourced schools are given tablets or laptops as part of their educational resources. Furthermore, they are often assigned tasks (homework) on these devices, making it difficult to take them away.
The physical and psychosocial impacts of childhood obesity are wide-ranging. Children who are obese face risks of developing conditions such as high blood pressure, high cholesterol, type 2 diabetes, orthopaedic issues, sleep disturbances, and asthma, among others.
The psychological, social, and behavioural effects of childhood obesity also mean that these children are more likely to experience body dissatisfaction, low self-esteem, social exclusion, discrimination, depression, and bullying.
However, the main reason why being overweight and obesity are linked to being bullied is the stigma surrounding weight. For example, the public blames individuals who are overweight and obese for not managing their weight, implying they are responsible for their condition. As a result, people may develop negative perceptions of those with excess weight, viewing them as lazy, unmotivated, untidy, and lacking self-discipline. These damaging stereotypes about weight contribute to weight stigmatisation, which subsequently leads to bullying.
Preventing obesity
Promoting healthy diets: Parents are to be intentional in helping maitain normal weight. This can be achieved by:
Promoting healthy eating habits within the family begins with adequate antenatal care during pregnancy, promoting breastfeeding, and a seamless transition to complementary foods (weaning). Everyone in the household should eat the same meals. They should encourage the consumption of more traditional dishes made from vegetables (e.g., Kotombire, cassava leaves, “ayoyo”, spinach, garden eggs, lettuce, etc.), legumes, meats, and fruits. Parents are to discourage their children as much as possible from drinking sugary beverages.
Regulating the food and beverage industry: The evidence shows that policies and laws, including taxes on sugary drinks, clear front-of-package labelling requirements, and restrictions on the marketing of unhealthy foods to children, are the most effective in reducing consumption of these products.
Promoting physical activity: There should be intentional national policies for recreational grounds in schools and communities. Some schools lack playing fields, especially those in newly developed settlements. Anecdotally, lands designated for recreation or as schools are encroached upon and developed into residential properties, depriving children of spaces for physical activities such as playing football, riding bicycles, hopscotch, and the girls playing “ampe.”
It should be compulsory for schools to incorporate physical activities into their curricula and to provide clear messaging to promote active lifestyles. The policies should also consider improved urban design and transportation policies, with roads built to accommodate commuters and bicycle lanes included. These policies must ensure that children from poorer homes or communities have access to playing grounds and do not have to pay fees to visit amusement parks.
Screen time guidance
Parents are advised to minimise screen time by following these guidelines for different age groups, as outlined: < 18 Months: Avoid all screen time, except for video chatting with family. 18–24 Months: Limit to high-quality educational programming, watched with a parent. 2–5 Years: Up to one hour daily of sedentary, non-educational or recreational screen time. 5–17 Years: Up to 2 hours of recreational screen time per day.
Strategies for Reducing Screen Time
Limiting daily screen time, removing devices from bedrooms, and encouraging physical activity can effectively reduce weight gain. These can be achieved by: Establish rules: Implement strict daily limits and specific times for screen use. Creating “No Screen” times and days: Keep TVs and devices out of bedrooms and off during family meals.
Provide Alternatives: Encourage outdoor play and physical activity. Parents acting as role models: Demonstrate a positive example by reducing your own screen time. Adults are recommended to spend less than 2 hours daily on recreational screens. Supervise what they watch: Monitor their viewing content and screen time. Message to healthcare professionals and parents
For healthcare professionals, if you encounter a school-age child who repeatedly presents with the same symptoms, such as abdominal pain, headaches, or chest pain with no obvious cause, consider emotional issues, particularly bullying.
It will require a thorough history, examination, and appropriate investigations. If you are a less experienced practitioner, consider referring the child to a more experienced colleague or specialist for further management (as we always say).
For parents, if your child regularly approaches you with the same complaints, particularly vague symptoms, yet they can still carry on with their daily activities, and you’ve consulted various medical professionals without success, don’t lose hope—consider seeking a “second opinion.” There may be issues your child is too embarrassed or scared to tell you about, for fear of being scolded. Your healthcare professional is well-placed to help you navigate this uncertain and sometimes distressing journey.
The Author is a consultant paediatrician at The Bank Hospital, Cantonments, Accra.
DISCLAIMER: The Views, Comments, Opinions, Contributions and Statements made by Readers and Contributors on this platform do not necessarily represent the views or policy of Multimedia Group Limited.
DISCLAIMER: The Views, Comments, Opinions, Contributions and Statements made by Readers and Contributors on this platform do not necessarily represent the views or policy of Multimedia Group Limited.
Source: www.myjoyonline.com
