Stephanie Klein's diary entry from a "terrible" rainy Tuesday in 1989, when she was 13 years old, included the following rants:
"J.P. never called me back after I called him 4 times!!
"I had to run in gym.
"Some kid called me "moose."
The "moose" insult plagued Klein, now 34, over several years when she was clinically obese. Other girls threw chocolates at her and called her "hot stuff" when she wore a bathing suit. If she won at spin-the-bottle at teen parties, boys would ask for do-overs.
"When I was 8 years old, I was sent to a nutritionist... who told me, 'You will be fat for the rest of your life, even if you look thin,'" Klein said. "Intellectually, I know better, but emotions don't know right from wrong. And it's true across the board for everyone -- the kid with a mole, the fat kid -- however you were ostracized."
Even after she lost weight in high school, made more friends and had more dates, Klein said she hung on to the pain of being the fat kid. The feeling came back whenever she felt rejected.
Studies have shown that children who rank as less popular often have low self-esteem and a poor social support system -- which can translate to poor health outcomes, including depression, drug and alcohol abuse, eating disorders, even suicide.
And the wounds of adolescence can be so deep that they affect a person's physical health long after school days are a distant memory.
Researchers from Sweden found that being unpopular in school increased a person's risk of heart disease and diabetes -- while being popular was linked to good health as an adult. Results from the study were just published in the Journal of Epidemiology and Community Health.
"[Heart disease and diabetes] have not previously been examined in relation to peer status," said Ylva Almquist, a doctoral student at the Center for Health Equity Studies in Stockholm, Sweden, and author of the study. "I think these results further highlight the importance of acknowledging that school is not only about performance and grades, but equally so about the social interplay between children."
The study tracked hospital records from over 14,000 people who were part of the Stockholm Birth Cohort Study that began in 1953. Popularity was measured by asking children, once they reached grade 6 in 1966, to select peers with whom they preferred to work at school. Children were ranked based on how many nominations they received.
Hospital data from 1973-2003 showed that children ranked least popular were nine times more likely to develop heart disease and four times more likely to be treated for diabetes and other hormonal diseases, as well as twice as likely to develop a mental illness.
It was unclear if the stress of being unpopular played a role in disease development, or if popularity was an outward sign of behavioral tendencies that might lead to disease.
Psychologists agree that the study's conclusions make sense, but because of limitations in the study, they warn against making too many assumptions about a link between social standing and health.
Nadine Kaslow, chief psychologist at the Emory University School of Medicine, pointed out that social standings change with age and context. A person may not have many friends at school, for instance, but may be accepted at work or at a summer camp.