OBESITY

Obesity

Obesity

Introduction

Obesity can have severe psychological consequences. It is sometimes argued that the life dissatisfaction, social liabilities, and body image distress produced by obesity are beneficial in that they motivate people to lose weight. It is more likely that these form barriers to emotion regulation that, for both biological and psychological reasons, lead to increased eating. It is also possible that these consequences, perhaps through their impact on serious disorders such as depression, form one link between obesity and chronic disease.

Understanding body image is important to specifying the social and psychological experience of being obese, the medical consequences of psychological issues, and the psychological contributors to the etiology of obesity, but also to providing care. In this paper, we will describe the social consequences of obesity and hypothesize how these would create body image problems, as described many years ago by Stunkard and colleagues ([Stunkard, 1976 and Stunkard & Wadden, 1992]). The heart of this paper is a review and analysis of the relationship of obesity with body image, focusing specifically on whether risk factors exist that might explain who in the obese population is most vulnerable, the status of attempts to remedy body image disturbances, and the implications of these findings for research and clinical work.

Before proceeding, we must explain how we use the terms “obesity” and “overweight.” These terms are often used interchangeably to describe the condition of excess weight, but in a health context are now separated. The World Health Organization (1998) defines overweight as a body mass index (BMI) between 25 and 29.9 and obesity as body mass index above 30. This distinction is important for specifying health risks, but it is less clear whether these BMI cutoffs are meaningful with respect to the social and psychological consequences of excess weight. Where the literature permits, we discuss whether the degree of overweight is an important variable, but otherwise use obesity to describe the condition of having excess weight rather than only representing BMI greater than 30.

The social reality of obesity

The psychological impact of obesity may be shaped by both physical and social processes. The physical processes are not well-understood, but there is every reason for exploration. For instance, poor diet and excess weight could affect mood through changes in neurotransmitters, which in turn might affect body image. Stress can disinhibit eating and also influence body fat distribution and cortisol release ([Epel et al., 2001]; [Epel et al., 2000]). If we are to truly understand the impact of weight on psychological factors such as body image, biology must be considered.

Social factors are better understood. Negative messages about being overweight are relentless. This reflects a strong anti-fat bias that is evident in the media, institutions such as schools and business, and everyday discourse. This bias results in stigma and discrimination ([Puhl & Brownell, 2001]). As one example, an analysis of overweight and non-overweight characters in popular television programs shows that the overweight characters are more often the object of jokes, less likely to be portrayed as leaders and in ...