Psychological aspects of obesity

doi:10.1016/j.clindermatol.2004.01.006

Clinics in Dermatology

Volume 22, Issue 4, July–August 2004, Pages 332-337

https://doi.org/10.1016/j.clindermatol.2004.01.006 Get rights and content

Abstract

Obesity is a complex condition associated with a host of medical disorders. A common assumption is that obesity must also be related to psychological and emotional complications. Research on the psychosocial aspects of obesity has grown more sophisticated over the years, from purely theoretical papers to cross-sectional comparisons of people with and without obesity to prospective investigations of the temporal sequence of obesity and mood disturbance. These studies have shown that obesity, by itself, does not appear to be systematically associated with psychopathological outcomes. Certain obese individuals, however, are at greater risk of psychiatric disorder, especially depression. The present paper reviews the research findings and presents their clinical implications. Chiefly, treatment providers should not assume that a depressed or otherwise disturbed obese person needs only to lose weight in order to return to psychological health. Significant mood disturbances should be treated equally aggressively, regardless of a patient's weight status.

Section snippets

Stigma and discrimination

Prejudice and discrimination toward obese individuals persist despite worldwide increases in the prevalence of obesity and the recognition of genetic contributions to body weight. In America, negative attitudes and behaviors are likely exacerbated by our culture's idealization of thinness. Ridicule and disparagement of obese individuals seems to remain a socially acceptable form of prejudice.

The “fat is bad” stereotype begins early in life. Children as young as 3 years old have been found to

Studies of the general population

Early studies of the psychosocial status of obese individuals in the general population yielded inconsistent results.1 Some found that obesity was related to greater emotional distress, whereas others reported that obese people displayed less psychological disturbance. Regardless of the direction of the relationships between obesity and psychopathology, these studies consistently failed to find clinically significant results. The differences between obese and nonobese individuals were not

Potential risk factors

In recent studies, the focus of inquiry has shifted from whether obesity is related to greater psychological distress to which obese people are at increased risk for psychopathology. This new question characterizes the second-generation studies and recognizes the heterogeneity of obese persons. Discovery of risk factors is of great importance given that there is likely greater variability among obese individuals than between obese and nonobese people. In this section we review the

Temporal sequencing of obesity and psychopathology

Researchers have begun to examine the question of whether obesity precedes depression or whether an existing mood disturbance predisposes to increased weight. Three studies have addressed this issue. Goodman and Whittaker24 studied a nationally representative sample of 9374 U.S. adolescents in grades 7–12. Participants reported their height and weight and completed a depression questionnaire in 1995 and again in 1996. The investigators explored the reciprocal relations between obesity and

Clinical implications

The preceding sections have shown that obesity is related to a slight increase in the risk of mood disturbance—but only among women—and that depression appears to precede obesity in adolescence but to follow the onset of obesity in later adulthood. Clinicians are reminded, however, that the vast majority of obese people are not depressed. Careful assessment is needed.

When confronted with an obese patient who is also depressed, the clinician should not assume that the patient's depression is

Conclusions

Contrary to common stereotypes and assumptions, obesity is not strongly associated with depression or any abnormal personality characteristics. Psychological traits are more widely varied within the population of obese persons than between obese and nonobese individuals. As with people of average weight, certain factors appear to increase the risk of psychopathology among obese persons. Obese females, binge eaters, and extremely obese persons are at increased risk for emotional disturbance.

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Prepregnancy obesity is considered a risk factor for future development of ovarian and breast cancer (OR: 1.4; 95% CI: 1.1–1.9; P = 0.045). Furthermore, some obese individuals are at greater risk of psychiatric disorders, especially depression [4–6]. Not only that obesity has a negative effect on quality of life, it can become an obstacle in creating life.
To investigate whether maternal obesity poses a risk for long-term cardiovascular morbidity in the offspring.
Data were analyzed from a non-selective population of all infants born between the years 1991–2014 at the tertiary Soroka University Medical Center (SUMC), the sole hospital in the southern region of Israel. Offspring's cardiovascular morbidity from childbirth up to eighteen years old was compared among children whom their mothers were with and without obesity (maternal pre-pregnancy body mass index (BMI) ≥30 kg/m2). Kaplan–Meier survival curve was used to compare cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards model was used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for long-term cardiovascular hospitalizations.
A total of 242,342 deliveries met the inclusion criteria, 3290 (1.36%) had a BMI > 30 kg/m2. Total cardiovascular hospitalizations were comparable between the study groups (1.1% vs. 0.6%, OR = 1.79; 1.28–2.50). The Kaplan-Meier survival curve exhibited a difference in the cumulative incidence of total cardiovascular hospitalizations of the offspring (log-rank test, p < 0.001). In the Cox multi-variable analysis, a significant association was noted between obesity and cardiovascular morbidity even after adjustment for confounders such as maternal age, gestational age, hypertension and diabetes (adjusted HR = 1.59, 95% Cl 1.14–2.21).
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Therefore, those with severe obesity are at higher risk of subsequent coronary artery atherosclerosis and transient endothelial dysfunction. The mechanisms contributing to the impaired psychosocial health among those with severe obesity may include an increased risk of medical complications, lowered self-esteem, and a greater likelihood of experiencing long-term body image dissatisfaction, prejudice, and discrimination.31 Weight stigma, internalization of weight bias, and other psychological stressors are identified mediators of anxiety and depression.11
It remains unclear whether cardiac rehabilitation (CR) provides similar benefits to patients with varying levels of body mass index (BMI). We assessed the psychosocial and cardiometabolic health of patients with increased BMI who completed CR.
The records of 582 patients who completed a 3-month outpatient CR program were analyzed. On the basis of their BMI at baseline, patients were categorized as normal (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), obese (30.0-34.9 kg/m²), or severely obese (≥ 35.0 kg/m²). Analysis of covariance was used to compare health-related quality of life (ie, Physical Component Summary [PCS] and Mental Component Summary scores), anxiety, depression, and cardiometabolic health indicators between BMI categories after CR.
At baseline, patients with severe obesity, when compared with those with normal BMI, had lower PCS scores (39.7 ± 8.5 vs 44.4 ± 8.4, P < 0.001), elevated levels of anxiety (7.0 ± 3.7 vs 4.8 ± 3.2, P = 0.001) and depression (5.5 ± 4.4 vs 3.4 ± 3.7, P < 0.001), higher glycated hemoglobin A1C (6.5 ± 1.1 vs 5.6 ± 0.7%, P < 0.001) and triglycerides (1.6 ± 0.5 vs 1.1 ± 0.4 mmol/L, P < 0.001), and lower high-density lipoprotein cholesterol (1.1 ± 0.3 vs 1.2 ± 0.4 mmol/L, P = 0.006). After CR, notwithstanding a greater percent weight reduction in obesity (−3.5% ± 6.9% vs +1.1% ± 7.0%, P = 0.002) and severe obesity (−6.5% ± 6.9% vs +1.1% ± 7.0%, P < 0.001), smaller improvements in PCS scores were seen in the obese (4.1 ± 7.4 vs 6.9 ± 7.6, P = 0.011) and severely obese (4.1 ± 7.6 vs 6.9 ± 7.6, P = 0.039) when compared with those with normal BMI.
Poorer psychosocial and cardiometabolic health at baseline coupled with smaller improvements in the PCS score suggest that patients with obesity and severe obesity will benefit from enhanced care in the CR setting.
Il n'a pas encore été déterminé si les effets bénéfiques de la réadaptation cardiaque (RC) sont les mêmes quel que soit l'indice de masse corporelle (IMC). Nous avons évalué la santé psychosociale et cardiométabolique de patients ayant un IMC plus élevé qui avaient suivi une RC.
Nous avons analysé les dossiers de 582 patients qui avaient suivi un programme de RC pendant trois mois en dehors de l'hôpital. Chaque patient a été classé, en fonction de son IMC, dans l'une ou l'autre des catégories suivantes : poids normal (de 18,5 à 24,9 kg/m²), surpoids (de 25,0 à 29,9 kg/m²), obésité (de 30,0 à 34,9 kg/m²) ou obésité grave (≥ 35,0 kg/m²). L'analyse de la covariance a été utilisée pour comparer la qualité de vie liée à la santé (c.-à-d. les scores du sommaire de la composante physique [SCP] et du sommaire de la composante mentale) et les indicateurs de l'anxiété, de la dépression et de la santé cardiométabolique des patients des différentes catégories d'IMC après la RC.
Au départ, les patients atteints d'obésité grave, comparativement à ceux ayant un IMC normal, présentaient un score du SCP moins élevé (39,7 ± 8,5 vs 44,4 ± 8,4, p < 0,001), des degrés élevés d'anxiété (7,0 ± 3,7 vs 4,8 ± 3,2, p = 0,001) et de dépression (5,5 ± 4,4 vs 3,4 ± 3,7, p < 0,001), un taux plus élevé d'hémoglobine glyquée A_1C (6,5 ± 1,1 vs 5,6 ± 0,7 %, p < 0,001) et de triglycérides (1,6 ± 0,5 vs 1,1 ± 0,4 mmol/l, p < 0,001) et un taux plus faible de cholestérol à lipoprotéines de haute densité (1,1 ± 0,3 vs 1,2 ± 0,4 mmol/l, p = 0,006). Après la RC, malgré une réduction de poids en pourcentage plus élevée dans les groupes des patients atteints d'obésité (-3,5 % ± 6,9 % vs +1,1 % ± 7,0 %, p = 0,002) et d'obésité grave (-6,5 % ± 6,9 % vs +1,1 % ± 7,0 %, p < 0,001), des améliorations moins marquées du score au SCP ont été observées chez les patients obèses (4,1 ± 7,4 vs 6,9 ± 7,6, p = 0,011) et gravement obèses (4,1 ± 7,6 vs 6,9 ± 7,6, p = 0,039) comparativement à ceux ayant un IMC normal.
Du fait de leur moins bonne santé psychosociale et cardiométabolique initiale conjuguée à des améliorations plus faibles du score au SCP, les patients atteints d'obésité ou d'obésité grave tireront profit de la prise en charge améliorée offerte dans le cadre d'une RC.
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^☆: Supported in part by grants (1-U01-DK57135 and K24-DK065018) from the National Institute of Diabetes and Digestive and Kidney Diseases.

View full text

Psychological aspects of obesity☆

Abstract

Section snippets

Stigma and discrimination

Studies of the general population

Potential risk factors

Temporal sequencing of obesity and psychopathology

Clinical implications

Conclusions

J Appl Dev Psychol

Surg Clin North Am

Compr Psychiatry

Mayo Clin Proc

Psychological correlates of obesity: moving to the next research generation

Psychol Bull

Body weight and psychological distress in NHANES I

Int J Obes

Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study

Am J Public Health

A study of social stereotype of body image in children

J Pers Soc Psychol

Overweight/obese patients: an overview

Practitioner

Weight bias among health professionals specializing in obesity

Obes Res

Prejudice against fat peopleideology and self-interest

J Pers Soc Psychol

The weight of obesity in evaluating others: a mere proximity effect

Pers Soc Psychol Bull

Bias, discrimination, and obesity

Obes Res

Weight-based discrimination in employment: psychological and legal aspects

Pers Psychol

Do parents discriminate against their heavy-weight daughters?

Pers Soc Psychol Bull