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The impact of obesity on psychological well-being

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Children and adolescents with obesity face stigmatization and discrimination in many areas of their lives, and it has been assumed that their psychological well-being will be compromised as a result. This chapter examines the most recent empirical evidence on the relationship between childhood obesity and body dissatisfaction, self-esteem and depression. Studies of clinical samples typically report poorer psychological well-being in treatment seekers when compared with population-based obese and normal weight controls. However, research in community samples suggests that despite moderate levels of body dissatisfaction, few obese children are depressed or have low self-esteem. A number of important moderators and mediators of the association between obesity and well-being have emerged, with females, Caucasians and adolescents being particularly at risk. Implications for treatment and future research priorities are suggested.

Section snippets

Body dissatisfaction

Body image has been measured in many different ways. The simplest measures use single questions or figure drawings of increasing size from which respondents must select their actual and ideal figures. Included here are studies that have used measures of perceptual appraisal of appearance rather than mere judgements of size.

There is an extensive literature on body image in children and young people, driven largely by concerns about excessive weight concern and dieting in girls. In a review of

Self-esteem

Self-esteem was defined by William James (1890) in terms of a balance between a person's attainments and their goals or aspirations. Others emphasize the social aspect of self, such that whether we have high or low self-esteem depends at least partly upon how others regard and treat us (Cooley, 1902, cited in Reference 31). Self-esteem can be measured either globally (e.g. ‘I think that I am a great person’) or with regard to a specific domain (e.g. ‘I think that I have a good body’). Clearly

Depression

A substantial body of work has focused on depression as a potential consequence of obesity, but the weight of evidence suggests that the link between obesity and depression is modest at best and may even be negligible. This was the conclusion of a review by Friedman and Brownell56, although they hypothesized that the failure of most research to examine potential moderating variables—gender, socio-economic status (SES) or ethnicity—might be partially obscuring the true association. It is

Overall conclusions

In spite of adverse social and interpersonal consequences of obesity, it appears that obese children may have only moderate levels of body dissatisfaction, and few are depressed or have low self-esteem. This raises three important questions:

  • Why are children unaffected?

  • Why does the scientific community persist in assuming that obesity leads to psychological maladjustment?

  • What are the implications for treatment?

The apparent resilience of obese children echoes findings of research into the impact

Summary

Obese children and adolescents are subjected to social rejection, discrimination and negative stereotyping. Such experiences could be expected to lead to negative consequences in terms of self-image, self-esteem and mood, and there is a widespread assumption that obesity has profound psychological costs. An extensive literature has examined links between obesity and these aspects of psychological well-being. Having reviewed the most recent studies in this area, we conclude that whilst levels of

Conflict of interest

There are no conflicts of interest for either author.

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