The Psychological Distress of Being Overweight
Obesity is usually defined by a body mass index (BMI) greater than 30 kg/m2 in adults. Environments that contribute to obesity include easy availability of high fat/high sugar foods, sedentary lifestyles, and behavioral conditioning from parental feeding habits (Campbell, 2016). The earliest research into body image and obesity goes back to the 1960s when Albert J. Stunkard [1] (1922-2014) confirmed five aspects of obesity as a disorder of embodiment. These factors have been repeatedly confirmed since that time:
- Not all obese persons have BID, but body dissatisfaction is predominant especially in women.
- Body weight as an overriding concern is a primary aspect of obesity.
- Body weight and BID are not necessarily correlated nor is BID affected by weight loss.
- Adolescence is a crucial stage for body weight and shape concerns.
- The obesity community is huge and varied (Vögele, Lutz, & Gibson, 2018).
The psychological dynamics of obesity are complex and nuanced in a variety of ways. A qualitative investigation into the experience of being obese found four key psychological themes (Ueland et al., 2019):
- Formed by Childhood
Most obese persons can pinpoint when and where in their childhood their body weight problems began. It typically occurs in a dysfunctional family that uses food in dysfunctional ways; e.g., reward and punishment. Food often becomes a substitute for emotional nurturance.
Being unable to identify and process negative emotions is underneath most eating disorders. This is known as emotional dysregulation which means being unable to label the emotional feeling, not being able to resolve it, and then engaging in emotional eating (Spence & Courbasson, 2012).
- Ensnared by Food
Many obese individuals feel enslaved by food and are very ambivalent about it. They feel they cannot live the life they want as everything evolves around food.
- Stigmatized by Society
Stigmatization makes a person feel as if they are constantly watched and judged by others. Some obese persons limit their social interactions because of this. Obese people see an increasingly hostile society amplified by media and public health messages.
- Judged by One’s Self
Many obese persons internalize the judgements and blame heaped upon them by those around them. This, coupled with warped childhood experiences, feeling imprisoned by food, and just depressed, all culminate in feelings of self-hate or bleak indifference toward the self.
[1] Albert J. (“Mickey”) Stunkard was an American psychiatrist. He is known for identifying binge eating and night eating disorders in the 1950s.
The Stigmatization for Being Overweight
The body-ideals of Western culture emphasize thinness, leanness, and muscularity among other somatic features. Those who do not meet these ideals—especially those who deviate beyond the average body weight—are singled out, condemned, and stigmatized. Obesity is linked to poor body image much of the time. Risk factors are being overweight, female, and binge eating with increasing vulnerability with the early onset of obesity, race, and other factors (Schwartz & Brownell, 2004).
Discrimination against overweight and obese people has been observed in a wide range of domains, including employment settings, healthcare settings, and romantic relationships. For example, prospective employers view overweight job candidates as less desirable—they are seen as less qualified, less effective, and less trustworthy than their slimmer counterparts (Roehling, 1999, Rudolph et al., 2009). Other research has shown that health care professionals, including physicians, dieticians, and medical students, hold negative attitudes towards and stereotypes of obese people (Puhl & Heuer, 2009).
One Australian study measured the experience of weight stigmatization of a small group of obese persons using the ecological momentary assessment (EMA) protocol (Vartanian, Pinkus, & Smyth, 2014). Forty-six subjects—22 males, 24 females—enrolled in a program to study “the life experiences of overweight and obese individuals.” Their mean age was 28.4 years and their mean BMI was 30.52. The EMA includes a range of measures that observe the dynamic processes in real time as they unfold in daily life. The subjects in this study used a personal digital assistant (PDA) to record each time they experienced an episode of weight stigma over a two-week period. They also recorded their positive and negative feelings after each stigma incident. Results showed that:
- Participants experienced an average of 11.12 episodes of weight stigma.
- Stigma was most common from strangers, spouses, friends, parents, and the media.
- Stigma from strangers was associated with the most negative affect.
Closing Thoughts
There is limited knowledge about longing among those suffering from obesity because we here in the West tend to assign moral failings on behavioral deviations while in the East they tend to place the blame more on environmental factors.
Regardless, we blame people for being fat.
Those who are obese experience complex psychological distress. Their bodies are radically different from the cultural ideals and so they are pretty much fair game for stigmatization. The growing evidence is pointing out that weight stigmatization can have a variety of negative effects on the obese including low self-esteem, depression, and increased BID along with decreased desire to diet or exercise. Stigmatization objectifies a person and deprives him or her of their humanity. We need approach obesity with some openness, tolerance, and compassion. Health care workers—many of who are now part of the problem—must learn more about the condition from a sympathetic, holistic point of view.
Paul Shane, Ph.D., LMT
Director, Academic Content
References
Campbell, M. (2016). Biological, environmental, and social influences on childhood obesity. Pediatric Research, 79(1-2), p. 205–211.
Schwartz, M. & Brownell, K. (2004). Obesity and body image. Body Image 1, p. 43-56.
Spence, S. & Courbasson, C. (2012). The role of emotional dysregulation in concurrent eating disorders and substance use disorders. Eating Disorders 13, p. 382-385.
Ueland, V., Furnes, B., Dysvik, E., & Rørtveit, K. (2019). Living with obesity–existential experiences. International Journal of Qualitative Studies on Health and Well-being 14(1), 1651171, doi: 10.1080/17482631.2019.1651171.
Vartanian, L., Pinkus, R., & Smyth, J. (2014). The phenomenology of weight stigma in everyday life. Journal of Contextual Behavioral Science 3(3), p. 196-202.
Vögele, C., Lutz, A., & Gibson, E. (2018). Mood, emotions, and eating disorders. In W. Agras & A. Robinson (Eds.), The Oxford Handbook of Eating Disorders, Second Edition. Oxford, UK: Oxford University Press, pp. 155-186.
Revised 10-24-24