The prevalence of obesity has seen a rapid growth around the World with the rates doubling for the adults and children (6-11 years) and tripling for the adolescents (12-19 years) over the last 30 years. This is one of the reasons why more care and awareness needs to be created about this health condition.
The World Health Organization has defined obesity as the disease where there is excessive fat accumulation which may have adverse effects and impair the health. A person is classified as obese on the basis of his/her Body Mass Index (BMI). BMI is defined as the ratio of the weight of an individual to that square of the height of that person. A person with a BMI of greater than or equal to 30 is classified as an obese individual.
It is usually perceived that obesity occurs due to the lack of motivation of the person to eat healthy food and non-indulgence in any kind of physical activity but, evidence has suggested that it is a chronic medical illness which is caused by the interplay of a wide range of factors.
The factors responsible for obesity may include behavioral, genetic, environmental and metabolic factors. Obesity has been addressed as a complex condition with many predictors that are out of the control of an individual by the obesity society in 2008. Some of the environmental factors that have contributed to obesity include decreased physical activity, sedentary lifestyle, increased food consumption, increase in the television watching time, use of medications with weight gain as a side-effect.
However, not all the people who are exposed to these environmental factors become obese meaning that there are genetic factors which predispose some people to suffer from obesity. In terms of genetic influences, a gene named fat mass and obesity-associated (FTO) gene has is know to show considerable effects and seems to be modified by life practices.
There is also a role of the nervous system in response to weight gain and obesity. The hypothalamus region of the brain receives signals from the other parts indicating the end of a meal in the short term and in a long-term sending signal about the body energy stores. These signals help in determining the future intake of food and about the energy expenditure. The sympathetic nervous system which is controlled by the hypothalamus regulates the energy expenditure by altering the heat production in the adipose tissue (a tissue where all the fat is deposited). The damage to the hypothalamus thus is also related to increased appetite and weight gain along with the decreased activity of the sympathetic nervous system which in turn reduces the heat production by some tissues.
Some other illnesses that the person is suffering from such as Cushing’s disease (too much production of the hormone cortisol- which is the stress hormone), and polycystic ovary syndrome, or because of taking certain psychiatric drugs such as anti-depressants may also cause weight gain.
The adoption of a Western lifestyle is a very significant factor involved in weight gain where we are more involved in work that is sedentary (working on computers in the office), using technologically advanced resources such as children playing video games rather than going out to play and also the increased interest in eating fast food through advertisements and marketing.
Obesity increases the risk for many medical conditions and disorders such as hypertension, cardiovascular diseases, coronary heart disease (CHD), gallbladder disease. A lot of emphasis has been paid to physiological consequences of obesity but the effect it has on mental health of an individual is not talked much. Mental health can be defined “as a state of well being in which a person is aware of their own competencies, has the ability to deal with stressors faced in the normal life, shows a productive attitude at work, and is able make a contribution to their community as a whole”. Obesity hampers the normal state of mind of an individual such that it impairs their psychosocial functioning.
The society has set certain standards of beauty and physical appearance and we have been brought up seeing this bias in our environment. A child who is different from these norms of the society in terms body weight, height, or any other characteristic is viewed from a very discriminatory lense. When an obese individual interacts with others a lot of thoughts concerning this prejudice might come in their mind and they may eventually start evaluating themselves as how others are seeing them.
They may become very critical about their weight and view themselves as lacking something which their peers or closed ones have. This may lead to the development of a negative body image (the individual’s evaluation of their own appearance). The people suffering from such negative beliefs and disturbance will often experience a sense of dissatisfaction with their body weight and their looks. Consequently, this may have an impact on their self-esteem, cause mental distress such as depression, engage in disordered eating behaviours and other psychological consequences.
An obese individual may face weight related teasing/bullying from their friends, criticism from parents about excessive weight gain and some external control beliefs (beliefs like the weight is beyond the control of a person). The children who are obese may face marginalization and may be subject to prejudicial attitudes of their parents and peers. The child in order to avoid such teasing may not take part in school related activities and avoid interaction with children of their age.
Peer approval is a significant developmental factor and a lack of this may lead to the internalization of the negative stereotypes and stigma associated with obesity. The people who believe that they are responsible for their obesity and think that being obese interferes with their social functioning/interaction are more likely to exhibit lower self-esteem. The emotion of shame they face is also debilitating for the obese individual. This will eventually contribute to a maladaptive cycle of isolation and inactivity and can thus transform into lifelong pattern of social isolation and adulthood inactivity.
Becoming a victim of constant bullying because of weight concerns may reduce the self-esteem of an individual along with showing behaviours such as poor school performance and absenteeism from school/work. The child would be having low self-esteem and may lack the confidence to look at oneself in a positive way. They may also face rejection in terms of their romantic relationships which may further impact their self-esteem. Eisenberg et al. (2003) have found that adolescents who reported weight-related teasing by both family members and peers reported significantly lower scores in self-esteem.
Many psychiatric disorders may also co-occur along with obesity such as depression and eating disorders. Obesity by subjecting individuals to marginalization may instill a sense of loneliness and experience episodes of low moods thus making them vulnerable to negative outlook of the World around them.
Research has indicated that disordered eating is common more among the obese females rather than the males. People who are suffering from binge-eating disorder are more at a risk of becoming obese and binge eating disorder can also occur as a result of facing the physical illness of obesity. Because these individuals are dissatisfied with their bodies, they may engage in dieting behaviours and when not able to follow a healthy routine they might further get stressed and engage in eating more fatty food.
The influence which obesity has on the mental health needs to be addressed now and interventions cognitive behaviour therapy, mindfulness meditation, counselling parents of the obese individuals, and organising awareness campaigns about mental health and obesity might come out to be really effective.
CBT would focus on the cognitions, emotions, behaviours that are related to body dissatisfaction. This would not only improve the self-esteem of the individual but would also help in reducing overeating. The goal of this therapy is to give the thought process a direction such that the individual evaluates one’s self-worth and relationship to food in a positive way.
The CBT treatment includes self-monitoring techniques, challenging automatic thoughts and beliefs, correcting the distorted thinking and relaxation techniques. Just like this, mindfulness meditation tries to replace the negative thinking patterns and image with self-acceptance and having a non-judgemental attitude.
Mindfulness may help in re-establishing a schema, core beliefs, behaviours which maintain body dissatisfaction and develop a sense of compassion for oneself. Parents from childhood should try to make children eat all kind of vegetables and not label any kind of food as bad or good. They should just focus on giving their children home cooked meals. Parents of obese children need to be more sensitive to them and not use harsh words about the body weight of their child while interacting with them.
In today’s time the media has become a very essential part of our life which emphasises a lot on body ideals. Obese individuals by comparing themselves to these standards may impact their mental health to a significant level. Thus, a need for a more empathetic society is the need of the hour.