Stigmatisation in ObesityWhen considering psychological aspects of obesity, it is widely believed that most
psychological disturbances are more likely to be consequences, rather than causes, of
obesity. One of the most compelling illustrations was reported in the early 1990s,
based on 47 patients who were, on average, 66 kg overweight before surgery for morbid
obesity, who lost 45 kg or more subsequently and who successfully maintained
weight loss for at least 3 years. As a group, they perceived their previous morbid
obesity as having been extremely distressful. Most patients said that they would prefer
to be normal weight with a major handicap (deaf, dyslexic, diabetic, legally blind,
very bad acne, heart disease, one leg amputated) than to be morbidly obese. All
patients said they would rather be normal weight than a morbidly obese multi-millionaire.
Thus obesity, as perceived by obese individuals themselves, is an extremely
serious handicap, although not always perceived as such by others. A recent review
summarised that extreme obesity is associated with significant psychiatric morbidity
and impaired health-related quality of life that in many cases imposes a greater burden
of suffering than the physical complications of obesity.
A second issue is how the obese individuals are treated by others. Negative attitudes
are prevalent, and exacerbated by idealisation of thinness in many Western cultures.
There are numerous examples of obesity-related discrimination, including how
children perceive overweight and obese peers, among employers, students’ ideas
about suitable spouses. In a classic study on childhood stereotypes, young children
associated overweight in children with being lazy, dirty, stupid, cheats and liars. The perception of obesity as a self-inflicted condition creates little sympathy for
the obese. Studies of morbidly obese patients show that in many instances they feel
that they are treated disrespectfully by the medical profession because of their weight,
that people look critically at them and their shopping cart when they go shopping,
and that their spouses and children do not like them to accompany them to social
functions because of their weight. At the workplace, they often feel that they are
placed out of sight of the public and they may be passed over for promotion. When
the 47 patients studied by Rand and Macgregor were asked the same questions
after gastric bypass surgery which they had answered before the surgery, their
responses were dramatically different showing a much more positive view of their
own position. Therefore, these perceptions are reversible, following efficient treatment
of obesity. This demonstrates that the obese suffer not only from negative attitudes
but, in addition, also from frank discriminatory behaviour. Unsuccessful dieting may have negative psychological consequences, due to a sense
of distress, failure and self-blame assumed to accompany the visible consequences of
weight gain. The data supporting this are, however, mixed. In severely obese subjects,
the number of previous dieting attempts was associated with mood disturbance and
anxiety, and was a strong predictor of obesity-related psychosocial problems in women.
In contrast, an evaluation of young women before and after treatment at a weight clinic
did not detect any significant effect of one cycle of weight loss and regain on mood.
