Correlates of body image dissatisfaction among overweight women seeking weight loss

Dissatisfaction with body image and weight gain in middle-aged women: A cross sectional study

OBJECTIVES

To investigate the relationship between weight gain and body image perception in in middle-aged women.

METHODS

Cross-sectional study with 453 women. Body image was assessed using the Stunkard scale, in which women were classified as: satisfied or dissatisfied (general, thinness or obesity). The identification of possible factors associated with body image dissatisfaction was performed using binary logistic regression analysis.

RESULTS

The mean age was 55.7 (±9.6) years; 80.8% were classified as dissatisfied with body image. As for body composition, women satisfied with their body image had lower values of body fat and higher values of lean mass. In the logistic regression, for general dissatisfaction and obesity, the associated variables were BMI, education and physical activity. As for "dissatisfaction with thinness", only BMI was associated.

CONCLUSION

Thus, the prevalence of body image dissatisfaction is high in women and part of associated factors are linked to lifestyle behaviors.

Weight-Teasing and Eating Disorders-A Comparative Study in Adolescent and Adult Samples

Disordered eating, unhealthy weight-control behaviours and body dissatisfaction are associated with diminished mental health. A key aspect that has been identified for the development of disordered eating behaviours and body dissatisfaction is to be teased. Additionally, the literature suggests that weight may affect the relationship between weight-teasing and disordered eating and body dissatisfaction, although this pattern is unclear. This study presents two cross-sectional studies with an adult and an adolescent sample. The adolescent sample comprised 15,224 participants, and the adult sample comprised 321 participants, all from Spain. Hierarchical regression analyses were conducted. Aims: to assess the relations among disordered eating, body dissatisfaction, weight, and weight-teasing among adolescents and adults; and to examine whether weight-teasing, weight, age, and gender predict disordered eating and body dissatisfaction in adults and adolescents. The results showed that adolescent girls presented greater effects, and all interactions were significant between weight-teasing and eating disorders. Adults also showed greater effects for women, and only eating disorder interactions were significant. Weight-control behaviours did not show any relationship with weight-teasing. Conclusion: Different approaches may be used in the prevention of eating disorders. Our results show that weight-teasing affects adults differently from adolescents.

What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding

Substantial progress has been made in the understanding of anorexia nervosa (AN) and eating disorder (ED) genetics through the efforts of large-scale collaborative consortia, yielding the first genome-wide significant loci, AN-associated genes, and insights into metabo-psychiatric underpinnings of the disorders. However, the translatability, generalizability, and reach of these insights are hampered by an overly narrow focus in our research. In particular, stereotypes, myths, assumptions and misconceptions have resulted in incomplete or incorrect understandings of ED presentations and trajectories, and exclusion of certain patient groups from our studies. In this review, we aim to counteract these historical imbalances. Taking as our starting point the Academy for Eating Disorders (AED) Truth #5 "Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses", we discuss what we do and do not know about the genetic underpinnings of EDs among people in each of these groups, and suggest strategies to design more inclusive studies. In the second half of our review, we outline broad strategic goals whereby ED researchers can expand the diversity, insights, and clinical translatability of their studies.

Factors associated with the improvement of body image dissatisfaction of female patients with overweight and obesity during cognitive behavioral therapy

BACKGROUND

Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss.

OBJECTIVE

The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss.

METHODS

One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m², age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires.

RESULTS

Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID.

CONCLUSION

Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID.

CLINICAL TRIAL REGISTRATION

[https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052], identifier [UMIN000006803] and [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850], identifier [UMIN000049041].

Body dissatisfaction in midlife women: The applicability of the tripartite influence model

Body image issues and disordered eating are relatively under-researched areas within midlife populations. Accordingly, this study investigated the applicability of the Tripartite Influence Model (TIM) to midlife women. In an online survey, predominately Australian female participants (N = 206) aged 40-55 years (M = 46.75, SD = 4.54) completed measures related to sociocultural pressures, thin-ideal internalisation, appearance comparison, body dissatisfaction, bulimic symptoms, restrained eating, and psychological distress. Path analysis was used to evaluate the model. Greater peer and media pressure were associated with greater appearance comparison, which in turn was associated with greater thin-ideal internalisation, and through this greater body dissatisfaction. Similarly, greater body dissatisfaction was associated with greater restrained eating and bulimic symptoms, which in turn were associated with greater psychological distress. Unexpectedly, family pressure also emerged as an important direct predictor of outcomes, while sociocultural influences were not associated with thin-ideal internalisation, nor was family pressure associated with appearance comparison. Furthermore, appearance comparison was not associated with body dissatisfaction. Overall, the findings provide partial support for applicability of the TIM for midlife women and suggest practical implications such as targeted interventions that may assist body image disturbance and associated outcomes for midlife women.

Body-related attentional bias as mediator of the relationship between body mass index and body dissatisfaction

Body image disturbance, consisting of an affective (body dissatisfaction) and perceptual (body distortion) component, is not only found in eating disorders, but is also present in healthy individuals, affecting their psychological well-being and everyday life. A higher body mass index is associated with higher body dissatisfaction, whereas results in relation to body distortion are mixed. Furthermore, body dissatisfaction is associated with a weight-related attentional bias. This study aimed to investigate the mediating role of a weight-related attentional bias in the relationship between body mass index and body image disturbance. Forty-one college women took part in a virtual reality and eye tracking procedure, in which the illusion of owning a virtual avatar with their body measurements was induced. During this procedure, body-related attentional bias was measured and afterwards body image disturbance was assessed. Mediation analysis revealed that weight-related attentional bias mediated the relationship between body mass index and body dissatisfaction (but not distortion). These findings suggest that modifying weight-related attentional bias would be a useful treatment target for improving body dissatisfaction. In addition, virtual reality technology could serve as an innovative method for modifying attentional bias in an ecologically valid way. HIGHLIGHTS: This Virtual Reality and Eye-Tracking study expands our knowledge about the relation between body mass index, body-related attention and body image disturbances. The results suggest that attentional bias towards weight-related body parts mediates the relation between BMI and body dissatisfaction. On the contrary, the relation between BMI and body distortion was not significant.

Longitudinal Evaluation of a Weight Reduction Program for Patients on Peritoneal Dialysis

♦ Objectives

Patients on peritoneal dialysis (PD) are exposed to glucose-based dialysate solutions with consequent risk of obesity and its attendant health problems. We wished to examine the role of changes in dialysis prescription, individualized dietary input, and exercise on body weight and composition.

♦ Design

A 1 year, prospective interventional study integrating the care of the renal nurse, dietitian, and physiotherapist to support, educate, and encourage overweight patients on PD in a weight-reduction program.

♦ Patients

Patients were considered for the study if they had been on PD for more than 3 months, had a body mass index (BMI) > 25, and were considered medically fit to undergo the planned exercise program. Recruitment was intentionally limited to a maximum of 12 patients to facilitate group interaction. Weight, BMI, and bioimpedance were measured every 3 months.

♦ Results

8 of 11 enrolled patients completed the study; 3 received transplants. There was a significant fall in median body weight at initiation, from 94.6 kg to 92.4 kg at 6 months and 89.5 kg at 12 months ( p = 0.017). This equates to a reduction in BMI from 33.2 (range 26.6 – 38.4) kg/m2 at initiation to 32.1 (range 24.5 – 37.6) kg/m2 at 6 months and 32.1 (range 23.9 – 36.5) kg/m2 at 12 months. There were no significant changes in total body water, lean body mass, or percentage body fat during the study.

♦ Conclusion

7 of 8 patients achieved significant weight loss during the study. The use of an informal group setting motivated patients to continue with exercise and sensible eating patterns. This study demonstrates that, with adequate support, PD patients can achieve and maintain weight loss.

The Mediating Role of Depression in the Relationship Between Body Image Dissatisfaction and Cyberbullying Perpetration

Preliminary evidence suggests that psychopathological factors (e.g., depression) are associated with higher engagement in cyberbullying perpetration, and those with elevated body image dissatisfaction (BID) are more susceptible to depression. However, the possible impact of body image dissatisfaction (BID) on cyberbullying remains untested. The present study examined the direct and indirect relationships of BID with cyberbullying via depression among a sample of 507 university students (mean age, 21.37 years; range 18–44 years). t tests showed that males had a higher prevalence of cyberbullying than females. Structural equation modeling indicated that BID was directly and indirectly associated with cyberbullying via depression among the total sample and males. However, BID was only indirectly related to cyberbullying via depression among females. Depression fully explained the relationship between BID and cyberbullying among females, although there were additional mediating factors between BID and cyberbullying among males. The findings are in accordance with theoretical models suggesting that individuals’ personal characteristics including psychopathological factors are associated with cyberbullying. Furthermore, males attempt to cope with their body image–related psychopathology with more externalizing behaviors than females.

Clinical Practice Recommendations for the Management of Obesity in the United Arab Emirates

With rapid urbanisation and improved living conditions as a result of rising incomes in Gulf Cooperation Council (GCC) countries, obesity has become a major and growing health problem for the region. The United Arab Emirates (UAE) has a resident population of 9.3 million (in 2016), many of whom (85.5%) lived in urban areas and led sedentary lifestyles. Based on the World Health Organisation (WHO) estimates for 2010, 25% of Emirati men and 40% of the women were obese. Obesity rates in this country has doubled from 16 to 34% compared to the year 2000, and severe obesity (BMI > 40 kg/m2) has risen dramatically from 2 to 11%. While a number of international guidelines for the management of obesity are already available in public domain, local guidelines for the UAE and the region, which are structured and individualized for the management of obesity, are sorely needed to help the family physician to provide affordable treatment for the patient at the point-of-care and to reduce the burden on the local healthcare system. A multi-disciplinary panel of international and regional experts who treat patients with overweight and obesity was convened with the aim of developing consensus recommendations for the UAE. The objective is to have a simple and easy-to-refer set of recommendations for busy clinicians as there were already many comprehensive international guidelines available. The panel reviewed and streamlined these recommendations in its entirety for relevance, coherence and usability in the local context. These recommendations for overweight and obesity management were circulated and endorsed by the local practising family medicine community, namely, the Emirates Medical Association and Family Medicine Society. We believe these recommendations would also be of interest to clinicians in other GCC countries. A summary and algorithm of these recommendations are provided.

Self-worth and psychological adjustment of obese children: An analysis through the Draw-A-Person

AIM

To investigate psychopathological correlates of child obesity via the Draw-A-Person test (DAP).

METHODS

The participants were 50 children with a mean age of 9.74 years. Body mass index (BMI) was used as a measure of body fat. Children were divided into normal (n = 17), overweight (n = 14) and obese (n = 19). Two qualitative methods of scoring the DAP based on an integrative approach were used to assess self-concept (ESW) and overall level of children's adjustment (EAC). A procedure for judging interpretative skills of clinicians was implemented before they evaluated children's drawings.

RESULTS

As predicted by our hypothesis, BMI was negatively correlated with ESW, r (50) = -0.29, P < 0.05, but not with EAC, r (50) = - 0.08, P = ns. To evaluate the effect of gender, Pearson correlations were re-computed regrouping the sample accordingly: BMI and EAC reached a significant negative correlation in female subjects, r (24) = -0.36, P < 0.05, and a positive correlation in male subjects, r (26) = 0.37, P = < 0.05; negative correlation between BMI and ESW became stronger in females, r (24) = -0.51, P < 0.01 but not in males, whose correlation disappeared resulting not-significant, r (26) = -0.06, P = ns. No effect of age was found. Results indicate that obesity has a negative correlation exclusively on overall adjustment and self-concept in female children.

CONCLUSION

It was concluded that there is a negative bias toward females that reveals how the stigma of obesity is widespread in Western society.

Does High Self-Esteem Cause Better Performance, Interpersonal Success, Happiness, or Healthier Lifestyles?

Self-esteem has become a household word. Teachers, parents, therapists, and others have focused efforts on boosting self-esteem, on the assumption that high self-esteem will cause many positive outcomes and benefits—an assumption that is critically evaluated in this review.

Appraisal of the effects of self-esteem is complicated by several factors. Because many people with high self-esteem exaggerate their successes and good traits, we emphasize objective measures of outcomes. High self-esteem is also a heterogeneous category, encompassing people who frankly accept their good qualities along with narcissistic, defensive, and conceited individuals.

The modest correlations between self-esteem and school performance do not indicate that high self-esteem leads to good performance. Instead, high self-esteem is partly the result of good school performance. Efforts to boost the self-esteem of pupils have not been shown to improve academic performance and may sometimes be counterproductive. Job performance in adults is sometimes related to self-esteem, although the correlations vary widely, and the direction of causality has not been established. Occupational success may boost self-esteem rather than the reverse. Alternatively, self-esteem may be helpful only in some job contexts. Laboratory studies have generally failed to find that self-esteem causes good task performance, with the important exception that high self-esteem facilitates persistence after failure.

People high in self-esteem claim to be more likable and attractive, to have better relationships, and to make better impressions on others than people with low self-esteem, but objective measures disconfirm most of these beliefs. Narcissists are charming at first but tend to alienate others eventually. Self-esteem has not been shown to predict the quality or duration of relationships.

High self-esteem makes people more willing to speak up in groups and to criticize the group's approach. Leadership does not stem directly from self-esteem, but self-esteem may have indirect effects. Relative to people with low self-esteem, those with high self-esteem show stronger in-group favoritism, which may increase prejudice and discrimination.

Neither high nor low self-esteem is a direct cause of violence. Narcissism leads to increased aggression in retaliation for wounded pride. Low self-esteem may contribute to externalizing behavior and delinquency, although some studies have found that there are no effects or that the effect of self-esteem vanishes when other variables are controlled. The highest and lowest rates of cheating and bullying are found in different subcategories of high self-esteem.

Self-esteem has a strong relation to happiness. Although the research has not clearly established causation, we are persuaded that high self-esteem does lead to greater happiness. Low self-esteem is more likely than high to lead to depression under some circumstances. Some studies support the buffer hypothesis, which is that high self-esteem mitigates the effects of stress, but other studies come to the opposite conclusion, indicating that the negative effects of low self-esteem are mainly felt in good times. Still others find that high self-esteem leads to happier outcomes regardless of stress or other circumstances.

High self-esteem does not prevent children from smoking, drinking, taking drugs, or engaging in early sex. If anything, high self-esteem fosters experimentation, which may increase early sexual activity or drinking, but in general effects of self-esteem are negligible. One important exception is that high self-esteem reduces the chances of bulimia in females.

Overall, the benefits of high self-esteem fall into two categories: enhanced initiative and pleasant feelings. We have not found evidence that boosting self-esteem (by therapeutic interventions or school programs) causes benefits. Our findings do not support continued widespread efforts to boost self-esteem in the hope that it will by itself foster improved outcomes. In view of the heterogeneity of high self-esteem, indiscriminate praise might just as easily promote narcissism, with its less desirable consequences. Instead, we recommend using praise to boost self-esteem as a reward for socially desirable behavior and self-improvement.

Social phobia and quality of life in morbidly obese patients before and after bariatric surgery

BACKGROUND

Morbidly obesity is characterized by physical and psychological comorbidities which are associated with reduced quality of life. Bariatric surgery has been linked to a reduction of psychopathology other than to a reduction of weight and improvement in physical functioning. Aim of the present study was to compare psychological features of two groups of morbidly obese patients, before and after bariatric surgery, assessing social phobia and quality of life.

METHODS

A total of 46 morbidly obese patients were enrolled in the study. Of them, 20 were waiting for bilio-pancreatic diversion (group A), while 26 had already undergone surgical procedure (group B). Psychometric evaluation assessed social phobia, fear for the body-shape and quality of life, using appropriate psychometric tests.

RESULTS

The percentage of patients showing social phobia was significantly higher compared to a sample of healthy controls (p=0.004), both in group A (p=0.003) and in group B (p=0.029). No differences in percentage of patients affected by social phobia were found between groups. A significantly higher percentage of patients affected by distress about the body (p<0.0001) was found in group A with respect to group B. A reduction of quality of life was found in both groups.

CONCLUSIONS

The present study shows a high prevalence of social phobia in a population of morbidly obese patients, both before and after surgery. A general reduction of quality of life was also observed, with a partial improvement after surgery. Future studies are needed to clarify the relationship between social phobia and quality of life in surgically-treated morbidly obese patients.

Psychological predictors of body image concerns 3 months after bariatric surgery

BACKGROUND

Although studies have associated postoperative weight loss with improvement in body image dissatisfaction, some individuals continue to report body image concerns after bariatric surgery. These concerns are linked to increased depressive symptoms and decreased self-esteem in bariatric populations.

OBJECTIVE

This study sought to explore preoperative factors that may predict early body image concerns 3 months after bariatric surgery.

SETTING

Academic medical center.

METHOD

Data were analyzed from 229 patients evaluated for bariatric surgery who completed a 3-month postoperative psychology appointment and the Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF). Scales measuring depression, persecution, self-doubt, and inadequacy were examined. Medical records were reviewed for demographic characteristics, psychotropic medication usage, history of psychological treatment, and current or lifetime depression diagnosis.

RESULTS

Patients who preoperatively scored higher on demoralization (F [1, 227] = 35.40, P< .001), low positive emotions (F [1, 227] = 4.18, P< .05), ideas of persecution (F [1, 227] = 15.24, P< .001), self-doubt (F [1, 227] = 27.47, P< .001), and inefficacy (F [1, 227] = 21.34, P< .001) were significantly more likely to report body image concerns 3 months after bariatric surgery. Similarly, body image concerns were more common in patients with a preoperative depression diagnosis (χ(2) = 8.76, P<.01), current psychotropic medication usage (χ(2) = 7.13, P<.01), and history of outpatient therapy (χ(2) = 8.34, P<.01) and psychotropic medication (χ(2) = 9.66, P< .001).

CONCLUSION

Bariatric surgery candidates with psychopathology and other psychological risk factors are more likely to report body image concerns early after bariatric surgery. Future research is warranted to determine whether this association remains further out from surgery.

Assessing the factor structure of the Body Uneasiness Test (BUT) in an overweight and obese Croatian non-clinical sample

PURPOSE

The study objectives are to investigate the psychometric properties of the Body Uneasiness Test (BUT-A) in a general sample of overweight and obese persons in Croatia, to evaluate structure differences between men and women and to examine the relationship with other measures of body dissatisfaction as well as with objective body mass measure.

METHODS

This study included 320 adults (156 women and 164 men; aged between 20 and 71) with BMIs ranging from 24 to 48.83 kg/m(2).

RESULTS

The analysis confirmed a structural one-factor model for BUT-A. The one-factor model fits the data equally as well as the more complex five-factor model did and should be considered a more robust, parsimonious and adequate model. Female participants showed higher results (higher body uneasiness), but the importance of items is roughly comparable between genders. The BUT-A score significantly contributes to the prediction of general body dissatisfaction, even after gender and BMI are controlled. The multifaceted nature of the BUT-A might explain the relatively low measure of general body dissatisfaction in this sample. Congruent with previous studies, obese subjects expressed dissatisfaction with their body on the figure rating scale by selecting the ideal figure two units thinner than their current body figure. In overweight and obese men, body dissatisfaction is lower than in women.

CONCLUSION

The BUT-A can be a reliable one-dimensional tool for the assessment of body uneasiness in a wide range of samples, including obese individuals.

The monster in the mirror: reasons for wanting to change appearance

PURPOSE

Many adults are dissatisfied with their body, regardless of their weight, and weight loss is commonly perceived as an effective solution to this dissatisfaction. The main purpose of this study was to examine the reasons for wanting to modify one's bodily appearance (shape and weight), and to compare these reasons by sex, age, and weight group.

METHODS

The sample consisted of 796 French-speaking Canadian adults (100 men, 696 women; M age = 27.00 years, SD = 7.88, range 18-64; M body mass index = 24.99 kg/m(2), SD = 6.37, range 12.6-66.5 kg/m(2)) who were asked online whether or not they wanted to change their appearance and if so, why. Answers were subjected to a content analysis wherein recurrent themes were grouped and labeled.

RESULTS

Most participants (83.2%) wanted to change their appearance. Women, participants with a higher BMI, and older participants were significantly more likely to report this desire. The three most frequently evoked reasons were body dissatisfaction, well-being, and health/shape.

CONCLUSIONS

The results suggest that body dissatisfaction constitutes the primary motive for change for both men and women of all ages, especially for those who are of healthy weight or underweight. Women and younger adults seem to be under the impression that in changing their appearance they will be more comfortable in their own skin. Men, older adults, and overweight adults, on the other hand, are more preoccupied by their health/shape and seldom relate their appearance to their psychological balance.

Body Image in Adult Women: Moving Beyond the Younger Years

In spite of copious literature investigating body dissatisfaction and its correlates in adolescents and young adult women, exploration of body image disturbances in adult women remains an underrepresented domain in the literature. Yet, there are many reasons to suspect that body image in adult women both may differ from and possibly be more complex than that of younger women. Adult women face myriad factors influencing body image beyond those delineated in the body image literature on adolescents and young adult women. For instance, aging-related physiological changes shift the female body further away from the thin-young-ideal, which is the societal standard of female beauty. Further, life priorities and psychological factors evolve with age as well. As such, adult women encounter changes that may differentially affect body image across the lifespan. This paper aims to provide an up-to-date review of the current literature on the relationship between body image and associated mental and physical health problems and behaviors in adult women. In addition, we explore factors that may influence body image in adult women. Lastly, we use this review to identify significant gaps in the existing literature with the aim of identifying critical targets for future research.

Psychosocial variables and self-rated health in young adult obese women

AIM

The aim of this study is to describe relationships among self-rated health, stress, sleep quality, loneliness, and self-esteem, in obese young adult women.

BACKGROUND

Obesity has steadily increased among young adults and is a major predictor of self-rated health.

METHODS

A sample of 68 obese (BMI 30 or higher, mean 35), young (18-34 years, mean 22) adult women were recruited from a health center. Survey data were gathered and analyzed using descriptive and bivariate procedures to assess relationships and group differences.

RESULTS

Scores reflected stress, loneliness, poor sleep quality, and poor self-esteem. There were positive correlations among stress, loneliness, and sleep quality and, a high inverse correlation between loneliness and self-esteem. Those who ranked their health as poor differed on stress, loneliness, and self-esteem when compared to those with rankings of good/very good.

CONCLUSIONS

Assessing and addressing stress, loneliness, sleep quality and self-esteem could lead to improved health outcomes in obese young women.

The relation between weight-based teasing and psychological adjustment in adolescents

OBJECTIVE

To determine the prevalence of weight-based teasing, and evaluate its association with depression, anxiety and unhealthy eating behaviour in a large sample of adolescents in the Ottawa (Ontario) area.

METHODS

A total of 1491 adolescents from public and private middle schools and high schools in rural and urban areas of Ottawa responded confidentially to surveys.

RESULTS

More girls than boys reported that they experienced weight-based teasing (33% versus 18%). The prevalence of weight-based teasing by peers was significantly higher among overweight and obese youth than among normal weight youth (45% versus 22%). Teasing about body weight was consistently associated with anxiety, psychological distress and disordered eating, and these associations held for both boys and girls, and were independent of weight status.

CONCLUSIONS

Weight-based teasing is a common experience among Ottawa-area adolescents, especially among overweight girls, and was found to be associated with psychological morbidity. Effective interventions are needed to help victims cope with and prevent further weight-based teasing and its harmful psychological sequelae.

Predictors of weight variation and weight gain in peri- and post-menopausal women

This research encompasses a community sample of 497 women in peri- and post-menopause and uses structural equation modelling to investigate the structural models of weight variation and weight gain. Variables such as body shape concerns, depression, stress and life events are explored. Weight gain (from pre-menopause to current menopausal status) was observed in 69 per cent of participants. The predictors of weight gain were lower education level ( β = −.146, p = .017), less or no physical exercise ( β = −.111, p = .021), having a recent psychological problem ( β = .191, p < .001), transition from peri- to post-menopause ( β = .147, p = .013) and more frequent body shape concerns ( β = .313, p < .001). Prevention of weight gain in pre-menopause is recommended; risk groups should be targeted considering the predictors of weight increase.

Effectiveness of rhythmic movement therapy for disordered eating behaviors and obesity

The aims of the present study were: a) to examine associations between pre-treatment BMI, body dissatisfaction, perfectionism, alexithymia, and restraint, emotional and external eating behaviour in obese patients; b) to analyze the impact of the pre-treatment measures in psychological variables on the outcome of cognitive-behavioral therapy (CBT) program; c) to test the effectiveness of rhythmic movement therapy (RMT) in the treatment of disordered eating behaviors and obesity with the CBT non-responders. At the first stage of treatment a total of 104 patients (32 males and 72 females, mean age was 37.6 +/- 6.7 years) self-referred or referred by professionals to CBT weight management program were selected at random. At the second stage 58 obese CBT-non-responders were randomly divided among the continuing CBT individual treatment group and RMT group. Control group was included. Results revealed that: a) significant associations existed between pre-treatment BMI, external eating and two dimensions of perfectionism, as well as between emotional and external eating and all dimensions of perfectionism, alexithymia and body image dissatisfaction; b) pre-treatment means of psychological variables significantly impacted the CBT program outcome; c). the efficacy of RMT approach for weight reduction as well as for the improvement of psychological status for CBT-non-responders was confirmed.

Body image after sleeve gastrectomy: reduced dissatisfaction and increased dynamics

BACKGROUND

Individuals with severe obesity commonly report poor body image. Improvement in body image has been found after conservative weight reduction programs as well as after bariatric surgery (gastric bypass, biliopancreatic diversion, or gastric banding). However, no studies investigating body image after laparoscopic sleeve gastrectomy (LSG) are available.

METHODS

Of 70 consecutive patients who planned to undergo LSG at a comprehensive obesity center, 62 patients were included in the study and evaluated before surgery. Their mean body mass index (BMI) was 51.3 kg/m(2) and the patients' mean age before surgery was 43.8 years. One-year follow-up data were obtained for 51 patients (82.3 %). Body image was assessed using the body image questionnaire (BIQ-20), and depression was assessed using the Patient Health Questionnaire (PHQ-9).

RESULTS

Patients reported poor body image before surgery. One year after LSG, negative evaluations of the body and perceptions of body dynamics and vitality had markedly improved, without reaching healthy levels. No correlations between body image and weight-related parameters (BMI, percentage of excess weight loss) or mood after 1 year were found.

CONCLUSIONS

Body image improves after LSG. This improvement might reflect changes to patients' attitudes, beliefs, and thoughts rather than real weight lost. Further studies should investigate the factors that mediate improvement of body image after bariatric surgery.

The psychology of obesity

G. Stanley Hall, the first person to earn a Ph.D. in psychology in the United States, did research on eating behaviors in the nineteenth century (Lepore in The New Yorker, 2011). Research on psychological aspects of obesity accelerated in the 1950s and there has been a great deal done at this point. We review areas of considerable activity and relevance.

Assessment tools in obesity - psychological measures, diet, activity, and body composition

The global increase in the prevalence of obesity has led to an increased need for measurement tools for research, management and treatment of the obese person. The physical size limitations imposed by obesity, variations in body composition from that of normal weight, and a complex psychopathology all pose tremendous challenges to the assessment of an obese person. There is little published research regarding what tools can be used with confidence. This review is designed to provide researchers and clinicians with a guide to the current and emerging measurement tools specifically associated with obesity research and practice. Section 1 addresses psychological measures of well being. Sections 2, 3, and 4 focus on the assessment of food intake, activity, and body composition. All sections address basic challenges involved in the study and management of obesity, and highlight methodological issues associated with the use of common assessment tools. The best available methods for use in the obese both in research and clinical practice are recommended.

Impact of eating disorders and psychological distress on the quality of life of obese people

OBJECTIVE

Quality of life (QoL) is impaired in obesity, but the roles of eating behavior and psychological distress need to be more documented.

METHODS

One hundred thirty consecutive obese patients seeking medical care filled out questionnaires evaluating QoL, the presence of an eating disorder (ED), levels of anxiety and depression, and perception of body image.

RESULTS

Global QoL was poor in 16.4% and intermediate in 61.8% of the patients. EDs were present in 58% of patients who were more (P = 0.05) overweight; 24.2% of patients had binging. EDs impaired significantly the global and specific dimensions of QoL; binging impaired physical and sexual QoLs (both P < 0.02). Anxiety and depression were found in 73.6% and 50.4% of patients, respectively; depression was more frequent in women (P = 0.007) and in patients with EDs. Anxiety and/or depression impaired global (P < 0.001) and specific dimensions of QoL. Body shape concern was marked in 86.4% of women and associated with poor global (P < 0.001) and specific QoL, and with anxiety and depression.

CONCLUSION

The impairment of QoL in obese patients is increased by the presence of an ED, anxiety, and/or depression and marked body shape concern. These psychological factors should be assessed more carefully and taken into account in global strategies aiming to improve the well-being of obese patients.

Media Exposure, Body Dissatisfaction, and Disordered Eating in Middle-aged Women

The primary aim of our study was to examine the influence of media exposure on body dissatisfaction and disordered eating in middle-aged women. A sample of 101 women, aged between 35 and 55 years, completed questionnaire measures of media exposure, thin-ideal internalization, social comparison, appearance investment, aging anxiety, body dissatisfaction, and disordered eating. Television, but not magazine exposure, was positively related to body dissatisfaction and disordered eating. In contrast, both television and magazine exposure were positive correlates of all four proposed media-processing variables (internalization, social comparison, appearance investment, and aging anxiety), which were themselves positive correlates of both body dissatisfaction and disordered eating. Structural equation modelling revealed that the influence of media exposure was fully mediated by the proposed media processes. The analyses also indicated that our proposed sociocultural model of disordered eating provided a reasonably good fit to the data, suggesting that sociocultural theory can be extended to women of middle-age. An important practical implication of this finding is that strategies aimed at challenging and minimizing these media processes may reduce some of the negative impact of media exposure in middle-aged women.

Parents and vehicle purchases for their children: a surprising source of weight bias

According to current estimates, 68% of the population in United States is considered either overweight or obese. Despite its relative frequency, prejudice and discrimination against overweight and obese Americans is a common occurrence. This study seeks to build on previous findings that overweight individuals are more likely than their skinnier peers to rely on themselves, rather than family, to fund their education. We examined whether this trend continued in car-buying practices. Results suggest that overweight and obese individuals differentially rely on their own sources of income to finance a car, even after controlling for socioeconomic differences. Possible explanations and implications are discussed.

Public opinion about laws to prohibit weight discrimination in the United States

Weight discrimination is pervasive in American society and impairs quality of life for obese persons. With approximately two-thirds of Americans now overweight or obese, vast numbers of people are vulnerable to weight prejudice and its consequences. Currently, no laws exist to prohibit weight discrimination. This study conducted an online survey with a national sample of 1,001 adults (representing demographics of the United States) to examine public support for six potential legislative measures to prohibit weight discrimination in the United States. Results indicated substantial support (65% of men, 81% of women) for laws to prohibit weight discrimination in the workplace, especially for legal measures that would prohibit employers from refusing to hire, terminate, or deny promotion based on a person's body weight. Laws that proposed extending the same protections to obese persons as people with physical disabilities received the least support, suggesting that Americans may not be in favor of considering obesity as a disability. Findings also highlight specific predictors of support (related to sex, age, education, income, body weight, and political ideology). These findings can be used to inform policy makers in efforts to develop antidiscrimination laws. Such measures will rectify health disparities for overweight Americans and facilitate public health efforts to address obesity.

Appearance-related teasing, body dissatisfaction, and disordered eating: A meta-analysis

A meta-analysis was conducted to determine the relationship between appearance and weight-based teasing and three outcome measures: body dissatisfaction, restrictive eating, and bulimic behaviors. Four meta-analyses were conducted. Fifty effect sizes (N=10,618) resulted in a moderate effect size of .39 for the relationship between weight teasing and body dissatisfaction; 24 effect sizes (N=7190) resulted in an effect size of .32 for the relationship between appearance teasing and body dissatisfaction; 20 effect sizes (N=4792) resulted in an effect size of .35 for the relationship between weight teasing and dietary restraint; and 22 effect sizes (N=5091) resulted in an effect size of .36 for the relationship between weight teasing and bulimic behaviors. Significant moderators that emerged were teasing measure type, publication type, study type, age group, and gender. The findings offer further support for the inclusion of strategies in body image and eating disorders' prevention and intervention programs that focus on handling negative, appearance-related commentary.

Obesity stigma: important considerations for public health

Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.

Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: results of a qualitative study

Acne, psoriasis and atopic eczema are common diseases and have been consistently associated with adverse psychological sequelae including stigmatization. Being teased on the basis of appearance has been associated with psychiatric morbidity in children and adolescents. The objective of this qualitative study was to explore the experiences of teasing and bullying in patients with acne, psoriasis and eczema, and the role of appearance-related teasing and bullying as mediators of psychological morbidity in these patients. Data collection consisted of 62 in-depth semi-structured interviews with patients with acne, psoriasis or atopic eczema recruited from both specialist dermatology and general practices. Data analysis was cumulative and concurrent throughout the data collection period reflecting a grounded theory approach. Analysis followed the analytic induction method, allowing themes to emerge from the data. Teasing, taunting or bullying was a considerable problem for a significant minority of acne, psoriasis and atopic eczema participants. Themes that emerged were the universally negative nature of the teasing, the use of teasing as an instrument of social exclusion, and as a means of establishing or enforcing power relationships, teasing related to contagion and fear, the emotional and psychological sequelae of teasing and the theme of 'insensate' teasing. For those who had suffered teasing or bullying, this was causally linked in respondents' accounts with psychological sequelae, especially self-consciousness and effects on self-image and self-esteem. Experiences of teasing and bullying were found to have principally occurred during the adolescence of participants and the perpetrators were other adolescents, but there were findings of respondents with psoriasis also having been subjected to ridicule or derogatory remarks by health professionals. Teasing, taunting and bullying may represent an underappreciated source of psychological morbidity in children and adolescents with these common skin diseases.

Compulsão alimentar antes e após a cirurgia bariátrica

RACIONAL: A obesidade é distúrbio de origem multifatorial complexa que congrega aspectos de ordem psicológica, social, biológica e requer abordagem multidisciplinar. É considerada fator de risco para a compulsão alimentar, de modo que a dinâmica emocional do obeso contribuiria para desencadear o ato compulsivo. OBJETIVO: Analisar os indícios de compulsão alimentar em pacientes submetidos à cirurgia bariátrica, antes e dois anos após a operação. MÉTODOS: Foi realizado estudo prospectivo em 50 pacientes submetidos à cirurgia bariátrica pela técnica de Fobi-Capella. Os instrumentos de avaliação psicológica, aplicados antes e após dois anos, foram o teste das Pirâmides Coloridas de Max Pfister e entrevista clínica semi-estruturada. O teste foi aplicado antes e após a operação para identificar indícios de compulsão. A entrevista somente no pós-operatório. RESULTADOS: Citando somente os dados principais, os dados mostraram estabilidade e capacidade para lidar com conflitos em 16% dos pacientes antes da operação e em 10% após. Para a capacidade de controle e adaptação, 36% dos pacientes apresentavam fortes indícios de atitude de controle e rigidez antes da operação e 32% após. Quanto aos indicadores de impulsividade, agressividade e irritabilidade, houve fortes indícios de atitudes agressivas e impulsivas em 28% antes da operação e em 36% após. Quanto ao comportamento beliscador, eram presentes em 94% dos pacientes no pré-operatório e em 60% no pós. Quanto à preferência alimentar, foi a por alimentos calóricos sem menção à bebidas alcoólicas no pré-operatório, e no pós-operatório por alimentos de fácil ingestão. Quanto ao motivo atribuído aos episódios compulsivos, antes da operação 4% dos pacientes relataram estado de nervosismo, 24% afirmaram distúrbios de humor e 52% identificaram sentimentos de impotência ou submissão. No pós, foram 10%, 28% e 38%. Quanto às respostas compensatórias, eram elas ingestão de doces em 12%; ingestão de petiscos em 2% e comer indiscriminadamente tudo que estivesse ao alcance em 64% dos pacientes. Após, 18%, 10% e 22%. CONCLUSÃO: Os pacientes apresentam indícios de compulsão alimentar antes e após a operação. Ela está relacionada a aspectos psicológicos. Os hábitos e preferências alimentares modificam-se após a operação, de modo que os pacientes passam a consumir alimentos de fácil ingestão frente a situações que os faziam comer compulsivamente, não sendo observado trocas de compulsão. O comportamento alimentar inadequado persiste ou é agravado após a operação.

Psychometric evaluation of the eating disorder examination-questionnaire for bariatric surgery candidates

OBJECTIVE

Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates.

METHODS AND PROCEDURES

Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology.

DISCUSSION

Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients.

Body checking and avoidance among behavioral weight-loss participants

The present study examined the psychological and weight-related correlates of body checking and avoidance behaviors in individuals who have lost weight through obesity treatment. Among 185 individuals in behavioral weight-control treatment, the prevalence of body checking and avoidance behavior was assessed, as well as the relationship of checking and avoidance to attitudinal disturbances, weight loss, and perception of struggling in treatment. Checking and avoidance were frequent, and they correlated significantly with higher overvaluation of shape and weight, lower self-esteem, greater body dissatisfaction, higher fear of fat, and the perception of greater struggling in weight-loss treatment. Checking was inversely correlated with the percentage weight lost in treatment and BMI lost but not related to pre-treatment or current BMI. Thus, body checking and avoidance behaviors were associated with psychological disturbances and poorer treatment outcome.

Psychiatric considerations of the massive weight loss patient

As bariatric surgery for extreme obesity continues to grow in popularity, so does interest in postbariatric surgery body-contouring surgery. There is an extensive literature on the psychological characteristics of persons with extreme obesity who undergo bariatric surgery and the psychological changes that typically occur postoperatively. Far less, however, is known about the psychological aspects of body contouring following massive weight loss. This article reviews the psychosocial characteristics of individuals with extreme obesity who undergo bariatric surgery, as well as the changes in these traits that typically occur postoperatively. Because there have been few studies of the psychological aspects of patients who have lost massive amounts of weight, we use related literatures on the relationship between body image dissatisfaction and other plastic surgical procedures to identify the most relevant research and clinical issues for this unique patient population. Appropriate psychiatric screening and management of these patients is believed to play an important role in successful postoperative outcomes.