Will You Be A Millionaire

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93 Pages · 2017 · 1.15 MB 

Obesity is a serious health problem worldwide. In the United States, the number of obese people (defined as BMI>30) has reached epidemic proportions, affecting approximately one-quarter of the American population. The prevalence of obesity is increasing worldwide, and the percentage of people who are overweight has steeply risen more than 30% since 1980 (Bray, 1998). Data from the National Center for Health Statistics indicate an uneven distribution of obesity, with African-American and Mexican American females most affected (F legal, Carroll, & Kucfzmarski, 1998). 

Children and adolescents are not immune to this epidemic. Data suggest that over 20% of children are currently overweight, and 30% of these individuals become obese adults later in life. Excess weight increases the risk of serious medical consequences such as hypertension, diabetes, coronary heart disease, and some forms of cancer. It has been argued that the “preponderance of evidence suggests that even mild overweight is probably associated with some increase in mortality risk" (Solomon, Willett, & Manson, 1995). 

In addition to the tremendous health risks, the financial cost of obesity is staggering. Obesity-related problems are estimated to cost the United States 39.3 billion dollars annually (Col-ditz, 1998). Given this backdrop, it is not surprising that the study of obesity has received an increasing amount of attention from local and federal policy-makers, health care professionals, and researchers. Despite the well-established relationship between medical risks and obesity, the relationship between psychological functioning and obesity remains less clear. Common beliefs implicating psychological distress as a contributing factor in the development of obesity has not been well supported by research (Hill & Williams, 1998). Several large- 2 scale studies, each involving at least 500 subjects, found no consistent evidence to support the claim that severely obese persons show higher levels of psychopathology than normalweight controls (Moore, Standard, & Srole, 1996; Silverstone, 1968; Hallstrom & Noppa, 1982; Kittel, Rustin, Dramaix, DeBacker, & Kornitzer, 1978; Hill & Williams, 1998; Stunkard & Wadden, 1992). Wadden, et al. (2001) contend that a substantial minority of extremely obese patients seeking bariatric surgery present with significant emotional complications. Despite the bulk of support indicating a lack of relationship between psychopathology and obesity, a few studies have demonstrated the opposite, suggesting the presence of significantly higher levels of depression and anxiety in the obese (Sullivan, et al, 1993; Goldsmith, et al., 1992). However, many research trials include a high proportion of treatment-seeking individuals, who demonstrate a higher percentage of psychopathology, similar to other treatment-seeking medical populations. 

Thus, it has been argued that these clinical samples may be over re presented in the literature, resulting in a selection bias (Williamson & O’Neil, in press). A review of the literature concluded that divergent findings were often the result of methodological inconsistencies, and it would be premature to make firm conclusions regarding the relationship between psychopathology and obesity (Friedman & Brownell, 1995). A complex association between obesity and psychopathology appears to exist, and importantly, obese individuals constitute a heterogeneous population, making it very difficult to draw generalized conclusions. A growing body of literature has begun to focus on the experience of body image in obese populations. There is a converging line of evidence demonstrating that obese 3 persons experience a more negative body image when compared to non-overweight controls. Overall, studies using non-clinical populations show that obese persons, especially women, report a more negative body image than persons of normal body weight (Bro die & Sade, 1998; Cash, 1990; Cash, 1994 a; Walden, Foster, Drunkard, & Horowitz, 1989). A negative body image may adversely affect quality of life and impact social and interpersonal behaviors. For example, 

many individuals organize their lifestyle to accommodate a negative body image by avoiding social situations which may emphasize their appearance. The clinical implications of a negative body image was observed more than 30 years ago by the research of Drunkard and Mendelson (1967). In their seminal work, they concluded that: “ the body image disturbance takes the form of an overwhelming preoccupation with one’s obesity, often to the exclusion of any other personal characteristic. It may make no difference whether the person be also talented, wealthy, or intelligent, his weight is his only concern and he sees his whole worth in terms of body weight.” To further illustrate the self-disparagement which often accompanies obesity, Rand and MacGregor (1991) revealed that not a single patient in a sample who maintained an average loss of 45 kg for at least 3 years would prefer being obese to being deaf, diabetic, or having heart disease. These findings provide striking evidence to the powerful nature of the body image dissatisfaction which can accompany obesity. However, it is important to again note that a great deal of heterogeneity exists among obese persons. Thus, body image problems should not be considered as universal. Rather, it appears individual differences such as a juvenile onset of obesity, presence of a co-morbid disorder, or binge eating may place some individuals at a greater risk for a 4 negative body image (Cash, 1990; Cash, 1993; Drunkard & Burt, 1967; Brown ell & Walden, 1992). Those who have been teased by parents and friends, especially during adolescence, appear to have a stronger disparagement (Walden & Drunkard, 1985). The identification of factors which may contribute to the development of a negative body image is an important area of study and will be further addressed in a following section.