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Effects of Obesity
The effects of obesity include the medical co-morbidities, the psychological effects, the social effects and the effects on society as a whole.

Psychological Effects Very overweight and obese people have reduced psychological health. Their self-esteem and social interaction may be impaired, they may have a poor body image and anxiety and depression. Many studies show that depression is especially present in females who are obese and that there is more depression present in those who are obese than persons of normal weight. Studies have also shown that binge eating is common amongst severely obese adolescents and is related to high levels of anxiety and depression, as well as to low levels of self-esteem and body attitude. A young female is more vulnerable to the psychological effects and is more likely to exhibit abnormal behaviour such as binge-eating. __________________________________________________________________________________ Social Effects Obese people suffer from prejudice and discrimination in many situations. Society can have a negative opinion of overweight and obese people and they can be perceived in a negative way. They can encounter prejudice and discrimination in, for example, the fields of employment travel,

schooling, healthcare, retail and so on.They may have great difficulty in buying clothes and fitting into seats on planes, incurring extra costs in requiring tailor-made clothes and double seats when travelling. Difficulty in getting or keeping a job (with reduced pay and promotion prospects) may lead to poverty reinforced low self-esteem and reduced quality of life. Effects on Society As well as detrimental effect on the individual, obesity places a financial burden on society as a whole. There is a huge cost to the economy from obesity-related ill-health, premature retirement, unemployment, premature death, benefit payments, productivity and loss of working days. The direct and indirect costs of obesity in England (2002) have been conservatively estimated at 3.3 to 3.7 billion. With the rise in obesity, this figure is likely to increase. Reference: House of Commons Health Committee 2004. Amended April 2008. __________________________________________________________________________________

Overview Of Childhood Obesity

Obesity Facts " No (health) problem needs our attention more than the epedemic of obesity in America. In sheer numbers and its toll in death and disability, obesity has reached crisis proportions in the United States " Dr. C. Everett Koop former United States Surgeon General In the United States, obesity has risen at an epidemic rate during the past 20 years. One of the national health objectives for the year 2010 is to reduce the prevalence of obesity among adults to less than 15%. Research indicates that the situation is worsening rather than improving. U.S. Obesity Trends 19852003 BRFSS, 1985, 1991, 1996 and 2003 BMI > 30, or ~ 30 lbs. overweight for 5'4" person





Source: Behavioral Risk Factor Surveillance System, CDC During the past 20 years there has been a dramatic increase in obesity in the United States. In 1985 only a few states were participating in CDCs Behavioral Risk Factor Surveillance System (BRFSS) and providing obesity data. In 1991, four states had obesity prevalence rates of 1519 percent and no states had rates at or above 20 percent. In 2003, 15 states had obesity prevalence rates of 1519 percent; 31 states had rates of 2024 percent; and 4 states had rates more than 25 percent. The data shown in these maps were collected through CDC's Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults. Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS as slightly different analytic methods are used. Prevalence of Overweight Among Children and Adolescents: Ages 6 - 19 Years, For Selected Years 1971 - 2001

Results from the 1999 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that 13% of children, ages 6-11 years, and 14% of adolescents, ages 12-19 years, are overweight. In 2001, in a study conducted by Dr. Sarita Dhuper, Director of Pediatric Cardiology and the Director of the Pediatric Obesity Program at the BUHMC, it was found that in the Brownsville-East New York section of Brooklyn, which is designated a Health Crisis Zone, the incidence of morbid obesity was 2-3 times the incidence nationwide with a coexistent higher adult mortality rate from heart disease and diabetes than the rest of Brooklyn and New York City. During this study it was also found that the prevalence of obesity was also three time higher than the average among African-Americans. From an examination of dietary history Dr. Sarita Dhuper found out about the enormous quantity of fruit juice and other sweetened beverages consumed in addition to other calories. This has prompted an important emphasis on changing dietary patterns. It was also evident

that the population, in this region, maintained a very low level of meaningful and sustained physical activity. This has focused the program on the need for supervised exercise as a means of weight reduction. Finally we have learnt about the denial of patients and more importantly, the denial by families of patients with morbid obesity. Many appointments are missed and when follow-up calls are made, the caseworkers are told by family members that they wont come because the children are not obese. (Very often the parents are obese too). This shows the critical continuing needs of community education to alert the population to the risks involved. TOP Obesity Causes WHO: "The fundamental causes of the obesity epidemic are societal, resulting from an environment that promotes sedentary lifestyles and consumption of high-fat, energy-dense diets"

A number of factors are responsible for causing obesity in both children and adults. These include genetic, environmental and behavioral. Genes

The Thrifty Phenotype Hypothesis

First put forward by Hales and Barker. Early pre- and post-natal life is a critical period during which environmental exposures that hinder growth lead to the programming of thrifty mechanisms that are adaptive during the period of limited supply of nutrients. This contributes to increased risk for diseases during improved nutrition and catch up growth later in life.

Catch Up Growth

There is compelling evidence that catch up growth is characterized by a disproportionately higher rate of fat gain than lean tissue gain and that hyperinsulinemia is an early feature of such preferential catch up growth. Growth patterns: adiposity rebound : age that corresponds to the second rise in BMI after birth. The occurrence of AR at a younger age of < 5 is recognized as an important predictor for high BMI that tracks from childhood to adulthood.

Some individuals have a genetic tendency to gain weight and store fat. This is based on the Thrifty Gene Hypothesis: Individuals with thrifty metabolic adaptations convert more of their calories into adipose tissue during periods of feasting. However, not everyone with this tendency will become obese. Moreover, some people who do not have genetic predisposition also become obese. Hence, it is not entirely correct to blame the genes for obesity.

99% of our genetic material has been in place before the advent of agriculture. With the advent of agriculture, diets have changed significantly. with more refined grains and sugar and less protein forming a part of them. Departure from mans natural way of eating (consuming more meat and fish) and living leads to maladaptive functioning, obesity and disease. Environment The environmental factors also strongly influence obesity. This includes lifestyle behavior such as what a person eats and his or her level of physical activity. Increased availability of calorie dense foods has played a major role in increasing the percentage of obese people in the American society. Americans tend to eat high calorie foods, and put taste and convenience ahead of nutrition. Easy availability of fast foods, which has such high caloric density that by the time one feels full, one has already overeaten. FAST FOOD restaurants are feeding the obesity epidemic by tricking people into eating many more calories than they mean to.

Bite By Bite It All Adds Up Also, obesity has grown significantlty as a result of the increased time spent in sedentary activities such as watching TV, playing video games etc. Most Americans do not exercise regularly. This leads to an imbalance of the equation :

" More In, Less Out "

Obesity Prevalance Trend For Women (1971 - 2000)

Obesity Prevalance Trend For Men (1971 - 2000)

Obesity Prevalance Trend For (1971 - 2000) For US Adolescents (Aged 12 - 19) Content Source: American Obesity Association Thus, it is important to promote an environment which encourages consumption of nutritious foods in reasonable portions and regular physical activity. A healthy environment is important for all individuals to prevent and treat obesity and maintain weight loss. Healthy environments can be created at home, school, work and beyond. Gene-Environment Interaction in the Pathogenesis of Obesity

Although genetics is an important factor in the pathogenesis of obesity, the recent increase in obesity cannot be attributed to genetics alone and must be a result of alterations in environmental influences. However, people with certain genetic backgrounds are particularly predisposed to weight gain and obesity-related diseases, especially when they are exposed to a precipitating lifestyle. A striking example of this is given by the Pima Indians of Arizona. Lifestyle changes have resulted in an epidemic of obesity and diabetes within this population during the last 50 years [1]. Today, the Pimas of Arizona consume a high-fat diet (50% of energy as fat) provided by government surplus commodities rather than their traditional lowfat diet (15% of energy as fat), and they are much more sedentary than when they were farmers. In contrast, Pima Indians who live in the Sierra Madre mountains of Northern Mexico, and consequently who have been isolated from Western influences, eat a traditional Pima diet and are physically active as farmers and sawmill workers. The Pimas of Mexico have a much lower incidence of obesity and diabetes than their genetic kindred in Arizona.
1) Pratley RE. Gene-environment interactions in the pathogenesis of type 2 diabetes mellitus: lessons learned from the Pima Indians. Proc Nutr Soc. 1998;57:175-181. 2) Ravussin E et al. Effects of a traditional lifestyle on obesity in Pima Indians. Diabetes Care 1994; 17:1067-1074.

Developmental Origins of Obesity Clinical and Public Health Implications

Prevention of gestational diabetes and excess maternal weight gain during pregnancy Reduce maternal smoking & improve maternal health Promote breast feeding Modify maternal diet Avoid infant overfeeding

Cumulative effect of small daily imbalances in energy intake on body fat mass

TOP Obesity Effects Health Effects Obese people are at risk of developing one or more serious medical conditions, which can cause poor health and premature death. According to a recent study by the RAND organization, obesity is more damaging to health than smoking, high levels of alcohol drinking, and poverty. Obesity affects all major bodily systems - heart, lung, muscle and bones. Medical Consequences of Obesity

Metabolic changes Hyperinsulinemia Dyslipidemia Hypertension Accelerated risk for Type II diabetes and coronary artery disease Obstructive sleep apnea, orthopedic complications, psychosocial Serious Adverse Health Effects of Obesity On Different Parts of The Body

There is a direct correlation between mortality and Body Mass Index as can be seen from the following graph:

As the BMI increases the Mortality Ratio also increases. Insulin Resistance is aggravated by obesity and physical inactivity both of which are increasing in the U.S. Most people with insulin resistance have central obesity. Insulin Resistance in its turn causes: C oronary artery disease H ypertension A dult onset DM (2) O besity S troke Also associated with dyslipidemia TG HDL, sleep apnea, PCOS, Gout. Insulin Resistance: Causes And Associated Conditions

Insulin Resistance is closely associated with metabolic syndrome. The metabolic syndrome is characterized by a group of metabolic risk factors in one person. They include:

Abdominal obesity (excessive fat tissue in and around the abdomen) Atherogenic dyslipidemia (blood fat disorders mainly high triglycerides and low HDL cholesterol that foster plaque buildups in artery walls) Raised blood pressure (130/85 mmHg or higher) Insulin resistance or glucose intolerance (the body cant properly use insulin or blood sugar)

The underlying causes of this syndrome are overweight/obesity, physical inactivity and genetic factors.

People with the metabolic syndrome are at increased risk of coronary heart disease, other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes.

The metabolic syndrome is diagnosed by the presence of three or more of these factors:

Abdominal obesity as measured by waist circumference: Men Greater than 40 inches Women Greater than 35 inches Fasting blood triglycerides greater than or equal to 150 mg/dL Blood HDL cholesterol: Men Less than 40 mg/dL Women Less than 50 mg/dL Blood pressure greater than or equal to 130/85 mmHg Fasting glucose greater than or equal to 110 mg/dL

An estimated 47 million U.S. residents have the metabolic syndrome. (NHANES III [198894], CDC/NCHS; JAMA. 2002;287:356-359)

Prevalance of Metabolic Syndrome

The age-adjusted prevalence of the metabolic syndrome for adults is 23.7 percent. The prevalence ranges from 6.7 percent among people ages 20-29 to 43.5 percent for ages 60-69 and 42.0 percent for those age 70 and older. The age-adjusted prevalence is similar for men (24.0 percent) and women (23.4 percent). - Cached Effects of obesity What are the dangers in being obese? If you are overweight, it is important to understand the health effects of obesity. Obesity is associated with more than thirty medical conditions and scientific evidence has established a strong relationship with at least fifteen of those conditions.1 Obesity is associated with the development of osteoarthritis of the hand, hip, back, and knees. Obesity increases the risk of breast cancer in men and women. It is strongly associated with cancer of the esophagus. Obese women have three to four times the risk of endometrial cancer than women with lower BMI. Obesity increases cardiovascular disease risk because of its effect on blood lipid levels. Obesity is a major risk factor for heart attack. Gallstones are common in overweight and obese persons. Obesity decreases the bodys resistance to harmful organisms. Obesity is the most common factor of nonalcoholic steatophepatitis, a major cause of liver disease.

These are just some examples of how obesity negatively affects the health of a person.

American Obesity Association ( shares possible treatments for obesity that they emphasize should not take the place of medical advice from a health professional.

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Health Effects of Obesity

Some of obesity's health effects include an increased risk for a range of problems, such as diabetes, fatty liver disease, osteoarthritis, stroke, and high blood pressure. The prospect of losing weight may seem daunting. However, the good news is that by losing just 5 percent of your current weight, you Even more concerning is that approximately 15 percent of children and adolescents are overweight, compared to just 4 percent a few decades ago, and another 15 percent are at risk for being overweight. Childhood obesity is a growing concern in today's world. An alarming number of children are obese and developing diseases normally seen in adulthood. Overweight adolescents have a greatly increased risk of dying from heart disease in adulthood. Even our youngest citizens are at risk. About 10 percent of preschoolers weigh more than is healthy for them.

Even more concerning is that approximately 15 percent of children and adolescents are overweight, compared to just 4 percent a few decades ago, and another 15 percent are at risk for being overweight. Childhood obesity is a growing concern in today's world. An alarming number of children are obese and developing diseases normally seen in adulthood. Overweight adolescents have a greatly increased risk of dying from heart disease in adulthood. Even our youngest citizens are at risk. About 10 percent of preschoolers weigh more than is healthy for them. Weighing too much may increase your risk for developing many health problems. If your body mass index (BMI) indicates that you are overweight or obese, you may be at risk for many of obesity's health effects. These include:

Type 2 diabetes Heart disease Stroke High blood pressure (hypertension) High cholesterol (hypercholesterolemia) Certain cancers Sleep apnea Osteoarthritis Gallbladder disease and gallstones Fatty liver disease (also called nonalcoholic steatohepatitis or NASH) Gastroesophageal reflux disease (GERD) Gout Psychological and emotional effects.

The good news is that you can lower your health risks by losing as little as 10 to 20 pounds. Type 2 Diabetes and Obesity

One of the major health effects of obesity is the development of type 2 diabetes. The most common form of diabetes is type 2 diabetes. This was formerly known as adult-onset diabetes. About 90 to 95 percent of people with diabetes have type 2. Diabetes is a serious disease, because there are numerous complications associated with it that increase a person's chances for premature death. Type 2 diabetes is associated with:

Older age Obesity Family history of diabetes Previous history of gestational diabetes Physical inactivity Ethnicity.

(Click Diabetes Risk Factors for more information about what can increase a person's chances of developing this condition.) Link to Obesity More than 80 percent of people with type 2 diabetes are overweight or obese. It is not known exactly why people who are overweight are more likely to suffer from this disease. It may be that being overweight causes cells to change, making them less effective at using sugar from the blood. This then puts stress on the cells that produce insulin (a hormone that carries sugar from the blood to cells) and makes them gradually fail. Impact of Weight Loss You can lower your risk for developing type 2 diabetes by losing weight and increasing the amount of physical activity you do. A recent study showed that lifestyle modifications resulting in a 5 to 7 percent weight loss could delay and possibly prevent type 2 diabetes. If you have type 2 diabetes, losing weight and becoming more physically active can help you control your blood sugar levels (see Diabetes and Exercise). Losing weight and exercising more may also allow you to reduce the amount of diabetes medication you take.

Heart Disease Another serious health effect of obesity is heart disease. Heart disease refers to diseases that only occur in the heart and the blood vessel system within the heart (see Heart Diseases). The most common type of heart disease is coronary heart disease (CHD), also known as coronary artery disease (CAD) and ischemic heart disease. Heart disease is the number one killer of both men and women in the United States and in most Westernized countries. People with heart disease are also at increased risk for angina, congestive heart failure, or an abnormal heart rhythm (arrhythmia). Link to Obesity People who are overweight are more likely to suffer from:

High blood pressure High triglycerides (blood fats)

High LDL cholesterol (a fat-like substance often called the "bad cholesterol") Low levels of HDL cholesterol (the "good cholesterol").

These are all heart disease risk factors. In addition, people with more body fat have higher blood levels of substances that cause inflammation. Inflammation in blood vessels and throughout the body may raise a person's risk for heart disease. (See Obesity and Heart Disease for more information.) Impact of Weight Loss Losing 5 to 15 percent of your weight can lower your chances of developing heart disease. If you weigh 200 pounds, this means losing as little as 10 pounds. Weight loss may lower blood pressure, triglyceride, and cholesterol levels; improve how your heart works and your blood flows; and decrease inflammation throughout your body.

Stroke A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. More than 700,000 strokes occur each year in the United States, which makes stroke the third leading cause of death in the country and the number one cause for serious disability. Link to Obesity People who are overweight are more likely to suffer from:

High blood pressure

High levels of triglycerides (blood fats) High LDL cholesterol (the "bad cholesterol") Low levels of HDL cholesterol (the "good cholesterol").

These are all risk factors that can increase a person's chances of having a stroke.

Impact of Weight Loss Same as with heart disease, losing 5 to 15 percent of your weight can lower your chances of having a stroke. Weight loss may improve your blood pressure, triglyceride, and cholesterol levels.

(Click Stroke Prevention for more information on reducing your risk for stroke.)

High Blood Pressure

Blood pressure is a measure of the pressure inside your blood vessels -- both while the heart is beating and while it is relaxed. As you might assume, high blood pressure is when the pressure within your blood vessels is too high. This is also known as hypertension. About 65 million American adults -- nearly 1 in 3 -- have high blood pressure, making it the most common cardiovascular disease. People with high blood pressure are at increased risk for a number of serious health problems, including heart disease and stroke (see Effects of High Blood Pressure).

Link to Obesity Being overweight or obese increases your risk of developing high blood pressure. In fact, blood pressure rises as body weight increases. Impact of Weight Loss Losing even 10 pounds can lower blood pressure -- and it has the greatest effect for those who are overweight and already have hypertension. (Click Weight and High Blood Pressure for more information.)

High Cholesterol Cholesterol is a type of fat that is made in your body. Cholesterol is also in some foods that you eat. Your body needs some cholesterol to work properly. However, if too much cholesterol gets into your blood, it can cause problems. This is known as high cholesterol. Over time, high cholesterol can lead to atherosclerosis, which is a condition where blood vessels narrow and harden because of the buildup of plaque, which is a collection of cholesterol, fats, and other debris. This increases a person's risk for heart disease, stroke, or a heart attack (see Effects of High Cholesterol). Link to Obesity Overweight or obesity increases the risk of developing high cholesterol. Specifically, obesity has been linked to increases in total cholesterol, LDL ("bad cholesterol"), and triglycerides but to decreases in HDL ("good cholesterol"). Impact of Weight Loss A little weight loss can decrease your cholesterol level by about 10 percent. Weight management is especially important for those with a group of risk factors that includes high triglyceride and/or low HDL levels and being overweight with a large waist measurement (more than 40 inches for men and more than 35 inches for women). Your healthcare provider will probably suggest both a low fat/low cholesterol diet and moderate exercise if you are overweight (see Exercise and Cholesterol). Cancer The effects of obesity on your health also include an increased risk for developing cancer. Cancer occurs when cells in one part of the body, such as the colon, grow abnormally or out of control and possibly spread to other parts of the body, such as the liver. Cancer is the second leading cause of death in the United States. Link to Obesity

Being overweight may increase the risk of developing several types of cancer. For men, obesity increases the risk for:

Colon cancer Rectal cancer Prostate cancer.

For women, obesity increases the risk for:

Breast cancer Uterine cancer Ovarian cancer

Gallbladder cancer Cervical cancer.

Gaining weight as an adult increases the risk for several of these cancers. Being overweight also may increase the risk of dying from some cancers. It is not known exactly how being overweight increases one's cancer risk. It may be that fat cells make hormones that affect cell growth and lead to cancer. Also, eating or physical activity habits that may lead to being overweight can also contribute to the risk for cancer.

Impact of Weight Loss Avoiding weight gain may prevent a rise in cancer risk. Weight loss, as well as healthy eating and physical activity habits, may lower one's risk for cancer.

Sleep Apnea
Sleep apnea is a sleep disorder characterized by interruptions of a

person's breathing while he or she is asleep. People with sleep apnea often snore loudly and experience daytime sleepiness. Link to Obesity The risk for sleep apnea is higher for people who are overweight. A person who is overweight may have more fat stored around his or her neck. This can make the airway smaller. A smaller airway can make breathing difficult, loud (snoring), or stop altogether. In addition, fat stored in the neck and throughout the body can produce substances that cause inflammation. Inflammation in the neck may be a risk factor for sleep apnea. Impact of Weight Loss Weight loss usually improves sleep apnea. It also may help to decrease neck size and lessen inflammation.

Osteoarthritis Osteoarthritis is a common joint disease, especially in older people. In osteoarthritis, cartilage has worn away, which allows bones to rub together. Common symptoms include joint pain and limited movement. This condition is one of the most frequent causes of physical disability among adults, especially those ages 65 or older. Link to Obesity Extra weight may place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation. Inflammation at the joints may raise the risk for osteoarthritis. Impact of Weight Loss Weight loss can decrease stress on your knees, hips, and lower back, and lessen inflammation in your body. If you have osteoarthritis, losing weight may help improve your symptoms.

Gallbladder Problems Gallstones are clusters of solid material that form in the gallbladder. They are made mostly of cholesterol, and can sometimes cause abdominal or back pain. Link to Obesity People who are overweight have a higher risk for developing gallbladder disease and gallstones. They may produce more cholesterol -- a risk factor for gallstones. Also, people who are overweight may have an enlarged gallbladder, which may not work properly. Impact of Weight Loss Weight loss -- especially fast weight loss (more than 3 pounds per week) or loss of a large amount of weight -- can actually increase your chances of developing gallstones. Modest, slow weight loss of about to 2 pounds a week is less likely to cause gallstones. Fatty Liver Disease Fatty liver disease occurs when fat builds up in the liver cells and causes injury and inflammation in the liver. It can sometimes lead to:

Severe liver damage Cirrhosis (buildup of scar tissue that blocks proper blood flow in the liver) Liver failure.

Fatty liver disease is like alcoholic liver damage, but it is not caused by alcohol and can occur in people who drink little or no alcohol. Link to Obesity People who have diabetes or "pre-diabetes" (when blood sugar levels are higher than normal but not yet in the diabetic range) are more likely to have fatty liver disease than people

without these conditions. And people who are overweight are more likely to have diabetes. It is not known why some people who are overweight or diabetic get fatty liver disease and others do not. Impact of Weight Loss Losing weight can help you control your blood sugar levels. It can also reduce the buildup of fat in your liver and prevent further injury. People with fatty liver disease should also avoid drinking alcohol.

Other Health Effects of Obesity There are still more potentially negative effects of obesity. GERD Gastroesophageal reflux disease (GERD) is another of the health effects of obesity. This problem occurs when the lower esophageal sphincter does not close properly and stomach contents leak back -- or reflux -- into the esophagus. Gout Gout is one of the most painful forms of arthritis. The term "arthritis" refers to more than 100 different rheumatic diseases that affect the joints, muscles, and bones, as well as other tissues and structures. Gout accounts for approximately 5 percent of all cases of arthritis. It occurs in approximately 840 out of every 100,000 people. It is rare in children and young adults. Psychological and Emotional Effects Emotional suffering may be one of the most painful parts of obesity. American society emphasizes physical appearance and often equates attractiveness with slimness, especially for women. Such messages make overweight people feel unattractive. Many people think that individuals with obesity are gluttonous, lazy, or both. This is not true. As a result, people who are obese often face prejudice or discrimination in the job market, at school, and in social situations. Feelings of rejection, shame, or depression may occur.

Final Thoughts on Obesity's Health Effects Today, more than 65 percent of adults in the United States are overweight or obese. Even more concerning is the increasing occurrence of childhood obesity. There are many effects of obesity, such as: heart disease, type 2 diabetes, high blood pressure, stroke, and some forms of cancer, as described in this article. But there is good news. If you are overweight, losing as little as 5 percent of your body weight may lower your risk for several of these effects, including heart disease and diabetes. (Click BMI to learn how healthcare providers estimate if a person's weight is in a healthy range. Click BMI Calculator to determine your estimated body mass. Click BMI and Weight for more information on assessing your risk for obesity-related medical problems.) - Cached

Psychological Effects of Teen Obesity

The surge in obesity among children and adolescents in the U.S. poses a number of serious physical, psychological and emotional issues. Educating the public on the psychological problems of childhood obesity is paramount in reducing the serious effects of the epidemic, according to experts at the Texas Department of Health. If your teen is obese or overweight and shows psychological symptoms, consult the guidance of a qualified professional who can provide proper treatment. Low Self-Esteem According to research performed by Dr. Richard Strauss at the University of Medicine and Dentistry in New Jersey, obese teens have significantly lower self-esteem than teens of normal weight. Low self-esteem often appears as loneliness, nervousness and sadness. Teens with low self-esteem may also engage in risky behavior such as experimenting with drugs, alcohol or cigarettes. Obese teens who experience low self-esteem during childhood and adolescence often carry these feelings into adulthood. Depression Depression is a common psychological effect of teen obesity. An obese teen who is heavier than her peers may experience feelings of sadness or hopelessness. Signs of depression include changes in sleep patterns, withdrawal from family or friends and loss of interest in activities she previously enjoyed. reports that some teens try to hide depression and appear emotionally flat rather than sad.
Anxiety Most children experience anxiety for various reasons throughout adolescence. Obese teens, however, may experience severe anxiety that often results in destructive behaviors or avoidance of friends and family. Overweight teens may also have social anxiety, the result of excessive bullying or teasing. Severe anxiety often interrupts the learning process and may lead to a decline in academic performance. Being an overweight teen can also affect an individual's anxiety level as an adult. Research conducted by Dr. Sarah Anderson and her colleagues published in "Psychosomatic Medicine" revealed that overweight teen girls may have a higher chance of developing anxiety disorders or depression in adulthood. Poor Body Image Obese teens often experience poor body image as a result of being overweight. This may keep your teen from playing sports or engaging in physical activity, spending time with friends or wearing formfitting clothing. Poor body image is connected to a number of psychological problems, including depression, anxiety and low self-esteem. Teens with poor body image are also at risk of developing an eating disorder. Eating Disorder

Obese adolescents are at risk of developing disorders such as bulimia, anorexia or compulsive

overeating. An eating disorder is often the result of an overweight teen's effort to lose weight through risky and unhealthy behaviors. If you suspect your teen has an eating disorder, consult a medical professional immediately. References "Psychosomatic Medicine"; "Adolescent Obesity and Risk for Subsequent Major Depressive Disorder and Anxiety Disorder: Prospective Evidence"; Sarah Anderson et al; 2007 "Pediatrics"; "Childhood Obesity and Self-Esteem"; Dr. Richard Strauss; 2000 Mayo Clinic: Childhood Obesity ___________________________________________________________________________ ___________________________________________________________________________ Article Source: - Cached Psychological Effects of Teen Obesity By James Rouse It only seems natural to consider the psychological effects of teen obesity and how it is affecting our youth. Not too long ago it would be unheard of to be having this discussion. The child obesity issue worldwide has received so much attention it seems appropriate to consider what is going on in their head. How is their weight issue effecting them emotionally? It's what we don't see in our children that is of most concern. We can easily see their day to day routines but what underlining psychological effects of teen obesity don't we see? It has been perceived that young children who are obese will grow out of it or they are just carrying "baby fat". In some cases this is true and they do grow out of it, but what if they don't. It's a known fact that kids can be mean and bully. Children who are teased about their weight are more apt to have poor body image, low self-esteem, and symptoms of depression. Everyone wants to have friends but sometimes the obese teen feels isolated and lonely. Their self esteem is low and they use food as their comfort zone, which is usually high in fat, sugar, and calories. The isolation makes them less active so exercise is compromised. Because of peer pressure the psychological effects of teen obesity affects their overall health which can lead to more serious medical problems. The teen years are all about growing up, being more independent, and socialization. Peer pressure in teenagers is a major issue whether they have a weight problem or not , which is why teasing obese teens can be psychologically devastating. Peer pressure is the hub of the psychological effects of teen obesity. The spin off is problems in school and missing too much school. Obese teens are absent from school more often than non obese teens. Some will miss school or skip classes to avoid ridicule and others due to medical complications associated with being obese. Behavioral and learning problems develop because they feel depressed and socially unaccepted . Obese teens have an equal right to education as non obese teens but the taunting effects them emotionally and it's easier to avoid than confront. They are missing out on their education because of the psychological effects of teen obesity.

It appears clear that the psychological effects of teen obesity have the potential to be carried into adulthood. Including in some cases anxiety and obsessive compulsive behavior. An alarming number of obese teens grow up to be obese adults, although it doesn't have to be this way. Once the weight problem is cured and their physical appearance has improved; their self esteem and body image will be restored. We must be careful not to ignore the psychological effects of teen obesity that they may still have bottled up inside. Triggers To Watch For 1. Your obese teen has less energy or interests and is hesitant to participate in social relationships or other activities; 2. Your obese teen appears increasingly sad, lonely, angry or withdrawn. 3. Your obese teen has few friends.
4. 5. 6. 7. Your obese teen has thoughts of causing harm to him/herself or others. Your obese teen is obsessed with eating. Your obese teen sleeps too much or not enough. Your obese teen is reluctant to go to school.

There are steps that parents can do to help ease the psychological stress that results from teen obesity. Engage your teen in open dialog about their eating habits . Many times teens over eat because they are depressed. Openly communicating with your obese child about the problem will allow you to work a plan that is attainable. The good news is with proper nutrition, exercise, and a real good diet plan teens can overcome obesity and live a full normal life. James Rouse is a personal weight loss coach and author of the popular - a website created out of his passion. Possibly you have a passion or hobby you'd like to write about. Discover how to turn it into a profitable Web site like James has. Visit: to learn more. Article Source: ___________________________________________________________________________ ___________________________________________________________________________ - Cached Article Source: Childhood Obesity: Psychological Effects By Dr. Mark Clayson In the United States today, childhood obesity is a real issue. More children are becoming dangerously overweight at an earlier age than ever before. Obesity brings with it the threat of numerous diseases, ranging from bone and joint problems to asthma and type 2 diabetes. Once a child begins to lose weight, these health problems seriously lessen or, in some cases, go away altogether.

One side effect of obesity that is scarcely acknowledged or dwelled upon are the psychological effects that come with it. Studies have recently established that even if a child manages to lose weight in adulthood, some of the psychological damage from being an obese child linger. Obese children tend to have low self esteem and less confidence in social situations
than their peers. Sometimes they will even try to avoid gym class out of shame for their appearance.

While obese children generally tend to have poor body images, this is not helped by all the teasing that they tend to have to endure at school and in other social situations with their peers. A lot of times, obese children will skip school or drop out altogether in order to avoid having to confront their peers' teasing head on. This is why drug and alcohol use among overweight teenagers has also risen in recent years. Illicit substances have become an unfortunate way of escaping from and coping with the problem of obesity. Substance abuse problems also contribute to increasing the amount of depression an obese child suffers. There are some things a parent can do to help lessen the psychological stress that results from obesity. For one thing, the subject of overeating should be brought up. Oftentimes, a child will overeat because they are depressed. Once this problem is brought out in to the open, it can be easier to find strategies for coping with it - not to mention alternative approaches to solving depression. What's more, parents can talk to their children about personal appearance and how they feel about themselves. Physical beauty is often dwelled on in this society to an unhealthy degree. What ever happened to inner beauty? Highlight the qualities that make your child special different, and thus more attractive to others. What's more, you should make it a habit to praise your children whenever they accomplish something positive. Do this often. When dealing with obesity in the family, you should never use food as the basis of reward. When your child accomplishes something worth celebrating, go to a movie rather than splurge on fast food or a night of eating. Children should never be criticized for not losing weight or accomplishing personal goals. Instead, the parent should always be constructive. Talk it out and find a solution. Parents should also serve a good example for their kids. That means that the whole family should eat healthy and engage in physical activity as a unit. If you as a parent are not healthy on a mental and physical level, then you cannot expect your children to be, either. Read opinions and promote your views at The World's Best Homepage and read and submit reviews and opinions at Free Opinions and Content Article Source: ___________________________________________________________________________ ___________________________________________________________________________ - Cached

Psychological Effects of Childhood Obesity The psychological effects of childhood obesity are probably the second worse aftereffect besides one's health going for a spin. Find out how to help your child deal with problems related to being overweight... Being overweight at such a young age isn't something children can deal with so early on in their life. Even grown ups face troubles of being ridiculed in public or being the center of fat jokes. Kids face a hard time in school dealing with those who take pleasure in watching fat kids break down or drown in embarrassment. They think it's cool to pass remarks when it comes to their weight, often being the big bullies of the school that no one usually wants to mess or associate with. This can cause a child to fall into bouts of depression, withdrawing from classmates, family and people in general. Grades and overall health is taken for granted as a result, and it is up to a parent to help out their kids. Teachers who notice these in their classrooms must immediately make it known to the parents to wake up and take notice of what is going on with their child. The psychological effects of childhood obesity can reach detrimental heights with kids later turning to bulimia, where he/she will eat excessively and then puke themselves or use laxatives to avoid putting on weight. You'd be dealing with a mentally disturbed child obsessed with being thin and convinced that he/she still needs to lose weight. The long-term effects can be quite damaging, that is why it is important to help your child lose weight in a healthy way, with stress on how important it is to eat right and not go overboard on what can cause injury to the body. Effects of Childhood Obesity The childhood obesity causes are due to obvious factors that prevail in society today, especially in countries that are well-developed. The United States has a shocking record of housing the world's number one food bingers. With their over the top fast food joints serving larger than life food servings, not to mention the unhealthy eating competitions and prizes for those who can gorge the most, they're setting a bad example to those watching. It's a shame how much food is laid out on a table, and how much more is even wasted as a result of not being able to finish it. Portion control is an alien concept to those who love to down junk in the US. So what are the emotional effects of childhood obesity and what are the reasons behind it? Overeating Leads to Eating Disorders Parents encourage kids to dig into buckets of chicken and donuts slathered with cream toppings, where it would rightly seem like a family that binges together stays together. When kids are encouraged to do something as tempting as this throughout their childhood, it's no wonder why they can't see their toes when they stand up straight by age 10. The problem with kids these days who don't even know how bad what they are doing is, is that if they don't get the same junk that they were bought up on, they'll find it someplace else. With the kind of food joints out there making the eating experience cheap, kids are waltzing into stores too and buying off the shelves whatever they please. Kids then turn bulimic as they age, which is a mental obsession on being thin, where one binges on food and drink and then pukes

themselves or turns to laxatives to empty the system. This can have a serious effect on mental and physical health. Depression, Lack of Self Worth and Withdrawal from Friends and Family All overweight kids can do today is go to school, sit down all day in front of that blackboard, and then wobble on back home. There are no games, sports or fun physical activities that they want to be a part of anymore. They're even looked down upon in gym class where kids giggle and point when they pass by. Being the butt of all jokes isn't fun, or easy to take. It can lower self-esteem and put a deep dent in your confidence as a person. It can be quite troublesome to see kids having to deal with this everyday. The worst thing that can happen is not showing up at school, and causing a scene at home to avoid going at all. Seeking One's Home as a Hideaway Kids see their homes as a place to seek refuge in from the outside world where no one is pointing at him/her and judging them for their outward appearance. Some parents pressure the child into doing things they don't want to do anymore like playing outside or going to a place where he/she is likely to bump into kids from school. They seclude themselves from anything that would cause them emotional injury, turning anti social and bitter as time lapses. It is important to note these signs and pay attention to his/her grades and what teachers have to say at meetings that could seriously damage your child's outlook on life. The psychological effects of childhood obesity can be best avoided if you practice healthy food alternatives from day one. I'm sure you're aware of the childhood obesity statistics that are skyrocketing charts like never before. It is important to understand that kids are just kids, and that introducing them to unhealthy ways of eating and living at such a prime time is irresponsible on the parents' part. Understanding what the risks of childhood obesity are, is important, to help save your child from severe problems in the future. By Naomi Sarah Published: 3/29/2011 ___________________________________________________________________________ ___________________________________________________________________________ - Cached Childhood Obesity Facts Childhood obesity can lead to numerous health problems in children. Here are some childhood obesity facts that can help you understand causes and prevention of obesity in children. Childhood obesity is a serious problem. It can give rise to numerous physical as well as psychological problems in children. Of course, increase in weight is normal as the child grows up. But if it is more than healthy body weight, then your child can be considered as obese. Obesity in children can be a cause of various diseases such as elevated levels of cholesterol, high blood pressure and diabetes. This article will help you to understand the causes and the treatment options for obesity in children. Causes

According to world facts, obesity in children is due to multiple causes including imbalance between calories gained from food and calories expended in physical activity and basal metabolic rate. Childhood obesity is most frequently found to be resulting from interaction of physiological, nutritional, familial and psychological factors. Some known causes of obesity in children are as follows:

Family: It is observed that tendency to gain weight is more common in children who have both parents obese. It may be because of powerful genetic factors or parental modeling of exercise and eating behavior. Low energy expenditure: Obesity problem is frequently found with children who watch television for several hours. Many of them continuously keep eating highcalorie snacks while watching television or doing homework. Heredity: It's not necessary that all children who eat high-calorie food and have less activities tend to gain weight. According to recent research, heredity significantly contributes to obesity. Infants of overweight mothers are found to be more inactive and obese by the age of three months as compared to infants of normal weight mothers. Certain diseases: Some hormonal disorders and genetic diseases can be predisposing factors for childhood obesity. Cushing's syndrome and Prader-Willi syndrome may contribute to obesity in small proportion.

Risk Factors Several factors can increase the risk of obesity in your child. Frequent consumption of highcalorie food like baked goods, fast foods and vending machine snacks can lead to obesity; as such foods contain high calorie content. Consumption of desserts, candy and soft drinks can also lead to obesity, because such foods and beverages are rich in sugar and calories. If a child is not burning calories in physical activities, it can cause weight gain. Many children tend to spend lots of time in leisure activities like playing video games or watching television. A child from the family of overweight people has a tendency to put on excess weight. Some psychological factors can also contribute to childhood obesity. Some children are not able to cope with emotional problems like boredom or stress and they usually tend to overeat. Their parents are likely to have similar tendencies. Socioeconomic factors can be responsible for obesity in children. It is observed that children from low-income background are at higher risk of gaining excess weight because poor parents may not pay enough attention towards children's diet and exercise. Effects on Health Obese children are at increased risk of developing several serious health problems. These health problems include coronary artery diseases (hardened and blocked arteries), high cholesterol, high blood pressure, Type II diabetes, metabolic syndrome, liver disease, skin infections, sleep disorders and asthma and other respiratory problems. Obese children may suffer from stroke, heart attack, high blood pressure, Type II diabetes and bowel cancer in adulthood. In addition to physical problems, obese children may face psychological distress. Obese children are teased about their appearance. This can affect a child's self-esteem and confidence. Such children are depressed and isolated. Maintaining Healthy Body Weight

When you notice that your child is gaining excess weight, you need to help your child to lose extra calories and maintain healthy weight. You can encourage your child to have wellbalanced, healthy diet, make changes in eating habits and increase physical activities.

Healthy Diet: It is advised that children should not be put on weight-loss diet as it can affect their growth. Children's diet should be fresh and nutritious. Starchy foods that are rich in complex carbohydrates are filling and good nutrition. Foods like bread, rice, potatoes and pasta can provide half the energy in diet. Try healthier alternatives like fresh fruits, crackers and crusty bread instead of high-fat foods including biscuits, crisps, cakes and chocolates. You may go for grilled or baked foods instead of fried foods. You should prefer fresh fruit juices diluted with water or other sugar-free alternatives to fizzy drinks with higher sugar content. You can start your child's day with a healthy breakfast including low-sugar cereal, milk and fresh fruits. Instead of sweets, you can give tinned fruit or dried fruit and frozen yogurt instead of ice cream. Changes in eating habits: You need to change habits and attitude towards food and exercise to achieve lasting effects. You should try to set good example with your own good habits. Provide snacks and meals at regular times to prevent your child from grazing whole day. Don't allow the child to eat while studying or watching television. Avoid keeping plenty of high-sugar and high-fat snacks in home. Teach your child to chew food slowly, so that he/she will feel fuller. Physical activity: You should encourage walking wherever possible, instead of traveling by car or bus. Suggest your children to get involved in sports and team activities. Encourage them to participate in outdoor games like football or cricket.

Treatment Treatment for childhood obesity depends upon child's age and medical conditions. Usually, child obesity can be managed with changes in diet and level of physical activity. However, in specific circumstances, medications or weight-loss surgery may be required.

Medications: Orlistat (Xenical) and sibutramine (Meridia) are prescription weightloss medications recommended for adolescents. Orlistat is preferred for the adolescents older than 12. It can stop absorption of fat in the intestine. Sibutramine is prescribed for the adolescents older than 16. This drug can change brain's chemistry and makes the body feel fuller more rapidly. However, it is better to consult your doctor before starting any kind of medication. Weight-loss surgery: Weight-loss surgery is generally recommended for some severely obese adolescents, who cannot lose their weight with conventional weightloss methods.

Now that you have come to know about all facts associated with childhood obesity, you will be able to deal with this problem comfortably. You can help your child to maintain normal body weight and remain healthy and active. By Reshma Jirage ___________________________________________________________________________ ___________________________________________________________________________ - Cached The Social Effects of Obesity in Childre Jul 15, 2010 | By Laura E. Williams

Read more: According to the Centers for Disease Control and Prevention (CDC), as of 2008 as many as 19.8 percent of adolescents younger than 19 were considered obese. Many theories exist about why rates of obesity have increased so dramatically in the last 20 years, but regardless of whatever combination of factors contribute to the problem, the resulting effects wreck havoc on these children's lives. In addition to the well-documented physical side effects, a 2003 study published in the "Journal of the American Medical Association" found that obese children face emotional and social side effects similar to those of children facing cancer treatment. Targets of Bullying Barring any other factor, obesity increases the likelihood of being bullied by other children by as much as 63 percent. In a study published in the June 2010 issue of the journal "Pediatrics," researchers at the University of Michigan found the results staggering. Even though the prevalence of obesity has grown significantly, making overweight and obesity in youth seem more normal, the rate of bullying hasn't decreased. Kids can be cruel. This cruelty can have significant effects on the psyche of children struggling with obesity. Obese children miss more school than children at a normal weight. They might not perform as well in the classroom, withdraw socially or act out. Children Books Authors Be a Published Children's Book Author. Free Book Consultation! Sponsored Links Poor Social Skills According to the Mayo Clinic, obese children often display poorer social skills than their normal weight peers. The social stigmatization of obese children leads to self-esteem problems, which often leads to more social stigmatization. When a child constantly feels isolated, denigrated and helpless, her resulting actions in a social context might be hindered. The cycle then continues, as poor social skills often lead to more bullying. Depression Continual low self-esteem and hopelessness, often supplemented by poor functioning at school and in social contexts, often leads to depression in obese children. Even though depression is a psychological issue that

many obese children deal with, depression often has social ramifications. Children might withdraw from activities they once enjoyed, experience additional weight gain, stop wanting to spend time with family or friends and act out in social contexts. Eat to Lose Weight? Learn What Foods to Eat to Lose Weight. Find Out Now, Free! BMI For Healthy Kid Is Your Kids Growing Up Right ? Learn This Healthy Formula Right ! HealthyKids.Org.My/BMIForKids Too much Tummy Fats/Skin? Mini Tummy Tuck is the Solution. No General Anaesthesia. No Hospital Neurofeedback at Home $620 Complete System Improve Attention - Concentration Sponsored Links References

WIN: Obesity Affects Childrens Quality of Life CDC: Childhood Obesity Medline Plus: Bullies Target Obese Kids Childhood Obesity Complications KidsHealth: Understanding Depression

___________________________________________________________________________ ___________________________________________________________________________ - Cached Some Psychological and Social Effects of Obesity - Tips to Avoid Weight Gain By Syd Hs There can be many social effects of obesity and a lot of other disorders associated with it. Overweight people might become self-conscious of their weight and think that people might make fun of them. Some of the social effects of obesity might include avoiding social situations, decrease in self esteem, discrimination etc. Others might make fun of obese people which might not be good for the self esteem of the individual. A lot of emphasis is often placed on good looks and appearance. This too can have an impact on obese people. Many people consider obese people to be lazy and gluttonous, which might not always be true.

Obese people might suffer from emotional effects of obesity as well as psychological effects. All of the above mentioned problems might be common for such people - but still many times overweight people might not have any more psychological problems than other people of average weight. Still its always a good idea to keep your weight in check and try to lose any
unwanted weight in a healthy manner.

Below are a few tips to keep in mind to prevent weight gain: 1. Learning to eat more nutritious food - see here: 7 fat burning foods 2. Becoming physically active and not be a couch potato. 3. Including more fruits and vegetables in your diet. 4. Avoiding crash diets where you would starve yourself throughout the day. Do realize that proper and healthy dieting is important. 5. Avoiding junk food - realizing that junk food can be really really bad for our health and fitness. 6. Drink healthy amounts of water during the day. There are many weight loss diet plans in the market but most of them do not work. However there is one which has received a lot of positive feedback from people. Read about it here and how it can help you with weight loss - Fat Loss 4 Idiots Diet Program Review Find out how you can skyrocket your fat loss success with this free report - Weight Loss Success Secrets For You Article Source: ___________________________________________________________________________ ___________________________________________________________________________ - Cached The Effects of Obesity The effects of obesity extend far beyond physical weight and related health problems. Obesity side effects can include a greater risk of mental health problems and low self-esteem. Social attitudes on obesity range from avoidance to outright discrimination and bullying. For those suffering from childhood obesity, effects of this condition can last a lifetime. Obesity Health Effects The effects of obesity on physical health are well documented. The Stanford Hospital (2010) reports obesity causes up to 300,000 premature deaths a year in the United States alone. Obesity health effects range from backaches and joint pain to life-threatening conditions.

The following is a list of health conditions attributed to obesity. This list is by no means exhaustive; the effects of obesity on physical health are, unfortunately, many and varied. Obesity side effects include:

Angina (chest pain) Atherosclerosis (hardening of the arteries) Cancer Diabetes Heart attack High blood pressure Joint pain Metabolic syndrome Mobility impairment Osteoarthritis Stroke.

Mental Health Effects of Obesity Obesity side effects can include mental health disorders. The mental effects of obesity have not been studied as extensively as physical obesity side effects. Evidence suggests, however, that being obese negatively affects mental health. Low self-esteem is common among the severely obese. Rates of depression and anxiety appear to be higher; a Swedish study found that severely obese people are three to four times more likely to exhibit symptoms of anxiety and depression, as compared to those with a healthy weight. Obesity Side Effects and Social Stigma A long history of mocking and discriminating against the obese runs through many cultures. Many people assume the obese are to blame for their condition, and that obesity is a sign of low willpower, overindulgence or slovenliness. Obese people may have fewer social and romantic relationships compared to the non-obese. College admission, careers and earning power may be negatively affected by weight, particularly for obese women. While it may not be generally acceptable to discriminate based on gender, religion or ethnicity, many people continue to ridicule, mock or even abuse the obese. Childhood Obesity Effects According to the Centers for Disease Control and Prevention (2010), childhood obesity rates have tripled since the 1980s. Almost 20 percent of U.S. children aged 6 to 11 are now obese. Childhood obesity effects include a heightened risk of early-onset hypertension and heart disease, and an increased risk of problems such as stroke, heart disease and diabetes as adults. Socially, childhood obesity effects include an increased risk of bullying and teasing. Although long-term effects of childhood obesity on self-esteem and relationships continue to

be studied, obese children and teens report lower levels of self-esteem than their non-obese counterparts. Resources Marcus, M. (2002). Effects of obesity on the quality of life. Retrieved June 2, 2010, from Mocan, N. ___________________________________________________________________________ ___________________________________________________________________________ - Cached The Social Effects on Overweight Kids May 26, 2011 | By Rachel Morgan The medical and public health communities have good reason to be concerned about the epidemic-level overweight and obesity rates among kids. Being overweight not only causes a number of health problems during childhood, but also sets kids up for major medical concerns once they reach adulthood. Yet chronic diseases are just one part of the overall risk to overweight kids. Children with weight problems face social and emotional problems that can have far-reaching effects on their quality of life. Bullying Overweight and obese children are often the target of both psychological and physical bullying. Research finds that young adolescents who are overweight are more likely to be the subject of rumors, lose friendships, face teasing and be physically harmed than their peers who are of a normal weight, according to study published in May 2004 in the journal "Pediatrics." Overweight kids are also more likely to avoid participating in physical activities at school out of fear of being teased, according to 2006 research from the University of Florida. Ask a Doctor Online Now A Doctor Will Assist You Now! Questions Answered Every 9 Seconds. Sponsored Links Anxiety Being overweight can also lead to anxiety development in children. A study of French children found that being overweight was associated with increased general anxiety and emotional problems, according to April 2010 research published in the journal "Obesity." Kids who face ridicule from peers at school or from family members may isolate themselves,

leading to the development of social anxiety or phobia. Children who've experienced stressful situations and been the target of negative attention are at risk for having social anxiety. Academic Problems Difficulty with social interaction coupled with poor self-image can play a role in how successful overweight kids are in school. Academic priorities may fall to the back burner as kids struggle with anxiety, isolation or other psychosocial problems. In some cases, they may also act out in the classroom, disrupting the learning process. Overweight girls are at particular risk for social problems affecting their ability to function academically. In fact, they are less likely to go to college as a result of being overweight, according to a July 2007 article in "Sociology of Education." Depression Poor body image and self-esteem are not uncommon in overweight kids, and both are involved in their development of depression. Depression is a serious mental health concern that can affect kids in every aspect of their lives. They may experience prolonged sadness or show little emotion at all. They are likely to stop participating in hobbies or activities they once found pleasure in, which can further social isolation. Overweight and obese kids are also more likely to have drug problems and eating disorders, in which depression can play a role. TOMATIS METHOD (Official) Learn more about our method. Find / become a Practitioner Too much Tummy Fats/Skin? Mini Tummy Tuck is the Solution. No General Anaesthesia. No Hospital Neurofeedback at Home $620 Complete System Improve Attention - Concentration BMI For Healthy Kid Is Your Kids Growing Up Right ? Learn This Healthy Formula Right ! HealthyKids.Org.My/BMIForKids References

"Pediatrics"; Associations Between Overweight and Obesity with Bullying Behaviors in School-aged Children; I Janssen, et al; May 2004 University of Florida: Bullying Keeps Overweight Kids Off the Field "Obesity"; Child Overweight, Associated Psychopathology and Social Functioning: A French School-based Survey in 6- to 11-year-old Children; I Pitrou, et al; April 2010 Nemours Foundation TeensHealth: Social Fobia Childhood Obesity "Sociology of Education"; Gender, Obesity and Education; R Crosnoe; July 2007

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EFFECTS OF OBESITY ON THE QUALITY OF LIFE Chapter 14 - Marsha D Marcus, PhD October 24, 2002 The social Impact of obesity In dealing with obesity many physicians like to view the social impact that obesity presents in the sufferers. Usually the person will suffer with issues of weight preoccupation and roller coaster dieting that is accompanied by feeling of regret, remorse and failure. A lot of times these feelings are increased by the treatment the obese person experiences in the world at large. People tend to equate obesity with lazy, overweight people lying around all day eating bon-bons and watching television, however this is rarely the case. Some obese people may have jobs that require them to work seated for long hours, their inactivity is caused by a job that keeps them from being active. In such a situation the person is taking in many more calories than their level of activity can burn off thus making them gain weight. Obesity is not simply a problem of overeating it can also be a problem associated with low self-esteem, as well as other psychological reasons that could include sexual abuse, alcoholism, or dysfunctional relationships with foods. Some people who are obese are using eating as a way to cope with problems that affect them in their everyday lives. Some may feel that eating relaxes feelings of not being accepted or embarrassment over ones weight. Studies show that women have a negative body image regardless of what size they may be. The obese woman feels this feeling more acutely; they will try to lose weight without success which causes a feeling of failure. They learn to feel like they didnt try hard enough or they are not good enough to be smaller and look like the models that society says women must look like. Sometimes women feel these feeling of contempt for themselves. To improve a persons body image they will need to learn to like and care for themselves through exercise and eating right as well as making healthy life style changes that not only fosters weight loss but also builds self esteem and good health. When women learn not to use dieting as a way to deal with emotional stresses and finds healthier methods of dealing with problems they will find their self worth does not come from food. It is important for the people dealing with obesity to feel good about themselves mentally and physically. This way they will find a way to combat obesity. ___________________________________________________________________________ __________________________________________________________________________ INTRODUCTION In 1947 the World Health Organization defined health as both the absence of disease and infirmity and the presence of physical, mental, and social well being (1). Accordingly, healthrelated quality of life refers to well being in the physical, psychological and social domains, and each domain can be measured by objective functioning and subjective perceptions of health (2). An assessment of the relationship between obesity and health-related quality of life is a complex task because of the multiple domains of quality of life and the heterogeneity of

obesity. Moreover, the concept of health-related quality of life is difficult to operationalize in that it theoretically includes all aspects of life (3), and each domain of health has many components (2). Consequently, quality of life has been measured by specific indices that reflect particular aspects of overall quality of life (e.g., depression, functional limitations), and global concepts that provide little information about specific aspects of health or changes in health status (e.g., satisfaction, well-being). Similarly, studies focusing on the relationship between obesity and quality of life have utilized generic scales designed for the general population or measures designed specifically for obese individuals. In addition, obesity is a heterogeneous condition, and there is evidence that cultural, social, familial and individual factors affect the impact of obesity on a given individual. Nevertheless, despite definitional and assessment issues, a growing body of evidence has linked obesity to impairments in health-related quality of life. In this chapter I will review evidence that obesity affects quality of life in each quality of life domain, physical, psychological and social, and consider relevant moderators of the relationship between obesity and specific aspects of quality of life including demographic factors, obesity-related factors and treatment seeking. The relationship between changes in weight and health-related quality of life across quality of life domains also will be evaluated. Measurement of Quality of Life A complete discussion of issues related to measurement is beyond the scope of this chapter, and comprehensive reviews are available for interested readers (2,4,5). For the present purpose, however, it is important to note that numerous generic measures (6-9) and obesityspecific scales (10-17) have been utilized to assess quality of life in obese individuals. Accordingly, in addition to difficulties posed by the complexities in defining quality of life, interpretation of extant data is complicated by use of differing assessment tools. For purposes of illustration, examples of several commonly utilized generic and obesity-specific scales along with sample items are presented in Table 1. As seen, the items on various measures range from the global, such as, "In general, would you say your health is excellent, very good, good, fair or poor (9)?" to the very specific, "Because of my weight, I have difficulty getting up from chairs (15)." Although there is considerable overlap across measures, the information gathered in a particular investigation will vary according to measures used. Le Pen and colleagues (16) compared data generated using a general quality of life measure and an obesity-specific scale, and concluded that use of the different measures generated distinct, but complementary information. In summary, the literature bearing on the relationship between obesity and quality of life must be evaluated with assessment issues in mind. Table 1. Examples of Generic and Obesity-Specific Measures of HealthRelated Quality of Life Quality of Life Measures Sample questions Number of items

Generic measures Medical Outcomes Study 36 Short-form 36 (SF-36) (6)

Physical functioning Role limitations due to physical problems Social functioning

10 4

Does your health now limit you in climbing several flights of stairs? During the past week, have you had difficulty performing work or other activities? During the past week to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors or groups? How much bodily pain have you had during the past week? During the past week have you felt so down in the dumps that nothing could cheer you up? During the past work have you cut down the amount of time you spent on work or other activities as a result of any emotional problems? During the past week, did you feel full of pep? In general, would you say your health is excellent, very good, good, fair, or poor? Would you say that in general your health is excellent, very good, good, fair, or poor? Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good? Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Bodily pain General mental health

2 5

Role limitations due to emotional problems


General health perceptions 5 Center for Disease Control (CDC) Behavioral Risk Factor Surveillance System (BRFSS) Questions (18) 4

Sickness Impact Scale (8) Independent Categories

136 I sit during much of the day.

(i.e., Sleep and rest, Eating, Work, Home management) Physical

I am not working at all I am not doing any of the maintenance or repair work around the house that I usually do I walk shorter distances or stop to rest often I stay away from home for only brief periods of time I am very clumsy in body movements I am doing fewer social activities with groups of people I isolate myself as much as I can from the rest of the family I act irritable and impatient with myself


Obesity specific measures Obesity Adjustment Survey (11) 20 Walking up stairs is especially difficult at my present weight. I cannot walk even short distances without becoming short of breath and getting very tired. I hate the appearance of my body It's depressing to be at my present weight

Obesity Related Well Being (ORWELL 97) (10) Psychological status



Does your weight interfere with your social activities? Does being overweight make you more nervous? Is your weight an obstacle for your physical activity? Do you suffer from shortness of breath?

Physical status

Impact of Weight on Quality of Life (IWQOL-Lite) (15) Physical function Self-esteem Sexual life Public distress


11 7 4 5

Because of my weight, I have difficulty getting up from chairs Because of my weight, I don't like myself. Because of my weight, I have little or no sexual desire Because of my weight, I worry about finding chairs that are strong enough to support my weight.


Because of my weight, I have trouble getting things accomplished or meeting my responsibilities

OBESITY AND PHYSICAL QUALITY OF LIFE There is compelling evidence that obese individuals report poorer physical quality of life than do normal weight individuals (12,19). For example, data collected from the Behavioral Risk Factor Surveillance System (18) have provided strong evidence of the relationship between obesity and physical quality of life in the largest US study to date (N=109,076). After adjusting for numerous covariates including age, gender, ethnicity, education, employment status, smoking and physical activity, results documented that obese participants [Body Mass Index (BMI) > 30 kg/m2] reported impaired physical well being when compared to nonobese individuals. The relationship between obesity and poorer quality of life was observed in all age groups, both genders, and among Caucasian, African American and Hispanic individuals. Similar evidence has been obtained in European studies. In a study of 8889 randomly selected adults in Great Britain (20), individuals with moderate or morbid obesity had significantly poorer physical well being than those in all other BMI categories. The effects of obesity on physical quality of life are apparent even among individuals with chronic diseases (20,21). Katz and colleagues (21) assessed quality of life in 2931 patients with chronic health conditions [hypertension, diabetes, congestive heart failure, recent myocardial infarction, and depression] receiving medical care. Overweight and obese patients had significantly poorer health related quality of life on physical health measures and health perceptions than did normal weight patients, even after adjusting for demographic characteristics, health habits, medical conditions and depression. Factors that moderate the relationship between obesity and physical quality of life In addition to overall evidence linking obesity and impaired physical quality of life, numerous factors that moderate the relationship have been identified including demographic variables, obesity-related factors, and treatment seeking. First, women appear to be more vulnerable to the negative effects of obesity on quality of life. Obese women tend to report poorer health-related quality of life than obese men do (10,22,23). Among women, higher body weight also is associated with higher rates of health care utilization (24). Severity of obesity clearly is related to physical quality of life; that is, more severely obese individuals report poorer health than do those with milder obesity. For example, Doll et al. (20) found a strong linear relationship between BMI and poorer quality of life. Similarly, data from the Swedish Obese Subjects study (12), a longitudinal study of severely obese men (BMI > 34 kg/m2) and women (BMI > 38 kg/m2) have documented that health-related quality of life in severely obese individuals is significantly more impaired than in less obese individuals. Central adiposity, or an excess of visceral fat, also has been associated with increased morbidity, independent of BMI (19,25). Measurements of waist-to-hip ratio (WHR) and waist circumference have gained acceptance as useful proxies for amount of visceral adipose tissue, and are associated with cardiovascular risk factors and poorer health outcomes. Specifically, in adults, waist circumferences > 35 inches in women and > 40 inches in men or a WHR >1

are associated with higher risk for the development of obesity related risk factors including hypertension, hyperlipidemia, and type 2 diabetes (26). There is substantial evidence that men and women with large waist circumferences have an excess burden of poor health. For example, in a large cross-sectional, population-based study of Dutch men and women (25), the risk of major cardiovascular risk factors, type 2 diabetes, back problems, and problems with activities of daily living increased significantly for men and women with greater waist circumferences. Treatment seeking and physical quality of life Health-related quality of life among obese individuals also differs as a function of whether or not the individual seeks obesity treatment as well as the intensity and type of the treatment (23,27,28). The effects of treatment seeking were clearly explicated in a recent study (23) that compared quality of life among diverse groups of obese men and women, those who were not in treatment, clinical trial participants, outpatient program participants, day program participants, and gastric bypass patients. Quality of life was poorer among individuals who sought any treatment compared to individuals in the community who were not seeking obesity treatment, irrespective of gender or category of BMI. Moreover, impaired quality of life was associated overall with increasing BMI; however, within each category of BMI, increasing level of treatment intensity was associated with poorer quality of life. Individuals in the community who did not seek treatment had less impairment in perceived health, while individuals seeking bariatric surgery had the most impairment. Effects of weight change on physical well being The evaluation of research evidence from epidemiological studies that have examined the impact of weight change on health and well being has been hampered by the methodological limitations of existing studies (29). Many investigations have not included information about whether observed weight changes were volitional, or have failed to control for confounding factors. Nevertheless, the preponderance of available data from epidemiological studies has shown that stable weights or minimal weight change is associated with longevity (29,30). There are, however, some indications from epidemiological research that weight change is related to physical health. For example, in a prospective study of 40,098 women participating in the Nurses Health Study, Fine et al. (31) reported that weight change was strongly associated with physical health in women. Participants were divided into three groups, weight maintainers (39%), weight gainers (38%), and weight losers (17%). Weight gain was associated with decrements in physical health-related quality of life among women less than 65 years of age in all BMI categories. The most dramatic changes in physical function, vitality and bodily pain occurred in those who gained 9 kg or more over the four years of the study. Conversely, except for women in the lowest category of BMI (< 25 kg/m2), weight loss was associated with improved vitality and physical functioning. In women older than 65, weight gain was associated with poorer physical functioning, and weight loss was associated with improvements in physical functioning, with one exception. Weight loss was associated with poorer functioning among women in the lowest category of BMI (< 25 kg/m2), perhaps due to involuntary weight loss. In summary, data from this large longitudinal study provide support for recommendations to avoid weight gain at all levels of BMI, and for overweight women to lose weight.

At present, there is no conclusive evidence that voluntary weight loss produces health benefits over the long term. However, there is an impressive body of evidence from clinical research studies showing that even moderate weight loss has significant benefits over the shorter term, particularly reductions in risk factors for heart disease and diabetes (32). Along with improvements in obesity-related comorbidities, weight loss is associated with improvements in health-related quality of life (33,34). For example, Fontaine et al. (33) examined the short-term effects of a lifestyle weight loss program on quality of life in mildly to moderately overweight men and women, and found dramatic improvements in quality of life including physical functioning, physical role, general health, and vitality. Weight loss appears to be associated with improvements in health related quality of life regardless of treatment intensity. In a Finnish study, Kaukua and colleagues (35) found that men who participated in a four-month weight loss study that combined a very low calorie diet and behavior modification reported sustained improvements in health related quality of life. Finally, data from the Swedish Obese Subjects (SOS) intervention (36) have shown that severely obese individuals treated with gastric surgery evidenced dramatic improvements in health related quality of life that persisted for two years. Further, improvements in quality of life were related to the amount of weight change, with patients losing the most weight showing the greatest improvements. There has been substantial controversy about whether repeated bouts of weight gain and weight loss have deleterious effects on health and health-related quality of life. Some studies have suggested that cycles of weight loss and regain may have negative health consequences, particularly for cardiovascular risk(37,38). However, contrary to initial reports, it does not appear that weight cycling makes subsequent weight loss more difficult (39). Moreover, the health risks associated with obesity appear to outweigh potential risks associated with cycles of weight loss and regain, and thus current recommendations are for obese individuals to lose weight, despite the likelihood of eventual weight regain (26). OBESITY AND PSYCHOLOGICAL QUALITY OF LIFE Evidence documenting the relationship between obesity and psychological quality of life has been equivocal and the data linking obesity and poorer psychological quality of life is much weaker than evidence documenting poorer physical quality of life in obese individuals. Earlier studies found few or no differences between obese and normal weight individuals in psychological functioning (40,41,42). Similarly, some more recent population-based studies (16,20), have demonstrated marked differences between obese and non-obese individuals in physical quality of life, but few differences in the psychological or social dimensions of quality of life. Nevertheless, there is some good evidence that obesity affects psychological quality of life. As noted previously, the Behavioral Risk Factor Surveillance Study (18) documented a robust relationship between obesity and impairments in physical quality of life. This investigation also yielded evidence indicating the impact of obesity on psychological quality of life, although the relationship between obesity and psychological functioning was not as strong as that between obesity and physical functioning. Specifically, after controlling for numerous covariates, individuals with BMIs > 30, in comparison to non-obese individuals, reported impaired mental health. In particular, there was a significant association between BMI and the risk of having fourteen or more days of poor mental health during the last 30 days.

Some research has shown that the co-occurrence of obesity and chronic illness is associated with significant impairments in emotional well being (20). Other studies have documented a relationship between obesity and particular aspects of psychological functioning. For example, Roberts et al. (43) recently reported that after controlling for baseline mental health and relevant covariates such as chronic conditions and limitations in activities of daily living, there was no relationship between obesity and unhappiness or low optimism. However, obesity was a significant risk factor for incident depression, more about which below. Factors that moderate the relationship between obesity and psychological quality of life The general finding that obesity may be weakly related or unrelated to overall psychological health does not obviate the fact that obesity may affect quality of life in ways that are not reflected by standard measures of psychological functioning. For example, obesity has been linked to poor self-esteem and body image (44). Further, research evidence suggests that obesity may have profound consequences on psychological well being in sub-groups of the obese population. Potential moderating factors including demographic variables, obesityrelated variables and treatment seeking will be considered in turn. Next, evidence linking obesity and specific forms of psychopathology will be reviewed. Finally, the relationship between psychological well being and weight change will be evaluated. Women appear to be particularly vulnerable to the negative psychological consequences of obesity. Although some research (43) has failed to find an association between gender and mental well being in obese individuals, most studies have shown that gender moderates the relationship between body obesity and psychological quality of life. Specifically, increased BMI is associated with poorer psychological adjustment in women than in men (22,45,46). In the SOS study, mental well being in severely obese women (12) was significantly poorer than in severely obese men, and women perceived more psychosocial difficulties. In another investigation (23) treatment seeking and non-treatment seeking obese women, when compared to obese men, reported lower self-esteem, and perceived quality of sexual life. There is strong evidence that more severely obese people differ significantly from normal weight and more mildly obese individuals in psychosocial functioning. Evidence from the Swedish Obese Subjects (SOS) study indicated that clinically significant depression, anxiety and impaired social interaction were 3-4 times higher in severely obese individuals than in matched non-obese individuals (12). In addition, visceral adiposity, as reflected by higher levels of waist circumference or waistto-hip ratio, has been associated with poorer psychological functioning among obese individuals. Bjorntorp and colleagues (47-49) have hypothesized that psychosocial stress or other psychosocial handicaps may lead to chronic arousal of the hypothalamic-pituitaryadrenal (HPA) axis and increased cortisol secretion, which in turn promote increased insulin resistance, disturbed lipid and glucose metabolism, and accumulation of visceral fat. Numerous investigators have found that among women (50-53) and men (54-56) higher waist-to- hip ratios are associated with lower socioeconomic status, work problems, unemployment and increased sedentary behavior. For example, Lapidus et al. (53) documented associations between increased WHR and mental disorder, and use of antidepressants and tranquilizers in women. Similarly, Raikkonen and colleagues (50) found cross-sectional associations between waist circumference and depression, anxiety, low levels of social support and quality of life in women. Rosmond and colleagues (56) found a relationship between WHR and degree of melancholy, use of antidepressants and anxiolytics,

and life satisfaction in middle-aged men. Moreover, after treatment with antidepressant medication, non-depressed individuals showed favorable changes in HPA axis regulation and metabolic factors (57). In a study of twin pairs discordant for obesity (58) investigators found that visceral fat, but not obesity in general, was associated with markers of increased psychosocial stress including urinary cortisol, noradrenaline excretion, emotional distress, alcohol intake and decreased amount of quiet sleep. Although the data have been mixed, several reports have documented that individuals with abdominal obesity have higher rates of depression (52,59,60) with concomitant neuroendocrine abnormalities similar to those that are seen in depression. Treatment seeking and psychological quality of life Data from individuals seeking treatment consistently has documented the deleterious effects of obesity on emotional well being. Friedman and Brownell (42) reviewed evidence comparing obese individuals seeking treatment to population controls and concluded that extant evidence has corroborated a relationship between depression and obesity in those individuals who seek treatment. Fontaine et al. (27) found that individuals seeking obesity treatment at a university clinic, when compared to a population-based reference group, reported significantly worse mental health, and emotional and social functioning. Similarly, in another study (61), obese men and women who sought treatment had significantly poorer psychological quality of life than obese individuals in the community. Obesity and specific forms of psychopathology Depression has been the most consistent target of studies that have sought to examine the relationship between obesity and mental health. Evidence from cross-sectional epidemiological studies has been mixed, but conflicting results may well have been due to differences in populations studied and measures utilized. In contrast, data from a large, prospective community study have shown a relationship between obesity and depression. Roberts and colleagues (62) examined the relationship between obesity and depression controlling for numerous covariates including sociodemographic factors, social support, chronic medical conditions, functional impairment, and life events. Cross-sectional analyses documented a relationship between obesity and depression. Specifically, 15.5% of obese individuals were depressed in comparison to 7.4% of normal weight individuals. Moreover, when individuals who were depressed at the initial evaluation were excluded, prospective analyses documented a relationship between obesity at time 1 and depression one year later. Gender may moderate the relationship between depression and obesity. In a study that utilized a structured interview to diagnose major depression in a large sample of adults (22), obese women were likelier than non-obese women to have had a major depressive episode during the previous year. Similarly obese women, when compared to non-obese women, were likelier to report suicidal ideation and attempts. In contrast, obese men, when compared to non-obese men had a reduced risk of depression, suicidal ideation and suicide attempts. There also is substantial evidence that binge eating, defined as episodes of eating objectively large amounts of food with an associated sense of loss of control over eating behavior, is common among obese individuals (63,64). Moreover, binge eating disorder (BED), a syndrome of recurrent and persistent binge eating without the regular compensatory behaviors seen in bulimia nervosa, and that is associated with marked shame and distress, is

more common in obese individuals than their non-obese counterparts. A population-based study of Black and White men and women (65) reported that binge eating disorder affected approximately 3% of obese individuals, in comparison to 1.5% of the overall cohort. Rates of BED were comparable among Black and White women, but rates among Black men were low. Moreover, there was a strong relationship between the diagnosis of BED and depressive symptoms across all individuals examined. Rates of binge eating among obese individuals who seek treatment are markedly higher than rates in the general population of obese individuals. Numerous investigations have documented that as many as 30% of those who seek obesity treatment in university settings meet criteria for binge eating disorder, and have confirmed the association between binge eating problems and depression (64,66). Moreover, some data have indicated binge eating may explain, at least in part, the relationship observed between obesity and impairments in psychological quality of life (67). The relationships among binge eating, depression and obesity are complex and almost certainly multi-dimensional (6). Binge eating and depression may contribute to weight gain and obesity, which, in turn, may negatively affect mood. Depression also may be associated with decreases in physical activity, which may increase obesity risk. Recurrent episodes of binge eating are extremely unpleasant for those who experience them, and are associated with shame and despair that may promote clinical depression. Finally, available evidence suggests that individuals who are preoccupied with weight and have psychiatric symptoms are those most vulnerable to the development of aberrant eating (68). Additional research is needed to elucidate the interrelationships among weight, mood and eating behavior. It is important to note, however, that dieting does not appear to exacerbate binge eating or induce negative psychological sequelae in obese individuals who attempt to lose weight (69). Effects of weight change on psychological well being There has been concern that dieting to lose weight (as opposed to actual weight loss) may be harmful to psychological well being, since dieting is often unsuccessful and may have negative consequences for self-evaluation. In a review of the consequences of dieting, French and Jeffery (70) concluded that despite problems in the measurement of dieting behavior, dieting per se is not associated with negative psychological effects or the development of disordered eating in most individuals. Moreover, numerous studies have documented improvements in psychological functioning as a result of weight loss treatment in moderately obese (33,71) and seriously obese (36,72) individuals. Individuals in behavioral weight loss programs consistently have reported improvements in depressive symptoms and well being (73,74) as have individuals participating in trials of a weight loss medication (70). Bariatric surgery patients have reported impressive improvements in psychological functioning that are associated with degree of weight loss (36,72). Finally, evidence from a study of individuals who maintained significant weight loss for periods of five or more years indicated that successful losers reported improved mood, social interactions and self-confidence (75). Although some studies (31) have failed to demonstrate a relationship between weight gain and mental health, others have found that significant weight gains are associated with poorer physical and mental health (76), particularly in women (31). Some reports have indicated that weight cycling, or repeated bouts of weight gain and loss may be associated with

psychological difficulties, especially, binge eating and depression in women (77,78). Other investigations have failed to document a relationship between weight cycling and psychological problems (79,80). It seems fair to conclude that repeated failures to maintain weight losses might pose emotional difficulties for some individuals. However, it is unclear whether weight cycling is a cause or consequence of psychological symptoms. OBESITY AND SOCIAL QUALITY OF LIFE There is substantial evidence that obesity has profound effects on quality of life in the social domain. Obesity is a stigmatized condition in affluent societies, and there is discrimination against obese individuals in multiple social domains. Finally, there is a strong inverse relationship between obesity and socioeconomic status. Stigmatization of obese individuals There is significant prejudice against obese individuals, historically (81) and currently (82), and in eastern and western cultural traditions (81). Pervasive negative attitudes toward overweight can be identified in children as young as three years old (83). Obese children often are the victims of social stigmatization (84,85), and obese children themselves endorse negative stereotypes of obese individuals (84). Other data have suggested that obese teenagers are at risk for victimization by peers and may be less likely to develop romantic attachments (86). Obesity has been shown to have negative effects on college admission (87), and overweight young women appear to be less likely to secure parental support for college tuition (88). Thus negative stereotypes associated with overweight are evident even in children and may have significant implications for social development during adolescence. Obese adults face intense prejudice, although women are more likely than men are to be stigmatized for obesity (89). Crocker and Cornwell (90) noted that the stigma attached obesity is related to a response to appearance-related aspects of overweight, which are markedly discrepant from western cultural preferences for a slim and fit body type, and to judgments about character traits attributed to obese individuals (e.g., overweight people are lazy, gluttonous, or lack will power). It is often assumed, therefore, that obese individuals are responsible for their weight problems, which may promote self-blame and exacerbate distress (91). Studies also have documented negative attitudes toward obese individuals among health care professionals, in general (3,92), and among health professionals who treat obesity (93). Unsurprisingly more frequent exposure to stigmatization has been linked to more severe obesity and greater levels of psychological distress (94). Prejudicial attitudes toward obese individuals extend to discriminatory behaviors against them. In a review of the literature on discriminatory attitudes and behaviors, Puhl and Brownell (92) noted significant shortcomings in the existing literature, but concluded that there was consistent evidence documenting pervasive bias against obese individuals in areas that almost certainly affect health and well being. Specifically, there appears to be a prejudice against hiring obese individuals as well as pay discrimination against overweight women. Similarly, Wadden et al. (41) documented discrimination against obese individuals in the workplace. In summary, obesity is associated with discriminatory attitudes and behaviors across a variety of social domains. Obesity and socioeconomic status

In western cultures there is a robust relationship between degree of obesity and socioeconomic status. In a seminal article, Sobal and Stunkard (82) reviewed the available research literature, and concluded that there is compelling evidence documenting the negative relationship between obesity and socioeconomic status. The relationship was most apparent in women in the US and Europe, but although the relationship was less consistent among men and children, the inverse association between obesity and socioeconomic status was striking in individuals above the median BMI. The nature of the relationship between obesity and socioeconomic status is unclear. That is, obesity may lead to lower socioeconomic status (for example, through discrimination in hiring), low socioeconomic status may lead to obesity (for example, through difficulties in sustaining a health-promoting diet or adequate levels of physical activity), or there may be other factors that promote both obesity and lower socioeconomic status (95). There is, however, evidence from longitudinal investigations that indicate that obesity may have profound consequences for later social functioning. For example, Gortmaker et al. (96) found that women who were obese in late adolescence were less likely seven years later to be married, and had less education and lower incomes than did non-obese individuals. Although more research is needed to clarify the nature of the relationship between socioeconomic status and obesity (95), it is clear that there are complex interrelationships between socioeconomic status and obesity that have profound consequences for quality of life. SUMMARY AND CONCLUSIONS Obesity is a heterogeneous phenomenon with multifactorial genetic, social, familial, and individual determinants, and it is accordingly unsurprising that the relationship between obesity and quality of life across multiple domains also is a complex phenomenon that defies simple analysis. Similarly, the definition and assessment of quality of life are problematic, and may not adequately capture the impact of obesity on the lives of particular individuals. Nevertheless, obesity has dramatic negative consequences for physical well being and there is also strong evidence that obesity is negatively associated with health-related quality of life in the psychological and social domains, particularly for women, more seriously obese individuals, and for those who seek treatment. In summary, the overall evidence that obesity impairs perceived health and quality of life is compelling and provides additional impetus for the already urgent need to develop better prevention strategies and treatments for this significant public health problem. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________