Academic journal article Health and Social Work

The Obese Client: Myths, Facts, Assessment, and Intervention

Academic journal article Health and Social Work

The Obese Client: Myths, Facts, Assessment, and Intervention

Article excerpt

A review of the social work literature reveals an absence of information on the complex issues confronting the person who is considered obese. The few articles available simply describe obesity as an eating disorder or note that it is a symptom of an eating disorder (Van Bulow, 1991; Weiss, 1989). Certainly, some people who are considered obese have eating problems and perhaps eating disorders, just as some people who are average size or extremely thin struggle with issues of food and weight. But the assumption that all obese people have eating disorders creates the myth that they are pathological and may foster professional bias. Many people who are heavier than average might benefit from the help of a social worker, but the need does not always include help with an eating disorder.

As with any client, an assessment that is based on knowledge of the cultural, social, biological, and psychological factors affecting the person's situation is essential for planning an appropriate service focus. This article provides information on each of these factors and challenges many of the myths about weight. The article concludes with the presentation of a framework that social work practitioners can use when assessing the heavier than average client.


U.S. society values thinness. This value is clearly reflected in the $30 billion spent annually on weight loss services and products (Berg, 1993). This concern with weight is pervasive, as popular and scientific surveys suggest. Of the 33,000 women who responded to a national magazine survey, 75 percent reported feeling too fat. However, when respondents' weight-height ratio was compared with ideal weight tables, only 25 percent could be considered overweight. Even more disturbing was the fact that 45 percent of women who were underweight thought they needed to lose weight ("Feeling Fat," 1984). Similarly, in a study conducted by the Centers for Disease Control (Berg, 1993), 40 percent of all U.S. adult women and 25 percent of adult men were trying to lose weight. Of these, 62 percent of the women and 44 percent of the men were not overweight.

For adolescents, the percentages tend to be even higher. In fact, for many adolescent girls dieting has become a way of life. The relatively new thinness standard promoted by the mass media has fostered many misconceptions. Although these misconceptions affect both men and women, the effect on women is particularly pernicious (Tiggemann & Rothblum, 1988). What is popularly regarded as the correct size for women in Western cultures was not the standard in the past, and it is not the current standard in many non-Western cultures (Furnham & Alibhai, 1983; Furnham & Baguma, 1994; Rothblum, 1990, 1992b).

In any era, what society regards as an acceptable size for women is a reflection of complex biological, social, and economic factors. For example, before the 20th century, a woman's value and marriage possibilities depended on her potential to bear children. Because a woman did not have legal status, economic survival depended on marriage. Women with fat on their bodies were good candidates for marriage because they were considered healthy, strong enough to resist infectious diseases, and more likely to have bountiful reproductive lives. Thinness was viewed as a sign of frailty.

At the beginning of this century, the women's liberation movement expanded women's roles beyond motherhood. New employment opportunities allowed women to demonstrate their economic value outside the home. This new freedom to explore less traditional roles often necessitated changes in clothing styles. The layered and heavy clothes of the past were no longer functional in the modern workplace. Because the new, less cumbersome clothes were more revealing, the actual shape of the body became a greater concern (Bennett & Gurin, 1982; Seid, 1989). Even though there was a shift toward valuing thinness by the 1920s, the degree of thinness admired today has never before been an esthetic or sexual ideal. …

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