Academic journal article The International Journal of Behavioral Consultation and Therapy

A Conceptual Piece: Contextualizing Obesity Struggles

Academic journal article The International Journal of Behavioral Consultation and Therapy

A Conceptual Piece: Contextualizing Obesity Struggles

Article excerpt

Self-stigma--a battle with the body

Though there are multiple ways of approaching obesity, most treatments explicitly focus on weight loss strategies. A contextual approach to understanding problematic weight gain highlights underlying behavior patterns of avoidance of unwanted experiences. Experiential avoidance is defined as; any attempt to avoid, change, or control thoughts and feelings when doing so causes harm. Weight-related self-stigma is recognized by self-devaluation and fear of judgments based on weight (Lillis, Luoma, Levin, & Hayes, 2010). Self-stigma may include thoughts about being undesirable and that "there is something wrong with me". Body dissatisfaction has been described as one form of internalized self-stigma among persons with obesity (Wang, Brownell, & Wadden, 2004). Body dissatisfaction is characterized by behaviors such as preoccupation with weight, self-devaluation, avoidance of body exposure and avoiding for example intimate relationships (R. M. Puhl & Heuer, 2009). Body dissatisfaction correlates with both depression and low self-esteem among overweight and obese patients (Gavin, Simon, & Ludman, 2010; Hrabosky, Masheb, White, & Grilo, 2007). One strategy for handling negative emotions is eating for emotional relief (Ricca et al., 2009; Spoor et al., 2006). Evidence shows that shame and body dissatisfaction correlate significantly with over eating (Annis, Cash, & Hrabosky, 2004; Hrabosky, et al., 2007; R. Puhl & Brownell, 2001). In addition, experiences of obesity stigmatization predicts binge eating behaviors (Ashmore, Friedman, Reichmann, & Musante, 2008).

An interpretation of research findings is that binge eating could be functionally working as an escape from self-stigmatizing thoughts and worries. If this is a conditioned process body dissatisfaction and self-stigma should proceed binge eating. In a prospective study, body dissatisfaction was shown to predict binge eating after five years (Neumark-Sztainer et al., 2007). In another prospective study, avoidance used as a coping strategy early in life was shown to increase the risk for the later development of binge eating (Ghaderi, 2003). The key in the behavioral chain is that the person wants to avoid unwanted thoughts and feelings. Results have shown that experiential avoidance mediate the relation between negative emotions and binge eating (Kingston, Clarke, & Remington, 2010).

Both overeating and restrictive eating may be functionally related to self-stigmatizing thoughts. Even though having different forms the function may be the same. Candidates for obesity surgery most often have a long history of yo-yo dieting.

Rebound effect of experiential avoidance

People with higher BMI tend to engage more in both unhealthy (e.g., skipping meals) and healthy dieting (e.g., eating vegetables) than normal weight persons (Gillen, Markey, & Markey, 2012). Reviews examining the success of dieting conclude that diets lead to short-term weight loss, usually 5-10% of body weight, but this weight loss is not maintained over the long-term for the majority of people (Garner & Wooley, 1991; Jeffery et al., 2000; Mann et al., 2007; Perri, 1998). In a review of a range of diet programs, it was found that, an average weight loss of 4% is maintained after 4 years (National Institutes of Health, 1998). A treatment-seeking person with obesity often has several cycles of weight loss and weight gain in his/her history (Gibbons et al., 2006). Some research indicates that restrictive dieting increases the risk of negative emotions and body dissatisfaction (Roehrig, Thompson, & Cafri, 2008; Stice & Shaw, 2002). Rigid patterns of controlling body weight may reduce anxiety for the moment. A feeling of relief is elicited when engaging in behaviors aiming at changing the body from "undesirable" to "desirable". However in the long run, the body becomes conditioned to aversion in the context of rigid control, making the person vulnerable for enhanced self-stigma. …

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