Obesity and Body Image
JAMES C. ROSEN
Obesity is viewed as physically unattractive and the result of personal misbehavior; hence, many overweight persons develop a negative body image. Distressing body image experiences are associated with psychological and eating disorder symptoms, and can influence the outcome of weight control programs (see Chapter 108). Although concern about physical appearance is a main reason that people seek weight reduction, specific intervention to improve body image has been neglected in the treatment of obesity.
Studies of nonclinical samples indicate that obese persons do not have more severe mental health symptoms or maladaptive personality traits than nonobese persons (see Chapter 71). The only consistent obese–nonobese difference on psychological measures is body image. Obese persons are more prone to distort their body size, more dissatisfied and preoccupied with physical appearance, and more avoidant of social situations. Thus, all three components of body image are affected: perception, cognition–affect, and behavior.
The most common aspects of physical appearance that are dissatisfying to obese and nonobese persons, especially women, are the waist or abdomen, whole body, thighs, lower body, and buttocks. Close to one-third of obese persons report concern with issues other than size of large body regions, including facial features, facial or head hair, skin blemishes, teeth, and breast size or shape. Morbidly obese persons in particular complain of other appearance problems, such as excessive facial hair or skin discoloration; these often are related to their extreme weight. Frame size and hip circumference in women are better predictors of body dissatisfaction than body fat and degree of overweight. Therefore, weight reduction by itself may be ineffective in reducing body dissatisfaction.