Obesity: Lifestyle Factors And Psychological Barriers

Introduction

Clinically, obesity is described to be ‘an abnormal or excessive accumulation of fat that may affect health when it is … a BMI greater than or equal to 30’1. Although primarily a health issue, it also poses societal and psychological implications, usually pertaining to the wellbeing of individuals; how obesity is influenced by wider society and the impact of an obese population on society.

How Can Obesity Be Measured?

Body Mass Index (BMI) is calculated as weight (kg) divided by the height of the individual (metres), squared2. BMI is universally used and accepted as the primary means of measuring whether an individual is obese. However, it is not always deemed to be the most effective indicator of obesity as the index is unable to distinguish between adiposity and lean mass, and its distribution3. It does, however, positively correlate with percentage body fat4, and so, it is the measure used most often. It may be pertinent to measure BMI alongside waist circumference and/or waist hip and waist: height ratios to establish and confirm whether the standard is indicative of obesity. Alone, these measures cannot prove to be a true barometer of obesity as they have not been standardised, however, they can provide an indication of whether the BMI calculated is more reflective of muscle weight or adiposity. David’s BMI is calculated to be 36.4, a value which exceeds the standard (see Appendix 1a) and so, he is deemed to be obese using this measure. An alternative to the BMI, which allows for clear distinction between adiposity and lean mass, is Densitometry. Through this process, individuals are weighed whilst ‘in the air and when submerged in a tank’5. As fat is more buoyant than muscle, someone with a higher percentage of adipose tissue is likely to have a lower body density5. Although this requires individuals to be submerged in water, and is highly specialised in its methodology, it provides the most accurate representation of whether an individual is obese. Due to its specificity, it is carried out in a clinical setting, and so, is not a method that can be readily used to determine obesity.

Lifestyle Factors that Contribute to the Risk of Obesity

Poor diet and lack of physical activity are often seen to be the underlying factors which contribute to obesity. The imbalance between energy intake and energy expenditure is the root cause for this. The built (urban) environment is one that encourages overconsumption6, with high calorie foods easily accessible and widely advertised. Increased energy intake cannot be deemed the sole cause for increasing the risk of obesity as high energy density of foods consumed and larger portion sizes factors are also attributed to overeating7, which consequently increases the risk of obesity. Coupled with a reduction in physical activity, it results in a positive energy balance which requires the body fat mass to increase in order to restore the energy balance to normal levels8. Human physiology is adapted for an environment in which food is not readily available, and high levels of physical activity are needed9. With global development comes increased accessibility and so, decreased levels of physical activity.

A sedentary lifestyle, such as that which David leads, is encouraged in wider society through the availability of jobs and career paths which are predominately office based, and through TV becoming the main leisure activity. This involves little physical activity – those leading a sedentary lifestyle are ‘three-four times more at risk of obesity’8. Thus, as less energy is expended, the risk of obesity is greater as the balance between energy intake and energy expenditure is not maintained, and is thus skewed.

Potential Psychological Barriers to Losing Weight

Obesity is largely perceived to be something intrinsically wrong, holding negative connotations in wider society10. As a consequence, few individuals accept the term, with only 7% of obese men correctly identifying themselves as such7. This denial could stem from the idea that the term is considered to be undermining and derogatory11, with mass media content projecting and presenting those that are obese as “freaks”12. A lack of self-acceptance over whether an individual is obese could be due to the health conditions and diseases that could manifest as a result of obesity, such as Type 2 Diabetes, and so, individuals may struggle to come to terms with this. Stigma pertaining to obesity can also influence feelings of anxiety13 and stress, which fosters insecurity and so, has a detrimental effect on the health of the patient.

Although barriers may be psychological in nature, they are influenced by social perceptions and norms. Across most media forms, there is a certain pressure to conform to a particular size and look, with those that are slimmer viewed more favourably than those that are not. If a patient does not conform to these societal standards, it could lead to them becoming demoralised as they do not fit the norm. Due to this narrative that has been portrayed, obesity has become stigmatised, with weight-based stereotypes common14. As David does not view himself to be obese, he may not be motivated to lose weight as he does not believe it applies to him. This lack of willpower presents a psychological barrier to following the advice to lose weight15, as he is likely to not put the advice given into practice, and so, his condition will persist and proliferate. David’s own psychology impacts his ability to change, as he does not see a reason to change. Thus, the mental wellbeing of a patient should be considered.

However, not only does obesity bring about low self-esteem, but obesity related conditions, such as the chronic pain felt by David, which could hinder an individual’s ability to recover and to carry out physical activity16. This is symptomatic of the negative multiplier effect, as the pain felt could result in limited mobility and subsequently, affect the individual’s ability to lose weight16. These physical hindrances may further affect the mental wellbeing of the patient as they are unable to partake in activities that will improve their health, perpetuating their condition and leading to feelings of hopelessness, and in some instances, the onset of depression. The patient may enter a negative spiral, as they cannot bring about change physically, which further deteriorates their mental wellbeing and so, become trapped. As they feel they cannot change, they do not attempt to, thus, presenting a psychological barrier to losing weight.

Obesity and Socio-Economic Status

It can be argued that obesity is intrinsically linked to the socio-economic status of a population17. As nation’s develop, globalisation and cultural diffusion often result in transnational corporations beginning to operate in these developing countries. As this occurs once a country begins to industrialise, individual’s have an increased expendable income, leading to widespread changes in diet and lifestyle. This has been a driving force behind changes in percentage obesity in developing nations, with over 904 million adults obese in the developing world, a value that has more than tripled between 1980 and 200818.

Alternately, in developed nations, disparities in wealth often result in poorer demographics accessing food of poor nutritional value. It has been noted that as a consequence of food poverty, low-income households are unable to obtain and afford fruits and vegetables, instead, favouring and opting to consume ready-to-eat meals, due to their greater affordability and availability19. It can be argued that those living in developed nations are vulnerable to the phenomena termed ‘Status Syndrome’20. The implication of a social gradient suggests that those who have better access to adopting a healthier lifestyle, due to economic means, are likely to fare better, whereas those of lower socio-economic status will persistently have worse health. Therefore, poor health, and by extension obesity, can be heavily influenced by wealth.

Misconceptions of whether an individual is obese is especially prevalent in those individuals of poor socio-economic status, with self-perception of obesity in the UK decreasing despite rates of obesity increasing21. This could be due to societal norms; if the majority of a local population are overweight or obese, the normal is recalibrated to align itself with this. The individual is not seen to be obese relative to their setting, and so, is not perceived to be obese within this environment. Similarly, this idea of social norms may also translate into an office environment. As many within this setting have adopted a sedentary lifestyle, with the risk of obesity increased in such a setting8, David may feel that he falls on the spectrum as ‘normal’ and so, his attitude may be fixed in that he does not need to change.

Conclusion

David’s ability to lose weight is influenced as much by his lifestyle as his mentality. His psychology towards losing weight may be impacted by social norms within his immediate environment, as well as wider sociological impacts. He is hindered in his want to lose weight by a culmination of biological factors, such as his diet, psychological factors and sociological factors. As medical professionals, obesity should be treated as a biopsychosocial issue, rather than solely a biomedical issue.