Consequences of Obesity 12575% higher with BMIs 27; 137% higher with BMIs
32) (Rexrode et al., 1997).
Gallstones.Obesity is a risk factor across both age and
ethnicity for gallbladder disease. The risk of gallstones is
4 to 6 times higher for women with BMIs 40 compared
to women with BMIs 24 (Stampfer, Maclure, Colditz,
Manson, & Willett, 1992).
Sleep Apnea.Sleep apnea is a serious and potentially life-
threatening breathing disorder, characterized by repeated
arousal from sleep due to temporary cessation of breath-
ing. Both the presence and severity of sleep apnea, is
associated with obesity, and sleep apnea occurs dispropor-
tionately in people with BMIs 30 (Loube, Loube, &
Miller, 1994). Large neck circumference (17 inches in
men and 16 inches in women) is highly predictive of
sleep apnea (Davies & Stradling, 1990).
Women’s Reproductive Health.Menstrual irregularity and
amenorrhea are observed with greater frequency in over-
weight and obese women (Hartz, Barboriak, Wong, Kata-
yama, & Rimm, 1979). Polycystic ovary syndrome, which
often includes infertility, menstrual disturbances, hir-
sutism, and anovulation, is associated with abdominal
obesity, hyperinsulinemia, and insulin resistance (Dunaif,
1992; Goudas & Dumesic, 1997).Impact on Mortality
Not only does obesity aggravate the onset and progression
of some illnesses, it also shortens life (Allison, Fontaine, Man-
son, Stevens, & Van Itallie, 1999). Studies show that all-cause
mortality rates increase by 50% to 100% when BMI is equal to
or greater than 30 as compared with BMIs in the normal range
(Troiano, Frongillo, Sobal, & Levitsky, 1996). Indeed, more
than 300,000 deaths per year in the United States are attribut-
able to obesity-related causes (Allison et al., 1999).
Psychosocial Consequences
Many obese people experience social discrimination and
psychological distress as a consequence of their weight. The
social consequences associated with obesity include bias,
stigmatization, and discrimination„consequences that can
be highly detrimental to psychological well-being (Stunkard
& Sobal, 1995). Social bias results from the widespread, but
mistaken, belief that overweight people lack self-control.
Negative attitudes toward obese people, which are pervasive
in our society, have been reported in children as well as
adults, in health care professionals as well as the general pub-
lic, and in overweight individuals themselves (Crandall &
Biernat, 1990; Rand & Macgregor, 1990). An obese person is
less likely to get into a prestigious college, to get a job, to
marry, and to be treated respectfully by a physician than is his
or her nonobese counterpart (Gortmaker, Must, Perrin, Sobol,
& Dietz, 1993; Pingitore, Dugoni, Tindale, & Spring, 1994).
Indeed, obesity may well be the last socially acceptable object
of prejudice and discrimination in our country.
Despite the negative social consequences of overweight,
most early studies have reported similar rates of psy-
chopathology in obese and nonobese individuals. However,
these studies suffered from a number of limitations, for exam-
ple, failing to account for gender effects (Wadden, Womble,
Stunkard, & Anderson, 2002). More recent studies have at-
tempted to rectify this. A large-scale, general population study
(Carpenter, Hasin, Allison, & Faith, 2000) recently showed
that obesity was associated with a 37% greater risk of major
depressive disorder, as well as increased suicidal ideation and
suicide attempts among women but interestingly, not among
men, for whom obesity was associated with a reduced risk of
major depression. A consistent “nding is the higher levels of
body image dissatisfaction that are widely reported by obese
individuals. Body image dissatisfaction is particularly ele-
vated in women with higher socioeconomic status, those who
were overweight as children, and binge eaters (French, Jeffery,
Sherwood, & Neumark-Sztainer, 1999; Grilo, Wil”ey,
Brownell, & Rodin, 1994). In contrast, members of certain mi-
nority groups, particularly, Hispanic and African Americans,
are less likely to display disparaging attitudes toward obesity
in either themselves or others (Crandall & Martinez, 1996;
Kumanyika, 1987; Rucker & Cash, 1992). In fact, Black
women often ascribe positive attributes such as stamina and
authority to being large (Rosen & Gross, 1987).
In contrast to studies of obese persons in the general pop-
ulation, research on psychological disturbance in people pre-
senting for treatment at obesity clinics shows a clear pattern
of results. Obese help-seekers display higher rates of psycho-
logical distress and binge eating when compared to normal-
weight individuals and to obese persons who are not seeking
help (Fitzgibbon, Stolley, & Kirschenbaum, 1993; Spitzer
et al., 1993).Economic Costs of ObesityThe economic impact of obesity is enormous. In 1995, the
total costs attributable to obesity amounted to $99.2 billion
(Wolf & Colditz, 1998). This total can be further viewed in
terms of direct and indirect costs. Direct costs (i.e., dollars
expended in medical care due to obesity) amount to approxi-
mately $51.6 billion and represent 5.7% of national health