Obesity 155depression-related problems. Similarly, Kasen et al. (2008) explored the rela-
tionship between depression and BMI in mothers who were interviewed as
part of a “children in the community” study in the US and concluded that
those with a BMI greater than 30 were five times more likely to be depressed.
It is likely, however, that being obese has a more complex impact upon
the individual, and this research has also assessed the relationship between
obesity and other forms of psychological morbidity. For example, Tuthill
et al. (2006) reported not only high levels of depression but also increased
anxiety, poor body image, and impaired quality of life. Similarly, Grilo et al.
(2005) reported high levels of body image dissatisfaction which were higher
in obese women than obese men, Sarwer et al. (1998) reported body dis-
satisfaction, particularly with the waist or abdomen, and Wardle et al. (2002)
reported that greater body dissatisfaction in the obese was higher in those
who had developed obesity prior to age 16. Likewise, Hill and Williams
(1998) explored psychological health in a nonclinical sample of obese people
and concluded that those with a BMI greater than 40 reported more body
dissatisfaction and poorer self-esteem than the lighter obese people.
Research, therefore, indicates that obesity influences not only individuals’
health but also their psychological state. In particular, research highlights
a role for depression, anxiety, self-esteem, and body dissatisfaction. This
is further supported by research exploring the effectiveness of obesity
treatment such as behavioral, medical, and surgical interventions which
illustrate that weight loss can result in improvements in these areas (Ogden
et al., 2005; Karlsson, Sjostrom, and Sullivan, 1998; Vallis et al., 2001). Ogden
and Clementi (in press) carried out a qualitative study of the experience
of being obese and reported that the obese described a multitude of
negative ways in which their weight impacts upon their self-identity which
is exacerbated by living in a society that stigmatizes their condition. They
also described how many of these negative effects are reversed once weight
loss maintenance is achieved. These studies suggest a relationship between
body size and psychological problems (see figure 8.3).
It is possible, however, that depressed obese individuals are more likely
to seek treatment for their obesity than the ones who are not depressed
and that there may be many obese individuals who are quite happy and
therefore do not come into contact with health professionals or researchers.
Ross (1994) addressed this possibility and interviewed a random sample of
more than 2,000 adults by telephone. These were individuals who varied
in weight and were not necessarily in the process of seeking help for any
weight-related issues. The results from this large-scale study showed that