WHAT ARE THE PROBLEMS WITH OBESITY?
Physical problems
Obesity has been associated with cardiovascular disease, diabetes, joint trauma, back
pain, cancer, hypertension and mortality (e.g. Bray 1986; Chan et al. 1994). The effects
of obesity are related to where the excess weight is carried; weight stored in the upper
body, particularly in the abdomen, is more detrimental to health than weight carried on
the lower body. It is interesting to note that although men are more likely than women to
store fat on their upper bodies, and are therefore more at risk if obese, women are more
concerned about weight than men and most treatment studies examine women. The
relationship between BMI and mortality is shown in Figure 15.3. It has been suggested
that most problems seem to be associated with severe obesity and weights in the top
10 per cent (Wooley and Wooley 1984).
Psychological problems
Research has examined the relationship between psychological problems and obesity.
The contemporary cultural obsession with thinness, the aversion to fat found in both
adults and children and the attribution of blame to the obese may promote low self-
esteem and poor self-image in those individuals who do not conform to the stereo-
typically attractive thin image. In line with this, Bull et al. (1983) reported that both
obese patients waiting for a gastric bypass operation and normal obese patients rated
themselves as more depressed than normal weight subjects, although the levels of
depression did not reach clinical proportions. Furthermore, Hopkinson and Bland
(1982) reported that one-fifth of their sample of obese subjects, also waiting for surgical
treatment, reported having at least one period of clinical depression requiring treatment.
Fig. 15-3 Relationship between BMI and mortality (after Bray 1986)OBESITY AND CORONARY HEART DISEASE 355