Self-Esteem, Control and Well-Being in Obesity

Obesity in the UK – individual problem or national plague?

Introduction:

Levels of obesity are on the rise in the UK and following calls from doctors and other health professionals, the government has pledged to fight obesity with promises to help British society to fight the problem on a number of levels. Predictions are that in 2010 almost one third of adults will be obese (Lean et al., 2006), and the obesity epidemic, which is running out of control could bankrupt the health service (Haslam et al., 2006) adding to the calls for something to be done about the problem. Tony
Blair has offered to provide money for prevention and fighting the existing symptoms of obesity. Obesity is arguably the greatest challenge to public health in Britain today and there is a need for effective action. One of the major warning signs is the rising levels of obesity among children and there is a growing recognition that if the problem is not tackled with some degree of urgency in this group the long term health of the nation will suffer. While there are now a number of well established potential treatments for obesity in the UK, it has been suggested that measures for enhancing self esteem would be particularly important in those groups identified as being at risk from later eating disorders and obesity (Button et al., 1997, p.46).

The issue of health in general concerns the nation, with the government, consumers and businesses sharing the burden of addressing health related issues. The National Audit Office has estimated that obesity accounts for eighteen million days of sickness absence and 30 000 premature deaths each year (Bourn, 2001). Obesity has physical and psychological causes and symptoms but the nature of the psychological mechanisms involved in adjusting to obesity are unclear (Ryden et al., 2001). There are a number of health problems associated with obesity, with mortality rising exponentially with increasing body weight (Wilding, 1997).Despite the growing level of the problem, questions have been asked in respect of whether Britons really need this help at a national level and if they realise that obesity is a problem for individuals and the nation as a whole.

The purpose of this study is to assess the views of Britons on the obesity issue. Levels of psychological well being, the locus of control and self esteem will be measured in relation to being overweight. Differences between men and women will be considered. In addition two different age groups will be investigated – under thirties will be compared with over thirties to ascertain similarities and differences. There is also an investigation into the effects, if any, of ethnicity on obesity. The main focus of interest will be to determine if there is a difference in self perception between those who consider themselves to be overweight and those who do not. In order to investigate the issue the body mass index will be calculated for all participants and compared with the perceptions they have of themselves in terms of being overweight.

It is hypothesised that men will have higher levels of self esteem and will score more highly on measures of psychological well being than women. Previous studies have suggested that there are no significant differences between men and women in terms of locus of control in respect of weight (Furnham and Greaves, 1994). In order to investigate if this finding is still valid, the study will test the above variables taking into consideration differences in age and weight.

Methodology:

The sample will consist of a selection of individuals attending Weight Watchers meetings and sessions at the local gym. There will be sixty participants consisting of
men and women aged over eighteen.

Materials:

A questionnaire will be designed to examine the variables discussed above and any relationship between them. The questionnaire will be divided into four parts:

· Part One – will ask questions about gender, age group (under thirties and over thirties), weight, height and will ask participants to declare whether o nt they believe themselves to be overweight;

· Part Two – will ask questions in respect of self esteem;

· Part Three – will ask questions in respect of locus of control;

· Part Four – will ask questions about psychological well being.

In order to measure the effects of the various variables the following instruments will be used: Rotter’s Internal-External Locos of Control Scale (Rotter, 1996), Radloff’s
CES-D Depression Scale (Radloff, 1977) and Rosenberg’s Self-Esteem Scale (SES) (Rosenberg, 1965).

Procedure:

Half of the questionnaires will be given to those attending Weight Watchers sessions and the other half will be administered to those attending the local gym. Participants
will be informed of the nature and purpose of the study and will be given assurances tat all information given will be treated in the strictest confidence and will not be used
for any other purpose. It will be stressed that participation in the study is voluntary and participants are free to withdraw at any time. Participants will also be free to omit
any questions which they do not want to answer. Written consent will be obtained before participants take part in the study. Contact details will be given to the researcher in case of follow up queries.

Analysis of Data:

Data collected will be analysed using quantitative statistical analysis in the form of TTests.

Discussion:

The obesity epidemic in the UK continues to run out of control, with none of the measures that have been taken showing any sighs of halting the problem much less
reversing the trend (Haslam, 2006, p.640). A number of areas have been identified which need to be addressed. There is the recognition that mental health problems in
the context of low self esteem are associated with eating disorders. Mental well being is affected in the context of the workplace, with obese people often facing some
degree of discrimination in their professional and social lives. There is also a growing body of evidence to suggest that the problem is more widespread in some ethnic
groups than in others. Many of the medical problems and complications associated with obesity are found in adults, but the increasing prevalence of obesity or the tendency to become obese in children, is also a worrying trend, further strengthening suggestions that prevention rather than cure is the key to tackling the problem in the
long term. While prevention in terms of maintaining weight loss and preventing people from putting on weight in the first place is the ideal, maintaining weight loss has been a major limitation of many of the approaches so far adopted (Wliding, 1997,p.998).

Self Esteem:

Although there is a general consensus that there are a number of factors at work in the context of eating disorders, self image has frequently been thought of as having a high profile role in the nature of these disorders (Button et al., 1997, p.39). Research in this area has been to a large degree unclear as those who have typically participated in the research have been those who have been in the process of seeking help and may therefore not be representative of the obese population in general (Ryden et al., 2001, p.186). It has often been suggested that a low self image is present and can be a contributory factor in causing individuals to develop eating disorders. Dyken and Gerrard gathered considerable empirical evidence to suggest that patients with eating disorders had slower levels of self esteem than their counterparts who are of normal weight (Dyken and Gerrard, 1986). A great deal of the research has been speculative in nature with very little evidence to suggest a causal link between low self esteem and the onset of eating disorders. As discussed above, it has been documented that obese individuals face discrimination on a number of levels. This can lead to their accepting these negative perceptions which can reduce self esteem even further and can lead to mental health problems (Ryden et al., 2001). Studies carried out in Sweden have supported this idea, with individuals who were obese experiencing significantly psychological distress than not only their healthy counterparts, but than those who had been involved in various forms of accidents or who were chronically ill (Sullivan et al., 1993).

Studies carried out by Button found that girls aged 11-12 who had low levels of self esteem were, indeed more likely to have developed an eating disorder than their
counterparts when they took part in a follow up study some years later when they were aged 15-16. These girls also displayed a range of other psychological problems
(Button, 1990 cited in Button et al., 1997). Dieting usually results in weight loss and the lower the calorie intake, the more weight will be lost. Weight is usually regained
and there is evidence that cognitive behaviour therapy may be a more successful approach, particularly if it is coupled with physical exercise. This may have more long term success, making it an effective approach with children and adolescents as good behaviour patterns in terms of adopting a healthy lifestyle can be developed and
maintained (Wilding, 1997).

In order to investigate the area of self esteem further Button and colleagues investigated rates of self esteem in a much larger sample of girls aged 15-16. Those
who were identified as having eating disorders did display lower levels of self esteem than their counterparts, and the area in which they had the lowest levels of self esteem was in respect of their external appearance, cited as an area of low self esteem by 75% of the respondents who were problematic eaters (Button et al., 1997).

Gender Differences:

Eating disorders have been viewed as largely affecting women, with relatively few studies having been carried out in respect of men who have problems with weight and
weight control. Since the 1990s there have been increasing numbers of males being identified as having eating disorders (Fernandez-Aranda et al., 2004, p.368). Research has begun to focus on whether there are gender differences associated with eating disorders. It has been suggested that men who develop eating disorders have higher levels of the personality traits associated with these disorders as overall rates are less for men than they are for women. Research has shown that men had less of a
preoccupation with ideal body size and the drive for thinness than females (Fernandez-Aranda et al., 2004).

Mental Health:

Eating disorders in general, and obesity in particular have been attributed to underlying psychological problems such as depression or an inability to cope with certain aspects of life (Leon and Roth, 1977). This has led to the increasing adoption of cognitive therapy methods, providing training in better ways to deal with the difficulties in one’s life which can lead to obsessive eating behaviour. Ryden and colleagues have proposed that the coping mechanisms which individual shave at their disposal can have an enormous impact on whether or not they will become obese (Ryden et al., 2001).

The Extent of the Problem:

The body mass index has been increasing in a number of countries and in the UK the National Audit Office have found that in the period from 1984 to 1993 rates of obesity doubled for both men and women (National Audit Office, 1994) and have been on the rise ever since. Not only are the rates of obesity continuing to rise, with 17% of men and 21% of women currently obese in the UK, but they are rising at a faster rate than in the past, with people being fatter than they were in the past (Clark, 2006, 123). Obesity levels are rising faster in the UK than elsewhere (While, 2002, p.438). There are also some quite startling differences, with women in the UK who
are the heaviest weighing up to twice as much as their counterparts of the same height who are not overweight. Despite an increasing awareness about obesity and the
benefits of healthy eating and exercise, the obesity problem continues to rise, being attributed to a complex interplay between a number of environmental factors. In their
work in respect of eating disorders and self esteem Button and colleagues found that the rates of partial eating disorders were quite high at about 8% (Button et al.,1997). Obesity is starting to overtake smoking in the UK as the greatest preventable cause of illness and premature death (Haslam, 2006, p.641). Obesity has been strongly linked with poverty and with a lack of available public information, with many individuals realising that high fat products were unhealthy but they were unable to judge which products were high in fat and by how much (Vlad, 2003p. 1308).

Psychological Well Being:

Eating disorders in general have been linked to overall psychological well being. This means that in addition to the nation’s physical health, obesity must be addressed in the context of the effect it is having on the nation’s psychological well being. Button et al. found that those who had been identified as having eating disorders scored low on the self esteem scale but also had higher scores on the anxiety scale than their counterparts. The authors pointed out that their work which involved school students, was carried out close to examinations which may account for increases in levels of anxiety, and they could therefore not suggest a causal link without further follow up work (Button et al., 1997).

Button and colleagues used a questionnaire in order to elicit further information in respect of self esteem in their subjects. When girls expressed general dissatisfaction
with themselves, this was most often referred to in the context of physical appearance, with those identified as having eating disorders being more likely to make globally
negative comments about themselves (Button et al., 1997, p.45). The same research found that family was an important factor in negative perceptions and low self esteem with a significant number of those identified as having eating disorders reporting that their family lives were characterised by arguments and an inability to communicate.
The growing recognition that obesity has a psychological component, with low self esteem being recognised as an important factor, has led to suggestions that support needs to be given to people who are obese rather than ridiculing them (Mayor, 2004).

Causes of Obesity:

If obesity is to be successfully tackled in the UK and elsewhere, a sound understanding of the root causes must be established. The spiralling levels of obesity in the UK and elsewhere over the past thirty years have prompted suggestions that it is the environment which is playing the largest part in the problem as genes could not have changed to such a degree in such a short space of time (Clark, 2006, p.124), although there is recognition that there is a genetic component (Barth, 2002, p.119), with research from twin studies suggesting that the tendency to become obese is inherited. Not only are people eating more than they did a generation ago, but there have been a number of changes to the types of activities in which people are engaged. There has been a steady decline in the need for active working at home or in the workplace and an associated increase in sedentary jobs and occupations. In real terms physical activity has been seen as having shifted from something which people were paid to do, to something which people must now pay for in the form of joining a gym or similar pastimes.

Considerable criticism has been levelled at the food production industry which produces high calories foods which are being eaten as snacks, taking daily calorie allowances above the recommended allowances. There has been an attempt to address this problem in the form of a number of initiatives such as those to increase physical activity to two hours per week in schools and the promotion of fruit and vegetables in schools, but there is little evidence of widespread success. Research carried out by Skidmore and Yarnell has suggested that the majority of obese adults were not overweight as children. This is suggestive of the fact that obesity comes about as the result of excess calorie intake over a period of many years. Education for healthy eating and living is therefore seen as vital in preventing future obesity and the associated health risks (Skidmore and Yarnell, 2004).

Environmental factors:

Despite the identification of a genetic component, it has been argued that obesity can be largely prevented, with lack of physical activity and chronic consumption of excess calories, being the main preventable causes of obesity (Skidmore and Yarnell, 2004, p. 819). It has been suggested that the environment provides a number of opportunities for the over consumption which leads to excessive weight gain. This has led to the conclusion that the obesity epidemic can only be effectively targeted if there are major changes in the environment and the ways in which people interact with it in respect of food and eating (Clark, 2006).

Effects of Obesity:

Obesity affects people of all ages including children and has damaging effects on all organs in the body. Long term consequences include diabetes and hypertension which
can ultimately lead to strokes and coronary heart disease (Barth, 2002, p.119). The effects of obesity in relation to mortality can be marked. Research carried out has found that the risk of diabetes in men who were very overweight increased to a risk of being forty two times more likely than those who were not overweight and women and children have been identified by research as the groups most affected by obesity (Bhate, 2007, p.173).

The governments proposed intervention has come about due to the realisation that many individuals are not able to make enough proactive changes to prevent excess
weight gain and are simply reacting to their environment, one in which people eat larger portions, are more prone to snacking and are taking less exercise than their
counterparts from a generation ago. Food is seen to be attached to a range of emotions, with eating being associated with celebration as well as a comfort when one
is depressed. Because of the huge impact which the environment appears to be having on obesity, it has been argued that education alone will be insufficient in dealing with the problem, and environmental changes are urgently needed (Lean et al., 2006). Attempts to tackle the obesity problem have themselves brought difficult issues in
terms of adverse outcomes such as the rise in eating disorders as more and more people battle with their weight. It has been suggested that long term monitoring of approaches to treating obesity is required in order to deal with these associated problems (Skidmore and Yarnell, 2004).

Obesity as a Disorder:

There is a growing recognition that obesity comes about as a result of an addiction to food, and, as with all addictions those who suffer require help and advice. It would
appear that many of those who are obese eat not when they are hungry but in the context of a wider social agenda, fuelled by the constant availability of food. Once the
cycle of weight gain begins it becomes cyclical in its nature and is compounded by lack of exercise, which leads to greater levels of weight gain. Many commentators
have suggested that the failure of traditional approaches to tackling obesity point to the fact that a more successful approach may be to take the view of obesity being a
disability which is characterised by a range of adverse consequences. Like other addictions, obesity requires treatment and support. The benefits of effective treatment
cannot be overstated as even a small weight loss can reduce health risk for obese individuals (Goldstein, 1992).

Addressing the Obesity Issue:

The problem of obesity is placing a strain on public resources in the National Health Service as well as endangering the nation’s health. Action is therefore required at the
national level as it has been argued that many of the factors operating at the environmental level such as the availability if fast food and the lack of exercise cannot be dealt with at the level of the individual and must therefore be addressed through a number of public health initiatives. Guidelines for prevention and treatment have been introduced in the United States and the United Kingdom, but it has been suggested that their implementation may take a number of years due to their complex nature and
the number of organisations involved in the process (Skidmore and Yarnell, 2004).

It has been suggested that the issue can only really be addressed through changes in the environment which will enable individuals to make more healthy lifestyle choices.
Suggestions include making public transport more appealing and parks more inviting in order that individuals will want to take some moderate exercise and will not have
to make considerable effort and choice in order to achieve this end. Eating healthy food should become the norm as these foods should be more prominently displayed in shops and other food outlets. While it is recognised that prevention would be the best ideal outcome in respect of obesity, until there is some success with preventative
measures, the goal should be to help patients to deal with some of the physical and psychological costs of the problem and to ensure that any treatment given does not
compound the problems that obese individuals already have.

Prevention:

Prevention is more important and easier to achieve than weight loss, with research showing that one third of obese patients will not lose weight by any medical means. It
is therefore necessary to focus on preventing obesity in the first place, and enabling individuals to maintain their current weight. The principles of losing weight and
maintaining weight loss are well known, but an effective evidence base of effective measures for preventing obesity does not currently exist (Haslam, 2006, p.641). The
promotion of healthy eating and regular physical exercise is essential for both the prevention of future obesity and for treating individuals who are already overweight
or obese. It has been suggested that obesity management should be included as an important part of health service planning with increasing numbers of staff trained in
dealing with the problem. Research has shown that not only is considerable weight loss achievable through a programme of diet and exercise, but that this can also
prevent the onset of type 2 diabetes, which is becoming more common due to the increasing obesity problem (Skidmore and Yarnell, 2004, p.821).

Goals of Obesity Management:

With the recognition that obesity is having a major effect on the health of the nation comes the realisation that something must be done to tackle the problem. The basic
goal of obesity management is for individuals to reduce their weight in a way which is safe and not overly restrictive in terms of diet, which can lead to harmful adverse
effects. Current recommendations from the World Health Organisation are that individuals should attempt to lose around 10% of their body weight (World Health
Organisation, 1997), but for many individuals, particularly those who are unhealthy or physically inactive, this may not be realistic and it may be more reasonable to suggest not gaining any further weight as a realistic goal.

Obesity in Children:

One of the major areas of concern in respect of the obesity debate is the increasing prevalence of obesity in children. The government has set targets for the reduction of
obesity in this age group but it has been suggested that the targets for reduction of the problem by 2010 are unlikely to be met because of confusion which exist among
professional in respect of how to effectively tackle the problem.

Even if preventative measures in respect of obesity were immediately successful, there would still be an epidemic of diabetes and related complications in the next two
decades, because so many young people are already in the clinically “latent” phase of the disease, before clinical complications present (Haslam, 2006, p.641). As noted
above one of the main problem areas is the issue of obesity in children, and many food preference choices are made in childhood, largely as a result of parental influence (Skidmore and Yarnell, 2004, p.821). In March 2005, the Health secretary John Reid, when announcing the government’s three year strategy in respect of obesity, said that improving children’s eating habits is central to making Britain a healthier nation. The issue of childhood obesity is of concern due to the short term and long term effects. Most of the recommendations in this strategy concerned ways of tackling the problem of obesity in children. The Audit Commission has pointed out that little progress has been made in the area o childhood obesity and if present trends continue, the next generation will have a shorter life expectancy than their parents (The Audit Commission, 2003, cited in Cole, 2006).

The British Medical Association has recommended a series of preventative measures for schools, including provision of healthy food in schools and the development of a
curriculum pertaining to healthy eating. Advertising of unhealthy foodstuffs particularly aimed at children has largely been banned, and there have been calls for the Food Standards Agency to develop new standards in nutritional content, food labelling and marketing. It has been shown that there is a correlation between socioeconomic status and poor diet, so it has been suggested that efforts should be particularly concentrated on less well off parents to enable them to make better choices for their children (Skidmore and Yarnell, 2004, p.821).

Reilly and colleagues have investigated a number of risk factors for obesity in children. A number of factors have been identified but the causal links are largely unclear. One of the factors identified is the level of parental obesity, but it is unclear whether this is the result of a genetic component or the shared environment of the parents and their children (Reilly et al., 2005). Their study provides evidence for the early intervention in childhood obesity. Traditional methods have tended to focus on preventative measures in childhood and adolescence, an approach which Reilly has suggested is not beginning early enough and would go some way to explaining why these interventions have been largely unsuccessful. These authors have suggested that future preventative strategies should focus on short periods in early infancy, early childhood or even in utero.

Self Perception:

The effects on physical health of being obese are well documented, but recent years have seen an increasing focus on the psychological effects. Attention has increasingly
focused on how having a body weight that deviates from that regarded as normal, may affect the way in which people evaluate themselves. There is some support in the
literature that satisfaction of physiological, love and belonging, and self esteem needs are related to eating behaviour or weight management (Timmerman and Acton, 2001).

A variety of theoretical perspectives suggest that overweight people should have lower levels of self esteem than their peers, but data in this respect have been inconsistent with reviewers unable to agree on a consensus of opinion (Pokrajac- Bulian, 2005). Obese individuals do tend to suffer from low levels of self esteem, and the lives of children can be made exceedingly difficult as they suffer considerable rebuke from their peers (While, 2002). The relationship between self esteem and health behaviours has had mixed results, suggesting that there may be additional factors to be taken into consideration, suggesting the need for further research in this area.

Evidence indicates that in addition to low self esteem, those who are overweight suffer feelings of stigmatisation, indulge in binge eating and have a lower quality of life than their peers who do not have weight problems (Clark, 2006, p.123). It is more likely that those who have weight problems will experience depression and associated illnesses with one fifth of obese patents reporting having at least one period of clinical depression which required treatment.

Obesity is associated with a number of problems in respect of self perception. It has been shown that diets which improve weight loss are often ineffective in the long term
with individuals regaining the weight. This has been shown to led to binge eating (Polivy and Herman, 1995), which can further damage self confidence and self esteem. This can lead to further eating disorders with research showing that females who had dieted were eight times more likely to develop eating disorders than their counterparts who had not dieted (Patton et al., 1990, cited in British Dietetic Association, 1997, p.95). Research has also shown that there is a positive correlation
between high levels of self esteem in women and prolonged weight loss and maintenance. This has important implications in the context of developing self esteem as it is women who are most at risk from the effects of obesity.

Emotional Eating:

Eating in response to emotions has been identified as a possible cause of the consumption of excess calories (Timmerman and Acton, 2001, p.691). These negative
emotions can occur when basic needs as defined by Maslow’s hierarchy of needs are not satisfied and can cause stress to an individual. An individual’s ability to care for
himself or herself is based on the availability of a number of resources internal and external to the individual. Self esteem has been identified as part of a person’s internal resource base, and if the basic needs of love and so on are met continually over time, this will be well developed and built upon. This means that in times of stress an individual can call on this bank of resources to deal with stress in a way which is not detrimental to overall well being. If needs are consistently not met the individual is unable to build up a bank of resources and may experience a decreased ability to deal with stressful situations which can in turn lead to emotional eating and the risk of obesity and associated health problems associated with this.

Whose responsibility?

While it is now recognised that obesity is a problem for the country as a whole, questions have been asked about who should take responsibility. The increased levels
of obesity have raised questions in respect of who should take responsibility for the nation’s health. This has caused ideas about corporate social responsibility to impact
on the debate at a number of levels including the economy, the food industry and public perception of the food industry (Bhate, 2007). Research carried out by Bhate sought to investigate who was perceived by the public as having responsibility for the problem of obesity. There was a clear finding that consumers thought that the public
should take responsibility for growing levels of obesity. Individuals were aware when they were eating unhealthy foods that there were certain health risks associated with
these and may feel personally responsible for their actions (Bhate, 2007, p.174).

Individuals did feel that there was not enough information given in respect of some foods and that this was the responsibility of manufacturers who should be put under
pressure for adequate labelling by the government.

Education and Training:

As mentioned above, one of the danger areas in respect of obesity, is the fact that the problem is so widespread in children. Education is vital, not only in addressing and
preventing the obesity, but in tackling the prejudice that is associated w