with obese children is their eating habits. Evidence points to the fact that
obese persons overeat. It seems also to be a pattern that many obese individuals
systematically underestimate their food consumption. The underestimation is
not deliberate. The individuals really seem to have difficulty to remember how
much they ate. It has also been observed that obese children eat faster and fail
to show the normal pattern of slowing down the rate of eating toward the end of
a meal. It is still not clear what role these different patterns have in obesity.
It is estimated that between 20 and 30% of obese adults engage in binge eating
and bulimic behaviors [22]. Especially obese girls are at risk for developing
an eating disorder. For many bulimic patients the disorder starts in adolescence.
And many adult bulimics have a history of childhood obesity. It seems clear that
there is a connection between bulimia and obesity but we don’t know the exact
nature of the association. Some investigators have suggested that repeated
attempts at loosing weight might cause binge eating disorder. A contributing
factor could be that in some people dieting, even in moderate forms, leads to
considerably increased sensitivity of serotonin receptors [23]. The alteration in
brain serotonin neurotransmitters could lead to deregulation of eating.
Obese adolescents with bulimia or binge eating have more often than
obese adolescents without eating disorder additional emotional and behavioral
problems. Many start early with dieting and have many unsuccessful attempts
of weight reduction. They report difficulties in perceiving hunger and satiety.
Many feel that they lack control over eating. Their self-esteem is low and they
are to a great extent dissatisfied with their bodies. The risk of a major depression
later in life is also increased for this group [24].
When planning the treatment of obese children it seems wise to consider
the risks of promoting eating disorders. It is important that potential bulimic
tendencies are not aggravated by health care professionals’ recommendations
for dieting and exercise.
Concluding Remark
Psychology has an important role in both research and treatment of obesity.
We still need to know more about psychological factors that influence eating
behaviors, activity, well-being and healthy weight. It could be stated that obesity
is a consequence of maladaptive behavior. There are many psychological
factors that influence behavior – from feeding style in infants to parenting
styles and emotional factors. These issues affect children in individual ways.
Therefore, the circumstances of obese children need to be analyzed individually.
In order to gain control over weight the child and the parents need to make
permanent changes. The changes affect habits and habits are difficult to alter. It
is important to find circumstances that facilitate change as well as obstacles
preventing change. These kinds of necessary changes cannot be imposed on
parents and children. Information and advice is important but not enough.
Parents and adolescents need help in exploring their problem and clarify their
values and feelings that may contribute to obesity as well as identifying feasible
goals and choices. Parents, and children when they have become mature
enough, need to accept responsibility for their lifestyle. It has been suggested
[25] that shared responsibility where parents provide different healthy foods but
where children decide when and how much to eat is the most accessible way –
at least in our democratic and individualistic culture.
However, it is unfair to shift all responsibility to parents and children. The
type of lifestyle that is contributing to obesity is a result of the culture we live in.
Different institutions, organizations and businesses shape this culture. Many
messages that are directed through mass media to children and adults influence
them towards over nutrition, sedentary life and dissatisfaction with their bodies.
It is a trend nobody wants to take responsibility for.
I wonder also if successful treatment should be gauged by attained BMI?
Other aspects of how young persons are affected by obesity ought to be taken
into account and attended to. The quality of life of the obese partly depends on
how they think and feel about themselves. It is important to help those who
have low self-esteem, negative identity, and are depressed and risk developing
an eating disorder. It is not always helpful if patients suppose that their main
goal is to attain ‘normal’ weight. In many cases it is an unrealistic goal, which
inevitably leads to an experience of failure. Many end up feeling incompetent
and rejected. As a consequence many give up altogether their attempts at weight
control and healthier lifestyle.
Too much, too little as well as wrong food can be fatal. In the middle ages
people in some places in Europe consumed contaminated food because of
hunger. The scarce and adulterated food made them sick and probably kept
them in a semi permanent state of hallucination and madness [26]. In our days
anorexia is a serious condition leading in many cases to death. Obesity on a
large scale has become only recently an important public health problem in
those parts of the world where food is abundant and over nutrition possible.
From a philosophical point of view, it can be said that lack of moderation leads
to problems. Maybe obesity is only one symbol of our excessive culture?
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