different areas of psychology such as developmental, motivational and social
psychology, the psychology of personality, of perception and of psychopathology.
The questions asked and the answers that are produced give many interesting
perspectives but at the same time produce a somewhat jumbled impression.
Partly, it is so because there is no unifying psychological theory of obesity
(psychoanalytical theory of obesity is not considered here). Partly it is due to
the fact that the descriptions and characteristics given refer both to possible factors
that produce obesity and at the same time refer to effects that obesity has on
individuals. Often the cause and effect is unclear (e.g. the relationship between
obesity and depression) and probably many of the processes take place simultaneously
reinforcing each other (e.g. becoming more obese and more depressed).
I think, as many colleagues working in adjacent fields, that the epidemic
of obesity has multifactorial causes. Certainly, the societal changes of the last
decades are of major importance. What is presented here are viewpoints on
different psychological factors contributing to obesity and helping to explain
why some individuals become more easily obese, apart from the fact of genetic
influence.
I think it is interesting to observe first that culture sets certain premises for
how parents and children can eat and behave. Our habits are shaped by society.
At the same time modernity has been characterized by increased individuality.
This has affected people’s relationship to eating and food. In former times,
when individual life was controlled to a greater degree by religion and morals,
customs as well as economic resources controlled food intake. There existed
social controls over when and what individuals could eat [1]. To overeat was
once immoral and individuals risked to be publicly denounced by the Church.
Scarcity of food, famines, religion and morals jointly prevented most people
from constant overeating and from becoming morbidly obese. Now the situation
is different at least in the western world and in westernized societies and
cultures. The moral and religious restrictions are weak and it is an individual
responsibility to decide when, what and how much to eat. The individual alone
must regulate his easily stimulated appetite in the face of unbounded food
resources and intense promotion of appealing but unhealthy foodstuffs.
In the following I present three areas of psychological interest. First,
I describe some factors influencing the regulation of hunger and of appetite.
Second, I describe some characteristics of obese children and third some psychological
problems that are associated with obesity. I try also to answer some
questions often asked about obese children. How does obesity affect individuals
psychologically? Are obese children more depressed and troubled than
normal weight children? What happens to overweight children’s self esteem?
Have severely obese adolescents and young adults been to a greater degree
abused physically and sexually than the population in general? What are the
links between eating disorders such as bulimia and binge eating and obesity?
Do weight-losing programs lead in some cases to the development of an eating
disorder, which in turn, only aggravates overweight?
The views presented here reflect findings about young people in our Western
world. There are important cultural differences especially when it comes to attitudes
towards obesity. In many non-Western cultures to be obese is not, or is
less, stigmatizing. On the other hand, the trend seems to be that in the present
global culture children and adolescents adopt many western attitudes and
ideals. It has been observed for example that body shape and weight ideals are
changing towards slimmer figures and less weight among Afro-Americans
where traditionally heavier bodies were appreciated. At the same time the
incidence of dieting in the group is increasing.
Psychological Factors Regulating Hunger,
Appetite and Food Preferences
One aspect of the intricate puzzle of obesity appears to have something to
do with the actual regulation of hunger and appetite. The regulation of hunger
and appetite is made by complex biological mechanisms. The regulation begins
in infancy and is in part influenced by early experiences of nurture and care.
Infants learn from early days how much to eat, what to prefer to eat and how
fast. Limited evidence [2] suggests that breast-fed and formula-fed children
learn slightly different things when it comes to the control of hunger and satiety
and preferences for tastes. Children who are breast-fed exert greater control
over how much to eat. It is their own feelings of hunger and satiety that control
how much to eat and when to stop. It is probable that breast-fed children
develop to a greater extent internal controls for eating. When children are bottlefed
it happens easily that mothers exert control over how much the child eats
and encourage the baby in different ways to drink more than the baby would do
otherwise. In those cases it is not the child’s internal cues that guide him how
much to eat but external cues from the environment. Another important observation
suggests that breast-fed children show greater acceptance of new foods
than bottle-fed (formula fed) children. Breast-fed children learn early to accept
different kinds of tastes because different kinds of tastes are transmitted in the
mother’s milk. Formula-fed children have experience with only a single taste
and might therefore be more negative to trying new tastes and accepting a more
varied diet. Acceptance of variation might be important in the light of the fact
that children by nature prefer foods high in fat and sugar and need to learn
liking less caloric and healthier foods.
Breast-feeding has many positive qualities that render it the preferred feeding
choice in infancy. The results from studies on bottle-fed versus breast-fed
children and obesity are diverse. It seems nevertheless that breast-feeding is
more common among normal-weight mothers than among overweight and obese
mothers. And it seems that the eating environments in families with obese parents
differ in important ways from families in which neither parent is obese. On the
one hand, it seems that in many cases the consumption of calorie rich and fat
food is high. On the other hand, it seems that many obese parents begin early to
control the eating behavior of their children. The controlling probably makes it
more difficult for these children to develop their own control mechanisms of
food intake. Parents shape their children’s eating environments in many ways.
First, they do it through the choice of an infant feeding method, i.e. bottle vs.
breast-feeding. Second, it is shaped by the foods that are made available at
home. Parents function also as models for their children in many ways. They
mediate food and taste preferences, attitudes to new foods and table manners.
Parents probably convey other subtle information affecting children’s eating
habits such as eating speed. Parents promote habits affecting weight by encouraging
or discouraging television watching in the home. Television in its turn provides
eating models through advertisements and promotes sedentary lifestyle.
Many concerned and well-meaning adults try to influence the food preferences
of children and adolescents by pervasive messages about health consequences
of unhealthy eating. They try also to control the eating of unhealthy
foods by forbidding them and by encouraging the consumption of healthy
foods. Research findings suggest that these popular practices often have a
negative effect. Restricting children’s access to foods enhances the liking of the
forbidden foods and increases their consumption. Persuading children to eat
new foods is equally counterproductive and often produces resistance and even
aversion towards the new food. Children come to like and eat what is familiar.
It is natural for infants and children to reject new foods with the exception of
sweet and salty foods. Therefore, it is important for children to have early experiences
of new tastes and to be gradually and repeatedly exposed for new foods.
Modeling, where children see parents and other children eat new and healthful
foods, is probably the easiest way to shape healthier eating habits.
Perceptual Factors Influencing Appetite
Our food preferences are based to a great extent on taste, appearance,
texture and even the feel and sound of the food and to a lesser extent on the
nutritional value. Many obese people seem to differ in systematic ways from
many non-obese when it comes to factors that influence appetite. Through a
series of experiments, Schachter [3] could demonstrate that many obese people
are to a greater extent guided by external cues when it comes to eating. For
many obese people it is the sight and smell of food and the time of the day that
function as cues for eating. In contrast, normal weight people seem to depend
more on inner cues such as stomach contractions, glucose levels and so on. In
everyday situations it means that obese people will frequently consume more
food because they will encounter many situations that will be tempting. In our
culture a lot of foods and sweets are displayed in public places to attract our
attention and to hit our senses. Not all obese people are ‘externals’ but still it
seems that externality is one mediating factor contributing to obesity in some
individuals.
It seems further that obese individuals are more sensitive and receptive to
sensory qualities of food. In several experiments it has been shown that obese
people eat significantly more than non-obese when the food tasted good, but eat
about the same amount when it tasted unenticing [4]. Adult persons participated
in these experiments but anecdotal evidence suggests that there are many
gourmets among children too. It is probable that obese children too are influenced
more by the positive sensory qualities of food than non-obese.
Children can learn to like almost anything if they start getting it early. The
aborigines of Australia find worms delicious. In Sweden some people like
rotten fish. Humans learn preferences through associating the food eaten with
consequences. For example, nausea leads to strong aversion towards a food
that has been consumed. We learn quickly to avoid foods that make us sick.
However, learning to select foods that are nutritious and healthy takes more
time. Pleasant experiences like feeling well afterwards, pleasant environment
and friendly company give positive associations with the food and also increase
the liking.
Emotional Factors in Overeating
From clinical experience, we know that some obese children eat even when
they are not hungry but because they feel emotionally upset, stressed or frustrated.
Possibly the mothers of these children comforted their babies with food
when the children cried or showed discomfort. Later in life such people may see
food as a consolation. Eating and digestion produce feelings of physical satisfaction,
which balance negative feelings of sadness, sorrow or anger.
Parental lack of attention or neglect is a factor predicting obesity. Many
mothers from low-income environments can be preoccupied with surviving
their daily life stresses and have less capacity to feel and care about the different
needs of their children. In such a situation many use food to cope with the
stresses and use food as a tool in parenting. The mothers can have difficulties
in setting limits with their children around food. Many have inadequate knowledge
about normal child development, eating behaviors and healthy food habits.
The lack of knowledge makes it difficult to find solutions and alternatives to
problems in parenting [5].
Research on adults suggests there is a relationship between emotional
distress and overeating. Depression for example usually results in weight loss
but some depressed individuals gain weight. It seems that tendency to eat more
when depressed is mediated if the person is high in self-restraint [6]. People
who often diet tend to be restrained eaters. Restrained eaters are people who
continually worry about how much and what they eat. Restrained eaters often
feel hungry, are readily tempted by the sight and smell of food and consciously
attempt to control their eating. But when emotionally upset they easily lose
control and overeat or eat foods high in calories. Different negative emotions
(anxiety, sadness, dissatisfaction and so on) cause these individuals to breach
their intentions to diet. Afterwards many of them feel guilty and unhappy
because they have eaten the ‘forbidden foods’. The feelings of guilt and failure
easily start a vicious circle of overeating and reinforced negative emotions.
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