December 10th, 2012

Feeling the Weight: The Psychosocial Effects of Childhood Obesity

Developmental Psychology By: Rich Wiand

Special points of interest:

Childhood Obesity: A Global Wake Up Call

Childhood obesity is reaching epidemic proportions. According to the Centers for Disease Control (CDC), one in three American children between the ages of 2 and 19 are overweight or obese. Confined not only within the borders of Earths wealthiest nation, the World Health Organization (WHO) estimates some 42 million children worldwide, under the age of five, are overweight. While considerable research has focused on the physical pitfalls associated with childhood obesity (increased rates of diabetes, heart disease, sudden heart attack, cancer, infertility), the body of knowledge concerning the emotional effects suffered by obese and overweight children is shockingly limited and hotly contested. In fact, a literature search using the keywords childhood obesity returns an overwhelming amount of peerreviewed research that addresses proximate questions, not ultimate questions. Could it be that science is misguided in this endeavor? Is it possible that childhood obesity is a sign of deeper emotional or developmental issues and not the sole result of decreased activity and increased appetite? Are the very mechanisms necessary to produce healthy children (regular exercise, balanced diets, participation in peer-based athletics) hampered by the social stigma of being fat? Are the tools of the 21st century (video games, television, fast food restaurants) outlets for already stigmatized children or the cause of the problem? Once a child becomes overweight, is there any hope of breaking the cycle? These questions probe deep into the greatest health risk facing our children today and, unfortunately, are without absolute answers. Failing to accurately assess every aspect of childhood obesity could result in an epidemic that surpasses tobacco as the leading cause of death (Bhattacharya, 2006).

One in three American Children are overweight High-stress home environments increase the production of neurotransmitters thought to be responsible for eating disorders. The stigmatization of obese children continues to increase Childhood obesity results in depression, low self-esteem and negative self-image

Inside this issue:

The Stigma of Being Fat Psychological Effects of Childhood Obesity Coping: Avoidant versus Approach Childhood Obesity Trends Whos at Risk?
2

The Familial Influence on Childhood Obesity

3

Directions for Treatment Thinking About Childhood Obesity

Recent evidence suggests that maternal habits in the home environment significantly affect the eating behavior of children (Puder & Munsch, 2010). In laboratory experiments, mothers who ate more at one sitting were accurate predictors of increased consumption rates by their children. Large bite sizes, heaping servings, and mandatory

plate-cleaning rules may contribute, according to Pruder and Munsch, to childhood obesity. Even if a child isnt overweight at the time, these learned behaviors may have later consequences effecting the child or their offspring. Increased stress levels in the home environment may also be a factor in

childhood obesity. Stress resulting from economic disadvantage, marital discourse or parental mental illness may catalyze the production of stress-related neurotransmitters in children which disrupt appetite regulation and suppression mechanisms (Puder & Munsch, 2010).

Feeling the Weight: Childhood Obesity

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The Stigma of Being Fat

In 1961, when asked to rank, in order of popularity, silhouettes depicting an average weight child, an overweight child, a child in a wheel-chair, a child with a facial deformity, a child with crutches, and a child missing a limb, children overwhelmingly placed the obese child last in favorability (Richardson et al., 1961). Convinced that a relatively low Obese children often face prevalence of childsocial isolation. hood obesity in the sixties was to blame for this shocking evidence, Latner and Stunkard (2003) duplicated Richardsons experiment more than 40 years later and found a notable difference. Despite the increase in childhood obesity rates and a presumed desensitization to obesity, stigmatization of obese children nevertheless increased significantly (Latner & Stunkard, 2003). From a psychosocial standpoint, obesity is considered to be one of the most stigmatizing and least socially acceptable conditions in childhood (Schwimmer, 2003). Obese children are often perceived by their peers as lazy, ugly, mean, socially inept, and of low intelligence (Cramer & Steinwert, 1998). Unlike the days of old when stigmatization was left in the hallways of school or on the playground, a new and intrusive vehicle for peer-based aggression is now available. Social media sites continue to expand the stigmatization arena. According to Strauss and Pollack (2003), obese children receive fewer likes, fewer friend requests, and are routinely excluded from social networking cohorts, thereby assuming their positions on the fringe of society.

From a psychosocial standpoint, obesity is considered to be one of the most stigmatizing and least socially acceptable conditions in childhood.

The Psychological Effects of Childhood Obesity

While a causal relationship between childhood obesity and psychological neurosis is speculative at best, it seems only prudent to assume that a relationship does, in fact, exist. Low self-esteem, increased anxiety, and depression are some of the most commonly reported psychological effects associated with childhood obesity (Warschburger, 2005). A study of 47 morbidly obese adolescents found that 70% of the participants had at least one mood disorder, anxiety disorder, or social phobia severe enough to register on the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (Warschburger, 2005). A longitudinal study examining 9 to 10 year olds and 13 to 14 year olds found a significant decrease in global self-esteem versus a control group of normal-weight participants (Strauss, 2000). The sample of obese children in this study also reported statistically significant increases in sadness, loneliness, and nervousness (Strauss, 2000). In order to cope with these increased levels of anxiety, isolation, and depression, obese children, according to Strauss, are more likely to engage in risky behaviors such as smoking and using alcohol. The directionality of obesity and the psychological effects mentioned here remains vague; that is, does obesity cause neurosis or is obesity a symptom of neurosis?

Coping Strategies: Approach versus Avoidant

Coping with the social stigma of obesity and the seemingly inevitable decline in self esteem that follows, children employ either approach or avoidant coping strategies with the hope of mitigating the effects of appearance-based stigmatization. Approach based coping mechanisms are pro-active in nature and rely on social support and strong peer and family-based relationships to confront their problems head-on (Lodge & Feldman, 2007). Conversely, according to Lodge and Feldman, avoidant coping techniques internalize negative feelings which result in distractive and isolative behaviors (video games, television) and feelings of low selfworth and self-blame. Lodge and Feldman point out that every avoidant coping strategy employed by obese children in their longitudinal study accurately predicted increased levels of depression and decreased abilities to adapt to changing environments. The question then becomes, how do obese children employ approach -based coping strategies when the stigma of being fat is the very cause of their isolation?

Low self-esteem may induce avoidant coping mechanisms.

Feeling the Weight: Childhood Obesity

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Childhood Obesity and Related Trends

The nearly three-fold increase over the last four decades of overweight and obese children in the United States and abroad has garnered considerable attention. Potential explanations for this sudden surge include decreased physical activity, changes in dietary composition, and price indexes of various foods. While these explanations have considerable face validity, the facts pose more questions then answers. For example, by 2001, the distance children covered either walking or bicycling declined from 1977. However, the frequency of both bicycling and walking by children increased from 1977. Furthermore, the time spent engaging in these physical activities likewise increased from 1977 to 2001 (Sturm, 2005). Adolescents participating in activities lasting at least 20 minutes, which resulted in increased heart rate and heavy breathing, declined from 1993 to 2001 from 65.8 to 64.6%, a marginal decline at best (Sturm, 2005). Unfortunately, no data is available pre 1993 for this measure. carbohydrates) has remained relatively constant from 1977 to 1998 for both boys and girls with one exceptioncarbohydrates (Strum, 2005). While fat consumption declined by nearly ten grams per day for both boys and girls from 1977 to 1998, carbohydrate intake has increased by nearly 50 grams per day for both sexes across the same period (Strum, 2005). The most notable change post 1970 is the price increase of fruits and vegetables versus sugar-based foods and drinks. The reduced access to fruits and vegetables because of price likely plays a role in dietary habits and increased soft drink consumption (Strum, 2005). Not surprisingly, researchers have yet to reach consensus on the cause of childhood obesity. While the increase in both carbohydrate intake and the price of fruits and vegetables may play a role in this epidemic, the argument that todays children are less active and engage in fewer physical activities appears to be incorrect. Perhaps it is time to consider other potential causes, namely stress, depression and low self-esteem as the driving force behind childhood obesity.

Obesity trends show a three-fold increase from 1970.

Dietary composition (protein, fat,

Whos at Risk?
Childhood obesity risk factors vary from country to country and across socio-economic, ethnic, and racial groups. For example, in the United States, low socio-economic status (SES) increases the risk of obesity (Wang, 2001). Mexican-American males age 12 to 19 report the highest risk of obesity, followed by African-Americans and NonHispanic white males. Amongst American females of the same age (12-19), African-Americans report the highest risk, followed by Mexican-Americans and Non-Hispanic whites (CDC,2012). Conversely, China shows an increased risk of childhood obesity in higher SES groups while Russias risk group composes both high and low SES (Wang, 2001). According to Wang, one possible explanation for the variation in risk factors between the US and China is simply the cost of food. Chinese children from high SES groups have better access to high-energy foods, culturally popularized by western societies, while American children from low SES groups do not have access to more expensive, less energy-dense fruits and vegetables. Along with the SES, ethnic, and racial risk factors contributing to the childhood obesity epidemic, depression also places adolescents at increased risk. According to Blaine (2008), depressed children are at significantly greater risk of becoming obese; most notably, depressed adolescent females have a 95% chance of becoming obese.

The data generally show fewer changes in physical activity changes in time studying at home, participating in exercise, or taking part in high school PE than commonly thought. -Roland Strum, NIH

Directions for Treatment

Perhaps the most important tool available to health care providers in an honest and accurate assessment by the patient detailing eating habits, exercise routines, familial conditions, and a willingness of the patient to change (Jonides, Buschbacher and Barlow, 2002). Reductions in sedentary lifestyle, energydense diets, increased peer and family support, and group based or individual mental health counseling are necessary to treat obesity (Jonides et al., 2002). However, according to Jonides, a growing concern among health care professionals is the reluctance of some providers to treat obese children who otherwise seem healthy. Recent findings suggest that children suffering from obesity either already exhibit or may eventually develop various forms of neurosis which may have serious psychological and physical health ramifications later in life (Jonides et al., 2002). Parents and children are encouraged to seek professional treatment for obesity and its psychological correlates. Perhaps the most important form of treatment comes from identifying the risk factors and behaviors that lead to or accompany childhood obesity. That is, teachers, parents, and providers must recognize the social stigma of obesity and actively work to counter the isolative and avoidant behaviors that further propagate weight gain. Keeping obese children active in peer-related activities is perhaps the best treatment option available.

Treatment after diagnosis requires both psychological and behavioral protocols.

Regardless of the cause of obesity, treatment options require lifestyle change and, depending on the situation, psychological counseling.

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Read this and other newsletters by the author at scribd.com

We welcome your feedback Rich Wiand Phone: 270.313.9413 E-mail: richard.wiand751@topper.wku.edu

Editorial: Thinking About Childhood Obesity

Failing to acknowledge the role of decreased activity, increased caloric consumption, proliferation of energy-dense processed foods, and limited access to organic fruits and vegetables in the childhood obesity epidemic would be nothing short of a monumental oversight. However, failing to understand the psychosocial effects of obesity is likewise a profound misjudgment. Perhaps a logical, linear thought experiment can shed new light on this growing epidemic. For example, imagine that most normal-weight children are exercising and eating as they always have. Thanks to the relatively low price of high-fructose corn syrupbased drinks, processed foods, and the high price of organic fruits and vegetables, average-weight children, especially those from low SES groups, gain weight. With this new weight comes the social stigma of being fat. Ostracized, teased, and abused by their peers, obese children withdrawal from the very social activities that are critical to the formation of self-esteem and identity. Attempting to cope with this painful stigma, overweight children employ avoidant coping mechanisms that result in isolative behaviors such as playing video games and watching television. By engaging in these isolative behaviors, children further decrease their participation in peer-based sports and other physical activities enjoyed by averageweight peers and necessary in maintaining healthy psychological and physical lifestyle. Add to these new isolative behaviors high-stress home environments, poor familial eating habits, and parents who fail to recognize the signs and symptoms of depression and low self-esteem, and voilepidemic. Treating childhood obesity, therefore, must be a multi-faceted approach. Promoting healthy eating habits and active lifestyles only go halfway in addressing this epidemic. Educating teachers, parents, and peers to the emotional ramifications of appearance -based stigmatization is equally important in reversing this trend. Obese and overweight children must be pulled from the proverbial shadows, embraced by society, and provided the emotional support necessary to reverse the avoidant coping mechanisms that contribute to this global killer.

References
Bhattacharya S. (2004). Obesity to Surpass Tobacco as Top U.S. killer. Retrieved January 31, 2006, from www.newscientist.com/article.ns?id=dn4763. Blain, B. (2008). Does Depression Cause Obesity? A Meta-Analysis of Longitudinal Studies of Depression and Weight Control. Journal of Health Psychology, 13, 1190-1197. Cramer, P., & Steinwert, T. (1998). Thin is good, Fat is Bad: How early does it begin? Journal of Applied Developmental Psychology, 19, 429 451. Latner, J. D., & Stunkard, A. J. (2003). Getting worse: The stigmatization of obese children. Obesity Research, 11, 452 456. Puder, J. J., & Munsch, S. S. (2010). Psychological Correlates of Childhood Obesity. International Journal of Obesity, 34S37-S43. doi:10.1038/ijo.2010.238 Richardson, S. A., Goodman, N., Hastorf, A. H., & Dornbusch, S. M. (1961). Cultural Uniformity in Reaction to Physical Disabilities. American Sociological Review, 26, 241 247. Schwimmer, J., Burwinkle, T., & Varni, J. (2003). Health-related Quality of Life of Severely Obese Children and Adolescents. Journal of the American Medical Association, 289, 1813 1819. Strauss, R. S., & Pollack, H. A. (2003). Social marginalization of obese children. Archives of Pediatrics and Adolescent Medicine, 157, 746 752 Sturm R. Childhood obesityWhat we can learn from existing data on societal trends, part 2.Preventing Chronic Disease. 2005b;2:A20. [PMC free article] [PubMed] Wang, Y. Cross-national Comparison of Childhood Obesity: The Epidemic and the Relationship Between Socioeconomic Status. Int J of Epidemiology, 2001; 30:1130-1150