Psychological Effects of Obesity in Teens in Urban Areas: Literature Review

Introduction

Obesity is a cause for concern due to its negative effects on human health. The presence of obesity or excess weight increases the risk of many diseases and pathological states. Obesity often results in depression and anxiety. In addition, obese people are often subjected to ridicule, humiliation, hostile attitude of others and of the opposite sex, discrimination in various aspects of production and social life, which leads to low self-esteem and social isolation. Obesity leads to a narrowing of the interests range, self-actualization, self-service difficulties as well as emotional and social activity decrease (Latner, Puhl, Murakami, & O’Brien, 2014).

Overweight people are more likely to experience family conflict and change, suffer from sexual problems and become a subject of sexual deviancy and paraphilia. For those who have never experienced the psychological consequences of obesity, it is often difficult or even impossible to understand the magnitude of such problem. Sometimes it is difficult to find a solution as it causes depression and contributes to weight gain. However, the treatment of both conditions improves the life quality of the patient (Latner, Puhl, Murakami, & O’Brien, 2014). Teenager are subjected to bias and bullying due to an extra weight or obesity, especially in urban areas, where the social standards for appearance are relatively higher that in rural ones (Wardle, & Cooke, 2005). Current study aims at identifying the scopes of modern research studies on psychological effects of obesity in urban areas.

Research Objectives

The problem of obesity is widely spread around the world. The growing rate of adolescent obesity and related physical and psychological consequences is a frequent subject for scientists in many fields, such as psychology, behavioral sciences, developmental studies, pediatrics, medicine, etc. (Latner, Puhl, Murakami, & O’Brien, 2014). Therefore, there are a number of studies of different types on the matter.

The prevailing study types are meta-analyses and surveys. Current literature review comprised eight articles, four literature reviews and four meta-analyses articles. The researches were chosen irrespective of the country of study in order to show world achievements and studies’ results reflecting the overall state of the problem. Moreover, such different article types were selected in order to conduct comprehensive research and involve as many types of researches as possible. In addition, several other sources were covered, but not included into the literature review due to small inconsistencies with topic or narrow scope of the study. They were the study by Jackson, Steptoe, Beeken, Kivimaki, & Wardle (2014) and by Friedman & Brownell (2002). Short-term and general purpose articles were not included into the review, which creates possible limitation for the research findings. However, according to Latner et al. (2014), long-term consequences of pathological states (obesity in a particular case) are more indicative and are of greater importance than those reflecting the future scopes of the problem.

The articles of different time intervals were intentionally selected for investigation in order to identify the time-based prevalence of the problem and to cover greater period. The obvious consequence of time study is that the prevalence and importance of the problem with years have grown. Additionally, no results were found for the relation of psychological health to the changes in weigh, i.e. the loss and regaining of weight and loss and regain of self-esteem as the result of the constant weight changes.

Review

Self-esteem. As it was mentioned earlier, obesity among children and adolescents is a problem of growing importance. From the literature review, it can be concluded that most of the studies are focused on self-esteem and depressive state of obese adolescents. Wardle & Cooke (2005) state that human self-esteem depends on how others perceive and treat them. According to French, Story, & Perry (1995), adolescents are mostly vectored to the opinion of peers. As a result, the mechanisms that cause depression and low self-esteem development have the growing rates (Zametkin, Zoon, Klein, & Munson, 2004). The studies on self-esteem are divided into two parts: clinical and community-based studies. Normally, the results of studies do not differ. However, in approximately 30 percent of studies clinical trials show significantly low results (Wardle, & Cooke, 2005).

Cross-sectional studies, performed by French, Story and Perry (1995), showed that self-esteem directly depends on Body Mass Index (BMI) valued. The proportion is simple, the higher BMI, the lower the sense of self-esteem. Davis, Bennett, Befort & Nollen (2011) state that low self-esteem and body dissatisfaction are significantly higher in female individuals due to greater expectations imposed by the society. Black & Macinko (2008) found out that the decrease of self-esteem also depends on the areas and neighborhood. Researchers concluded that the economic position of neighborhood as the whole and individual in particular greatly influence the prevalence of obesity, i.e. the self-esteem (French, Story, & Perry, 1995). The study by Zametkin, Zoon, Klein & Munson (2004) showed that the prevalence of unhealthy diet in low-income area is a strong predictor of obesity rate increase among adolescents. The study by Gordon‐Larsen (2001) cautions that genetic predisposition both to obesity and mood-related disorders, such as depression and low self-esteem, are also prevailing factors for psychological states leading to or causing obesity among teens. On such basis, the researchers tend to call obesity and related psychological disorder a chronic disease and worldwide epidemic (Zametkin, Zoon, Klein, & Munson, 2004).

Davis, Bennett, Befort & Nollen (2011) studied the differences in rural and urban prevalence of psychological problems related to obesity. The study showed that children and teenagers are more likely to develop low self-esteem in rural areas, due to differences in health behavior. Davis, Bennett, Befort & Nollen (2011) indicate that according to recent studies, children in urban areas lead healthier lifestyle as the result of greater possibilities and capabilities to find healthy food and sporting activities. The study indicates that teens from rural areas are more likely to develop low self-esteem due to the impossibility to cope with obesity problem on their own (French, Story, & Perry, 1995). Low self-esteem, in its turn, leads to shyness and inability to address to school counselor or other nursing authorities for help (Gordon‐Larsen, 2001). Consequently, the problem may remain undisclosed and unsolved for a long time.

Depression. On the background of low self-esteem, researchers widely investigated the prevalence of depression among obese adolescents. The study by French, Story, & Perry, (1995) indicates that the state of neighborhood was a strong predictor of depressed mood appearance. The authors caution that the “prevalence of neighborhood, but not personal, obstacles, differs widely across levels of urbanization” (Wardle, & Cooke, 2005, p. 202). Zametkin, Zoon, Klein & Munson (2004) found out that low self-esteem was not the predictor of depression, but the result of it. Davis, Bennett, Befort & Nollen (2011) say that bullying, biasing and weight-based discrimination among peers and adults may lead to depression, and in some rare cases to suicidal thoughts and schizophrenia.

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Joshu, Boehmer, Brownson & Ewing (2008) studied the relation between eating disorders and depression among teenagers from urban areas. The topic was only slightly discussed in used studies, since it was not the focus of the research. However, French, Story, & Perry (1995) indicated that depression and low self-esteem were frequent causes for bulimia, anorexia and other eating disorders, which are also considered to be of psychological origin. Despite the promising results of the study, the authors failed to identify the mechanism of correlation between obesity, depression and eating disorders.

As the matter of fact, such problem prevails among overwhelming majority of studies (Wardle & Cooke, 2005). The researchers succeeded in meta-analyses and surveys that showed the direct correlation between depression and obesity. Nevertheless, the authors have not clearly identified the nature of such correlation and the mechanism of its appearance. Zametkin, Zoon, Klein & Munson (2004) state that depression among obese adolescents is prevalent due to social factors and biasing. Other researchers, for example Ji (2007) and Joshu, Boehmer, Brownson & Ewing (2008) indicate that the two factors correlate as the result of family influence and personal traits. Finally, French, Story & Perry (1995) caution that the prevalence of obesity and depression is caused by the ineffective work of school counselors and local nursing authorities. As it can be seen, researches indicate several theories, but neither of them indicates that the main and only cause for depression is obesity. On the opposite, Zametkin, Zoon, Klein & Munson (2004) say that the main predictors for depression occurrence can be outlined by the combinations or mixtures of the mentioned theories in different proportions.

Other Psychological Consequences. As it has been mentioned earlier, depression and low self-esteem were the most prevalent psychological consequences of obesity. However, there are rarer results leading to it, such as social anxiety, inferiority complex and constant loneliness. Zametkin, Zoon, Klein & Munson (2004) state that in the long-term perspective, obesity leads to strong social anxiety and inability to communicate with other people. Even if a significant weight loss took place, the social awareness, imposed in adolescence, prevented individuals from having full-fledged membership in the society. Moreover, it was the cause of severe social phobia (Gordon‐Larsen, 2001).

It is important to note that inferiority complex, as the direct result of low self-esteem, was not scrutinized by any author. Gordon‐Larsen (2001) only slightly mentioned inferiority complex as the psychological consequence of obesity. It creates great limitations for the indicated studies, but does not mean that the fact was not studied at all. Burkhauser & Cawley (2008); Husemann & Erzigkeit (1981) and other researchers conducted the corresponded studies.

Race and Ethnicity. Race and ethnicity were among the key factors for almost every study. Most of the researchers showed that African-American and Hispanic participants are more likely to develop obesity and, therefore, corresponding psychological consequences. Joshu, Boehmer, Brownson & Ewing (2008) state that the combination of ethnic and weight biasing becomes a strong cause for development of depressed mood, low self-esteem, bulimia, schizophrenia and other related diseases. The research conducted in China showed that psychological consequences related to obesity prevailed in five general urban areas due to lower socioeconomic status of the respondents (Ji, 2007). It gave evidence for Black & Macinko (2008) work, stating that socioeconomic position of some ethnicities is a predictor for obesity-based psychological disorders. Zametkin, Zoon, Klein & Munson (2004) also claim that being in low economic position discourages physical activity, making a teenager more depressed and, therefore, susceptible to bias and bullying.

Gender. All examined studies distinguished the participants by the age and, as the result, analyzed the results independently. Davis, Bennett, Befort & Nollen (2011) found out that obesity prevailed among boys. Despite such findings, they also state that there were more girls among investigated population. On the opposite, Ji (2007) stated that obese boys are more likely to develop constant sense of loneliness and social anxiety. It was explained by French, Story and Perry (1995) as a result of the fact that boys are usually less sociable and unconcerned than girls. Moreover, they adopt psychological symptoms easier and deeper than girls due to native closed nature and decreased sense of empathy.

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Age. It was indicated in the title that the participants being surveyed are teenagers. However, despite relatively strict age limits, authors differed in age range of their studies. French, Story & Perry (1995), for example, investigated children from 13 to 18, considering the adolescent period of human developments. Wardle and Cooke (2005) started the study from 11-years-old participants, and Zametkin, Zoon, Klein and Munson (2004) from 9. Different age groups discussed showed different results. Ji (2007), for example, showed that obesity in early adolescence (11-14 years) may cause psychological consequences. Zametkin, Zoon, Klein and Munson (2004) explained it by larger psychological susceptibility of young individuals while French, Story and Perry (1995), in their turn, explained such fact by greater care and attention paid to youngsters, which lead to unhealthy diet and obesity.

Restrictions

The conducted review showed that with time, the scopes of study had widened and researcher began to investigate even slight influences of obesity on psychological state of children. However, such studies create several limits. First, the lack of information greatly influenced current literature review. Moreover, it explains the necessity for further investigation of the problem. Anyway, it does not mean that there are no results for providing investigations on specific topics. However, such situation obviously restricts the researchers from receiving the comprehensive information on the matter. Simultaneously, such restriction leaves the place for further investigations and new openings as possible predictor of the problem severity decrease or increase.

Conclusion

The conducted research was aimed at identification of the most prevalent findings related to psychological effect of obesity in adolescents of urban areas. The review had to outline the studied fields, as well as possible restrictions for the described studies. The review showed that all the authors conducted research on relatively similar topics, using similar methods. In addition, the review indicated that obesity is a direct predictor for having psychological disorders, most frequent of which are low self-esteem and depression. The results of literature review also proved that not all diseases and complications were studies, which opens a perspective for further investigations.

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