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Psychological problems
Page 355 Black blue OBESITY AND CORONARY HEART DISEASE 355 WHAT ARE THE PROBLEMS WITH OBESITY? Physical problems Obesity has been associated with cardiovascular disease, diabetes, joint trauma, back pain, cancer, hypertension and mortality (e.g. Bray 1986; Chan et al. 1994). The effects of obesity are related to where the excess weight is carried; weight stored in the upper body, particularly in the abdomen, is more detrimental to health than weight carried on the lower body. It is interesting to note that although men are more likely than women to store fat on their upper bodies, and are therefore more at risk if obese, women are more concerned about weight than men and most treatment studies examine women. The relationship between BMI and mortality is shown in Figure 15.3. It has been suggested that most problems seem to be associated with severe obesity and weights in the top 10 per cent (Wooley and Wooley 1984). Psychological problems Research has examined the relationship between psychological problems and obesity. The contemporary cultural obsession with thinness, the aversion to fat found in both adults and children and the attribution of blame to the obese may promote low selfesteem and poor self-image in those individuals who do not conform to the stereotypically attractive thin image. In line with this, Bull et al. (1983) reported that both obese patients waiting for a gastric bypass operation and normal obese patients rated themselves as more depressed than normal weight subjects, although the levels of depression did not reach clinical proportions. Furthermore, Hopkinson and Bland (1982) reported that one-fifth of their sample of obese subjects, also waiting for surgical treatment, reported having at least one period of clinical depression requiring treatment. Fig. 15-3 Relationship between BMI and mortality (after Bray 1986) Page 355 Black blue