Understanding Extreme Obesity

Hyper-obesity is not simply an unattractive characteristic it can be a dangerous, life threatening disorder, resulting in diabetes, muscoskeletal problems, high blood pressure and other cardiovascular diseases that can place the individual at high risk for heart attacks. Extreme obesity may result from metabolic or hormonal disorders but most individuals who are obese become so through ingesting more calories than they can burn off.

This may be placed in several diagnostic categories depending on which characteristics are being emphasized. Obesity can be viewed as psychosomatic disturbance since psychological factors lead to physical changes. Clinicians do not view the problem as the excessive weight itself but as the long standing habit of eating which is quite similar to the problems found in the personality disorders.

Biological Factors

Constitutional biological factors are relevant but there are people who seem to be able to eat high-calorie foods without gaining considerable weight. Others will unfortunately become overweight easily and have a constant struggle with their weight gain. More people usually gain with advancing age but this is mainly due to reduced activity as well as the fact that older people need fewer calories but are likely to continue their earlier eating habits. However, there are individuals who have metabolic or endocrine anomalies that can produce obesity at any age which is quite rare.

Obese adults have generally more adipose cells than people of normal weight. During weight loss, the size of the cells is reduced but not their number. Apparently the total number of adipose cells stays the same from childhood onwards. It may, however, be possible that overfeeding infants and young children may cause them to develop more adipose cells predisposing them to weight problems in the future.

Psychological Factors

Usually the key determinants of excessive eating and obesity appear to be family behavior patterns. The customary diet or overemphasis in many or all families may produce obesity in many or all family members. For example, a fat baby may be considered to be healthy and there may be considerable pressure on infants and children to eat more than they need or want. In other households overeating become a habitual means of alleviating emotional distress.

The three psychological views concerning the causes of gross habitual overeating

The Psychodynamic View

These obsessive individuals are fixated at the oral stage of psychosexual development. These individuals base their lives on oral gratification because the libidinal energies and psychological growth have not advanced to a more mature level.

There is a difference between developmental obesity and reactive obesity though. Developmental obesity develops in childhood as a response to parental rejection or other sever disturbance in the parent-child relationship. The parents will thus overcompensate for this rejection by overfeeding and overprotecting the child. These children never learn to distinguish different internal signals as the mother responds to all signs of distress by giving them food. This pattern leads to a distorted perception on internal states which are a lack of awareness of satiation when enough food has been ingested.

Obesity is also a symptom of underlying depression which causes the individual to believe that weight loss would make them more depressed.

Reactive obesity occurs in adults as a reaction to trauma or stress. These individuals use the defense mechanism of overfeeding themselves to deal with feelings of distress.

The Externality Hypothesis

This occurs when eating is under the control of external cues instead of the individual’s internal state. This means that the obese person is at the mercy of environmental inducements. For example, they may be prompted to eat again simply by the sight or smell of food.

The Behaviourial View

Eating behavior usually becomes conditioned to a wide range of environmental factors. Obese individuals are conditioned to more cues than persons of normal weight. Anxiety, anger, boredom and social inducements may contribute to their eating behavior. The behavior will continue since good food is pleasureable and the individual’s tension is reduced. This obviously increases the probability that overeating will continue at an even higher level.

Sociocultural Factors

Different cultures tend to have particular concepts of beauty as some value slimness while others a more rounded figure. Obesity might even be valued as a sign of social influence and power. In Western societies, obesity may be related to a high carbohydrate diet in lower-class families.

Treatment of extreme obesity includes a variety of approaches including dietary programmes, group self-help programmes, medical measures ranging from appetite suppressing drugs to intestinal bypass surgery and behavior management systems.

Dietary programmes are generally unsuccessful but self-control behavioural management programmes are more effort. It is conducted in groups and includes the use of a follow-up booster sessions.

Amphetamines suppress the desire for food and have been extensively used, however, weight gain occur if usage stops.

The jejunoileal bypass operation involves disconnecting and bypassing large portion of the small intestine. The operation allows for the reduction of the food-absorptive capacity of the intestine that could produce rapid weight loss.

Behaviourial management methods are the most effective psychological treatment procedures which teach the individual to take off weight gradually through reduced food intake and exercise. These procedures are more effective than classical conditioning procedures such as aversive conditioning in which shock or unpleasant thoughts may be paired with the eating behavior.