It can be accepted that, in some cases, the prejudice and associated discrimination are frequently experienced by the obese patient as external conditioning factors, for which they may not feel responsible and which often determine defensive victimhood and not depressive blaming.
On the contrary, the disabilities and consequent physical dysfunctions that the morbidly obese have fundamentally cannot be attributed to external factors and constitute, in theory, a continuous source of frustration and potential depressive guilt.
All the authors who have studied the reactive psychological alterations presented by obese patients have pointed out, as the first surprising fact, the disproportion between the intense adverse social pressure and the disabilities or physical dysfunctions they suffer and the little psychological repercussion they have.
Indeed, and as has been pointed out repeatedly, obese patients suffer from social and occupational discrimination and, not infrequently, disrespectful medical treatment, which objectively would have to lead to maladaptive reactions.
Naturally, in these cases one would have to expect frequent dysphoric reactions which, however, do not occur.
Thus, and in line with many other reviews of studies that show that emotional disorders in obesity are more the consequences than the cause.
Using strict diagnostic criteria, Halmi et al demonstrated in a group of 86 morbidly obese patients that the lifetime prevalence of depressive disorders diagnosable on axis I of the DSM system was around 29 percent, that is, not far from the figures reported in various studies. epidemiological factors attribute to the lifetime prevalence of depression in the normal population.
It is evident, however, that the psychoaffective assessment instruments most used in the clinic may not reveal painful feelings of self-deprecation that appear reactively to certain situations, such as the inability to maintain and not recover lost weight.
Also humiliation, for example, for not being able to find a suitable seat or for not being able to get on public transport, etc.
The low levels of psychological alteration detected in the affective sphere contrast with the manifest rejection of their body image that many obese patients have.
In a strict sense, this phenomenon cannot be classified as a dysmorphic phobia -delusional belief in seeing one’s body as aberrant- since the objective alteration is evident, but it shares with it, at least in some cases, the character of overvaluation and behaviors of phobic avoidance (that is, the characteristic rejection of the mirror).
Clinical experience indicates that rejection of body image is not, however, universal, and that emotionally healthy obese people do not present this alteration.
It is more common in upper-middle class women, as well as in cases where obesity began in childhood and in the critical period of adolescence the future obese patient received jokes and attitudes from parents and friends sarcastic about being overweight.
Once the body image disturbance is established, it rarely disappears spontaneously.
In numerous series of obese patients undergoing bariatric surgery, it has been possible to verify the highly beneficial effect of a treatment of this type on these symptoms, with the practical disappearance of disgust and rejection of body image in most cases.
-Jensen MD, Ryan DH, Hu FB, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. circulation. 2013;129:S102–38. [PMC free article].
-Sarwer DB, Lavery M, Spitzer J. A review of the relationships between extreme obesity, quality of life, and sexual function. Obes Surg. 2012;22(4):668–76. [PubMed] [Google Scholar].