Obesity and Body ImageObesity and Body Image

© Dr. Bonnie Meekums© Dr. Bonnie Meekums

University of LeedsUniversity of Leeds

Overview of presentationOverview of presentation

• Dimension of body image: what is it?Dimension of body image: what is it?

• Body image dissatisfaction / distress Body image dissatisfaction / distress (BID)(BID)

• Obesity and BIDObesity and BID

• Stigmatisation of obese individualsStigmatisation of obese individuals

• Implications for intervention designImplications for intervention design

• The Leeds ProjectThe Leeds Project

• DiscussionDiscussion

Dimensions of body image Dimensions of body image (Jarry & Berardi 2004)(Jarry & Berardi 2004)

• Perceptual (can I accurately assess my Perceptual (can I accurately assess my body size?)body size?)

• Attitudinal (affective / evaluative, i.e. Attitudinal (affective / evaluative, i.e. degree of satisfaction / dissatisfaction. degree of satisfaction / dissatisfaction. Also cognitive/behavioural component: Also cognitive/behavioural component: how important is my appearance to my how important is my appearance to my self-evaluation?)self-evaluation?)

• Behavioural (checking imperfections / Behavioural (checking imperfections / avoidance of situations)avoidance of situations)

Body Image Dissatisfaction Body Image Dissatisfaction (BID)(BID)

• Associated with depression, social anxiety, Associated with depression, social anxiety, low self-esteem, impaired sexual low self-esteem, impaired sexual functioning and insecure/pre-occupied functioning and insecure/pre-occupied attachment style attachment style (Jarry & Berardi 2004)(Jarry & Berardi 2004)

• Internalisation of the thin ideal associated Internalisation of the thin ideal associated with risk of disordered eating with risk of disordered eating (ibid)(ibid)

• Most researched interventions include Most researched interventions include group CBT group CBT (ibid)(ibid)

• Alternatives to CBT focussing on emotion / Alternatives to CBT focussing on emotion / reflection and exercise show promise but reflection and exercise show promise but are under-researched are under-researched (ibid)(ibid)

Obesity and BIDObesity and BID

• Obese more likely to suffer BID and avoid social Obese more likely to suffer BID and avoid social situationssituations (Annis, Cash & Hrabosky 2004)(Annis, Cash & Hrabosky 2004)

• Women / girls at greater risk of BID Women / girls at greater risk of BID (ibid)(ibid), , especially White and Asian (black BI most especially White and Asian (black BI most positive) positive) (Duncan, Al-Nakeeb and Nevill 2004; Schwartz & Brownell (Duncan, Al-Nakeeb and Nevill 2004; Schwartz & Brownell 2004)2004)

• Inverse relationship between women’s body mass Inverse relationship between women’s body mass and BI quality of lifeand BI quality of life (Annis, Cash & Hrabosky 2004) (Annis, Cash & Hrabosky 2004)

• Binge eating is risk factor for psychological Binge eating is risk factor for psychological distress, low self-esteem, negative body image distress, low self-esteem, negative body image and affective disorders and affective disorders (ibid)(ibid)

• Obese individuals more likely to binge eat Obese individuals more likely to binge eat (ibid)(ibid)

• Chicken or egg?Chicken or egg?

StigmatisationStigmatisation

• Overweight individuals experience poorer quality Overweight individuals experience poorer quality of life of life (ibid)(ibid)

• Stigmatisation of obese individuals begins in Stigmatisation of obese individuals begins in childhood childhood (ibid)(ibid)

• History of stigmatisation associated with current History of stigmatisation associated with current BI distress BI distress (ibid)(ibid)

• Early stigmatisation affects internal schemata Early stigmatisation affects internal schemata rendering vulnerable to depression, social anxiety rendering vulnerable to depression, social anxiety and reduced quality of life and reduced quality of life (ibid)(ibid)

• Emphasis on poor BI as motivator for weight loss Emphasis on poor BI as motivator for weight loss may excuse this last acceptable form of may excuse this last acceptable form of discrimination discrimination (Schwartz & Brownell 2004)(Schwartz & Brownell 2004)

Implications for intervention Implications for intervention designdesign

• BID may prevent some people from engaging in BID may prevent some people from engaging in healthy lifestyle activities e.g. exercise healthy lifestyle activities e.g. exercise (Duncan, Al-(Duncan, Al-Nakeeb and Nevill 2004)Nakeeb and Nevill 2004)

• Need ethnically sensitive programmes Need ethnically sensitive programmes (ibid)(ibid)

• Most research excludes men! Most research excludes men! • Argument that BID motivates weight loss is Argument that BID motivates weight loss is

spurious; increased eating & psychological distress spurious; increased eating & psychological distress may be more likelymay be more likely (Schwartz & Brownell 2004) (Schwartz & Brownell 2004)

• Need for non-stigmatising therapy that addresses Need for non-stigmatising therapy that addresses emotions & reflection emotions & reflection (Jarry & Berardi 2004)(Jarry & Berardi 2004)

• Moderate exercise improves mood and helps Moderate exercise improves mood and helps maintain weight loss maintain weight loss (Butki and Rudolph 1997;(Butki and Rudolph 1997; Kayman, Bruvold Kayman, Bruvold and Stern 1990) and Stern 1990)

The Leeds ProjectThe Leeds Project

a) Randomised controlled study, 2 interventions: DMT + diet; a) Randomised controlled study, 2 interventions: DMT + diet; exercise + diet. Control individualised dietary advice only. exercise + diet. Control individualised dietary advice only. Measurements 0 & 18 wks: BI, BMI, self esteem, self-efficacy, Measurements 0 & 18 wks: BI, BMI, self esteem, self-efficacy, physical activity level, treatment satisfaction. physical activity level, treatment satisfaction.

• b) Qualitative, retrospective interview-based study, b) Qualitative, retrospective interview-based study, supplemented by therapist notes (DMT and exercise), digital supplemented by therapist notes (DMT and exercise), digital video recordings (DMT only) and clinical supervision notes video recordings (DMT only) and clinical supervision notes (DMT only). Participant focus groups (DMT and physical (DMT only). Participant focus groups (DMT and physical exercise) to contribute to analysis. exercise) to contribute to analysis.

• Three centres: predominantly African-Caribbean; South Asian; Three centres: predominantly African-Caribbean; South Asian; White (socio-economically disadvantaged) (DH 2000, NSF White (socio-economically disadvantaged) (DH 2000, NSF coronory heart disease).coronory heart disease).

• Sample women and men, 18+, BMI Sample women and men, 18+, BMI 30. Exercise: N=24 (12 30. Exercise: N=24 (12 m, 12 f); DMT: N=24 (12 m, 12 f); Control: N=24 (12 m, 12 f).m, 12 f); DMT: N=24 (12 m, 12 f); Control: N=24 (12 m, 12 f).

• Hoping to share data with Prof. Buckroyd of UH (art therapy).Hoping to share data with Prof. Buckroyd of UH (art therapy).

Dance Movement therapyDance Movement therapy

• One of the Arts Therapies, a group within One of the Arts Therapies, a group within Allied Health Professions (recommended Allied Health Professions (recommended for state registration)for state registration)

• Sessions typically include: physical warm-Sessions typically include: physical warm-up; creative improvisation; discussionup; creative improvisation; discussion

• Change occurs via the exploration of Change occurs via the exploration of ‘movement metaphors’ ‘movement metaphors’ (Meekums 2002)(Meekums 2002)

• Relevant metaphors: being invisible vs. Relevant metaphors: being invisible vs. strutting my stuff; lightness and heaviness strutting my stuff; lightness and heaviness of touch; taking in and expellingof touch; taking in and expelling

ReferencesReferences

• Annis, N.M., Cash, T. & Hrabosky, J.I. (2004) Body image and Annis, N.M., Cash, T. & Hrabosky, J.I. (2004) Body image and psychosocial differences among stable average weight, currently psychosocial differences among stable average weight, currently overweight, and formerly overweight women: the role of stigmatising overweight, and formerly overweight women: the role of stigmatising experiences. experiences. Body ImageBody Image 1: 155-167. 1: 155-167.

• Butki, D.B and Rudolph, D.L. (1997) Do short bouts of exercise reduce Butki, D.B and Rudolph, D.L. (1997) Do short bouts of exercise reduce anxiety? anxiety? Medicine and Science in Sports and ExerciseMedicine and Science in Sports and Exercise, 29: S118 , 29: S118 [abstract].[abstract].

• Duncan, M.J., Al-Nakeeb, Y., & Nevill, A.M. (2004) Body esteem and body Duncan, M.J., Al-Nakeeb, Y., & Nevill, A.M. (2004) Body esteem and body fat in British school children from different ethnic groups. fat in British school children from different ethnic groups. Body ImageBody Image 1: 1: 311-315.311-315.

• Jarry, J.L. & Berardi, K. (2004) Characteristics and effectiveness of stand-Jarry, J.L. & Berardi, K. (2004) Characteristics and effectiveness of stand-alone body image treatments: a review of the empirical literature. alone body image treatments: a review of the empirical literature. Body Body ImageImage1: 319-333.1: 319-333.

• Kayman, S., W. Bruvold and J.S. Stern (1990). Maintenance and relapse Kayman, S., W. Bruvold and J.S. Stern (1990). Maintenance and relapse after weight loss in women: behavioral aspects. after weight loss in women: behavioral aspects. American Journal of American Journal of Clinical NutritionClinical Nutrition 52:800-807. 52:800-807.

• Meekums, B. (2002) Meekums, B. (2002) Dance Movement Therapy. Dance Movement Therapy. London: Sage. London: Sage.• Schwartz M.B., & Brownell K.D. (2004) Obesity and Body Image. Schwartz M.B., & Brownell K.D. (2004) Obesity and Body Image. Body Body

ImageImage 1: 43-56. 1: 43-56.

DiscussionDiscussion

• There is more than one kind of evidence: the There is more than one kind of evidence: the research literature and your own clinical research literature and your own clinical experience may be equally validexperience may be equally valid

• Given the literature (including anything you Given the literature (including anything you have read) and the experience within your have read) and the experience within your group, how do you feel you might improve group, how do you feel you might improve the provision in the areas in which you work?the provision in the areas in which you work?

• What questions does this leave you with?What questions does this leave you with?• What implications does this have for What implications does this have for

research?research?