In this essay, obesity will be explored in three different ways. First, from a biological perspective to consider how to identify if a person is obese and the different lifestyle factors that contribute to the risk of obesity. Second, from a psychological perspective to investigate the psychological barriers of following advice to lose weight. Third, from a macro-sociological perspective to explore different factors that can affect David’s ability to change his perspective and lose weight.
How to determine whether an individual is obese from a biological perspective
There are different methods to determine whether an individual is obese. The most widely used method is to calculate body mass index (BMI) (1).
Calculating BMI is a simple and inexpensive method to measure obesity (2). BMI gives an indication whether the weight of a person is healthy relative to their height (3). It is calculated by the following formula: BMI = weight (kg) ÷ height (m) 2 and a person is considered obese when their BMI exceeds 30 (kg/m2) (2, 4). However, the limitations of this method include its inability to differentiate between lean and fat mass and lack of indication regarding body fat distribution (2).
There are more accurate methods to assess the amount and distribution of adipose tissue. Examples of such methods are, x-ray absorptiometry (DEXA) and imaging techniques (2). However, they also have limitations which have resulted in them being used less often. For example, their lack of standardised ranges (thresholds which indicate severity of obesity) and high cost (2).
Central obesity measures are other methods to determine obesity, for example, waist circumference to hip circumference and waist circumference to height ratios. These measures are also used for clinical assessments, however, do not add much additional information compared to BMI. These ratios also have limitations such as not having standardised ranges and inaccuracy in people with a BMI of greater than 35 (kg/m2), severely obese (2).
In conclusion, to determine whether the individual was obese I would use the body mass index. This is due to its common use in the medical field, standardised ranges and simplicity (easy for patients to understand and calculate themselves). In this case David would have a BMI of 36.4 (kg/m2) to three significant figures (BMI = 118 ÷ 1.82 = 36.4 (kg/m2)). This is a BMI greater than 35 (kg/m2) so indicating that he is severely obese.
Lifestyle factors that contribute to the risk of obesity
Obesity is the accumulation of excess fat in the body and there are many different lifestyle factors that contribute to this disease (5, 6). This accumulation of fat is normally caused by chronic consumption of more food than is needed to provide enough energy for daily activities (5, 7).
Different lifestyle factors can contribute to the risk of obesity, with some of the most frequent being lack of physical activity, overeating and mental conditions (6). Examples of lifestyle factors that can contribute to lack of physical activity are having a sedentary job, such as the full-time office job David has, and watching much television in free time (6). Such factors reduce energy usage and so lead to the accumulation of excess energy which is mostly stored in adipose tissue (7).
Consuming a large amount of high energy food and drink, such as fast food (which is high in sugar and fat) and sugary drinks result in an increase in the energy intake and so contribute to the formation of excess fat in the body (8).
Mental conditions can influence both the amount of energy intake and energy usage. As an example, increase in snacking behaviour mainly for foods high in fat and high in sugar has been shown to be as a result of stress or ‘daily hassles’ (9). Stress can also lead to a reduction in physical activity (10).
Overall, I think that there is a wide range of lifestyle factors that can have a great influence on increasing the risk of obesity, with some of the key facts mentioned above.
Psychological barriers to following advice to lose weight
Advice to lose weight is based on a person’s healthy diet and/or physical activity (to reduce high energy intake and to increase energy usage).
Research studies have shown that one of the most frequent barriers to eating a healthy diet and being physically active was lack of motivation (11, 12). Lack of motivation could be due to the individual not reaching their high unrealistic weight loss goals. Loss of confidence could also be a result of failure in completing goals, that can act as a psychological barrier to attempting other weight loss advice. One example could be if an individual who fails to perform an unrealistic goal of exercise and a strict diet each week. This person may lose confidence and think that they cannot lose weight, so believing that following other advice regarding their weight loss is a waste of their time.
Mental conditions such as stress and depression may also act as a psychological barrier to following weight loss advice. Research studies have shown that either of these can act as a barrier to a person losing weight (11, 13). Stress or depression can make a person want to isolate themselves from others and so possibly preventing them from attending social exercises. Exercising individually has also been seen to reduce motivation to lose weight which would impact a person’s confidence in losing weight further (11). Stress also has an impact on the types of food a person chooses to eat. During periods of stress people mainly choose food with high sugar and/or fat content such as sweets (14, 15). This is because eating high energy foods reduces the behavioural symptoms of stress (11, 15). Hence, a person under stress may not follow dietary advice to help them lose weight, due to their habits of eating high energy foods to provide comfort.
Another psychological barrier could be that the patient/person is in denial to accept their obesity, such as the case with David. Such a person could be offended by weight loss advice and may not think the advice given to them is relevant hence will not follow them. This could lead to an increase in both their obesity and in denial so making it even more difficult for them to lose weight in future. This shows how impactful psychological barriers can be to a person’s ability to comply to weight loss advice.
How macro-sociological forces impact David’s ability to lose weight
Macro-sociological forces are related to how the structure and organisation of a social environment, like a neighbourhood, can impact the lifestyle of the population. In this section the influence of such forces on David’s ability to change his activity and diet to lose weight will be considered.
David may like to increase his physical activity by using walking or cycling for transport, or as a hobby in his free time. However, his ability and extent to which he may be motivated to perform such activities, is related to macro-sociological factors. A research study performed across 12 countries showed that the smaller the perceived walking distances to destinations (e.g. gym, school and supermarket) and the less danger associated with reaching these destination (e.g. absence of high traffic), the lower the BMI of locals in the area. This shows how the structure of local areas can help motivate individuals, such as David, to walk or cycle as modes of transport and increase their physical activity so promoting their ability to uptake a healthier lifestyle (16).
Accessibility to sporting facilities in a community is another macro-sociological factor that can impact David’s regular physical activity. Research studies have shown that people who have easier access to sporting facilities (less distance required to travel) show more physical activity than those who are more distant to these facilities (17, 18). People who need to travel further to reach sporting facilities may lose their motivation to take part in exercise involved with such facilities (19). Hence, if David lives far away from a sporting facility he may lose his motivation to travel there to exercise. On the other hand, living close to sporting facilities can increase the likelihood of him using the facilities, hence, supporting his ability to lose weight and adopt a more physically active lifestyle.
The type of food that is most available at David’s neighbourhood will also influence his ability to maintain a healthy diet. Fast food outlets normally serve foods with high energy, salt and saturated fat content and so are considered as unhealthy, which as mentioned earlier, can contribute to obesity (20). High fast food outlet exposure is linked with increase in fast food consumption, body weight and chance of being obese (20, 21). Hence, living in a neighbourhood with high fast food outlet exposure can have a negative effect on David’s ability to lose weight. Seeing many fast food outlets when he leaves his home can tempt him to buy from them and move towards an unhealthy diet. David’s financial ability can also have an impact on the foods he chooses to eat. Healthier food options can be more expensive compared to the cheap fast food ones, this can increase his temptations and reduce his motivation to maintain his healthy diet (more so if he has a low financial income).
This essay shows how a medical condition, such as obesity can be influenced by psychological, sociological factors and biological factors. Hence, it is vital for medical professionals, such as the general practitioner (GP) in David’s case, to use a holistic approach when consulting their patients.