Themes explaining why people are obese

In my interactions with patients, I always ask them to tell me when their weight problems began and what they believe contributed to their weight gain.

Broadly speaking, there are two categories: people, who were big (or were considered big by others) as long as they can remember and those, who can often clearly pinpoint when their weight problem started. Individuals in the latter group can often recall a specific event or situation that led to their weight gain (e.g. when I miscarried, when I entered puberty, after my second child, when I moved to Canada, etc.).

After hearing hundreds of such stories, common themes emerge, which in the past have led me to make statements such as, “Many roads lead to obesity” or, “Obesity can happen to anyone – no one is immune”.

So how exactly do people with obesity tend to explain their excess weight and do men and women differ in their explanations?

This fascinating topic was now explored by Louise Smith and Lotte Holm from the University of Copenhagen, in a paper published in the Scandinavian Journal of Public Health.

The researchers conducted extensive in-depth interviews of 20 Danish middle-aged men and women who had experienced obesity, randomly selected from a representative nationwide dietary survey.

While some of the participants had lost weight, others were weight stable. Some reported being overweight from childhood, others reported steady or sudden weight gain later in life.

Most interestingly, there were clear gender differences in the explanations offered for weight gain between men and women.

In men, the following central themes emerged: Firstly (and most commonly), men reported life-course transitions (usually from youth to adulthood), whereby they perceived education or work-related obstacles that prevented or reduced physical activity levels as most relevant. Men also frequently referred to injuries that reduced their physical activity.

Some men reported eating for comfort or due to personal problems, most often related to work, unemployment, or financial concerns – rarely to social or relationship problems.

Some men also mentioned work environments that promoted overeating (e.g. when I began work as a cook).

The stories that women told were strikingly different. Although women also presented “life-course” explanations, these were less frequently related to shifting living conditions or social obligations, but rather to transitions in the female biological cycle such as puberty, pregnancy, and menopause.

The second theme in women was related to changes in social relationships (e.g. when I met my husband, when we moved in together, etc.).

The third theme in women was overeating related to personal problems, in all cases related to intimate social relationships (e.g. I did not receive adequate love in my childhood, I was brought up in a family with an alcoholic father, etc.).

The fourth theme in women was related to the use of psychopharmaca (e.g. for depression, when I began having lithium, etc.).

As the authors point out, it is perhaps not all that surprising that women are more likely to relate the beginning of their weight problems to their biology (which is clearly far more striking and eventful in women than in men) and to problems in their intimate and personal relationships.

In contrast, men look at both life-transitions and emotional stressors more in the context of work (e.g. new job, retirement, unemployment, financial trouble) or blame injury or other circumstance for reduced activity levels.

Thus, as previous research has shown, when it comes to overeating, women typically invoke family obligations, whereas men allude to obligations outside the family.

The fact that the use of psychopharmaca came up as a distinct theme in women but not in men, may be related to the fact (as the authors suggest) that these drugs are far more commonly used in women than in men.

These gender differences are not only striking but may also have important implications for addressing obesity both in populations and in individuals.

Firstly, nowhere in this discourse of life stories, did “lack of knowledge” come up as a driver of weight gain. Thus, it is perhaps not at all surprising, that the public health strategies focussing on “educating” the public on healthy eating and activity, have thus far had virtually no impact on obesity rates.

Rather, based on their findings, the authors suggest that obesity prevention strategies need to target men and women differently and must take into account their very different life histories:

In women, obesity prevention strategies are perhaps best focussed at key times during their biological lifecycles (e.g. at puberty, around pregnancies and menopause) and emotional eating may be best dealt with by addressing and improving coping skills in personal relationships (i.e. at home, within families, etc.).

In men, obesity prevention efforts are perhaps best targeted at periods of educational or professional transition. Emotional eating in men may be best dealt with by addressing social stressors related to work and livelihood and are probably best offered in the workplace.

Certainly a lot for the public health folks to chew on.

In light of these findings I cannot but help emphasize just how important it is to engage and listen to the people who actually have the problem, which we as researchers and health professionals are trying to help solve.

Arya M. Sharma is a Professor of Medicine at the University of Alberta who blogs at Dr. Sharma’s Obesity Notes.

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