Body image partially mediates the relationship between obesity and psychological distress.

AbstractFRIEDMAN, KELLI E., SIMONA K. REICHMANN,PHILIP R. COSTANZO, AND GERARD J. MUSANTE.Body image partially mediates the relationship betweenobesity and psychological distress. Obes Res. 2002;10:33Ð 41.Objective: Body image is considered as a potential mediatorof the relationship between obesity and psychological dis-tress.Research Methods and Procedures: One hundred ten menand women in a residential weight control facility com-pleted the Multidimensional Body Self-Relations Question-naire, the Beck Depression Inventory, the Rosenberg Self-Esteem Scale, and the Binge Eating Scale.Results: For both men and women, body-image satisfactionpartially mediated the relationship between degree of over-weight and depression/self-esteem.Discussion: Sociodemographic factors that may influencethe relationships among weight, body image, and depres-sion/self-esteem are discussed.Key words: adults, body-image dissatisfaction, depres-sion, self-esteem Introduction The nature of the relationship between obesity and psy-chological distress continues to be debated by researchersand clinicians alike. Studies of nonclinical samples of obesepersons have consistently shown that obese individuals donot differ from their non-obese counterparts in psycholog-ical symptoms, psychopathology, or personality overall (1).However, studies do indicate that subgroups within theobese population, such as obese individuals presenting forclinical weight-loss treatment and obese binge-eaters, showelevated psychopathology (2Ð 4). Individuals seeking treat-ment for weight loss have consistently demonstrated ahigher prevalence of distress than their nontreatment-seek-ing counterparts. For instance, it has been found that obesetreatment seekers show elevated levels of depression (5),binge eating (2), general psychiatric symptoms (2), andbody-image distress (6). Goldsmith et al. (5) reported that55.6% of their participants who were seeking weight-losstreatment met criteria for current or past psychiatric illness,especially major depression and dysthymia. Binge eating,which occurs in ! 30% of obese individuals seeking weight-loss treatment (7), also has been linked to elevated levels ofdepression. Marcus et al. (8) found that obese binge-eatershad substantial depressive symptomatology compared withtheir nonbinging counterparts. Additionally, Kuehnel andWadden (9) reported that individuals diagnosed with binge-eating disorder had significantly higher levels of depressionthan both nonbingers and problem eaters. This binge eating-mediated pattern of results has been confirmed in numerousadditional studies (10,11). The results of these studies sug-gest that when attempting to understand the relationshipbetween obesity and symptoms of psychological distress, itseems useful to consider mediating variables, such as treat-ment-seeking status or binge eating, to explain the presenceof psychological symptomatology.With respect to potential mediators, Friedman andBrownell (12) have proposed several additional risk factorsthat may determine which obese individuals will suffernegative psychological consequences. These include socialclass, degree of obesity, and body-image dissatisfaction. Inthis study one of the proposed risk factors, body-imagedissatisfaction, is investigated as a potential mediator of therelationship between dysphoric psychological states (e.g.,depression and low self-esteem) and obesity in a treatment-seeking population.Body image is an individualOs psychological experienceof the appearance and function of his/her body and is oneaspect of an individualOs mental representation of him/herself (13,14). Although it was long assumed that bodyimage was a unidimensional construct, recent research has