In the popular (especially with teachers) US series This is Us, we follow the character Kate Pearson’s story of being fat from childhood to being obese in adulthood, with all its resultant problems. Her childhood journey goes from being asked by her mother if she wants less-fattening food (unlike her siblings), wearing a T-shirt to cover up at the pool and mean notes from her so-called friends to the ultimate humiliation of realising that the “M” on her slender mother’s clothing stands for medium and the “XL” on hers for extra large.
The actor who plays Kate, Chrissy Metz, is now a champion for body positivity. But when she was a child and overweight, her experiences were no less painful than her character’s. She went to Weight Watchers at around 11 years old - “I was the youngest person in the damned room and it was awkward”. And most hurtful of all, her body “seemed to offend” her stepfather, she says in her memoir. “He couldn’t help but stare, especially when I was eating.”
In later life, she talks of depression over a lack of work owing, she believed, to her size, which meant that she began “eating her feelings” and putting on even more weight.
That’s a powerful description. We place much emphasis on the physical effects of obesity but there’s little consideration of the psychological effects on children. In fact, emotions and feelings seem to disappear into the background: all we see is the fat. A Google search on obesity in children brings up a wealth of physical health information but no mention of mental health.
And there’s a distinct difference in treatment from other eating disorders. Obesity - not to be confused with being fat or overweight - is often considered a medical illness with metabolic and genetic origins, and best treated by mainstream medicine and lifestyle modification, whereas with anorexia and bulimia, the focus is very much on psychological treatment. For obese children, there is plenty of talk about how to lose weight - eat more healthily, get more exercise - but little recognition of the associated mental health problems of living with obesity. A review of 53 pieces of research in 2016 found that childhood obesity was “negatively associated with psychological comorbidities such as depression, poorer perceived health-related quality of life, emotional and behavioural disorders, and self-esteem during childhood”.
But what we do not know is whether these negative psychological effects are the result of being obese or if they instigate behaviours that can cause obesity. Obese children suffer from more bullying, which can affect their attainment, as can teacher prejudice. And this disproportionately affects the already disadvantaged.
Obesity “has become almost subconsciously or culturally associated with being poor, low income, less educated, so therefore, if you are obese, that is how you are almost routinely seen”, says Max Davie, officer for health improvement at the Royal College of Paediatrics and Child Health.
He has a potential solution: a reclassification of obesity educationally. “We have children who have physical limitations but, actually, the thing that’s getting in the way of their education is the behavioural and emotional consequences of that original disability, and that’s a special educational need,” he says.
Would such a label help? Only if we begin, as a society, to see obesity in a very different light - not as a choice but as a consequence of complex factors. As This Is Us’ Metz explains, obese children and adults “don’t sit around eating themselves into oblivion. The food is the symptom, it’s not the issue. When you put the food down, the issues come up.”
We need to make sure we see those psychological issues just as clearly as we see their physical manifestation.
@AnnMroz
This article originally appeared in the 6 November 2020 issue under the headline “We need to recognise obesity is psychological, not just physical”
