Introduction

In discussions about the theories, common problems, and treatment of repeat dieters or those dealing with issues of weight preoccupation, obesity and dieting are often interrelated. There are physical, psychological and social aspects to the problems of obesity. This is why the social work profession is ideally suited to understanding the problems and provide effective intervention.

Some controversy surrounds whether obesity is considered an "eating disorder." Stunkard (1994) has defined Night Eating Syndrome and Binge Eating Disorder as eating disorders that contribute to obesity. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV ™) (American Psychiatric Association, 1994) characterizes eating disorders as severe disturbances in eating behavior. It does not include simple obesity as an eating disorder because it is not consistently associated with a psychological or behavioral syndrome. Labeling obesity as an eating disorder that needs to be "cured" implies a focus on physical or psychological processes and does not include recognition of the social factors that may also have a contributive impact. Weight preoccupation and dieting behaviors will certainly have some aspects of an eating disorder and its psychological implications such as inappropriate eating behaviors or disturbances in body perception. In this paper, neither obesity or weight preoccupation are considered to be eating disorders. Labeling these as eating disorders does not provide any useful clinical or functional purpose and only serves to further stigmatize the obese and weight-preoccupied.

What is Obesity?

It is difficult to find an adequate or clear definition of obesity. Many sources discuss obesity in terms of percentage above normal weight using weight and height as parameters. Sources vary in their definitions as to what is considered "normal" or "ideal" versus "overweight" or "obese." Sources range in defining a person who is 10% above ideal as obese to 100% above ideal as obese (Bouchard, 1991; Vague, 1991). Even ideal weight is difficult to define. Certainly not all people of a certain height should be expected to weigh the same. Determining obesity by poundage alone is not always indicative of a weight problem.

Bailey (1991) has suggested that the use of measuring tools such as fat calipers or water submersion techniques where the percentage of fat is determined and considered within acceptable or non-acceptable standards is a better indicator of obesity. Waist-hip ratio measurements are also considered to be a better determination of risk factors due to obesity. The waist-hip ratio takes into account the distribution of fat on the body. If fat distribution is mainly concentrated at the stomach or abdomen (visceral obesity), the health risks for heart disease, high blood pressure, and diabetes increase. If fat distribution is concentrated at the hips (femoral or saggital obesity), there is considered to be somewhat less of a physical health risk (Vague, 1991).

Currently, the most common measurement of obesity is through the use of the Body Mass Index (BMI) scale. The BMI is based on the ratio of weight over height squared (kg/MxM). The BMI gives a broader range of weight that may be appropriate for a specific height. A BMI of 20 to 25 is considered to be within ideal body weight range. A BMI between 25 to 27 is somewhat at a health risk and a BMI above 30 is considered at significant health risk due to obesity. Most medical sources define a BMI of 27 or higher to be "obese." Although the BMI scale does not take into account musculature or fat distribution, it is the most convenient and presently most widely understood measure of obesity risk (Vague, 1991). For the purposes of this study, a BMI of 27 and above is considered to be obese. The terms obese or overweight are used interchangeably throughout this thesis and refer to those with a BMI of 27 or higher.

Obesity and Dieting Demographics

Berg (1994) reported that the most recent National Health and Nutrition Examination Survey (NHANES III) revealed that the average body mass index of American adults has risen from 25.3 to 26.3. This would indicate an almost 8 pound increase in the average weight of adults over the past 10 years. These statistics indicate that 35 percent of all women and 31 percent of men have BMIs over 27. The gains extend across all ethnic, age, and gender groups. Canadian statistics indicate that obesity is prevalent in the Canadian adult population. The Canadian Heart Health Survey (Macdonald, Reeder, Chen, & Depres, 1994) showed that 38% of adult males and 80% of adult females had BMIs of 27 or higher. This statistic has remained relatively unchanged over the past 15 years. Therefore, it clearly indicates that in North America, approximately one-third of the adult population is considered to be obese.

The NHANES III study reviewed the possible causes of the pervasiveness of obesity and took into consideration such issues as an increasing American sedentary lifestyle and the prevalence of eating food outside the home. It is interesting to note that in an era in which dieting has become almost the norm and profits from the diet industry are high, overall weight is increasing! This could this lend some credibility to the notion that dieting behaviors lead to increased weight gain.

In the Canadian survey, approximately 40% of men and 60% of women who were obese stated that they were trying to lose weight. It was estimated that 50% of all women are dieting at any one time and Wooley and Wooley (1984) estimated that 72% of adolescents and young adults were dieting. In Canada, it was striking to note that one third of women who had a healthy BMI (20-24) were trying to lose weight. It was disturbing to note that 23% of women in the lowest weight category (BMI under 20) wanted to further reduce their weight.