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The Danger of Fat-Think

Believing you're fat may be more emotionally damaging than actually being obese.

Obesity causes severe health problems. It's also a source of severe shame. Just perceiving oneself as fat, in fact, may produce greater emotional damage than actually being overweight.

A German study by Bärbel-Maria Kurth and Ute Ellert in the June Deutsches Ärzteblatt International finds that young people who think they're fat suffer a poorer quality of life than truly fat people. In their study — "Perceived or True Obesity: Which Causes More Suffering in Adolescents?" — Kurth and Ellert asked 6,654 German boys and girls, aged 11 to 17, questions about six aspects of their quality of life during the preceding week, including their physical and emotional well-being, self-esteem, everyday functioning at school and relationships with family and friends.

The children's responses were assigned numerical values between 1 and 100, with higher numbers representing a higher quality of life. Totals for each quality-of-life aspect, as well as an overall total for each child, could then be compared. The children were then asked to rate themselves on a five-point weight scale: "far too thin," "a bit too thin," "just the right weight," "a bit too fat" or "far too fat." The children's height and weight were also recorded, enabling comparison between an objective measure and a subjective perception of their weight.

Overall, about three-quarters of the children were of normal weight. But only about a third of the girls thought their weight was "just right," and nearly half thought they were either a little or a lot overweight. The study confirmed other research showing that boys generally tend to underestimate their weight. Among obese children, the girls' body images were far more accurate than the boys': 60 percent of the obese girls thought they were "far too fat," while only about 32 percent of the obese boys felt that way.

Quality-of-life measures were also skewed. Obese children of both sexes felt their quality of life was impaired in all dimensions. Obese boys had particular problems with friendships; obese girls felt their physical well-being and self-esteem were damaged.

But the most striking problems were found among children — especially girls — who thought they were too fat when they weren't. Compared with both normal-weight children and obese children, children with this distorted body image experienced dramatically diminished quality of life and very low self-esteem. Girls' overall quality-of-life scores ranged from around 10 to nearly 20 points below those of normal-weight girls who thought their weight was "just right." And compared with obese girls, their scores were about five to 10 points lower. Normal-weight boys who thought they were overweight showed similar but slightly less dramatic differences.

This study is consistent with other studies of body image, obesity and health and suggests body image distortions may be worsening, the authors say. In research from the early 1990s, less than 50 percent of 12- to 16-year-old girls and about 25 percent of the boys thought themselves "a bit too fat" or "far too fat"; those figures have risen by nearly 5 percent for girls and more than 10 percent for boys. Kurth and Ellert are concerned that campaigns against obesity may be increasing susceptibility to eating disorders among normal-weight children who perceive themselves as seriously overweight; they recommend that weight-education programs include information on the dangers of obesity and the risks of eating disorders.

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