Overvaluation of Shape and Weight in Obesity

Prevalence and associated features in those without eating disorders.

Posted Jul 10, 2020

Overvaluation of shape and weight (i.e., judging the self-worth exclusively or predominantly in terms of his or her shape, weight, and their control) is common to anorexia nervosa and bulimia nervosa patients, and it is reported by more than 50 percent of those with binge-eating disorder (BED).

Overvaluation of shape and weight should be differentiated from body dissatisfaction. Indeed some studies have shown that the former is more stable and closely associated with self-esteem than the latter, which is malleable, fluctuates greatly in response to circumstances and environmental stimuli (e.g., mood changes, recent food intake), and is commonly reported in the general population.

Figure 1 (below) shows on the left the self-evaluation pie chart of a person without the overvaluation of shape and weight characterized by a predominant slice representing shape and weight, and a few other slices. While on the right is represented a pie chart of someone without the overvaluation of shape and weight, which will include a greater number of slices and a smaller slice representing shape and weight. The size of each slice of the ‘pie’ will represent the relative importance that the person gives to each domain. 

 Riccardo Dalle Grave, M.D.
Figure 1. An example of a pie chart of a person with the overvaluation of shape and weight (on the left) and one without the overvaluation of shape and weight (on the right).
Source: Riccardo Dalle Grave, M.D.

Although not a diagnostic criterion, overvaluation of shape and weight has been proposed as a marker of comorbid psychopathology and a specifier of BED severity. This because individuals with BED and overvaluation of shape and weight report more severe eating-related psychopathology and psychological impairment (e.g., depression, low self-esteem, poor quality of life) than those with BED and subclinical overvaluation of shape and weight, as well as an overweight comparison group. Some studies have also reported that higher baseline overvaluation of shape and weight predicts the poorest outcomes at the end of treatment and at follow-up in patients with BED. 

It is well known that BED is often associated with obesity, and 1.4% to 9% of patients seeking treatment for obesity meet the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for BED. These data indicated that overvaluation of shape and weight is inevitably present in a subgroup of individuals seeking treatment for obesity with BED, but no study had previously attempted to determine whether it is also present in treatment-seeking patients with obesity but without BED or other eating disorders

A study recently published in Obesity aimed to assess the presence of the overvaluation of shape and weight and its associated features in 1,134 patients with obesity but no eating disorder who were seeking treatment from a specialist unit.

The Eating Disorder Examination interview was administered by expert clinicians to assess the eating disorder psychopathology and overvaluation of shape and weight. Patients also completed the Symptom Check List-90-Revised and the 36-Item Short Form Health Survey to assess general psychopathology and quality of life, respectively.

About 20 percent of the patients with obesity presented with clinical overvaluation of shape and weight, which was associated with the female gender, higher expected weight loss, more severe eating-related psychopathology, higher general psychopathology, and lower mental quality of life. Moreover, female gender, eating concern and the mental component of quality of life were independently correlated with overvaluation of shape and weight in these patients.

The results of the study have two important clinical implications. First, given the association with eating psychopathology, poorer psychological functioning, and mental quality of life, as well as its potential negative influence on treatment outcome, overvaluation of shape and weight should be routinely assessed for in patients seeking treatment for obesity, especially in females (see Table 1).

Table 1. Some questions derived by the Eating Disorder Examination Interview (EDE) to assess the presence of the overvaluation of shape and weight

  • “Over the past four weeks, has your shape influenced how you feel about (judge/think/evaluate) yourself as a person?”
  • “Over the past four weeks, has your weight influenced how you feel about (judge/think/evaluate) yourself as a person?” 

As these concepts are quite complex, another question that may help to understand the two above question may be:

  • “If you imagine the things which influence how you feel about (judge/think/evaluate) yourself, such as your performance at work, being a parent, your marriage, and how you get along with other people, and put these things in order of importance, where does your shape (or weight) fit in?”

Derived from Fairburn, C.G., Cooper, Z., O’Connor, M. (2008). Eating Disorder Examination (16.0D). In Fairburn CG. Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press.

Second, if the presence of clinical overvaluation of shape and weight is detected, it should be addressed directly, as it is not associated with body weight, and therefore it is unlikely to improve through weight loss alone. This can be done by integrating specific strategies and procedures to address the overvaluation of shape and weight derived by the cognitive behavior treatment of eating disorders into weight-loss lifestyle-modification treatments for obesity.

References

Dalle Grave, R., Misconel, A., Fasoli, D., & Calugi, S. (2020). Overvaluation of Shape and Weight and Associated Features in Patients Without Eating Disorders Seeking Treatment for Obesity. Obesity, 28(4), 733-739. doi:10.1002/oby.22750

Grilo, C. M., White, M. A., Gueorguieva, R., Wilson, G. T., & Masheb, R. M. (2013). Predictive significance of the overvaluation of shape/weight in obese patients with binge eating disorder: findings from a randomized controlled trial with 12-month follow-up. Psychological Medicine, 43(6), 1335-1344. doi:10.1017/s0033291712002097