Medical and Dental Consultants’ Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 129   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size

  Table of Contents 
Year : 2017  |  Volume : 20  |  Issue : 10  |  Page : 1302-1308

Assessment of body perception, psychological distress, and subjective quality of life among obese and nonobese subjects in Turkey

Department of Medical History and Ethics, Department of Nutrition and Dietetics, Afyon Kocatepe University, Afyonkarahisar, Turkey

Date of Acceptance18-Dec-2016
Date of Web Publication1-Dec-2017

Correspondence Address:
Dr. N Son
Department of Medical History and Ethics, Department of Nutrition and Dietetics, Afyon Kocatepe University, Afyonkarahisar
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1119-3077.219509

Rights and Permissions

Background: Obesity can lead to psychological, social, and medical problems that may negatively affect the quality of life Aim: In our study, we aimed to evaluate the body perception, psychological distress, and subjective quality of life of obese subjects in comparison with normal weighted ones. Methods: A total of 494 subjects, aged between 18 and 64 years, were included to the study. Patients with the body mass index (BMI) of ≥18.5–24.9 kg/m2 were assigned to the control group; BMI ≥ 30 kg/m2 were assigned to the obese patient group. An ethical committee approval with protocol No. of 2011/242 was obtained from the Ethical Committee of Eskişehir Osmangazi University Faculty of Medicine. Interviews were performed two times with obese subjects in the 1st and the 6th month of weight loss program, once with the control group. Data identification form, the form which included the biochemical parameters, Trait Anxiety inventory, State anxiety scale, Quality of Life scale-Short Form [(SF-36)(QOL)], Multidimensional Body-Self Relations Questionnaire (MBSRQ), Zung Depression Rating Scale, and Zung Anxiety Rating Scale were applied to participants. Results: Obesity is more common in women. Obesity reduces the quality of life, negatively affects body perception, and triggers anxiety. Because of their body structure, obese individuals are exposed to social pressure and unethical attitudes. Conclusions: Both health risks and social implications of obesity are important. Further studies are needed to ethically evaluate the psycho-social problems caused by obesity.

Keywords: Obesity, body perception, quality of life, obesity and depression, obesity, and ethics

How to cite this article:
Son N. Assessment of body perception, psychological distress, and subjective quality of life among obese and nonobese subjects in Turkey. Niger J Clin Pract 2017;20:1302-8

How to cite this URL:
Son N. Assessment of body perception, psychological distress, and subjective quality of life among obese and nonobese subjects in Turkey. Niger J Clin Pract [serial online] 2017 [cited 2022 Nov 29];20:1302-8. Available from:

   Introduction Top

Obesity, one of the most important health problems of both developed and developing countries is a chronic disease which may lead to psychological, social, and medical problems that may negatively affect the quality of life.[1] In recent years, the prevalence of obesity in all age and socioeconomic groups is increasing rapidly.[2]

The most practical way used to diagnose obesity is to calculate BMI. Obesity, which is defined as BMI ≥ 30kg/m2

[weight (kg)/height 2 (m 2)], causes the emergence of many diseases by affecting all systems of the human body. It also affects the quality of life by leading to psychosocial disorders and exposure to unethical negative discrimination in some people.[3],[4]

Studies showed that obesity can lead to social isolation, inferiority, unemployment, decreased self-esteem, anxiety, depression, and marital incompatibility.[5],[6] In addition, obese people face new challenges, because of social pressure and humiliation against obese people, preparation of some unethical offensive rules for obese people and troubles caused by being overweight. This situation has brought the debate of rules, which are tried to be implemented in a scientific world, to be ethical. Our aim in this study was to compare the body perceptions, psychological distress, and subjective quality of life of obese and normal-weight adults. We hypothesized that obesity negatively affects both body perception and subjective quality of life which can cause psychological distress.

There are many studies focused on the body perception, quality of life, anxiety and depression levels separately, and most of them were cross-sectional.[3],[4],[7],[8] In this study, we aimed to assess such levels in 1 study and assess the changes of such parameters in obese subjects in a prospective design.

   Materials and Methods Top

This is a prospective study conducted among patients who were admitted to the Endocrine and Metabolic Diseases clinic of Osmangazi University Medical Faculty Hospital, Eskisehir, and a private hospital in the province of Eskişehir, Turkey, between August 2011 and November 2012. Subjects were assigned to two groups as a patient group (n=355) and a control group (n=193). A control group with similar characteristics with the study group were selected from the cases who admitted to our hospital for periodical examinations without any comorbidities. Interviews were performed two times with obese subjects in the 1st month and 6th month of weight loss program, once with the control group upon this time period. All questionnaires were applied by the author with face-to-face interview. At 6th month controls, we reached 301 patients who completed the first interview. 84.7% participation rates have been achieved in the obese group. Voluntary obese patients in the age group of 18–64 years, BMI of ≥30 kg/m 2, not receiving any medication, no special training on weight control were assigned to the obese group. Voluntary subjects in the age group of 18-64 years and BMI between 18.5 and 24.5 kg/m 2 were assigned to the control group. An ethical committee approval with protocol No. of 2011/242 was obtained from the Ethical Committee of Eskişehir Osmangazi University Faculty of Medicine, Turkey.

Data were collected using a questionnaire which contained sociodemographic details of respondents such as age, height, and weight. Height (cm) was measured using a stable wall-mount device. Weight was measured using a constant electronic scale (max: 250 kg). BMI was calculated as body mass (kg) divided by height (m) squared. A tape measure was used for waist and hip circumference (cm). The respondents anxiety level was assessed with State-Trait Anxiety inventory (STAI)[8] and Zung Anxiety Rating Scale,[9] and depressive symptoms were assessed with Zung Depression Rating Scale.[10] Furthermore, respondents quality of life was assessed with Quality of Life scale-Short Form [(SF-36)(QOL)][11],[12],[13] and the Multidimensional Body-Self Relations Questionnaire (MBSRQ) (14) was used. All scales and questionnaires were Turkish validated.[8],[9],[10],[11],[12],[13],[14] Data were named as Obese (A) for the first data of obese group, Obese (B) for 6th-month data, and Control for the control group data.

Statistical analysis

All data analyses were performed by using PASW Statistics 18. Continuous variables summarized with n (sample size), mean and standard deviation, categorical variables summarized with n (sample size), median and 25th-75th percentiles. Non-normally distributed variables were compared with the Mann–Whitney U test for independent groups and the Wilcoxon test for dependent two groups. P value less than 0.05 (P < 0.05) was accepted significant.

   Results Top

A total of 494 subjects were included in this study which consists of 301 obese and 193 control subjects. In the obese group, 220 (73.1%) were female and 81 (26.9%) were male. In the control group, 132 (68.4%) were female and 61 (31.6%) were male [Table 1]. The mean ages were 37.79 years (SD = 10.60) for the obese group and 33.62 years (SD = 8.59) for the control group.
Table 1: Socio-demographic characteristics of the participants

Click here to view

At the end of the 6th month, the average body weight of obese group was 92.43±16.73 (-7.57±00.02 kg less than baseline), and BMI was 34.25±5.94 (–2.79±0.1 less than baseline). These values were statistically significant

(P < 0.001) [Table 2].
Table 2: Measurement characteristics regarding body structure of participants

Click here to view

In the SF-36 scale, statistical differences between Obese (A) and Obese (B) were found in favor of Obese (B), for general health perception (P < 0.001), mental health (P < 0.001), and social functioning (P < 0.05) subgroups [Table 3].
Table 3: Results of the Quality of Life Questionnaire (SF-36)

Click here to view

The State Anxiety Inventory between obese (A) and obese (B) groups revealed a statistically significant difference between the obese and the control groups (B) (P < 0.001). The Trait Anxiety Inventory between obese (A) and obese (B) groups, revealed a statistically significant difference in favor of Obese (B) (P < 0.001) [Table 4].
Table 4: Results of the State-Trait Anxiety Inventory

Click here to view

While the Zung anxiety scale scores decreased from baseline in the obese group (P < 0.05), the Zung Depression Scale scores showed a statistically significant increase from the baseline in the obese group (P < 0.01) [Table 5].
Table 5: Results of Zung Anxiety and Depression Scale

Click here to view

   Discussion Top

Obesity is related with many metabolic diseases, by adversely affecting the life expectancy and quality of life, by causing psychological and social problems, and is described as a disease of the century.[15],[16] In subjects who meet inclusion criteria of our study, higher population of female subjects shows that obesity is more common in women and such finding was similar with other studies.[17],[18],[19],[20]

Also, such a result can indicate that women are more concerned about their weight more than man.

Similar with our results, some studies reported being married, unemployed, and having low level of education as risk factors for obesity.[21],[22] According to studies, obese patients have a poor quality of life; also, obesity causes many social and psychosomatic problems which can be improved with weight loss.[23],[24],[25],[26]

In our study, consistent with the literature, the evaluation of subscales of quality of life questionnaire revealed statistically significant difference in favor of obese (B) patients in areas of general health (P < 0.001) and mental health (P < 0.001) with compatible weight loss.[26],[27]

According to our results, in the obese group, scores of trait anxiety scales decreased with weight loss. The negative body image is one of the psychosocial problems caused by increased BMI. Some studies stated that obesity plays a role in emergence of psychopathological conditions ranging from anxiety to psychosis by causing low self-esteem.[17],[25],[28] Obese people are often stigmatized by their physical appearance and get messages that make them feel bad, incompetent, and ugly.[29],[34],[35]

In obese people, feeling upset about their body structure, and having poor body image can cause depression, communication disorders, and can negatively affect academic achievement and social relation.[31],[32],[33],[34],[35],[36]

Comparison of Obese (A) and Obese (B) group in subscales of Multidimensional Body-Self Relations Questionnaire (MBSRQ) showed positive improvement between 1st and 6th month applications, in appearance evaluation, physical capability evaluation, physical capability orientation, health evaluation, health orientation, body areas satisfaction, and scale total score (STS) except appearance orientation. Determined significances are statistically significant for health orientation, and statistically significant at an advanced level in all other subscales [Table 6]. In addition to the health risks as reported in the literature, obesity also leads to various psychological problems such as depression, self-esteem, and negative body image.[34],[35]
Table 6: Results of Multidimensional Body-Self Relations Questionnaire (MBSRQ)

Click here to view

According to studies, the depression rate seemed to be increased in relation to BMI.[5],[6],[7],[30],[36] Alicia et al.,[37] in 2009, evaluated obese individuals and obese weight losers, and reported increased physical function, improved general health, feeling more energetic, having increased quality of life, and decreased depression, with weight loss. Similarly, a number of studies have reported that weight loss decreases depression.[38],[39],[40],[41],[42],[43] The Zung anxiety scale results are in accordance with the articles defending the idea that obesity increases anxiety.

In conclusion, obesity disease impairs the quality of life of individuals. Quality of life decreases at the same rate that obesity increases. Weight loss increases body satisfaction of obese patients. Weight loss for obese patients increases the quality of life especially in male patients and with increasing education level. Women are more prone to depression than men, and depression increases with low education level. Obesity is a disease that should be treated in all respects. In treatment of obese patients, following Endocrinology examination, creation of individual specific medical nutrition and exercise plans, providing psychological support and most importantly making them feel self-worth are necessary. Members of the treatment team should consist of experts in their field and must demonstrate ethical approach to patients. During the treatment inner voice and expectations of patients should be taken into account.


This article is produced from the thesis of “Ethical evaluation of body perception and quality of life in obese and non-obese subjects”. The study has received no financial support. I owe my thanks to Professor Dr. Ömür ŞAYLIGIL for her valuable contributions.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest

   References Top

Leblanc E, O'connor E, Whitlock EP, Patnode C, Kapka T. Screening/management of obesity in adults. Rockville: AHRQ Publication. 2011;9-40.  Back to cited text no. 1
Play L, Pillsbury L. Leveraging Food Technology for Obesity Prevention and Reduction Effords, Psychological consequences of obesity: weight bias and body image in overweight and obese youth. Washington, DC: National Academies; 2011;118.  Back to cited text no. 2
Andersen ER. Obesity etiology assessment treatment and prevention. Human Kinetics 2003;3-85.  Back to cited text no. 3
Hancock P, Hughes B, Jagger E. The body, culture and society. Great Britain, Biddles Ltd 2000;64-117.  Back to cited text no. 4
Bray AG. Contemporary Diagnosis Management of Obesity. A Division of AMM Co. U.S.A. 1998;5-100.  Back to cited text no. 5
ÖÇ Çirpar, Muluk NB, Yalçinkaya F, Arikan OK, Oǧuztürk Ö, Aslan F. State-Trait Anxiety Inventory (STAI) assessment of mothers with language delayed children. Clin Invest Med 2010;33:E30-E35.  Back to cited text no. 6
Saraç F, Parıldar S, Duman E, Saygılı F, Tüzün M, Yılmaz C. Quality of life for obese women and men in Turkey. Prev Chronic Dis 2007;4:A5-Epub 2007 Jun 15.  Back to cited text no. 7
Burns CM, Tijhuis MA, Seidell JC. The relationship between quality of life and perceived body weight and dieting history in Dutch men and women. Int J Obes Relat Metab Disord 2001;25:1386-92.  Back to cited text no. 8
Mantar A, Yemez B, Alkın T. [The validity and reliability of the Turkish version of the anxiety sensitivity index-3]. Turk Psikiyatri Derg 2010 Fall 21:225-34.  Back to cited text no. 9
Baltas A. The Turkish version of Zung's SDS. Neurology Monographs. Istanbul University Faculty of Medicine 1974.  Back to cited text no. 10
Pinar R. Reliability and construct validity of the SF-36 in Turkish cancer patients. Qual Life Res 2005;14:259-64.  Back to cited text no. 11
Bilge U, Unalacak M, Unluoglu I, Ipek M, Celer O, Akalın A. Relationship between 1, 25-dihydroxy Vitamin D levels and homeostatic model assessment insulin resistance values in obese subjects. Niger J Clin Pract 2015;18:377-80.  Back to cited text no. 12
[PUBMED]  [Full text]  
Kocyigit H, Aydemir O, Fisek G, Olmez N, Memis A. Validity and reliability of Turkish version of Short form 36: A study of a patients with romatoid disorder. J Drug Ther (in Turkish) 1999;12:102-6.  Back to cited text no. 13
Büyükyilmaz F, Sendir M, Salmond S. Evaluation of body image and self-esteem in patients with external fixation devices: a Turkish perspective. Orthop Nurs 2009;28:169-75.  Back to cited text no. 14
Özgür G, Gümüş BA, Palaz C. Investigation of depressive symptom levels of obese individuals and effective factors. J Anatol Nursing Health Sci 2008;11:3-5.  Back to cited text no. 15
Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, et al. FG. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. 2010;67:220-9.  Back to cited text no. 16
Cash TF, Pruzinsky T. Body image New York: A Division of Publications, Inc. 2002;5-210.  Back to cited text no. 17
The Management of Overweight and Obesity Working Group, VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity, Washington. 2006;15-117.  Back to cited text no. 18
Satman I, Omer B, Tutuncu Y, TURDEP II. Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28:169-80.  Back to cited text no. 19
Ata A, Vural A, Keskin F. Body perception and obesity. Ankara Med J 2014;14:74-84.  Back to cited text no. 20
Singh GK, Siahpush M. Ethnic-Immigrant Differentials in Health Behaviors Morbidity Cause-Specific Mortality in the United States: An Analysis of Two National Data Bases, Human Biology, Wayne State University Pres USA. 2002;74:83-109.  Back to cited text no. 21
Sadock BJ, Sadock VA. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. Baltimore: Lippincott Williams and Wilkins 2000;1787-97.  Back to cited text no. 22
Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev 2001;2:219-29.  Back to cited text no. 23
Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. Body image and quality of life in post massive weight loss body contouring patients. Obesity 2006;14:1626-36.  Back to cited text no. 24
Palmeira AL, Markland DA, Silva MN, Branco TL, Martins SC, Minderico CS, et al. Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis. Int J Behavior Nutr Phys Act 2009;6:1-12.  Back to cited text no. 25
Lazar CC, Clerc I, Deneuve S, Auquit-Auckbur I, Milliez PY. Abdominoplasty after major weight loss: improvement of quality of life and psychological status. Obes Surg 2009;19:1170-175.  Back to cited text no. 26
Doll HA, Petersen SE, Stewart-Brown SL. Obesity and physical and emotional well-being: associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire. Obes Res 2000;8:160-70.  Back to cited text no. 27
Budderberg-Fıscher B, Klaghofer R, Sigrist S, İ Budderberg C. impact of psychosocial stres and symptoms on indication for bariatric surgery and outcome in morbidly obese patients. Obese Surg 2004;14361-9.  Back to cited text no. 28
Levin J. Obesity and self-image. New York: The Rosen Publishing Group 2009;58.  Back to cited text no. 29
Wykes M, Gunter B. The media and body image. Great Britain: Athenaeum Press 2005;65-190.  Back to cited text no. 30
Muennig Peter. The body politic: the relationship between stigma and obesity-associated disease BMC Public Health 2008;8:128. DOI: 10.1186/1471-2458-8-128.  Back to cited text no. 31
Migliori F, Rosati C, D'Alessandro G, Cervetti GG. Body contouring after biliopancreatic diversion. Obes Surg 2006;16:1638-44.  Back to cited text no. 32
Hout GC, Hagendoren CA, Verschure SK, Heck GL. Psychosocial predictors of success after vertical banded gastroplasty. Obes Surg 2009;19:701-7.  Back to cited text no. 33
Gardner RM, Gallegos V, Martinez R, Espinoza T. Mirror feedback and judgments of body size. J Psychosom Res 1989;33:603-7.  Back to cited text no. 34
Schwartz MB, Brownell KD. Obesity and body image. Body Image 2001:43-56.  Back to cited text no. 35
Talen MR, Mann MM. Obesity Mental Health Primary Care Clinics in Office Practice. 2009;36:17-34.  Back to cited text no. 36
Alicia R, Ruelaz MD. Psychiatric involvement in obesity treatment. Focus 2009;3:310-16.  Back to cited text no. 37
Faulconbridge LF, Wadden TA, Berkowitz RI, Sarwer DB, Womble LG, Hesson LA, et al. Changes in symptoms of depression with weight loss: results of a randomized trial. Obesity (Silver Spring) 2009;17:1009-16.  Back to cited text no. 38
Dhananjai S, Sadashiv J, Tiwari S, Dutt K, Kumar R. Reducing psychological distress and obesity through Yoga practice. Int J Yoga 2013;6:66-70.  Back to cited text no. 39
[PUBMED]  [Full text]  
Hayden MJ, Dixon JB, Dixon ME, Shea TL, O'Brien PE. Characterization of the improvement in depressive symptoms following bariatric surgery. Obes Surg 2011;21:328-35.  Back to cited text no. 40
Kolotkin RL, Meter K, Williams GR. Quality of life and obesity. Obes Rev 2011;2:219-29.  Back to cited text no. 41
Colles SL, Dixon JB, O'Brien PE. Loss of control is central to psychological disturbance associated with binge eating disorder. Obesity (Silver Spring) 2008;16:608-14.  Back to cited text no. 42
Wedin S, Byrne K, Morgan K, Lepage M, Goldman R, Crowley N, et al. Presurgical weight is associated with pain, functional impairment, and anxiety among gastric bypass surgery patients. Pain Res Treat 2012;15:35-45.  Back to cited text no. 43


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

This article has been cited by
1 The Effect of Care Needs on Quality of Life and Chronic Disease Care in Patients with Diabetes
Turkish Journal of Family Medicine and Primary Care. 2020; : 56
[Pubmed] | [DOI]
2 Body-image distress is increased in women with polycystic ovary syndrome and mediates depression and anxiety
Snigdha Alur-Gupta,Anat Chemerinski,Chang Liu,Jenna Lipson,Kelly Allison,Mary D. Sammel,Anuja Dokras
Fertility and Sterility. 2019;
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Article Tables

 Article Access Statistics
    PDF Downloaded353    
    Comments [Add]    
    Cited by others 2    

Recommend this journal