See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/228482366

The relationship between body weight, body image, self esteem and
relationship quality

Article · November 2005

CITATIONS READS

0 215

1 author:

Melinda Millard
Austin Health
9 PUBLICATIONS   52 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Melinda Millard on 04 January 2016.

The user has requested enhancement of the downloaded file.

The Relationship Between Body Weight, Body Image, Self Esteem
and Relationship Quality

Melinda Millard
B.App.Sc.(Nursing), Grad.Dip.CritCare, Grad.Dip.B.Sc.(Psyhology)
0653535

A thesis submitted in partial fulfilment of the requirements of

the degree of Honours in Psychology

Faculty of Life and Social Sciences

Swinburne University of Technology

October 2005

Word count
10,066
 Table of Contents

Page

Declaration vii

Acknowledgements viii

Abstract x

Table of Contents

Chapter 1: Introduction 1

1.1 Prevalence of Obesity 1

1.2 Economic Consequences of Obesity 2

1.3 Medical and Psychological Consequences of Obesity 3

1.4 Definition of Obesity 4

1.5 Etiology 4

1.6 Prejudice and Discrimination 5

1.7 Body Image and Body Image Dissatisfaction 7

1.8 Body Image and Obesity 8

1.9 Body Image and Self Esteem 10

1.10 Body Image and Relationship Quality 12

1.11 Self Esteem and Relationship Quality 20

1.12 The Present Study 21

1.13 Research Aims and Hypotheses 23

Chapter 2: Methodology 24

2.1 Participants 24

2.2 Measures 26

2.2.1 Body Mass Index 27

2.2.2 The Contour Drawing Rating Scale 27

2.2.3 The Rosenberg’s Self-Esteem Scale 28

2.2.4 Relationship Satisfaction Scale 28

2.3 Procedure 29

Chapter 3: Results 30

3.1 Overview of Results 30

3.2 Preliminary Data Analyses 30

3.2.1 Detecting Outliers 31

3.2.2 Assessing Univariate Normality, Linearity and

Homoscedasicity 31

3.3 Data Analysis 32

3.3.1 Intercorrelations between the variables 32

3.3.2 Differences on Body Image, Self-esteem, and

Relationship Quality Constructs for Body Weight

Groups 33

3.3.3 Post Hoc Comparisons 36

3.4 Mediation Analysis 37

Chapter 4: Discussion 39

4.1 Overview of Aims and Findings 39

4.2 Body Weight and Body Image 40

4.3 Body Weight and Self-Esteem 44

4.4 Body Weight and Relationship Quality 48

4.5 Mediation 49

4.6 Implications 49

4.7 Further Limitations of the Present Study and Directions for

Future Research 52

4.8 Conclusion 54

Chapter 5: References 56

Chapter 6: Appendices 84

Appendix A: Informed Consent and Questionnaire

 List of Tables

Page

Table 1 Summary of Reliability Coefficients and Bivariate

Correlations Between Study Variables 33

Table 2 Means and Standard Deviations of Body Mass Index, Body

Image, Self-Esteem and Relationship Quality for Healthy,

Overweight and Obese Weight Groups. 35

Table 3 Squared semi partial Correlation, Standard and Unstandardised

Beta Coefficients, Standard Error and Significance with

Mediation of Body Image 37

 List of Figures

Page

Figure 1 Mediational Model for Self-Esteem 38

 Declaration

I declare that this report does not incorporate without

acknowledgement any material previously submitted for a degree in any

University, College of Advanced Education, or other educational institution,

and that to the best of my knowledge and belief it does not contain any

material previously published or written by another person except where due

reference is made in the text.

I further declare that the ethical principles and procedures specified in

the School of Behavioural and Social Sciences Human Research Ethics

Committee document have been adhered to in the preparation of this report.

Name: Melinda S. Millard

Signed:

vii
 Acknowledgements

I would like to thank the following people who played significant roles in this
project:

Dr. Simon Knowles, for his supervision throughout the bulk of the research.
His expertise, guidance, support, patience, optimism and sense of humour
were truly appreciated.

Dr. Katie Wood, for her expertise and guidance in the initial phase of the
research.

Dr. Nic Kambouropoulos for his assistance with REP and when Simon was
away.

My partner Charlie, for many things, but mostly for his belief in me, which
never wavered and helped me to persevere and strive for success.

My darling daughter Amelia, your presence constantly put things into

perspective especially when I was about to lose my grip on reality. Thanks
also to Playschool and the Wiggles!

My stepson Oliver, for his patience in letting me use the computer in his
room, while he tried to play or sleep.

My Golden Retriever Hamish, the walks helped create the balance required to
get through.

viii
My parents and grandmother, for looking after Amelia every Friday, and
helping with the endless task of housework.

My friends, for clarifying, proofreading, and understanding my absence from

their lives.

My work colleagues and patients, for their patience and understanding

especially on the occasions when I was distracted.

To the authors of some of the reviewed articles, who kindly sent me copies of
their work, when I was unable to access these via the databases.

Finally, I would like to thank the organisations that made collection of data

possible, and of course the many people for their keen participation and

interest in such an important area of research.

ix
 Abstract

The aim of the current study was to examine the relationships between body

weight, body image, self-esteem and relationship quality in a community

sample of obese, overweight and healthy weight individuals. It was

hypothesised that as body mass index increased individuals would report

greater body image dissatisfaction, experience lower self-esteem and perceive

poorer relationship quality. A further prediction was self-esteem would

mediate the relationship between body image and relationship quality. The

sample consisted of 214 subjects, 162 were female and 52 were male, ages

ranged from 18 to 72 years (M = 36.22 years, SD = 10.89 years). The

participants anonymously completed a self-report questionnaire. The results

supported the hypotheses, demonstrating a significant difference in the trends.

This was significantly different for obese and healthy weight individuals, but

not for overweight individuals. Future research using a larger sample size

may assist in determining a difference. In addition, self-esteem mediated the

relationship between body image and relationship quality. These findings

support the idea obesity is indeed a complex condition that includes important

psychological and psychosocial elements, which should not be overlooked

when dealing with an obese individual.

x
 Chapter 1

Introduction

1.1 Prevalence of Obesity

Obesity today is far from being a problem experienced by a select few. In

Australia, and indeed in most Western countries, the frequency of obesity is

increasing at an alarming rate (Field, Barnoya, & Colditz, 2002). According

to the World Health Organisation (WHO) the prevalence of obesity has

reached epidemic proportions throughout the world, affecting virtually all age

groups (Cameron, 1999; Mustillo, Worthman, Erkani, Keeler, Angold, &

Costello, 2003; Waters & Baur, 2003; Zametkin, Zoon, Klein, & Munson,

2004) and socio-economic groups (Variyam, 2002; WHO, 2000). Rather than

being an issue affecting only developed nations, obesity is now a global

concern, as the prevalence is beginning to rapidly rise in developing countries,

often coexisting with malnutrition (WHO, 2000). It has been estimated that

approximately 300 million adults are obese globally (Australian Institute of

Health and Welfare Health [AIHW] & National Heart Foundation of Australia

[NHFA], 2004; WHO, 2000). Recent statistics on Australia's obesity problem

estimated the proportion of obese adults has doubled in the past decade, with

over 3.3 million adults now classified as obese (Australian Bureau of

Statistics [ABS], 2001; AIHW & NHFA, 2004; Cameron, Welborn, Zimmet,

Dunstan, Owen, Salmon, Dalton, Jolley, & Shaw, 2004). In addition, the

report found obesity is becoming one of the biggest health problems facing

1
Australia today, with well documented links to high morbidity and mortality

rates (Allison, Fontaine, Manson, Stevens, & VanItallie, 1999; AIHW &

NHFA, 2004; Field et al., 2002; O’Brien & Webble, 2004; Waters & Baur,

2003).

1.2 Economic Consequences of Obesity

Obesity is a contributing factor in thousands of deaths and is responsible

for a large percentage of chronic physical and psychological illness and

disability of Australian adults annually (ABS, 2001; Doll, Petersen, &

Stewart-Brown, 2000; Cameron et al., 2004). Subsequently, obesity

contributes significantly to the increasing health care costs of most

industrialised countries (Field et al., 2002; Kortt, Langley, & Cox, 1998;

WHO, 2000). Indirect costs, such as the value of lost productivity and loss of

wages are also rising rapidly (Gorstein & Grosse, 1994; Gortmaker, Must,

Perrien, Sobal, & Dietz, 1993; Rosenberger, Sneh, Phipps, & Gurvitch, 2005).

Undoubtedly the medical and economic consequences of obesity are

profound, resulting in reduced quality of life and life expectancy, and

accounting for billions of dollars in health care expenditure (Fontaine,

Baraofsky, & Cheskin, 1997; Fontaine, Cheskin, & Baraofsky, 1996;

Gortmaker et al., 1993; Kolotkin, Head, Hamilton, & Tse, 1995; Kolotkin,

Meter, & Williams, 2001).

2
1.3 Medical and Psychological Consequences of Obesity

Clearly, this heterogeneous condition has severe adverse physical and

psychological consequences (Doll et al., 2000; Weschler & Leopold, 2003).

Obese individuals are at greater risk of developing diseases such as type II

diabetes (Cameron et al., 2004), cardiovascular disease, like hypertension

(Gallagher, Franklin, Ehrman, Keteyian, Brawner, de Jong, & McCullough,

2005), stroke, atherosclerosis (AIHW & NHFA, 2004), depression (Freidman

& Brownell, 1995 cited in Wadden, Womble, Stunkard, & Anderson, 2002)

and some types of cancer (Pan, Johnson, Ugnat, Wen, & Mao, 2004). Non-

fatal disorders like sleep apnoea, osteoarthritis (Gallagher et al., 2005;

Visscher & Seidell, 2001), and lowered self-esteem (Johnson, 2002) can also

present in obese people. Obese people are at greater risk of experiencing co-

morbidities and are as a result more difficult to treat, especially in terms of

complications post surgery (Cameron et al., 2004; Doll et al., 2000; Weschler

& Leopold, 2003). For example, weaning from mechanical ventilation is

often fraught with difficulty, as is repositioning unconscious obese individuals

in bed to try to prevent blood clot formation, the development of pneumonia,

or pressure sores (Trembley & Bandi, 2003). These are but a few examples

and demonstrate how ensuing longer hospital stays are sometimes inevitable

(Epstein, Read, & Hoeffer, 1987).

3
1.4 Definition of Obesity

Obesity is commonly defined as having excess body fat (Field et al., 2002;

Sobal, 1984), however measuring body fat is difficult (AIHW & NHFA,

2004). Traditionally body mass has been measured by weight alone or weight

adjusted for height (AIHW & NHFA, 2004; Field et al., 2002; Hoyt & Kogan,

2001). In recent years, body mass index (BMI) has become the most

commonly used method to determine body weight in adults and is a

reasonable reflection of overall body fat (Field et al., 2002; Weschler &

Leopold, 2003). BMI is an individual’s weight calculated in kilograms

divided by the square of their height in metres (AIHW & NHFA, 2004;

Weschler & Leopold, 2003; WHO, 2000). The BMI classification applied by

the WHO defines obesity as a BMI greater than 30 (WHO, 2000).

1.5 Etiology

The increasing obesity epidemic reflects a change in society and its

behavioural patterns (AIHW & NHFA, 2004; WHO, 2000). Put simply, the

population is eating more and undertaking less physical activity. Poor

nutrition, including foods that are energy-dense, nutrient poor, and which

contain high levels of saturated fats and sugar, when combined with a marked

reduction in physical activity have led to the global rise of obesity (AIHW &

NHFA, 2004; Dixon & Waters, 2003; WHO, 2000). A notable shift towards

less physically demanding jobs, more passive leisure pursuits and the

4
escalating use of technology at work and home has created a more sedentary

lifestyle (Dixon & Waters, 2003; O’Brien & Webble, 2004; WHO, 2000).

1.6 Prejudice and Discrimination

Historically carrying a few extra kilos symbolised an affluent lifestyle, a

style of figure well desired (Schwartz & Brownell, 2003). Today the situation

is somewhat different. Social perceptions and expectations of the ideal body

in the modern Western world emphasise thinness (Anshel, 2004; Kim & Kim,

2001; Schwartz & Brownell, 2003). Being overweight, more particularly

obese, is no longer acceptable (Anshel, 2004; Schwartz & Brownell, 2003).

Negative attitudes, subsequent prejudice and discrimination have now become

commonplace (Cash, 2004; Grover, Keel, & Mitchell, 2003; Hoyt & Kogan,

2001; Schwartz & Brownell, 2003). It is paradoxical that in a culture that

worships slimness, the population is getting larger (Parquette & Raine, 2004;

Perez & Joiner, 2002).

Obesity comes from the Latin obesus, which has two meanings: The less

well-known meaning is coarse or vulgar (Barnett, 2005), the latter a view

frequently synonymous with obese individuals. The literature reflects a

widely held societal view that obese people are less competent, less attractive,

less desirable, and less disciplined than healthy weight individuals (Cash,

1995; Fowler, 1989; Gortmaker et al., 1993; Grover et al., 2003; Rothblum,

Brand, Miller, & Oetjen 1990; Sargent, & Blanchflower, 1994; Schwartz &

5
Brownell, 2003; Wadden et al., 2002). Negative stigmatisation has been

found to have consequences in educational, socio-economic, relational and

occupational facets of the obese individual’s life (Blaine, DiBlasi, & Connor,

2002; Bocchieri, Meana, & Fisher, 2002). Obese people are prejudiced in

dating relationships, have greater difficulty attracting a marriage partner,

marry later, marry less desirable partners, and marry heavier partners (Blaine

et al., 2002; Enzi, 1994; Mendelson, Mendelson, & Andrews, 2000; Sheets &

Ajmere, 2005; Sobal, Rauschenbach, & Frongillo, 1995; Sobal,

Rauschenbach, & Frongillo, 2003). These findings are not surprising when

other studies have found obese people are more likely to remain single

throughout life, are perceived to be less sexually active (Trappnell, Meston, &

Gorzalka, 1997) and have fewer dating opportunities (Gortmaker et al., 1993;

Wiederman & Hurst, 1998). In Wiederman and Hurst’s (1998) study, women

who believed they might be ridiculed and stigmatised because of their weight

frequently avoided social settings. The authors concluded social

marginalisation further limited development of social skills and any prospect

for the formation of interpersonal relationships. This is a view robustly

supported and well acknowledged in other studies (Miller, Rothblum,

Barbour, Brand, & Felicio, 1990; Strauss & Pollack, 2003). Fowler (1989)

extended on this viewpoint and proposed that a lack of social interaction

inhibited the development of identity formation, which has been found to

affect self-esteem and body image.

6
1.7 Body Image and Body Image Dissatisfaction

The bias against obese people is frequently considered the last form of

socially acceptable discrimination against a minority group (Bocchieri et al.,

2002; Wadden et al., 2002). With ubiquitous prejudice and discrimination of

obesity, it is not surprising obese people internalise these opinions shaped by

the cultural expectations of thinness (Hoyt & Kogan, 2001; Sarwer &

Thompson, 2002). Unable to escape the pressures to achieve the ideal body,

the pursuit of thinness has led to concomitant increases in dieting behaviour

(Hoyt & Kogan, 2001; Kim & Kim, 2001). Dieting has been implicated in

such problematic behaviours as disordered eating (de Zwaan, 2001; Perez &

Joiner, 2002; Rieder & Ruderman, 2001), which may, in part, explain the

upsurge in eating disorders over the past few decades (Becker, Burwell,

Navara, & Gilman, 2003; de Zwaan, 2001; Furnham, Badmin, & Sneade,

2002; Reider & Ruderman, 2001) especially in young girls (Anshel, 2004;

Burrows & Cooper, 2002; Holt & Espelage, 2002; Slade, 1995). In addition,

attempting to emulate the impossible cultural body ideal has seen a significant

rise in body image dissatisfaction (Sarwer & Thompson, 2002; Sarwer,

Thompson, & Cash, 2005).

Body image is an active and complex area of research in psychology, a

construct often conceptualised as multidimensional in nature (Franzoi &

Herzog, 1986; Franzoi & Shields, 1984). Whilst there is no one clear

definition of body image, there is an extensive body of research that suggests

7
body image can be described as an individual’s own perception of and attitude

about his or her body (Cash, Morrow, Hrabosky, & Perry, 2004; Pruzinsky &

Cash, 2002; Connor, Johnson, & Grogan, 2004). Therefore, having a negative

attitude and perception towards one’s body would imply body image

dissatisfaction. Today, being unhappy with your body shape and weight is the

norm, rather than the exception (Befort, Foley-Nicpon, Robinson-Kurplus, &

Huser, 2001; Furnham & Calnan, 1998; Sarwer & Thompson, 2002; Sarwer et

al., 2005; Wadden et al., 2002).

1.8 Body Image and Obesity

Obese people are receiving the message, predominantly via the media

(Bas, Asci, Karabudak, & Kiziltan, 2004; Dittmar & Howard, 2004;

Sherblom, 2004), that thinness equals attractiveness (Fallon & Rozin, 1985;

Kostanski & Gullone, 1998; Grover et al., 2003). With the exclusion of

underweight individuals, evidence unmistakably demonstrates that body

image dissatisfaction worsens as BMI increases (Hill & Williams, 1998;

Markey, Markey, & Birch, 2004; Schwartz & Brownell, 2003). Obese

individuals frequently report more body image dissatisfaction compared to

other weight groups (Pole, Crowther, & Schell, 2004; Sarwer, Wadden &

Foster, 1998; Wadden et al., 2002). However, Sarwer and Thompson (2002)

found the level of body image dissatisfaction did not worsen as the degree of

obesity increased.

8
 In a study by Sarwer and colleagues (1998), the behaviour of a sample of

predominantly obese participants was influenced by poor body image. The

women reported being frequently upset when thinking about their bodies,

hiding their obesity with loose clothing, avoided looking at their bodies and

went to great lengths to prevent others, including their partners, from seeing

their figure. Interestingly, this behaviour is not specific to obese populations,

but has been found to extend across all weight groups (Davison & McCabe,

2005). Undoubtedly, having poor body image significantly impacts on one’s

life. The apparent lack of research investigating the causality of the

association between body image and obesity is noteworthy considering the

topical nature of both variables and subsequent negative consequences.

The link between obesity and body image becomes less apparent when

investigating subgroups, such as women seeking weight loss or women with

binge eating disorders. To demonstrate, Sarwer et al. (1998) found no

significant correlation between body image and BMI in their sample of

overweight women seeking weight loss treatment. Similar results were

demonstrated in Matz, Foster, Faith, and Wadden’s (2002) study. However, it

is feasible confounding factors such as increased self-esteem, for example,

may have influenced these results. It is well acknowledged that at the

commencement of treatment programs, self-esteem improves markedly,

especially if weight loss is experienced (Doll et al., 2000; Johnson, 2002;

Porter & Wampler, 2000; Teixeir, Going, Houtkooper, Cussler, Martin,

9
Metcalfe, Finkenthal, Blew, Sardinha, & Lohman, 2002, cited in Teixeir,

Going, Sardinha, & Lohman, 2005). Interestingly, as noted by Nir and

Neumann (1991), in their study, self-esteem returned to baseline twelve

months after program commencement, regardless of weight loss. Russell and

Cox (2003) proposed that with weight loss, perceptions of the ideal body alter

causing a shift toward a thinner standard, and hence resultant body image

dissatisfaction continues. Of course, not all obese people have poor body

image and are vulnerable to developing body dissatisfaction (Faubel, 2001;

Sarwer et al., 2005; Teixeira, Going, Sardinha, & Lohman, 2005), which is an

issue that still remains one of the enigmas confronting theorists of body

image. While investigation findings are beginning to provide a better

understanding of body image and obesity and the related effects, the picture

still remains unclear.

1.9 Body Image and Self Esteem

Self-esteem is considered to be one of the most researched constructs in the

field of psychology (Rosenberg, Schooler, Schoenbach, & Rosenberg, 1995).

Self-esteem can be conceptualised as a person’s independent feelings about

themselves (Rosenberg, 1965). That is, individuals with high self-esteem

have been characterised as possessing self worth and self-respect, and indeed

better psychological well-being (Rosenberg et al., 1995). In contrast, those

with low self-esteem are thought not to respect themselves, feel inadequate,

unworthy or otherwise inefficient (Rosenberg, 1979). Findings have shown

10
low self-esteem can have detrimental effects on psychological well-being as

well as physical health (Gray–Little & Hafdahl, 2000; Rosenberg et al., 1995).

Extensive research findings have found the association between self-

esteem and body image to be consistently high (Befort et al., 2001; Davison &

McCabe, 2005; Furnham et al., 2002; Henriques & Calhoun, 1999; Kim &

Kim, 2001; Mirza, Davis, & Yanovski, 2005; Secord & Jourard, 1953;

Thompson & Thompson, 1986). This implies that those who report low body

image are likely to report poorer self-esteem. Interestingly, Keppel and

Crowe (2000) inferred people who were predisposed to lower self-esteem

were more likely to develop negative body image, rather than poor body

image being the cause of low self-esteem. Matz et al. (2002) found self-

esteem accounted for a large variance in body image dissatisfaction, which

suggests evaluations of physical self and overall self are linked. In support of

this inference, numerous other studies have concluded body image is perhaps

not a separate construct to self-esteem but an important aspect of self-esteem,

frequently termed body esteem (Franzoi & Herzog, 1986; Lerner &

Karabenick, 1974; Lerner, Karabenick, & Stuart, 1973; Mendelson, McLaren,

Gauvin, & Steiger, 2002; Mendelson et al., 2000; Pilner, Chiken, & Fleet,

1990; Secord & Jourard, 1953). This is a possible explanation why obese

individuals vary in their body image perceptions. Hence, body image

evaluations have significant implications for more global evaluations of the

11
self, and for self-esteem (Henriques & Calhoun, 1999; Mendelson,

Mendelson, & White, 2001).

Self-esteem and body image have both been crucially linked to the

development and course of affective disorders like depression (Davison &

McCabe, 2005; Masheb & Grilo, 2002; Wadden et al., 2002). More

specifically, consistent findings demonstrate low self-esteem and poor body

image, significantly correlate with depression (Davison & McCabe, 2005;

Keppel & Crowe, 2000). As obese individuals are prone to low self-esteem

and low body image these findings strongly suggest depression is a significant

risk factor for this population. Despite this evidence there are very few

studies that have investigated body image and self-esteem in an obese

population.

1.10 Body Image and Relationship Quality

Conceptually it would seem logical that individuals who feel positively

about their bodies would be more comfortable and confident within

themselves, and this confidence would permeate other areas of life, including

interpersonal relationships (Wadden et al., 2002). As obese individuals tend

to report poorer body image, it is reasonable to expect they may experience

poorer relationship quality than other weight groups (Macias, Leal, Lopez-

Ibor, Rubio, & Caballero, 2004).

12
 Inherently, human beings are social creatures who require interpersonal

relationships for personal growth and development (Lang & Fingerman, 2004;

Robles & Kiecolt-Glaser, 2003). The role of the marital (partner) relationship

is particularly important, because research has consistently found that a good

marital relationship predicts better physical and psychological health, and

overall well-being (Lang, & Fingerman, 2004; Katz & Joiner, 2002, Sobal,

Rauschenbach, & Frongillo, 1992; Sobal et al., 2003). As noted by Sobal et

al. (1992, 2003), because of the social support and intimacy this relationship

provides, married people are generally healthier and are subsequently at a

lower risk of death than people who are unmarried. Wickrama and Lorenz

(1997) found a negative correlation between relationship quality and illness,

such that as relationship quality improved, physical illness decreased.

Research has shown marriages where at least one partner is obese are

unhappier unions (Sobal et al., 2003). This suggests that obesity can negate

the value of good relationship quality and well-being.

Relationship quality can be conceptualised as assessing the perceptions

individuals have about their feelings, behaviours and attitudes towards his or

her relationship (Hendrick, 1988; Lang & Fingerman, 2004). A good quality

relationship is when the individual perceives overall satisfaction in their

relationship. Research in the field of relationship quality has been somewhat

burdened with assessment issues, with the matter of how to evaluate

relationship quality appropriately remaining largely unresolved. One issue is

13
defining what is being investigated. More specifically, global relationship

quality scales are being applied to measure specific dimensions of

relationships. To illustrate, the dimension of intimacy is measured and

evaluated using a global scale rather than analysing the construct

independently. A further limitation is despite the increasing trend of

cohabitation (ABS, 2001), cohabiting couples including homosexual couples,

are poorly represented in study samples. The present study endeavours to

address this methodological limitation.

Previous research findings investigating the association between

relationship quality and body image are offering new and interesting insights.

However, studies have primarily focused on peer and romantic heterosexual

relationships in the general population. A review of the literature established

body weight is associated with marriage (Lipowicz, Gronklewicz, & Malina,

2002; Sobal et al., 2003). More specifically, individuals, especially women,

will gain weight in the first few years after the wedding (Anderson, 2004;

Bove, Sobal, & Rauschenbach, 2003; Jeffrey & Rick, 2002; Sobal et al.,

2003). Interestingly however, Sobal and colleagues (1995), in their earlier

work, found weight gain after the wedding was only prevalent for men and

not women. Nonetheless, it was deduced that having a spouse, encouraged

and facilitated eating among people (Sobal et al., 2003; Jeffrey & Rick, 2002).

Furthermore, married individuals were more likely to be overweight and

14
obese than those who are unmarried (Kahn, Williamson, & Stevens, 1991;

Lipowicz et al., 2002; Sobal & Rauschenbach, 2003; Sobal et al., 1992, 2003).

Interestingly, Sobal et al., (1995) established obese women were more

likely to be satisfied with their marriages, while obese men tended to have

marital concerns. Stuart and Jacobson’s (1987) study, found a link between

weight gain and poor relationship quality. In their community sample of

women, those in unsatisfactory marriages gained more weight than happily

married women. The authors implied women turned to food for comfort to

help with satisfying emotional needs not present in the relationship and to

avoid or escape the stresses of the relationship. In support of this, based on

the systemic model, Ganley (1986) postulated obesity is a psychosomatic

syndrome that fulfils a homeostatic role in relationships to camouflage other

problems. These observations are not unfounded (Becker et al., 2003; Makeri,

Cummings, & Lees, 1997; de Zwann, 2001). Although binge eating was first

recognised by Stunkard (1959) as an important characteristic of obesity,

recent recognition that binge eating behaviour is widespread has gained

momentum (Bocchieri et al., 2000; de Zwann, 2001).

Qualitative research by Faricy (1991) also sheds light on the effect obesity

has on relationship quality. Through individual interviews, spouses and their

obese partners reported that obesity put his or her relationship under pressure.

A theme to emerge highlighted that the excessive weight of one partner was a

15
source of conflict, frequently resulting in emotional and sexual distancing

with the potential outcome being marital discord and poorer relationship

quality. Quantitative studies have backed these findings, having established

that overweight couples report difficulty with intimacy as a consequence of

their weight, which has resulted in poorer relationship quality (Cash,

Theriault, & Annis, 2004; Doherty & Harkaway, 1990; Rand, Kowalske, &

Kuldau, 1984: Rand, Kuldau, & Robbins, 1982). Though this information is

useful, a gap in the literature exists when attempting to discern why an

increase in BMI is linked to marriage, what the subsequent effects on

relationship quality might entail and more specifically, whether body image is

a contributing factor.

In general, studies investigating body image and relationship quality

suggest greater body image dissatisfaction is associated to lower relationship

quality. Hoyt and Kogan (2001) established a correlation in a sample of

university students’ peer and romantic relationships. However, it was difficult

to evaluate relationship quality accurately, as this was not psychometrically

measured, and only relationship status was determined. In addition, while

BMI was measured its effect on the association was not reported.

Studies observing this correlation in marital partners have demonstrated

inconsistent findings. A link between low body image and perceived poor

relationship quality was demonstrated in the study by Friedman, Dixon,

16
Brownell, Whisman, and Wilfley, (1998). However, this study had several

limitations. BMI classification did not conform to the current WHO

recommendations and therefore people who were of healthy weight and

overweight were considered overweight and obese respectively. Secondly, the

sample was a clinical population of women who were attending a weight loss

program, and so no data on men’s experiences was documented. In addition,

whether the association was affected by confounding factors commonly linked

to clinical groups, such as poor self-esteem (Fennell, 1997; Guillon, Crocq, &

Bailey, 2003). Finally, with acknowledgement from the authors no

psychometrically sound scales were used to measure the variables of body

image and relationship quality. Therefore, the results ought to be interpreted

with caution.

In contrast, results in specific populations reporting altered body image as

a consequence of medical issues such as the removal of a breast due to breast

cancer or congestive heart failure, have in general indicated improved

relationship quality (Andersen & Jochimsen, 1985; Rohrbaugh, Shoham,

Cranford, Nicklas, Sonnega, & Coyne, 2002; Wimberly, Carver, Laurenceau,

Harris, & Antoni, 2005). A possible explanation is that these particular

circumstances allow the partner to give love, support and attention

unreservedly, thereby creating a more supportive cohesion, which can help

foster greater relationship satisfaction and therefore enhance well-being. Also

it is reasonable to assume the experience of body image dissatisfaction under

17
these circumstances is more socially acceptable compared to obesity,

especially since obesity is commonly perceived as a self-induced condition

(Wadden et al., 2002). It is also possible that obesity is not seen as a true

condition, or if so, one that does not require support. Therefore, offering

support may not be done willingly, nor with much enthusiasm or sincerity.

Surprisingly, there is a paucity of studies investigating the effect body

image has on relationship quality in an obese population. One area where a

considerable number of longitudinal studies have revealed inconsistent

findings is following gastric surgery (Crisp, Kalucy, Pilkington, & Gazet,

1977; Dubovski, Haddenjorst, & Murphy, 1985; Hafner, 1991; Leon, Eckert,

Teed, & Buchwald, 1979; Neill, Marshall, & Yale, 1978; Rand et al., 1984;

Rand et al., 1982; Stunkard, Stinnett, & Smoller, 1986). Among these studies,

sexuality is frequently the main focus, where respondents invariably report an

improved sexual life, after experiencing significant weight loss post gastric

surgery. As Crisp et al (1977) demonstrated though, an increase in sexual

function did not necessarily contribute to greater marital satisfaction. Rand et

al. (1982) found in the relationships considered problematic before surgery

improved after surgery albeit for a short period tending to return to the pre-

surgical concerns. Reasons for these findings were akin to Ganley’s (1986)

theory, that obesity previously played a stabilising role in the relationship. It

is postulated that marked weight loss instigates role changes such as increased

autonomy and improved social interactions, that may destabilise the

18
relationship, subsequently leading to marital conflict and discord. These

findings suggest that marital stability and marital satisfaction are indeed two

very different constructs. As a result, they ought to be thought of and treated

separately, especially when dealing with distressed couples in a therapeutic

setting.

In contrast, Dubovski et al, (1985) found improvements to both sexual and

marital functioning. The authors speculated that once respondents no longer

worried about being left by their partner, weight loss helped improve

confidence in many facets of the individual’s life. This enabled respondents

to be more assertive about what they wanted from a relationship and able to

make changes within the relationship.

A limitation of some of these studies, however, was that relationship

quality was frequently assessed without using psychometrically sound

measures and reported retrospectively. This type of analysis is always fraught

with validity and reliability issues (Bergman, Eklund, & Magnusson; 1991).

Nonetheless, it was often speculated that weight loss alone contributed to the

improvement in relationship quality. Alternative reasons for improved

relationship quality such as improved self-esteem and body image were not

explored, although assumed and consequently remain unclear.

19
1.11 Self Esteem and Relationship Quality

Rogers (1959) proposed that individuals who perceive themselves to be

accepted and understood by their partners are likely to have positive self-

evaluation. Thus the link between self-esteem and relationship quality is

intuitive, an association that has been well documented both within

quantitative and qualitative studies, in the general population (Culp & Beach,

1998; Lippes, 1999; Shackelford, 2001). Specifically, the evidence emerging

from these findings has indicated individuals who have poor self-esteem

perceive poorer relationship quality in comparison with individuals who have

high self-esteem (Cramer, 2003).

In their examination of university students’ perception of self-esteem and

relationship quality, Katz and Joiner (2002) reported an interaction among

these two constructs. Specifically, participants with high self-esteem were

more inclined to perceive their relationship as satisfactory. The authors

surmised that subsequent positive implications for personal growth and

development were more likely. Likewise, Cramer (2003) noted an interaction

between self-esteem and relationship quality in his convenience sample of

university students. This was particularly prevalent among students who

required a high level of approval from their partner. Similar results were

determined in a community sample involving older participants whose

relationship length was longer (de Hart, Pelham, & Murray, 2004). However,

20
this study did not use a psychometrically tested scale to test relationship

quality and consequently the results need to be cautiously reviewed.

Despite its intuitive logic, much less is known about the association

between self-esteem and relationship quality in a population of obese

individuals. If obesity is a potential stressor for contributing to marital and

health issues, then research on body weight in relationships is important,

especially since rising divorce rates in the Western world, and indeed

Australia, continue to be a concern (ABS, 2004). There is a dearth of

evidence that clearly demonstrates lower marital functioning is a sound

indictor of divorce (Gottman, 1991; Pittman, 1993; Rogers & Amato, 1997;

Walsh, Jacob, & Simons, 1995). These results taken together strongly suggest

that perhaps self-esteem is consequential for both body image and relationship

quality and therefore self-esteem plays a bigger role in the association

between these two constructs than previously determined.

1.12 The Present Study

A considerable body of research has investigated the physiological effects

of obesity. Although it is vital to understand the medical impact of obesity, it

is equally essential to focus on the psychological and psychosocial

consequences of obesity. While research is beginning to provide a basis for

the psychological and psychosocial aspects related to obesity, these areas have

yet to be studied as systematically or diligently as the physical aspects and

21
therefore remain to be fully understood. In general, this area of research is

characterised by longitudinal, correlational, retrospective studies, is plagued

by causality issues and commonly uses a convenience sample of

predominately female subjects, often recruited from clinical settings. These

investigations frequently produce inconsistent, conflicting results,

complicated by confounding factors.

The literature addressing body image, self-esteem and relationship quality

in an obese population is surprisingly scarce considering the intuitively

reasonable assumption that these constructs would relate. With the increasing

trend of obesity, coupled with the physical, psychological and economic

effects associated with this complex condition for both the individual and

society, it is imperative to study these constructs. Therefore, the current study

attempted to confirm the relationships between body weight, body image,

self-esteem and relationship quality, focusing particularly on obesity. This

study also investigated the role of self-esteem in understanding how it may

influence the association between body image and relationship quality.

Securing an improved understanding of the various affects of obesity will

contribute significantly to this area of psychosocial research and assist in

improving the physical and psychological health and well-being of obese

individuals. It is anticipated that the findings may contribute to research on

developing a conceptual framework for the physical and psychological

treatment of this heterogenous condition.

22
1.13 Aims and Hypotheses

Extending previous research, the aim of the proposed study was to examine

the relationship between body image, self-esteem and relationship quality in a

population of obese, overweight and healthy weight individuals in an attempt

to better understand the effects body weight, in particular obesity, has on these

constructs. More specifically, whether a satisfactory body image protects

obese individuals from experiencing low self-esteem and poor relationship

quality. In addition, the study aims to investigate if self-esteem plays a

mediating role in the association between body image and relationship quality.

It was hypothesised that obese individuals will report poorer body image,

experience lower self-esteem and perceive poorer quality in their romantic

relationship compared to overweight and healthy weight individuals. In

addition, overweight individuals will report poorer body image, experience

lower self-esteem and perceive poorer quality in their romantic relationship

than healthy weight individuals but report higher in these constructs than the

obese weight group. Finally it was hypothesised that self-esteem will mediate

the relationship between body image and relationship quality.

23
 Chapter 2

Method

2.1 Participants

The sample consisted of 214 subjects, 162 of whom were female and 52

were male. Ages ranged from 18 to 72 years (M = 36.22 years, SD = 10.89

years). Fifty-five participants completed the paper version of the

questionnaire (45 females and 14 males, ages ranging from 18 to 58 years, M

= 35.68 years, SD = 12.52 years), and 155 participants the online version of

the questionnaire (117 females and 38 males, ages ranging from 18 to 72

years, M = 36.45 years, SD = 10.24 years). The original sample comprised

392 participants, however 178 cases were excluded from the current study.

The reasons for this were that missing data was greater than 30% for one or

more of the scales (n = 52), they were not in a current monogamous

relationship (n = 15), in a relationship for less than 6 months (n = 14), they

were under 18 years of age (n = 12), or they were underweight BMI<

18.5(kg/m2) (n = 23). In addition, confounding circumstances, which may

have affected the participant’s self-esteem were also excluded. These were

medical conditions (n = 22), a current eating disorder (n = 13), or currently

involved in a weight management program for less than twelve months (n =

21), or a combination of 2 or more of the latter (n = 6).

24
 Participants were recruited from a number of sources. First year

psychological students from Swinburne University received course credit for

participating in the study, or for passing the questionnaire onto another

individual who met the criteria. The link to an online version of the survey

was placed on various websites and internet groups, and a free advertisement

displaying the online address was publicised in a volunteer register column of

a Melbourne newspaper. To be eligible, participants were required to be aged

18 years or over and in a monogamous relationship for more than six months.

The majority of participants reported they reside in Australia (56.5%), with

the remainder residing in America (21.5%), United Kingdom (9.8%), Asia

(5.1%), Europe (4.7%), and other continents or regions (2.4%). The

participants identified mostly with an Australian ethnic group (49.1%),

American (15.9%), United Kingdom (16.4%), Asian (4.2%), European

(7.5%), Mediterranean (4.2%), African (1.4%), or Middle Eastern (1.3%).

Of the sample 15% had attained postgraduate qualifications, 42.6% tertiary

qualifications including university and TAFE, 20.1% were currently

completing a tertiary qualification, and 21.9% had secondary qualifications

(including partial secondary). In terms of primary occupation status, 47.2%

were employed full time, 17.3% part-time, 4.2% casual, 7.5% engaged in

home duties, 13.0% were students, 6.1% were self employed and the

remaining 3.8% were either unemployed, retired or on a disability pension.

25
 Most participants were in a married/defacto relationship 75.3%, while

19.6% were seriously dating, and the remaining 5.1% were engaged and

living apart. The length of these relationships ranged between 6 months to 48

years (M = 3.53, SD = 2.08). The participants were mainly heterosexual

88.8%, while 6.5% were homosexual and 4.7% bisexual.

The vast majority of participants reported to they kept track of their weight

(68.7%) and the weight measurement given was deemed accurate (86%).

Body mass index (BMI) scores ranged from 19.57 to 60.49 (M = 29.04, SD =

7.67). The sample comprised of 76 healthy weight individuals (BMI 18.5-

24.9), 53 were overweight (BMI 25-29.9), and 85 were obese (BMI ≥ 30).

A large proportion of the sample reported they had a weight problem

(62.1%). Fifty-two percent of the sample assessed what they ate, with most

stating this was for a healthier lifestyle (31.3%). Over half of the sample

(52.3%) had partaken in a weight management program in the past for the

main purpose of losing or maintaining weight (33.6%).

2.2 Measures

An array of published, widely used and researched measurements were

compiled to form a self-report questionnaire used to explore the relationships

between body weight, body image, self-esteem and relationship quality.

Demographic questions included age, gender, education, occupation,

26
relationship status, and height and weight were also included. An informed

consent form accompanied both versions of the questionnaire. Refer to

Appendix A for a full copy of the questionnaire and informed consent form.

2.2.1 Body Mass Index

Participants BMI (kg/m2) was calculated using self reported weight and

height values. These were classified into three weight groups; a BMI between

18.5 and 24.9 is considered within the healthy weight range, a BMI between

25 and 29.9 is considered overweight, and a BMI ≥ 30 is considered obese

(WHO, 2000; Weschler & Leopold, 2003). Research indicates that self

reported height and weight is highly correlated with measured height and

weight (Mendelson, Mendelson, & Andrews, 2000; Stevens, Keil, Waid, &

Gazes, 1990; Stewart, 1982).

2.2.2 The Contour Drawing Rating Scale

The Contour Drawing Rating Scale (CDRS) (Thompson & Gray, 1995)

was used to assess the respondents’ body image dissatisfaction. Subjects

rated their current body size and their ideal body size according to a set of

nine male and female figures graduating from small, anorexic body size, to

large, obese body size. The difference between the current and ideal ratings

provided an indication of their existing body image dissatisfaction. A score of

zero indicates body satisfaction, a negative score indicates respondents’

preference for a larger body size and a positive score indicates respondents’

27
preference for a smaller body size. A high score represents greater body

image dissatisfaction. Scores of zero and above were used in this study’s

analysis. As a measure of test-retest reliability, the correlation coefficient

reported by Thompson and Gray (1995), was r = .78 and highly significant p

< .0005. Also, good construct validity was reported by Thompson and Gray

(1995) and was therefore considered psychometrically sound.

2.2.3 The Rosenberg Self-Esteem Scale

The Rosenberg Self Esteem Scale (RSE) (Rosenberg, 1965) was used to

assess the participant’s self-esteem. The RSE reflects a global sense of self-

worth. The scale comprises a 10-item inventory, five positively worded and

five negatively worded questions, such as “ I certainly felt useless at times”.

These items are measured using a 4-point Likert scale ranging from strongly

disagree (1) to strongly agree (4). After reverse coding the five negatively

worded items, items are keyed in a positive direction where scores can range

from 10-40 with a high score representing high global self-esteem. Rosenberg

(1979) reported a test-retest reliability of .88 and strong construct validity,

thereby demonstrating sound psychometric properties for the self esteem

scale.

2.2.4 The Relationship Assessment Scale

The Relationship Assessment Scale (RAS) (Hendrick, 1988) is a 7-item

inventory measured using a 5-point Likert scale, ranging from (5) high

28
satisfaction to (1) low satisfaction. Items are keyed in a positive direction

with scores ranging from 7–35 with a high score indicating high general

relationship satisfaction. Due to the generic nature of Hendrick’s (1988)

relationship scale, it can tap into the several dimensions of relationship quality

while allowing it to be used across many relationship types and

circumstances. For instance, the measure is appropriate for heterosexual and

homosexual couples, married or dating. As a measure of scale reliability, the

alpha coefficient reported by Hendrick (1988) was .86. The RAS has also

demonstrated good test-retest reliability, and discriminant and convergent

validity, and hence, is a psychometrically sound scale (Hendrick, 1988).

2.3 Procedure

All participants completed either the paper version or the online version of

the questionnaire anonymously in their own time, taking approximately 30

minutes to complete. Participants were contacted through websites and

internet groups that were linked to obesity and other related issues.

Undergraduate psychology students were provided with an outline of the

research prior to lecture commencement with the opportunity to take a

questionnaire to complete in their own time. There was no monetary reward

for participation.

29
 Chapter 3

Results

3.1 Overview of Results

The main focus of the research investigated differences between body

weight groups on the variables body image, self-esteem and relationship

quality. In order to test the difference a between-groups multivariate analysis

of variance (MANOVA) was conducted. To test the role self-esteem plays in

the association between body image and relationship quality a mediation

analysis was done.

3.2 Preliminary Data Analyses

The data was analysed using the Statistical Package for Social Sciences

(SPSS) (Version 12). Initial data screening procedures were performed to

ensure there were no errors in the data file. There were very few missing

values in the data set, and these were in a random pattern, so after recoding

negatively worded items, missing values were imputed by a mean substitution

for that particular item. Study variables demonstrated adequate internal

consistency and Cronbach’s alpha for each scale was body image α = .74,

self-esteem α = .88, relationship quality α = .94.

30
3.2.1 Detecting Outliers

Initial data screening revealed a small number of univariate outliers on

each of BMI, body image, self-esteem, and relationship quality variables.

Given the scores appeared to be genuine and were likely to be a legitimate

part of the target sample, all cases were retained for analysis.

3.2.2 Assessing Univariate Normality, Linearity and Homoscedasicity

Examination of the skewness and kurtosis statistics, plus inspection of

histograms and normal probability plots revealed moderate violations of

normality in the variables. The Kolmogorov-Smirnov statistic was

significant, however, significant values of this statistic, indicating violations

of normality, are quite common in larger samples (Pallant, 2001).

Nevertheless, normality tests revealed body image dissatisfaction and BMI

was positively skewed, and, self-esteem and relationship quality were

negatively skewed, all of which seem to reflect the underlying clinical nature

of these measures. Given that skewness rather than outliers were causing the

non-normality, with reasonably large samples skewness does not make a

substantive difference in analyses (Tabachnick & Fidell, 2001). For this

reason, it was decided that transformation of data was not appropriate.

Investigation of the scatterplots and standardised residual plots between each

pair of dependent variables revealed evidence of linearity and

homoscedasicity in all instances.

31
3.3 Data Analysis

3.3.1 Intercorrelations Between the Variables

Correlations and tolerance statistics indicated no evidence of

multicollinearity. As expected, Table 1 demonstrates there was a moderate

positive correlation between BMI and body image. Therefore, people with a

high BMI are more likely to report greater body image dissatisfaction than

individuals with lower BMI. BMI also had weak negative correlations with

self-esteem and relationship quality. As BMI increases, an individual’s self-

esteem and perception of relationship quality decreases. Also as expected,

there was a negative moderate correlation between body image and self-

esteem and a weak negative correlation between body image and relationship

quality. Individuals with greater body image dissatisfaction tend to report

poorer self-esteem and relationship quality than individuals who are more

satisfied with their bodies. A moderate to strong positive correlation between

self-esteem and relationship quality was present, as anticipated. People with

high self-esteem tend to report better relationship quality compared to

individuals whose self-esteem is low.

32
Table 1

Summary of Reliability Coefficients and Bivariate Correlations Between Study

Variables. (N = 214)

Variable 1 2 3 4

1. Body Mass Index –

2. Body Image .55** .74

3. Self-Esteem -.24** -.45** .88

4. Relationship Quality -.23** -.28** .57** .94

Note. *p < .05; **p < .01 *** p < .001, (2-tailed); Cronbach’s alpha values are italicised
across the diagonal

3.3.2 Differences on body image, self-esteem, and relationship quality

constructs for body weight groups.

In order to test for differences between body weight groups in body image,

self-esteem and relationship quality, a between-groups multivariate analysis of

variance (MANOVA) was conducted. The independent variable BMI was

entered after categorisation into the following three weight groups healthy

weight (BMI 18.5 – 24.9), overweight (BMI range 25 - 29.9) and obese (BMI

range > 30). Body image, self-esteem and relationship quality were entered as

the three dependent variables.

Further to the preliminary data analysis, the data for MANOVA was

assessed for suitability. Observations were measured independently of each

other, and the sample size was greater than 30 in each cell, which, according

33
to Pallant (2001) is sufficient. With the use of p<0.001, criterion for

Mahalanobis distance, one multivariate outliers was identified. As the score

was not too diverse, and not likely to make a substantive difference, the case

was retained for analysis.

Levene’s test of equal variance demonstrated non-significant values for the

body image measure only, while self-esteem, relationship quality and BMI

indicated a violation of equal variance. Similarly, Box’s M was significant

revealing a violation of the variance-covariance matrices. Consequently,

Pillai’s Trace statistic was interpreted, as it is the most robust, given there

were some assumption violation (Tabachnick & Fidell, 2001). An alpha level

of .05 was used for all multivariate tests. While MANOVA is robust to

assumption violation when sample sizes are equal, caution should be taken

with the interpretation of this study’s results, as sample sizes were unequal.

The means and standard deviations for BMI, body image, self-esteem, and

relationship quality measures for each weight group are presented in Table 2.

34
 Table 2

Means and Standard Deviations of Body Mass Index, Body Image, Self-

Esteem and Relationship Quality for Healthy, Overweight and Obese Weight

Groups. (N = 214)

Healthy Overweight Obese Total

Measure n = 76 n = 53 n = 85 Construct
Mean
M (SD) M (SD) M (SD) M (SD)

Body Mass Index 22.19 (1.58) 27.06 (1.53) 36.24 (6.49) 28.98 (7.51)

Body Image 2.29 (2.04) 4.15 (1.89) 5.54 (2.55) 4.04 (2.63)

Self-Esteem 31.51 (4.73) 30.25 (6.67) 27.99 (6.85) 29.80 (6.30)

Relationship Quality 28.11 (5.62) 27.32 (6.03) 24.75 (7.30) 26.58 (6.58)

Note. Body Mass Index (kg/m2); Body Image (scale 0-12); Self-Esteem (scale 10-40);
Relationship Quality (scale 5-35).

The means shown in Table 2 clearly demonstrate with an increase in BMI,

body image dissatisfaction worsens, self-esteem is lower and relationship

quality is poorer. Obese individuals reported poorer body image, self-esteem

and relationship quality compared to overweight and healthy weight

individuals.

As expected, the results of the MANOVA indicated there was a significant

differences among the variables body image, self-esteem and relationship

quality for healthy, overweight and obese weight groups, (F (6, 420) = 12.50,

35
p < .001; Pillai’s Trace = .30, partial η2 = .15). The main effects revealed

significant differences in body image (F (2, 211) = 42.98, p < .05, partial η2

= .0.29), self-esteem (F (2, 211) = 6.82, p < .05, partial η2 = .06) and

relationship quality (F (2, 211) = 5.91, p < .05, partial η2 = .53) of the

healthy, overweight and obese body weight groups.

3.3.3 Post Hoc Comparisons

Post hoc comparisons were performed using Tukey Honestly Significant

Difference (HSD) to correct for type I error (Tabachnick & Fidell, 2001).

Tukey HSD indicated obese individuals have greater body image

dissatisfaction than overweight and healthy weight groups. Furthermore, as

expected overweight individuals were found to have poorer body image than

healthy weight groups but reported greater body image satisfaction than obese

individuals.

Obese individuals reported lower self-esteem and perceived poorer

relationship quality compared to healthy weight individuals. There was no

significant difference of the self-esteem and relationship quality constructs

between obese and overweight, and overweight and healthy weight

individuals.

36
3.4 Mediation Analysis

To test the hypothesis that self-esteem mediates the relationship between

body image and relationship quality, a series of three standard regression

analyses were performed, as outlined by Baron and Kenny (1986). Squared

semi partial correlation (Sr2), standard (β) and unstandardised beta (B)

coefficients, standard error (SE B) and significance with mediation of body

image are shown in Table 3.

Table 3

Squared Semi-partial Correlation, Standard and Unstandardised Beta

Coefficients, Standard Error and Significance with Mediation of Body Image.

(N = 214)

B SE B β Sr2

Regression 1

Body Image – Relationship Quality -.68 .17 -.28*** -.27

Regression 2

Body Image – Self-Esteem -1.06 .15 -.45*** -.42

Regression 3

Body Image – Relationship Quality -.07 .16 -.03 -.03

Self-Esteem – Relationship Quality .58 .07 .55*** .52

Note. *p < .05; **p < .01 *** p < .001

37
 Body image significantly predicts self-esteem, and alone significantly

predicts relationship quality. However, when body image and self-esteem are

both in the model, self-esteem significantly predicts relationship quality, but

the effect of body image on relationship quality is no longer significant.

Figure 1 presents a graphical description of the mediation analysis.

Self-Esteem

-.45*** .55***

-.28***
Body Image Relationship
-.03 (ns)a Quality

Figure 1. Mediational Model for Self-Esteem

Note. *p < .05; **p < .01 *** p < .001; ns = non-significant; a refers to the indirect effect
when self esteem is included in the model. Numbers without a refers to the direct effect
without self esteem in the model.
N = 214

As demonstrated in Figure 1, the relationship between body image and

relationship quality was mediated by self-esteem with an indirect effect of .25.

Therefore, 25% of the variance in relationship quality can be explained by the

combined influence of body image and self-esteem. Individuals with good

body image are more likely to report higher self-esteem and therefore perceive

better relationship quality.

38
 Chapter 4

Discussion

4.1 Overview of Aims and Findings

This present study provides important insights about obesity and related

constructs. The investigation was unique and has contributed to the literature,

by means of examining the relationship between body image, self-esteem and

relationship quality, in a community population of obese, overweight and

healthy weight individuals, which had not been tested previously. The general

aims of this research were to extend on previous research but also to take

account for some of the limitations in past literature. This included the

development of specific criteria to categorise individuals into weight groups,

the selection of individuals whose relationship were greater than six months in

duration, and excluding participants who had been diagnosed as having a

current eating disorder, were underweight, currently in a weight loss program

or had a medical condition. By accounting for these, the study addressed the

limitations and decreased the possibility of confounding factors commonly

associated with research in this area.

In addition, this study looked at whether a satisfactory body image

protected obese individuals’ from experiencing poor self-esteem and

relationship quality. It was hypothesised that obese individuals perceptions of

body image, self-esteem and relationship quality would be lower than

39
overweight and healthy weight individuals. In addition, that overweight

individuals, would report poorer body image, self-esteem and relationship

quality compared to healthy weight individuals, but have higher body image

and self-esteem, and better relationship quality than obese individuals. A

further hypothesis was to examine whether self-esteem mediated the

association between body image and relationship quality. The findings in

relation to these specific hypotheses are examined in the following discussion.

4.2 Body Weight and Body Image

The results of the present study found a significant moderate positive

association between body weight and body image dissatisfaction, in that as

BMI increased, body image dissatisfaction increased. These findings support

the hypothesis that obese individuals will report greater body image

dissatisfaction than overweight and healthy weight individuals. Further, as

predicted, overweight individuals perceived poorer body image than healthy

weight individuals but higher body image than the obese weight group. This

relationship is therefore congruent with prior research findings (Sarwer,

Wadden & Foster, 1998; Wadden et al., 2002). Furthermore, the results

overwhelmingly found that the majority of respondents, across all weight

groups, were dissatisfied with their body. This finding simply highlights the

widespread normative discontent with one’s body in Western society today.

40
 One possible explanation for this phenomenon is perhaps the media’s

influence. There is no doubt the media is a pervasive and powerful tool, that

promotes and emphasises the sociocultural ideal of slimness as being normal,

and well desired. The persistent reminder of the ideal body has also created

the attitude that thinness equates to attractiveness. Consequently obese

individuals are getting the message that not only is their body shape and

weight unacceptable, but they are unattractive as well. It is not surprising

then, that this negative attitude and bias has infiltrated the psyche of obese

individuals and shaped their body image perceptions.

For this research sample, body image dissatisfaction appeared to influence

eating habits, as just over half of all the respondents reported assessing what

they ate. This implies that being unhappy with one’s body can influence

particular behaviours. These results lend support to the assertion that dieting

behaviour can alter in the pursuit of the thin ideal. Given that dieting

behaviour has been implicated in disordered eating, this is important to

consider, particularly in a population of obese individuals, as binge eating

disorder is a known characteristic of obesity (Stunkard, 1959). Since obese

people are more vulnerable to developing and experiencing binge eating

disorder than other weight groups, it could therefore be argued disordered

eating is a much larger problem in our community than previously known. In

addition, the current sample comprised a good number of males, which if

these assumptions are indeed true, the issue of disordered eating may well be

41
prevalent in both genders. This adds another dimension to this already

troubling problem and the subsequent ramifications are yet to be understood.

To put this into context though, none of these participants reported having a

current eating disorder as those who did were excluded. However, this

response may be explained by the possibility that there is a lack of knowledge

within the general population, regarding disordered eating, particularly binge

eating. The community is only just starting to acquire knowledge about this

recently recognised disorder. Further research investigating disordered eating

in a community sample of obese males and females needs to be accomplished

to quantify these assertions.

Furthermore, while it was interesting to note eating behaviours were

regularly assessed, very few respondents reported participating in exercise.

Given a large proportion of the sample consisted of obese and overweight

individuals this result is not surprising, as it is well acknowledged society’s

obesity problem is, in part, a consequence of more sedentary behaviours

(AIHW & NHFA, 2004; WHO, 2000). One possible explanation why obese

individuals do not participate in exercise and sport is the potential

embarrassment and ridicule that may confront them. As it is well

acknowledged prejudice and discrimination towards obese individuals is still

rife today. Exercise and sport generally requires a level of fitness and

stamina. Obese people are less likely to be as fit as healthy weight

individuals, which probably impedes their sporting attempts. This only

42
confounds the already difficult situation of weight loss. Nonetheless,

understanding why some behaviours are altered and others are not as a

consequence of body image dissatisfaction, is intriguing and requires more

research to further evaluate the extent of this societal concern.

On the other hand, it could be asserted that the assessment of eating may

be due to the preoccupation with food, a known characteristic of obesity

(Wadden & Phelan, 2002). This lends support to the notion that eating is

potentially problematic for this population. Future studies are needed, to

further establish the dynamics of eating in this population and whether this

behaviour is also regulated and monitored. Although speculative, it seems

society that there is a broad acknowledgment of the obesity problem with little

real effort to rectify the situation. In terms of this sample, this is surprising as

the education level was of a high standard and is thought to be synonymous

with a lower incidence of obesity. This implies that the obesity problem is a

lot more complex than altering behaviour alone.

While behavioural etiology in relation to the obesity epidemic is definitely

relevant, the role of cognitions and affect should also be considered in terms

of these findings (Tiggermann, 2002). Cognitions and affective behaviour

become particularly prevalent when considering the paradox that, despite

society’s tendency to worship thinness, the incidence of obesity continues to

rise (AIHW & NHFA, 2004; WHO, 2000). To illustrate, as individuals

43
become increasingly aware they are unable to realistically emulate current

societal standards and expectations of the ideal body, they find comfort in

food. The media frenzy surrounding body image may have indeed produced a

population of emotional eaters. So, the shift in body weight comprises a much

greater issue than the failure to eat less and exercise more. Cash et al. (2004),

suggests the empowerment of individuals, particularly women, with greater

media literacy in terms of body image and body acceptance, may help to

generate a shift away from the current perceptions of body image

dissatisfaction. However, it appears this development may be a long way off.

This information uniformly highlights the extent of the body image issues

and the subsequent debate in our society today. The problem for the obese

population appears to be of a greater magnitude than for other weight groups.

Future research is undeniably important to further the understanding of other

behavioural, cognitive and affective changes that might be occurring as a

consequence of body image disturbances.

4.3 Body Weight and Self-Esteem

The investigation of the hypothesis that poorer self-esteem would be

prevalent in individuals whose BMI was higher was supported by the results.

There was a weak significant negative relationship between BMI and self-

esteem, where participants with a higher BMI are characterised by

experiencing lower self-esteem. Therefore, the hypothesis that obese

44
individuals would experience lower self-esteem compared to the other weight

groups was supported. This is in line with previous research (Manus &

Killeen, 1995; Wardle, Waller, & Fox, 2002). Post hoc comparisons

however, revealed the link between body weight and self-esteem was

significantly different between the obese and healthy weight groups but not

for the overweight groups. Therefore, trend results ought to be treated with

caution. However, a larger sample size may be required to observe a

significant difference in the self-esteem of obese, overweight and healthy

weight groups.

Unlike all previous studies though (e.g. , Kim & Kim, 2001; Manus &

Killeen, 1995), these findings offer further insight into the area of obesity and

self-esteem in a community sample of adult males and females. In this study

the association between these variables was established in a community

sample of adult men and women, rather than a clinical population of

predominately female participants seeking weight loss, or children. The

evidence clearly demonstrates that the effects of obesity are far greater

reaching than had been previously studied. This information is important to

consider in terms of the potential implications this heterogenous condition

encompasses.

Conceptually, the association between body weight and self-esteem seems

more complex, which suggests other factors, may be influencing this

45
relationship. In this study, the relationship between these variables was low,

which implies a confounding factor may have impacted on this association.

The intercorrelations demonstrated a stronger relationship between self-

esteem and body image. It could therefore be speculated that body image may

indeed play a greater role in the association between self-esteem and body

weight. Past research has demonstrated a relationship between self-esteem

and body image (Davison & McCabe, 2005; Furnham et al., 2002; Henriques

& Calhoun, 1999; Kim & Kim, 2001; Mirza, Davis, & Yanovski, 2005).

Consequently then, these results are not surprising. With this in mind, as

obese individuals are susceptible to low body image they are consequently

more likely to report poorer self-esteem. However, this study is unique in that

few previous studies have observed this link in an obese population. These

findings are important to consider, especially in terms of the development of

depression. Obese individuals are prone to poor self-esteem and low body

image and it would seem they are thus at greater risk of depression. As the

study comprised of a community sample of males and females, the findings

imply that this problem may not be restricted to clinical samples of females

alone as shown in previous research.

Differences in self-esteem between obese and healthy weight individuals

suggest healthy weight individuals encompass a more global interpretation of

self-esteem than obese people. In that they generate a sense of self through

many additional avenues, other than their body. This suggests that healthy

46
weight people have fewer tendencies to be preoccupied with their bodies and

are able to make a clear distinction between the physical self and overall self.

In contrast, obese individuals’ body image evaluations have significant

implications for more global evaluations of the self, and for self-esteem. It is

likely negative attitudes, overt prejudice and discrimination, impacts and

influences how they view their bodies. It is reasonable to assume, this

external pressure becomes all encompassing and be the only means of self-

definition.

Furthermore, there was a fair amount of variance for the self-esteem

variable. Therefore, for each weight group, but particularly the obese and

overweight individuals, there were varying levels of self-esteem. This

suggests that not all obese people have poor self-esteem. This offers a

possible explanation why traditional weight loss programs are successful for

some individuals and not others, such that individuals with increased self-

esteem had greater success with weight loss than those with low self-esteem

(Johnson, 2002). Further exploration investigating the cognitions employed to

enhance self-perceptions to maintain an adequate global self-esteem, may help

to better understand why some individuals are susceptible to low self-esteem

and some are not.

47
4.4 Body Weight and Relationship Quality

Similar results were demonstrated between the variables body weight and

relationship quality. There was a significant main effect between these

constructs, as BMI increased, perceptions of relationship quality worsened.

The findings support the hypothesis that individuals with a greater BMI would

perceive poorer relationship quality. However, caution should be taken when

interpreting this trend, as this difference was only significant for the obese and

healthy weight groups. Again, studies in the future should endeavour to use a

larger sample size to assist in clarifying this issue. Nonetheless, these

findings are consistent with previous research (Sobal et al., 1995; Stuart &

Jacobson, 1987) and provide support to Sobal and colleagues (1995, 2003),

assertion that obesity can be a source of conflict in a marriage, which may

lead to marital unhappiness and potential cessation of the union.

The results showed some variance in relationship quality for the obese

weight group, highlighting that not all obese individuals perceive poor

relationship quality. There are several factors that might be contributing to

this outcome such as better communication, preference for larger figures,

similarity of attitudes, or both partners might be obese and as a result obesity

is not an issue. However, this statistic does lend some support to the assertion

that obesity may play a stabilising role in a relationship (Becker et al., 2003;

Ganley, 1986; Makeri, Cummings, & Lees, 1997; de Zwann, 2001).

However, as Ganley (1986) pointed out, the stabilising role of obesity may

48
help to disguise other problems in the relationship. So, the relationship may

well be of poorer quality anyway. This is, however only speculation and

future testing is required to see, if indeed, this occurs.

4.5 Mediation of Self-Esteem

Of particular interest to the current study was to ascertain the role of self-

esteem on the relationship between body image and relationship quality. The

hypothesis that self-esteem would mediate this relationship was supported.

This implies that body image affects the level of self-esteem, which in turn

has an effect on the degree of relationship quality perceptions. The mediation

analysis finds strong support for the interpretation that self-esteem does play a

larger and pivotal role in the association between body image and relationship

quality. The idea that increasing self-esteem can reduce the effect of body

image dissatisfaction on relationship quality is certainly appealing from a

therapeutic perspective. It would be interesting for future research to test this

link in specific populations where body image can be an issue, such as breast

cancer patients or ballet dancers.

4.6 Implications

Obesity is simply not just a physical problem, but a complex one that

entails psychological and psychosocial concerns as well. Currently the major

focus of treatment for obese individuals is directed towards weight loss,

through means of dieting and exercise (AIHW & NHFA, 2004; WHO, 2000).

49
This requires individuals to donate a considerable amount of time and effort,

which may be partly responsible for poor compliance and weight cycling

problems. Whilst it is generally acknowledged that alterations to behaviour

are important in losing weight, such programs that focus exclusively on these

functions may do so at the neglect of equally important affective and

cognitive responses to obesity. The mediation analysis results suggest that

improving self-esteem would in turn enhance perceptions of body image,

which Johnson (2002) asserts substantially increases the success of losing

weight. An improvement in self-esteem and ultimately body image, is an idea

that is just beginning to gather momentum in the weight loss arena. An

increasing body of evidence demonstrates support for programs, designed to

incorporate methods that counteract poor self-esteem and body image in the

treatment of obesity for both adults and children (Johnson, 2002; O’Dea,

2004). It seems the approach to the growing obesity problem must be

radically changed if this complex condition is to be thwarted. Providing

people with the necessary tools, will assist individuals to develop and

maintain healthier lifestyles, which may well alter the course of obesity.

The results of this present investigation have far reaching implications, not

simply for obese individuals but for the wider community. Overall these

results are important because they give us access to a deeper understanding of

the dynamics involved in romantic relationships. The significant mediation of

self-esteem on the relationship between body image and relationship quality,

50
demonstrates that it may not be sufficient to focus on the general aspects of a

relationship when working therapeutically with distressed couples. It is

important to be mindful of other potential issues like obesity, poor self-esteem

and body image dissatisfaction, and integrate these dimensions into

relationship counselling.

These findings also have implications for the medical profession. General

practitioners play an important role when dealing with obese patients,

especially now they are becoming increasingly aware of the importance of

holistic care and that an intact psychological status assists in enhanced well-

being. The general practitioner frequently is the first person to review

individuals in distress. Having a broader understanding of the psychological

and psychosocial dimensions of obesity, will assist in prompt, appropriate

treatment and referral.

An improved understanding of the vulnerabilities and nature of obesity,

may also help in forming and executing preventative strategies earlier in its

development, such as in adolescence or childhood. This is important, as

obesity is becoming increasingly prevalent in the younger generation and

subsequently can be more problematic as the child grows into an adult (WHO,

2000).

51
4.7 Further Limitations of the Present Study and Directions for Future

Research

One limitation of the current study, not unlike many studies in this field,

was that the sample consisted mainly of Caucasian participants. This issue

limits the generalisability of the findings. Efforts to obtain a more global

representation should be undertaken in future research as it is important to

determine whether the pattern of relations generalises across a broader span of

culture and ethnicity. Understanding the broader nature of body weight, body

image, self-esteem and relationship quality from a global perspective is

equally important. Nonetheless, the study does appear to provide useful

information about the experiences of obese individuals.

A further limitation with the present study pertains to the exclusive

reliance on self-reported methods. Therein lies the question of accuracy, as

self-reporting can lead to problems such as social desirability, especially in

terms of such personal issues as weight and to a lesser extent, height. While

there is evidence to support the accuracy of self-reported height and weight,

future studies should endeavour to obtain actual measurements of participants

to avoid any discrepancies in these measures.

In addition, while BMI is considered a suitable and appropriate method of

assessing body weight, it is not always an optimal technique for measuring

body fat composition. For example, when considering an individual with a

52
muscular build, such as a body builder, the BMI method would overestimate

body fat when the increased weight is actually due to muscle and not fat.

Future studies may consider alternative assessment techniques to obtain more

accurate measures of body fat rather than body weight per se, such as

computed tomography or underwater weighing (Wechsler & Leopold, 2003).

Another limitation of the study was in relation to the scale used to measure

body image dissatisfaction. It appears since the CDRS was first developed,

the population may indeed have increased in size because the largest body

picture does not accurately represent current obese body sizes. Further studies

replicating the current design, using an updated version of the body size

drawings or an alternate body image measure might be worthwhile.

While this study offered new insights into the area of obesity particularly

in relation to relationship quality, a further limitation was the research focused

on the perceptions of one person in the relationship and included no reports

from the partners themselves. An important goal for future research will be to

assess partners' perceptions directly and cross-reference the accuracy of these

perceptions to those of the other party. Assessing the perceptions of both

partners will undoubtedly add to the value of understanding the role body

weight, body image and self-esteem have in terms of relationship quality.

This undoubtedly would facilitate in gauging a broader knowledge of

relationship quality, especially in an obese population.

53
 A final limitation of the study, was majority of respondent’s relationships

were in the early stages. Research using individuals, whose length of

relationship was longer, may yield different findings especially as older

people can tend to view their bodies differently to younger people. In

addition, investigating specific aspects of relationship quality, such as sexual

experience and intimacy, plus gender differences may contribute to the overall

understanding of relationship quality in an obese population.

However, despite these limitations, this study provides further information

regarding previously underemphasised relationships between body weight,

body image, self-esteem and relationship quality, with particular emphasis on

a community population of obese males and females.

4.8 Conclusion

It is well acknowledged that the prevalence of obesity is rapidly increasing

throughout the developed world. An abundance of research exists pertaining

to the physical issues related to obesity, but surprisingly comparatively fewer

studies have investigated the psychological and psychosocial impacts of

obesity. This study sought to examine whether there was a difference in body

image, self-esteem and relationship quality between the three weight groups.

More specifically, whether a satisfactory body image protected obese

individuals from experiencing poorer self-esteem and relationship quality.

The overall strengths of this study was the large community sample of males

54
and females, the specific criteria for categorisation of weight groups, strict

exclusion criteria such as those who were underweight, currently in a weight

loss program and who reported a current eating disorder to name a few. These

addressed limitations identified in previous research in this area.

In summary, the results of the present study found support for the

interrelationships between obesity and body image, self-esteem and

relationship quality. As BMI increased perceptions of body image, self-

esteem and poorer relationship quality worsened. The prediction these trends

would be different for each weight groups were not supported and future

research with a larger sample size may be required to observe a difference

between these constructs. Nonetheless these findings demonstrate the

complex nature of obesity and that this condition is not merely a physical

problem, or one that can be fixed by altering behaviour alone, but that it

incorporates psychological components as well. The results highlight the

value of understanding the constructs of self-esteem and body image in the

interpersonal context of an obese population.

55
 Chapter 5

References

Allison, D., Fontaine, K. R., Manson, J. E., Stevens, J., & VanItallie, T. B.,

(1999). Annual deaths attributable to obesity on the United States.

Journal of the American Medical Association, 282, 1530-1539.

Anderson, A. S. (2004). Shared lives, an opportunity for obesity prevention?

Appetite, 43, 327-329.

Andersen, B. L., & Jochimsen, P. R. (1985). Sexual functioning among

breast cancer, gynecological cancer and healthy women. Journal of

Consulting and Clinical Psychology, 53, 25-32.

Anshel, M. H. (2004). Sources of disordered eating patterns between ballet

dancers and non-dancers. Journal of Sport Behaviour, 27, 115-134.

Australian Bureau of Statistics. (2001). Corrigendum Health Risk Factors.

Retrieved March 15th 2004 from http://www.abs.gov.au/Ausstats/abs

Australian Bureau of Statistics. (2005). Marriages, divorce and defacto

relationships. Retrieved May 25th 2005 from

http://www.abs.gov.au/Ausstats/abs

56
Australian Institute of Health and Welfare Health (AIHW) and National

Heart Foundation of Australia (NHFA). (2004). The relationship between

overweight, obesity and cardiovascular disease. AIHW Cat. No. CVD 29.

Canberra AIHW (Cardiovascular Disease Series No. 23. Retrieved

November 24th 2004 from

http://www.aihw.gov.au/publications/index.cfm/title/10078

Barnett, R. (2005). Historical Keyword: Obesity. Lancet, 365, 1843.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable

distinction in social psychological research: conceptual, strategic, and

statistical considerations. Journal of Personality and Social Psychology,

51, 1173-1182.

Bas, M., Asci, F. H., Karabudak, E., & Kiziltan, G. (2004). Eating attitudes

and their psychological correlates among Turkish adolescents.

Adolescence, 39, 593-600.

Becker, A. E., Burwell, R. A., Navara, K., & Gilman, S. E. (2003). Binge

eating and binge eating disorder in a small-scale indigenous society: The

view from Fiji. International Journal of Obesity, 34, 423–431.

57
Befort, C., Foley-Nicpon, M., Robinson-Kurplus, S. E., & Huser, L. (2001).

Body image, self-esteem and weight related criticism from romantic

partners. Journal of College Student Development, 42, 407-420.

Bergman, L. R., Eklund, G., & Magnusson, D. (1991). Studying individual

development: problems and methods. In D. Magnusson, L. R. Bergman, G.

Rudinger & B. Torestad (Ed). Problems and methods in longitudinal

research: Stability and change. Cambridge: University Press.

Blaine, B. E., DiBlasi, D. M., & Connor, J. M. (2002). The effect of weight

loss on perceptions of weight controllability: Implications for prejudice

against overweight people. Journal of Applied Biobehavioural Research,

7, 44-56.

Bocchieri, L. E., Meana, M., & Fisher, B. L. (2002). A review of

psychosocial outcomes of surgery for morbid obesity. Journal of

Psychosomatic Research, 52, 155-166.

Bove, C. F., Sobal, J., & Rauschenbach, B. S. (2003). Food choices among

newly married couples: Convergence conflict, individualism and

projects. Appetite, 40, 25-41.

58
Burrows, A., & Cooper, M. (2002). Possible risk factors in the development

of eating disorders in overweight preadolescent girls. International

Journal of Obesity, 26, 1268-1273.

Cameron, J.W. (1999). Self esteem changes in children enrolled in weight

management programs. Comprehensive Paediatric Nursing, 22, 75-85.

Cameron, A. J., Welborn, T. A., Zimmet, P. Z., Dunstan, D. W., Owen, N.,

Salmon, J., Dalton, M., Jolley, D., & Shaw, J. E. (2004). Overweight and

obesity in Australia: The 1999-2000 Australian diabetes, obesity and

lifestyle study: AusDiab Study. Medical Journal of Australia, 180, 427-

432.

Cash. T. F. (1995). Developmental teasing about physical appearance:

retrospective descriptions and relationships with body image. Social

Behavioural and Personality, 23, 123-130.

Cash. T. F. (2004). Body image and psychosocial differences among stable

average weight, currently overweight and formerly overweight women:

The role of stigmatising experiences. Body Image, 1, 155-167.

59
Cash, T. F., Morrow, J. A., Hrabosky, J. I., & Perry, A. A. (2004). How has

body image changed? A cross sectional investigation of college women

from 1983 to 2001. Journal of Consulting and Clinical Psychology, 72,

1081-1089.

Cash, T. F., Theriault, J., & Annis, N.M. (2004). Body image in an

interpersonal context: Adult attachment, fear of intimacy and social

anxiety. Journal of Social and Clinical Psychology, 23, 89-103.

Connor, M., Johnson, C., & Grogan, S. (2004). Gender, sexuality, body

image and eating behaviours. Journal of Health Psychology, 9, 505-515.

Cramer, D. (2003). Acceptance and need for approval as moderators of self

esteem and satisfaction with a romantic relationship or closest friendship.

The Journal of Psychology, 137, 495-505.

Crisp, A. H., Kalucy, R. S., Pilkington, T. R., & Gazet, J.C. (1977). Some

psychosocial consequences of ileojejunal bypass surgery. American

Journal of Clinical Nutrition, 30, 109-120.

Culp, L. N., & Beach, S. R. H. (1998). Marriage and depressive symptoms:

The role and bases of self-esteem differ by gender. Psychology of Women

Quarterly, 22, 647-663.

60
Davison, T. E., & McCabe, M. P. (2005). Relationships between men’s and

women’s body image and their psychological, social and sexual

functioning. Sex Roles, 52, 463-475.

de Hart, T., Pelham, B., & Murray, S. (2004). Implicit dependency

regulation: Self esteem, relationship closeness and implicit evaluation of

close others. Social Cognition, 22, 126-146.

de Zwaan, M. (2001). Binge eating disorder and obesity. International

Journal of Obesity, 25, 551-555.

Dittmar, H., & Howard, S., (2004). Thin ideal internalisation and social

comparison tendency as moderators of media models impact on women’s

body focused anxiety. Journal of Social and Clinical Psychology, 23,

p768, 24-28.

Dixon, T., & Waters, A. M. (2003). A Growing Problem: Trends and

Patterns in Overweight and Obesity among Adults in Australia, 1980 to

2001. AIHW Cat. No. Aus 36. Canberra AIHW Bulletin Issue 8.

Doherty, W. J., & Harkaway, J, E. (1990). Obesity and family systems: A

family FIRO approach to assessment and treatment planning. Journal of

Marital and Family Therapy, 16, 287-298.

61
Doll, H. A., Petersen, S. E. K., & Stewart-Brown, S. L. (2000). 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. Obesity Research, 8, 160-170.

Dubovski, S. L., Haddenjorst, A., & Murphy, J. A. (1985). A preliminary

study of the relationship between preoperative depression and weight loss

following surgery for morbid obesity. International Journal of

Psychiatric Medicine, 15, 185-1996.

Enzi, G. (1994). Socioeconomic consequences of obesity: the effect of

obesity on the individual. PharmacoEconomics, 5, 54-57.

Epstein, A. M., Read, J. L., & Hoeffer, M. (1987). The relation of body

weight to length of stay and charges for hospital services for patients

undergoing elective surgery: A study of two procedures. American

Journal of Public Health, 77, 993-997.

Fallon, A. E., & Rozin, P. (1985). Sex differences in perceptions of

desirable body shape. Journal of Abnormal Psychology, 94, 102-105.

Faricy, L. G. (1991). The role of obesity in marital relationships.

Dissertation Abstracts International, 51, pp.5561.

62
Faubel, M. (2001). Body image and depression in women with early and late

onset obesity. The Journal of Psychology, 123, 385-395.

Fennell, M. J. V. (1997). Low self esteem: A cognitive perspective.

Behavioural & Cognitive Psychotherapy, 25, 1-25.

Field, A. E., Barnoya, J., & Colditz, G. A. (2002). Epidemiology and health

and ecomnomic consequences of obesity. In T. A. Wadden, & A. J.

Stunkard (Ed). Handbook of Obesity Treatment. New York: Gilford

Press.

Fontaine, K. R., Cheskin, L. J., & Baraofsky, I. (1996). Health related

quality of life in obese persons seeking treatment. Journal of Family

Practice, 43, 265-270.

Fontaine, K. R., Baraofsky, I., & Cheskin, L. J. (1997). Predictors of quality

of life in obese persons. Journal of Psychosomatic Research, 40, 59-66.

Fowler, B. A. (1989). The relationship of body image perception and weight

status to recent change in weight status of the adolescent female.

Adolescence, 24, 557-567.

63
Franzoi, S. L., & Herzog, M. E. (1986). The body esteem scale: convergent

and discriminant validity study. Journal of Personality Assessment, 50,

24-31.

Franzoi, S., & Shields, S. (1984). The body esteem scale: Multidimensional

structure and sex differences in a college population. Journal of

Personality Assessment, 48, 173-178.

Friedman, M. A., Dixon, A. E., Brownell, K. D., Whisman, M. A., &

Wilfley, D. E. (1998). Marital status, marital satisfaction and body image

dissatisfaction. Marriage and Body Dissatisfaction, 81-85.

Furnham, A., Badmin, N., & Sneade, I. (2002). Body image dissatisfaction:

gender differences in eating attitudes, self esteem and reasons for

exercise. The Journal of Psychology, 136, 581-596.

Furnham, A., & Calnan, A. (1998). Eating disturbances, self-esteem, reasons

for exercising and body weight dissatisfaction in adolescent males.

European Eating Disorders Review, 6, 58-72.

64
Gallagher, M. J., Franklin, B. A., Ehrman, J. K., Keteyian, S. J., Brawner, C.

A., de Jong, A. T., & McCullough, P. A. (2005). Comparative impact of

morbid obesity versus heart failure on cardiorespiratory fitness. Chest,

127, 2197-2203.

Ganley, R. M. (1986). Epistemology, family patterns psychosomatics: The

case of obesity. Family Process, 25, 437-451.

Gorstein, J., & Grosse, R. N. (1994). The in direct costs of obesity to

society. PharmacoEconomics, 5, 58-61.

Gortmaker, S. L., Must, A., Perrien, J. M., Sobal, A. M., & Dietz, W.

(1993). Social and economic consequences of overweight in

adolescences and young adulthood. New England Journal of Medicine,

329, 1008–1012.

Gottman, J. M. (1991). Chaos and regulated change in families: A metaphor

for the study of transitions. In P. A. Cowan, & E. M. Hetherington (Ed).

Family Transitions. Hillsdale NJ, England: Lawrence Erlbaum

Associates, Inc.

65
Gray–Little, B., & Hafdahl, A. R. (2000). Factors influencing racial

comparison of self esteem: A quantitative review. Psychological Bulletin,

126, 26-54.

Grover, V. P., Keel, P. K., & Mitchell, J. P. (2003). Gender differences in

implicit weight identity. International Journal of Eating Disorders,

34, 125-135.

Guillon, M. S., Crocq, M. A., & Bailey, P. E. (2003). The relationships

between self-esteem and psychiatric disorders in adolescents. European

Psychiatry, 18, 59-62.

Hafner, R. J. (1991). Morbid obesity: Effects on the marital system of

weight loss after gastric restriction. Psychotherapy Psychosomatics,

56, 162-166.

Hendrick, S. S. (1988). A generic measure of relationship satisfaction. The

Journal of Marriage and the Family, 50, 93-98.

Henriques, G. R., & Calhoun, L. G. (1999). Gender and ethnic difference in

the relationship between body esteem and self-esteem. The Journal of

Psychology, 133, 357-368.

66
Hill, A. J., & Williams, J. (1998). Psychological health in a non clinical

sample of obese women. International Journal of Obesity, 22, 578-583.

Holt, M. K., & Espelage, D. L. (2002). Problem solving skills and

relationship attributes among women with eating disorders. Journal of

Counselling and Development, 80, 346-354.

Hoyt, W. D., & Kogan, L. R. (2001). Satisfaction with body image and peer

relationships for males and females in a college environment. Sex Roles,

45, 199-216.

Jeffery, R. W., & Rick, A. M. (2002). Cross sectional and longitudinal

associations between body mass index and marriage related factors.

Obesity Research, 10, 809-815.

Johnson, C. (2002). Obesity, weight management and self-esteem. In T. A.

Wadden, & A. J. Stunkard (Ed). Handbook of Obesity Treatment. New

York: Gilford Press.

Kahn, H. S., Williamson, D. F., & Stevens, J. A. (1991). Race and weight

change in US women: the roles of socio-economic and marital status.

American Journal of Public Health, 81, 319-323.

67
Katz, J., & Joiner, T. E. (2002). Being known, intimate and valued: Global

self-verification and dyadic adjustment in couple and roommates.

Journal of Personality, 70, 33-56.

Keppel, C.C., & Crowe, S.F. (2000). Changes to body image and self-

esteem following stroke in young adults. Neuropsychological

Rehabilitation, 10, 15-31.

Kim, O., & Kim, K. (2001). Body weight, self-esteem and depression in

Korean female adolescents. Adolescence, 36, 315-322.

Kolotkin, R. L., Head, S., Hamilton, M., & Tse, C. J. (1995). Assessing

impact of weight on quality of life. Obesity Research, 3, 49-56.

Kolotkin, R. L., Meter, K., & Williams, G. R. (2001). Quality of life and

obesity. Obesity Reviews, 2, 219-230.

Kortt, M. A., Langley, P. C., & Cox, E. R. (1998). A review of cost of

illness studies on obesity. Clinical Therapeutics, 20, 772-779.

68
Kostanski, M., & Gullone, E. (1998). Adolescent body image

dissatisfaction: Relationships with self-esteem, anxiety and depression

controlling for body mass. Journal of Child Psychology and Psychiatry,

39, 255-262.

Lang, F. R., & Fingerman, K. L. (2004). Growing together: Personal

relationships across the lifespan. Cambridge, University Press.

Leon, G. R., Eckert, E. D., Teed, D., & Buchwald, H. (1979). Changes in

body image and other psychological factors after intestinal bypass

surgery for massive obesity. Journal of Behavioural Medicine, 1, 39-55.

Lerner, R. M., & Karabenick, S. A. (1974). Physical attractiveness, body

attitudes and self-concept in late adolescence. Journal of Youth and

Adolescence, 3, 307-317.

Lerner, R. M., Karabenick, S. A., & Stuart, J. L. (1973). Relations among

physical attractiveness, body attitudes and male and female college

students. The Journal of Psychology, 85, 119-129.

Lipowicz, A., Gronklewicz, S., & Malina, R. M. (2002). Body mass index,

overweight, obesity in married and never married men and women in

Poland. American Journal of Human Biology, 14, 468-475.

69
Lippes, T. E. (1999). Mutuality in marriage: The self-esteem connection. A

self in relation analysis. Dissertation Abstracts International: Section B:

The Sciences & Engineering, 59 (9-B). pp. 5095.

Macias, J. A. G., Leal, F. J. V., Lopez-Ibor, J. J., Rubio, J. M. A.,

Caballero, M. G. (2004). Marital status in morbidly obese patients after

bariatric surgery. Reprinted from the German Journal of Psychiatry, 7,

22-27.

Makeri, K., Cummings, C. E., & Lees, A. W. (1997). Sexuality, body image

and quality of life after high dose or conventional chemotherapy for

metastatic breast cancer. Sexuality, 6, 1-8.

Manus, H. E., & Killeen, M. R. (1995). Maintenance of self-esteem by

obese children. Journal of Child and Adolescent Psychiatry Nursing, 8,

17-27.

Markey, C. N., Markey, P. M., & Birch, L. L. (2004). Understanding female

body satisfaction: The role of husbands. Sex Roles, 51, 209-217.

Masheb, R. M., & Grilo, C. M. (2000). Accuracy of self reported

weight in patients with binge eating disorder. International Journal of

Eating Disorders, 29, 29-36.

70
Masheb, R. M., & Grilo, C. M. (2002). The nature of body image

disturbance in patients with binge eating disorder. International Journal

of Eating Disorders, 33, 333-341.

Matz, P. E., Foster, G. D., Faith, M. S., & Wadden, T. A. (2002). Correlates

of body image dissatisfaction among overweight women seeking weight

loss. Journal of Consulting and Clinical Psychology, 70, 1040-1044.

Mendelson, B. K., McLaren, L., Gauvin, L., & Steiger, H. (2002). The

relationship of self-esteem and body esteem in women with and without

eating disorders. Wiley Periodicals, Inc.

Mendelson, M. J., Mendelson, B. K., & Andrews, J. (2000). Self esteem,

body image and body mass in late adolescents: Is a Competence x

Importance model needed? Journal of Applied Development Psychology,

21, 249-266.

Mendelson, B. K., Mendelson, M. J., & White, D. R. (2001). Body esteem

scale for adolescents and adults. Journal of Personality Assessment, 76,

90-106.

71
Miller, C. T., Rothblum, E. D., Barbour, L., Brand, P. A., & Felicio, D.

(1990). Social interactions of obese and non-obese women. The Journal

of Personality, 58, 365-380.

Mirza, N. M., Davis, D., & Yanovski, J. A. (2005). Body dissatisfaction,

self-esteem and overweight among inner city Hispanic children and

adolescents. Journal of Adolescent Health, 36, 16-20.

Mustillo, S., Worthman, C., Erkani, A., Keeler, G., Angold, A., & Costello,

E. J. (2003). Obesity and psychiatric disorder: Development trajectories.

Paediatrics, 111, 851-860.

Neill, J. R., Marshall, J. R., & Yale, C. E. (1978). Marital changes after

intestinal bypass surgery. Journal of American Medical Association, 240,

447-458.

Nir, Z., & Neumann, L. (1991). Self-esteem, internal-external locus of

control, and their relationship to weight reduction. Journal of Clinical

Psychology, 47, 568-575.

72
O’Brien, K., & Webble, K. (2004). Health, well-being and body weight:

Characteristics of overweight and obesity in Australia 2000. AIHW Cat.

No. Aus 43. Canberra AIHW Bulletin Issue 13. Retrieved November 24th

2004 from http://www.aihw.gov.au/publications/aus/bulletin13.pdf

O’Dea, J. (2004). Evidence for a self-esteem approach in the prevention of

body image and eating problems among children and adolescents. Eating

Disorders, 12, 225-239.

Pallant, J. (2005). SPSS Survival Manual (2nd ed). Crows Nest: Allen &

Unwin.

Pan, S. Y., Johnson, K. C., Ugnat, A. M., Wen, S. W., & Mao, Y. (2004).

Association of obesity and cancer risk in Canada. American Journal of

Epidemiology, 159, 259-268.

Parquette, M. C., & Raine, K. (2004). Sociocultural context of women’s

body image. Social Science and Medicine, 59, 1047-1058.

Perez, M., & Joiner, T. E. (2002). Body image dissatisfaction and disordered

eating in black and white women. International Journal of Eating

Disorders, 33, 342-350.

73
Pilner, P., Chiken, S., & Fleet, G. L. (1990). Gender differences in concern

with body weight and physical appearance over the life span. Personality

and Social Psychological Bulletin, 16, 263-273.

Pittman, F. (1993). Beyond betrayal: Life after infidelity. Psychology Today,

26, 32-33.

Pole, M., Crowther, J. H., & Schell, J. (2004). Body dissatisfaction in

married women: The role of spousal influence and marital

communication patterns. Body Image, 1, 267-278.

Porter, L. C. & Wampler, R. S. (2000). Adjustments to rapid weight loss.

Families, Systems and Health, 18, 35-55.

Pruzinsky, T. & Cash, T. F. (2002). Understanding body images; Historical

and contemporary perspectives. In T. F. Cash & Pruzinsky, T. Body

image: A handbook of theory, research and clinical practise. New York:

The Guilford Press.

Rand, C. S., Kowalske, K., & Kuldau, J. M. (1984). Characteristics of

marital improvement following obesity surgery. Journal of Consulting

Liaison Psychiatry, 25, 221-226.

74
Rand, C. S., Kuldau, J. M., & Robbins, L. (1982). Surgery for obesity and

marriage quality. Journal of American Medical Association, 247, 1419-

1422.

Reider, S., & Ruderman, A. (2001). Cognitive factors associated with binge

and purge eating behaviour: the interaction of body dissatisfaction and

body image importance. Cognitive Therapy and Research, 25, 801-812.

Robles, T. F., & Kiecolt-Glaser, J. K. (2003). The physiology of marriage:

Pathways to health. Physiology & Behaviour, 79, 409-417.

Rogers, C. R. (1959). A theory of therapy, personality, and interpersonal

relationships, as developed in the client-centered framework. In S. Koch

(Ed.), Psychology: A study of a science. New York: McGraw-Hill.

Rogers, S. J., & Amato, P. R. (1997). Is martial quality declining? The

evidence from two generations. Social Forces, 75, 1089-1101.

Rohrbaugh, M. J., Shoham, V., Cranford, J. A., Nicklas, J. M., Sonnega, J.

S., & Coyne, J. C. (2002). Couples coping with congestive heart failure:

Role and gender differences in psychological distress. Journal of Family

Psychology, 16, 3-13.

75
Rosenberg, M. (1965). Society and the adolescent self-image. New Jersey:

Princeton University Press.

Rosenberg, M. (1979). Conceiving the self. New York: Basic Books.

Rosenberg, M., Schooler, C., Schoenbach, C., & Rosenberg, F. (1995).

Global self-esteem and specific self-esteem: Different concepts, different

outcomes. American Sociological Review, 60, 141-156.

Rosenberger, R. S., Sneh, Y., Phipps, T, T., & Gurvitch, R. (2005). A spatial

analysis of linkages between health care expenditures, physical inactivity,

obesity and recreation supply. Journal of Leisure Research, 37, 216-235.

Rothblum, E. D., Brand, P. A., Miller, C. T., & Oetjen, H. A. (1990). The

relationship between obesity, employment discrimination and

employment related victimisation. Journal of Vocational Behaviour, 37,

251-266.

Russell, W. D., & Cox, R. H. (2003). Social physique anxiety, body

dissatisfaction, and self-esteem in college females of differing exercise

frequency, perceived weight discrepancy and race. Journal of Sport

Behaviour, 26, 298-318.

76
Sargent, J. D., & Blanchflower, D. G. (1994). Obesity and stature in

adolescence and earnings in young adulthood. Analysis of British birth

cohort. Paediatric Adolescent Medicine, 148, 681–687.

Sarwer, D. B., Wadden, T. A., and Foster, G. D. (1998). Assessment of body

image dissatisfaction in obese women: Specificity, severity and clinical

significance. Journal of Consulting & Clinical Psychology, 66, 651-655.

Sarwer, D. B., & Thompson, J. K. (2002). Obesity and body image

disturbance. In T. A. Wadden, & A. J. Stunkard (Ed). Handbook of

Obesity Treatment. New York: Gilford Press.

Sarwer, D. B., Thompson, J. K., and Cash, T. F. (2005). Body Image and

Obesity in Adulthood. Psychiatric Clinics of North America, 28, 69-87.

Schwartz, M. B., & Brownell, K. D. (2003). Obesity and body image. Body

Image, 1, 43-56.

Secord, P. F., & Jourard, S. M. (1953). The appraisal of body cathexis: Body

cathexis and the self. Journal of Consulting Psychology, 7, 343-347.

Shackelford, T. K. (2001). Self-esteem in marriage. Personality and

Individual Differences, 30, 371-390.

77
Sheets, V., & Ajmere, K. (2005). Are romantic partner a source of college

students weight concern? Eating Behaviours, 6, 1-9.

Sherblom, P. R. (2004). Body image, figure rating and body mass index of

girls enrolled in health, physical education or athletics classes.

Perceptual and Motor Skills, 99, 473-482.

Slade, P. (1995). Prospects for prevention. In G. Szmukler, C. Dare & J.

Tresure (Ed). Handbook of eating disorders: Theory, treatment and

research. London: John Wiley and Sons.

Sobal, J. (1984). Marriage, obesity and dieting. Marriage and Family

Review, 7, 115-139.

Sobel, J., & Rauschenbach, B. S (2003). Gender, marital status and body

weight in older US adults. Gender Issues, 21, 75-95.

Sobal, J., Rauschenbach, B. S., & Frongillo, E. A. (1992). Marital status,

fatness and obesity. Social Science and Medicine, 35, 915-923.

Sobal, J., Rauschenbach, B. S., & Frongillo, E. A. (1995). Obesity and

marital quality: Analysis of weight, marital unhappiness and marital

problems in a US national survey. Journal of Family Issues, 16, 746-764.

78
Sobal, J., Rauschenbach, B. S., & Frongillo, E. A. (2003). Marital status

changes and body weight changes: A US longitudinal analysis. Social

Science and Medicine, 56, 1543-1555.

Stewart, A. L. (1982). The reliability and validity of self reported weight

and height. Journal of Chronic Diseases, 35, 295-309.

Strauss, R.S., & Pollack, H. A. (2003). Social marginalisation of overweight

children. Archives of Paediatrics and Adolescent Medicine, 157, 746-

752.

Stuart, R. B. & Jacobson, B. (1987). Weight, sex, and marriage. New

York: WW Norton.

Stunkard, A. J. (1959). Eating patterns and obesity. Psychiatric Quarterly,

33, 284-295.

Stunkard, A. J., Stinnett, J. L., & Smoller, J. W. (1986). Psychological and

social aspects of the surgical treatment of obesity. American Journal

Psychiatry, 4, 417-429.

Tabachink, B. G., & Fidell, L. S. (2001). Using multivariate statistics (4th

ed.). New York: Harper Collins.

79
Teixeira, P. J., Going, S. B., Sardinha, L. B., & Lohman, T. G. (2005). A

review of psychosocial pre-treatment predictors of weight control.

Obesity Reviews, 6, 43-65.

Thompson, M., & Gray, J. (1995). Development and validation of a new

body-image assessment scale. Journal of Personality Assessment, 64,

258-269.

Thompson, J. K., & Thompson, C. M. (1986). Body size distortion and self-

esteem in asymptomatic, normal weight males and females. International

Journal of Eating Disorders, 5,1061-1068.

Tiggerman, M. (2002). Media influences on body image development. In T.

F. Cash & Pruzinsky, T. Body image: A handbook of theory, research

and clinical practise. New York: The Guilford Press.

Trappnell, P. D., Meston, C. M., & Gorzalka, B. B. (1997). Spectatoring the

relationship between body image and sexual experience: Self focus or

self valence. Journal of Sex Research, 34, 267-278.

Trembley, A., & Bandi, V. (2003). Impact of body mass index on outcomes

following critical care. Chest, 123, 1202-1207.

80
Variyam, J. N. (2002). Pattern of caloric intake and body mass index among

US adults. Food Review, 25, 16-21.

Visscher, T. L., & Seidell, J. C. (2001). The public health impact of obesity.

Annual Review of Public Health, 22, 355-375.

Wadden, T. A., & Phelan, S. (2002). Behavioural assessment of the obese

patient. In T. A. Wadden, & A. J. Stunkard (Ed). Handbook of Obesity

Treatment. New York: Gilford Press.

Wadden, T. A., Womble, L. G., Stunkard, A. J., & Anderson, D. A. (2002).

Psychological consequences of obesity and weight loss. In T. A. Wadden,

& A. J. Stunkard (Ed). Handbook of Obesity Treatment. New York:

Gilford Press.

Walsh, F., Jacob, L., & Simons, V. (1995). Facilitating healthy divorce

processes: Therapy and mediation approaches. In N. S. Jacobson, & A. S.

Gurman, (Ed). Clinical handbook of couple therapy. New York: Guilford

Press.

Wardle, J. Waller, J., & Fox, E. (2002). Age of onset of body dissatisfaction

in obesity. Addictive Behaviours, 27, 561-573.

81
Waters, E. B., & Baur, L. A. (2003). Childhood obesity: modernity’s

scourge. Medical Journal of Adolescence, 178, 422-423.

Weschler, J. G., & Leopold, K. (2003). Medical management of obesity.

Langenbacks Archives Surgery, 388, 369-374.

Wiederman, M. W. & Hurst, S. R. (1998). Body size, physical attractiveness

and body image among young adult women: Relationships to sexual

experience and sexual esteem. Journal of Sex Research, 35, 272-282.

Wickrama, J., & Lorenz, F. (1997). Marital quality and physical illness: A

latent growth curve analysis. Journal of Marriage and Family, 59, 143-

155.

Wimberly, S. R., Carver, C. S., Laurenceau, J. P., Harris, S. D., & Antoni,

M. H. (2005). Perceived partner reactions to diagnosis and treatment of

breast cancer: Impact on psychosocial and psychosexual adjustment.

Journal of Consulting and Clinical Psychology, 73, 300-311.

World Health Organisation. (2000). Obesity and overweight: Global

strategy on diet, physical activity and health. Report of a WHO expert

committee. WHO. Geneva. Retrieved March 15th 2004 from

http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/

82
Zametkin, A.J., Zoon, C.K., Klein, H.W., & Munson, S. (2004). Psychiatric

aspects of child and adolescent obesity: A review of the past ten years.

Journal of the American Academy of Child and Adolescent Psychiatry,

43, 134-151.

83
 Chapter 6

Appendices

Appendix A

Informed Consent and Questionnaire

84
 SWINBURNE UNIVERSITY OF TECHNOLOGY
SCHOOL OF SOCIAL AND BEHVIOURAL SCIENCES

The Relationships between Body Weight, Body Image, Self Esteem and Relationship Quality.

Investigators: Ms Melinda Millard & Dr Simon Knowles

This project is part of an Honours degree in Psychology at Swinburne University. The project aims to examine the
relationships between body weight, body image, self-esteem and relationship quality. We hope that the results of
this study will help to better understand these relationships, and the possible impact that different body weights
can have on body image, self-esteem and relationship quality.

We are seeking male and female participants, aged 18 years and over, who have been in a relationship and living
together for more than 6 months. If you volunteer to participate, you will be asked to complete some
questionnaires, which will take about 30 minutes. The questionnaires include questions about your age, gender,
level of education, height, weight, and relationship status, as well as questions about how you feel about yourself
and your body. You will also be asked to rate your body image, and to answer some questions about your current
relationship.

No identifying information is needed and your responses will be treated with the strictest confidence. The results
of this project may be used in scientific journals or at conference presentations. In this case, only group data will
be analysed and presented and no individual person’s data will be able to be identified.

Your involvement in the study is voluntary and you are free to withdraw at any stage without prejudice. If you
decide to participate, please try and answer all questions. If you are a student from Swinburne University, please
return your completed questionnaire in the allocated box on the 7th Floor of the BA Building (Hawthorn) or the
questionnaire return box Level 1 (Lilydale). If you are not a Swinburne University student, please return your
completed questionnaire in the reply paid envelope provided. The return of the questionnaire will be taken as your
informed consent to participate.

The research conforms to the principles set out in the Swinburne University Policy on Research Ethics and the
NHMRC guidelines in the National Statement on Ethical Conduct on Research with Humans. Please consider the
purposes and time commitment of this study before you decide whether or not to participate. Please retain this
information for your own records. We do not anticipate any risk or negative effect to arise due to your
participation in the study. However, in the event of you having concerns about certain issues raised by the current
research, you can contact the Swinburne Psychology Centre on
+61 3 9214 8653 (Hawthorn), or if a Swinburne student the Swinburne Counselling Services at either Hawthorn
(+61 3 9214 8025) or Lilydale (+61 3 9215 7101).

If you have any queries or concerns about this study please contact, Melinda at melindamillard@optusnet.com.au
or Simon Knowles (Senior Investigator) on +61 3 9214 8206. Melinda can also be contacted if you would like a
summary report of the major findings.

If you have any queries or concerns, which Simon Knowles the senior investigator was unable to satisfy, contact:
The Chair, SBS Research Ethics Committee, School of Behavioural Sciences,
Mail H24, PO Box 218, Swinburne University of Technology, Hawthorn, 3122.
If you have a complaint about the way you were treated during this study, please write to:
The Chair, Human Research Ethics Committee,
Swinburne University of Technology,
P O Box 218, Hawthorn, 3122.
Thank you for your time and interest in this study.
DEMOGRAPHIC QUESTIONS

1. What is your age in years?__________

2. What is your gender? (please circle)

1. Male 2. Female

3. What is your sexual preference? (please circle one option only)

i. Heterosexual
ii. Bisexual
iii. Homosexual

4. What country were you born in? ____________________________________________________

5. What country was your mother/guardian born? _________________________________________

6. What country was your father/guardian born? __________________________________________

7. Which ethnic/cultural background do you most strongly identify with? ______________________

8. What is your highest level of education? (please circle one option only)
No formal education 1
Completed Primary School 2
Some Secondary School 3
Completed Secondary School 4
TAFE/Diploma/Apprenticeship/Trade 5
Some University undergraduate study 6
Completed University undergraduate degree 7
Some University postgraduate study 8
Completed University postgraduate degree 9
9. What is your main employment status? i.e. what do you spend most hours doing per week (please circle
one option only)
Full-time employment 1
Part-time employment 2
Casual employment 3
Unemployed 4
Self-employed 5
Part-time student 6
Full-time student 7
Pensioner (old age/disability) 8
Home duties 9
Retired 10

10. What is your current occupation? ____________________________

11. What is your income category? (please circle one option only)
Below $20,000 1
$20,001 – less than $30,000 2
$30,001 – less than $40,000 3
$40,001 – less than $50,000 4
$50,001 – less than $60,000 5
$60,001 – less than $70,000 6
$70,001 – less than $80,000 7
$80,001 – less than $90,000 8
Over $90,001 9

12. What is your height? _______________________ (please state the units of measurement you are
using, e.g., cm or feet/inches)

13. Please indicate on the scale below how accurate this measure is? (please circle one option only)
1 2 3 4 5 6 7
Not Accurate Unsure Very Accurate
14. Do you keep track of your weight? (please circle)
1. Yes 2. No

15. How often do you weigh yourself? (please circle one option only)
More than once a day 1
Once a day 2
Once a week 3
Three times per week 4
Twice a week 5
Once a fortnight 6
Once a month 7
Once every two months 8
Once every six months 9
Once a year 10
Never 11
Other (please specify) ______________________ 12

16. What is your weight? _______________________ (please state the units of measurement you are
using, e.g., kgs or stones/pounds)

17. Please indicate on the scale below how accurate this measure is? (please circle one option only)
1 2 3 4 5 6 7
Not Accurate Unsure Very Accurate

18. In your view, what is your ideal weight (i.e., the weight that you would like to be)?
_______________________ (please state the units of measurement you are using, e.g., kgs or
stones/pounds)

19. Do you feel you have a weight problem? (please circle)

1. Yes 2. No
20. Are there any medical factors that are currently impacting on your weight? (please circle)
1. Yes 2. No

If yes to q20, please describe these factors (e.g., thyroid problem, pregnancy, diabetes, hormonal
irregularities such as Cushing’s disease
_______________________________________________________________________________________
_______________________________________________________________________________________

21. Are you actively assessing what you eat (e.g. nutritional, calorie and fat intake, portion size? (please
circle)
1. Yes 2. No

If yes to q21, is this active assessment for

Dieting purposes 1
Medical reasons 2
Healthier lifestyle 3
Other (please describe)______________________________4

22. Have you ever participated in any of the following weight management programs? (please
circle the most applicable option)
No 1
Weight Watchers 2
Gut Busters 3
Lite and Easy 4
Regular dieting (not healthy eating) 5
Exercise geared to lose weight 6
Sure Slim 7
Jenny Craig 8
Multiple programs 9
Other (please describe) ________________________ 10
23. Are you currently participating in any of the following weight management programs?
(please circle the most applicable option)
No 1
Weight Watchers 2
Gut Busters 3
Lite and Easy 4
Regular dieting (not healthy eating) 5
Exercise geared to lose weight 6
Sure Slim 7
Jenny Craig 8
Multiple programs 9
Other (please describe) ________________________ 10

24. Why did you get involved with a weight management program? (please circle the most applicable
option).
Not Applicable 1
Healthier Lifestyle 2
Lose weight 3
Gain weight 4
Ongoing weight Management 5
Preparation for an event e.g. wedding, surgery 6
Instructed by health professional 7
Alter Eating Habits/Behaviour 8
Other (please specify)______________________________9
25. How long have you been or are still involved with a weight management program? (please circle the
most appropriate option)
Never 1
Less than one week 2
One week 3
A fortnight 4
A month 5
Two to three months 6
Three to four months 7
Four to five months 8
Five to six months 9
Six months to one year 10
Greater than one year (please specify length of time)__________________11

26. If you answered ‘greater than a year’ to q25, why this length of time? (please circle the most
appropriate option)
Not Applicable 1
Healthier Lifestyle 2
Lose weight 3
Gain weight 4
Ongoing weight Management 5
Preparation for an event e.g. wedding, surgery 6
Instructed by health professional 7
Alter Eating Habits/Behaviour 8
Other (please specify)___________________________________________9

27. Do you feel you have been successful at the weight management program? (please circle one option
only - circle N/A if this question does not apply to you) N/A

1 2 3 4 5 6 7
Not Successful Unsure Very Successful
28. Have you ever been diagnosed with an eating disorder? (please circle)
1. Yes 2. No

If yes to q28, what type of eating disorder? (e.g., Anorexia Nervosa, Bulimia, etc.)
________________________________________________________________________________

Who made this diagnosis? (e.g., GP, Psychiatrist, Psychologist, self etc.)______________________

29. Do you feel you may have an undiagnosed eating disorder? (please circle)
1. Yes 2. No

If yes to q29, what type of eating disorder? (e.g., Anorexia Nervosa, Bulimia, etc.)
_________________________________________________________________________________

30. If you answered yes to questions 28 or 29, is this a current problem? (please circle)
1. Yes 2. No

31. What is your current relationship status? (please circle one option only)
Single, never married 1
Casually dating (I date other people as well) 2
Seriously dating (I do not date other people) 3
Engaged, but not living together 4
Married/DeFacto and living with your partner 5
Married/DeFacto and living apart (not separated or divorced) 6
Married/DeFacto and living apart (separated) 7
Divorced 8
Widowed 9
Other (please specify)____________________________________10

32. If you are currently in a relationship, what is the length of this relationship?
________ years ________months
33. How do you think your partner perceives your current body shape? (please circle one option only)
1 2 3 4 5 6 7
Extremely Negative Neutral Extremely Positive

34. Does your partner support your current body shape? (please circle one option only)
1 2 3 4 5 6 7
Not at all Moderately Very Much

35. Do you think your current body shape adversely affects your relationship? (please circle one option
only)
1 2 3 4 5 6 7
Not at all Moderately Extremely

36. If you are dieting, does your partner support your dieting behaviours? (please circle one option only)
1 2 3 4 5 6 7
Not at all Moderately Extremely

37. Does your partner ask you to diet for other than medical reasons? (please circle one option only)
1 2 3 4 5 6 7
Never Sometimes Very Often

38. Does your partner diet for other than medical reasons? (please circle one option only)
1 2 3 4 5 6 7
Never Sometimes Very Often
CURRENT
Draw a mark below the drawing, which most accurately depicts your current body size. You may place the
mark anywhere below the drawings, including between figures. Now place a mark on the line below the set
of opposite sex figures that depict what you think is the average figure.
IDEAL
Draw a mark below the drawing, which most accurately depicts your ideal body size (the size you would
like to be). You may place the mark anywhere below the drawings, including between figures. Next draw a
mark below the drawing of the opposite sex figure which you believe is the ideal body size (again you may
place the mark between figures).
Please answer the questions below which ask you how you generally felt about yourself over the last few
months. Please circle the number which best describes that way you feel.

Strongly Strongly
Disagree Agree

1. I feel that I’m a person of worth, at least on an 1 2 3 4

equal plane with others.
2. I feel that I have a number of good qualities. 1 2 3 4

3. All in all, I am inclined to feel that I am a 1 2 3 4

failure.
4. I am able to do things as well as most other 1 2 3 4
people.
5. I feel that I do not have much to be proud of. 1 2 3 4

6. I take a positive attitude toward myself. 1 2 3 4

7. On the whole, I am satisfied with myself. 1 2 3 4

8. I wish I could have more respect for myself. 1 2 3 4

9. I certainly feel useless at times. 1 2 3 4

10. At times I think that I am no good at all. 1 2 3 4

Please answer the questions below which ask you how you generally felt about your relationship over the
last few months. Please circle the number which best describes the way you feel.

1. How well does your partner meet your needs?

1 2 3 4 5
Not at all Slightly Moderately Considerably Extremely

2. In general, how satisfied are you with your relationship?

1 2 3 4 5
Not at all Slightly Moderately Considerably Extremely

3. How good is your relationship compared to most?

1 2 3 4 5
Much worse Not as good About the same Better Much better

4. How often do you wish you hadn’t entered this relationship?

1 2 3 4 5
Never Seldom Sometimes Often Very often

5. To what extent has your relationship met your original expectations?

1 2 3 4 5
Not at all A little Moderate Considerable Very much

6. How much do you love your partner?

1 2 3 4 5
Not at all A little Average Quite a bit Very much

7. How many problems are there in your relationship?

1 2 3 4 5
Hardly any Less than average About average More than average A great many

View publication stats