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Research findings from adult studies suggest that being teased about weight or size when growing up may be a risk factor in the development of later eating and body image problems. However, little research has focused directly on teasing experiences in childhood. The current study aimed to extend previous work and investigate the frequency of overweight-related victimisation and its psychological correlates in preadolescent boys and girls. It was hypothesised that victimised children would have lower self-esteem, more body dissatisfaction, and be more likely to report dieting to lose weight. From the sample of three hundred and eighty-three children (200 boys and 183 girls), aged nine years, it was found that 41% of girls and 36% of boys reported general victimisation. Furthermore, 21 % of girls and 16% of boys reported overweight-related victimisation, which included being teased, bullied, and called names about being fat. Overweight-related victimisation was associated with reduced self-esteem and greater levels of body dissatisfaction, even when controlling for BMI. These children were also more likely to report dieting and restrained eating behaviours than non-overweight victimised participants. Moreover, the overweight-related victimised participants received less attractiveness nominations from their peers than non-overweight victimised participants. Not surprisingly these participants rated fat teasing worse than other forms of teasing and it was more upsetting for them. This study also investigated characteristics associated overweight-related victimisers and found they had lower behavioural conduct esteem and lower global self-worth. In addition, they considered physical appearance more important for self-worth than those who did not victimise others for overweight. To date, this is the first study to describe levels of overweight related victimisation in a community sample of preadolescent boys and girls. Overall, this study highlights the presence of obesity stigmatisation, through teasing, in children and the potential negative consequences of overweight-related victimisation. Further research is required to examine the role of peer victimisation as a risk factor in the emergence of eating and weight concerns.

Obesity is a growing problem throughout the world and accompanies many physical and psychological issues. Increasingly Bariatric Surgery is being turned to as a means of losing weight, often after many failed attempts to use diet and exercise. The focus of this project is on the experiences of patients who opt for Bariatric Surgery. The literature review explored the qualitative studies on experiences after Bariatric Surgery. It adopted a Narrative Synthesis approach and the findings were analysed for themes. A total of twelve papers were included and three main themes emerged. They were titled “Transformation”, “Adjustment & Coping” and “The Paradoxes”. The review highlighted clinical recommendations regarding patients unmet needs after surgery and suggested topics for further research. The research report explored the longer term experiences of patients who had undergone Gastric Bypass Surgery (GBS), which is a frequently used procedure for weight loss. The study utilised Grounded Theory techniques to collect and analyse the data. Seventeen participants were interviewed, all of whom had undergone GBS three to eight years ago. A core category titled “The Battle for Control” was found to permeate the majority of experiences pre and post surgery. A theoretical model was devised to propose factors that enabled the participants to develop self-control after surgery, such as viewing the bypass as a tool and learning to self monitor. It also outlined circumstances that impeded this process, such as finding ways to cheat the bypass. Issues relating to food addiction and body image also emerged from the data. The findings are discussed in relation to existing literature, along with theories relating to self-efficacy and locus of control. Further recommendations for clinical practice and research are also given. The critical appraisal is a reflective, personal account that discusses some of the important issues relating to quality in qualitative research.

The prevalence of obesity in adolescence has tripled over the last 30 years in the western world and the 'obesogenic environment' is implicated as one of the factors which may have contributed to the epidemic. Fast food has been shown to be calorie dense, high in salt and saturated fat and low in micronutrients. This thesis aims to explore the association between fast food accessibility, fast food consumption and obesity in the United Kingdom. Data from participants of a UK birth cohort (ALSPAC) were used for the majority of these analyses. A weighted accessibility score of the number of fast food outlets within a 1km network buffer of the participant's residence at age 13 was used as the main measure of access to fast food. Cross sectional and longitudinal data analyses were undertaken using several statistical methods. The structural equation modelling analyses showed that the teenagers who ate at fast food restaurants consumed more unhealthy foods and were more likely to have higher BMISOS than teenagers who did not eat frequently at fast food restaurants. The teenagers who were exposed to more takeaway foods at home ate more frequently at fast food restaurants and eating at fast food restaurants was also associated with lower intakes of vegetables and raw fruit in this cohort. In the longitudinal analyses the consumption of fast food at age 13 was associated with higher BMISOS, higher body fat percent and increased the likelihood of being obese at age 15. The relationship between access to fast food outlets and the consumption of fast food varied over space with some areas having a positive association (increased access more likely to consume fast food) whilst another area had a negative association (increased access less likely to consume fast food). This evidence could be used to encourage improvement in the nutritional content of fast food within the UK but targeted, rather than blanket, restrictions on the location of fast food outlets may be beneficial in reducing fast food consumption.

Aim: Within the field of obesity, evidence shows that weight regain following weight loss is extremely common, demonstrating that weight loss treatments are not effective. Considering that attachment history influences a person’s capacity for emotional regulation and that some people use food to self-soothe, increasing our understanding of the relationship between attachment style and obesity might inform better treatments. This study is comprised of two parts: the first part investigates whether attachment style predicts outcome in a 12-session group treatment for obesity and the second part explores the experience of that treatment. Design: The study utilises a mixed methods design with participants from a group treatment for obesity which comprises: the Attachment Style Questionniare (ASQ), completed by 52 group members, along with their body mass index (BMI) measures at the start and end of the treatment, analysed using a backwards multiple regression to test whether the 5 dimensions of the ASQ can predict participants’ change in BMI; and semi-structured interviews with 7 people from the same treatment analysed according to Interpretative Phenomenological Analysis (IPA) guidelines. Method: Data was collected from 52 people attending group treatment for obesity with an NHS service in South East England, which included the ASQ and BMI measures at Week 1 and Week 12 of treatment. The change in BMI was entered as the dependent variable for the regression in SPSS and the five attachment dimensions were entered as predictors. 7 people who had taken part in Part I of this research participated in interviews about their group experience. Transcripts were subjected to IPA. Results: Quantitative findings produced a model in which the ASQ dimension Confidence (in relationships) significantly predicted change in BMI in a negative direction (i.e. the participants who scored higher on Confidence lost less weight than those with lower scores). Confidence explained 8% of the variance (R2=0.08, F(1,50)=4.32, p<0.05). Qualitative findings produced four super-ordinate themes which included: the sadness at the course ending; the support and comfort felt from others in the group experience; the positive aspects of the group treatment; and the negative aspects of the group treatment. Other group members appeared to have a substantial impact on participants, whether positive or negative. Some accounts reflected the importance of others in feeling accepted and supported. Other accounts conveyed less of an emphasis on feeling part of the group and more on feeling separate. Conclusions: The quantitative results are inconclusive and possible reasons for this are discussed. The qualitative findings suggest that it is likely that group intervention for obesity could be improved by attention to attachment and by tailoring treatments more specifically to individuals.

Text in English / In order to address the paucity of knowledge in regard to the psychological and physiological processes associated with lifelong weight loss (>20 years), this study adopts a qualitative approach informed by phenomenology to explore the experience of lifelong weight loss and maintenance of women who participated in the ITAND Programme. The research questions guiding the exploration of the current research are: (i) Which strategies from the ITAND Programme do women perceive as assisting with initial weight loss? (ii) What are the processes mediating lifelong weight loss? (iii) What strategies and skills mediate the maintenance of lifelong weight loss? (iv) What feelings or beliefs motivate women to continue attempts to lose weight after experiencing multiple failures on diets? and (v) Which psychological, cognitive and behavioural processes are identified as mediating lifelong weight loss? Eight overweight and obese women were invited to write their narratives and engage in interviews in regard to exploring their relationships with food, their bodies and their weight, after a period of more than 20 years following their participation in an integrative, transactional analysis, anti-diet programme (the ITAND Programme). Narratives were used to explore their beliefs about constructs, processes and strategies mediating long-term weight loss maintenance. The participants’ narratives and interviews were analysed through applying narrative analysis and interpretive phenomenological analysis. In addition to a non-diet paradigm, four processes definingweight loss maintenance were identified, including the adult learning process of transformative learning, the psychological process of transactional analysis, the physiological process of intuitive eating and the cognitive-behavioural processes relating to weight loss maintenance. This study contributes an integrative, transactional analysis, non-diet treatment model (ITAND model) which is enabled by the processes of transformative learning, intuitive eating and cognitive-behaviour modification to the successful long- term treatment of overweight and obesity. This model may be applied in whole or in part in a primary health care or community context. The findings of this study may be used to inform future research into the development and implementation of non-diet weight loss maintenance interventions in the treatment of overweight andobesity. / Psychology / D.Litt. et Phil. (Psychology)