A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention


  • E. Hemmingsson

    Corresponding author
    1. Obesity Center, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
    • Address for correspondence: Dr E Hemmingsson, Obesity Center, Karolinska University Hospital, Department of Medicine, Karolinska Institutet, Norra Stationsgatan 93, SE-11364 Stockholm, Sweden.

      E-mail: erik.hemmingsson@ki.se

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The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self-esteem and self-worth, negative emotions, negative self-belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho-emotional overload, triggering a cascade of weight gain-inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up-regulation, low-grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.