A Psychological Perspective - Case Study Example

«A Psychological Perspective» Introduction Obesity in children has become one of the major health problems in the US. It has been observed that growth in the percentage of obese children has become rapid since the advent of television and personal computers in homes. Children are attracted to television and video games more than the outdoor physical games (Tauber and Jouret 2004, p.91). This has also led to an increase in the habit of eating without awareness. However, the question is, are television and sedentary lifestyle the only causes of obesity? The roots of obesity lie in the emotional and the psychological aspects of the child. The case study discussed in this paper shows that if prevalence of obesity is to be reduced successfully, then understanding the real cause of obesity is very important. The case study has revealed an important fact that obesity is mostly a result of unfulfilled emotional and psychological needs than a physical problem. Hence, it is necessary to adopt a holistic and a humanistic approach towards obesity as only this approach can help in healing the person completely. The Case Study Tom is an 11-year-old boy studying in year 5. He is obese. He is suffering from obesity since age 6. He is teased a lot by his class mates and hence, he is reluctant to participate in the physical education program at school. He often asks his mother to give him a note asking him to be excused and she does that without probing more into the issue. She does not think that obesity is a serious problem as she thinks that he is just going through a phase. She believes that he will grow out of it when he has his growth spurt in puberty. Tom does not like playing with his friends. He prefers to stay home and play computer games and play station as these are his favorite activities. He likes to snack on biscuits and soft drinks while watching television. The Background To understand the background of the case, the technique used was interview. Tom and his mother were encouraged to talk about his habits, history of obesity, his family background, his emotional patterns, eating habits etc. During the conversation, it was revealed that Tom was not happy with the way ‘things are going’. He was sad with the school and does not feel like going to school. His mother was encouraged to go deep into the matter to understand what makes Tom feel unhappy at home and at school. The interview revealed that Tom’s sedentary lifestyle was not the only cause of his obesity. His unfulfilled emotional needs were causing obesity by making him overeat. Tom was suffering from obesity since age 6. He started gaining weight at the age of 4. His mother was working and was divorced from his father when Tom was 2 years old. His father has never loved him and had never shown any affection towards him. Tom was brought up with all the physical comforts. His mother tried her best to fulfill all his demands. However, as his mother was busy in her work, she was not able to spend enough time with him. His maternal grandmother came and stayed with them till he was 8 years old. Tom always looked forward to spend time with his mother but was not able to, as she returned home late from work. To divert his attention from his mother, he was allowed to watch TV and play video games as much as he wanted. He was also allowed to eat whatever he wanted and whenever he wanted it. His mother and grandmother never stopped him from eating fast food or junk food. He used to spend time watching TV till she came and this used to make him to late to sleep. By the age of 6 , Tom was overweight and started becoming lethargic. Instead of sitting on a dining table for eating, he used to sit on the sofa in front of the TV. He was not able to bond with his grandmother as she had come to stay with them out of the feeling of duty. This created more problem for Tom as he felt that he was unwanted child. His grandmother left when he was 8. Tom became obese by the age of 8 and his condition was becoming serious. His mother realized the seriousness of the problem when she was notified by Tom’s teacher regarding his concentration problem in the class and lack of interest in study. Till that time, she had considered his obesity as a ‘phase’. However, after talking to Tom about his lack of interest in study, he told her that he was feeling ashamed to go to school. He was being teased by his class mates every day and is made fun of whenever they get a chance. He does not have friends and feels that he is worthless. This was the first time Tom’s mother realized that she was doing a major mistake by ignoring his physical condition. This made her to seek counseling to help him overcome fear, insecurity and obesity. During the conversation, many times Tom referred to the lack of emotional support from his mother unknowingly. Following are some of the sentences that show deep feelings about absence of his mother: “As mom was not around, I used to spend time watching TV”, “I wanted to tell mom but she was busy with her work”, “ I used to cry to sleep dreading the next day at school, thinking that mom will get angry if I told her”, “ I like it when mom takes me out with her, but that’s not often”, “ I feel that she does not love me as I am a hopeless child” etc. These sentences show that there was a lack of emotional support from his mother and he was craving for emotional fulfillment. Tom’s mother has never displayed her love and affection through words, gestures, touch or body language. He started getting pleasure and comfort in food and started binging on junk food. Tom’s obesity had resulted from bad eating habits and the lack of physical exercise. However, what led to this behavior was the lack of emotional fulfillment at home. Symptoms Tom was suffering from low self-esteem and lack of confidence. He was not able to concentrate in the class and also avoided playing with his classmates. He was feeling low as he thought that he cannot fulfill the expectations of his mother. He spent more time at home and in front of TV. He feared ridicule from people and hence, never went to the park nearby. He avoided participating in social activities fearing negative reaction from people. Tom had become lonely and used to feel uncomfortable while talking to people. During the conversation, his body displayed restlessness and he was fidgety. He showed discomfort with his body and avoided direct eye contact and open body language. He sat and walked with slouched shoulders in an attempt to hide his obesity. Tom had grown emotionally distant from his mother and had become lethargic. He lacked mental and physical energy. He used to feel low most of the time and no activity aroused his interest anymore. Diagnosis Tom’s symptoms revealed that he was suffering from depression. The symptoms of depression in children are feeling of worthlessness, loss of energy and enthusiasm, inability to concentrate in different activities, low confidence level and depressed mood (Tauber and Jouret 2004, p.130). In a study conducted by National Center for Childhood Obesity (Sweden), obese children revealed that they experience the symptoms of depression and parents of the obese children said that in comparison to the children who were not obese, their children had less stamina and energy (Tauber and Jouret 2004, p.130). Tom had no stamina and felt tired even after walking to his bus. Most of the times, he preferred doing things that needed him to sit and avoided activities that needed even a small amount of physical exertion. The negative treatment that the obese children undergo during their social interaction leads them to feel that they are not worth anything. The feeling of worthlessness makes them to keep to themselves and avoid participating in the social activities at school or home. The indirect rejection shown by people around them makes them feel depressed and low (Tauber and Jouret 2004, p.130). Hence, obesity leads to depression and low self-esteem. This behavior pattern gives rise to the chances of the obese child ending up gaining more weight, as instead of mixing with friends, the obese children prefer staying at home. They watch TV or play video games and develop a binging habit to compensate the feeling of sadness and rejection. This gives rise to a vicious cycle of obesity prone behavior. The lack of confidence in their physical characteristics leads the obese children to develop low self-esteem (Tauber and Jouret 2004, p.130). Low self-esteem again leads to lack of confidence and hence, they become more vulnerable and open to criticism and rejection by others. In fact, with growing age, the level of self-esteem seems to decrease in the obese children. A study of 1,090 obese children in USA found that during the transition from preadolescence to adolescence, the obese children’s self-esteem decreases more and they lose their remaining confidence in their physical appearance (Tauber and Jouret 2004, p.130). Hence, if people ignore the obesity in their children thinking that their children will get in shape once they reach adolescence, then they are inviting more trouble and psychological problems for their child. Tom’s mother had ignored the obesity thinking that it won’t last long and Tom will reduce weight when he reaches puberty. This was a wrong understanding and led to increase of obesity in Tom. Tom developed a low self-esteem as a result of his obesity. The low self-esteem affected his performance at school and his grades were dropping regularly. The emotional suppression and insecurity led him into depression. He was in need of total and unconditional love. Intervention In Tom’s case, his mother’s thinking that “he is chubby and will become ‘normal’ with growing age”, showed ignorance of the problem. Subconsciously, she was avoiding accepting the reality that her child was suffering from obesity. Her conscious ignorance of the problem was creating a danger for Tom’s future. There are many chances that Tom might continue experiencing the obesity problem in his adult life and lose on opportunities of the better future. It was necessary to make his mother understand that by ignoring the problem, she is not helping him but is making it grow. It was time for her to take the responsibility of her child’s problem and take efforts to heal him from the problem. The obese children are likely to suffer increase in their physical, emotional and psychological problems if the parents overreact to their obese situation or react negatively to their obesity (Brown 2008, p.13). Hence, instead of focusing only on his diet, the counseling sessions were designed to focus on helping Tom to get emotional and psychological empowerment. As the bad diet is a part of a behavior problem, change in the diet pattern was the aim of the session, but was not considered as a major part of therapy. Tom’s current diet was unhealthy and harmful. Tom and his mother were advised to go through weekly counseling sessions. During these sessions, Tom was counseled on his behavior pattern, his mundane habits and the changes needed to be adopted to empower him to get an energetic body and emotional fulfillment. The following intervention strategies were used to treat obesity in Tom. A) Diet Plan The unhealthy eating patterns are found to be one of the important causes of obesity in children. When a child consumes more energy and calories compared to the amount he expends, then he develops obesity and overweight problem (Brown 2008, p.13). Eating out at fast food restaurants has also increased the chances of consuming more calories than is needed by the body (Brown 2008, p.13). Through television and internet, children are exposed to the manipulative advertisements which attract them to the fast food and get them addicted to the habit of eating out (Tauber and Jouret 2004, p.91). Tom’s habit of eating while watching TV was not allowing him to realize how much he was eating. His attention was focused on TV and not on the amount of food that he was eating. Also, Tom was not physically active. He did not use his bike. He preferred to be driven by his mom and avoided walking even to the nearest store. This led him to lose a chance on burning calories. It has been found that the modern lifestyle has made people to give up their mundane natural physical activities like walking, jogging, playing outdoor games, washing utensils etc. Hence, the energy which was expended in these activities is not being used anymore and at the same time, the consumption of food has not decreased (Brown 2008, p.13). In fact, people are eating more to kill their boredom and to ‘feel good’. Hence, Tom was given suggestion to adopt some fresh and interesting activities to modify his eating habits and to become physically active. Tom and his mother were suggested to go for a walk together. This was intended not only to make Tom physically active but also to grow an emotional bond between him and his mother. His mother was advised to create different opportunities where she will get to spend more time with Tom. For example, she was suggested to take Tom with her to grocery shopping and allow him to select whatever fruits, vegetables and other healthy eating products that he liked. When children get to choose their food, they feel a sense of freedom and responsibility which helps them to maintain the positive attitude towards the diet modification (Brown 2008, p.13). To reduce obesity in a member of a family, it is very important for the whole family to follow the healthy eating habits (Brown 2008, p.13). Particularly, when a child is suffering from obesity, he should be provided with great support from all the other members of the family. Hence, a positive change in environment and changes in the lifestyle of the family becomes an important factor. If the family members eat fast food and ask the obese child to eat veggies or fruits, then it develops craving and feeling of suppression in the child. This discourages his efforts to reduce weight and makes him feel more depressed. It also creates a feeling of punishment in him. He feels isolated. To avoid the feeling of isolation in Tom, Tom’s mother was advised to get into healthy eating habits and to have early dinner with him. Having dinner together will help them both to come close to each other and by sharing their day’s experiences, they will start to understand each other. As a part of physical exercise, Tom was suggested to join yoga as yoga not only helps in gaining physical health but also makes people achieve emotional and psychological health. B) Yoga The root cause of obesity is not just the biological structure but also the psychological and emotional structure of a child. Some children overeat to cope with the stressful situations at school and at home (Tummers 2009, p.6). Children, who do not get love and emotional support from their family, tend to find those feelings through food (Tummers 2009, p.6). There are certain foods, when consumed, make children feel good by causing their body to release dopamine (Tummers 2009, p.6). Hence, their brain associates the feeling of ‘goodness’ with eating those foods. This creates a sort of addiction to those foods. Yoga is more beneficial than any other physical exercise method as yoga provides not only the physical exercise to the child, but also gives a holistic and comprehensive approach to health through physical movements, breath exercises and relaxation (Tummers 2009, p.4). Research has shown that the mind and the emotions of a person are connected to the breathing pattern and hence, these can be calmed by calming the breath (Tummers 2009, p.5). In this way, by controlling the breathing pattern, the emotional eating can be controlled. Moreover, by practicing yoga, the self-efficacy in children increases as it increases the ability of the mind to successfully handle the stress (Tummers 2009, p.5). Tom needed to increase his self-esteem. To handle the negative reaction from people, he needed to get strong internally and become self confident. Hence, yoga was helpful as it teaches a child how to bring the focus inside himself and take the responsibility of his actions, rather than focusing on the external aspects of the problem and blaming people for what he is going through (Tummers 2009, p.5). Yoga also increases the self awareness which helps the children to internalize their focus and work with their own emotions and needs of the body, rather than getting influenced by advertisements, television commercials and websites (Tummers 2009, p.7). Hence, yoga was suggested to Tom as it was good for his overall development and was not harsh and physically demanding. C) Humanistic Approach In Counseling: Humanistic approach in psychology is a result of dissatisfaction that psychologists like Abraham Maslow and Carl Rogers felt regarding the psychoanalysis and behaviorism theories (Wong 2006, p.198). Maslow is one of the most positive psychologists in the world as instead of considering a human being as a robot who should be trained to behave in certain way, he considered him a ‘whole’ being who should be helped to achieve his highest potential (self actualization), by showing him how to satisfy his needs on every level of his existence (Wong 2006, p.198). According to Maslow, the behavior and actions of human beings are motivated by the desire to fulfill the unmet needs in their life (Sharma 2004, p.147). On the basis of this theory, he designed the ‘hierarchy of needs’ which are as follows: 1) physiological needs, 2) Love needs, 3) Security needs, 4) Esteem needs and 5) Self- Actualization needs (Sharma 2004, p.147). Maslow says that if a particular need is not fulfilled, then the person struggles to fulfill it and is not able to move ahead in the hierarchy (Sharma 2004, p.148). The unfulfilled need hampers growth and his progress is stunted (Sharma 2004, p.148). Hence, he is not able to achieve his complete potential (Sharma 2004, p.148). Tom’s background clearly shows that his love needs were not fulfilled. He was having problem in socializing and making friends. He desired to be loved by others but instead, he was getting rejection and negative response from them. This made him sad and hopeless. He started getting depressed. The major cause of depression was that his love needs were not being fulfilled. This created obstacle in his security needs and esteem needs. He was feeling insecure in the school. He felt that he was unprotected from the bias treatment that he was getting in school. Studies have found that not only the fellow students but even the teachers are likely to treat obese students with bias (Puhl, Heuer and Brownell 2010, p.26). This affects the educational performance of the obese students negatively, as the bias treatment from teachers discourages them from achieving their goals (Puhl, Heuer and Brownell 2010, p.27). Tom was suffering from negative effects of social stigma. This made him to spend time alone with himself at home and avoid meeting anyone or making friends. In this scenario, the major step was to fulfill his love needs. Tom’s mother was advised to display her love towards Tom and to show him that he is loved the way he is. She was advised to show him unconditional affection and love, as often as possible. This will make him feel that he is accepted as he is and no conditions are set for his acceptance. According to the client centered therapy, which was developed by Carl Rogers (1940), the counselor in the therapy should treat the client as unique and individual human being (Raskin, Rogers and Witty 2008, p.141). Hence, during the therapy, Tom was assured that there was nothing wrong with him. He was advised that these sessions were designed to help him achieve his deepest potential so that he can mix with people confidently and get back his ability to concentrate in the class. Carl Rogers believed that instead of driving a person to ‘become’ someone, psychotherapy should aim at making a person understand that he is ‘complete’ in himself and does not need to change himself in an attempt to ‘be someone’(Raskin, Rogers and Witty 2008, p.141). He called the concept of accepting a person as he is, as the ‘unconditional positive regard’ (Raskin, Rogers and Witty 2008, p.141). The humanistic approach is one of the best approaches towards psychotherapy as it respects the spirit of humanity. Tom showed openness and comfort with the sessions as he realized that he was not being blamed or criticized for his obesity and low self-esteem. He realized that there was no expectation or goal set for him to achieve but was being helped to fulfill his need of understanding and love from other people. Results The humanistic approach in the therapy proved successful as Tom showed signs of improvement in a month’s time. He had joined yoga and found that he was not the only one who was obese. He made friends in the yoga class. This made him happy and he started looking forward to it. There was a visible positive change in his body language as he did not fidget or showed restlessness during the sessions. Even though it was not possible to know the results regarding his weight loss so early, the marked difference in his behavior showed that his self-esteem was increasing and he was becoming confident. Research in the field of child obesity has revealed that obesity in children can be reduced by 10% in a year’s time if they follow healthy diet, undertake regular exercise and modify their behavior pattern (Ostman, Britton and Jonsson 2004,p.227). Changes in Tom’s behavior was a positive sign as it showed that this will give him a drive to stick to the healthy eating pattern and achieve a healthy body. Conclusion Obesity should be treated as an emotional and psychological problem rather than a physical disease. Obesity can be tackled successfully only if the true cause of it is understood. Moreover, when treating obesity, a holistic approach proves to be the best approach as it not only helps the person to gain confidence in his body but also strengthens his spirit by letting him realize that he is ‘complete’ in himself. Self acceptance is the most important step towards a fulfilled and happy life. Hence, as self-acceptance is the core of humanistic approach to psychotherapy, it is the best approach to work with clients. References Brown, J.E. 2008. Nutrition Now. 5th ed. Belmont: Thomson Wadsworth. Ostman, J., Britton, M. and Jonsson, E. eds. 2004. Treating and Preventing Obesity. Weinheim: Wiley-VCH. Puhl, R.M., Heuer, C.A. and Brownell, K.D. Stigma and Social Consequences of Obesity. In: P.G.Kopelman, I.D. Caterson and W.H.Dietz, ed. 2010. Clinical Obesity in Adults and Children. 3rd ed. Hoboken: Wiley-Blackwell. Ch.3. Raskin, N.J., Rogers, C.R. and Witty, M.C. Client-Centered Therapy. In: R.J.Corsinin and D. Wedding, eds. Current Psychotherapies.2008. Belmont: Thomson Brooks/Cole. Ch.5. Sharma, M. 2004. Administrative Thinkers. New Delhi: Anmol Publications. Tauber, M. and Jouret, B. Role of Environmental factors in Obesity. In: W.Kiess, C.Marcus and M. Wabitsch, ed. 2004. Obesity in Childhood and Adolescence. Basel : Karger AG, PP.91-102. Tummers, N.E., 2009. Teaching Yoga for Life: Preparing Children and Teens for Healthy, Balanced Living. Champaign: Human Kinetics. Wong, P. Existential and Humanistic Theories. In: Hersen, M. et al. eds. 2006. Comprehensive Handbook of Personality and Psychopathology. Hoboken: John Wiley & Sons, Inc. Read More