[Psychosocial aspects of obesity]

There is a strong psychosocial prejudice and discrimination against obese persons. Despite this pressure, they show no greater psychological disturbance than normal-weight persons do. Patients with bulimia, distortion of body image and - to a lesser degree - with extreme obesity are an exception to the rule and often require psychiatric help. There is no evidence for an obesity-specific disturbance of personality or of eating behavior. Behavior modification - with or without anorectic agents is still a matter of debate - has been the most successful form of therapy. As dieting carries the danger of psychosocial stress and morbidity its indication has to be carefully considered. With the high attrition rate, low compliance of obese persons and the poor outlook for a permanent therapeutic effect supportive care and guidance of obese patients is the most important and difficult task for the physician.