[Psychosocial determinants of massive obesity]

Subjected to the reversed relationship between corpulence and socio-cultural level, massive obesity is, in Western countries, more frequent in the lowest social classes, and particularly in women. The influence on bodyweight of restricted food intake, physical activity and relative proportion of fats in daily diet has been demonstrated, and these 3 interacting factors vary with the social class. Although they are unanimously blamed for their enormous weight, subjects with massive obesity do not have a higher psychopathological index than other obese subjects or people with normal weight. On the other hand, the search of these massively obese subjects for a hypernormal presentation to compensate for the "abnormality" of their physical appearance (partially dependent on genetic factors) leads them to deny a great deal of the emotional and nutritional reality. This denial, overlooked by health institutions, could have been full of consequences. By generating wrong evaluations it would have contributed to the inadequacy of therapeutic responses which in turn would have made the obesity worse. Taking into account this phenomenon should improve the adequacy of therapeutic strategies and hence the prognosis.