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Anxiety On Obesity

CHAPTER I

INTRODUCTION

One of the most common psychiatric illnesses is anxiety. Anxiety and its symptoms are associated with disruptions in daily life and with use of the health care system. Anxiety can have various clinical manifestations such as headache, palpitations, abdominal discomfort, muscle tension, feeling of lack of rest and fatigue. Anxiety also increases the poor prognosis, worsens quality of life and mortality. Many factors such as socio-economic, violence and traumatic events have been associated with anxiety and its symptoms. Obesity and overweight are two important somatic factors in this case.1, Obesity is a public health problem besides anxiety, which is also associated with disability and mortality. Obesity is characterized by excess body weight and is estimated to be one of the largest contributors to the burden of disease worldwide. It is estimated that about one third of the world's adult population has a body mass index (BMI) in the overweight category. Over the last few decades the prevalence of obesity has increased dramatically and the prevalence of obesity in children and adults has increased from year to year. Excessive body weight is a risk factor for death and 70% of these deaths are associated with heart and blood vessel disease caused by high BMI.1, Obesity is associated with anxiety disorders and several other psychiatric disorders. Discrimination related to weight and the stigma that exists in society can be a source of stress for individuals with obesity, in addition to the negative effects of

CHAPTER II

LITERATURE REVIEW

A. Worry Anxiety is a normal response to challenges or threatening situations, and is the most common psychological reaction in dealing with stress and frustration in everyday life. Feelings of anxiety create a physical response when a person feels threatened. Symptoms of anxiety are palpitations, sweating, trembling and feelings of fear or panic, and if the symptoms are continuous, severe and persistent, anxiety can interfere with daily activities, as well as social and occupational functioning. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) classifies anxiety disorders into several categories, namely, panic disorder, specific phobia, social phobia, agoraphobia, generalized anxiety disorder (generalized anxiety disorder),5, B. Anxiety Prevalence Anxiety disorders are common disorders worldwide, with one in 14 people meeting the diagnostic criteria at some point in their life. The prevalence of anxiety disorders in the world is estimated at 7.3% for each anxiety disorder. The prevalence of anxiety disorders is highest in countries that do not have conflict, such as the United States (10.1%) and New Zealand (8.3%) compared to countries that experience conflict, such as Iraq and Lebanon (5.4% and 6.4%). ,2%).^7

C. Obesity Obesity refers to excessive and abnormal fat deposition in the body which impairs health. In general, men with more than 25% body fat and women with more than 35% body fat are considered to have belly fat. Obesity is caused by many factors and is associated with various chronic diseases. Obesity is usually defined in the body mass index (BMI), which is calculated as a person's weight in kilograms divided by a person's height in meters squared. The World Health Organization (WHO) defines that a person has obesity if they have a BMI ≥30kg/m2. But WHO says universal BMI criteria cannot be applied to Asian populations because body fat percentage and health risks differ from European populations. In Indonesia, someone is considered obese if they have a BMI ≥25kg/m2.5, D. Obesity Prevalence The prevalence of obesity worldwide continues to increase. In 2008 WHO estimated that more than 1.4 billion adults aged 20 years and over were struggling with being overweight. In these overweight adults, more than 200 million men and 300 million women worldwide live with obesity. In America, based on the National Health and Nutrition Examination Survey 2011-2012, the prevalence of obesity in adults aged 20 years and over is 34.9%. In Indonesia, based on data from Basic Health Research (Riskesdas) in 2018, the prevalence of obesity in Indonesia among people aged over 18 years is around 21.8%. The

larger study, it was found that compared with obese men, obese women are more likely to develop depression, paranoid ideation, somatization, obsessive- compulsive behavior, anxiety and hostile behavior. Other studies have also reported that obesity is often accompanied by psychological consequences such as depression, somatization, interpersonal disorders, difficulty adjusting to the social environment and low self-esteem.^10 Research shows that the way of thinking of obese patients is characterized by cognitive distortions that can be related to anxiety disorders. A large number of obese patients appear with a rigid, simple and moralistic way of thinking. Obese patients face not only physical problems but also social problems in their lives. To deal with obesity patients use various coping strategies. Research shows that female patients with obesity show avoidance reactions and passive responses as coping behaviors to experiences in dealing with someone.^10 G. Personality Traits and Obesity Obese patients usually come with personality traits between passive- dependent and passive-aggressive. Other studies have found immaturity, poor impulse control and impaired quality of life. It was also reported that higher scores were found on self-doubt, insecurity, sensitivity, dependency and emotional instability. Aggressive and sociopathic personality traits have also been linked to obesity. Patients with severe obesity may be accompanied by personality disorder features associated with eccentric clusters (schizoid, paranoid) and anxious clusters (compulsive, dramatic). The hypothesis is that

high scores on the schizoid and paranoid scales coincide with difficulties expressing aggressive feelings and interpersonal sensitivity. On the other hand,^10 H. Anxiety and Obesity Anxiety disorders are the most common mental disorders in developing countries. Anxiety occurs not only with high frequency in the population, but also is chronic. Anxiety disorders fluctuate over the life cycle and usually experience improvement and worsening. Anxiety, fear, excessive worry and anticipatory anxiety are the main psychological symptoms, while feeling tense in the muscles, fatigue and chest discomfort are the main physical symptoms of anxiety disorders. Anxiety disorders are known to increase disability and death rates and have a negative contribution to quality of life.1. The relationship between obesity and anxiety and vice versa is still being studied today. Obesity is related to anxiety disorders in several ways. Social discrimination against people with obesity is a common problem. Low self- esteem is a factor that causes people with obesity to experience anxiety when trying to adjust to a social environment. Because they perceive themselves as inadequate and the environment around them is hostile, they develop psychological distress, social avoidance and anxiety. The way they see other people with obesity can be the way they see themselves. They blame themselves for being obese, trying so hard to get thinner (usually without a good plan leading to failure) and preoccupation with eating and weight control lead to excessive worry and anxiety. Furthermore, obesity can lead to several medical conditions,

play a role in obesity and anxiety disorders. The family environment also has an important role. Violence during childhood has been found to be a risk factor for obesity and anxiety disorders. Another factor that appears to be a predisposing factor for anxiety and obesity is the presence of psychiatric disorders. Anxiety disorders often coexist with other psychiatric disorders, especially with disorders that result in weight gain, such as mood disorders and eating disorders. Another important but complicated matter is the problem of personality disorders. Several personality traits such as avoidant coping, hypersensitivity to criticism and neuroticism are often present in individuals with obesity and anxiety disorders.3,10, The last important issue is the role of pharmacological factors used to treat obesity. One example is rimonabant, which is a class of antagonists for the cannabinoid CB1 receptor. The endocannabinoid system is known to play a role in mental processing, such as relaxation, reduction of pain and anxiety, and initiation of sedation. This system is also reported to play a role in appetite regulation and metabolism to maintain energy balance. This underlies the premise that the cannabinoid system is related to obesity. Ribonabant, which is used to treat obesity by regulating the cannabinoid system and resulting in weight loss, was discontinued due to its association with anxiety and depression. These facts further clarify the link between obesity and anxiety:^10

CHAPTER III

CONCLUSION

Anxiety disorders and obesity are common disorders in society. Anxiety is normally felt by a person when facing a challenge or a threatening situation, but if feelings of anxiety, worry, fear occur continuously, are severe, are persistent and result in pressure and disruption of life functions, then this becomes a disorder. Obesity refers to excessive and abnormal fat deposition in the body, which is usually calculated using the body mass index (BMI). For Europeans, the World Heatlh Organization (WHO) defines a person as obese if they have a BMI ≥30kg/m2 and for Asians it is called obese if they have a BMI ≥25kg/m2. Anxiety and obesity have a relationship: anxiety can cause obesity, obesity can cause anxiety,

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