Research Article: Multimodal Body Representation of Obese Children and Adolescents before and after Weight-Loss Treatment in Comparison to Normal-Weight Children

Date Published: November 22, 2016

Publisher: Public Library of Science

Author(s): Simone Claire Mölbert, Helene Sauer, Dirk Dammann, Stephan Zipfel, Martin Teufel, Florian Junne, Paul Enck, Katrin Elisabeth Giel, Isabelle Mack, Andreas Stengel.


The aim of the study was to investigate whether obese children and adolescents have a disturbed body representation as compared to normal-weight participants matched for age and gender and whether their body representation changes in the course of an inpatient weight-reduction program.

Sixty obese (OBE) and 27 normal-weight (NW) children and adolescents (age: 9–17) were assessed for body representation using a multi-method approach. Therefore, we assessed body size estimation, tactile size estimation, heartbeat detection accuracy, and attitudes towards one’s own body. OBE were examined upon admission and before discharge of an inpatient weight-reduction program. NW served as cross-sectional control group.

Body size estimation and heartbeat detection accuracy were similar in OBE and NW. OBE overestimated sizes in tactile size estimation and were more dissatisfied with their body as compared to NW. In OBE but not in NW, several measures of body size estimation correlated with negative body evaluation. After weight-loss treatment, OBE had improved in heartbeat detection accuracy and were less dissatisfied with their body. None of the assessed variables predicted weight-loss success.

Although OBE children and adolescents generally perceived their body size and internal status of the body accurately, weight reduction improved their heartbeat detection accuracy and body dissatisfaction.

Partial Text

Childhood obesity is increasing worldwide, and it is associated with both psychosocial and medical complications [1, 2]. Awareness of the problem and motivation are considered a key factor in changing health behavior [3, 4]. In this sense, it has been suggested that a lack of awareness of the own body size or indifference towards own weight status contribute to overweight, as they hamper motivation for weight loss [5–7]. In addition, it has been suggested that a disturbed interoceptive processing, as indicated by poor heartbeat detection accuracy, might contribute to an excessive food intake [8, 9]. As yet, no study has comprehensively investigated different types of body representation in obese children and adolescents. It is still unclear whether obese children and adolescents really have a disturbed body representation and whether weight loss also involves changes in body representation that could be addressed in weight loss treatment.

Table 1 provides an overview on the characteristics of the study population. At T2, seven children had dropped out so that the longitudinal data refers to a sample of 53 obese children. The length of intervention in OBE was 38±10 (min-max: 16–70) days. To exclude possible age effects, all analyses were repeated excluding the four youngest children (aged 9 to 10 years from the OBE group), which however, did not influence the results. Similarly, we explored whether results would change if absolute values of percentage of mis-estimation instead of perception scores were used. Again, this was not the case.

Our observations suggest that obese children and adolescents generally represent their bodies as accurate as normal weight age mates, though in OBE, body size representation was associated with eating concern. Our observation that none of the assessed variables predicted weight loss success is contradictory to ideas that a lack of awareness of their excess body size or poor interoception contributes to being overweight. However, we observed that in the obese children and adolescents, not only eating concern, but also heartbeat detection accuracy improved throughout weight loss, suggesting that the program induced improvements in interoceptive processing.