Psychosomatic Medicine 2:141-206 (1940)
© 1940 American Psychosomatic Society

Obesity in Childhood: V. The Family Frame of Obese Children

¹ Department of Pediatrics, College of Physicians and Surgeons, Columbia University, the Pediatric Division of the Vanderbilt Clinic, and the Babies Hospital, New York City

Evaluation of the food intake and muscular activity of obese children which were discussed in previous articles of this series indicated that factors in the home environment had contributed to the development of obesity.

The purpose of this investigation was to disclose common, if possible typical, features in the family constellation. The title "family frame" is intended to designate that the problem was approached from the angle of the parents, but is focussed upon the obese children. Their response to the family environment, however, will not be discussed in the present report.

The 40 families which were investigated represent a cross-section of the clinic population of obese children. The economic level was marginal. It will be necessary to supplement the findings by a study of patients coming from a higher cultural and economic level.

The condition of the homes was surprisingly good. The amount of money spent for food was disproportionately large.

The investigation of the background and personal development of the parents revealed many fathers as weak and unaggressive persons, with little drive and ambition. The mothers had suffered from great poverty and insecurity in their childhood and had been thrown upon their own resources early in life. They had reacted to their experience with self-pity and resentment and had been blocked in their emotional development.

The difference in temperament between the parents became even more apparent in the marital relationship. Only in few families was the marital relationship satisfactory. Disharmony expressed itself in open fighting or contempt of the mothers for their husbands. With few exceptions the mothers were domineering in the life of the families.

The families were conspicuous by their small size. Seventy per cent of the children were only children or the youngest. There were many admitted abortions, and more than 50 per cent of the children had been unwanted. The sex of the boys had frequently been a disappointment to the mothers.

A marked ambivalence was apparent in the attitude of the mothers towards the obese children. A fundamental rejection was compensated for by over-protection and excessive feeding. Hostility of the mothers expressed itself in unreasonable and cruel discipline. Greater security was revealed in the relation to the fathers, who, however, were too weak to give positive guidance. The handling of other children varied; marked differences were not uncommon.

The obesity of the children was rarely a matter of concern to the parents, in contrast to the exaggerated concern over acute physical disorders. Fear of sexual maldevelopment was marked in the parents of obese boys. Cooperation and interest in treatment were frequently poor.

The home environment as described did not offer adequate eniotional security. In these surroundings food had gamed an exaggerated importance. It had been charged with a high emotional value and stood for love, security and satisfaction and represented in all instances an important tie in the relationship between parents and children. The parents hesitated to withhold food in order not to upset a precarious balance.

Muscular activity and social contacts, on the other hand, had been associated with the concept of danger, threat and insecurity.

The occurrence of excessive intake of food and of avoidance of muscular activity, two important factors in the developments of obesity, becomes comprehensible under these circumstances. They are expressions not only of a disturbance in the weight regulating mechanism but of poor social adjustment and delayed emotional maturation.

The present report has been deliberately restricted to the description of the environmental forces. The conjugate importance of the individual responsiveness is emphasized. The discussion of this factor will from the content of a later article.

Note:

This investigation has been aided by a grant from the Josiah Macy, Jr. Foundation.

This article has been cited by other articles:

				G. Vila, E. Zipper, M. Dabbas, C. Bertrand, J. J. Robert, C. Ricour, and M. C. Mouren-Simeoni Mental Disorders in Obese Children and Adolescents Psychosom Med, May 1, 2004; 66(3): 387 - 394. [Abstract] [Full Text] [PDF]

				P. J. Morrissette and D. Taylor Family Counseling and Childhood Obesity: A Review of Approaches The Family Journal, January 1, 2002; 10(1): 19 - 26. [Abstract] [PDF]

				H. J. Kelley and J. E. Redfield Chapter VI: Physical Growth from Birth to Maturity Review of Educational Research, December 1, 1941; 11(5): 573 - 591. [PDF]