What is Obesophobia?

According to a recent health survey conducted by the government and the NHS, two-thirds of adults in the UK are overweight, with 28% of adults being classed as obese. However, although obesity is an issue that both the government and the NHS want to tackle, on the flip side of that is eating disorders, with up to 3.5 million people in the UK being affected by eating disorders.

Obesophobia, the extreme and overwhelming fear of gaining weight or getting ‘fat’, is a type of phobia that often leads to, or occurs in conjunction with, eating disorders. It is a serious mental health condition that can affect many aspects of someone’s life, including their mental, emotional and physical health and their social and personal life.

Today, we are going to look at obesophobia in more detail, including the common causes, triggers, symptoms and treatment options.

What is obesophobia?

Obesophobia is the extreme, irrational and overwhelming fear of gaining weight or getting fat. Also known as pocrescophobia, obesophobia is a type of specific phobia which is characterised by an enduring, overwhelming and irrational fear of a specific object, situation, place or person; in this case, an extreme fear of gaining weight. It is also frequently categorised as a type of anxiety disorder or eating disorder.

Someone with obesophobia will have an abnormal, irrational and consuming fear of gaining weight. The thought or reality of gaining weight will likely result in feelings of fear, anxiety, panic or dread. These negative feelings can be overwhelming and can begin to significantly impact a person’s day-to-day life.

Obesophobia can result in negative thoughts, feelings and behaviours surrounding food, eating, socialising, getting dressed, shopping for clothes, taking photographs and seeing other people that the individual considers to be overweight. The individual may go to extreme lengths to avoid gaining weight or to lose weight.

This phobia can result in negative and damaging behaviours, such as:

• Excessive calorie counting.
• Refusing to eat anything they haven’t prepared themselves to ensure they have complete control over what they eat and don’t need to worry about hidden calories.
• Self-criticism to the extreme.
• Negative judgements, attitudes and behaviours towards people who are overweight or don’t watch their weight.
• Exercising excessively.
• Withdrawing from social activities that involve eating.
• Following ‘fad diets’ or extreme diets.
• Considering extreme weight loss or body-changing options, such as liposuction or other surgeries.

Obesophobia can also result in an eating disorder or disordered eating patterns, such as anorexia nervosa, bulimia nervosa or avoidant restrictive food intake disorder. Someone with obesophobia can become so fixated on their weight that they become underweight or malnourished. They may weigh themselves several times a day or become obsessed with the types of foods they are eating and the amount of exercise they are doing.

As well as resulting in body image issues, excessive self-criticism and the need to conform to unhealthy social or beauty standards, obesophobia can also negatively impact an individual’s physical health. Restrictive eating or not eating enough food can result in you being underweight or malnourished.

It can also result in abnormally low blood pressure and a slower-than-normal heart rate. You could also experience low energy or lethargy, mood swings, sleeping difficulties, hair loss, reduced bone density (osteoporosis) and even heart failure.

Obesophobia can result in restrictions in your eating habits. You may develop an abnormal or unhealthy relationship with food and difficulties functioning normally in social or professional situations involving food. If you have obesophobia, you may experience difficulties functioning normally or concentrating in certain places or situations, because of the fear that you may have to eat ‘unhealthy’ food or engage in an activity that makes you feel overweight. You may become consumed with the thought of food and your weight and the fear, anxiety and panic that you feel can have a significant impact on your mental and emotional well-being and your behaviour.

Obesophobia can also result in avoidance behaviours. Someone may go to extreme lengths to reduce their contact with food or avoid situations where they may be expected to eat foods they consider to be unhealthy. For example, they may refuse invitations to birthday parties or meals out with friends because of the anxiety and dread of what types of food they may encounter. Avoidance behaviours can also make everyday tasks and socialisation difficult.

Although avoidance behaviours are designed to help you avoid gaining weight and prevent you from experiencing negative thoughts and feelings and adverse symptoms, they can actually have a paradoxical effect.

Instead of helping you to manage or reduce your fear and anxiety, avoiding certain foods or certain places or situations can have the opposite effect and instead reinforce your anxiety and result in a more severe phobia. Avoidance behaviours can also negatively impact your social life and professional life, your relationships and your ability to function normally.

You may be aware that your phobia of gaining weight is extreme and irrational and that your obsession with your weight is unhealthy. However, you may still be unable to minimise damaging behaviours or manage negative thoughts. You may also be unable to control or prevent any physiological, psychological or behavioural symptoms you experience if you gain weight or think about gaining weight.

Although many people try to manage or control their weight and engage in activities such as calorie counting and exercising, this does not necessarily mean they are experiencing obesophobia.

To be classified as obesophobia, your fear of gaining weight will include:

• Feelings of intense fear, panic or anxiety that are difficult to manage.
• Anxiety or panic that is out of proportion to the situation.
• A fear of gaining weight that lasts for at least six months.
• Engaging in avoidance behaviours to prevent gaining weight or to avoid foods, activities and situations that you fear will result in weight gain.
• A fear of gaining weight that interferes with your day-to-day life, overall well-being or social or professional life.

Obesophobia is often connected to and can occur in conjunction with other mental illnesses, such as:

• Anorexia Nervosa: An eating disorder characterised by abnormally low body weight, an extreme fear of gaining weight, restrictive eating and body image disturbance.
• Bulimia Nervosa: A pattern of eating characterised by binge eating followed by purging (making yourself vomit or taking laxatives) to prevent weight gain.
• Avoidant Restrictive Food Intake Disorder (ARFID): Avoiding certain foods, having a limited variety of preferred foods and having little interest in eating food.
• Body Dysmorphic Disorder: A mental health condition involving excessive worrying or obsessing about your perceived defects or flaws (which are often not noticeable to others).
• Orthorexia Nervosa: An obsession or fixation around healthy eating that restricts your behaviour or eating habits and can result in excessive weight loss or malnourishment.
• Obsessive Compulsive Disorder (OCD): A mental health condition that involves obsessive thoughts and compulsive behaviours.

How common is obesophobia?

Because obesophobia is a type of specific phobia, any diagnosis of this condition will fall under the specific phobia umbrella. This means that there are no individual statistics available regarding how many people experience a phobia of gaining weight or becoming fat.

Although approximately 5 million people in the UK experience a type of specific phobia, obesophobia is not one of the most common types of specific phobias. Instead, the most common specific phobias are arachnophobia (spiders), ophidiophobia (snakes) acrophobia (heights), aerophobia (flying), agoraphobia (open spaces) and claustrophobia (enclosed spaces).

However, eating disorders and other relevant mental health conditions, including obesophobia, are on the rise. More people than ever before are being treated for an eating disorder and an extreme fear of gaining weight is becoming more prevalent.

Similarly to other phobias, obesophobia is thought to be a significantly underdiagnosed phobia, with statistics not representing the true figures of how many people are experiencing a phobia of gaining weight.

There are multiple reasons why this could be happening, for example:

• Unlike other eating disorders, many people have never heard of obesophobia so may not realise they are experiencing a diagnosable medical condition and that effective treatments are available.
• Obesophobia is most likely to develop during adolescence and the adolescent may not inform adults around them of their phobia or they may be expected to grow out of it.
• Someone with obesophobia may not discuss their feelings with others so may not realise what they are experiencing is abnormal.
• Someone may implement strict avoidance behaviours and eating and exercise routines, reducing the likelihood that they will gain weight and reducing the obvious signs of this phobia.
• Someone with obesophobia may be embarrassed about their negative thoughts and feelings so may not want to tell their doctor.

It is also important to consider that, as mentioned earlier, not everyone who is focused on their weight or their diet and exercise is experiencing obesophobia.

Negative thoughts and feelings concerning your weight can occur on a spectrum, ranging from mild anxiety to severe fear, panic and anxiety that can impact your day-to-day life, affect your decision-making and result in changes in your behaviour. In some situations, being preoccupied with your weight may not be a cause for concern, for example, if you are trying to manage or reduce your weight for health reasons or because of a recommendation from your doctor.

Who is at risk of obesophobia?

Although anyone can develop obesophobia, certain risk factors can increase the likelihood of someone developing a phobia of gaining weight or becoming fat.

Such as:

• Having another eating disorder, such as anorexia nervosa or bulimia nervosa.
• Having another mental health condition, such as OCD or an anxiety disorder.
• Having a previous negative or traumatic experience involving gaining weight or food.
• Having another relevant phobia, such as cibophobia (an extreme fear of food).
• Being exposed to unhealthy attitudes to weight and food, particularly during childhood or adolescence.
• Having a close family member, for example, a parent or sibling, with obesophobia.
• Having a close family member, for example, a parent or sibling, with another eating disorder or mental health condition.
• Having low self-esteem or body issues.
• Being a victim of physical, sexual or emotional abuse or assault.
• Being a victim of bullying (particularly during childhood or adolescence).
• Going through a significant life stressor, having higher than usual stress levels or being in a heightened mental state (particularly if you are exposed to the fear of gaining weight or have a negative experience involving weight gain during this time).
• Having a substance use disorder, such as an addiction to drugs or alcohol.

However, keep in mind that although the above risk factors can increase the chance that you will develop obesophobia, they do not guarantee this. Someone with none of the above risk factors can develop a phobia of gaining weight unexpectedly, whereas someone with several of the above risk factors may never develop obesophobia and may enjoy a healthy relationship with their weight and food throughout their life.

Although obesophobia can develop at any age, it is most prevalent in adolescents. This could be because of their perceived societal expectations and because adolescents are more likely to want to fit in with their peers. Adolescents may also be more sensitive to unkind comments from their peers or other people in their life and may be more sensitive to social media.

Obesophobia, similar to other eating disorders, is also more common in females, compared to males. This could be for multiple reasons, such as the cultural pressure young girls often feel to stay slim. However, we should always be aware of stereotypes or statistics regarding the prevalence of mental health conditions in one gender versus the other. Mental health difficulties do not discriminate and can affect people of all genders, ages and backgrounds.

How to deal with obesophobia

Although medical interventions and treatment have proven to be extremely effective for people with obesophobia, there are also other strategies you can implement that can help you to successfully manage your fear of gaining weight. Coping and calming strategies can be combined with lifestyle changes to help reduce negative thought patterns and connected behaviours, alleviate the symptoms of your phobia and reduce the impact it has on your mental health and well-being.

Some coping and calming strategies are most effective when implemented long term, meaning you should engage in them regularly (for example, every day or several times a week). This can help to reduce the frequency and severity of your phobia symptoms over time and reduce the likelihood that encountering a trigger or gaining weight will result in a negative response.

Other coping and calming strategies are designed to be implemented short term if you begin to experience symptoms or are faced with a triggering situation. Short-term strategies can minimise or prevent any physiological, psychological or behavioural symptoms and prevent an anxiety-inducing situation from escalating.

Some long-term and short-term coping and calming strategies you can implement to help you deal with your phobia of gaining weight and getting fat are:

• Join a support group
  Joining a support group with other people who have had similar experiences to you can be a great way to help you confront and deal with your phobia. Support groups are usually run by experts and are made up of people who are facing or have overcome similar difficulties to you. The sessions can give you important information and advice while also validating your thoughts and feelings and providing you with reassurance and empathy. Support groups are run both in-person and online.
• Gain a deeper understanding of your fear
  Thinking about your fear in more detail and trying to understand what initially caused you to develop a fear of gaining weight can help you to address the root cause of your phobia. Gaining a deeper understanding also allows you to deal with any negative thought processes, feelings and behaviours attached to your phobia and understand your triggers in more detail. By rationalising and understanding your obesophobia, you can reduce your automatic fear response, and reduce the frequency and severity of your symptoms.
• Find a support network
  You don’t have to deal with your phobia and the difficulties surrounding your weight alone. Finding a support network and leaning on them when you’re struggling can make a real difference. Unfortunately, you can’t simply decide to no longer be afraid of gaining weight, instead, recovery will be a process. Your support network could be your family and friends, other people who have experienced obesophobia, mental health professionals, people in your support group or even people online. Tell your support network if you are struggling and let them know what usually helps you or makes you feel worse.
• Keep a journal
  A journal can be extremely beneficial and can have a variety of purposes. You could use a journal to write down your concerns and difficulties, to record your day-to-day progress, to track your recovery goals or you can fill it with positive and inspiring thoughts and affirmations. A journal can help to keep you motivated, inspired and empowered and even make you accountable.
• Create a fear ladder
  A fear ladder can help you to analyse and understand your fear of gaining weight and can also help you to identify which of your triggers creates more severe anxiety and panic than others. Because phobias are highly individualised, everyone’s fear ladder is different. Although your fear ladder may look different, an example is shown below:
  – 1 = Gaining weight.
  – 2 = Someone calling you fat or saying you’ve put on weight.
  – 3 = Buying a larger size when clothes shopping.
  – 4 = Eating fatty or unhealthy food.
  – 5 = The gym being closed.
  – 6 = Going to a restaurant to eat.
  Once you have created your fear ladder, you can then confront your triggers one at a time, starting at the bottom of the ladder (the trigger that results in the least phobic response). This can help you to slowly deal with your phobia and the triggers that are worsening the symptoms of your phobia.
• Challenge negative thoughts and feelings
  You may find yourself fixating on your weight or becoming increasingly anxious or distressed at the thought of putting on weight. If you find yourself obsessing over your weight or fixating on what you are going to eat or when you are going to exercise, try to disrupt these negative thought patterns and distract yourself. Remind yourself that your thoughts are unhealthy and that eating a certain food or missing exercise one day isn’t going to harm you.
• Visualise overcoming your phobia
  Visualisation techniques can help you to overcome the anxiety you have surrounding your weight and can help you imagine the positive impact not focusing on your weight will have on your life and well-being. Visualising yourself in triggering situations and then imagining how you would confront and overcome your fear and anxiety can make overcoming your phobia seem more achievable. Your brain often cannot differentiate between imagination and thoughts and reality so visualising a positive relationship with your weight can make this more likely to become a reality.
• Reduce how much you weigh yourself
  It may not be possible to suddenly stop weighing yourself; however, you can gradually reduce how often you weigh yourself. Making positive changes to your unhealthy habits can significantly improve how much obesophobia impacts your life. If you currently weigh yourself several times a day, you can gradually reduce this by first reducing it to once a day, then once every two days, then twice a week etc. The aim is to get to a stage where you are no longer reliant on weighing yourself.
• Find new hobbies and activities
  Finding fulfilling hobbies and activities is a great way to improve your overall mental health. It allows you to spend time doing something you enjoy and gives you something new to focus on. For example, you could begin learning to play an instrument, join a club or team or sign up for an art class. Engaging in more activities, spending time with other people and spending less time focusing on your weight can be beneficial to both your physical and mental health. Improved mental health can make it easier for you to deal with obesophobia and can help you to manage your triggers more successfully.
• Avoid negative portrayals of gaining weight
  Unfortunately, there are many negative portrayals of overweight people in the media, the fashion world and in TV and film. Being exposed to negative portrayals of being overweight can validate and reinforce any negative thoughts and feelings you already have and worsen your anxiety surrounding your weight. Try to avoid any negative or triggering portrayals to prevent your phobia from escalating.
• Practise mindfulness
  Mindfulness is an effective calming strategy for a number of mental health difficulties, including phobias. Mindfulness teaches you how to focus your breathing and attention and reduce your chances of experiencing high levels of anxiety or a panic attack if you gain weight or are faced with your triggers. In addition to managing stress and anxiety, mindfulness can help you explore the connection between mind and body, as well as reduce the impact of the symptoms of obesophobia.
• Practise yoga or meditation
  Yoga and meditation are long-term strategies that help you manage or reduce the impact obesophobia has on your life. They can help you to control your breathing and your body’s automatic reaction to your triggers and help you to feel calmer and more in control. Yoga and meditation are most effective when you engage in them regularly. They can help you reduce any negative thoughts, feelings and reactions you may have when faced with any triggers in the future and help you improve your phobia’s symptoms over time and reduce the impact it has on your life.
• Make lifestyle changes
  Lifestyle factors such as lack of sleep and high levels of stress can exacerbate the symptoms of your phobia and increase your anxiety. By making lifestyle changes, you can reduce the impact your phobia of gaining weight has on your life. Some lifestyle changes you can make include:
  – Implement a successful sleep routine.
  – Reduce your daily stress.
  – Avoid caffeine, sugar and other stimulants.

What triggers obesophobia?

A trigger, also known as a stressor, is a thing, person, place, situation or thought that triggers an adverse reaction. In the case of phobias, a trigger can lead to a person feeling anxious, fearful, panicked or another negative emotion. It can also lead to physiological, behavioural and other psychological symptoms. Your brain perceives triggers as a threat to your physical or mental safety or well-being and will react accordingly.

Because obesophobia, similar to other phobias and eating disorders, is an individualised condition, it can manifest in different ways, with different things triggering the onset of symptoms. The things, places, situations and thoughts that can trigger this phobia vary from person to person. Some people only have one or two triggers, whereas others have many different triggers.

The types of triggers and the number of triggers experienced by different people can vary depending on what initially caused their fear of gaining weight to develop, their perception of the potential risk, the severity of their symptoms and their current mindset and mental health.

There are many possible triggers for obesophobia.

The most common triggers are:

• Gaining weight.
• Thinking about gaining weight.
• Needing to buy a larger size when buying new clothing.
• Someone telling you that you have put on weight.
• Weighing yourself or measuring yourself (e.g. hip dimensions).
• Seeing someone in your family who is overweight (because of the fear that it is genetic).
• Seeing or feeling expected to eat unhealthy foods, such as baked goods, chocolate or fried food.
• Being presented with a large portion of food.
• Seeing the calories of a specific food on a menu or on the packaging.
• Being expected to eat food that you didn’t cook yourself.
• Not being able to follow your usual exercise programme.
• Going to an event that is centred around food, such as a party or meal out.
• Times of the year when food becomes a focus and you are expected to eat more, such as Christmas.
• Trying on clothes in a shop.
• Food shopping.
• Going to a restaurant, café or another place centred around food.
• Somebody else talking about their weight.
• Hearing that someone is on a diet.
• Being diagnosed with a condition that can make managing your weight more difficult (such as diabetes).
• Being put on medication where weight gain could be a possibility.
• Experiencing an injury that restricts your movement.

What are the symptoms of obesophobia?

The symptoms of obesophobia differ from person to person and often occur on a spectrum, with some people experiencing mild symptoms and others experiencing severe symptoms that significantly affect their day-to-day life. Differences in the severity of symptoms and how frequently they occur can happen for multiple reasons, such as how acute your phobia is, your triggers, your perception of the situation and your current mental health and mindset.

The symptoms of obesophobia can occur at any time, including if you gain weight or think about gaining weight or if you face another trigger. The symptoms of a phobia are often automatic and uncontrollable. It may feel like you are unable to control or manage your thoughts or feelings and that your phobia is taking over your body.

Although the symptoms experienced by someone with obesophobia can vary, the most common symptoms are:

Psychological Symptoms:

These are the mental, cognitive and emotional symptoms of your phobia.

The most common psychological symptoms of obesophobia are:

• Intense, overwhelming, persistent, excessive and unreasonable fear, anxiety, panic or dread if you put on weight or think about putting on weight.
• Fear, anxiety or panic when faced with high-calorie foods or being unable to exercise.
• Having lower self-esteem or lower confidence because of insecurities about your weight.
• Being unable to control your fear, anxiety or panic even if you are aware that they are unreasonable or out of proportion.
• Anticipatory anxiety in the lead-up to weighing yourself or being in a triggering situation.
• Difficulties concentrating or functioning normally when in triggering situations.
• Feeling defenceless or vulnerable.
• Experiencing frequent or distressing nightmares about getting fat.
• Feeling like you are losing control.
• Feeling like you have gained weight, even if the weight on the scales is the same or lower.
• Feeling like you are going to develop a health condition or die if you gain weight.

Behavioural Symptoms:

Behavioural symptoms refer to changes in your behaviour that occur as a result of your phobia. They are usually characterised as negative, damaging, unusual or abnormal behaviours that differ from your typical behaviour.

The most common behavioural symptoms of obesophobia are:

• Obsessively or unhealthily counting calories.
• Excessively exercising.
• Frequently following diets.
• Refusing to eat certain foods.
• Avoiding situations and social events involving food.
• Weighing yourself frequently.
• Avoiding being around people who are overweight.
• Overusing or misusing laxatives or diuretics.
• Constantly checking how many calories you have burnt each day (e.g. on a fitness watch).
• Self-criticising in an extreme or damaging way.
• Refusing to eat any foods you didn’t cook or prepare yourself.
• Restricting your diet excessively or refusing to eat certain foods.
• Being unable to eat or having a lack of appetite during or in the lead-up to triggering situations.
• Difficulties sleeping or insomnia in the lead-up to triggering situations.
• Refusal or avoidance of talking about weight OR obsessively talking about weight.
• Refusing to watch a TV show or film about food (such as cooking shows) or a TV show or film with overweight characters.
• Feeling like you want to run away or hide when faced with triggering situations.
• Withdrawing from social situations that could potentially involve eating or involve unhealthy food.
• Becoming socially isolated or finding it difficult to make or maintain relationships.

Physiological Symptoms:

These are the symptoms you experience that are connected to your body – the physical disturbances or effects your body displays in relation to your phobia. Anxiety, fear or panic trigger the fight-or-flight response in your body, which is designed to prepare you to fight off a threat or escape a potential threat of danger. Your sympathetic nervous system releases stress hormones, including adrenaline and cortisol, in response to the fight-or-flight response. You may experience physiological symptoms if you are in a triggering situation, or you find out you have gained weight.

Some common physiological symptoms are:

• Shaking, trembling or chills.
• Nausea, indigestion, an upset stomach or feeling like you have butterflies in your stomach.
• Unusual or excessive sweating or clamminess.
• Feeling dizzy, lightheaded or faint.
• Difficulties breathing, such as rapid breathing, shallow breathing, hyperventilating or feeling like you cannot catch your breath.
• Heart palpitations, increased heart rate or feeling like your heart is pounding.
• Increased blood pressure.
• Tightness in your chest or chest pains.
• Feeling confused or disoriented.
• A choking sensation, finding it difficult to swallow or feeling like something is stuck in your throat.
• Unusual headaches or other pains.
• Pins and needles, particularly in your hands, feet, arms or legs.
• Feeling unusually tired or fatigued.
• Having a dry or sticky mouth.
• Muscle tension or stiff muscles.
• An unusual sensitivity to hot or cold temperatures.
• Having pale or flushed skin.
• Having a panic attack.

Some people with obesophobia only experience a few of the above symptoms or may only experience symptoms from one of the categories. For example, they may experience psychological symptoms, such as anxiety and panic, but are able to control their behavioural symptoms and don’t experience any physical symptoms. Other people experience psychological, behavioural and physiological symptoms. It is also possible to experience different types and severity of symptoms at different times, depending on the trigger.

Some people with obesophobia begin to show symptoms consistent with other eating disorders, such as anorexia nervosa or bulimia nervosa. Because the symptoms of eating disorders can be similar to the symptoms of obesophobia, it is recommended that you always seek advice from a doctor if you are experiencing any of the above symptoms.

What causes obesophobia?

Obesophobia has multiple different possible causes and, in many cases, an individual likely developed a phobia of gaining weight as a result of several different factors. Some people are unable to determine when their phobia initially started or what contributed to them developing obesophobia, whereas other people are able to pinpoint exactly when and why they began to fear gaining weight.

Identifying the root cause or causes of your phobia can be extremely beneficial, as it allows you to address your initial triggers and any negative patterns of thought or feelings that are attached to your initial triggers. This can make it easier to manage your symptoms and reduce the impact your phobia has on your life.

The causes of obesophobia can be psychological, environmental, societal or genetic and can vary greatly from person to person.

The most common causes of obesophobia are: 

• Societal pressure and weight stigma
  Society often discriminates against people who are overweight or obese, whilst simultaneously celebrating people who are slim and often underweight. Many models who are celebrated for their attractiveness would be considered underweight based on their body mass index (BMI). Being surrounded by slim people and being continuously told that being thin is desirable can cause someone to develop a phobia of gaining weight in case they are then viewed as being undesirable or unattractive. Pressure to remain slim can come from the media, family and friends, social media, wider society, and yourself.
• Taking part in an activity or sport that puts a lot of emphasis on weight or size
  Being involved in particular activities, sports or hobbies that require you to be a certain size or weight can put a lot of pressure on someone. Examples include ballet, gymnastics, pageantry and sports such as boxing, where you are required to maintain a particular weight to stay in your weight category. People who engage in activities such as these are more likely to develop obesophobia or an eating disorder, particularly if they engage in them during childhood and adolescence. They may receive pressure from their coaches, their families and themselves and may have to engage in restrictive eating or excessive exercise in order to excel at the activity or sport, all of which can contribute to obesophobia.
• Currently or previously experiencing sexual, physical or emotional abuse or violence
  Someone who has been abused or assaulted, either physically, mentally or sexually, may develop obesophobia, sometimes alongside an eating disorder, as it is a way of gaining or maintaining a small amount of control. Although they feel they may not be able to control or change what is happening to them (or what happened in the past), controlling their weight, what they eat and how much they exercise is a way they can keep control over their own body. This can then develop into a fear of gaining weight or not being in control of their weight.
• Currently or previously experiencing bullying
  Being bullied, either physically or mentally, can be a risk factor for obesophobia for multiple reasons. It can be a way of someone who has been bullied trying to fit in or appear more attractive to their peers, especially if they were previously bullied for their appearance. As with someone who has experienced abuse, it can also be a way to maintain some level of control, or as a cry for help – particularly for adolescents.
• Having a medical condition that makes you fear gaining weight
  Certain health conditions, such as diabetes and heart disease, can be much more dangerous and difficult to manage if you are overweight. It can also make it more likely that you will develop complications and can even increase the likelihood that you will become seriously ill or die. Even if someone is a healthy weight, they can begin to fear gaining even a small amount of weight, in case it negatively impacts their medical condition and their health. This can then develop into obesophobia.
• A negative or traumatic experience involving your weight
  Past negative experiences related to gaining weight or being overweight can lead to obesophobia in what is known as a direct learning experience or traumatic conditioning. For example, this could include being bullied or humiliated about your weight. Following the traumatic experience, you may begin to have intrusive and negative thoughts or memories of the negative experience and begin to avoid trauma-related triggers and start to control your weight. This can cause any anxiety you have centred around your weight or food to linger or worsen and can cause you to become fixated on your weight and develop obesophobia.
• Aiming for the perfect weight
  Having a goal weight in mind that you want to aim for or maintain can lead to obesophobia. A goal weight, particularly if this is a weight you have previously maintained, can be damaging to your mental health as it doesn’t take into account changes to your body that occur as you age. Solely focusing on maintaining a specific weight also doesn’t account for muscle density and how your weight can go up the more you exercise. Because a goal weight doesn’t take into account changes due to age, exercise, or bodily changes (for example, after pregnancy) and the fact that these factors can make it difficult to achieve or maintain an unrealistic goal weight, this can cause a fixation on the goal weight which can lead to obesophobia.
• A learned phobia
  Also known as an observational learning experience, a learned phobia could occur if you observed obesophobia in another person and learned to develop the same anxieties and negative thought processes yourself. It could also be that you were exposed to unhealthy attitudes to weight and eating and this contributed to you developing obesophobia. You are more likely to learn obesophobia if you were exposed to it during childhood or adolescence.
• Experiencing significant or higher than usual stress levels
  Significant or long-term stress can have a substantial impact on your mental health. Stress can trigger physical, mental and emotional difficulties and you can begin to create your own coping mechanisms. If you find yourself unable to cope with stress or your stress levels continue to escalate, the stress may begin to manifest emotionally and behaviourally and can cause you to fixate on something (such as your weight or eating habits) and try to control your weight, food intake and exercise.
• An informational learning experience
  This can occur if you are exposed to information about gaining weight that scares you or creates feelings of anxiety. For example, learning about the number of weight-related deaths that occur in the UK every year and the different ways that being overweight can affect your health, well-being and life expectancy can cause you to become unhealthily focused on your weight, which can develop into obesophobia.

How is obesophobia diagnosed?

If you think you are experiencing obesophobia, your first step will be to make an appointment with your GP.

You should ensure you see your GP if you experience:

• Anxiety, panic, distress or dread at the thought of gaining weight.
• An obsession or fixation with weight loss or maintaining your weight.
• Frequent dieting or overexercising or obsessively counting calories.
• Avoidance of activities or situations involving food.
• A negative body image.
• Negative behaviours in relation to food, such as food restriction or avoidance or purging.

As well as assessing your symptoms, your GP will also likely refer you to a psychologist or another mental health professional. Both healthcare professionals will ask for more information about your fear of gaining weight or getting fat.

Their questions will likely centre on:

• The symptoms you experience, including what your symptoms are, how frequently they occur and how severe they are.
• The initial onset of your fear, including when your symptoms first began and what initially triggered your fear of gaining weight.
• Your medical history, including whether you are currently or have previously had any eating disorders, anxiety disorders, panic disorders, phobias or other mental health conditions.
• Any medication or supplements you take (to ensure that your symptoms cannot be attributed to another source).
• Whether you have a family history of phobias or eating disorders.
• How much your fear interferes with your day-to-day life, your well-being and your behaviour.
• Whether your fear of gaining weight results in avoidance behaviours.

A psychological evaluation will be conducted to look into your symptoms in more detail and evaluate your eating behaviours. Because the symptoms can be fairly similar, they will also want to ascertain that your symptoms are consistent with obesophobia, rather than an eating disorder.

The psychologist will also likely conduct a phobia questionnaire to gain more insight into your negative thoughts, feelings and behaviours surrounding the fear of gaining weight. Because obesophobia is a type of specific phobia, your symptoms will be compared to the diagnostic criteria for specific phobias.

In order to receive a diagnosis of obesophobia, your symptoms will need to correspond with the seven key criteria, listed below:

1. The fear must be persistent, excessive and unreasonable. It can occur when you gain weight, think about gaining weight or encounter another trigger.

2. Gaining weight or exposure to a trigger leads to an immediate anxiety response or extreme fear, panic or distress in the majority of situations.

3. The fear is excessive and disproportionate to your actual weight or any problems regarding your weight.

4. Your anxiety causes you to avoid places or situations that could trigger your phobia, and this can have a significant impact on your day-to-day life.

5. You have taken unreasonable steps to control your weight or to attempt to look, feel and be a particular weight or size.

6. The fear has lasted for a minimum of six months.

7. The phobia is not associated with another disorder or mental health condition.

If your symptoms correspond to the above criteria and the psychologist does not think you are experiencing an eating disorder, you will then receive a diagnosis of obesophobia and be offered treatment.

How is obesophobia treated?

Because obesophobia centres around an unhealthy fixation on your weight and often affects your eating and exercise habits, it can frequently occur alongside an eating disorder or develop into an eating disorder. For this reason, any individual with a diagnosis of obesophobia will be offered treatment. If you think you may be experiencing obesophobia, but you don’t have an official diagnosis, you should visit your GP and request a diagnosis and treatment as quickly as possible, to prevent your phobia from escalating.

There are multiple different treatment options available that successfully treat obesophobia and the treatment you will be offered will depend on several factors.

Such as:

• How severe your phobia is.
• How frequently you experience symptoms.
• How your symptoms affect your everyday life and well-being.
• Whether an eating disorder is present.
• Any other mental health difficulties you experience.

Your psychologist will create a personalised treatment plan that is designed to treat your phobia most effectively. Your treatment plan will also be designed to reduce the likelihood that you will go on to develop an eating disorder.

Some of the most common treatment options for obesophobia are:

Cognitive Behavioural Therapy (CBT):

CBT is one of the most common treatment options for obesophobia. It is a type of structured talk therapy that is designed to help you understand and control your irrational or unhealthy negative patterns of thought and the negative emotions and behaviours that are centred around your weight.

CBT can help you to unlearn any negative thoughts and harmful beliefs you have about gaining weight or being overweight and change your thoughts and feelings surrounding food and exercise. You will work to deconstruct any negative thoughts surrounding weight, food and exercise into smaller fragments, which can then be addressed individually. These will then be replaced with positive patterns of thinking and healthy beliefs.

CBT takes place over multiple sessions and depending on the severity of your phobia, it may be recommended that you engage in CBT long term.

During the sessions you will work to:

• Understand your triggers and what initially caused your fear of gaining weight.
• Recognise distorted patterns of thinking.
• Change any unhealthy beliefs surrounding your weight.
• Learn positive habits and positive body image.
• Learn coping strategies and calming strategies, such as deep breathing exercises, distraction techniques and coping statements.

Exposure Therapy:

Also known as systematic desensitisation, exposure therapy helps you to confront your fears gradually, in a safe, controlled and judgement-free environment.

You may be gradually exposed to the idea of changing your eating and exercise habits and the idea of gaining an appropriate and healthy amount of weight under supervision. You will also work to change negative patterns of thought and negative beliefs surrounding weight and what a desirable weight is (if relevant). Exposure should take place gradually over multiple sessions, with the number of sessions required depending on the severity of your phobia.

You will be required to visualise and talk about your fear and experience your triggers in real life. This will happen gradually starting with the least anxiety-provoking trigger, for example, you may start by looking at pictures or watching videos of people who are slightly overweight but are still extremely healthy and fulfilled.

Once you are comfortable with this level of exposure, you may talk about gaining a pound of weight or eating a food you would normally avoid. Exposure will continue, with each exposure being more triggering than the last. When you are comfortable with each level, you will move on to the next one. For example, by attending a birthday party, eating high-calorie food and going to eat in a restaurant with someone you trust.

The aim is that exposure therapy will reduce or eliminate the fear and anxiety responses you usually feel in relation to gaining weight. During your sessions, you will also learn relaxation techniques and coping and calming strategies.

Clinical Hypnotherapy:

Because hypnotherapy involves putting you into a deeply relaxed state, this makes you more susceptible to positive changes. A combination of guided relaxation techniques and focused attention can help you change your thought processes and your overall perception of gaining weight and can help improve the way you think and feel about your triggers.

The hypnotherapist will also try to help you identify the underlying causes of your fear of gaining weight and will work on any unprocessed trauma surrounding weight and food. You will also learn how to overcome any negative thoughts and feelings about gaining weight, both long term and short term. You will also learn calming techniques.

Medication:

Although phobias are not usually treated with medication, obesophobia may be different, as a phobia of gaining weight may also occur alongside other mental health difficulties, an eating disorder or even physical health issues.

You may be prescribed medication if:

• You are also experiencing another mental health condition, such as anxiety or depression.
• You are also experiencing an eating disorder.
• Your fear of gaining weight has resulted in malnutrition or has caused you to become underweight.