Hierarchical Self Esteem

The Lamar University Electronic Journal of Student Research Fall 2008

Hierarchical Self-Esteem And the Relationship to Bariatric Surgery Brigid A. Wilson, PhD Assistant Professor Department of Health and Human Performance Whitlowe R. Green College of Education Prairie View A&M University Member of the Texas A&M University System Prairie View, Texas

William Allan Kritsonis, PhD Professor and Faculty Mentor PhD Program in Educational Leadership Hall of Honor (2008) William H. Parker Leadership Academy Whitlowe R. Green College of Education Prairie View A&M University Member of the Texas A&M University System Prairie View, Texas Visiting Lecturer (2005) Oxford Round Table University of Oxford, Oxford, England Distinguished Alumnus (2004) College of Education and Professional Studies Central Washington University ________________________________________________________________________ ABSTRACT The purpose of this article is to briefly discuss obesity as a disease and the prejudice associated with it. Obesity has accelerated at an alarming rate. Prejudice has developed from misguided assumptions. The article deals with obesity as a disease and the possible risks associate with it. See: www.nationalforum.com Note: Thanks to Dr. Kimberly Grantham Griffith for her assistance in getting this article published.

________________________________________________________________________

Introduction The belief that the physical self is a significant component of self-esteem has prevailed since the predominant theories of self-esteem emerged in the 1950s (James, 1950). Whereas self-esteem has been linked with favorable health and involves the selfassessment of qualities perceived valuable (Crocker & Garcia, 2004), it is natural that the construct has been studied in conjunction with body mass. More recently, focus has centered on how possessing a body weight that differs from societal norms affects the self (Miller & Downey, 1999). Numerous theoretical perspectives contend that overweight individuals possess low self-esteem due to the vast amount of stigmatization they face in social, educational, and employment settings (Crossrow & Mcguire, 2001; Wadden, Womble, Stunkard, & Anderson, 2002). Other researchers believe that heavy weight is not associated with low self-esteem (Crocker & Major, 1989; White, O’Neil, Kolotkin, & Byrne, 2004). This article will examine the controversy.

Purpose of the Article Interventions exist to counter obesity, yet only gastric bypass surgery has shown the possibility of producing significant long-term weight loss results. Few studies have examined the psychological affects of the surgical procedure, especially on the hierarchical trait of self-esteem. The purpose of this article is to briefly discuss hierarchical self-esteem, its components and structure, as it is a significant aspect of an individual’s psychological functioning. Subsequently, the article will focus on how bariatric surgery affects hierarchical self-esteem.

Hierarchical Self-Esteem In research, self-esteem is most commonly measured as a global, singular construct, not a hierarchical, multifaceted construct (Blascovich & Tomaka, 1991; Guindon, 2002). This practice ensues because it is a simplistic method by which researchers can achieve some assessment of self (Fleming & Courtney, 1984). Numerous scholars favor a simplistic method because their studies typically center on numerous psychological constructs, not purely self-esteem and hence data analysis can be complex (Watkins & Regmi, 1990). Popular instruments that examine global self-esteem by producing one comprehensive score are the following: Rosenberg Self-Esteem Scale (Rosenberg, 1965), the Self-Esteem Inventory (Coopersmith, 1967), the Piers-Harris Children’s Self-Concept Scale (Wylie, 1974), the Tennessee Self-Concept Scale (Fitts, 1965), and the Self-Perception Profile for Children (Harter, 1985). Although the global self-esteem construct may be the easiest and most popular method for assessing self-esteem, it is not necessarily the most accurate (Heatherton & Wyland, 2003; Watkins & Regmi, 1990). It may not be an accurate measure of how individuals perceive themselves (Blascovich & Tomaka, 1991; Guindon, 2002) because it assumes that self-esteem does not have subscales (Heatherton & Polivy, 1991). Several scholars have suggested, however, that self-esteem is a complex construct that is

composed of diverse subscales (Heatherton & Wyland, 2003; Jambekar & Crocke, 2001; Leary & Baumeister, 2000). Consequently, researchers (Bushman & Baumeister, 1998; Heatherton & Vohs, 2000; Newman & Wadas, 1997; Watkins & Regmi, 1990) have conducted studies (Bracken, Bunch, Keith, & Keith, 2000; Song & Hattie, 1984) that view self-esteem as hierarchical and multifaceted and assess it utilizing the established Self-Rating Scale (Fleming & Courtney, 1984), a scale commonly used to examine self-esteem because it recognizes the subscales of social self-esteem, physical self-esteem, academic self-esteem, and emotional self-esteem, and combines them to comprise global self-esteem (Fleming & Courtney).

Popularity of Bariatric Surgery Numerous interventions exist to counteract obesity’s detrimental effects, but presently only gastric bypass surgery has proven the capability of producing substantial long-term weight loss results (Buchwald et al., 2004). Due to this actuality, and the fact that obesity’s classification as a disease has mandated insurance companies to pay for obesity-related medical visits, prescriptions, and surgeries (Hartwig & Wilkinson, 2004), bariatric surgery’s popularity has dramatic risen in the past few years. In the United States, the number of bariatric surgical procedures performed rose from 26,700 in 2000 (Waraksa & Vinson, 2004) to over 140,000 in 2005. The dramatic increase amounts to a greater than five-fold increase (American Society for Bariatric Surgery, 2001) in merely 5 years. One of the most popular types of gastric surgeries is Roux-en-Y gastric bypass [RYGB] (Frank, 2006). RYGB is commonly performed procedure because patients view it as a quick manner to lose a remarkable amount of weight (Beauchamp-Johnson, 2006) with only minor and short-term physiological complications (American Society for Bariatric Surgery, 2006). RYGB typically produces a weight loss of 100–200 pounds after 2 years (Aurora Healthcare, 2006).

Bariatric Surgery and Self-Esteem Bariatric surgery research focusing on psychological affects has not been extensive (Wald, 2001), even though many patients list social, rather than medical reasons as the basis for having the surgery (Farber, 2003). Bariatric surgery research concerning psychological well-being post-surgery has mainly pertained to the issues of body image (Schwartz & Brownell, 2004), eating disorders (Guisado et al., 2002), depression (Greenberg, Perna, Kaplan, & Sullivan, 2005), and self-esteem (Bocchieri, Meana, & Fisher, 2002). Self-esteem has been linked with advantageous health and focuses on the selfassessment of qualities judged valuable (Rosenberg, 1979), therefore, it is natural that the construct has been studied in conjunction with body mass. The belief that the physical self is a significant component of self-esteem has prevailed since the predominant theories of self-esteem in the 1950s (James, 1950). More recently, the focus has been on how possessing a body weight, which differs from societal norms, affects the self (Miller & Downey, 1999). Numerous theoretical perspectives contend that overweight

individuals possess low self-esteem due to the vast amount of stigmatization which they face in societal, educational, and employment settings (Friedman & Brownell, 1995; Miller & Turnbull, 1986), while other researchers believe that heavy weight is not associated with low self-esteem (White et al., 2004). Because of these conflicting opinions, debate exists as to how bariatric surgery affects a morbidly obese individual’s self-esteem. Although self-esteem has been studied in respect to bariatric surgery, it has typically been examined in terms of short-term effects and as a global construct (Hell, et al., 2000) as opposed to studying it as a multidimensional hierarchical trait with independent subcomponents (Heatherton & Wyland, 2003). Therefore, the hierarchical construct of self-esteem has yet to be comprehensively examined in morbidly obese individuals undergoing bariatric surgery (Jambekar, Quinn, & Crocker, 2001). Due to the rising popularity of bariatric surgery, it is imperative that scholars study the surgical procedure from a psychological viewpoint. When an individual undergoes bariatric surgery, that individual experiences multiple lifestyle changes that need to be contended with, because bariatric surgery is not an effortless, unproblematic miracle cure for obesity (Park Nicollet Clinic, 2005).

Concluding Remarks In conclusion, the purpose of this brief article was to discuss hierarchical selfesteem as it relates to gastric surgery. Gastric surgeries are being performed at an rapidly increasing rate, and hence their psychological affect on an individual needs to comprehensively examined. Physiological transformations are often occupied with psychological adjustments.

References American Society for Bariatric Surgery. (2006). Rationale for surgical treatment of morbid obesity. Retrieved June 2, 2006, from http://www.asbs.org/html/rationale.html Aurora Healthcare. (2006). Types of bariatric surgery. Retrieved February 14, 2006, from www.aurorahealthcare.org/services/bariatricsurgery/bariatricoptions.asp Beauchamp-Johnson, B. M. (2006). Scale down, bariatric surgery’s risks. Nursing Management, 9, 27–32. Blascovich, J., & Tomaka, J. (1991). Measures of self-esteem. In J. P. Robinson, P. R. Shaver, & L. S. Wrightsman (Eds.), Measures of personality and social psychological attitudes, Volume 1 (pp. 115–160). San Diego, CA: Academic Press. Bocchieri, L. E., Meana, M., & Fisher, B. L. (2002). A review of psychosocial outcomes of surgery for morbid obesity. Journal of Psychosomatic Research, 52(3), 155– 165.

Bracken, B. A., Bunch, S., Keith, T. Z., & Keith, P. B. (2000). Child and adolescent multidimensional self-concept: A five instrument factor analysis. Psychology in the Schools, 37, 483–493. Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. Journal of American Medical Association, 292(14), 1724–1737. Bushman, B. J., & Baumeister, R. F. (1998). Threatened egotism, narcissism, self-esteem, and direct and displaced aggression: Does self-love or self-hate lead to violence? Journal of Personality and Social Psychology, 75, 219–229. Coopersmith, S. (1967). The antecedents of self-esteem. San Francisco: W. H. Freeman. Crocker, J., & Garcia, J. A. (2004). Self-esteem and the stigma of obesity. Retrieved January 1, 2006, from http://www.rcgd.isr.umich.edu/crockerlab/articles/2005_Crocker_Garcia_SelfEsteem_&_Stigma_of_Obesity.pdf Crocker, J., & Major, B. (1989). Social stigma and self-esteem: The self-protective properties of stigma. Psychological Review, 96, 608–630. Crossrow, N., Jeffery, R., & Mcguire, M. (2001). Understanding weight stigmatization: A focus group study. Journal of Nutrition Education, 33, 208–214. Farber, S. K. (2003). Weight-loss surgery: A magic bullet? A realistic look at medical and psychological risks. Retrieved January 1, 2005, from http://obesitysurgeryinfo.com/wlspysche.htm Fleming, J. S., & Courtney, B. E. (1984). The dimensionality of self-esteem II. Hierarchical facet model for revised measurement scales. Journal of Personality and Social Psychology, 46, 404–421. Fitts, W. H. (1965). Tennessee Self-Concept Scale (Manual). Nashville, TN: Counselor Records and Tests. Frank, A. (2006). Bariatric surgery: Too many unanswered questions. American Family Physician, 73(8), 1335–1336. Friedman, M. A., & Brownell, K. D. (1995). Psychological correlates of obesity: Moving to the next research generation. Psychological Bulletin, 117(1), 3–20. Greenberg, I., Perna, F., Kaplan, M., & Sullivan, M. A. (2005). Behavioral and psychological factors in the assessment and treatment of obesity surgery patients. Obesity Research, 13, 244–249. Guindon, M. H. (2002). Toward accountability in the use of self-esteem construct. Journal of Counseling and Development, 80(2), 204–215. Guisado, J. A., Vaz, F. J., Lopez-Ibor, J. J., Lopez-Ibor, M. I., del Rio, J., & Rubio, M. A. (2002). Gastric surgery and restraint from food as triggering factors of eating disorders in morbid obesity. International Journal of Eating Disorders, 31, 97– 100. Harter, S. (1985). Supplementary description of the self-perception profile for children – revision of the perceived competence scale for children. Denver, CO: University of Denver. Hartwig, R. P., & Wilkinson, C. (2004). Obesity, liability, and insurance. Retrieved June 12, 2006, from http://server.iii.orj_data/binary/735718_1_0/obesity.pdf#search=`insurance%20in formation%20institue%20%20obesity%20liability%2C%20%26%20insurance’

Heatherton, T. F., & Polivy, J. (1991). Development and validation of a scale for measuring state self-esteem. Journal of Personality and Social Psychology, 60, 895–910. Heatherton, T. F., & Vohs, K. D. (2000). Interpersonal evaluations following threats to self: Role of self-esteem Journal of Personality and Social Psychology, 78, 725– 736. Heatherton, T. F., & Wyland, C. L. (2003) Assessing self esteem. In S. J. Lopez & C. R. Snyder (Eds.), Positive psychological assessment: Handbook of models and measures (pp. 219–233). Washington DC: American Psychological Association. Hell, E., Miller, K. A., Moorehead, M. K., & Norman, S. (2000). Evaluation of health status and quality of life after bariatric surgery: Comparison of standard Roux-enY gastric bypass, vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding. Obesity Surgery, 10, 214–219. Jambekar, S., Quinn, D. M., & Crocker, J. (2001). The effects of weight and achievement messages on the self-esteem of women. Psychology of Women Quarterly, 25, 48– 56. James, W. (1950). The principles of psychology. New York: Dover. Leary, M. R., & Baumeister, R. F. (2000). The nature and function of self-esteem: Sociometer theory. In M. P. Zanne (Ed.), Advances in experimental social psychology (pp. 1–62). San Diego, CA: Academic Press. Miller, C. T., & Downey, K. T. (1999). A meta-analysis of heavy weight and self-esteem. Personality and Social Psychology Review, 3, 68–84. Miller, D. T., & Turnbull, W. (1986). Expectancies and interpersonal processes. Annual Review of Psychology, 37, 233–256. Newman, L. S., & Wadas, R. F. (1997). When the stakes are higher: Self-esteem instability and self-handicapping. Journal of Social Behavior & Personality, 12(1), 217–232. Park Nicollet Clinic. (2005). Emotional and psychological changes. Retrieved January 16, 2006, from http://www.parknicollet.com/bariatrics/after-emotion-psychchanges.cfm Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. Rosenberg, M. (1979). Conceiving the self. New York: Basic Books. Rosenberg, M., Schooler, C., Schoenbach, C., & Rosenberg, F. (1995). Global selfesteem and specific self-esteem: Different concept, different outcomes. American Sociological Review, 60(1), 141–157. Schwartz, B. M., & Brownell, D. K. (2004). Obesity and body image, Body Image I, 7, 43–56. Song, I. S., & Hattie, J. (1994). Home environment, self-concept, and academic achievement: A causal modeling approach. Journal of Educational Psychology, 76, 1269–1281. Wadden, T. A., Womble, L. G., Stunkard, A. J., & Anderson, D. A. (2002). Psychosocial consequences of obesity and weightloss. In T. A. Wadden and A. J. Stunkard (Eds.), Handbook of obesity treatment (pp. 144–169). New York: Guilford Press.

Wald, E. (2001). Psychological aspects of gastric bypass surgery. Retrieved January 6, 2005, from http://www.dieteticintern.com/distance/litreviews/psych%20and%20bypass.htm Waraksa, S. & Vinson, J. (2004). Bariatric surgery on the rise: Managing the challenges. Retrieved January 8, 2006, from http://www.webmd.com/content/Article/14/1689_51239.htm?printing=true Watkins, D., & Regmi, M. (1990). Antecedents of self-esteem of Nepalese and Filipino college students. Journal of Genetic Psychology, 90(151), 341–348. White, M. A., O’Neil, P. M., Kolotkin, R. L., & Byrne, T. K. (2004). Gender, race, and obesity-related quality of life at extreme levels of obesity. The North American Association for the Study of Obesity, 12, 949–955. Wylie, R. C. (1974). The self-concept: A review of methodological considerations and measuring instruments (Rev. Ed.). Lincoln, NB: University of Nebraska Press. See: National FORUM Journals: www.nationalforum.com