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 self-
assessment 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 self-
assessment 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 self-
esteem 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.

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See: National FORUM Journals: www.nationalforum.com