Sanjay Kalra ( Department of Endocrinology, Bharti Hospital, Karnal, India. )
Manish Bathla ( Department of Psychiatry, MM Medical college, Ambala, India )
Nitin Kapoor ( Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) -632004, India, and Non Communicable Disease Unit, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia. )
As the world grapples with a rapidly increasing prevalence of obesity, epidemiologists, health care professionals and policy makers are working together to increase awareness about its prevention and management. However, what is also increasingly visible in a subset of not very obese individuals, is an undue concern about their weight, a condition we call Baromania. Akin to orthorexia nervosa, anorexia and bulimia. we define baromania as "a state of extreme attention towards one's own weight, accompanied by elation and excitement regarding weight loss and maintenance". This paper describes the different clinical presentations, diagnosis and management of persons with Baromania.
Keywords: Obesity, South Asian phenotype. Baromania, Barophenotype, Orthorexia Nervosa, Eating disorders, Body image.
As the pandemic of obesity continues to grow,1 creating multiple other epidemics in its wake, we are now confronted by a contrarian epidemic, or contrademic. This is the phenomenon of baromania.
Mania is defined, by the dictionary, as "a great enthusiasm for something."2 The word is also used to refer to a psychiatric disorder characterized by extremely elevated and excitable mood.2 We define baromania as "a state of extreme attention towards one's own weight, accompanied by elation and excitement regarding weight loss and maintenance". Just as mania can have varied clinical presentations, so can baromania. Baromania, too, can vary in style and severity, from time to time, and from person to person.
Scope and Spectrum
Baromania includes, but is not limited to, the clinical condition of orthorexia nervosa3 and other eating disorders. Eating disorders4 are defined by alteration in eating habits and behaviours, while baromania includes a broad spectrum of weight-related thoughts, beliefs, words and actions (Table). Baromania has not been termed as a specific disease condition, but its various facets are obvious to the metabolic physician.
Individually reported over many years, it has been known as weight consciousness and preoccupation with a slim image,5 overt body self-perception6 overt body consciousness and slimming behaviour7 unhealthy weight control behavior8 etc. These behaviours are notably more common in girls than boys.6,9
It is important to recognize the symptoms and signs of baromania. Presence of these red flags should prompt a focussed intervention to not only preempt and prevent possible adverse consequences, but also promote and propagate salutogenic behaviours. If identified in time, "barohypomania", a condition similar to hypomania, may be utilized to promote right health-care seeking and health care acceptance. If not addressed in a timely manner, it may progress to pathological eating disorders, with or without other psychologic/psychiatric abnormalities.
This also highlights the importance of having a psychiatrist or a psychologist in the obesity management team, as the psychological burden associated with obesity is huge10 and the phenotype at times can be very subtle and may need multiple sittings of intensive behavioural therapy.
Public Health Relevance
Baromania may be a double-edged sword. Unwarranted, and inaccurate, emphasis on weight loss may lead to unnecessary physical, emotional and monetary ill-health. The resultant ill effects on the affected individual may cascade into misinformation and may hamper, rather than promote, efforts to achieve optimal weight management.
With the widespread use of social media and rapid transfer of information through multiple portals, misinformation regarding baromania may further compound the problem.11 Moreover, it adds to the already overburdened health care system in the south Asian countries. Policy makers are required to implement public health strategies for the prevention and management of healthy weight keeping in mind the increasing rates of baromania related behaviour.
Though obesity prevention and weight control measures are the need of the hour, it is also important to recognize the contrarian epidemic of baromania that has ensued with the rising prevalence of obesity. Understanding its clinical spectrum, relevance and public health importance will help in early recognition, intervention and prevention of its progression to eating disorders.
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