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Medical Hypotheses 95 (2016) 10–19

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Medical Hypotheses
journal homepage: www.elsevier.com/locate/mehy

Connecting the obesity and the narcissism epidemics


Bruno Lemaitre
Global Health Institute, School of Life Science, EPFL, CH1015 Lausanne, Switzerland

a r t i c l e i n f o a b s t r a c t

Article history: Obesity and metabolic syndromes are major threats to health in both developed and developing coun-
Received 10 May 2016 tries. This opinion article is a holistic attempt to understand the obesity epidemic, by connecting it to
Accepted 9 August 2016 the widespread narcissism in society. The narcissism epidemic refers to an increased prevalence of
status-striving individualism and a decreased sense of community, observed in Westerns populations
and spreading worldwide. Based on social personality and evolutionary psychology approaches, I specu-
late that this rise of narcissism underlies a steep social hierarchy resulting in increase of social stress. This
social stress markedly affects individuals who are sensitive to social hierarchy dominance due to their
personality, yet are relegated at a lower social position. I speculate that over-eating is one major mech-
anism for coping with this stress, and discuss the possibility that visceral fat may constitute an adaptive
behaviour to the lower social hierarchy position, which is perceived as unjust. Connecting the prevalence
of obesity to the narcissism epidemic allows for a more thorough examination of factors, which con-
tribute to obesity, which includes early difficult childhood experience, lower rank, and the overall com-
petitive framework of the society.
Ó 2016 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background cussed below. Several other evolutionary hypotheses for the meta-
bolic syndrome have been proposed, but none of them reach a
The increased prevalence of obesity is one of the most striking consensus possibly due to fact that the causes are multifactorial
changes in human health [1]. It impedes many progresses in public (see [3,4] for extensive reviews).
health and medicine because obesity is associated with comorbidi-
ties such as heart disease, type II diabetes, hypertension, and dys-
lipidemia [2]. The increase in obesity affects individuals, ethnic
groups and countries in an unequal pattern. A number of hypothe- The hypothesis
ses have been provided to explain this rise of obesity, such as the
recent change toward a sugar and processed-foods enriched diet, The purpose of this article is to discuss a hypothesis that views
a sedentary life style with reduced physical activity. Nevertheless, the rising prevalence of obesity as a secondary consequence of the
there is a general consensus among experts that the obesity prob- narcissism epidemic and rooting both of them in social dominance
lem is not simply a personal issue of doing too little exercise and interactions. While obesity is often associated to social stress and
eating too much, but a mismatch between human basic biology, lower-rank position [5], hardly any studies have attempted to con-
which is the consequence of millions of years of evolution, and nect the rise of narcissism to the obesity epidemic. I speculate that
modern society. A classical explanation, referred to as the ‘‘thrifty obesity, and possibly many other diseases that have increased over
hypothesis”, is that human history was characterized by frequent the last three decades, are a secondary consequence of a society
food scarcities and colonization of adversary climatic zones, and perceived as too competitive and stressful. This would particularly
that natural selection had favored individuals who would effec- affect individuals who are sensitized by their personality to social
tively store calories in time of surplus (reviewed in [3]. Therefore, dominance hierarchy. It is important to note that this essay does
the decrease of physical activities as a consequence of technology not oppose the classical obesity narrative, which involves the lack
and the concomitant increase in food availability in modern society of physical exercise concomitant with the availability of processed
is the alleged etiology of the obesity epidemic. Nevertheless, this and sugar-rich food in the modern diet. Rather our proposition is
theory fails to explain how lower social status individuals, or complementary, with an attempt to address why certain individu-
minorities, are much more affected by obesity, a phenomenon dis- als, certain minority groups, and certain societies, as a function of
their personalities, are more prone to obesity than others.
E-mail address: Bruno.lemaitre@epfl.ch The main principles of this article are:

http://dx.doi.org/10.1016/j.mehy.2016.08.001
0306-9877/Ó 2016 The Author. Published by Elsevier Ltd.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
B. Lemaitre / Medical Hypotheses 95 (2016) 10–19 11

i) Human ethnic groups and individuals within a population ambitions [10]. Thus, the dominant emotion is shame rather than
slightly differ in their predisposition to narcissism. Narcis- aggressiveness. Because of this antagonistic interaction between
sism could be conceptualized as a higher reactivity to social high expectation in life and shame, vulnerable narcissists have dif-
dominance hierarchy. ficult interpersonal relationships. They are very sensitive to the
ii) Societal changes have led to a rise of narcissism, notably in opinion of others, being easily hurt or embarrassed, and can be
the US, leading to a society perceived as more unequal, paranoid, thinking the world is unfairly stacked against them.
materialistic, hedonistic and competitive. This rise in narcis- Using the dimensional approach, vulnerable narcissism is charac-
sism underlies a steep social dominance hierarchy, and is terized by low agreeableness and high neuroticism. People with
associated with an increased social stress. pronounced neuroticism are characterized by impulsivity, greater
iii) Individuals, whose personalities predispose them to the anxiety, depression, vulnerability and hostility. They are much
social dominance hierarchy, but who are relegated to a more sensitive to social stress than other individuals.
lower position, are at higher risk for obesity because over- While grandiose and vulnerable narcissism are associated with
eating is a way to cope with social stress. an inflated self, both forms are accompanied by a higher depen-
dence on the regard of the others for admiration (grandiose) or
In this article, I will discuss whether over-eating and increased acceptance (vulnerable). As described later, this higher dependence
body weight is just a collateral consequence of the stress, or on the regard of others fits very well the notion that narcissism is
whether it could have a regulatory function, allowing individuals intricately linked with social dominance hierarchy. Narcissism is a
to re-adjust in the social hierarchy. While obesity researchers tend complex personality taxon, and those commonly called narcissists
to examine the problem in terms of metabolism and nutrition, our score high on several dimensions associated with narcissism. It is
essay attempts to take a broader perspective on the problem, inte- extremely important to note that the social-personality literature
grating both the psychological and biological dimensions to under- conceptualizes narcissism as a trait that is normally distributed
stand obesity. in the population and for which there is no clear cut-off for ele-
vated narcissism. Thus, there is no dichotomy between narcissists
and non-narcissists, but individuals that differ in an indefinite vari-
A social personality view of narcissism ety along this trait. The psychiatric literature conceptualizes severe
form of narcissism as the Narcissistic Personality Disorder. The
Two forms of narcissism, grandiose and vulnerable descriptions of strong forms of narcissism have been given above
to illustrate this personality, but this essay will focus on the mild,
Personality traits are enduring personal characteristics that are non-pathological form of narcissism, and notably on vulnerable
revealed in a particular pattern of behaviour. Narcissism is a rela- narcissists.
tively stable individual feature encompassing grandiosity, self-
love, a sense of specialness and inflated self-views [6,7]. Two pri-
mary forms of narcissism have been defined: grandiose and vul- Narcissism and parenting
nerable narcissisms. The grandiose narcissist has been the focus
of most studies and corresponds to the classical figure of the nar- Psychological studies have shown that narcissism is strongly
cissist in the eyes of the general public. Grandiose narcissists are influenced by the mode of parenting [11]. One theory links narcis-
over-confident, extraverted, high in self-esteem, dominant, atten- sism to excessive parental admiration and overindulgence, which
tion seeking, interpersonally skilled and charming. However, they leads children to believe that they are the center of the world. Nar-
are also aggressive, unwilling to take criticism, high in psycholog- cissism associated with the child-king cult and self-focused
ical entitlement and interpersonally exploitative [8]. In other upbringing would explain in part the recent rise of narcissism in
words, narcissists place more value on getting ahead than getting Western societies, notably in the US [12]. Another theory views
along socially. They tend to score high on traits associated with narcissism as the result of a parenting mode that is excessively
agency such as extraversion, action, competence and power, but guided by parental self-focus. Child narcissism develops as an
low on traits associated with ‘communion’ such as agreeableness, adaptive response to a parenting style that uses the child as a
warmth, kindness, and affection. Narcissists strive for high status means to satisfy the emotional needs of the parents (e.g., their
as well as leadership position, and they view their close relation- ambitions). A third theory suggests that parental neglect or rejec-
ships as self-enhancement mechanisms rather than partnerships. tion might also lead to narcissism by creating a sense of emotional
Grandiose narcissists are attracted by success and fame, and are deprivation. In fact, the most severe forms of narcissism are linked
less sensitive than others to negative social implications such as to under-parenting, such as the absence of one parent, the neglect
the costs for the community. Instead, they feel that they are special or abandonment of the child, the perception of favouritism toward
and entitled to certain privileges. The ‘inflated self’ underlines the another sibling. In this case, the inflated self could be seen as a des-
trend of narcissistic individuals to over-value their own achieve- perate mechanism to attract attention from the entourage that the
ments, while subtly depreciating the contribution of others. Social individual had been lacking during childhood.
personality studies have also shown that narcissism has a link with It is interesting to note that narcissism is a trait that tends to
short-term seduction. Narcissists are perceived as more attractive show an apparent inheritance through upbringing: narcissistic par-
in first acquaintance, but this positive view tends to decrease over ents tend to nurture narcissistic kids. For instance, adults who
time when the others discover that their own interests are not became narcissistic due to parental over-evaluation and indiscrim-
taken in consideration by the narcissist. According to the Big Five inate praise will tend to inflate achievement of their own children.
classification of personality, grandiose narcissism is characterized Similarly, adults who had a difficult childhood because their par-
by high extroversion and low agreeableness [9]. The term ‘low agree- ents neglected them, will have more difficulty to establish endur-
ableness’ could seem surprising, as narcissists often appear charm- ing marital relationships, and might eventually abandon their
ing, but this charm tends to vanish in the long term when they own children. While social personality psychology makes a strong
reveal their self-centeredness. emphasis on parenting, the origin of different forms of narcissism
Like the grandiose narcissists, vulnerable narcissists are filled might be better explained in the general evolutionary framework
with grandiose dreams, specialness and entitlement, but at the of parent-offspring with an important role of pre-natal and post-
same time, they feel intense shame regarding their needs and natal stress as mediators of these conflicts [13].
12 B. Lemaitre / Medical Hypotheses 95 (2016) 10–19

An evolutionary biology perspective on narcissism alliances (networking abilities), and presence at the center of
attention. Grandiose narcissism is characterized by high self-
Evolutionary psychology is an emerging research field, which esteem, which according to the sociometer theory signals a high
hypothesizes that many human psychology traits and behaviours position in the hierarchy.
have a genetic basis, and that the underlying alleles have been Both, the social personality approach that focuses on personal-
selected for during evolution. We will now analyse theories, which ity traits and attitudes and the evolutionary psychology approach
have linked the grandiose form of narcissism to short-term mating that attempts to decipher their biological origin, complement each
strategies and social dominance. other very well. Entitlement, desire to get ahead rather than along,
aggression towards challenging of status, selective socialization
with the most influential individuals, are all traits associated with
Narcissism and short-term mating
dominance. The capacity to seduce, inflated self, perpetual dissat-
isfaction (impulsivity) and the lack of empathy are traits that iden-
The immature human baby requires optimal parenting, which
tify more with short-term mating. For Holtzman and Donnellan,
involves substantial efforts by both the mother and the father. This
short-term mating strategies and dominance are the underlying
implies that human ancestry probably underwent positive natural
factors resulting in narcissistic traits [17] and their co-variation
selection for pair-bonding, at a time when the benefits of parental
explains the complexities of the narcissism personality. In this
investment in long-term relationships probably began to outweigh
model, inputs from the environment determine which program is
the benefits of promiscuous strategies. Holtzman and Strube sug-
activated at a given time.
gest that this new set of selection pressure may have created vari-
Finally, consistent with the evolutionary psychology hypothesis
ation in human personality traits that alters mating behaviour [14].
associating narcissism to short term mating strategies, narcissism
Despite this inclination toward long-term mating strategies
peaks at adolescence and in young adults and decreases with age
favouring bi-parental childcare, residual short-term mating strate-
[23]. Adolescents and young adults are characterized by higher
gies are still maintained in the human species. The authors suppose
short-term mating activity, while adolescence refers to the delicate
that short-term mating strategies are at the core of narcissism, and
period of life when humans find their position in the social hierar-
that other traits associated with this personality derive from these
chy. Use of the narcissistic personality index (NPI) indicates that
strategies. Their key point is to see narcissism as a strategy of
narcissism is slightly higher in males than in females [23]. This is
short-term seduction with high attractiveness, exhibitionist charm
consistent with observations indicating that men tend to strive
and interpersonal skills. Since narcissism trait levels vary continu-
more for status and have more to gain from short-term mating
ously in the human population, it might be more appropriate to see
strategies compared to women [20].
the level of narcissism as the degree of proclivity to pursue short-
term mating and adopting a mode of interaction based on seduc-
Speculations on the vulnerable narcissism form
tion rather than empathy [15]. This hypothesis has the value to
explain the link between narcissism and seduction that has been
Vulnerable narcissists are extremely sensitive to other people’s
the focus of much social personality research.
opinion and often ‘personalize’ harmless statements in a discus-
sion. They have great expectations of themselves, and search the
Narcissism and dominance approval of the other. In the most severe form, these individuals
have difficulty to handle any criticism, which could be seen as a
Another complementary view of narcissism is centred on social strategy to protect the self-esteem (i.e. the status). When someone
dominance [15–17]. There is strong evidence that psychological over-reacts and personalizes seemingly insignificant elements of a
mechanisms similar to the underlying dominance hierarchy in pri- discussion, we tend to be very careful with this person to avoid any
mates are also present in humans and influence human social hier- confrontation. This confers to such individual a special status and
archy [18]. The social attention holding potential (SAHP) theory suggests that the vulnerable narcissism form could also be linked
suggests that differences in social rank do not stem from threats to social dominance hierarchy. Vulnerable narcissists could be seen
or coercion in our species, but rather from differences in the as individuals who are susceptible to social dominance hierarchy
amount of attention conferred by others [19,20]. According to the because of their fragile self-esteem.
SAHP theory, humans compete with each other to be noticed and
valued in a group; when a group member bestows a lot of high Narcissism viewed as an emergent property
quality attention on an individual, that individual rises in status.
In contrast, ignored individuals are banished to a lower status. The influences of the parenting style and the child temperament
Interestingly, the extended sociometer theory revisits the self- on the extent of narcissism have been described. The third ele-
esteem concept by proposing that it represents a status-tracking ment, which influences narcissistic trait development and expres-
mechanism: an increase in self-esteem could signal an increase sion, is the conceptual framework of the society, and the overall
in the degree to which one is socially included and accepted by level of inequality in the society. This complex interrelationship
others [21,22]. Since social acceptance is likely to have been critical between individual difference, parenting/childhood experience,
to survival and breeding success, evolution would have favored a and influence of the framework of the society become obvious
mechanism that enables an individual to track his or her degree when we take in consideration the link between narcissism and
of acceptance by others. This mechanism could provide a feedback social dominance hierarchy. Our position in a social hierarchy is
of one’s place in the social hierarchy and help to take decisions not just an intrinsic property of an individual, but is an emergent
about challenging or submitting to others. property. A narcissist is an individual, who as a consequence of
Consistent with the hypothesis associating narcissism to domi- parenting, pre-natal and post-natal experiences and his or her tem-
nance, grandiose narcissists are striving for position of power and peramental proclivity, is more sensitive to the social dominance
are actually often found in the head of institutions, firms, hospitals hierarchy. At the same time, the steepness of social dominance
and politics, positions. Many personality traits associated with hierarchy is the result of interaction between all the members of
dominance are also similar to narcissism, including physical attrac- the group. A human society with a low level of inequality, con-
tiveness and charm, deep understanding of social relationships straints that frame the human life, and an emphasis on community
(‘‘mind-reading” ability), strong investment in forming powerful will tend to reduce the expression of narcissistic traits.
B. Lemaitre / Medical Hypotheses 95 (2016) 10–19 13

Evidence and consequences of a rise in narcissism time that in Western societies, economically poor individuals
(those at the bottom of the social hierarchy) experience decrease
The rise of narcissism underlies a steepest dominance hierarchy of health and longevity. Accordingly, stepwise descent in socioeco-
nomic status (socioeconomic status means income and/or educa-
In their book ‘‘The Narcissism Epidemic”, Campbell and Twenge tion level) predicts increased risks of cardiovascular, respiratory,
analysed the spread of narcissism and its damaging consequences and psychiatric diseases; infant mortality and also obesity, despite
in the US society [12]. The authors used experimental and histori- good access to modern medicine [26]. Studies have shown that this
cal data to show that the narcissism score of US-Americans has relation is predominantly a consequence of socioeconomic status
never been so high and that the shift was especially pronounced on health, rather than the opposite. As stated by Sapolsky, ‘‘poor
in women [12,24]. The symptoms deriving from a rise in narcissism health is not so much the outcome of being poor, but of feeling
are multiple: materialism, vanity, sense of specialness, antisocial poor” [26]. Thus, a decrease of social capital could be a prevalent
behaviour, exaggerated overconfidence, game playing conception factor driving obesity and many other diseases. With the obsession
of love, crude sexuality and a strong sense of entitlement (see of grandiose narcissists for specialness, rank and attention, a rise of
[15]). Other symptoms are the desire for status–defining objects, narcissism is expected to increase the perception of being poor and
as exemplified by the prosperity of the luxury good industry, disadvantaged for those individuals of a lower social standing.
despite the economic crisis. There is also the recent emphasis on A reasonable hypothesis is that this rise of narcissism is associ-
physical appearance as illustrated by an increased time spent on ated with an increased level of stress, notably ‘‘threat stress”,
grooming and the rise in aesthetic surgery. This raise of narcissism described as diffuse stress that one does not have the resources
is also associated with a more pronounced need for individuality to cope well with, such as impossibility of opposition to precise
and ‘‘being different”, as evidenced by the rise in ‘‘original” first identifiable stressors. Indeed, a large part of the damage of narcis-
names, tattoos, piercing or special diets [12]. The authors also pro- sism is inflicted at the meta-organizational level, and is invisible to
vide evidences for the spread of these symptoms to many other the community. One example is the economic crisis, caused by the
nations beyond the US. However, the reasons at the root of this rise self-interests of skilled and charismatic financiers and bankers,
in narcissism are not clear. Permissive parenting (‘child-cult’) and individuals whose behaviour has been routinely associated with
self-esteem–focused education, family de-structuration, media narcissism [27]. Another type of stress concerns the instability of
culture that provides an echo chamber to narcissists, internet marital relationships, especially since a divorce is often considered
and social networking, decline of traditional religions that con- as the second-most stressful life experience, second to the death of
straint social life by rites, lower synchronization as a consequence a closely related person. In a narcissism-oriented society obsessed
of increased individualism, ethnic heterogeneity as a consequence by ranking, physical appearances, wealth and status, our own
of migration, are all possible explanations for this change [12,15]. standing and achievements are constantly challenged. This chal-
This rise of narcissism might not be necessarily historically new, lenge is especially strong because we are constantly exposed to a
but it would be more visible today with the acceleration of time media culture of glamorous and self-confident celebrities, while
and the progress in psychology. being at the same time responsible for our own real or perceived
Taking into consideration the hypothesis from evolutionary failures. Such conflict can especially affect individuals with a frag-
psychology that conceptualizes social dominance as part of the ile self-esteem, which as described earlier, can be seen as a status-
evolutionary basis of narcissism, I have speculated that this rise tracking mechanism to evaluate our position in social hierarchy
of narcissism is the visible manifestation of a steep social domi- [21,22].
nance hierarchy [15]. This would mean in a society where individ- In summary, I hypothesize that the rise of narcissism creates a
uals behave more strategically to achieve their goals and to get steep social dominance hierarchy, thus resulting in a more stressful
ahead, they take less care of the consequences of their actions to society. This would explain the paradox, that despite their compa-
the community. An increase in narcissism would explain the sharp rably high level of wealth, health and technology, many westerners
increase in inequality (‘‘the rich get richer”) despite the strong perceive their society as more competitive and more stressful.
human interdependence. In addition, a hypothesis from evolution- Interestingly, a large amount of data has already associated obesity
ary psychology that conceptualizes short-term mating strategies as to stress, providing a link between the rise of narcissism and
the other underlying evolutionary basis of narcissism links this rise obesity.
of narcissism to a weakening of traditional (monogamous) values
and the diminished existence of enduring relationships, which
are replaced by relationships based on seduction with a constant
need for excitation. From a rise of narcissism to obesity

While there are still on-going efforts to decipher in non-human


A rise of narcissism leads to a decrease in social capital primates whether it is the dominant or the subordinate individuals
who experience more stress, there is a global agreement that social
The main consequence of high narcissism is a deterioration of dominance hierarchy is largely established by psychological stress
trust in relationships. Narcissism is linked to short-term seduction through coercion and threat [18,20,26]. Extrapolations of these
and the use of the other for self-enhancement purpose. Those who observations from non-human primates suggest that a steep dom-
suffer from a relationship with a narcissist, suffer also because this inance hierarchy may lead to social stress in our society. This stress
type of relationship weakens the trust in others [12]. The last should more strongly affect the individuals high in narcissism as
30 years have been characterized by a sharp decrease in trust their personalities render them more sensitive to the social domi-
towards our elite, including bankers, investors and politicians nance hierarchy (i.e. higher sensitivity to the regard of others).
[25]. This decrease of trust is especially prominent in the romantic Although this social stress should also affect grandiose narcissists
domain, where short-term seduction and game playing concept of striving for high status, it should be especially effective on vulner-
love become more prevalent. By decreasing trust at the work place able narcissists because of their fragile self-esteem but sensitivity
or in the affiliate domain, high narcissism decreases the social cap- to the regard of others. Furthermore, vulnerable narcissism is char-
ital, which is defined by a sense of community and trust in others acterized by neuroticism, a personality dimension associated with
[26]. Social scientists and health experts have noticed for a long higher sensitivity to stress [28].
14 B. Lemaitre / Medical Hypotheses 95 (2016) 10–19

This led us to the central idea of this essay, whereby increase of The observations that two hormones, testosterone and cortisol,
social stress resulting from a steep social dominance hierarchy are associated with social dominance and propensity for obesity,
affects predominantly certain lower ranked individuals, whose somewhat connects obesity to social dominance hierarchy.
personality instils a feeling of entitlement. Their over-eating could
be one option to cope with this stress.
Linking narcissistic traits to over-feeding

Chronic stress, notably social stress, promotes obesity


I will now enter a more speculative part of this essay to analyse
how certain traits associated with narcissism could be connected
In addition to higher caloric consumption and lesser physical
to over-eating. Social personality studies note that narcissists over-
activity, experts in obesity recognize that stress arising from social
sell their accomplishments, and have higher expectations when
situations and work interacts to promote the development of obe-
compared to non-narcissists. This over-sizing is linked to the con-
sity and related metabolic syndrome [29]. It is important to note
cept of inflated self at the core of narcissism personality. This over-
that stress is linked to visceral obesity, which is described as an
sizing is non-conscious and could be considered as a cognitive bias
excess of abdominal fat around internal organs such as the liver,
that could also affect the feeding behaviour. This could lead to an
pancreas and intestines and stomach. More importantly, studies
excessive appetite (‘‘the eyes bigger than the tummy”) or to
have shown that visceral fat is a better predicator of obesity-
over-feed the others by dishing out excessively large and calorific
related disease risk than total body fat mass [2].
food portions. Studies have indeed shown a marked increase in
Food intake, beginning from the first breast-feeding, is soothing
the size of US-American food servings in the last three decades
and provides comfort. Thus, over-eating could be viewed as a cop-
[47,48].
ing mechanism to deal with excessive stress. The ‘‘stress-eating” or
It is interesting to relate other narcissistic traits to the lack of
the ‘‘comfort food” hypothesis sees the excessive consumption of
exercise. Narcissists are capable of strong effort when they get
food, notably that with high palatability and caloric value, as a
public recognition. Successful grandiose narcissists enjoy individu-
means to cope with psychological stressors [30–33]. The increase
alistic sportive exploits (alpinism, marathons. . .), which push their
in food intake is considered a response to an emotional stress, to
limits, in an attempt to prove their agility and competency. Never-
diminish the distress in the short term.
theless, when narcissistic individuals do not get any recognition,
Supports for this stress hypothesis are numerous and can be
they do not make any effort and tend to stay self-absorbed. With-
found in epidemiological studies demonstrating a correlation
out peer recognition, narcissists rather engage in activity that gives
between waist to hip circumference ratio, low social economic sta-
them an immediate excitation (internet, TV, video games). These
tus and job stress [34,35]. The stress hypothesis is also reinforced
individuals are also less able to endure demanding activities, and
by a number of experimental observations in animals exposed to
may rather stay hidden at home than exposed to the regard of
chronic social stress, where they display abnormal changes in their
others, due to their high susceptibility to ego threat. The observa-
body fat distribution [33,36,37]. Clinical research have shown that
tion that injection of testosterone in testosterone-deficient obese
individuals with low socioeconomic status, who were repeatedly
male individuals not only reduces body fat but also increases moti-
subjected to psychological and economical stressors, developed
vation and activity, suggests that the lack of physical exercise asso-
both perturbation in hypothalamic-pituitary adrenal axis, a major
ciated with obesity is rather a consequence of a subordinate
pathway involved in the production of glucocorticoid hormone,
position than of fat excess per se. There is also evidence from other
and increased visceral adiposity [5,38]. The link between elevated
mammals supporting a link between subordination and low activ-
levels of the stress hormone cortisol and visceral fat accumulation
ity [37,49]. This lack of exercise could be related to a state of
is also supported by multiple studies [32,39]. For instance, human
depression (see below) that often accompanies obesity [50].
subjects treated with corticosteroids eat more, which may there-
Although this remains speculative, the stronger dependence of
fore promote obesity [40,41]. These findings strongly support the
narcissists on the regard of others could make them more vulner-
role of glucocorticoids in the development of obesity. Moreover,
able to the general reduction in social interaction and de-
a number of other metabolic disease models have also established
structuration of the social environment in the last three decades.
the importance of the hypothalamic-pituitary adrenal axis and
Since social attention (being the center of attention of the other)
chronic stress in weight gain [30,32].
is an indication of status, it is likely that the recent increase in time
In addition, the stress hormone cortisol has also been linked to
spent on screen (e.g., computer and television) in our society, may
social dominance through a complex interaction with testosterone.
contribute to obesity, beyond mere inactivity because it sequesters
While the link with aggressive behaviour is still uncertain, there is
our regard towards the others and thereby depreciate our close rel-
rather a good correlation between basal level of testosterone and
atives and friends.
status-striving personality traits in both males and females
[42,43]. Together with the stress hormone cortisol, testosterone
affects the social behaviour linked to status [42]. A number of stud-
ies suggest that testosterone levels are correlated to dominance Correlations between the narcissism and the obesity epidemics
only in individuals with low cortisol level [44]. It is striking to note
that plasma testosterone levels are inversely correlated with adi- I will now discuss a number of correlations consistent with the
pose tissue mass, and that half of obese male individuals display notion that the obesity epidemic could be a secondary conse-
low levels of testosterone [45,46]. If dominance is achieved by a quence of the narcissism epidemic.
high level of testosterone and low cortisol, obese individuals with
a low level of testosterone and a high level of cortisone will be
expected to behave as subordinate. Interestingly, injection of A concomitant increase in obesity and narcissism
testosterone has a positive effect in the management of obesity
in obese males with a testosterone deficiency. Long-term testos- The first notion relates to the rise in obesity and narcissism. The
terone therapy does not only reduce waist circumference and last three decades have been characterized by an increase in
BMI but also improves motivation, vigour, energy, and reduces fati- opportunism in love, crude sexuality, celebrity cult, wealth
gue [45]. inequality, individualism, and a parallel rise in obesity [12].
B. Lemaitre / Medical Hypotheses 95 (2016) 10–19 15

Geographical correlation as difficulty to restrain eating in stress condition or giving into


non-social activities with short-term pleasure (TV or video game)
Secondly, the worldwide increase of obesity seems to follow the over physically-demanding ones. Finally, personality studies have
increase of individualism, rise of aesthetic surgery, decrease of demonstrated that conscientiousness, a trait negatively correlated
family and traditional values. Obesity is rather prevalent in the with narcissism, is protective against overweight [54].
USA, which ranks among the most narcissistic nations in the world Vulnerable narcissism is associated with neuroticism and low
[23]. USA is also one of most unequal countries, which is worsened level of conscientiousness. The association between obesity and
by constant exposure of poor individuals to ultra-rich and extrav- these personality traits raises the question whether the latter are
agant lifestyles, as well as by celebrity cult through media expo- a consequence of obesity, or rather factors contributing to obeso-
sure. In contrast, European countries such as Denmark, Sweden genic behaviours. In the first case, these traits would be a sec-
or France, which invested significant efforts to combat inequality ondary consequence of the social prejudice associated with
and have a stronger communal spirit, show significantly less wide- obesity. Obese children are often being stereotyped as unhealthy,
spread obesity. Social norms or a pro-social religious framework, socially inept, academically unsuccessful, unhygienic and lethargic
which reduce inequality and short-term mating strategies, are [55,56]. Instead, I suggest that the personality traits (and their
expected to reduce the expression of narcissistic traits. Yet, as underlying biological origin associated with dominance) may
Twenge and Campbell suggest, the narcissism epidemic is spread- either promote or have a bi-directional interaction with obesity,
ing worldwide, as seen from indicators such as the increase in aes- which may be considered as a stress coping mechanism (see below
thetic surgery in Latin America [12]. for further discussion).

Increased prevalence of obesity in certain minorities Difficult childhood is a risk factor for both vulnerable narcissism and
obesity
The status of being a minority should increase the feeling of
specialness and is often associated with negative life experiences While the direction of causality between personality traits and
(e.g., difficult childhood, humiliation, discrimination, decreased obesity is difficult to disentangle, both obesity and vulnerable
socialization), both of which affect the level of narcissism. In par- forms of narcissism are influenced by parenting. Deprivation in
ticular, there is a good correlation between obesity rates and nar- childhood and parental neglect increases the risk of obesity by
cissism levels in US ethnic groups. Obesity is more prevalent in 7–10 times [57,58]. For instance, obesity is common in adults
African-American and Hispanic populations than in European who have been abused or abandoned in their childhood. That the
Americans, and European Americans are in general more obese same developmental factors, difficult childhood and poor parental
than those with an East-Asian origin. Although these numbers care, are also conducive to both the vulnerable form of narcissism
should be taken with a grain of salt, the use of the Narcissistic Per- and obesity is consistent with a model rooting both processes in
sonality Index (NPI) suggests that black Americans score higher on social dominance hierarchy.
the narcissism scale than Europeans Americans, and as expected,
East-Asians have the lowest score [24]. Although surprising when
Transmission of narcissism and obesity
considering their disadvantageous position, it is well known to
psychologists that Black Americans have higher self-esteem than
A striking feature of the obesity epidemic is the increase in
the overall US population [51–53]. The degree of narcissism in this
childhood obesity. Obese couples tend to give rise to obese chil-
US ethnic group also correlates with the percentage of single-
dren, and four out of five obese children will remain obese in adult-
parent families. As poor parenting leads to increased narcissism
hood [59,60]. This is comprehensible with our model that links
in the progeny, both factors, father-absence and narcissism, should
obesity to narcissism, whose underlying biological roots are in
reinforce each other in a vicious circle. Importantly, this NPI mea-
the social dominance hierarchy. Indeed, as mentioned above, nar-
surement of narcissism in ethnic populations does not mean that
cissism as a personality seems to be ‘‘transmitted” because narcis-
differences in the level of narcissism are fixed genetically. Mea-
sistic parents tend to raise narcissistic children. Of note, studies
surements of narcissism levels in Hispanic community using NPI
show that dominance can already be observed in two-year old chil-
lead to contradictory results. Hispanics NPI scores fall either
dren, supporting the idea that this trait is developed very early in
between black and white or between white and East Asian US-
childhood [18]. In this line, it worth mentioning that both over
Americans [24]. Given that Hispanics are recent immigrants, it is
and under-nutrition are risk factors for obesity [61,62]. This appar-
likely that they are initially protected by their Latino-American tra-
ent conundrum can be resolved when considering the link between
ditions, which provide a pro-social and pro-family framework.
narcissism and obesity, because narcissism can arise from both
However, those who are immersed in the individualistic and
child over-evaluation and under-parenting.
protestant-based social framework of the US, soon become less
All the correlations discussed above do not clarify the direction
protected against the ambient culture, and become more narcissis-
of causality or the presence of other major factors. Instead, they
tic. Furthermore, the low prevalence of obesity in the East Asian
only provide elements supportive of our hypothesis. Viewing the
minorities also correlates well with their lower NPI score. Collec-
narcissism epidemic as the underlying cause of obesity epidemic
tively, these observations suggest that not all human groups gain
is appealing because it would explain why certain countries are
weight in response to social stress, and could suggest differences
more affected than others, and why within these countries, certain
in temperamental proclivity in certain ethnic groups.
ethnic minorities and individuals are more affected than others.
A positive correlation between obesity and neuroticism
Is visceral fat gain a regulatory mechanism in the establishment
A number of studies have compared the personalities of obese of social hierarchy?
and non-obese populations (reviewed in [54]). Although complex
to interpret, the majority of these population-based studies indi- The main hypothesis of this article is that over-eating and the
cate a positive association of neuroticism with overweight/obesity. resulting weight gain constitute a coping mechanism to individuals
One facet of neuroticism that has been associated with obesity is whose personality instils both a feeling of entitlement and a vul-
impulsivity. Impulsivity could lead to obesogenic behaviours, such nerability to social-stress. This coping mechanism would be more
16 B. Lemaitre / Medical Hypotheses 95 (2016) 10–19

prevalent when these individuals find themselves in a lower rank In conclusion, accumulation of visceral fat could be a coping
position. It is their actual stress over their perceived (and not the mechanism for individuals subjected to dominance, allowing them
actual) status, that should be taken in consideration because these to re-adjust in the social hierarchy by modulating their hormonal
individuals perceive stress to be higher than it really is, due to their level. This would promote the acceptance of a lower status to avoid
personality. Thus, over-eating could be viewed simply as a mecha- confrontations and possible violent altercations. An interesting
nism to distract these individuals from their negative and stressful prediction deriving from this hypothesis would be that with equiv-
experiences, consistent with the notion of ‘comfort food’. An alter- alent socioeconomic level, ethnical background, and childhood
native view is that visceral fat in obese individuals also serves a conditions, obese individuals should be less violent than athletic
regulatory function, allowing the readjustment of the overweight individuals.
individuals in the social dominance hierarchy. The idea would be In primates, social dominance hierarchy often results in the
that visceral fat somewhat re-adjusts the personality towards control of reproduction by the most dominant members of the
being less aggressive, less ambitious, and possibly more sub- group. It should be noted that overweight humans have reduced
servient, with a higher fascination for the dominant individuals. fertility abilities [66,67] and that obesity impedes a normal sexual
This would promote integration in the community, and encourage life, as obese individuals are deemed less attractive [20]. Thus, it
acceptance of the lower position. As an underlying mechanism, vis- cannot be excluded that such anti-reproductive outcomes resulting
ceral fat might affect hormonal levels associated with social dom- from stress-induced weight gain in others may be a mechanism for
inance, for instance by lowering the plasma levels of critical dominant individuals in our society to monopolize the mating
hormones such as testosterone and cortisol. This would make the pool. Evolutionary psychologists consider that humans use thin-
obese individual less dominant and less sensitive to the ambient ness as a criterion of fertility in female, but it cannot be excluded
social stress. A regulatory role of visceral fat could be the legacy that it also signals high status. This would explain our unconscious
of an ancient evolutionary mechanism involved in social domi- negative feelings towards obese individuals.
nance. Incidentally, the accumulation of visceral fat may have been
greatly exacerbated by the availability of sugar-enriched and pro-
Obesity among other submissive strategies
cessed food in the modern diet. Alternatively, it could be an evolu-
tionary new regulatory mechanism of stress coping, possible today
It is often stated that obesity is a ‘mask for depression’, or that
due to the excessive availability of energy-rich food.
there is an ‘‘underlying depression” defended against by the obe-
There are a number of observations supporting a stress-coping
sity. The risk factors to develop obesity and depression are similar:
role for visceral fat. For instance, a study in macaques has shown
both have been linked to stress and neuroendocrine dysfunction as
that abdominal obesity is associated with low social status [63].
well as autonomic abnormalities. In addition, obesity tends to
It is also striking that anorexic women, devoid of any adiposity,
increase the risk of depression [50]. The psychologist Paul Gilbert
are usually viewed as more competitive and engaging in
already proposed that social anxiety and depression relate to
recognition-demanding activities, such as ballet dancing or exces-
defensive submissive strategies when individuals find themselves
sive physical exercise. Anorexia has also been associated with the
placed in lower status [68]. Depressed individuals enter into a
narcissistic personality [64]. Anorexia and obesity could represent
phase of latency, removing themselves from confrontation in social
two opposite responses to social dominance hierarchy, with the
life, while waiting for a better situation. Depression and obesity
former being about maintaining a dominant style through higher
could be viewed as two related coping responses to social stress.
activity and higher sensitivity to stress. The latter is about accept-
Other responses involve the use of violence (contesting the social
ing a subordinate style, with lower activity and less sensitivity to
hierarchy) or substance abuse (drugs, alcohol, tobacco). The obser-
stress. Similarly, intense body building activity and obesity could
vation that cessation of smoking often leads to weight gain due to
represent opposite responses in men, leading either to mesomorph
overeating is indicative that both mechanisms play a similar role
shape in status-striving individuals and more adiposity in less
for coping with social stress. It is likely that inputs from the envi-
competitive individuals. In this regard, the human body shape
ronment (childhood experience, socioeconomic parameters,
could provide insights into our personality. Consistent with this,
minority status, constraints of the society) and biological parame-
humans tend to associate certain personality traits to body shape,
ters (temperamental proclivity, ethnicity, gender) determine
which can function as a social signal [65].
which adaptive program is utilized in an individual at a given time.
The point is that an increase in social dominance hierarchy (i.e.
Depression would be more adapted to a transient loss of status
the rise of narcissism) should act as a differentiating factor that
while obesity could be more adapted to a permanent state of low
broadens a trend towards extreme shapes: thinner (female) or
status.
mesomorph (male) versus overweight. It is interesting to note that
many teenagers and young adults, especially females, exhibit peri-
ods of alternative weight loss and gain following successful diet The rise of narcissism and its impact on other diseases
and relapse times. Adolescence and young adulthood correspond
to psychologically difficult times, where individuals find their posi- Obesity might not be the only disease affected by the narcissism
tion in the social hierarchy. Studies have shown that individuals epidemic. The last decades have been characterized by the sharp
with concern about their weight (i.e. restraint dieters) are at risk increase in the frequency of many diseases in Western societies
of weight gain upon stress. This concern with one’s own weight such as allergies, autoimmune diseases, food intolerance, back pain
could reflect a higher sensitivity to social dominance hierarchy. and eating disorders, in addition to psychological ones. Changes in
It is well established that obese individuals, especially obese our alimentation habits, modifications of the intestinal microbiota,
females, have a lower self-esteem. The classical vision views the excessive use of antibiotics, influences of pesticides and pollution
low self-esteem of obese individuals as the interiorization of the are among the alleged reasons underlying the recent increase of
negative regards from the entourage [55,56]. The notion that vis- these diseases. However, much less discussion is made about the
ceral fat could have a regulatory function suggests an alternative psychosomatic nature of diseases as a secondary consequence of
interpretation, in which the decrease of self-esteem reflects a the rise in narcissism. A vast body of research has causatively asso-
decrease of status. This is consistent with the sociometer theory ciated psychological stress with a variety of concrete physiological
that views self-esteem as a status striving device. disorders, affecting immune system, digestion, sexuality and brain
functions [28].
B. Lemaitre / Medical Hypotheses 95 (2016) 10–19 17

Table 1
Measures to reduce narcissism epidemic.

1) Child education. To curb the self-esteem focused education (developed in the US), which teaches children that they are unique and special to boost their self-
confidence, especially given that the link between self-esteem and success is unclear, as illustrated by the success of East-Asian children. To educate children by
avoiding giving them too much power, by teaching them how to get along with others, by developing communal and pro-social activities, by combatting the
ubiquitous message of competition and winning, by encouraging them to perform difficult and enduring activities.
2) Parenting. As the vulnerable form of narcissism is strongly associated with poor parenting conditions and the absence of the father, measures that promote family
values and specifically the presence of a fatherly figure at home are expected to have a favourable effect against narcissism and possibly obesity.
3) Celebrity culture. The deleterious influence of celebrity in the media should be opposed. They put an extreme emphasis on physical appearance, crude sexuality and
encourage opportunistic concepts of love while creating unrealistic dreams.
4) Social life. Social life and the sense of belonging to a community energize individuals that are dependent on the regards of other. Increased social attention should be
given to our close relatives, neighbors and to our local communities with the idea that attention provides higher status and value. In the same line, reducing screen
time (video games, TV, internet) reorients our regard towards the others and allocates value to our close relatives and friends.
5) Synchronization by rites increases the feeling of being together, teaches the value of the group over the individual and decreases the tendency to differentiate. One of
the most important synchronizations is eating together, by associating food to socialization. Synchronization can also be promoted in team sports and activities,
especially those that value group efforts rather than individual contribution.
6) Inequality. Reduction of inequalities or at least of the crude displays of inequality could be positive. This is about moving toward a society which rewards
performance, yet does not place individuals in a hierarchic position. Talents and achievements should be acknowledged without being associated with displays of
superiority and dominance.

Anorexia usually affects young women who are perfectionists carded. Here again, it is worth to repeat again that it is the ‘per-
and competitive (e.g., classical ballet dancers, models), while thin- ceived’ stress and rank that matters since it is our personalities
ness is associated with self-control. It is suggested that this type of and their underlying biology, which prime the differently sensitive
eating disorder is exacerbated in Western countries, which pro- individuals to the same stimulus.
mote slimness as attractive, leading to the depreciation of ‘‘nor- Our theory is in line with obesity experts, who have stated that
mal” women [64]. While many seemingly independent disorders one of the main issues in our society today is that it is perceived as
such as food intolerance, eczemas and allergies could be due to too competitive with undue emphasis on physical appearance. This
environmental changes, a portion of them could have psychoso- essay is by essence reductionist, and does not attempt to assess all
matic origins, and the raise of narcissism might partially explain forms of obesity, some of which are likely to have other origins.
their increase in modern society. These diseases increase the feel- Nevertheless, it offers evidence to the notion that chronic stress
ing of specialness and put individuals apart from the group. For is a causative factor of obesogenic behaviours. It also roots the
instance, requirement for a special diet unconsciously marks a spe- well-known correlation between low socioeconomic status and
cial status. This tells the child that he is different from the others, bad health in social dominance hierarchy interaction. By linking
encouraging individual differentiation. Some of the diseases are obesity to social dominance hierarchy, we can expect differences
also a way to get attention from the family and peers, and to pro- in likelihood for obesity according to gender and possibly ethnical
tect ones’ self-esteem by externalizing difficulties. It is worth backgrounds, since human populations might slightly differ in
underlining in this context that the gut is an extremely well inner- their temperamental proclivities to narcissism. Finally, our essay
vated organ, often called the second brain. The human gut (and views obesity as a response, among others such as violence,
likely its microbiota) is extremely sensitive to stress, and it would depression, and substance abuse, as a coping mechanism against
not be surprising that the gut and its associated nervous system the reluctance of certain individuals to become subordinate. The
contribute to the establishment of social hierarchy by regulating amplitude of obesity is also likely to be amplified as food availabil-
stress-mediated interaction between humans. Consistent with this ity is no longer limited and physical efforts have become optional.
view, experts have reported a higher incidence of eating disorders One interest of the model is to link early childhood experience
and food intolerance in vulnerable narcissists, which suggests that to obesogenic behaviours and to make obesity conditional to cer-
their intestines could be more sensitive to stress than others [69]. tain environments beyond food availability. By connecting the nar-
In a narcissism-oriented society, dominated by freedom and indi- cissism epidemic (a social-personality view) to a steep social
vidualism, failures are much more difficult to accept because they dominance hierarchy scale (an anthropological view), I associate
directly challenge individual qualities and values. This would the current rise of individuality, the wealth and sexuality inequal-
explain the prevalence of psychological disorders (e.g., anxiety ity, the difficulty to establish enduring relationships and the con-
and depression) associated with fragile self-esteem notably in comitant decrease in social capital, to changes in biological
teenagers. Hence, diffuse stress linked to a steep social dominance parameters that affect human behaviours. It will be of interest to
hierarchy is likely to result in many more health issues than observe in the future if the current increase of narcissism is just
obesity. transient, which could prefigure a positive societal change, or if it
will further extend with possible deleterious consequences.
Current efforts to manage the obesity pandemic are centred on
Conclusions reducing sugar-enriched diet and processed food as well as pro-
moting exercise. Experts recognize that these approaches are diffi-
Using new concepts of narcissism from social-personality cult to implement and generally fail to stem the rise in obesity in
research and evolutionary biology, I speculated that a significant the long term. To date, family lifestyle interventions through beha-
part of the obesity problem derives from the recent rise of narcis- vioural therapy are measures that do provide a certain long-term
sism, reflecting a steep social dominance hierarchy. This increase of benefit. Changing the personality of an individual remains a chal-
narcissism would be a source of a diffuse stress, which affects indi- lenge. This difficulty is especially true for narcissists, both vulner-
viduals sensitized by their personality to social dominance hierar- able and grandiose, because they are extremely attached to a
chy. It is no surprise that this competitive framework is expected positive view of themselves and have difficulty to handle critics.
to affect certain vulnerable individuals, who are relegated to lower Our essay raises the notion that an optimal intervention against
socioeconomic position and whose personality instils a sensitivity obesity should include measures to combat the narcissism epi-
to the regard of others. The point is that our personalities are demic, such as those that instil community spirit, with a better
framed by our biology and not just a habit that can be easily dis-
18 B. Lemaitre / Medical Hypotheses 95 (2016) 10–19

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