Should Obesity Be a ‘Disease’?

Notes from Dr. Norman Blumenstock:
Please read what the NY Times has to say about obesity.

IN June 2013, millions of Americans contracted a disease. They developed it not because of some pathogen or illness, but thanks to the American Medical Association’s decision to label obesity a “multi-metabolic and hormonal disease state.”

On its surface, this seemed like a good move: Calling obesity a disease provides a clear warning of the significant health risks associated with excessive weight. And the obesity-is-a-disease message sparked attention, funding and research aimed at finding medically driven remedies.

We wondered, however, if there also might be psychological ramifications inherent in that message. Would it reduce or add to the burden of body-image concerns and shame? Would it empower people to fight back, or lead to a fatalistic acceptance of being overweight?

We suspected that, while there might be some benefits, the message that obesity is a disease might also have important psychological costs. In collaboration with our colleague Lisa Auster-Gussman from the University of Minnesota, we tested that hypothesis in three studies of more than 700 people, the results of which recently appeared in the journal Psychological Science.

We randomly assigned some participants to read a newspaper article that detailed the A.M.A.’s recent decision. As a control, we assigned the others to read either a standard public health message about weight-loss goals from Washington Family magazine, or an article specifically stating that obesity is not a disease, which combined news coverage from Forbes and the Fox News website. Finally, they all completed questionnaires related to their attitudes about weight loss and eating behavior.

Our findings confirmed our suspicions. On the positive side, we found that the obesity-as-disease message increased body satisfaction among obese individuals, probably because it removed the shame of obesity as a moral failing.

However, there was also a significant negative consequence. Suggesting that one’s weight is a fixed state — like a long-term disease — made attempts at weight management seem futile, and thus undermined the importance that obese individuals placed on health-focused dieting and concern for weight.

More important, these reduced concerns about weight predicted less healthy, higher-calorie food choices. We asked the participants in the study to look at a menu and select among sandwich options ranging from 230 to 980 calories. Obese participants in the obesity-is-a-disease condition group made choices that had 7 percent more calories than obese participants in the control condition group. For normal-weight participants, food choice did not differ between the control condition groups.

Obesity is a crucial public health issue with significant medical, psychological, economic and social consequences, and there is no simple response to it. Obviously, the prevention and management of obesity need to target its complex and multifaceted causes.

But knowing that fact doesn’t necessarily lead to the right policies. Indeed, this sort of nuanced approach was a goal of the A.M.A.’s decision to label obesity a disease. As Patrice Harris, an A.M.A. board member, noted, “Recognizing obesity as a disease will help change the way the medical community tackles this complex issue.”

However, our research suggests that in targeting this epidemic, it is misguided to paint the problem in the broad strokes of a single definition. Rather, an interdisciplinary perspective is needed. In addition to understanding the medical costs and benefits of public health care decisions and policies, we must examine the individual-level psychological ramifications. When medical fields make decisions without considering the psychological consequences, they do so at their own peril, or perhaps more accurately at the peril of the people they most seek to help.

To be fair, any decision that involves an issue that cuts across physiological and psychological conditions will involve complications and trade-offs. Our research highlights one of these: Calling obesity a disease may make people feel better about their bodies, but it also may contribute to the maintenance, rather than reduction, of obesity.

Ideally, we would have a public health message that leads to a decrease in self-blame and stigma while at the same time promoting adaptive self-regulation and weight loss — both equally important components of the fight against the obesity epidemic. We’ve yet to find an answer to this dilemma.