Obesity is a disease. It has been since June 2013, at least according to the American Medical Association (AMA). The AMA formally recognized obesity as a disease with the intention that such a classification would prompt additional funding for obesity research. However, a set of studies published in Psychological Science1 earlier this year suggests that designating obesity as a disease without considering the psychological consequences has a variety of positive and negative implications for obese and average-weight individuals.
Across a set of three studies where more than 50% of the 700+ participants were classified as overweight or obese according to the Body Mass Index (BMI), psychology researchers Crystal Hoyt, Jeni Burnette, and Lisa Auster-Gussman found that obese individuals reported significant decreases in weight concern and body dissatisfaction when they received the message that obesity was a disease, whereas average weight individuals demonstrated no such pattern when exposed to the same message. At first glance, this finding suggests that the “obesity as a disease” model is effective at increasing body satisfaction and, perhaps, decreasing internalized stigma.
At a recent talk I attended, Dr. Burnette discussed these findings as well as related findings from some more recent studies about the relationship between the obesity as disease message and an entity mindset. An entity mindset is the belief that an ability or characteristic, such as intelligence or weight, is fixed and not malleable as a result of effort or behavior change2,3. Burnette suggested that believing obesity is a disease implies that weight is static, that it’s not people’s lack of willpower or behavior making them obese, but rather, their genes and physiologies. This notion seems to decrease anti-fat prejudice and blame placed on obese individuals4. This approach seems promising: reducing stigma and blame, as well as increasing the likelihood of research funding.
There’s a catch, of course. In addition to the decreased weight concern and body dissatisfaction, obese individuals who saw the disease message were also more likely to make hypothetical unhealthy food choices, unlike average weight individuals or obese individuals exposed to the weight-management control. The researchers suggest that these food choices may be a downstream consequence of the disease label and the entity mindset it may induce. That is, if obesity indicates a physiological malfunction, thus making weight control efforts ineffective, why bother trying? The very message that decreases blame seems to reduce motivation to manage weight, too.
The belief that weight loss efforts are ineffective for obese individuals is not completely implausible. Food researcher Traci Mann and fellow obesity researchers have found that long-term weight loss for obese folks is the exception, not the norm. Receiving the message that obesity is a disease and fixed may be affirming to an obese person who was previously told that weight loss attempts were a personal failing. Regardless, it could be argued that the positive impact of affirmation and acceptance is diminished if it’s accompanied by regular unhealthy food choices.
In contrast, obese participants who were shown the control message of standard weight management strategies demonstrated a different pattern. Their concern for their weight did not decrease, but nor did they subsequently choose higher-calorie, unhealthy foods. The implication, which the researchers mention, is that some level of mild body dissatisfaction may be motivating to eat healthier foods and to be more active. But these findings present something of a double-edged sword, as Dr. Burnette mentioned at her recent talk.
The weight management (control) message may have induced an incremental mindset of weight, the alternative to an entity mindset about weight. An incremental mindset affords people more agency by implying that weight can be altered, presumably through behavior change. Accompanying empowerment, however, is the shift in blame away from an obese person’s genes and onto them and their behavior. As Burnette said, promoting either mindset to obese and non-obese individuals alike can have negative effects.
So, what’s a public health professional to do, particularly when obesity has already been officially labeled a disease? It’s exactly that sort of question that Burnette and her collaborators would like to pursue in future research. Specifically, how should public health messages be structured to motivate and promote an incremental mindset for obese individuals without the body image costs and blame? No obvious or simple answers exist yet. Burnette says that the answer to that question would be “the Holy Grail.”
Anyone out there come across research that might answer this or have a suggestion? Post it in the comments!
1Hoyt, C.L., Burnette, J.L., & Auster-Gussman, L. (2014). “Obesity is a disease”: Examining the self-regulatory impact of this public-health message. Psychological Science, 25, 997-1002.
2 Dweck, C.S., Chiu, C.Y., & Hong, Y.Y. (1995). Implicit theories and their role in judgments and reactions: A world from two perspectives. Psychological Inquiry, 6, 267-285.
3 Burnette, J.L., O’Boyle, E., VanEpps, E.M., Pollack, J.M., & Finkel, E.J. (2013). Mindsets matter: A meta-analytic review of implicit theories and self-regulation. Psychological Bulletin, 139, 655-701.
4Monterosso, J., Royzman, E.B., & Schwartz, B. (2005). Explaining away responsibility: Effects of scientific explanation on perceived culpability. Ethics & Behavior, 15, 139-158.