Obesity and public health campaigns: Finding the Holy Grail

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.

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Example of weight management-focused (incremental mindset) public health strategy

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.

 

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Mental Health Stigma, or, Why We Should Leave Amanda Alone

Image from NY Daily News

Image from NY Daily News

The inevitable has happened: Amanda Bynes has been put under a 72-hour psychiatric hold in LA. Her parents are seeking conservatorship of her affairs after over a year of bizarre behavior, most recently in the form of some severe Twitter allegations* about her father abusing her as a child, and a tweet recanting her statement and blaming it on a microchip her father had implanted in her brain. This is a familiar story. One can easily remember Britney Spears going through similar issues, attacking paparazzi with an umbrella and famously shaving her head. Or Lindsay Lohan, landing in court case after court case, and suffering from substance abuse. But it’s all too easy to forget that these celebrities are people, and they are going through (or have gone through) some mental health issues. And so have a lot of people.

Mental health diagnoses can be things like phobias, anxiety disorders, eating disorders, depression, substance abuse and schizophrenia. According to the National Institute of Mental Health (NIMH), in 2012 approximately 4.1% of US adults were suffering, or had suffered, with a serious mental illness within the last year. That might sound small, but that only accounts for a serious mental health diagnosis. The same year approximately 18.6% of US adults had suffered from mental illness in general. That’s almost 1 in 5! So, in reality, what Bynes is going through is a common experience, and she doesn’t deserve increased scrutiny about her mental health state just because she’s been in the public eye since she was seven.* * Let’s make like Britney and leave Amanda alone.

There’s a well-known relationship between stress and mental disorders. Obviously, the attention a celebrity receives is bound to be stressful, but sources of stress can range from your job to childhood abuse. Some illnesses even appear to be more common in populations of people who experienced some type of extreme or chronic stress (1,2). Working full time and juggling school from a young age could definitely act as a source of stress, which may help to explain the incidence of mental disorder in people who were child stars (and, similarly, in impoverished populations; 3). Clinicians believe that something called the gene by environment interaction (G x E) plays a large role in mental illness (4,5). Basically, it means that even if you have some sort of hereditary vulnerability to a mental illness, it may take environmental stressors to actually end up developing the disorder. Illnesses like Post-Traumatic Stress Disorder (PTSD) may be especially impacted by environmental factors. Soldiers deployed to Iraq during Operation Iraqi Freedom had a PTSD prevalence rate of 19.3% (6). Mental illness may ultimately be something that is brought out in us by our circumstances, rather than something that we “have.”

Regardless of how people come to be diagnosed with a mental disorder we know that mental illnesses are just as debilitating as physical ones. People living with mental illness may suffer from symptoms ranging from anhedonia and rumination, to things like delusions and suicidal thoughts. In fact, according to the National Alliance on Mental Illness, 90% of the people who commit suicide have received a mental health diagnosis. One of the reasons may be the amount of stigma that surrounds mental illness. Stigma can reduce self-esteem and opportunities to be social, and increase stereotyping and prejudice (7). There is also evidence that populations that endure prejudice are more likely to develop a mental illness, illustrating the complexity of the G x E interaction (8, 9, 10).

So let’s give Bynes’ bizarre behavior a pass. If she’d been diagnosed with cancer, people would empathize with her and leave her alone instead of hounding her and putting her in the spotlight. Mental illness is just as serious as any illness a person can have, and it’s past time we learned to see people beyond their maladies, regardless.

*Anyone who knows me well will know how much it pained me to write the phrase “severe Twitter allegations.”

**Ok, ok, she was 8 in this one. Sue me. I didn’t have the energy to deep Google it. I also totally had those Barbie™ hair extensions.

If you or someone you know is considering suicide, there is help. Visit the National Suicide Prevention Lifeline the American Foundation for Suicide Prevention, helpguide.org , or call the National Suicide Prevention Hotline (1-800-273-8255).

 

  1. Belle, D. (1990). Poverty and women’s mental health. American Psychologist, 45(3), 385-389.
  1. Horwitz, A. V., Widom, C. S., McLaughlin, J., & White, H. R. (2001). The impact of childhood abuse and neglect on adult mental health: A prospective study. Journal of Health and Social Behavior, 42(2), 184-201.
  1. Liem, R., & Liem, J. (1978). Social class and mental illness reconsidered: The role of economic stress and social support. Journal of Health and Social Behavior, 19(2), 139-156.
  1. Lesch, K. P. (2004). Gene-environment interaction and the genetics of depression. Journal of Psychiatry and Neuroscience, 29(3), 174-184.
  1. van Os, J., Rutten, B. P. F., & Poulton, R. (2008). Gene-environment interactions in Schizophrenia: Review of epidemiological findings and future directions. Schizophrenia Bulletin, 34(6), 1066-1082.
  1. Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13-22.
  1. Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625.
  1. Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91(11), 1869-1876.
  2. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38-56.
  3.  Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.