To be or not to be? Should Obesity be a disease?

This article was originally published on The Psych Report before it became part of the Behavioral Scientist in 2017.

We know that names matter.  Many people distrust Obamacare but support the Affordable Care Act. People would rather eat quiche than egg pie. A “Nutrition Assistance Program” sounds more dignified than “food stamps.”   A “cold snap” sounds almost tropical, or at least tolerable, compared to a “polar vortex.”

So, it matters that the American Medical Association decided, in June of 2013, to name obesity a disease. The official recognition of obesity as a disease is postulated to garner more funding for research, more attention from doctors, and more health insurance coverage for obesity-related issues.

The AMA also hoped the obesity name would reduce the stigma that comes from beliefs that weight is controllable and that excess weight is a result of laziness and failed self-control.

The disease label, they argued, would cultivate a greater appreciation of the multifaceted etiology of obesity. However, the decreased culpability for excess weight might come with a cost: a diminished belief that one can shed excess pounds. This new name might shift people’s beliefs regarding the malleability or controllability of body weight. Beliefs about the fixed vs. changeable nature of human attributes, in this case weight, are termed mindsets. A fixed mindset is the belief that regardless of effort, one’s weight is relatively stable. A growth mindset is the belief that with hard work, one can change their weight.

So, that brings us back to our scientific inquiry of what is in a name—the obesity name? We hypothesized that this label would encourage a fixed mindset regarding the nature of weight. We recently investigated this by recruiting over 500 participants to take part in an online survey across two different studies.  We randomly assigned participants to read an article describing weight as a disease or to read a control condition article (an article arguing that obesity is not a disease in Study 1 and an article stressing that weight can be changed in Study 2). Across both studies, participants in the disease message condition reported weaker growth-oriented beliefs about body-weight than participants in the control conditions.

And, perhaps most importantly, we have clear evidence that these mindsets matter for self-regulation and ultimately weight-related outcomes. For example, in other research we have seen that after facing severe and inevitable dieting setbacks, individuals encouraged to believe that weight is changeable (the growth mindset intervention), relative to individuals who received fitness and health-related tips (control condition), avoided weight-gain across a 12 week period (Burnette & Finkel, 2012).

Having the right mindset is crucial for individuals beginning to diet and as they continue to try and reach their goals. First, mindsets influence goal setting.  Clearly, individuals start with a goal of losing weight. However, individuals with a growth mindset set goals focused on approaching learning opportunities not just performance (Burnette, O’Boyle, VanEpps, Pollack, & Finkel, 2013). Second, having the right mindset can help individuals cope with challenges. Individuals with growth, relative to fixed, mindsets approach setbacks by adopting mastery-oriented strategies and remaining optimistic about the potential for future success. This sustained motivation predicts greater weight-loss (Burnette, 2010).

What, then, does our research mean for the AMA? Our initial investigations point to important psychological costs (Hoyt, Burnette, Auster-Gussman, 2014). However, as the AMA conjectured, labeling obesity a disease might serve to decrease perceptions that obese individuals are indolent and lacking in discipline.  That is, decreased perceptions of controllability might also usher in greater tolerance and serve to decrease discrimination against obese individuals. This is the current a line of research we are exploring. For now, we are seeking additional empirical evidence regarding both the costs and benefits of the decision to label obesity a disease in the hopes of stimulating fruitful discussion about the best message to send regarding the nature of obesity.