Psychological Consequences Of Calling Obesity A Disease

Does thinking about obesity as a disease lead to bad diet choices? A new study suggests so. Crystal Hoyt talks about her new research. Physician Dr. Leslie Walker also weighs in.

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MICHEL MARTIN, HOST:

I'm Michel Martin and this is TELL ME MORE from NPR News. I'd like to thank Celeste Headlee for sitting in for me while I was away. On the program today, we are focusing on some interesting health issues that might be on your mind after a week of holiday meals and family gatherings.

Later, we will tell you about some interesting new findings about depression in new mothers who are living in multigenerational households. But we're going to start by talking about obesity, which affects 1 in 3 Americans. Last year, you might remember, the American Medical Association, the nation's largest physicians group, classified obesity as a disease. AMA officials hoped the change would steer more medical attention to obesity.

But now a new study says people actually make poorer diet choices when they think of obesity as a disease. The study is from the Journal of Psychological Science. Crystal Hoyt is the lead author, and she's with us now from member station WCVE in Richmond, Virginia. Crystal Hoyt, welcome. Thanks for joining us.

CRYSTAL HOYT: Great to be here, Michel.

MARTIN: And for additional perspective, we've also called Dr. Leslie Walker, chief of adolescent medicine at Seattle Children's Hospital. Among her duties is counseling her patients on nutrition and weight. And she's with us from member station KUOW in Seattle, Washington. Dr. Walker, welcome back to you. Thanks for joining us once again.

LESLIE WALKER: Thank you, glad to be here.

MARTIN: So, Crystal Hoyt, I'm going to start with you. Your team did three separate experiments with more than 700 participants. And you found that obese participants who read a news article about the AMA declaring obesity a disease were less likely to be concerned about their weight and more likely to choose high calorie food. So first, I'm curious about what gave you the idea to test this idea and why do you think the findings turned out as they did?

HOYT: So as a social psychologist, as soon as the AMA decided to label obesity as a disease, I was interested in the impact of this label - the psychological impact of this label on people. It might be the case that thinking that one has a disease makes people think that weight's unchangeable and attempts at weight management seem pointless. So my colleagues Jeni Burnette, Lisa Auster-Gussman and I decided to test this research.

MARTIN: And why do you - and so you think that - what - it was kind of a disinhibitor, where people felt, well, there's nothing I can do. Is that what you think happened?

HOYT: Exactly. What we think is going on here is that the disease message shifts people's beliefs regarding the controllability of body weight. Right, so psychologists call these beliefs, whether we think human attributes can be fixed or changeable, mindsets. In this case, we have weight mindsets. And a fixed mindset is a belief that, regardless of effort, my weight's relatively stable, whereas a growth mindset is the belief that, well, with hard work, I can change my weight. And...

MARTIN: You did find that the disease classification had a good impact on people's body image.

HOYT: Exactly. So on the positive side, we found that the obesity as a disease message increased body satisfaction among obese individuals and probably did so because it removed the shame of obesity as a moral failing.

MARTIN: So, Dr. Walker, what do you make of these findings? Dr. Walker? I think - have we lost Dr. Walker? OK. All right. Well, Crystal Hoyt, one of the things we were interested in talking about is this whole question of whether - disease versus a chronic medical decision. You know, is there a difference?

HOYT: Well...

MARTIN: Some people - I know some physicians prefer chronic medical condition instead of a disease. Is there a difference in that? What does that mean?

HOYT: That's a good question. What does that mean? As so as a disclaimer, we haven't conducted any research on, you know, what's the impact of labeling something a chronic medical condition. I - our interest in thinking of the disease label was because people see disease as a fixed chronic state and one in which that - we don't have a lot of control over.

MARTIN: So, Dr. Walker, I take it you're back?

WALKER: Yes.

MARTIN: Happy about that.

WALKER: Yes.

MARTIN: Well, you know what we're talking about here. And the question is - now, I understand you prefer not to use the word disease, and you prefer chronic medical condition. What difference does that make?

WALKER: Well, I mean, that it's what it is. It's a chronic medical condition. It's not something that, you know, a person could do a diet, and they're better. You know, it's a lifelong work and lifestyle change. Most adults that are obese were obese as kids. And, you know, there's a lot of reasons beyond just diet and exercise that people become obese.

And it's not something that's easily fixed. And people need to understand that and understand that it's not just about their self-control or losing control with food. There's a lot that goes into somebody becoming obese, and there's a lot that goes into trying to manage that and be healthy.

MARTIN: How - you - when the AMA made this announcement that they were going to start using this terminology, obesity as a disease, is that something that you incorporated in your discussions with patients right away?

WALKER: That's something - you know, talking about it being a chronic medical condition, an actual condition and not just something that has to do with people's self-control, I've always talked about. And, you know, in some ways, we're very happy that it is categorized that way because right now insurance doesn't cover all the nutrition, nutritionists or the, you know, the team.

Like, we have a team of people that works on our obesity program for adolescent and young adults. And it's not covered by insurance. And so it would be nice to have the things that we know that have evidence based that work for people to help them be covered. And having it actually categorized is one step toward having that happen.

MARTIN: Have you observed, though, what the researchers led by Crystal Hoyt have observed, too, which is that in some patients and some of the people you work with, it kind of removes some of the incentive to take these positive steps? Have you seen that?

WALKER: Well, I think what I would see that as is it's removing some of the pain that people have. And, you know, to be obese, you deal with daily discrimination, bullying, feeling guilty, shame, you know, that it's your fault that you can't just manage this.

And to hear that maybe it's not completely your fault, that maybe there's something else going on beyond your self-control, might give people a little more release to say, man, maybe I don't have to try to drink this Diet Coke all the time. Maybe I don't have to eat just one pea and, you know - and really feel hungry. Maybe I can eat something I want once in a while.

And, you know, when you want to - when you're really working with people to help them manage this, it's about having a different relationship with food and not feeling so guilty. That's one of the things that helps. And it could be that they're beginning to see that and feel less guilty.

MARTIN: If you're just joining us, we are talking about classifying obesity at a disease. We're talking about new research that says that the classifying obesity as a disease may affect people's diet and health choices.

Our guests are physician Dr. Leslie Walker - that's who was speaking just now - also, psychology professor Crystal Hoyt, whose research found that people are actually making poorer health - poorer diet choices when they are exposed to this information that obesity is a disease.

So, Crystal Hoyt, you know, what about that? I mean, I understand that you can see where - I'm sure you can understand Dr. Walker's point of view from kind of a clinical perspective trying to give people - remove some of the stigma which might open up the opportunity for people to address this issue. But your findings suggest that really, at least in the short run, having been confronted with this, that people were actually kind of working less hard to address this. How do you want people to address these findings, Crystal Hoyt?

HOYT: Yes, so while our findings do show psychological costs in terms of self-regulation and deciding that obese individuals place less focus on health-focused dieting, less concern for weight, ultimately predicting higher-calorie food choices. That's one psychological outcome.

And what Dr. Walker's pointing to is another very important potential psychological outcome of labeling obesity as a disease, in that it might usher in a greater tolerance and serve to decrease discrimination against obese individuals. And that's actually the current line of research that we are exploring in our lab.

MARTIN: Tell me more about that, Crystal Hoyt, if you would. I was - that was going to be my next question, which is, what are some of the other things you're interested in learning about and researching?

HOYT: So right now we are looking at this idea of, is it the case and how is it the case that perhaps labeling obesity as a disease decreases the stigma, a self-stigma? And we kind of found that in our research where obese individuals felt less body dissatisfaction - were more satisfied with their body.

But might it also decrease the stigma that others have against them? And we know - I'm a social psychologist, and in my field and in other related fields, we know that stigma - reducing stigma against individuals, such as the overweight, can be useful in enabling them to attain their goals, such as weight loss.

MARTIN: Dr. Walker, what about the - is there an analogy here with substance addiction, with drug addiction, you know? We - you know, for - gosh, for decades now, people have referred to substance addiction as a disease. And I wonder if that has had the same kind of effect? I mean, on the one hand, food is different in that you can - I mean, it might be hard to avoid those substances that you're addicted to like alcohol or, you know, drugs, but you can.

You don't need them to live. Whereas food, you do need to live. So that's kind of a different scenario. But have you seen with patients that have drug addictions or substance addictions that the idea of categorizing it as a disease - have you found that to be helpful or disinhibiting in the same way that you see with food?

WALKER: Yeah, I think it is helpful because people realize that there's something more going on here. You know, when you have something - and, you know, addiction is a disease. We can see it now. We have the evidence looking at the brain that, you know, your brain changes when addiction occurs, and it - you know, the drive is enormous to use.

And so people understanding that and us as researchers understanding how to address it in that way makes us get a little bit closer to really being able to deal with it. And it is hard 'cause, you know, when you're having obesity, you still have to eat, and that's your trigger. And, you know, it's right there in front of you every day. You need it. And it's very difficult. And I think moving forward, we can find ways to help manage that a little better if we see it differently.

MARTIN: Crystal Hoyt, can I give you the final word here? What would you like people to draw from this study?

HOYT: I guess my final word or advice would be the importance of mindsets and how crucial they are for individuals beginning to diet and continue to try and reach their dieting goals. Research by my colleague Jeni Burnette and others shows very clearly that believing that weight is changeable - that is, having a growth mindset - sustains motivation and predicts greater weight loss than having a fixed mindset.

MARTIN: Crystal Hoyt is a psychology professor at the University of Richmond. She's author of the study "Obesity Is a Disease" in the journal Psychological Science. Dr. Leslie Walker is chief of adolescent medicine at Seattle Children's Hospital. I thank you both so much for joining us.

HOYT: Thank you, Michel.

WALKER: Thank you.

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