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Should Obesity Be Called a Mental Illness?
Kara Massie M.S., Amy Cavanaugh M.A., Julie Davis PhD. and Aleta Storch B.A.
The DSM-V's Work Group on Eating Disorders is charged with a number of complicated tasks, including whether or not obesity should be included in the DSM-V. The classification of obesity as a mental disorder is unwarranted and would be detrimental to individuals perceived as obese.
Obesity has been linked to numerous adverse physical health conditions, such as type II diabetes, hypertension, sleep apnea (Bray, 2003) and certain types of cancer (Bianchini, Kaaks, & Vainio, 2002), as well as to mental health conditions such as depression (Onyike, Crum, Lee, Lyketsos, & Eden, 2003). However, the nature of many of those linkages is by no means clear, and some obese individuals are in good physical and mental health (Bacon, Stern, Van Loan & Keim, 2005). Although a Body Mass Index (BMI) above 30 kg/m2 places some individuals at risk for physical problems, there is not a one-to-one causal relationship between obesity and these disorders (Campos, Saguy, Ernsberger, Oliver, & Gaesser, 2006). Specific to mental health conditions (e.g., depression), the fact that many individuals who are seen as obese live in societies where obesity is stigmatized seems a clear indication that in at least some cases, an individual’s mental health concerns result not from obesity but from this stigmatization (Campos, et al., 2006; Crandall & Biernat, 1990; Oliver & Lee, 2005). For this reason, it seems contradictory to classify obesity itself as a form of pathology.
It is true that there are other categories in the DSM (such as nicotine and alcohol dependence) that are similar to obesity in that they are risk factors for, rather than direct causes of, poor physical health. However, smoking and drinking are identifiable kinds of behavior, whereas obesity is not a kind of behavior in and of itself. In some cases obesity may be the result of behavior, and in other cases it may result from other factors (e.g., Caplan, 2008). These marked differences would complicate the treatment of obesity by mental health professionals, because it is not clear what psychotherapists would be expected to treat.
Obesity can have different causes—sometimes multiple ones in different combinations—in different individuals. Although some may become obese due to compulsive overeating or poor diet, others gain weight for entirely different reasons, including genetics (Arner, 2000), mobility disorders, negative effects from medications (Caplan, 2008), and other chronic medical conditions. The labeling of obesity as a mental disorder implies that obesity always has underpinnings of psychological distress. This would result in many incorrect classifications and impose on obese people the further burden of being psychiatrically labeled. These dangers have not been shown to be counterbalanced by any advantages.
The proposal to list obesity as a mental disorder seems to flow from the stigmatizing of obese people (Wang, Brownell, & Wadden, 2004), because it attributes maladaptive psychological traits to all obese individuals. Introducing a diagnosis of obesity in the DSM is potentially harmful, considering that the condition is not always caused by behavior, emotion, or cognition and is often not causally related to mental illness.
References
Arner, P. (2000). Obesity—a genetic disease of adipose tissue? British Journal of Nutrition, 83,9-16.
Bacon, L., Stern, J. S., Van Loan, M. D., & Keim, N. L. (2005). Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association, 105, 929-936.
Bianchini, F., Kaaks, R., & Vainio, H. (2002), Overweight, obesity, and cancer risk. Lancet Oncology, 3, 565-574.
Bray, G. A. (2003). Risks of obesity. Endocrinology & Metabolism Clinics of North America, 32, 787-804.
Campos, P. Saguy, A., Ernsberger, P., Oliver, E., & Gaesser, G. (2006). The epidemiology of overweight and obesity: public health crisis or moral panic? International Journal of Epidemiology, 35, 55-60.
Caplan, P. (2008). The pills that make us fat. New Scientist, 2646, 18-19.
Crandall, C, & Biernat, M. (1990). The ideology of anti-fat attitudes. Journal of Applied Social Psychology, 20, 227-243.
Oliver, J. E., & Lee, T. (2005). Public opinion and the politics of obesity in America. Journal of Health Politics, Policy, and Law, 30, 923-954.
Onyike, C. U., Crum, R. M., Lee, H. B., Lyketsos, C. G., & Eaton, W. W. (2003). Is obesity associated with major depression? Results from the third National Health and Nutritional Examination Survey. American Journal of Epidemiology,158, 1139-1147.
Wang, S. S., Brownell, K. D., & Wadden. T. A. (2004). The influence of the stigma of obesity on overweight individuals. International Journal of Obesity, 28, 1333-1337.
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