Obesity: Mental Disorder or Not?


Obesity refers to an excess of body fat that results from the long-term surplus of energy intake relative to energy expenditure (Galgani, 2008). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) states that obesity is not regarded as a mental illness as compared to anorexia, bulimia, and many other types of eating disorders (“Feeding and Eating Disorders,” 2013). Despite not being an eating disorder, obesity affects more than 1 in 3 Americans (“Obesity,” 2016), meaning that approximately 116 million people in the United States live with obesity.

In modern-day United States, being heavy is seen as the embodiment of gluttony, sloth, and stupidity (Crandall, 2003), while being “thin” or “slender” is the accepted ideal. Though DSM-5 classifies binge eating disorder (BED) as a mental disorder, society illustrates other eating disorders, including anorexia and bulimia, as a struggle to achieve the morality of “thinness.” On the other hand, misinformation about obesity linked to BED suggests an individual’s choice to be mentally ill and something that is brought upon one’s self (Kalb, 2000). As an example, a Newsweek article proposes, “you can’t pick your parents, but you can pick what you eat and how often you exercise” (Barrett Ozols, 2005). By this logic, genetic obesity should be disregarded and instead considered a mere “excuse” for a slew of poor lifestyle choices. While we should take other aspects such as genetic, physiological, and behavioral factors into account, the news media has exacerbated surrounding stigma by depicting obesity as the consequence of an individual’s self-negligence.

Dr. Patrice Harris, former member of the APA Board of Trustees, says that regarding obesity as a disease “will help change the way the medical community tackles this complex issue” (Moran, 2013). A report from the American Medical Association’s Council on Science and Public Health (CSPH) claims that “without a single, clear, authoritative, and widely accepted definition of disease, it is difficult to determine whether or not obesity is a medical disease state” (Moran, 2013). While a universal definition of disease has not yet been determined, John Seibel, M.D. of the American Association of Clinical Endocrinologists, encourages that “we now have an abundance of evidence identifying obesity as a multi-metabolic and hormonal disease.”

There also exists comorbidity between obesity and a number of mental disorders, including binge-eating disorder, depressive and bipolar disorders, and schizophrenia (“Obesity,” 2016). A group of researchers and peer wellness specialists medically screened 457 adults with severe mental illnesses in four U.S. states; this sample population revealed that 59% of individuals were obese, 25% diabetic, and 19% had both conditions (Cook, 2016). This study also explains that the use of psychotropic medications, high fat-low fiber diets, and sedentary lifestyles as a result of severe mental illnesses can further exacerbate the experience of obesity.

The Eating Disorders Work Group (EDWG) suggests a more biophysiological focus on the dimensions that may underlie both obesity and psychiatric disorders. Given the potential of obesity phenotypes caused by mental disorder, this focus can provide further insight into the role of neural mechanisms in the onset and maintenance of obesity and obesity-related behaviors (“Feeding and Eating Disorders,” 2013). The EDWG advises clinicians to monitor closely the weight and body mass index (BMI) in patients with psychiatric disorders in an effort to combat the negative health outcomes of obesity.

Addressing obesity in a clinical yet culturally appropriate manner has the potential to lower healthcare costs, reduce rates of illness and death attributed to obesity, and raise the quality of life (Marcus, 2012). By changing the viewpoint towards obesity, based on clinical evidence, media evolution, and favorable nutrition and fitness programs, we will especially reduce the physical and psychosocial burdens of the disease.

Remember that although DSM-5 does not classify obesity as a mental disorder, we should not discard the gravity of its effects on the 116 million Americans that live with the disease.

References:

American Psychiatric Association. (2013). Feeding and Eating Disorders. Retrieved from http://dx.doi.org/10.1176/appi.books.9780890425596.dsm10

Barrett Ozols, J. (2005). Generation XL. Newsweek, January 6. Retrieved from http://www.newsweek.com/id/47977

Centers for Disease Control and Prevention. (2016). Obesity. Retrieved from http://www.cdc.gov/obesity/data/adult.html

Cook, J. A., Razzano, L., Jonikas, J. A., Swarbrick, M. A., Steigman, P. J., Hamilton, M. M., … & Santos, A. B. (2016). Correlates of Co-Occurring Diabetes and Obesity among Community Mental Health Program Members with Serious Mental Illnesses. Psychiatric Services, appi-ps.

Crandall, C.S., & Eshleman, A. (2003). A Justification-Suppression Model of the Expression and Experience of Prejudice. Psychological Bulletin 129:414-46.

Galgani, J., & Ravussin, E. (2008). Energy metabolism, fuel selection and body weight regulation. International Journal of Obesity, 32, S109-S119.

Kalb, C. (2000). When Weight Loss Goes Awry. Newsweek, July 3, p. 46.

Marcus, M. D., & Wildes, J. E. (2012). Obesity in DSM-5. Psychiatric Annals, 42(11), 431-435.

Moran, M. (2013). AMA declares obesity requiring treatment. Psychiatric News, American Psychiatric Association. Retrieved from http://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2013.7b16

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