Response: A.M.A. recognizes obesity as a disease

I have seen a lot of responses to the recent declaration: Obesity is a disease. The responses are mixed. I am somewhat surprised that the ACSM supports it – but the announcement likely means more money in their pockets (with the Exercise is Medicine campaign). Who wouldn’t support an idea that puts more money in their pocket?

Me!! — I would rather see individuals succeed. A diagnosis of obesity does not set the platform for success – in fact it is counterproductive.

My reaction

I was initially outraged by this announcement. Obesity is NOT a disease. Suddenly, we are assigning another label to individuals. Supporters of the movement will argue that by defining obesity as a disease, those suffering with obesity will receive better medical assistance and insurance coverage for treatment. The problem? Sure, this could increase coverage for gastric bypass, lap band, etc – but is this really helping individuals? Is this a solution to the overwhelming problem?

Let me break this down to logical pieces and terms.

Obesity

Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual’s ideal body weight. The most common measure used for obesity is BMI.

Disease

A disease is a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.

At first read, you might think that obesity does fit this definition. The above definition is quite vague and as stated could fit the equally vague definition of a disease. But one word jumps out at me: symptoms. Overweight/obesity is a symptom.

It is a symptom of overconsumption of calories (it is NOT the symptom of underactivity as a standalone).

It is the symptom of a metabolic condition.

It is the symptom of hormone imbalances.

With that said. Can a symptom of symptoms of it own? Or is obesity a symptom that correlates with other symptoms of a true disease or condition?

Symptom

Another vague definition. A symptom is: subjective evidence of disease or physical disturbance or something that indicates the existence of something else.

It is unclear to me as to whether a symptom and disease can be synonymous terms. I could get technical – since disease is used in the definition for a symptom and you cannot define a word by using the word itself in the definition, then symptom and disease cannot be one in the same.

Like my logic?

A Real Life Story

Let me put this into perspective. Medical professionals can now assign an individual with the disease of obesity (another wonderful label, by the way, for individuals already struggling with self-esteem, body-image, and stigma). How do doctors quantify obesity? Body Mass Index, or BMI. I have written about BMI and why it is not a good measure, please read the previous post by clicking the link.

I fluctuate between being overweight and obesity on the BMI scale – depending on the season and what I may be training for. However, my appearance and my body fat percentage clearly indicate otherwise. Does this mean that the doctor would approve liposuction for me as a non-elective alternative? In the past, I have had a doctor tell me that I needed to lose weight – because she did not bother to actually look at me and only looked at my BMI. Today, that same doctor would have labeled me obese, and that would have gone in my medical history and I would be dealing with the long-term effects of that being on my medical record (and there are implications! I have learned this, having arthritis in my medical record from age 16 – it creates huge battles with the insurance companies).

The bottomline

I have given a lot of thought to whether obesity is a disease – long before this announcement. It is not. And sadly, this new definition will not solve the nation’s obesity epidemic. We have added stigma to an already debilitating label.

What about self-esteem?

What about self-worth and empowerment? A disease implies there is not much one can do about it – when the number one method of prevention and treatment of overweight obesity is empowerment. Seems to me that we may be going in the wrong direction with this diagnosis —

But some people will be making a lot of money.

Helpless in weight loss?

Learned helplessness occurs when someone feels she has little or no control over an outcome (Seligman, 1975). The helpless individual will give up easily when faced with a challenge. According to Cemalcilar, Canbeyli, and Sunar (2003), learned helplessness is

“when experience with uncontrollable events leads to the expectation
that future events will also be uncontrollable,
disruption in motivation, emotion, and learning may occur.”

Have you tried to make changes and failed? How does that affect your motivation, emotions to change, and desire to learn more about change? Do you feel overwhelmed? Helpless?

What is learned helplessness?

Helpless individuals believe the causes of bad events that happen to them are permanent.  They believe bad events will persist and will always affect their lives. Learned helplessness is a maladaptive coping mechanism that far too often leads to depression, low self-esteem, and low self-efficacy. This helplessness coincides with self blame and negative self-talk. We often attribute failures to internal, stable, general, persistent, recurrent, and important causes and this thought pattern restricts future learning and trying (Prapavessis & Carron, 1988).

Learned helplessness is the belief that failure is inevitable. We have an intrinsic need to be competent and to explore behaviors. When we fail, our confidence diminishes and we lose desire to explore. This is when we become helpless. If you failed in a task in the past, which led you to believe that you are incapable of doing anything in order to improve your performance, you will avoid the task in the future (Stipek, 1988).

Helplessness IS NOT depression

Learned helplessness is not synonymous with and should not be mistaken for depression – and as such does not require medications. Fisher (1999) summarized the three common thought errors associated with learned helplessness:

  • Personal: An individual sees herself as the cause and internalizes the cause of events.
  • Permanent: An individual sees the situation as unchangeable.
  • Pervasive: An individual sees situations as affecting all aspects of life.

Depression is a clinically diagnosable mental disorder; learned helplessness is a characteristic of depression. Learned helplessness does affect various psychological processes (Buckworth & Dishman, 2002; Fisher, 1999):

  • Motivation: Reduced or no incentive to try new, adaptive coping mechanisms.
  • Cognition: Inability to learn new responses to overcome prior learning that an event or situation is uncontrollable.
  • Emotion: The helpless state resembles depression.

Societal role

Unfortunately, our society encourages learned helplessness. For example, some parents can induce to the development of learned helplessness. Parents can put a significant amount of pressure on children to do things perfectly, telling their children, “well, if you cannot do it right, then I need to do it myself,” or “You’ll never be as good as ____.” In addition, Western society has bred a population of ‘quitters.’ You see this often, we who fail once – never try again.

Children are also often taught that they are not able to do things based on traditional gender roles. The thought, “I will never be good at football because I’m a girl.” Even though she might have a desire (and the ability) to do it, she already feels like she cannot.

Exercise as an intervention

Learned helplessness can be helped by physical activity in many ways. It is well known that the release and uptake of certain chemicals (e.g., dopamine, serotonin) and an increase in adrenaline can positively influence mood.  Further, the psychological benefits include increased self-efficacy, maintenance of identity, increased self-worth, and reductions in anxiety and worry (Buckworth & Dishman, 2002; Weisenberg, Gerby, & Mikulincer, 1993).

Your overall sense of self (i.e., identity) can certainly change. In fact, I have watched self identities change and improve daily. Most of my clients have hired me with a desire to improve their health or fitness. Many of these individuals have extremely low self-efficacy, “I can’t do pushups. I can’t jump.” However, by using appropriate progressions, I am able to show these individuals that they in fact can do these activities. Empowering!

Empowered!

And most exciting – I watch this feeling of empowerment as it is translated to other areas of life. Once you realize you can do things that you once felt you could not do, you will begin to take more risks and attempt activities you usually felt were impossible (Danish, Petitpas, & Hale, 1992; Weisenberg, Gerby, & Mikulincer, 1993). With increased confidence, it is likely you will take more risks and set more challenging goals in all areas of life. You will give yourself permission to DREAM BIG!

(Re)Building confidence

It is important to introduce strategies that are simple, yet challenging. Take for example introducing physical activity to the overweight woman trying to lose weight. She is unable to do pushups, adamant that she cannot. Many overweight women will not want to get onto the ground for a pushup—for fear of not being able to get back up. She may or may not have been stuck on the floor before. What do you do? You could start with a wall pushup or similar incline pushup and build confidence in your ability and build upper body strength.

Lastly, avoid the myths of weight loss. They will only increase risk of learned helplessness and decrease confidence.

References

Cemalcilar, Z., Canbeyli, R., & Sunar, D. (2003). Learned helplessness, therapy, and personality traits: An experimental study. Journal of Social Psychology, 143(1), 65-81.

Buckworth, J., & Dishman, R. K. (2002). Exercise psychology. Champaign, IL: Human Kinetics.

Danish, S. J., Petitpas, A. J., & Hale, B. D. (1992). A developmental-educational interventional model of sport psychology. The Sport Psychologist 6, 400-415.

Dweck, C. S., Davidson, W., Nelson, S., & Enna, B. (1978). Sex differences in learned helplessness: II. The contingencies of evaluative feedback in the classroom and III. An experimental analysis. Development Psychology, 14, 268-275.

Fisher, A. C. (1999). Counseling for improved rehabilitation adherence. In R.  Ray &  D. M. Wiese-Bjornstal (Eds.), Counseling in Sports Medicine (pp. 275-292). Champaign, IL: Human Kinetics.

Prapavessis, H., & Carron, A. V. (1988). Learned helplessness in sport. Sport Psychologist, 2(3), 189-201.

Seligman, M. E. P. (1975). Learned helplessness: Depression, development and death. W. H. Freeman: New York.

Stipek, D. E. P. (1988). Motivation to learning. Allyn & Bacon: Boston.

Weisenberg, M., Gerby, Y., & Mikulincer, M. (1993). Aerobic exercise and chocolate as means for reducing learned helplessness. Cognitive Therapy & Research, 17(6), 579-592.