Being overweight is an illness

The idea that being overweight should be seen as a medical illness was introduced into a new guideline by the American Heart Association in 2013. This led to much heated debate. Experts are still in disagreement. I think describing obesity as a disease is not the right approach.

One of the reasons I believe this is because of the results of psychological research. Different psychological mechanisms have been found that influence our behaviour:

• Self-efficacy expectations, i.e., the belief that we can successfully achieve a certain goal by means of a certain behaviour. Self-efficacy has been found in recent years to be a major factor influencing success in many areas, including educational performance, work, disease management, and athletic achievements. Studies have shown the importance of believing in yourself, especially when it comes to weight loss. Resisting temptation, especially at the start of a diet, is an example of self-efficacy, which Armitage et al. (2014) say provides a good prediction of the dieter’s ultimate success. It also works the other way around: in the treatment of anorexia, higher parental self-efficacy in relation to their child’s success is a condition for the child’s greater success in gaining weight (Byrne et al., 2015). The more we or others believe in our success, the higher our actual chances of success are.
• The influence of stereotypes. Research shows that we do less well when negative stereotypes are activated. For example, Spencer et al. (1999) showed that women performed less well in a maths test when they were reminded immediately before they took the test of the ‘women are bad at maths’ stereotype, while women who had not been influenced in this way scored the same as the men who took the test.
• Goal setting. Research carried out by Locke & Latham (1990, 2002) shows that the higher the goal, the better people perform. Even if the target seems unattainable, performance is better than with a lower, more achievable target. In spite of the higher achievement, though, the satisfaction it brings is lower. But that doesn’t change the fact that more has been achieved.

All these theories can be subsumed under the heading ‘self-fulfilling prophecies’, which is when our expectations of another person influence them in such a way that they act according to those expectations. In 1968, the psychologist Robert Rosenthal discovered this effect, which was later named after him. He told primary school teachers that some of their pupils had proven themselves in tests to be ‘intellectual bloomers’, who were expected to show a massive development in their intelligence. In fact, the ‘bloomers’ were chosen at random. Eight months later, however, precisely those pupils performed much better in a follow-up intelligence test and were also assessed much more positively by their teachers than the other children. This effect on the children’s performance was due to the teachers’ expectations alone, and so the prophecy that had been made by pure chance was fulfilled (Brehm et al., 2002).

Considering this research, what does our society’s current attitude to obesity mean for overweight people? The fat acceptance movement claims weight-loss success rates of less than 5 per cent. Reports about genes, the yo-yo effect, or starvation mode appear in the media, which lead people to think that changing your body weight is an impossible undertaking. The fact that magazines run sensational reports about people who have lost more than 20 kg also reinforces the impression that escaping (severe) obesity is something unbelievable.

When I lost weight, people congratulated me as if I’d achieved an outstanding feat. I can honestly say that I was congratulated more often and more enthusiastically for losing weight than for getting my doctorate.

Perhaps this says something about the emphasis we place on physical appearance in our society, but I also got the impression that some people do see losing 80 kg as a greater achievement than getting a PhD. I used to feel the same way, but that changed completely when I became aware of, and began to question, (my) fat logic. The realisation that I really only have to eat ‘normally’ and don’t have to keep to a particularly complicated or hugely restrictive diet, and that my (excess) weight is not determined by external factors but is completely in my control, ensured that I was able to develop the self-efficacy necessary to make the required changes.

The current attitude in society that obesity as a disease rather than a consequence of behaviour makes things more difficult for overweight people. The position may be well-intentioned, but illness is usually associated in our minds with something beyond our control — something that you get, like a virus or cancer, and something over which we hold no sway. With this idea of overweight people, we create a self-fulfilling prophecy of passivity and helplessness.

A study published in 2015 by Parent & Alquist supports this view. The researchers came to the conclusion that a belief that body weight can’t be influenced was associated with unhealthier eating habits and less exercise, which also led to poorer health. The authors refer to previous studies that show that people who read articles about body weight being uncontrollable were less motivated to exercise and were more likely to give up trying to lose weight when they experienced setbacks. The authors point out that the number of books like Health at Every Size and media claims about ‘set points’ and genetic predispositions has recently seen a dramatic increase.

This is one of my reasons for writing this book: I think it’s important to offer a counterweight to the prevailing attitude to obesity in our society. Although people believe they are doing good by trying to de-stigmatise being overweight, any suggestion of how difficult it is to change that situation can only make being overweight even more difficult to change. When it comes to the consequences of obesity, the goal should not be to promote a feeling of resignation, but to show possibilities for change, to strengthen self-efficacy, and to create a self-fulfilling prophecy that is positive rather than negative.