Is it fair to consider obesity a mental health issue?

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Obesity is a major public health problem in the United States. Two thirds of adults are overweight and one third of those are considered obese.

Being obese increases the risk for other diseases such as high blood pressure, heart disease, diabetes, osteoarthritis, sleep apnea and even some cancers.

On the other side is the question of whether obesity is a condition, a mental health disorder, a disease risk factor or a stand-alone disease.

What is the point of considering obesity, a physical illness, a mental illness when few other physical conditions are classified as mental illness?

Obesity itself is not acknowledged in the Diagnostic and Statistical Manual (DSM-5), but a person can be diagnosed as having EDNOS (eating disorder not otherwise specified), which is found in the DSM-5.

According to Harvard University research psychologist Paula Caplan, obesity is a consequence of ingesting too many calories and exercising insufficiently, possibly resulting from some emotional disorder that drives people to eat too much and exercise too little.

Although obesity is a result of some things, to call it a mental disorder is to convey the message that obesity is caused by psychological problems common to obese people. Obesity might be considered the result of a lack of self-discipline and self-respect or a manifestation of self-loathing.

Writing in Psychology Today, Joe Pierre, M.D., a health sciences clinical professor of psychiatry at UCLA, suggests that obesity is like other psychiatric disorders because it represents a dysfunction involving genetics, anatomy, and physical and environmental factors that result in the inability of the brain to properly regulate behavior.

On the other hand, Dr. Arya Mitra Sharma, professor of medicine at the University of Alberta and medical director of the Alberta Health Services Obesity Program, argues that obesity is not a mental illness, and he is relieved that the DSM-5 rejected it as a diagnosis.

He notes that the vast majority of overweight and obese people do not have mental health problems that differentiate them from the non-obese population.

Can we really assume that everyone with excess weight must have a mental health problem? The AMA has recognized obesity as a disease, but not a mental disorder.

Many other researchers suggest an addiction model to explain some forms of obesity. Similarities in terms of immediate psychological rewards derived from eating, loss of behavioral control and overlapping neural systems are what contributes to appetite consumption behaviors.

Treatments for obesity include self-help groups like Overeaters Anonymous, behavioral therapy, self-monitoring as well as medications that address weight-regulating hormones.

Some ideas for coping with obesity include recording your feelings and emotions whenever you eat. If you realize that you always have a snack at 4 p.m. because you're bored, it would be important to address the boredom.

From an addiction point of view, it might be helpful to consider that if you don't start eating an unhealthy food, then you don't have to stop eating it. This breaks the cycle of mindless emotional, addictive eating.

Janet Meyer, MSW, LISW-CP is an associate with Psychological & Counseling Associates of the Lowcountry, LLC in Bluffton.

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