Should Obesity be Deemed a Mental Illness in the DSM-V?

The American Psychiatric Association’s diagnostic “manual,” the Diagnostic and Statistical Manual of Mental Disorders, or DSM
for short, is used by is used by clinicians, insurance companies, and even the legal system to define and identify the types and thresholds of mental illness that become the focus of treatment and research.

Should obesity be included as a personality disorder? Let us examine the protocol.

Obesity is one of the major public health concerns facing developed and developing countries in the world. Since the turn of the twentieth century, health statistics shows that the prevalence of obesity and overweight has escalated owing to a number of factors including change in lifestyle patterns. In United States, it is estimated that more than a third of the entire population is obese. It is currently estimated that about 32.2% of United States adults are obese and it is feared that the rates of obesity will escalate in the future going by recent trends. Obesity has created public health fear because it is related to a number of conditions like cardiovascular disease, diabetes, cancer, high blood pressure, and other life threatening conditions. It is also estimated that it costs United States between $70 and $100 billion every year to treat various conditions arising as result of obesity. Obesity also reduces individual life by between 5 to 20 years which means rise in cases of obesity will come with devastating effects on the quality of life and life expectancy in the long run. Although the government has put in place programs that are aimed at fighting obesity, it is should be noted that the prevalence of obesity continues in the backdrop of these strategies. Evaluating the increased cases of obesity, it has become necessary to reason whether these strategies are effective or is it that they are not reaching the targeted population. Obesity is not a problem to particular groups in the society since individuals across the social demographic divide are affected. Current strategies are targeting all groups in the society but they have done little to mitigate the pandemic. These are just few of the facts on obesity that are agitating the call for immediate measures to supplement the current one which are not very effective in fighting obesity.

It is well know that obesity is caused by increase in body weight due to excessive accumulation of fat. This means that current strategies have emphasized on the need to reduce body weight since this will be the only way that obesity can be reduced. However, most of these interventions have flopped because they advocate for the wrong weight loss strategies. It has been noted with concerns that most interventions to fight obesity are commercialized with means they are advocated by organizations wishing to reap big from the current pandemic. Standard interventions which are based on promoting weight loss through lifestyle changes with an aim of decreasing excessive food consumption and increase engagement in physical exercise are advocated in few campaigns but they are also difficult to sustain. Although there have been major intervention that are encompassed in social and scientific processes in treating obesity and related conditions, morbidity from obesity and related disorders continue to increase due to failure of current strategies and intervention to sustain weight loss.

Failure of the above strategies has forced policy planners to go back to the drawing board and think of other strategies that can effectively deal with the pandemic. Great discrepancies that have been recorded between metabolic treatments of consequence of obesity and recorded failure to reverse obesity show that the condition goes beyond metabolic disorder. Psychologist are reasoning why individuals, despite understanding the grave consequences that accompany obesity, continue to overindulge while engaging in less physical exercises. In this regard, recent research has shown that there is psychological aspect of obesity which means that it is related to brain disorders. This implies that consideration of the mental component of obesity can be an important step in treating obesity and facilitate individual compliance with interventions and minimize the relapse. This means that obesity should be included in the DSM-V that is used in assessing mental disorders. DSM-IV recognizes the existence of eating disorders which bear mental component. It has been used to assess individuals who are suffering from eating disorders like anorexia and bulimia nervosa and in each case, it outline the symptoms of the conditions. It recognizes that these disorders have severe mental impairment and comes with adverse effects but it does not recognize obesity although it has devastating mental and psychological consequences. Recent researches show that a basic feature of obesity is compulsive food consumption that leads to failure to restrain from eating. This symptom is parallel to DSM-IV criteria for substance abuse and dependence on drug, anorexia and bulimia nervosa, and binge eating, which implies that obesity shares feature with the current DSM-IV conditions. This means that obesity should be included in DSM-V since it has similar symptomatic characteristics with most conditions that are in the current DSM-IV.

The main question for this study will be; should obesity be included in DSM-V? To prove that obesity should be included in the DSM-V, this study will prove that there is mental component in obesity. First, this study will get a close understand of obesity and its prevalence. Second, the paper will look at the risk factors for obesity and factors that have compounded on society efforts to fight the condition. Third, it will review the conditions in DSM-IV and their characteristics. Lastly, this paper will prove that obesity should in deed be included in DSM-V in light of facts gathered from the previous sections.

Defining obesity and its prevalence

Obesity is defined as increase in body weight. It is a medical condition that normally leads to increased body fat leading to increase in body weight beyond the normal ratio of body weight to height. Obese individuals have more than that 20% of recommended body weight. Obesity is different from being overweight and both can be differentiated through measurement of Body Mass Index which is a ratio of body weight and height squared. Obesity defines BMI above 30 while individuals with BMI between 25 and 29.9 are considered to be overweight.

According to Haines and Neumark-Sztainer (2006) obesity is an eating disorder that is directed by unhealthy eating. They show that obesity has been on the rise in United States and more than two thirds of Americans are overweight with an estimated a third of this population being obese. Over the last three decades, the prevalence of obesity and has increased across the demographic divides with 15% of young between the age of 6 and 19 considered overweight. Recent data shows that in all states, it was only Colorado that had less than 20% of its population obese. This means that most states in United States have more than 20% of their population obese. About 32 states showed prevalence of more than 25% and six states among these had prevalence more than 30% of the population. On average, the 2008 data estimated that more than 26% of all adults in United States were obese and future projection show that if nothing is urgently done to reverse the trend, more than 41% of adults in United States will be obese by 2015. The number of obese adults in the country has continued to increase from 19.4% in 1997 to 26.6% in 2007.

Government statistics also shows that in the last two decades, the percentage of children between 6 and 11 years has more than tripled from 6.5% to 19.6%. The percentage of teenagers who are obese has increased from 5% in 1980 to 18.1% in 2008. Obesity pandemic is also creeping in early childhood. Statistics shows that prevalence of obesity among children between 2 and 5 years has increased from 5.0% in 1980 to 12.4% in 2006.These statistics shows that the rate of obesity in the population is on the rise and unless something is done to reverse the trend, quality of life for most Americans will continue to deteriorate due to effects of the pandemic.

The main reason for having DSM is to provide criteria that can be used by healthcare professionals and the public in general to fight major conditions that are affecting the public. Although DSM has concentrated on mental disorders alone, it is important to consider that any condition that touches on life brings about mental conditions. This implies that with a condition like obesity that has eaten into the life of most Americans, it is important to include it in DSM-IV criteria due to the accompanying effects.

Risk factors for obesity and compounding social factors.

There are many factors that lead to obesity. Obesity results from interaction of different factors which can be related to genetics, culture, physical activities, emotional or psychological factors, gender, age, dieting, and medical problems.

Genetic factors have been identified as major factors leading to obesity. Genes play an important role in the body by regulating body caloric intake and research studies have found out that individuals whose parents are obese are also likely to become obese. Research evidence shows that family history increases the chance of becoming obese by 25-30% although this depends on environmental predisposition. A recent research by Khamsi (2007) revealed that there is defective gene referred to as FTO, which is associated with 70% increase risk of obesity. Individuals with two defective copies of FTO genes were shown to be 3 kg heavier than average.

On the other hand, culture has been identified as another major factor that leads to obesity. It has been identified that people learn how to eat and cook following patterns of family and community culture. While there are few individuals who can break this cycle, it is often postulated that cultural factors have a stronger influence on individuals eating patterns. There are social events which are centered on eating large meals which may encourage eating more than their body needs. The modern culture promotes eating habits that leads to obesity. It has become a common practice for families not to eat in their homes but most people prefer to eat out and mostly in fast food restaurants. It has also become a modern culture to cook using butter, chocolate and other high caloric foods which are contributing to excessive intake of calories. There is a growing behavior of overeating even when individuals are not hungry owing to increased availability of food.

Increased food intake, coupled with physical inactivity has increased the risks for obesity. The modern patterns of life are devoid of chances for physical activities. Most Americans are not engaging in physical activities. The concept of ‘automobility’ means that people are driving even for a shorter distance. As a result people become overweight and it becomes difficult to engage in physical activities due to pain in joints and other problems.

There are many emotional and psychological factors that are making people to eat more and become obese. In modern American life, food has been taken as a solace when people are stressed. Every time one feels down, one turns to food and as a result, they eat more and more without knowing that they are full. In addition, food has always been associated with celebration and this condition is compounded by trend toward consumption of fast food in these celebrations. There are a lot of significant memories that are attached to food even after weight loss and most people are not able to escape the cycles to go back to over eating again.

Reported by Risper and Jim Donahue

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