TCS Daily


Triumph of the Individual

By Gerard J. Musante - July 26, 2004 12:00 AM

The Medicare program recently decided to abandon its policy that obesity is not a disease. This step highlights how our national debate on obesity is evolving into two camps. One emphasizes that obesity results from such factors as genes, a disease state or physiology. The other focuses on the role personal responsibility plays and possibly defines obesity as a personal failing.

While the first camp paints the individual as a victim of forces beyond his control, the latter argues from a moral or social viewpoint. While I strongly support personal responsibility, even the discourse to this effect fails to address the most critical reason for espousing such a perspective. What is too often absent from both viewpoints is a direct consideration of the ramifications these arguments themselves can have on how individuals view their personal battles with overweight and obesity.

If one defines a problem as out of his control, then he remains powerless to influence it. However, nearly all experts acknowledge obesity ultimately results from violating a simple principle: calories consumed should equal calories expended. The idea that individuals are victimized by their own bodies or a toxic environment is problematic. For starters, it's untrue. But as importantly, it stymies their motivation and perceived ability to control their weight loss.

The scientific basis for discussing obesity in terms of personal responsibility, on the other hand, can shed light on a proper course of action. More than a public policy argument, personal responsibility enables individuals to manage their weight successfully. The key lies in a related psychological concept called self-efficacy, which was defined by Albert Bandura, a noted Stanford University psychologist, in 1977. He theorized that people's expectations of their ability to be effective influence whether and how they will act. It will affect how much effort they expend, and how long they will sustain their efforts in the face of challenges. If a person believes he lives in a "toxic food environment" or is suffering from a disease state, how can he have confidence in his ability to change his predicament?

Today, people are encouraged by family, friends and experts alike to try various weight loss methods. They often expect results from external cure-alls rather than through self-mastery. Short-term success may occur through use of a diet, pill or surgical procedure, but it does not resolve the root of the problem. Indeed there has been no proof that a specific composition of a diet can lead any one individual to success in losing weight and maintaining that loss.

These strategies also can lead to damaging effects when unsuccessful. An individual may anticipate a diet has some particular power and in itself will provide success. However, when the diet eventually doesn't work, he sees himself at fault. That person may conclude he cannot control the situation rather than building the confidence that he can develop and master skills that will make him successful.

Worsening the problem, we now are seeing efforts to sue food establishments, to demonize various industries, and to rid schools of vending machines. By blaming industries and products, society only makes individuals feel increasingly powerless about their ability to lose weight, and that perceived lack of control makes them less likely to attempt or experience success. Frivolous lawsuits against the food industry and the classification of obesity as a disease only reinforce the idea that obesity is something people cannot control.

There may be a silver lining in this debate. Discussion now is taking place that Medicare's recent action could lead to research on the effectiveness of various approaches. At present, what exists is a confusing collection of claims, and sometimes difficult, deficient or complex research. This expected research may lead to a better understanding of this extraordinary, multi-faceted issue and what really does work, as well as a deeper appreciation that the individual does possess and can develop the mastery of the necessary skills to overcome overweight and obesity.

Clinical psychologist Gerard Musante was the first person to adapt the principles of behavior modification to the eating habits of significantly overweight people and food abusers. For the past 30 years, Dr. Musante has taught these principles at Structure House, the residential weight loss facility he founded in Durham, N.C.


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