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Explanations for obesity

Study survey: Choice and biology explain obesity

Over 90% of participants attributed obesity to overeating and a majority of participants (57%) agreed that there is a medical cause to obesity
Psychotherapy or counselling was listed by 44% of participants as the most effective treatment for a food addiction, followed by dietary changes (22%)

Strong public acceptance of neurobiological explanations of overeating and obesity can co-exist with the view that personal choice is the predominant cause of obesity, according to  researcher Public Views on Food Addiction and Obesity: Implications for Policy and Treatment., published online in the journal Plos One.

The study investigators, from the University of Queensland, Brisbane, Australia, believes the study shows that “as the concept of food addiction is developed, its advocates need to pay greater attention to its effects on stigma, treatment and policy and to assessing whether its net impact on public health is likely to be harmful or beneficial”.

The authors undertook the study to examine the public’s acceptance of the concept of food addiction as an explanation of overeating, and assess its effects upon their attitudes toward obese persons and the treatment of obesity.

It has been well documented that patterns of eating in some individuals resemble the behaviour of drug-addicted individuals and many compulsive eaters and obese individuals demonstrate substance dependence when these are applied to the consumption of specific foods.


They conducted an online survey of 479 adults from the US (n=215) and Australia (n=264), primarily to identify any cross-cultural differences between public attitudes in two developed Westernised countries that have high rates of obesity.

They were asked three questions to assess their understanding of the causes of obesity and its risk factors. The first question was a multiple-choice question to assess what participants believed to be the main cause of obesity. “Biological causes” and “genetics or family history” were combined during analysis as the two represent causes external to personal control.


A total of 610 individuals began the online survey, with 79% completing the study without error (n=479), yielding 215 US and 264 Australian participants.

One third of participants said personal choice (32%) was the main cause of obesity, 27% ascribed it either to biological and genetic causes, and 23% chose the environment. A sizeable minority (18%) chose “other”, with most of these participants indicating that obesity was caused by a combination of factors.

Over 90% of participants attributed obesity to overeating and a majority of participants (57%) agreed that there is a medical cause to obesity, although over a quarter were unsure. Views on the causes of obesity did not differ significantly by country of residence.

Almost three quarters (72%) of participants believed that an addiction to certain foods caused obesity, just over half (54%) agreed that obesity should be treated as an addiction, and 64% were prepared to classify obesity as an eating disorder.

Most (86%) participants thought that certain foods are addictive (79% in the case of sugar) and 80% believed that some foods could be as addictive as alcohol, nicotine and cocaine. With regards to region, there were no significant differences in the participants belief that obesity was caused by a food addiction (69% v. 74%) or who considered obesity to be an eating disorder (60% v. 67%).

A significantly lower proportion of US (73%) than Australian (86%) participants agreed that obesity was harmful to society (OR = 0.49, 95% CI 0.29–0.84), and that obesity should be treated as an addiction: 47% US vs. 59% Australia (OR = 0.59, 95% CI 0.38–0.92).

Two thirds (69%) of participants were aware of research suggesting that foods could be addictive in the sense of producing changes in the brain similar to drugs of abuse. 81% of all participants supported this view. Participants from the US and Australia did not differ in their awareness and acceptance of neuroscientific evidence for food addiction.

Treatment of obesity

Two-thirds believed that diet was the most common treatment of obesity but only one quarter believed it to be the most effective. Just over a quarter of participants (27%) thought that exercise was the most effective treatment of obesity. Half of the participants thought that prescription drugs were the least effective treatment of obesity, followed by surgery (16%). Participants’ responses varied only slightly by country of residence: 31% of US participants believed that exercise was most effective whereas 30% of Australians thought that diet was most effective.

Psychotherapy or counselling was listed by 44% of participants as the most effective treatment for a food addiction, followed by dietary changes (22%). Educational and support groups were thought by 33% to be the most effective policy to address food addiction. Restrictions on advertising had the least support (5%). Over half of the participants (57%) disagreed that imposing a tax on certain foods would lower rates of obesity and 49% did not think that such a tax would be helpful to society. There were no significant differences between US and Australian participants on the most effective treatment and policy changes needed to reduce an addiction to certain foods. While the participants were aware of and supported the concept of food addiction, this did not change their attitudes toward obese individuals or the most effective method of treating obesity in 75% and 53% of participants, respectively.

Obese participants were less than a third as likely as their normal and overweight counterparts to view obesity as harmful to society (OR = 0.30, 95% CI 0.16–0.54). Obese participants were also less supportive of imposing a tax on foods than normal and overweight participants (OR = 0.52, 95% CI 0.21–0.58).

Participants’ awareness of certain foods’ addictive potential and their agreement with this did not significantly differ by BMI. Obese individuals were twice as likely to report a change in their views about obese individuals (p<0.05) and obesity treatment (p<0.001) after hearing about neuroscientific explanations of addiction than were normal weight participants.

Obese individuals believed that Sarah had less control over her eating and weight (OR = 0.36, 95% CI 0.21–0.58) and was less responsible for becoming obese (OR = 0.34, 95% CI 0.21–0.55) and losing weight (OR = 0.32, 95% CI 0.18–0.55) than normal and overweight participants. Perceived personal responsibility for weight decreased as BMI increased.

“Our findings indicate that while participants were willing to accept that some foods can be addictive, this did not entail support for medical treatments of obesity or change the strong emphasis placed on obese persons’ responsibility for their weight,” they state. “It may also reflect the view that medical treatments of obesity are of limited effectiveness. Very few thought that medical interventions such as prescription drugs (1%), surgery (8%) or psychotherapy (11%) would be effective. Diet was seen as the most common treatment of obesity by two-thirds of respondents but only a quarter of respondents believed it to be effective.”

With regards to country, Australian participants were more aware of the harmful effects of obesity on society and a significantly larger proportion of Australians thought that obesity should be treated as an addiction.

“There was substantial support for the idea of food addiction, particularly among obese participants,” they add. “Despite the strong support for seeing obesity as a form of addiction, respondents still saw obesity as primarily the result of personal choices and emphasised the need for individuals to take responsibility for their eating.”


“In our sample, obese participants were more likely to support the view that obesity represents an addiction to certain foods,” the authors conclude. “The apparent failure of neurobiological explanations of overeating and obesity to alter public views toward obese individuals and the treatment of obesity suggests that these explanations have not yet had the beneficial impacts assumed by their advocates.”

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