Friday, September 14, 2012

Do Public Health Messages Promote Weight Bias?

Regular readers may recall previous posts asking whether well-meant public health messages in response to the obesity epidemic could in fact promote weight bias, thereby causing more harm than good (at least amongst the intended audience).

This question has now been scientifically addressed by Rebecca Puhl and colleagues from Yale University’s Rudd Centre for Food Policy, in a paper published in the International Journal of Obesity.

Puhl and colleagues collected online data from a nationally representative sample of 1014 adults, who were shown a random selection of 10 (from a total of 30) messages from major obesity public health campaigns from the United States, the United Kingdom and Australia, and were asked to rate each campaign message according to positive and negative descriptors, including whether it was stigmatizing or motivating.

Participants responded most favourably to messages that were perceived to be most positive and motivating and which made no mention of the word ‘obesity’ at all, instead focusing on making healthy behavioral changes without reference to body weight.

Participants also responded favorably to messages involving themes of increased fruit and vegetable consumption, and general messages involving multiple health behaviors.

In contrast, messages that have been publicly criticized for their stigmatizing content (such as ‘Childhood obesity is child abuse.’, ‘Too much screen time, too much kid.’ and ‘Being fat takes the fun out of being a kid.’) received the most negative ratings and the lowest intentions to comply with message content.

There were also important differences on how people of different weights perceived the stigmatizing nature of these messages:

Thus, compared to non-obese participants, obese participants perceived messages like, ‘Skip seconds…Lose your gut.’, ‘You have the strength to take control of your health.’, or ‘The temptation to eat unhealthy food is hard to fight, but it’s a fight that you and your community can win.’ as significantly more stigmatizing.

As the authors point out,

“Despite widespread prejudice induced by societal weight stigmatization, there nevertheless remains a perception that stigmatizing obese persons will instill motivation to engage in healthier lifestyles or is necessary to raise public awareness about the seriousness of obesity….Although this perception may be common, considerable evidence demonstrates that individuals who feel stigmatized or shamed about their excess weight engage in higher calorie intake, unhealthy eating behaviors, binge-eating patterns, as well as avoidance of exercise,which can reinforce weight gain and impair weight loss. Thus, public health campaigns that communicate stigmatizing, shameful messages could inadvertently make the problem worse and harm those most in need of help.”

Given that the responses to messages were most positive, when there was no mention of body weight, the authors further suggest that,

“…making reference to obesity itself may not be necessary to instill motivation amongst most people who may feel more motivated to comply with message content that emphasizes health behaviors rather than body weight. Given that increased nutrition and physical activity are important for all segments of the population, these messages could have a broader reach to the American population when weight-related language is absent.”

Not surprisingly, the authors also conclude that it may in fact be a good idea to test messages on how they are perceived, especially by people with excess weight, prior to initiation of any public messaging campaigns.

Clearly it may be better if public health messages, as a rule, promoted ‘healthy lives’ rather than ‘healthy weights’.

If you have been inadvertently affected, irritated or offended by public health messages, I’d certainly love to hear from you.

AMS
Edmonton, Alberta
ResearchBlogging.org
Puhl R, Peterson JL, & Luedicke J (2012). Fighting obesity or obese persons? Public perceptions of obesity-related health messages. International journal of obesity (2005) PMID: 22964792

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7 Responses to “Do Public Health Messages Promote Weight Bias?”

  1. ksol says:

    I’ve been thinking about this, seeing it in the news today. I think most of us, when we think of a teacher or other adult who inspired and motivated us, we think of the one who showed us possibilities and benefits, not the one who told us we were worthless and stupid. I’m not sure why people continue to think that stigma is the solution. Yes, I’ve known people who’ve responded to being berated with a rebellion that led them to achieve. I would wager, however, that for every person who is motivated by negative messages about themselves, there are scores more who find it dispiriting and discouraging.

  2. hopefulandfree (RNegade) says:

    One of the most disheartening aspects of campaigns such as the one depicted (which uses images of children) is the sponsorship, endorsement, and/or financial support the campaigns frequently receive from health care institutions and agencies, such as hospitals or state-managed departments of health.

    That these campaigns attempt to provoke feelings of shame, self-blame (guilt) and fear as psychological motivators for behavior change seems obvious. Moreover, in at least one instance, campaign sponsors (when confronted about the potential for causing harm) rationalized the tactics as “strong but necessary” for breaking through personal psychological defenses (such as “denial”), which supposedly create barriers to individual behavioral change.

    These kinds of approaches, which mimic exploitative strategies previously used by diet industry profiteers, suggest that campaign sponsors are ignorant about the complexities of weight management (or control)—if they still believe that weight outcomes are largely determined by individual choices about how to behave. Ignorance (or lack of effective education about weight management and obesity) is problematic enough, but if not ignorance…?

    When I first saw campaigns like these, it was highly distressing to realize how much potential harm was being done in the name of health promotion.

    And when I found out that the sponsors are often health care agencies, I felt despair.

  3. DeeLeigh says:

    Of course messages that are meant to shame people and make them feel weak and defective are not effective. That’s bullying, not public service.

    What’s amazing to me is that anyone, especially anyone with a basic knowledge of marketing or psychology, would expect a message like the one above to be helpful in any way. That message is about enforcing a social hierarchy, not about helping people.

  4. Melinda Munro says:

    The message in this picture is actually kind of stupid – what about being a “little girl” is affected by being overweight? In addition to the weight stigmatization there is a ton of other kinds of gender bias in the message. So hear, hear, to the recommendation that these “health promoters” actually test market their ideas and do some critical analysis of their discriminatory biases.

    ksol nails it by saying we have completely upended education to remove messages of failure but in public health we still think that telling people they are wrong or bad will work.

  5. Arya M. Sharma, MD says:

    To Melinda’s point – can a ‘big’ little kid still just be a ‘little’ kid? Of course they can – this video is a perfect example of how weight being fat should not stop you from doing anything (even as a kid): http://www.youtube.com/watch?v=HUcPeMs871k&feature=youtube_gdata_player

  6. DebraSY says:

    Love that video! Toward the end he does the worm and a cartwheel. What a joyful kid!

    Alert, however, to those who play fat-hate bingo or have very few Size Acceptance sanity points in their account, DO NOT READ THE COMMENTS. Grrr. An example of the bully culture we live in (reinforced, of course, by the “public health” ad campaigns that denigrate children and others).

  7. Arlene Cox PHD says:

    I could not agree more that shaming will create the opposite effect. Confident people change! Dr. Brene Brown’s work on shaming and the importance of acceptance should be a must read before any of these messages are created.

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