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Do Shame And Blame Tactics Make The Obesity Problem Worse?


sharma-obesity-weight-discrimination4A widespread misconception, even amongst well-meaning folks, is that spreading the word about the dangers of obesity and using overt or even just subtle social pressure to “nudge” people to improving their health behaviours for their own good, is a reasonable approach to solving the obesity problem.

That such “shame and blame” tactics generally misfire should be no surprise to the many individuals actually affected by this condition.

For those, who still think increasing social pressure on people with excess weight by emphasizing the many drawbacks of excess weight and by declaring it largely a matter of lifestyle “choice”, an article by Brenda Major and colleagues from the University of California, published in the Journal of Experimental Psychology, may prove a worthwhile read.

In their experiments, the researchers randomly assigned women with a wide range of BMIs to read a news article about stigma faced by overweight individuals in the job market or a control article.

Reading the article on weight stigma caused women who perceived themselves to be overweight (irrespective of their actual BMI), to consume more calories and feel less capable of controlling their eating than exposure to the non-stigmatizing article.

The weight-stigmatizing article also increased concerns about being a target of stigma among both self-perceived overweight and non-overweight women.

These findings are particularly concerning as many normal weight women perceive themselves to be overweight and may thus be prone to such messaging.

As always, such findings pose a major dilemma for public health messaging around obesity where well-intended messages may have unintended negative consequences exactly for the people they are trying to help.

It is certainly bad enough to have to suffer the negative emotional and physical consequences of excess weight – being blamed for the problem and being constantly reminded just how bad it is without being offered any reasonably effective solution can only make  the whole situation even worse.

If you have experienced a negative emotional response to weight bias or discrimination, I’d like to hear about it. I’d also be interested in suggestions on how this problem may best be dealt with in the public discourse about excess weight.

@DrSharma
New Delhi, India

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12 Comments

  1. Obesity is NOT a lifestyle choice. It is a complex, multifactorial disease that is extraordinarily difficult to treat and address. Widespread ignorance of even the basics of the science involved, and a stubborn refusal by many to talk about addiction science, is deadly and damaging to self-esteem, employability, social interaction, and, ultimately, survival. This is NOT a “pick yourself up by your bootstraps” problem, easily addressed by “willpower.” Would you tell a person with terminal-stage cancer to think themselves healthy? Being called names, laughed at, and discriminated against only makes a horrible condition harder to address and bear; it can be devastating to the point of suicidality

    It is time for ignorance, unthinking opinion, and malignant, dysfunctional mutations of critical thinking, reason and the principles of rational argument to STOP so deeply hurt and suffering people can face their affliction with widespread support, understanding and science.

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  2. I agree with that. Having been a target of shaming tactics from one boyfriend in particular, I can tell you unequivocally that it backfired with me. Weight as a number should NEVER be the end goal. Emphasis on physical participation in sports or recreation, combined with (I hate to say it because the “H” word can be such a turnoff) a HEALTHY diet, is so much more effective. I just finished watching the very impressive and sobering documentary “Miss Representation” about the portrayal of women in the media. This should also be required viewing for anyone seeking to lose weight or helping people to do so. I advise an elimination “diet” of TV and tabloids, which blatantly or subliminally blare the fat-shaming message.

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  3. “Well Intentioned” shame is still shame and it NEVER works – I don’t understand why/how this is such a mystery to people.

    Two Examples:
    Eat Whole Grains, Don’t Eat Meat = OK, I tried that, guess what, I have problems with gluten. YOUR way makes ME sick. Now I’m in a position where I have to explain myself/ my sins because my body isn’t like yours (aesthetically or mechanically)

    Only Eat Organic = Aside from the high cost, what am I supposed to do when I want to socialize…? Oh yeah, that’s right, you want me to prepare my food and bring it with me to the restaurant. No, that’s not uncomfortable. That doesn’t make me look like a freak. That doesn’t put me in a spot where I (once again) must “defend” my food choices and explain/justify my body size. Or are you trying to tell me that I should isolate myself until I’m “socially-acceptable”?

    I’m tired of friends asking me why I can’t just “take a pill” or telling me to “do a cleanse”. If I only had 10 pounds to lose, that could work, but when it’s 100+ pounds, it’s guaranteed failure. This is less about choosing to be fat being the kid trapped at the bottom of a well… it’s going to take a team to help me get out, I can’t simply jump high enough and then “pop out” of the well. In the past 6 months I’ve started eating in a manner that is meant for people with arthritis, lyme disease, ulcerative colitis, and similar illnesses that cause excess inflamation in the body and my waist line has started to come back and weight is slowly coming off. I’d like to celebrate, but it’s too soon to know if this will last and/or if I can keep it up forever, and the hardest thing is when “well meaning” people point out the weight loss because when/if it all comes back )and then some) I’m an even bigger failure in everyone’s eyes and then the well meaning advice about portion control and “just get out there an walk some more” rubs salt in the wound.

    I have often wondered if, as we prescribe more and more drugs to manage/cure illnesses, the rate of obesity has risen. So many drugs have a side effect of weight gain and we’re on more and more drugs (especially maintainence drugs). Is that contributing to the problem? Have there been any studies on this? When I’ve asked my drs about this, they blow me off saying “well, it could happen, but we can deal with that later through diet and exercise”. After 40 years of adding a few pounds here and there, the answer always seems to be “portion control and walking” (translation: “expect to be hungry for the rest of your life, get off your lazy backside, and everything will be OK”)

    Thank you for the work you do Dr Sharma, I look forward to the info you share and your desire to help those of us who are working to make ourselve/ our lives better!

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  4. This suggest that obesity is all just a mental problem.

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  5. My professional background is in counseling and even though my client population is not obese, for other personal reasons, I am constantly speaking with obese individuals and groups dealing with this exact issue. Shame and blame are huge impediments to weight management and can quite often be the single thing that ends a successful weight management problem. You are indeed correct that when bringing up obesity, the professional is triggering a shame response in most obese individuals. There are multiple causes for this, but you did not ask for the etiology of shame but rightfully wanted to hear examples of how this problem can be minimized if not eliminated in public discourse. It is my experience that the first step in preventing and or eliminating shame is to acknowledge the strong possibility that it exists. By focusing a light on it, one has the ability to address the thought processes that allow it to blossom and overtake progress though immobilizing and depressing the individual. I tell people outright, that the most common response to obesity or to going off a proscribed eating program is shame. This is the second step, normalizing the shame response and helping people see that they are not alone. I then proceed to explain that obesity is a multilayered, medical, psychosocial and behavioral issue with tentacles that reach into almost every discipline. I go over the numbers for regain that readers of this blog are well aware of and can quote easily. I then tell the individuals that shame is a choice, a choice that is most often made regarding obesity, but still a choice. There are other responses possible to the same information. We go over the other possible responses and the difference in outcomes based on these responses. If I am in a group setting, I will often set up a role playing scenario that illustrates both a shame based response and one of detached observation and evaluation. It is at this point that I introduce basic CBT principles and apply them to obesity in general and/or to a possible lapse in following a prescribed eating plan. We compare the outcomes of choosing shame to choosing a different thought process. I than remind these individuals that this takes practice and that they must be on a lookout for shame based thoughts and actions. This works well in private practice and in support groups but it can also be modified to fit a public discourse. By directly acknowledging both the prevalence and the destructive qualities of shame and blame, you are already much further than most of your colleagues. Discussing obesity as a medical disease is also quite helpful. Finally, actively offering the obese individual examples of more productive ways to think about obesity would go a long way in replacing shame with a healthy thought process.

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  6. Dr. Sharma, so good that you published this, but so sadly predictable and to a large extent already known amongst many people (including researchers who have studied problems with weight, eating, parental commenting and modelling of behaviours) who have been obese or overweight, or who work with those who live with those realities.

    I had many reactions about what to do on a one-by-one basis but in terms of the public discourse, I would like to see obesity educators increase public awareness about the fact that it is no better or more well-intentioned to comment, criticize, or comment with veiled criticism (*the idea of comments being “well-intentioned” is a mixed bag in my experience and opinion – I think people comment for many reasons of their own, not necessarily just “trying to be helpful” to the other person) an obese or overweight person, than to approach someone who is living with any other chronic condition you could name, and do the same thing. I believe this kind of approach could be one quite powerful and effective way to raise awareness of and increase sensitivity about this matter.

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  7. I wouldn’t say it’s a mental problem. I would say it’s a hormonal problem. With the information we have about mood and the chemicals your body produces, making someone “feel bad” will cause certain chemical reactions, which will do some of several potential things like increase hunger, enhance fat storage, trigger tear ducts, or any of a host of things. Some of these things are counter to the desired effect of loss of fat.

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  8. I’ve been interested in obesity for some time and have been trying to figure out a way of facilitating change.

    As a midwife and a lactation consultant I’m interested/concerned about the difficulties experienced by obese ladies in lactation, and also the impact Breastfeeding has on future obesity for the mother and the child.. Not to mention risks in pregnancy.

    I thought I would try to implement a small support group for pregnant women, so they could develop (hopefully) a strong group identity, and eventually support each other with healthy nutritional habits, realistic exercise, and Breastfeeding issues.

    I’m trying to come from the perspective that group work and peer support may prove more useful to women that interventions “done to them”.

    I’d be really happy if anyone has any thoughts on that.

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    • Rachel, it was only during pregnancy that I, having fought obesity since childhood, could really feel good about my body sometimes, and once the debilitating nausea was more manageable, the only time I experienced normal hunger patterns, which continued a while into nursing. I have four children I nursed for nine months to eighteen months, their choice. I gained 20-40 pounds with each pregnancy, lost about half of it with delivery, and then slowly gained again. I conceived my first at about 180 pounds, and by the time the fourth was weaned, twelve years later, I was about 280 pounds. I am thankful to have had a positive nursing experience with all of them, feeling much more relaxed about my body than when not pregnant or nursing. In our food-oriented culture, with little children who are eager for junk food, too, and in a society in which stay-at-home moms must question their value (especially when they have Master’s degrees and college teaching experience), it’s really easy to fall into compulsive, addictive eating. That’s what I did. Now, in my 50’s, I’m tackling it with a 12-step program and have lost about half my excess weight. (I know I’m answering this long after you wrote your post, but there it is.)

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  9. The only weight bias I have ever experienced was with my family as a child “Natalie, don’t eat that; you’ll get fat and you’ll get diabetes!” (And I did, but it turned out to be Type 1) and from doctors, who feel compelled to tell me that my weight has varied from the last time I saw them, even while the variation has been within expected range and goes both up and down. So they praise me if it goes down, and make “hmmph” faces if it goes up.

    At this point I don’t think there should even BE a public discourse about excess weight, given that almost nobody in the general public even knows what excess weight is, except at the extreme, nor do they know anything about why a person might become large, nor the fact that all their advice is useless as best and hurtful at worst.

    The only discussion that I find useful is about how to accommodate people of all sizes and shapes, just as we accommodate people with disabilities, and how to fight size and shape discrimination. Of course, health issues are best discussed with one’s doctor, but even the “apple shape” on a non-obese person is becoming a target for discrimination, insult and self-hatred. We can’t all be Disney princesses, and I feel like we are being squeezed more and more into a standard form that fewer and fewer of us can meet.

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  10. Jayne,

    Where can we find more info on this inflammation reduction eating?

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  11. I can think of quite a few experiences that still trigger emotional responses even though they happened long ago.

    When I was a kid, the other kids on the school bus decided that “mack truck” was an appropriate nickname for me. One of my “friends” took me aside and told me that while she liked me and considered me to be a friend, she couldn’t admit to being friends with me in public because then the other kids wouldn’t like her. It taught me to stay isolated, because even friends couldn’t be trusted not to turn on me.

    A few decades later, a coworker took me aside to tell me that she understood me because her daughter was anorexic, and that was just like me being obese. I was both angry and ashamed, because she was calling attention to my weight, making assumptions about me, and telling me there was something wrong with me. I don’t think I’d ever even suggested to this woman that I had any interest in discussing weight with her.

    More recently, an employee in the grocery store felt the need to point out the calorie count of the food I was buying. More embarrassment and shame.

    The funny thing is that I’ve lost a lot of weight now because of a medical problem, something similar to achalasia. I’m eating a horrible diet because so few things work with my digestive system now. So now, instead of dealing with shaming, I’m dealing with those same well-intentioned people coming up to me and telling me how wonderful I look, how hard they know I must be working, and asking me what my secret is. Some of them are from people that don’t even know me well enough to know my name, These comments freak me out and and in some cases I’ve just resorted to a cold stare instead of an answer – why should I have to explain myself and my medical problems to someone that doesn’t even have enough interest in me otherwise to find out my name?

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