Friday, July 12, 2013

Why Shame And Blame Tactics For Obesity Will Backfire

sharma-obesity-policy1Regular readers will be well aware of my taking issue with public health and clinical approaches that use shame and blame as a way to “force” people to see the light and change their evil ways.

Indeed, much has been written on how anti-weight bias and the stigma associated with obesity is already directly and indirectly contributing to everything from poorer emotional and physical health to less chances for education, employment and promotion (especially for obese women).

Now, a rather lengthy treatise by Lindsay Wiley from the American University Washington College of Law, published on the Social Science Research Network, looks at how it would be wrong to draw on the “successful” experience of “anti-tobacco law” to fight a legal war on obesity.

Whereas much of the success of the “war on tobacco” was won by socially and legally “denormalizing” tobacco use, “denormalizing” obesity can only increase weight-bias and stigma, thereby worsening the problem.

Rather, Wiley suggests, it may be far better to use a “destigmatization” strategy based on the HIV prevention experience.

As Wiley notes,

“Subsidies and food industry regulations aimed at making our environment more conducive to physical activity and healthy eating are in danger of losing out to cheaper and more politically palatable measures aimed at convincing obese individuals to lose weight without making it more feasible for them to do so. For example, recent legal reforms penalize obese employees and Medicaid recipients through higher out-of-pocket health-care costs, shame parents and kids by measuring and reporting students’ body mass index through the school system, and demoralize obese patients by promoting unsolicited and ineffective weight-loss counseling by physicians.”

Rather than help, these measure are far more ikely to further stigmatize obese people — and lead to worse health outcomes — by contributing to hostile work, school, and health-care environments.

Wiley goes on to suggest a “destigmatization strategy” that would emphasize health (and not thinness) as the proper objective of public health law with interventions targeting unhealthy products and environments rather than obese individuals.

Such a strategy may also revive interest in anti-discrimination, anti-bullying, and privacy laws as tools for preventing the health problems associated with obesity.

@DrSharma
Edmonton, AB

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2 Responses to “Why Shame And Blame Tactics For Obesity Will Backfire”

  1. Vic says:

    All excellent points. Unfortunately in the USA it is far more likely that coercive programs will continue and even get worse. There is one being touted where obese employees have a choice of paying $2000.00 more per year for health care or wearing an electronic monitor that reports their activity. They have to average 5000 steps a day to keep their costs down. The sellers of this program claim it a great success. However they did not get baseline readings on these employees, so have no idea how much activity they engaged in to begin with, and they admitted they have no idea if it will result in health benefits! So the obese person’s privacy is invaded, they are being electronically monitored (like criminals) while their thin, but sedentary, potato chip eating workmates sit by, completely unmolested, creating a hostile work environment indeed. It really is just a system to punish the weighty, if they really felt it was for health reasons they would require it of all employees, not just the fat.

  2. Benedetta says:

    While obesity is a much more complex condition than most people realize, it is important to understand that the stigmatization of it is also very complex. De-stigmatizing obesity will be an uphill battle because sadly, a great many people, secretly or openly, find feeling superior to fat people deeply gratifying There is a strong drive to hate what we fear and feel helpless to control, and every day we are told that obesity is a terrible problem which is “out of control.” Everyone from the medical profession to policy makers seems to be floundering, trying to understand and find some way to provide meaningful help. Meanwhile we have a society where thin is considered an almost magically desirable attribute, and fat is the opposite. A huge stumbling block is that nobody wants to admit that individuals’ appetites are mostly out of their control for various complex reasons, and that if you happen to have a drive to eat that is perfectly calibrated to maintain an ideal weight, even in an environment full of carefully engineered super palatable foods, you are lucky, not morally superior. Overweight people can be the worst stigmatizers of their own condition, again from the need to believe and hope that it is all somehow within their control. Because if it isn’t, what hope is there to someday have that thin, lovely body? I am leaving out health considerations because I suspect that at the unconscious, or at least secret “I don’t want to admit I think this way” level of stigmatizing behaviour, health has little to do with it. It is mostly about wanting to be loved and accepted and the fear that if our bodies do not cooperate, we won’t be. Until there is a “cure” for obesity there will be fear of it, and as long as there is fear there will be stigmatization. I think what would really help is getting the research about how complex appetite regulation is out to the public. I sometimes wonder if what frightens us about obese people isn’t the fat body part of it but the idea of not being able to control appetite. The desire for and angst around control of appetites goes very, very deep in our society. If we accept that the drive to eat, in the long run, is not much more under our control than our breathing, then we can get on with helping people to shift their attention to their food environments and influence their food intake in subtler ways.

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