Why Shame And Blame Tactics For Obesity Will Backfire

Regular 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