Can Public Support For Obesity Prevention Be Harnessed Without Stigmatizing People Living With Obesity?

A key paper in the 2015 Lancet Series on obesity, by Terry Huang and colleagues, argues for a “bottoms-up” approach to obesity policies – i.e. to mobilise public support for policies aimed at obesity prevention.

Citing examples from tobacco, gun control and climate change, the authors describe various theoretical frameworks for harnessing the power of the public to demand and support policies to promote healthy eating and increased physical activity to reduce obesity.

As the authors note, this may require reframing of the obesity problem, in ways that may vary depending on the target audience.

For example,

“Findings of a study in the USA showed that conservative voters’ support for government policies increased substantially when obesity was linked to military readiness.”

Or,

“The framing of obesity issues can also incorporate how the medical care cost of obesity is distributed. These costs are not entirely borne by individuals with obesity. Some of the medical care costs of obesity are paid by the non-obese in the form of higher health insurance premia (for private health insurance) and in the form of higher taxes (for public health insurance).”

Importantly,

“Support might also depend on whether such taxes and subsidies are framed as rewards for healthy behaviour or penalties for unhealthy behaviour.”

As the authors discuss, key to harnessing public support, is to foster public dialogue on the problem.

Unfortunately, in the case of obesity, this dialogue is far from simple.

Thus, one aspect, not discussed by the authors, is the very real potential of this public dialogue to inadvertently promote weight-bias and discrimination by reinforcing simplistic messages about obesity and its causes.

After all, it is difficult to convince the public that we need to regulate the food industry to prevent obesity, without also implying that fat people are fat because they simply chose to eat too much, are too stupid to realise that obesity is hurting them, and/or are too weak-willed to resist the temptation of what the food industry throws at them. Ergo, if they cannot put down their forks, it is only understandable that we need the government to step in and force them to do so for their own good.

Clearly such a line of argument may well harness public support for policies (at least among the naturally slim), but will do so at the cost of stigmatizing the very people we hope to help.

Indeed, as long as the public health rhetoric focusses on “healthy eating and active living” as the only solution to the obesity problem, it will be hard for a non-expert to not interpret this as implying that fat people just have to eat less and be more active to no longer be fat.

The real backlash comes when such policies restrict or penalise people with normal weight: Why do I have to pay more for my soda just because these fat guys can’t control themselves? Why do I have to pay more for health insurance just because these fat guys won’t get off their asses?

Thus, anyone attempting to harness public support for policies aimed at reducing obesity has a fine line to walk – framing will need to occur with a rather delicate touch, one that does not make for strong or bold public messages.

Frankly, I see no easy solution to this dilemma other than to completely and entirely decouple policies to promote healthy eating and active living (both of which are undoubtedly important for public health, irrespective of whether or not you carry excess weight) from any discussion of obesity.

Let us not make people with excess weight the scapegoats for or the targets of such policies.

If the public wants the government to legislate and enforce policies to promote healthy eating, the public should demand such policies because they are healthier for everyone and not just because they may be a solution to the obesity problem.

@DrSharma
Edmonton, AB