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.

Edmonton, Alberta
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