Not too long ago, I applauded British Columbia’s Northern Health authority for the release of their forward-thinking health promotion policy paper on overweight and obesity.
Now, just in time for Movember, Northern Health has released another interesting document, “MANual: A Men’s Health Survival Guide“, which focusses on health promotion in men.
The guide addresses a wide range of topics from healthy eating (at camp) and weights to risk-taking behaviour. smoking, drugs, alcohol and sexuality. However, it also provides helpful advice regarding the risks for diabetes and heart disease as well as prostate, lung and colorectal cancer.
I assume that similar documents exist in other jurisdictions, however, I though that this one is particularly well laid out and informative.
Certainly an interesting and quick read for any man (and woman, who care about her man).
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.
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
A thoughtful and provocative commentary by Robert C. Whitaker, from the Departments of Public Health and Pediatrics, Temple University, Philadelphia, published in the latest issue of Archives of Pediatric and Adolescent Medicine, suggests that it may be time to focus on societal norms and the values underlying those norms rather than focusing on the ‘symptom’ (childhood obesity).
Thus, Whitaker reminds us that:
“The childhood obesity epidemic is just one symptom of our way of living. Reversing the epidemic may require that we apply a new approach to improving child health in the 21st century. One approach is to make societal changes to enhance human well-being rather than to prevent a particular symptom, such as childhood obesity. In the process, we may address obesity and other socially determined health conditions while preventing new ones from emerging.”
The discussion about ‘diet and exercise’ recommendations or targeting advertising to children is ‘misguided’ because it distracts from the broader societal discussion of how much value we place on creating a healthy and nurturing environment for our children.
As I have pointed out before – the questions (and answers) should focus on the ‘whys’ and not the ‘whats’ that determine our childrens’ health and well-being – in fact, obesity is only one of many problems attributable to the same ‘whys’.
Or, in Whitaker’s words:
“Many of the other “new morbidities,” such as depression, substance use, attention-deficit disorder, and bullying, are likely to share causes rooted in our way of living. To address those root causes, we must ask not only how our way of living has changed but why.”
Ignoring the ‘why’, Whitaker warns, may actually make things worse – not better:
“It is plausible that we could reverse the obesity epidemic by changing children’s environments in ways that make children less well than they are now, especially if we do not recognize that obesity may reflect how children are coping with multiple stresses induced by our current way of living.
For example, protecting children from food marketing or removing televisions from their bedrooms may leave children lean, but not well, if we fail to address the questions of whether we should market anything to young children or have more than 1 working television in a household.”
It is these decisions (that adults have made) that shape the environment for our kids.
“The decisions that led to changes in our way of living reflected the values of adults—what was important to us. Although these changes may have been disproportionately influenced by the values of those with the most political and economic power, the changes also reflected the values that parents brought to parenting, consumers brought to the marketplace, and voters brought to the polls.”
In fact, Whitacker suggests, the underlying ‘root causes’ of both the adult and childhood obesity (and other) epidemics likely share the same shift in values (consumerism, time pressure, etc.). Recognising these common roots should shift societal norms and values to benefit all – young and old, and not just their body weights.
“For example, addressing the problems of food insecurity and neighborhood safety can improve the well-being of both adults and children, involves questions of societal values, and can affect problems beyond the symptom of obesity. The need for a shared framework is also suggested by the fact that reversing the childhood obesity epidemic requires reversing the adult obesity epidemic, which should not necessarily require different approaches.”
Thus, both children and adults
“… need to find purpose and meaning in life, which requires lifelong growth and development… autonomy, competence, mastery, self-acceptance, positive relations with others, and transcending self through commitment or connection to something or someone else.”
“An emphasis on relationships might also clarify the tradeoffs in connecting to others through face-to-face vs electronic communication. The importance of helping children identify their natural gifts and find meaning and purpose in their lives might highlight the trade-offs in education between children’s cognitive development and their social, emotional, and spiritual development. Such trade-offs, while not about obesity per se, could also affect energy balance.”
I, for one, certainly concur with Whitaker that it will take a major and open public dialogue about the norms and values that underlie the way we run our societies to address these health issues of our times.
As I have said before, blaming, shaming and punishing will not solve the problem – this is simply shooting the messenger.
Nor will calls for laws and bans or other measures that target the symptoms (e.g. fast food) without addressing the real problem (e.g. lack of time) really solve the obesity issue (should we perhaps be learning something from the hopelessly lost ‘war on drugs’ here?)
No one said this would be easy.
San Francisco, CA
p.s. Hat Tip to Geoff Ball for alerting me to this article
Whitaker RC (2011). The childhood obesity epidemic: lessons for preventing socially determined health conditions. Archives of pediatrics & adolescent medicine, 165 (11), 973-5 PMID: 22065178