Stigmatizing obesity undercuts effectiveness of public health campaigns

With more than 78 million American adults considered obese, public health organizations and others have launched campaigns to motivate people to lead healthier lifestyles and shed some pounds. They include first lady Michelle Obama's “Let's Move” initiative, which intends to resolve the nation's childhood obesity epidemic within a generation.

In some instances, however, the messages in obesity-prevention campaigns make people who are an unhealthy weight feel bad about themselves because they seem to shame the obese, said a study published online Sept. 11 in the International Journal of Obesity.

One example is a Georgia campaign that said, “Being fat takes the fun out of being a kid.” A majority of the 1,014 study participants considered the message stigmatizing.

“By stigmatizing obesity or individuals struggling with their weight, campaigns can alienate the audience they intend to motivate and hinder the behaviors they intend to encourage,” said lead study author Rebecca Puhl, PhD. She is director of research at the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Conn.

To address this problem, Puhl recommends that primary care physicians discuss with patients inaccurate or potentially stigmatizing obesity-prevention information they hear about or read. She also encourages doctors to make sure the educational materials they have on wellness in their offices promote specific healthy behaviors people should adopt, such as eating a variety of fruits and vegetables each day, rather than focusing on just losing weight.

“Messages that focus on promoting specific health behaviors are likely to be more effective” than messages focused on weight, Puhl said.

A report published online Aug. 20 in Circulation found that some public health approaches can be effective. They include health warnings on cigarette packages, policies that make nutritious food more affordable and improving sidewalk design to encourage physical activity.

When it comes to obesity, Ovidio Bermudez, MD, encourages physicians to briefly address the importance of a healthy diet, exercise and a good body image at every patient visit, even if the individual is a healthy weight.

“If we get across to patients the message that nutrition, physical activity, wellness and self-acceptance are important aspects of health, I believe we will make a difference” in reducing obesity and eating disorders, said Dr. Bermudez, who specializes in psychiatry and adolescent medicine. He is chief medical officer at the Eating Recovery Center in Denver.

Personal empowerment

One in three U.S. adults is obese, as are 17% of children and adolescents, according to the Centers for Disease Control and Prevention. The prevalence of obesity in youths has nearly tripled from 1980, when about 6% were obese.

For the journal study, researchers issued online surveys to 1,014 U.S. adults 18 and older in July 2011 to gauge reactions to messages from major obesity-prevention campaigns implemented in Australia, the United Kingdom and the U.S. The initiatives were identified through Internet searches, assessing published reports and examining information from public health organizations such as the CDC.

Each participant was randomly assigned 10 messages from a total of 29. Individuals were asked to answer 13 questions that assessed their perceptions of the message's relevance, helpfulness, likability and whether it induced motivation to engage in healthy behaviors or promoted stigmatization of obese people.

Participants also were asked to rate how positive or negative each message was by using adjectives provided by researchers. Positive adjectives included the words “effective,” “motivating” and “informative.” Negative descriptors included “complex,” “confusing” and “stigmatizing.”

Researchers found that 36.5% of participants were considered to be a normal weight, 33.4% were overweight and 26.5% were obese. The remaining adults were considered underweight, which is defined as a body mass index lower than 18.5.

Participants responded more favorably to obesity-related health campaigns that emphasize specific health behaviors and personal empowerment for health compared with campaigns that imply personal blame and stigmatize the obese.

The most-stigmatizing message came from Australia: “Childhood obesity is child abuse.” The study found that 62.4% of participants considered the statement denigrating.

The least-stigmatizing message was the first lady's campaign urging the nation's youth to “Move every day!” Just 28.9% described it as disparaging.

A United Kingdom campaign — “Eat well. Move more. Live longer.” — received the most positive reaction and the most positive description by participants. Additionally, 85.3% of adults said they probably would comply to its health recommendations.

“It's very clear that negative messaging to the public, where shame, blame and stigma are the intent or driving forces, do not work,” Dr. Bermudez said.

In some instances, participants' weight status impacted how they perceived a health message. For example, obese adults were more likely to view the U.S. message “Skip seconds … Lose your gut” as stigmatizing compared with nonobese individuals.

Organizations that develop “obesity campaigns should be mindful of people who are obese and are very vulnerable to stigma and prejudice,” Puhl said. “More systematic research is needed to help guide the content and messaging of these campaigns to make sure they're helping and that they're not detrimental” to the public's health.