Friday, December 20, 2013

Public Perceptions of Obesity Health Messages

Fat shaming is extremely common these days. Just look at some of these "discussions" online and read some of the comments on them (if your sanity can take it). Or watch many weight-loss reality shows (if your blood pressure can take it).

This kind of fat shaming and scolding is the end result of many stigmatizing anti-obesity public health campaigns.

Research shows that public health campaigns that shame and scold fat people have negative effects on the health of fat people. Furthermore, they make fat people less likely to improve health habits or see their care providers regularly.

Perhaps the best approach to improving public health may well be the type that Health At Every Size® suggests ─ placing the emphasis on encouraging healthy habits instead of on losing weight as the main goal.


Int J Obes (Lond). 2013 Jun;37(6):774-82. doi: 10.1038/ijo.2012.156. Epub 2012 Sep 11.
Fighting obesity or obese persons? Public perceptions of obesity-related health messages.
Puhl R, Peterson JL, Luedicke J.  PMID: 22964792
OBJECTIVE: This study examined public perceptions of obesity-related public health media campaigns with specific emphasis on the extent to which campaign messages are perceived to be motivating or stigmatizing. METHOD: In summer 2011, data were collected online from a nationally representative sample of 1014 adults. Participants viewed 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 rated each campaign message according to positive and negative descriptors, including whether it was stigmatizing or motivating. Participants also reported their familiarity with each message and their intentions to comply with the message content. RESULTS: Participants responded most favorably to messages involving themes of increased fruit and vegetable consumption, and general messages involving multiple health behaviors. Messages that have been publicly criticized for their stigmatizing content received the most negative ratings and the lowest intentions to comply with message content. Furthermore, messages that were perceived to be most positive and motivating made no mention of the word 'obesity' at all, and instead focused on making healthy behavioral changes without reference to body weight. CONCLUSION: These findings have important implications for framing messages in public health campaigns to address obesity, and suggest that certain types of messages may lead to increased motivation for behavior change among the public, whereas others may be perceived as stigmatizing and instill less motivation to improve health.
J Bioeth Inq. 2013 Mar;10(1):49-57. doi: 10.1007/s11673-012-9412-9. Epub 2013 Jan 4. Primum non nocere: obesity stigma and public health. Vartanian LR, Smyth JM. PMID: 23288439
Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual's control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals' personal control, there are a range of biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm.
Am J Prev Med. 2013 Jul;45(1):36-48. doi: 10.1016/j.amepre.2013.02.010. Public reactions to obesity-related health campaigns: a randomized controlled trial. Puhl R, Luedicke J, Lee Peterson J. PMID: 23790987
BACKGROUND: Despite numerous obesity-related health campaigns throughout the U.S., public perceptions of these campaigns have not been formally assessed. In addition, several recent publicized campaigns have come under criticism in the popular media for reinforcing stigmatization of obese people. Thus, research in this area is warranted...The data were collected online in summer 2012 from a nationally representative sample of American adults (N=1085). INTERVENTION: Participants were randomly assigned to view 10 obesity-related health campaigns that were pretested and publicly criticized as being stigmatizing of obese people, or 10 campaigns that contained more-neutral content...RESULTS: Stigmatizing campaigns were no more likely to instill motivation for improving lifestyle behaviors among participants than campaigns that were more neutral (OR=1.095, 95% CI=0.736, 1.630). Stigmatizing campaigns were also rated as inducing less self-efficacy (adjusted mean difference = -0.171 SD, 95% CI= -0.266, -0.076) and having less-appropriate visual content compared to less stigmatizing campaigns (adjusted difference in probability = -0.092, 95% CI= -0.124, -0.059). These findings remained consistent regardless of participants' body weight, and were generally consistent across sociodemographic predictors. CONCLUSIONS: This study highlights the need for careful selection of language and visual content used in obesity-related health campaigns, and provides support for efforts to portray obese people in a nonstigmatizing manner.
Obesity (Silver Spring). 2007 Jan;15(1):19-23. Internalization of weight bias: Implications for binge eating and emotional well-being. Puhl RM, Moss-Racusin CA, Schwartz MB. PMID: 17228027
OBJECTIVE: This study examined the relationship between internalization of negative weight-based stereotypes and indices of eating behaviors and emotional well-being in a sample of overweight and obese women. Research Method and Procedures: The sample was comprised of 1013 women who belonged to a national, non-profit weight loss organization. Participants completed an on-line battery of self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias and symptoms of depression and self-esteem, attitudes about weight and obesity, and binge eating behaviors. In addition, participants were asked to list the most common weight-based stereotypes and whether they believed them to be true or false. RESULTS: Participants who believed that weight-based stereotypes were true reported more frequent binge eating and refusal to diet in response to stigma experiences compared with those who reported stereotypes to be false. The degree to which participants believed stereotypes to be true or false was not related to types or amount of stigma experiences reported, self-esteem, depression, or attitudes toward obese persons. In addition, engaging in weight loss strategies as a response to bias was not predicted by stereotype beliefs or by actual stigma experiences, regardless of the amount or types of stigma reported. DISCUSSION: These findings suggest that obese individuals who internalize negative weight-based stereotypes may be particularly vulnerable to the negative impact of stigma on eating behaviors and also challenge the notion that stigma may motivate obese individuals to engage in efforts to lose weight. This study highlights a new area of research that warrants attention to better understand weight stigma and its potential consequences for health.
J Health Psychol. 2008 Jan;13(1):131-8. Effects of weight stigma on exercise motivation and behavior: a preliminary investigation among college-aged females. Vartanian LR, Shaprow JG. PMID: 18086724
This study examined the relation between weight stigma, exercise motivation and exercise behavior. One hundred female undergraduates (BMIs [kg/m(2)] 17-38) completed measures of experiences with weight stigma, body dissatisfaction, self-esteem and exercise motivation, and reported on their exercise behavior. Stigma experiences were positively correlated with BMI and body dissatisfaction. Importantly, stigma experiences were related to increased desire to avoid exercise, even when controlling for BMI and body dissatisfaction. Exercise avoidance was in turn related to less frequent strenuous and moderate exercise. These findings suggest that weight stigma (through its impact on avoidance motivation) could potentially decrease physical activity levels.


Moose said...

Last month a call went out for non-medical people to offer an article for an upcoming issue of "Narrative Inquiry in Bioethics." The topic is the AMA's decision to declare that obesity is a disease.

Much to my surprise, my abstract was accepted. The point of my abstract is that by declaring obesity a disease the AMA has effectively given license on the further abuse of fat patients, many of whom are already struggling to get decent health care.

Part of my article will be information with references just like these. Part is my own narrative, but I am just one voice in the wind.

Any thoughts or advice is welcome. you can reach me via the email address tied to this comment. Thank you. :)

Related: It's well known that Yahoo! news articles are a haven for trolls and the ignorant. Try, just try, to comment there to point out that obesity does not kill people and that HAES is the way to good health. You'll be voted and shouted down by ignorant boobs who are sure they know better. After all, some talking-head Doctor on the tv says so, right?

Well-Rounded Mama said...

Moose, congratulations! How exciting. Good luck on your article! Let us know when it is published.

I wanted to share with everyone a link to an interesting article on fat shaming in bariatric rehabilitation, and one therapist's battle to stop fat shaming there. Overall it's a good article.

Moose said...

That's an EXCELLENT article. It's things like that that give me hope.

Mich said...

That's awesome you're getting published. You'll have to keep us updated.