Accountability or Punishment? Four Apps in Obesity

The blurry line between accountability and punishment is quite important to long-term outcomes in obesity. The difference between the two is substantial, but easily confused. Where accountability empowers people, punishment does the opposite. Punishment is imposed. Accountability flows from engagement.

Though people understand that punishment is an ineffective strategy for behavior change in obesity, the distinctions between punishment, incentives, and accountability get very confused when the subject of obesity brings in deeply held biases. Here are four applications where the line is blurry.

1. Health and Wellness Programs. The debate about carrots and sticks in health and wellness programs just won’t die. Mitesh Patel and colleagues have just published a study that will surely keep the debate alive. They found that penalties worked better for getting people to consistently meet daily physical activity goals than rewards. But they found no difference in the levels of activity, measured by steps. And neither this nor any other study has found that wellness penalties lead to better health outcomes. In contrast, health promotion programs that engage people in pursuing their own goals for health show marked health benefits. The classic example is the Diabetes Prevention Program.
    
2. Weight Stigma. Personal responsibility is a guiding principle commonly used to justify blaming and shaming people with obesity. When obesity is described in terms of personal responsibility, people are more likely to adopt attitudes of prejudice and blame against people with obesity. These attitudes add to the problem and make it harder to solve.
    
3. Physical Activity. “No pain, no gain” is a myth captured in a catchphrase that positions physical activity as punishment. Worse, exercise is commonly used as punishment in physical education, as this recent study found. Such an approach runs counter to considerable evidence that self-determination and intrinsic motivation is essential for fostering physical activity.
    
4. Food and Diet. Whether the subject is one’s own food or the food industry, people are sometimes drawn to notions of transgression and punishment instead of accountability and engagement. The notion of “clean eating” has been popular for a few years. It begs a question: just what is that “dirty eating” that must be repented? But the impulse for punishment is strongest when it comes to the food industry. Some folks see engagement and accountability as a potential “marketing ploy” to distract from the imperative to root out “bad foods.” Taxes on bad foods and drinks are presented as preferable strategies.

 
The human impulse to punish cheaters is strong and it may play an important role for fostering cooperation. But we wonder if the harms don’t outweigh potential benefits in nutrition, fitness, and obesity. Accountability has much more to offer.

Renaissances, photograph © ArTeTeTrA / flickr

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February 17, 2016