Obesity Policies: Punishment, Care, or Neglect?

We now have four decades of dramatic growth in obesity prevalence behind us. We have spent two of those decades bemoaning the problem and calling for urgent action. But obesity policies to date – however well-intended – have not even stopped the upward trend. Reversing the trend seems like a fantasy.

Perhaps part of the problem is conflicting impulses toward people with obesity. Shall we punish, care, or neglect?

The impulse for blame and punishment plays out daily in the lives of people with obesity. People hurl insults, healthcare providers dismiss, employers deny opportunities, and the media conveys disgust with images of headless bellies and derisive stereotypes. Donut jokes never subside.

More subtly, the impulse to punish plays out in obesity policy choices. In an elegant pair of new studies, Michael Berg and colleagues demonstrated how these choices are rooted in bias against people with obesity. They found that prejudice against people with obesity plays a significant role in preferences for policies that penalize people with obesity.

In one study, they found that people with more anti-fat prejudice were more supportive of more punitive policies. Even accounting for political leanings, beliefs about obesity, BMI, and other factors didn’t change the result. Prejudice drove the impulse to punish people with obesity.

In their second study, Berg et al looked at the impulse to target people or unhealthy behaviors. Again, prejudice told the story. People with strong anti-fat prejudice favored punitive policies directed specifically at people with obesity. Policies that targeted unhealthy behaviors across the board were less appealing for people with strong bias.

Clearly, bias gets in the way. Simply shifting the blame from people with obesity to “Big Food” might be satisfying. But read the headlines. We’re already heaping plenty of blame on big food, and the needle isn’t moving. Punishing Coke or Pepsi or McDonald’s has done nothing to bend the upward curve of obesity.

We will never make progress until we rethink our focus. Shifting from punishment to neglect will not help. Health must be our focus – the health of people with obesity and the health of the population.

Click here for the studies by Berg et al. Here, here, here, and here you will find further reflections on obesity policies.

Punished, photograph © Jasper Fields / flickr

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February 9, 2017