The Silent Scream

Don’t Panic, Obesity Is No Longer an Epidemic

Well, actually now it’s officially a pandemic. Nevertheless, it’s pretty clear that the language of obesity panic is totally unhelpful. Unfortunately, what it does accomplish is the promotion of bias and discrimination.

The Language of Moral Panic

More than a decade ago, Paul Campos published a commentary that described the response to obesity as a moral panic. He questioned the epidemiology of obesity and called us to:

Consider how propagating the idea of an “obesity epidemic” furthers the political and economic interests of certain groups, while doing immense damage to those whom it blames and stigmatizes.

Much of his argument has proven to be false. Though we can argue over the definition of obesity and the merits of BMI, the growing prevalence of obesity has become undeniable. The health consequences – e.g., 100 million Americans with type 2 diabetes – are growing quite serious.

But regarding the language of moral panic, he was quite correct. By sensationalizing obesity and cultivating a dire sense of panic, health advocates have indeed propagated bias and discrimination. Sometimes in quite visible ways. When people panic, they often don’t behave well.

Abigail Saguy and colleagues demonstrated this point with a series of experiments published in 2014. They found that “news reports on the ‘obesity epidemic’ – and, by extension, on public health crises commonly blamed on personal behavior – may unintentionally activate prejudice.”

More Objective Responses

Screaming fire in a crowded theater is not helpful. Ignoring a smoldering fire is unwise as well.

In their recent analysis of obesity prevention policies, Ximena Ramos Salas and colleagues suggest alternatives to this stigmatizing language of obesity panic. They call for a shift away from simplistic, stigmatizing messages about weight and toward a focus on health.

Shouting about a big fat crisis doesn’t help. What helps is constructive solutions. Replacing bias with respect would be a good start. Also helpful would be removing barriers to care before obesity progresses into devastating complications would help. Prevention programs that actually result in better health without promoting stigma would make for a trifecta.

Click here for the analysis by Ramos Salas et al, here for more on public health campaigns that stigmatize people with obesity, and here for an example of unhelpful reporting.

The Silent Scream, photograph © David Alonso / flickr

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February 2, 2018

2 Responses to “Don’t Panic, Obesity Is No Longer an Epidemic”

  1. February 02, 2018 at 6:57 am, Angela Meadows said:

    Ted, you say that the growing prevalence of obesity has become undeniable. It is clear that the number of fat people is increasing. By your definition though, obesity is a level of fatness that results in health complications, such as diabetes. Not all of those fat people have diabetes. And not all people with diabetes are fat. It is also worth noting that changes in diagnostic criteria mean that changes in prevalence of diabetes cannot be interpreted at face value.

    You are also conflating correlation with causation here – something I do not expect from you. As you know, exposure to stigma and inequality, whether for weight, race, or whatever reason, acts as a chronic stressor on the body, and is associated with higher levels of stress hormones, inflammatory markers, etc. All of this has been linked with increased risk of heart disease, hypertension, diabetes, etc. For example, evidence from cohort data demonstrates that perceived discrimination (for any reason) amplifies the association between waist circumference and glycaemic control. Cohort data also link exposure to weight discrimination with elevated scalp cortisol. And lab studies demonstrate that exposure to weight stigma increases oxidative stress, cortisol reactivity, etc independent of BMI, supporting a causal relationship between weight stigma exposure and the stress response.

    You then say that we should remove barriers to care before “obesity progresses into devastating complications.” For example, diabetes? Given that you define obesity as fatness with health complications, I’m not clear what you are suggesting here. This sounds to me more like the more typical definition of obesity as a degree of adiposity, independent of health complications.

    We all agree that sensationalist headlines and stigma help nobody. Clarity of language is important, not just in terms of terminology.

  2. February 02, 2018 at 8:33 am, Ted said:

    Thanks, Angela, for taking the time to share your views. We agree on many things.

    However, the facts are not on your side if you are suggesting that the rise in type 2 diabetes, liver disease, and other related conditions is unrelated to the rising prevalence of obesity. You are correct that BMI is a poor tool for diagnosing an individual with obesity. But it is a good tool for epidemiologists estimating the prevalence of obesity in adults. And that prevalence is rising.

    Finally, you asked about access to care before obesity progresses toward serious complications. If you wish to understand the progression of untreated obesity, think about how type 2 diabetes develops in someone with obesity. It typically starts with insulin resistance, progresses into prediabetes, and then to a diagnosis of type 2 diabetes. But that is not the end of it. Diabetes is a progressive, chronic disease. It becomes more and more complicated over time. Evidence-based obesity care can slow or reverse this progression, both before and after a diagnosis of diabetes.

    Again, thanks for sharing.