Fear

Fighting Obesity with Fear and Disgust

Fear and disgust can be powerful motivators. A new analysis in Health Affairs contends that they can also be effective tools for serving the interests of public health. Amy Fairchild and colleagues from the Mailman School of Public Health at Columbia University cite a “contested body of evidence about the motivational effects of fear” to support their assertion.

We beg to differ.

Motivating individuals to act on fear is not proof that campaigns of fear and disgust in highly stigmatized conditions are an effective way to improve public health. In their review of New York City’s experience with fear-based campaigns against smoking, HIV, and obesity, Fairchild et al conclude that it was effective only in the case of anti-smoking advertising. And that conclusion was based upon surrogate evidence of calls into a center for assistance with quitting.

In the case of HIV and obesity they found mixed results, saying:

Fear was a socially acceptable response to smoking. This would not hold true in the case of either obesity or HIV.

They go on to acknowledge that no evidence shows fear-based appeals in obesity and HIV had any effect on public health outcomes.

Advertising professionals who must drive consumer behavior, generate sales, and be accountable for results know that fear-based marketing is poisonous. Smoking cessation brands don’t tell people they’ll die unless they quit. They tell people “you can do it and we can help.” Dietitians put their energy into encouraging clients, not scaring them. Condom marketers know that fear-based appeals do nothing good for their sales.

But in the end, the most persuasive argument against fear and disgust in public health campaigns is morality. Borrowing words from David Hill and colleagues in a 1998 essay, we believe that fear and disgust represent “a health promotion profanity.”

Stigma and bias come along for the ride with fear and disgust. They bring flawed decisions that harm people, their health, and their quality of life. Particularly in HIV and obesity, stigma is well-understood to be an impediment to better health.

The New York City Department of Health has done some fine work in HIV, in smoking control, and in addressing obesity. But unleashing fear and disgust should not be a source of pride.

Click here to read the analysis by Fairchild et al.

Fear, photograph © stuart anthony / flickr

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4 Responses to “Fighting Obesity with Fear and Disgust”

  1. May 17, 2015 at 7:17 am, Joe Gitchell said:

    Ted – a robust discussion on this topic strikes me as absolutely critical–and I “fear” I don’t have the total answer (har har). But a few thoughts:

    1) I would quibble with your characterization of calls to the quitline as “anecdotal”–it is a piece of evidence and earns much more weight than a handful of people telling a reporter they remember seeing an ad.

    2) I would also resist invoking morality as a basis for decision-making in public health. Advancing public welfare, I believe (and I believe you believe), should be the metric, and I would rate that as a better decision-making guidepost than “I don’t think that this treats people fairly”. Plus, morals have this funny way of being different across people and time….

    That being said about morals, if a campaign that clearly ostracizes other humans cannot bring a massive benefit of welfare enhancement, I would submit that as public health pragmatists, it is time to go back to the drawing board!

    Thank you for sharing this, Ted!

    Joe

  2. May 17, 2015 at 7:47 am, Ted said:

    Very good points, Joe. Calls to quit lines are objective, but they’re surrogates for what matters — quitting.

    Regarding morality, you have a point. But I will persist in believing that whipping up fear and disgust is immoral. It has a long history of taking humanity into dark places.

  3. May 17, 2015 at 8:03 am, Joe Gitchell said:

    Ted – I will keep quibbling on calls to quitlines, but you are very right that fear appeals have a long track record of being able to be misused–they are very potent. But then, doesn’t that support my argument re a focus on public welfare and not relying on evolving and relative perspectives on right and wrong?

    I’m sorry I won’t be around on Tuesday for us to continue this discussion over cups of health-enhancing black coffee! Ha!

    Joe

  4. May 17, 2015 at 3:21 pm, Ted said:

    Thanks, Joe. I’ll be back, so you’ve got a rain check to claim for Tue.

    On appeals to fear and disgust, my view is not relativistic. It’s absolute. Anytime someone resorts to such an appeal, they lose my trust.