Dream Narrative

Four Competing Obesity Narratives

In a fascinating new paper, Paul Thibodeau and colleagues propose that four competing obesity narratives can explain a lot about how people think about obesity and the solutions they are willing to support. These narratives are:

  1. Sin. “A big problem with America is that people are unwilling to make an effort to take care of themselves. People who are overweight let their personal vices get in the way of being healthy.”
  2. Addiction. “A big problem in the U.S. is that people get hooked on certain things and just can’t quit. When people get used to eating sugary, fatty foods, some can’t keep themselves from continuing this habit.”
  3. Disorder. “A big problem in this country is that we blame the victim for things they cannot control. People who are overweight get treated particularly badly by others, whether at work or in social settings, even though their weight problems often aren’t their own fault.”
  4. Environment. “A big problem in the U.S. is that our society sends the wrong messages about what it means to be attractive. When people can’t achieve these unrealistic views of ideal weight, they feel bad about themselves and adopt maladaptive habits that cause them to become overweight.”

In observational studies, they found that the four narratives reliably conveyed different degrees of blame for obesity to individuals or to environmental causes. The “sin” narrative was most damning of the individual, while “addiction” conveyed roughly equal blame to individuals and the environment. Both the “disorder” and “environment” narratives assigned most blame to the environment. People who agreed with one of the narratives generally agreed with the blame they conveyed.

People who blame the individual were more likely to support policies to punish people for obesity. People who blame the environment were more likely to support policies to protect people from the harms of obesity.

Taking this work one step further, Thibodeau showed in a randomized, controlled experiment that exposure to these narratives influenced support for punitive or protective policies.

Naturally, other factors come into play. Gender, personal history, ideology, and BMI all have significant effects in this analysis. But Thibodeau makes the important point that narratives matter, and he brings objective data to support his view.

The dominant narrative behind obesity policy has been one of personal responsibility and individual blame. It’s an incomplete and arguably false narrative. But it’s driven a punitive approach to obesity that isn’t working.

Thibodeau commends the work of the Obesity Society and the AMA to adopt a more productive narrative driven by the science of obesity and the recognition of obesity as a complex, chronic disease.

We could not agree more.

Click here to read the study.

Dream Narrative, photograph © Vasile Hurghis / flickr

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