Public Health Policy That Harms More Than Helps

Writing in the Lancet, Janet Treasure and Suman Ambwani have a simple request. Public health policy should stop promoting weight stigma. The request is simple, but it may not be easy. For decades now, public health has often focused on promoting fear of fat, rather than the pursuit of health. The result is health policy that harms more than helps.

The instinct to rely on messages that catastrophize obesity is strong.

Calling for More Inclusive Health Policy

Treasure and Ambwani approach this from the perspective of eating disorders. Fear of fatness is a defining feature of many eating disorders. So from their perspective, public health has no business promoting such fear:

“We suggest that it may be wise to redirect public health attention toward health promotion, such as wider access to nutritious food options and safe, varied, and joyful physical movement rather than on obesity reduction per se. Additionally, greater scrutiny of environmental and biological factors could help to reduce emphasis on body size and shape and instead draw attention to those factors that more broadly shape health and wellbeing for people across the spectrum of body sizes and shapes.”

Fat Phobia in Public Health

New York City’s Public Health Department has taken pride in using fear and disgust to campaign against obesity. Depicting a person drinking soda with fat dripping down their face was seen as an edgy way to get the point across. Sodas are bad. Fat is bad. Don’t be like this.

The trouble with fat phobia is that it sticks to the people who are living with obesity – living with it not because they chose it, but because they are living in a world that promotes it. They inherited genes that set them up for it. So they internalize the stigma and it harms their health.

Speaking at a public workshop this week, Mary Bassett said of people with obesity, “There’s just too many of them.” So in her mind, we can’t afford to give everyone with obesity the medical care they need for this condition. “It’s just not going to work,” she said.

Bassett was New York City’s Commissioner of Health from 2014 to 2018.

Both Prevention and Care Are Necessary

Stigmatizing people with health issues only causes harm in public health. People living with an eating disorder and people living with obesity need access to care. Fat phobic anti-obesity policies have only made the problem worse.

So we concur with Treasure and Ambwani. Health policy must stop promoting weight stigma and idealizing thinness at the expense of health.

Click here for the commentary by Treasure and Ambwani, here for a related report from the UK charity, Beat Eating Disorders.

Angel, photograph © x1klima / flickr

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

June 24, 2021