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

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June 24, 2021

3 Responses to “Public Health Policy That Harms More Than Helps”

  1. June 24, 2021 at 4:35 pm, John Dixon said:

    This is a critical topic. Obesity, smoking, and alcohol consumption are considered major causes of preventable disease. Obesity is a disease not a choice. Is it preventable? Is it curable?

    No, well no more than most other chronic disease.

    Diabetes, heart disease, and many cancers are partly preventable using behavioral change but we have no issue using active therapies to prevent and treat these complications of obesity.

    Why is obesity treated in such a different way?
    Simple weight bias, stigma and discrimination.

  2. July 02, 2021 at 10:26 am, Richard Atkinson said:

    I agree with John Dixon. Obesity has been plagued with stigma that is inexcusable but the proposal by Janet Treasure and Suman Ambwani 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.” is a really bad idea. The disease is obesity and pretending that a “healthy lifestyle” will do something about obesity is futile. A PubMed search with the terms, “diet, physical activity, obesity and treatment” yields 13,487 publications, none of which show a significant long term effect on body weight (a 5% weight loss is not a “success”). As Dixon says, multiple other diseases including Type 2 diabetes and hypertension respond very well to diet and exercise, but no one pretends that they are adequate treatment. Obesity deserves effective treatment efforts and less stigma, whether direct or unconscious.

  3. July 06, 2021 at 11:32 pm, John Wright said:

    At a physiological level people living with obesity, live with excess fat storage and yet health promotion strategies do nothing to address this physiological constraint, other than a specious recommendation to move more.

    When you measure and explain the fat storage challenge and then work with the PWO to utilise stored fat more efficiently, they are empowered to learn more and adapt lifestyle habits accordingly.

    In our experience PWO do not lack the motivation to change, but the understanding as to what is happening to them, right now and how this changes over time.

    The addictive powers of UPFs dissipate over time when one can understand and act on the triggers for success.