Obesity Policy to Promote Stigma

Recent analyses of health policy on obesity present a rather stark picture. Policies aimed at obesity have done more to promote stigma than health.

The focus on individuals has not changed for decades, say James Nobles and his colleagues. In fact, they found that 58 percent of research aimed to prove that educating individuals to behave better could move the needle and stem the tide of obesity. This has not worked out to be true. But something very different has turned out to be true. This focus on individual behavior has  brought us “punitive policies for people living in larger bodies,” per the analysis of Briony Hill and her colleagues.

A Systematic Review

Hill et al conducted a systematic review of peer-reviewed literature on stigma, obesity, and policy. From 3,219 records, they found 47 papers for their narrative synthesis. That summary brings two things into sharp focus:

“Support for obesity-related policies focused on prevention or treatment was higher when obesity was attributed as an environmental rather than individual problem, with the latter seeming to promote weight stigma.

“Individual attributions for obesity may be associated with support for punitive policies for people living with obesity, such as higher taxes and health insurance costs, and thus may perpetuate weight stigma.”

A Steady Focus on Blame

Nobles et al looked at the Cochrane Review on child obesity prevention with a focus on determinants of health. To be specific, they paid attention to RCTs that targeted downstream factors versus upstream factors. The downstream focus is all about teaching individuals to do better, make healthier choices. But an upstream focus deals more with systems that promote obesity – food supply, built environment, economic factors, social policy, and more. They conclude:

“The evidence base on childhood obesity prevention has remained steadfast in its focus on changing individual lifestyle behaviours since the 1990’s. This comes despite the widespread acknowledgment that obesity is the product of a complex adaptive system.”

A Narrative Disconnected from Science

Many policy makers wring their hands about tackling obesity. But their narrative focuses on individual behaviors as the root cause of an epidemic. Writing in Perspectives on Public Health, Jilly Gibson-Miller and Angel Chater tell us we have work to do:

“We face head-on the challenge of transforming the damaging narrative on obesity, in which a simple equation (eat less, move more) is applied to all individuals to achieve and maintain weight reduction.”

To be sure, moralistic policy debates about obesity have been promoting stigma for a very long time. In the 1890s, Elizabeth Wasserman tells us that “conspicuous gluttony” went out of fashion along with the excesses of the Gilded Age.

But today, the health effects of obesity are leaving us with few options. Stigma only gets in the way. Simplistic narratives add to the problem. To overcome this health challenge requires us to embrace science, while setting aside stigma and bias.

Click here for the analysis by Hill et al and here for the Nobles analysis. For a historical view of the “war on fat,” click here.

Winter, painting by Jose Clemente Orozco / WikiArt

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December 4, 2021