Ineffective Obesity Policies Anchored to Stigma

Stigma serves as an anchor to policy for reducing obesity in Mexico and it renders those policies ineffective. That’s the view James René Jolin, Lauren Kim, Verónica Vázquez-Velázquez, and Fatima Cody Stanford eloquently present in Lancet Diabetes and Endocrinology this week. They write:

“Recalibrating the prevailing approach to obesity is essential to counteract the stigma undergirding the present policy making framework. The sole, undue focus on consumer dietary decision making that animates current methods perpetuates a stigmatising claim of causality: by obviating any discussion of genetic or structural determinants of obesity, policy makers implicitly blame individuals with the disease. This stigmatised view of obesity as a moral failing reinforces the dominant sensibility that merely changing consumer diets can resolve the obesity epidemic and that a biosocial approach is superfluous.”

Prodding Consumers to Make Better Choices

In 2013, Mexico passed a tax on sugar-sweetened beverages and junk food. Much has been made of data to suggest that these taxes have reduced consumption of these foods and beverages. Higher prices because of taxation will usually have that effect. On top of those taxes, legislation in 2019 required front-of-pack (FOP) labeling to warn consumers about excessive calories, sugar, salt, and saturated or trans fats. This required stronger warnings than the original FOP labels implemented in 2010 and later found to be ineffective.

The point of all these measures is prodding consumers to make better choices. The underlying assumption, as Jolin et al explain, is that obesity is caused by bad choices. This biased view of obesity presumes that simply prompting better choices will solve the problem of excess obesity. People with obesity are the problem because they keep making bad choices.

To state the obvious, promoting this view promotes stigma.

Thwarted by Food Businesses

To date, these initiatives might have altered patterns of food sales in Mexico, but they’ve had no noticeable effect on obesity. In 2012, obesity prevalence was 27 percent in adults. It rose to 33 percent in 2016, and in 2020, it reached 36 percent. Prevalence in children, likewise, has risen in the same timeframe.

Presenting at  ObesityWeek earlier this month, Simon Barquera of the National Institute of Public Health in Mexico had a facile explanation for the lack of effect on obesity:

“The main barrier for obesity prevention strategies in Mexico during the last 20 years has been the junk food industry protecting its interests. It’s a multinational industry that is very powerful.”

The story is that industry is manipulating people, making them buy bad food products to harm their health. But this is a misleading narrative of villains and victims. It relies upon and reinforces the stigma of obesity.

A More Accurate Narrative, More Effective Policies

Pressing forward with a narrative anchored in stigma will yield nothing but additional ineffective obesity policies. Instead, Jolin et al recommend a more accurate narrative that embraces biological, historical, and sociological explanations for this chronic disease.

More effective policies will come when public health in Mexico and around the world engages a broader coalition of stakeholders, including government, medicine, business, faith communities, and people living with this condition.

Click here for the commentary from Jolin et al, here and here for further perspective.

M.V. Balmoral’s Anchor, photograph by Neil Owen, licensed under CC BY-SA 2.0

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

November 29, 2022