Poison Frog

Did Anti-Obesity Campaigns Poison the Well?

Reading about the heated and not terribly well-reasoned arguments people are having about obesity prompts a sad conclusion. A history of ineffective and, at times, harmful anti-obesity campaigns may have poisoned the well of public sentiment about obesity. People have such strong feelings that facts and reason become irrelevant.

Aggrieved Advocates for People with Eating Disorders

Some of the strongest passions come from people who are advocates for loved ones and themselves as persons who have lived with eating disorders. Their passion comes from a simple fact. Anorexia has the highest mortality rate of any mental illness. Let that sink in.

So quite understandably, these people have very strong feelings about campaigns that for decades have tried to catastrophize obesity. Those campaigns worked to instill a fear of fatness. They range from televised PSAs from public health authorities that evoke fear and disgust to billboards that aim to shame parents of children with obesity. Research continues to document an intolerable prevalence of stigmatizing messaging in obesity prevention campaigns. And it doesn’t have to be this way. Research also shows that non-stigmatizing messaging can be effective for promoting health.

Perhaps one of the saddest chapters in the book of failed anti-obesity campaigns is the drive to weigh children at school and send “fat letters” home to parents. Long and often have we spoken out here about this horrid practice. With Sarah Armstrong (an author of the new AAP obesity guideline), we wrote in 2021 that BMI screenings need to be taken out of the school setting.

So yes, we agree that folks who care about the death toll of eating disorders have good reason to feel aggrieved.

The Consequences of Anger

Raw anger does prompt action. But it doesn’t always prompt rational or effective action. Unfocused anger and fear is what we are seeing in the response to the new guideline for pediatric and adolescent obesity care. We see it in an essay for the New York Times from an advocate who describes this evidence-based guideline as “terrifying.”

But perhaps the saddest response to the guideline was a press release from the Academy of Eating Disorders, criticizing the guideline for not focusing on eating disorders. Nevermind that the guideline calls for eating disorder screening. And nevermind that it points to comprehensive guidance from the AAP on the importance of identifying and treating eating disorders.

This is sad because it pits one group of young persons with serious medical needs against another that also has serious needs. But we refuse to choose. Young persons with eating disorders deserve good care, just as those living with obesity do.

So we have no use for people who set up such a false choice – either by opposing good obesity care or through anti-obesity campaigns that stoke fear, disgust, and fat phobia.

Click here and here for more on the problems of catastrophizing obesity.

Poison Frog, photograph by Aaron Ruy G. Musa, licensed under CC BY-SA 4.0

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January 29, 2023

2 Responses to “Did Anti-Obesity Campaigns Poison the Well?”

  1. January 29, 2023 at 8:10 am, John DiTraglia said:

    Anorexia nervosa, as opposed to bulimia, is not caused by social opprobrium. It is just as common in societies that prize chunkiness. But it is indeed deadly.

  2. January 29, 2023 at 10:02 am, Allen Browne said:

    Obesity is a disease. It is a malfunctioning of energy regulation that results in over 200 complications. It involves the development of an unhealthy “set point” for percentage of body fat and then defense of that unhealthy percentage of body fat. Obesity is not an eating disorder. Many people with the disease of obesity also have eating disorders. In a significant number of those people the eating disorder improves as the obesity is successfully treated. There is overlap between the two problems but there is no reason for competition or conflict in education, treatment, or support about the two problems.