As an expatriate Kiwi, I keep up to speed on happenings down-under by reading the New Zealand Herald. As articles like this one show, obesity has shot up the list of national health priorities, and has become an increasingly panicked topic. With the third highest rates of childhood obesity in the OECD, the New Zealand government recently announced a new, fairly ambitious Childhood Obesity Plan. It includes efforts to increase sports participation, more early childhood family interventions by health staff, greater regulation of food industry advertising, and a “Big Change Starts Small” media campaign to raise public awareness. Will this work? Obesity experts have expressed some skepticism about the likely effectiveness of many of the 22 new initiatives.
But there is another reason for concern that is generally overlooked as by experts and legislators alike as they design and evaluate these types of – often very expensive and time-consuming – campaigns. Obesity itself is highly stigmatized, attached to moral failings like laziness, greediness, and selfishness, embracing the idea that people are “to blame” for being heavy. Recent research suggests that feelings of being judged as a person because of body weight can undermine people’s weight loss in many ways, even when they are very highly motivated. Ill-conceived obesity campaigns can inadvertently derail their basic public health goals if they reinforce judgments and remind people they are viewed as failures and to blame. Our psychologist colleague Janet Tomiyama at UCLA surveyed obesity professionals at national conferences and has shown even they stigmatize people of weight (the same has been shown for other types of health professionals). These judgmental ideas can thus easily seep into campaigns, potentially undermining their entire stated purpose.
New Zealanders, like people in many other countries, have a clear pattern of weight stigma. We ourselves saw this when we collected data there in 2010 as part of a study of fat-stigma around the globe. So – how well do the proposed initiatives stack up in terms of reinforcing the messages that make people feel judged?
Policy: Four year old children will have free pre-school health check. Any overweight ones will be referred to a health professional for clinical assessment, and their families will be given advice on diet and exercise.
Stigma Grade: Fail
Why: Simply highlighting and categorizing children as obese among their peers highlights them as “different” and “defective”. It can create guilt and stress among parents, who are given suggestions that their child is unacceptable and unhealthy because of how they are (not) caring for them. Paul Campos calls this a “particularly invidious form of bullying.”
Policy: Weight management guidance will be given pregnant women to support a reduction in the incidence of inappropriate weight gain.
Stigma Grade: Fail
Why: This policy labels women who gain “inappropriate” weight during pregnancy as “high risk”, ignoring their actual health status or their personal choices about how they would want to manage their pregnancies or births. This measure is also likely to create feelings of worry, powerlessness, and guilt in mothers who think their weight will harm their unborn babies, regardless of any clear scientific or medical data to suggest this will actually happen.
Policy: A national media campaign will focus on childhood obesity, to raise public awareness of the health risks of childhood obesity.
Stigma Grade: Fail
Why: Once people are aware of the health risks associated with obesity (as most are), such ads and bulletin boards tend to remind people they are failing, and generate feelings of being judged. The “heart-shaped” ad campaign being rolled out right now all over New Zealand (pictured above) suggests child obesity is all about parents’ responsibility for what children eat. It would be better to promote healthy eating as a community responsibility, rather than reinforcing the idea that parents are to blame.
In the New Zealand campaign, we can detect an underlying, tacit assumption that a little shame might push people towards the lifestyle changes that would help them lose weight. As governments spend more and more on reversing obesity, more awareness of the possible impact of stigmatized thinking on the design of anti-obesity campaigns is needed if the goal is to actually help people live healthier and happier lives.