In Obesity Field, Contradictions Abound

Complications-of-0besityThroughout America, states and cities scramble to fund anti-obesity campaigns. Do they work? It all depends, and it is feared that the wrong kind of message can do more harm than good, as well as wasting a lot of money and other resources. Some experts say that public service announcements and other messages are not being evaluated to assess their effectiveness.

A stigmatizing campaign would be one that criticizes, blames, or shames the viewer, whereas a neutral campaign merely discusses healthy behaviors. Many believe that any message using negative words or images is counterproductive. Even if it is not perceived as outright stigmatizing, such a message can destroy an individual’s belief that it might be possible to lose weight.

Dr. Rebecca Puhl is Deputy Director of Yale University’s Rudd Center for Food Policy & Obesity. When she was director of research, she spoke with a health writer about a study in which more than a thousand subjects “of normal weight or above” were shown examples of either stigmatizing or neutral campaigns, drawn from magazine advertisements, web pages, billboards, and other media creations.

Then the participants answered questions about what the messages did for their motivation, and, more importantly, whether they felt capable of making the recommended changes to their behavior. Dr. Puhl found that the wrong kind of advertising could lead to the exact opposite of the desired results, causing depression and anxiety, exercise avoidance, and even such harmful actions as binge eating. Journalist Valerie Debenedette wrote:

Participants rated the stigmatizing campaigns and neutral campaigns as equally motivating for weight loss. But, when asked whether the campaigns promoted a clear plan of action or feelings that one could lose weight if they put their mind to it, participants found the stigmatizing messages less effective.

The other side of the coin, however, is that the same opinion is shared by the “Health at Every Size” advocates, who are known to have some rather dangerous ideas, so their endorsement is bound to set off a warning bell.

One member of that camp is Linda Bacon, Ph.D., who rejects the “societal clamor of food fear and body bias” and states that “fat isn’t the bogeyman it’s made out to be.” She wishes that public officials and medical professionals, and of course journalists, would pay more attention to the HAES “wisdom.” Admittedly, some of her arguments make sense:

Despite all the talk about “evidence-based” policy, for instance, Medicare is now covering doctor-prescribed weight-loss efforts while the evidence clearly shows that they don’t improve health or result in sustained weight loss. The First Lady is devoting herself to eradicating childhood obesity, when the latest meta-analysis of 55 interventions showed an approximate mean weight loss of… one pound.

On the other hand, Bacon denies that obesity leads to (avoidable) early death—a notion that, in the face of evidence, does not seem tenable.

To confuse the issue even further, concerned parties encounter the occasional headline along the lines of this one—“Fat-shaming May Curb Obesity, Bioethicist Says.” The bioethicist in question is Daniel Callahan, president emeritus of The Hastings Center, which is described as a nonprofit think tank. The senior researcher does not favor “safe and slow incrementalism that strives never to stigmatize obesity,” for the simple reason that it doesn’t seem to be working. His call for an “edgier strategy” is based partly on his own experience as an ex-smoker.

The force of being shamed and beat upon socially was as persuasive for me to stop smoking as the threats to my health. The campaign to stigmatize smoking was a great success turning what had been considered simply a bad habit into reprehensible behavior… Can there be social pressure that does not lead to outright discrimination—a kind of stigmatization lite?

What he has in mind as an example of “stigmatization lite” would be, for instance, a poster that asks, “If you are overweight or obese, are you pleased with the way that you look?”

Your responses and feedback are welcome!

Source: “Negative public health campaigns may undermine weight loss goals,” 06/21/13
Source: “Everyone Knows Obesity Is Hurting Us, But Is the Fight Against Obesity the Problem?,”, 03/07/12
Source: “Fat-shaming may curb obesity, bioethicist says,”, 01/24/13
Image by Next TwentyEight


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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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