Public health campaigns that stigmatize obese people by using negative images or text do not motivate them to lose weight any more than more neutral campaigns, finds a new study in the American Journal of Preventive Medicine. In fact, negative campaigns may backfire by undermining a person's belief that he or she is capable of losing weight.
"Hundreds of anti-obesity media campaigns are emerging in this country. What is really surprising and concerning is that these are really not being systematically assessed or evaluated," said Rebecca Puhl, Ph.D., director of research at the Rudd Center for Food Policy and Obesity at Yale University. "That is why we did this study."
Stigmatizing health campaigns in other issues, such as tuberculosis or smoking, have been shown to impede treatment efforts.
The researchers compared negative vs. neutral national public health campaigns, including full-page ads, web pages, logos, or billboards. Stigmatizing campaigns included those publicly criticized for blaming and shaming overweight adults and children. The neutral campaigns discussed healthy behaviors such as making better food or exercise choices.
In the study, 1083 people of normal weight or above were randomly assigned to view either stigmatizing or neutral campaigns and were then asked questions about whether the campaigns motivated them to want to improve their health, and whether they felt they could make the health behavior changes promoted by the campaigns.
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.
"Research shows that when people are made to feel stigmatized or ashamed of excess weight this leads to a range of different health consequences that can ultimately reinforce obesity," Puhl added. These can include binge eating and avoidance of exercise, as well as depression and anxiety. "We have the challenge of finding ways to grab the public attention without using shame or stigma."
"This corroborates with good science what those of us in the field have long thought: That negative approaches to urge people to lose weight do not work," said Patrick O'Neil, Ph.D., director of the Weight Management Center at the Medical University of South Carolina in Charleston, and past president of the Obesity Society. Obese people are already the targets of a variety of prejudices and discrimination, he noted. "If that were to have an effect, it would have done so by now."
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Puhl, R. et al. Public Reactions to obesity-related health campaigns: A randomized controlled trial. J Prev Med. 2013.