Obesity Campaigns: The Fine Line Between Educating and Shaming

Slogans that stigmatize obesity don't get their message across and may do more harm than good.

[Kevin Lamarque/Reuters]

After much media posturing (and some grassroots Twitter action) earlier this year about negative anti-obesity campaigns, researchers at Yale's Rudd Center for Food Policy and Obesity stepped in to measure Americans' actual attitudes about ads meant to encourage healthier eating and lifestyle habits.

The researchers took a nationally representative sample of Americans and asked them to assess a variety of highly visible campaign slogans in an online survey. They were interested in knowing what the respondents thought about how informative, motivating, or credible the slogans seemed. They were also curious as to which ads came off as confusing, stigmatizing, or inappropriate. Finally, they asked the respondents whether they intended to follow the messages' advice.

What they found is basically what was expected: the public craves positive reinforcement and rejects stigmatizing or otherwise negative messages. A simple message from First Lady Michelle Obama's "Let's Move" campaign -- "Move Everyday" -- was the public's favorite.

"The most positively rated were campaigns that focused on encouraging specific health behaviors or actions, like eating fruits and vegetables every day or engaging in physical activity" said lead author Rebecca Puhl, "And the most motivating were the ones that made no mention of obesity or weight at all."

The findings call attention to our feelings about personal responsibility -- respondents generally didn't seem to mind having the onus put on them to lose weight ("Eat Well. Move More. Live Longer" scored well), but they were against being told that their or their child's obesity was their fault ("The more you gain, the more you have to lose," didn't do well, and "Childhood obesity is child abuse" fared worst).

Obese respondents, in particular, were significantly more offended by messages like "Skip seconds... lose your gut" and "Fat kids become fat adults." They also responded more negatively to slogans that, at first glance, don't seem to be particularly stigmatizing, like "You have the strength to take control of your health," and "It's not a diet, it's a lifestyle." Based on what did do well, the problem may have stemmed from being told that they should be doing something different without being given clear advice on how that might be accomplished.

The word "obesity" itself can carry pejorative connotations, as Puhl's team has studied elsewhere. "Certainly what we find is when more neutral words are used, like 'unhealthy weight' or 'high BMI' those are preferred and viewed to be more motivating," Puhl told me.

What's really needed, of course, is a behavior-based study that attempts to measure people's actual compliance with the messages of PSAs. It seems obvious that people would say they're more likely to comply with instructions that teach them specifically how to live more healthfully, especially in cases like "Move Everyday," where the directive is so easy to follow, but it would be interesting to see how this actually plays out. Particularly because the defense used by the people behind negative campaigns is that they're purposely being confrontational and doing whatever it takes to get people's attention about these important issues, it would be useful to look at what strategies do get the message across most effectively.

But Puhl points out that despite the large amounts of money that go into these campaigns, little research has been done by the organizations behind them on their practical effectiveness. She urges the people spreading these messages to pay more attention to the effects they may be having -- especially when they're in danger of causing harm. As the authors wrote, "Considerable evidence demonstrates that individuals who feel stigmatized or shamed about their excess weight engage in higher calorie intake, unhealthy eating behaviors, binge-eating patterns, as well as avoidance of exercise." And previous studies done by these researchers revealed that exposing people to stigmatizing images worsens their attitudes toward obese people.

The trick is figuring out how to be anti-obesity without being anti-obese people -- and boiling these issues down to a slogan makes this difficult to do.