Primum Non Nocere: Obesity Stigma and Public Health

School of Psychology, The University of New South Wales, Sydney, NSW, 2052, Australia, .
Journal of Bioethical Inquiry (Impact Factor: 0.71). 01/2013; 10(1). DOI: 10.1007/s11673-012-9412-9
Source: PubMed

ABSTRACT Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual's control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals' personal control, there are a range of biopsychosocial barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm.

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    ABSTRACT: Increases in the body weight of people in Australia and other countries around the world have been the subject of intense scientific, political and media attention in recent years. The placement of body weight at the focal point of discourse about health is referred to as the ‘weight-centred health paradigm’. This paradigm has become dominant in public health policy in the developed English speaking world but has been subjected to intense critique on philosophical, ethical and empirical grounds. Many of the strategies used in weight-related public health initiatives are enacted through the discipline of health promotion. Health promotion is the process of working collaboratively with people to enhance the health of individuals, groups, communities and populations using a broad range of strategies. Health promotion is the spearhead of the new public health, and is explicitly based on a set of values and principles. Health promotion practice that is underpinned by the values and principles of best practice health promotion has been termed modern health promotion. Health promotion underpinned by values and principles not consistent with best practice has been termed traditional health promotion. Despite the major role of health promotion in implementing weight-related public health initiatives, these initiatives have received little critique in relation to the extent to which such initiatives reflect the values and principles of modern or best practice health promotion. This research project addressed that gap. The research questions for the project were: what are the discourses within weight-related public health initiatives in Australia; and to what extent do weight-related public health initiatives in Australia reflect the values and principles of health promotion? The research epistemology was constructivist, the theoretical perspective was critical theory, and the theoretical framework was Critical Systems Heuristics. Critical discourse analysis was used to examine ten weight-related public health initiatives commissioned or produced by the Australian Government or parliament between 2003 and 2013. The health promotion values and principles continuum provided heuristic support for critical reflection. From analysis of the claims, values, assumptions, power relationships and ideologies that were explicit, implicit, suppressed or hidden within the initiatives, I identified a broad range of discourses. The hegemonic but lexically questionable discourse of preventative health resulted in the almost complete invisibilisation of the discipline of health promotion. It also provided the foundation for alarmist, biomedical, reductionist discourses about body weight and health, with minimal attention to the social determinants of health, social justice and equity. Individuals were assumed to be naturally ignorant about the behavioural determinants of body weight but nonetheless to have ultimate responsibility for choosing these behaviours and thereby improving their health. Weight-related public health strategies adopted a mixed approach focusing on the whole population as well as the militarist targeting of negative, deficit-based interventions towards specific groups within the community. Discourse related to potential harm was minimal despite the significant potential for harm inherent in the public health initiatives. Discourse regarding evaluation of the initiatives focused on changes in behaviours and disease rates. The documents relied on the power, authority and status of experts to present uncontested discourses around body weight and public health responses to it. On the basis of these discourses, I determined that the weight-related public health initiatives were reflective of two modern and seven traditional health promotion values and principles related to why the weight-related public health initiatives were needed, and two modern and 11 traditional health promotion values and principles related to what weight-related public health strategies were proposed and implemented in the weight-related public health initiatives. Overall, the weight-related public health initiatives were not consistent with the values and principles of health promotion best practice. This project will contribute to the greater body of systemic change being implemented by social justice, fat acceptance and Health at Every Size advocates and activists, fat studies and critical weight studies scholars and others who are engaged in the enterprising task of shifting society from the weight-centred to a weight-neutral health paradigm, and thereby improving the health and wellbeing of people of all sizes.
    08/2014, Degree: PhD, Supervisor: Margaret Barnes
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    ABSTRACT: To examine whether the adverse effect of obesity on psychological well-being can be explained by weight discrimination. The study sample included 5056 older (≥50 y) men and women living in England and participating in the English Longitudinal Study of Ageing. Participants reported experiences of weight discrimination in everyday life and completed measures of quality of life (CASP-19 scale), life satisfaction (Satisfaction With Life Scale), and depressive symptoms (eight-item CES-D scale). Height and weight were objectively measured, with obesity defined as BMI ≥30 kg/m(2) . Mediation analyses were used to test the role of perceived weight discrimination in the relationship between obesity and each psychological factor. Obesity, weight discrimination, and psychological well-being were all significantly inter-related. Mediation models revealed significant indirect effects of obesity through perceived weight discrimination on quality of life (β = -0.072, SE = 0.008), life satisfaction (β = -0.038, SE = 0.008), and depressive symptoms (β = 0.057, SE = 0.008), with perceived weight discrimination explaining approximately 40% (range: 39.5-44.1%) of the total association between obesity and psychological well-being. Perceived weight discrimination explains a substantial proportion of the association between obesity and psychological well-being in English older adults. Efforts to reduce weight stigma in society could help to reduce the psychological burden of obesity. © 2015 The Authors Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).
    Obesity 03/2015; DOI:10.1002/oby.21052 · 4.39 Impact Factor
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    ABSTRACT: Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change. (Am J Public Health. Published online ahead of print February 25, 2015: e1-e15. doi:10.2105/AJPH.2014.302507).


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Jan 20, 2015