Anti-obesity campaigning and stigmatization

Last year Cancer Research UK launched the latest campaign aimed at reducing obesity related cancers. This is an important issue, with obesity now being recognised as the second biggest preventable cause of cancer, behind only smoking. The evidence for this is extremely solid, and it is expected to cause an additional 15,000 deaths in the UK from cancer this year alone. And the numbers are increasing steadily. In the 20 years from 1993 to 2013, the number of people classed as overweight or obese in the UK increased by 6 million.

Looking at these numbers it is very easy to make the case that an anti-obesity campaign is a perfectly acceptable, indeed necessary, part of our strategy to tackle cancer. This was the logic behind the CRUK campaign. However, that initiative was badly received by some people, who described it as “fat phobic” and very insensitive. These objections are easy to dismiss, especially when viewed alongside the obesity related cancer statistics. However, rather than immediately rejecting these arguments, it may be worth considering them for a minute.

Let’s get a few things clear first.

  1. Mental health problems are extraordinarily common and are a huge problem for us as a society. For example, it is thought that 25% of the population will experience mental health issues each year, with the OECD estimating an annual cost to the UK economy of £70 – 100 billion (around €80 – 115 billion). Several reputable sources put the cost as even higher than that. As a comparison, the economic cost of cancer is “just” £15.8 billion (around €18 billion), emphasising just how important an issue mental health is.
  2. Negative body image is associated with mental health problems. Unfortunately it is an extremely complex and under-studied field, so solid numbers are hard to come by, but it is estimated that 22% of adolescents suffering with depression have clinically significant body image concerns. This does not mean that one causes the other, but it is safe to assume that our societal problem with body image is damaging.

So let’s get back to cancer. The above information makes it clear that any anti-obesity campaign must balance the benefit of decreased obesity with the potential of further stigmatizing obesity and increasing body image problems. So does the CRUK campaign do this? This is an image of one of the adverts that drew the ire of body positivity campaigners.

Obesity

The first question that has to be asked is what is the aim of this campaign? Obviously the charity wanted to draw comparisons between obesity and smoking, emphasising how dangerous it is. The success of the campaign relies on the assumption that people are not aware how dangerous obesity is, and on the second assumption that if they are made aware of this, people will lose weight and crucially, keep it off. It appears that the first assumption is at least partially true. While people are aware that obesity is unhealthy, less than 25% of people are aware of the increased cancer risk. CRUK have identified the need to increase awareness, but it must be pointed out that although the cancer risk is underestimated, people are already aware that obesity is dangerous.

The second assumption made by CRUK is that fear of cancer will motivate people to lose weight. Scare tactics have been used in many campaigns, including well-known road safety and anti-smoking drives. The clear intention of this ad is to draw parallels with smoking, and therefore elicit the same response from people. However, there is reason to think that in the case of obesity, negative messaging may not work.

A study carried out in 2012 by researchers at Yale University found that messages deemed negative or stigmatizing were seen as the least motivating of all messages. People exposed to these messages were significantly less likely to comply with their recommendations. Furthermore, there is significant evidence that making people feel stigmatized or shamed about their excess weight makes them more likely to eat unhealthily and avoid exercise, thus decreasing the effect of any public health campaign.

The sole aim of this campaign is to highlight that obesity is linked to cancer. While this may on the surface seem like a sensible idea, unfortunately it is more likely to stigmatize obesity than have any meaningful effect on weight loss. This demonization of obesity is very prevalent, and studies have shown that society makes extremely damaging assumption about obese people, including that they are lazy, weak-willed, unsuccessful, unintelligent, lack self-discipline and have poor willpower. It is a little acknowledged but extremely prevalent form of prejudice. This stigmatization is known to be extremely damaging to mental health, but also to threaten physical health (through patient’s complaints being lazily and incorrectly ascribed to their weight), to generate health disparities, and as I mentioned above, to interfere with effectiveness of obesity intervention efforts.

It is clear that we need to do something about obesity. It is one of the most important health interventions we can make as a society, but increasing the stigmatization of obese people is not the way to tackle this issue. Positive, empowering messaging, healthy eating education (especially in childhood), advertising bans and facilitation of exercise have all been parts of successful anti-obesity drives in the past. Normally I think that Cancer Research UK are extremely effective in their campaigning. This time however, I think they got it wrong.

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