According to the Centers for Disease Control and Prevention, the drastic increase in the number of people who are overweight or obese in the United States over the past 20 years constitutes an epidemic. And this is not only a U.S. issue; the World Health Organization speaks of the global obesity epidemic as “taking over many parts of the world.” But while many agree that obesity trends must be countered, the best methods to do so are under debate. Using stigmatization to influence behavior is a highly controversial approach.
As they try to address the obesity epidemic, public health professionals, researchers, and healthcare providers have contributed to the stigmatization of overweight and obese people. In July of 2012, for example, the New York City Human Resources Administration launched its “Cut the Junk” campaign to help New Yorkers with limited incomes “make healthy food choices and cook nutritious meals.” Posters for this campaign feature a silhouette of a morbidly obese man pouring a full-sized bag of potato chips into his mouth.
Do campaigns that use such stigmatizing images actually help people make healthy choices and lead healthier lives? My work addresses this issue.
What is Fat Stigma?
In their 2001 paper, “Conceptualizing Stigma,” public health scholars Bruce Link and Jo Phelan define stigma as the result of five interacting components:
- People identify and label human differences. Those who work in medicine and public health must distinguish between healthy and unhealthy conditions and behaviors. One example of the ways differences are labeled is classification of people’s weight status, where a body mass index between 18.5 and 24.9 means “normal,” while 25 to 29 means “overweight” and 30 or more makes a person “obese."
- Labeled differences are linked with negative stereotypes. Many studies suggest that people link “fat” body types with negative stereotypes such as laziness, social ineptitude, lack of self-control, stupidity, worthlessness, and disgustingness.
- Labeled persons are placed into distinct categories, separating “us” from “them.” Labeling someone as fat or clinically determining them to be obese is different from saying a person has cancer, suffers from the flu, or has brown eyes or blond hair. Those sorted into distinct categories such as “obese” are labeled as being a type of person, not just as a person with certain characteristics. This process involves making labels part of a person’s identity, part of who they and others understand them to be.
- Stigmatized persons experience status loss, discrimination, and unequal outcomes. Researchers have documented that overweight and obese individuals are regularly the victims of employer discrimination. They may not be hired, earn lower pay, or end up wrongfully terminated, because employers may assume they are lazy or disabled because of their weight. Overweight and obese individuals may also experience discrimination from health care provider prejudice and thus receive lower-quality care.
- Political, social, and economic power reinforces the other components of stigma, especially when people sorted into distinct categories experience unequal outcomes due to status loss and discrimination. More powerful people with “better” characteristics and political, social, and economic capital shape definitions of “good” and “bad” in ways that fuel inequality.
The Use of Stigma in Public Health
Stigma is one tool that is used to pursue public health goals. Public health work can deepen existing social stigmas in the course of attempts to influence behavior. Labeling differences is an inevitable process; public health workers must distinguish between healthy and unhealthy conditions and behaviors. But it is not necessary to take further steps to link labeled differences with negative stereotypes and place people into distinct categories. Such steps can fuel full-blown discrimination in social life.
Public health campaigns deploy social stigma when programs and policies invoke negative emotions such as shame, disgust, anger, or fear. Advertising campaigns about smoking, for example, have successfully stigmatized smokers and helped bring about substantial declines in the number of U.S. smokers. Some would consider the “Cut the Junk” campaign against obesity to be another instance of the same sort. But in important ways, stigmatizing entire categories of people for public health purposes is ethically problematic.
Why Using Stigma to Achieve Public Health Goals is Dangerous
My current research suggests that the use of fat stigma in public health damages identities and diminishes moral agency. Fat stigma can end up depriving labeled overweight and obese people of opportunities for employment, fair pay, and fair evaluation of job performance. And it can also reduce such people’s access to affordable insurance and quality, nondiscriminatory health care. Fat stigma may also lead labeled and self-labeled overweight people toward negative understandings of themselves, causing them to feel less worthy of respect and consider themselves deficient in self-control and self-discipline.
Effects like these have been empirically demonstrated to harm people with high weights. In fact, people labeled overweight and obese often exhibit anti-fat attitudes. And regardless of their own weight status, many people say that fat individuals are lazier, dumber, and worth less than thin people. Researchers have found that people who apply weight biases to themselves tend to have negative body images and lower self-esteem. The result of such self-deprecation by people who take weight labels to heart may be the exact opposite of what public health campaigners hope to achieve. Deploying and spreading weight stigma may actually make many people less able to eat better and adopt healthy behaviors such as regular exercise. In short, because of such downsides, fat stigma should never be used as a tool to pursue public health ends.