Expert Opinion

Public health policy and campaigns; health promotion, without the stigma

In the third of our blogs to mark National Obesity Awareness Week, Dr Stuart Flint, Rebecca Smith and Maddie Sweetman from Leeds Beckett University discuss eliminating weight stigma and discrimination in health promotion campaigns.

Reducing body weight has become a focus within public health policy and campaigns, particularly in countries where the prevalence of overweight and obesity is reported to be high. Alongside this focus, is a wealth of evidence demonstrating that people with obesity are stigmatised and discriminated against in a range of settings including healthcare, education and workplaces. Stigmatising attitudes and discriminatory behaviours directed towards people with obesity due to stereotypical and inaccurate perceptions of body weight as well as a perceived acceptability to think, act and ultimately treat people differently based on their body weight and size.

Key to the reduction and elimination of weight stigma and discrimination is an appreciation, and where necessary, modification of the sources that contribute to the formation of stigmatising attitudes. Inevitably there is a focus on the role of the media as a key contributor to public awareness and understanding of population health. However, an increased appreciation of the role of public health policy and campaigns that aim to engage the population in healthier behaviour and in doing so, reduce health inequalities is warranted. Public health policies and campaigns should ensure that they are non-discriminatory and that by encouraging healthy behaviours, they avoid unintended stigmatisation of people perceived to not embody those healthy behaviours.

UK obesity policies tend to employ an individualistic frame, where the responsibility for a persons’ weight is placed on the individual, which includes making dietary and lifestyle changes perceived to be necessary. There is often an emphasis on projected economic consequences of overweight and obesity, positioning people with obesity as ‘bad citizens’ through “burdening of the NHS and wider society”. Perceptions of responsibility and economic encumbrance around obesity are associated with greater expression of anti-fat attitudes; a key precipitating factor in weight stigma and discrimination. There is evidence to suggest, therefore, that policies adopting the individualistic and economic framing of obesity may lead to increased weight stigma. A shift towards recognition and wider discussion of genetic, social, and environmental factors in policy may be necessary to promote policy engagement and minimise the counterproductive links with weight stigma and discrimination.

Similarly, many UK campaigns such as Change4Life have been criticised for simplifying obesity by suggesting that weight can be reduced easily by balancing “energy in” and “energy out.” Campaigns promoting physical activity often use images of slim, athletic models which can fail to appeal to people who are overweight, who may feel they will not be welcome or are not competent enough to take part. Studies have shown that body-inclusive spaces that are free from stigma are required for people with obesity to engage with physical activity campaigns. Therefore, a “Health at Every Size” approach has been encouraged and is visible in some campaigns where the aim is to focus on the adoption and maintenance of healthy behaviours rather than measure success in terms of weight loss. Campaigns such as “This Girl Can” and “Couch to 5K” are examples where the aim is to be inclusive by encouraging individuals regardless of their weight or ability level to participate.

Ultimately, people have the right to choose how they live and with that the behaviours that they wish to engage in. However, if public health policy and campaigns aim to promote engagement from all people, then the framing of messages within policies and campaigns needs addressing, and in many instances modifying for local, regional, and national initiatives to be realised. Thus, the role of the Government, Local Government Authorities, Public Health Organisations, and sectors of the community that support policy and campaign development is critical to effective public health action in 2018 and beyond.

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