LOS ANGELES — As American health authorities prosecute an all-out war against obesity, a small cadre of researchers is warning that the nation's 78 million obese adults and 12.5 million obese children are already suffering collateral damage. The message that they will become victims of self-inflicted disease, poor role models for their families and a drag on the economy unless they lose weight has left many obese Americans feeling depressed, defeated and ashamed, these experts warn.
Ironically, some of the campaigns aimed at obese Americans could sink efforts to help them improve their health by eating better and exercising more, the experts wrote Tuesday in the International Journal of Obesity.
Anti-obesity campaigns viewed as stigmatizing "instill less motivation to improve health," while the messages that appeared most effective at encouraging behavior change didn't mention obesity at all, according to the research team from Yale University's Rudd Center for Food Policy and Obesity.
The study comes as state and federal public health officials grapple with an obesity crisis that threatens to swamp efforts to contain health care costs and prolong Americans' life spans. In a bid to reverse surging rates of obesity in the United States and the industrialized world, public health officials have spawned a slew of campaigns that take a variety of approaches.
Many encourage behavior change with helpful tips such as "eat a variety of colorful fruits and vegetables every day," as a program backed by the Centers for Disease Control and Prevention advises.
But other campaigns have been less upbeat. In Georgia, a controversial series of video and billboard advertisements remind parents that "fat kids become fat adults," and that "being fat takes the fun out of being a kid." An Australian anti-obesity campaign pointedly warns viewers, "the more you gain, the more you have to lose."
Such messages are broadcast amid widespread stigma against the obese: heavy workers earn less, are more likely to be passed over for jobs and promotions, and are more likely than their thinner peers to be viewed as lazy and undisciplined, researchers have found. A poll released last month by Harris Interactive/HealthDay found that 61 percent of Americans do not consider negative remarks about a person's weight to be offensive.
Even among physicians, obese patients elicit feelings of prejudice and blame. A 2003 survey, published in the journal Obesity Research, found that half considered their obese patients awkward, ugly, unattractive and unlikely to follow their advice. In addition, one-third of doctors also viewed obese patients as weak-willed, sloppy and lazy.
Against this backdrop, it's little wonder that some public health campaigns would employ guilt and shame to motivate people to lose weight, said Rebecca Puhl, the Rudd Center's research director and leader of the new study.
"There tends to be a sense that maybe a little bit of stigma isn't such a bad thing, that maybe it'll give overweight or obese viewers a little motivation," she said.
But such views do not account for shame's boomerang effect.
"When children or adults are made to feel stigmatized, shamed or teased about their weight, they're likely to engage in binge eating and unhealthy weight-control practices, and to avoid physical activity," Puhl said. "We find that people actually cope with stigma by eating more food."