Challenging Dogma - Spring 2008

...Using social sciences to improve the practice of public health

Monday, April 21, 2008

Improving Public Health's Approach to Obesity: Redefining the Problem and Reassigning Responsibility- Abha Kundi

According to the Center for Disease Control and Prevention, “Since the mid-seventies, the prevalence of overweight and obesity has increased sharply for both adults and children”(2). While the obesity trend is generally recognized as problematic, public health has failed to design an effective anti-obesity campaign. The public health failure to address obesity can only be remedied if efforts to attribute obesity solely to individual behavior are abandoned, if corporations are held accountable for their role in the obesity trend and public health uses workable strategies to redefine the issue of obesity.

Efforts to Attribute Obesity Solely to Individual Behavior Must be Abandoned
A cornerstone of American culture is personal responsibility. In the article, “More than a Message: Framing Public Health Advocacy to Change Corporate Practices,” the authors explain that in the United States, “The central idea is that rugged individualism, self-discipline, and self- determination are the key variables for success in American society.” Because of this pervasive mentality, it is not surprising that American culture often assigns blame for health problems to the people who have them (3). Thus, the health problem of obesity is often seen wholly as a consequence of an individual’s lifestyle choices regarding diet and exercise.

The implications of this national attitude are broad: casting a problem as entirely the fault of individual behavior limits governmental responsibility for addressing it (3). Indeed, a typical argument against anti-obesity laws is that they are too paternalistic because they dictate lifestyle choices in a way that detracts from personal accountability (5). Furthermore, the American mindset has created a corporate culture that can levy all responsibility on individual consumers: “The food and beverage industry can blame people’s inability to control themselves and argue that problem ‘users,’ not problem products or problem promotions, cause obesity”(1).

However, there is increasing evidence that correlates viewing advertisements for unhealthful foods to choices about eating and to overweight and obesity (5). In the article “Obesity—The New Frontier of Public Health Law,” the authors provide some insight into the degree of corporate influence on food consumption in the United States:
American children are exposed to approximately 40,000 food advertisements per year, 72 percent of which are for candy, cereal, and fast food. Empirical studies, including recent reviews by the American Psychological Association and the Institute of Medicine (IOM), show that advertisements achieve their intended effects on children — that is, they shape product preferences and eating habits. Moreover, children younger than eight years of age are generally unable to understand the persuasive intent of advertising and to view it critically

In the face of such evidence, it is clear that in order to successfully combat the obesity trend, public health must shift blame from individuals and redistribute it more broadly among corporations.

Public Health Must Redefine Obesity to Hold Corporations Accountable
Encouraging a public health approach that allocates responsibility for the obesity trend more broadly is not intended simply as a “finger-pointing” method that aims to do little else except assign blame to corporations. A “systemic” framework that includes not just the individual but the context in which individuals make choices widens the spotlight, and recognizes the responsibility of businesses, government and broader social influences; this is important because “The closer the overall pattern of public discourse moves toward the systemic…the more conducive will be the environment for public policies that burden powerful groups and hold political institutions responsible for addressing the problem…systemic frames invite government action”(3).

Holding corporations responsible for their contribution to the obesity trend involve public health efforts to redefine the problem of obesity. The purpose of the new definition “must be to raise the common and recurrent issue of justice by exposing the aggressive and powerful structures implicated in all instances of preventable death and disability, and further to point to the necessity for collective measures to confront and resist these structures”(3).

Although redefining the problem of obesity is a considerable task, particularly in light of a national mentality that focuses on individualism, it is not impossible. The anti-tobacco movement is one example of a health problem that was redefined as an issue concerning the public at large. Instead of being viewed merely as an individual choice, smoking was recast as a highly addictive habit (thus not entirely within the control of the individual) that impacted the general public in the form of second-hand smoke (3). Redefining smoking as public problem caused largely by tobacco corporations generated support for government intervention. “Consequently, strategies are now directed toward creating rules that hold the tobacco industry disproportionately, but fairly, accountable for the death and disability it has caused”(4). If the obesity trend was similarly redefined, more effective strategies could be employed to reverse it.

Public Health Must Create Workable Campaign Strategies for Redefining Obesity
Public health advocates must redefine obesity effectively enough to compel public policy that extends the scope of responsibility and burdens powerful groups, i.e. the food industry (3). Successful efforts to do so depend on “…whether the health risk is portrayed as acquired deliberately or involuntarily (and the victim correspondingly as culpable or innocent); whether it is portrayed as universal (putting us all at risk) or as particular (only putting them at risk); and whether it is portrayed as arising from within the individual or from the environment”(3). A more expansive public health campaign to combat obesity would incorporate the social-ecological model and implicate not just the individual, but also interpersonal groups, organizations, communities, and ultimately society (2).

There are several specific strategies that public health campaigns can use to address the above elements. For example in the article “Obesity—The New Frontier of Public Health Law,” the authors explain, “...initiatives are most likely to gain acceptance if they focus on children and adolescents. Young people are especially vulnerable to advertising, and there is greater political tolerance for legal interventions on their behalf…”(5) This tolerance for legal intervention is also rooted in the belief that children lack culpability for their food choices, since adults are responsible for controlling their diets. As such, anti-obesity campaigns and lobbying aimed at youth would be a useful way to initiate a change in the national attitude and pubic policy regarding obesity.

Other strategies include public health campaigns that notify all consumers to their vulnerable to being manipulated by food advertisements (5). Such campaigns would convey the universality of the problem by limning the pervasiveness of corporate influence, and if aggressive enough, could pressure the food industry to self-regulate in order to deter the enactment of more intrusive public policy. Correspondingly, campaigns should expand the consumer knowledge base through scientific evidence that shows the obesity trend is a systemic problem rather than an individual one (5). The anti-smoking campaign mentioned above focused on the highly addictive nature of smoking, and was thus reframed from being an individual problem to a deliberate and harmful tactic used by tobacco corporations. While similar scientific evidence about the addictiveness of certain foods may not exist, anti-obesity campaigns would do well to incorporate statistics that demonstrate the impact food industry practices have on consumer eating habits.

Although the current approach to the obesity trend in the United States is failing because of its focus on individual responsibility, there is still hope. If public health strives to redefine obesity and broaden responsibility for it to include corporate practices, it may be able to tackle the national health problem successfully.

1. Berkeley Media Studies Group. Framing Brief. Berkeley, California. Berkeley Media Studies Group.
2. Centers for Disease Control and Prevention. Overweight and Obesity Fact Sheet. Washington, D.C.: Centers for Disease Control and Prevention.
3. Lawrence, Regina G. Framing Obesity: The Evolution of News Discourse on a Public Health Issue. The Joan Shorenstein Center on the Press, Politics and Public Policy. 2004; 9(3): 56-75.
4. Lori Dorfman et al. More than a Message: Framing Public Health Advocacy to Change Corporate Practices. Health Education and Behavior. 2005; 32: 320-336.
5. Michelle M. Mello et al. Obesity--The New Frontier of Public Health Law. New England Journal of Medicine. 2006; 354: 2601-2610.

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