"I'm Fat" T-shirt

“I’m Fat” T-shirt. Photograph courtesy of Global X

Arguing that obesity “may be the most difficult and elusive public health problem the United States has ever encountered” and that anti-obesity efforts have made little discernible difference, a leading American bioethicist says that we need more stigmatization.

Daniel Callahan, of The Hastings Center, says that successful anti-smoking campaigns should be the model for fighting obesity. A primary strategy has been to stigmatize smokers, he says, making it clear that their behavior is not only unhealthy for them but is also socially unacceptable. While public health officials have decisively rejected stigmatization of obesity, Callahan favours “stigmatization lite”.

Callahan does not deny that stigmatization can do harm, such as increasing the risk of discrimination in the workplace and health care.

But he believes that that risk would be minimized by “stigmatization lite,” in which people who are overweight consider the threat of discrimination itself as a danger to be avoided: “don’t let this happen to you!” Obese people would be encouraged to consider questions such as:

“Fair or not, do you know that many people look down upon those excessively overweight or obese, often in fact discriminating against them and making fun of them or calling them lazy and lacking in self-control?”

To some people, this might sound like bullying. But to Callahan, despairing of finding a better strategy, it is our best chance:

“For any of those good goals to have real bite, it will be necessary to make just about everyone strongly want to avoid being overweight and obese. Education has not shown itself to be up to that task. Fear of illness has not, either. No technologies—surgery or pills—have made a major difference. Stigmatization, we have been told, is counter-productive. Moreover, it is a telling commentary on the difficult road ahead that obesity experts have become willing (even if not happily) to settle for a success rate of 10% or less in finding ways to effectively help people lose weight and, most critically, to keep from putting it back on.”

Written by Michael Cook

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