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Obes Rev. 2021 Nov;22(11):e13333. doi: 10.1111/obr.13333. Epub 2021 Sep 09.

Weight stigma and obesity-related policies: A systematic review of the state of the literature.

Obesity reviews : an official journal of the International Association for the Study of Obesity

Briony Hill, Heidi Bergmeier, Angela C Incollingo Rodriguez, Fiona Kate Barlow, Alexandra Chung, Divya Ramachandran, Melissa Savaglio, Helen Skouteris

Affiliations

  1. Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  2. Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA.
  3. School of Psychology, University of Queensland, Brisbane, Queensland, Australia.
  4. Boden Institute, University of Sydney; Weight Issues Network, Sydney, Australia.
  5. Warwick Business School, The University of Warwick, Coventry, UK.

PMID: 34505334 DOI: 10.1111/obr.13333

Abstract

Weight stigma is an important issue colliding with obesity-related policies; both have population health and social impacts. Our aim was to conduct a systematic review of the peer-reviewed literature that combined the concepts of stigma, obesity, and policy. We searched PsycINFO, Medline, Scopus, and Google Scholar for peer-reviewed articles amalgamating terms relevant to stigma, obesity, and policy. Of 3219 records identified, 47 were included in the narrative synthesis. Two key types of studies emerged: studies investigating factors associated with support for obesity-related policies and those exploring policy implementation and evaluation. We found that support for nonstigmatizing obesity-related policies was higher when obesity was attributed as an environmental rather than individual problem. An undercurrent theme suggested that views that blame individuals for their obesity were associated with support for punitive policies for people living in larger bodies. Real-world policies often implicitly condoned stigma through poor language choice and conflicting discourse. Our findings inform recommendations for policy makers that broader socioecological stigma-reduction approaches are needed to fully address the issue of weight stigma in obesity-related policies. Efforts are needed in the research and policy sectors to understand how to improve the design and support of nonstigmatizing obesity-related policies.

© 2021 World Obesity Federation.

Keywords: obesity; policy; weight stigma

References

  1. Brewis A, Sturtzsreetharan C, Wutich A. Obesity stigma as a globalizing health challenge. Global Health. 2018;14(20):1-6. - PubMed
  2. Prunty A, Clark MK, Hahn A, Edmonds S, O'Shea A. Enacted weight stigma and weight self-stigma prevalence among 3821 adults. Obes Res Clin Pract. 2020;14(5):421-427. - PubMed
  3. Tomiyama AJ. Weight stigma is stressful. A review of evidence for the cyclic obesity/weight-based stigma model. Appetite. 2014;82:8-15. - PubMed
  4. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health. 2010;100(6):1019-1028. - PubMed
  5. Hartlev M. Stigmatization as a public health tool against obesity-a health and human rights perspective. Eur J Health Law. 2014;21(4):365-386. - PubMed
  6. World Health Organization. Global strategy on diet, physical activity and health-2004. May 26, 2004. Accessed February 15, 2021. Available at: https://www.who.int/publications/i/item/9241592222 - PubMed
  7. Obesity Policy Coalition. Obesity in Australia: A decade of inaction. Evaluating 10 years of government (in)action against the National Preventative Health Taskforce’s obesity policy recommendations. Victoria, Australia: Obesity Policy Coalition; 2020. https://www.opc.org.au/downloads/10-years/OPC_InAction_Report_FINAL.pdf. Accessed February 15, 2021. - PubMed
  8. UK policy targeting obesity during a pandemic-the right approach? Nat Rev Endocrinol. 2020;16:1-2. - PubMed
  9. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875-E891. - PubMed
  10. Pearl RL. Weight bias and stigma: public health implications and structural solutions. Soc Iss Policy Rev. 2018;12(1):146-182. - PubMed
  11. Puhl RM, Suh Y, Li X. Improving anti-bullying laws and policies to protect youth from weight-based victimization: parental support for action. Paediatric Obes. 2017;12(2):14-19. - PubMed
  12. Rubino F, Puhl RM, Cummings DE, et al. 2020Joint international consensus statement for ending stigma of obesity. Nat Med. 2020;26(4):1-13. - PubMed
  13. Huang T, Cawley JW, Ashe M, et al. Mobilization of public support for policy actions to prevent obesity. Lancet. 2020;385(9985):2422-2431. - PubMed
  14. Lobstein T, Neveux M, Landon J. Costs, equity and acceptability of three policies to prevent obesity: a narrative review to support policy development. Obes Sci Pract. 2020;6(5):562-583. - PubMed
  15. Puhl RM, Himmelstein MS, Pearl RL. Weight stigma as a psychosocial contributor to obesity. Am Psychol. 2020;75(2):274-289. - PubMed
  16. Wu Y, Berry DC. Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. J Adv Nurs. 2017;74(5):1030-1042. - PubMed
  17. Centre for Open Science. OSF Home. 2011, updated 2021. Accessed February 15, 2021. https://osf.io/ - PubMed
  18. Page M, McKenzie J, Bossuyt P, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):1-9. - PubMed
  19. Veritas Health Innovation. Covidence systematic review software, Melbourne, Australia: Veritas Health Innovation. Updated February 4, 2019. Accessed February 15, 2021. Available at www.covidence.org - PubMed
  20. Nevis IF, Sikich N, Ye C, Kabali C. Quality control tool for screening titles and abstracts by second reviewer (QCTSTAR). J Biom Biostats. 2015;6(12):1-15. - PubMed
  21. Centre for Evidence Based Management. Critical Appraisal Checklist for Cross-Sectional Study. July, 2014. Accessed February 15, 2021. Available at https://www.cebma.org - PubMed
  22. Critical Appraisal Skills Program (CASP). CASP Qualitative Studies Checklist. 2018. Accessed February 15, 2021. Available at https://casp-uk.net/casp-tools-checklists/ - PubMed
  23. Pearl RL, Lebowitz MS. Beyond personal responsibility: effects of causal attributions for overweight and obesity on weight-related beliefs, stigma, and policy support. Psychol Health. 2014;29(10):1176-1191. - PubMed
  24. Hart LM, Ferreira KB, Ambwani S, Gibson EB, Austin SB. Developing expert consensus on how to address weight stigma in public health research and practice: a Delphi study. Sigma Health. 2020;100(6):1019-1028. - PubMed
  25. Patchett AD, Yeatman HR, Johnson KM. Obesity framing for health policy development in Australia, France and Switzerland. Health Promot Int. 2016;31(1):83-92. - PubMed
  26. Hann A, Frawley A, Spedding G. Not very NICE: deviance, stigma and nutritional guidelines related to health weight and obesity. Int J Health Plann Mgmt. 2017;32(4):416-432. - PubMed
  27. Ramos Salas X, Forhan M, Caulfield T, Sharma AM, Raine K. A critical analysis of obesity prevention policies and strategies. Can J Public Health. 2018;108(5-6):e598-e608. - PubMed
  28. Vallgarda S, Nielsen M, Hartlev M, Sandoe P. Backward- and forward-looking responsibility for obesity: policies from WHO, the EU and England. Eur J Public Health. 2015;25(5):845-848. - PubMed
  29. Vallgarda S. Governing obesity policies from England, France, Germany and Scotland. Soc Sci Med. 2015;147:317-323. - PubMed
  30. Suh Y, Puhl R, Liu S, Millei F. Support for laws to prohibit weight discrimination in the United States: public attitudes from 2011 to 2013. Obesity. 2014;22(8):1872-1879. - PubMed
  31. Beeken RJ, Wardle J. Public beliefs about the causes of obesity and attitudes towards policy initiatives in Great Britain. Public Health Nutr. 2013;16(12):2132-2137. - PubMed
  32. Berg MB, Lin L, Hollar SM, Walker SN, Erickson LE. The relationship between weight-based prejudice and attitudes towards obesity-reducing public policies. Anal Soc Issues Pub Policy. 2016;16(1):125-142. - PubMed
  33. Frederick DA, Saguy AC, Sandhu G, Mann T. Effects of competing news media frames of weight on antifat stigma, beliefs about weight and support for obesity-related public policies. Int J Obes (Lond). 2016;40(3):543-549. - PubMed
  34. Frederick DA, Tomiyama AJ, Bold JG, Saguy AC. Can she be healthy at her weight? Effects of news media frames on antifat attitudes, dieting intentions, and perceived health risks of obesity. Stigma Health. 2020;5(3):247-257. - PubMed
  35. Garbarino E, Henry P, Kerfoot S. Using attribution to foster public support for alternative policies to combat obesity. Eur J Marketing. 2018;52(1):418-438. - PubMed
  36. Glendall P, Hoek J, Taylor R, Mann J, Krebs J, Parry-Strong A. Should support for obesity interventions or perceptions of their perceived effectiveness shape policy. Aust NZ J Publ Health. 2015;39(2):172-176. - PubMed
  37. Hayward L, Vartanian L. Potential unintended consequences of graphic warning labels on sugary drinks: do they promote obesity stigma? Obes Sci Prac. 2019;5(4):333-341. - PubMed
  38. Hilbert A, Hubner C, Schmutzer G, Danielsdottir S, Brahler E, Puhl R. Public support for weight-related antidiscrimination laws and policies. Obes Facts. 2017;10(2):101-111. - PubMed
  39. Holland K, Blood RW, Thomas SL, Lewis S. Challenging stereotypes and legitimating fat: an analysis of obese people's views on news media reporting guidelines and promoting body diversity. J Sociol. 2013;51(2):431-445. - PubMed
  40. Lund TB, Nielsen MEJ, Sandoe P. In a class of their own: the Danish public considers obesity less deserving of treatment compared with smoking-related diseases. Eur J Clin Nutr. 2015;69(4):514-518. - PubMed
  41. Mazzocchi M, Cagnone S, Bech-Larsen T, et al. What is the public appetite for healthy eating policies? Evidence from a cross-European survey. Health Econ Policy Law. 2015;10(3):267-292. - PubMed
  42. McGlynn J, McGlone M. Desire or disease? Framing obesity to influence attributions of responsibility and policy support. Health Commun. 2019;34(7):689-701. - PubMed
  43. Meyer J, Ruyter K, Grewal D, Cleeren K, Keeling D, Motyka S. Categorical versus dimensional thinking: improving anti-stigma campaigns by matching health message frames and implicit worldviews. Acad Mark Sci. 2020;48(2):222-245. - PubMed
  44. Niederdeppe J, Porticella N, Shapiro MA. Using theory to identify beliefs associated with support for policies to raise the price of high-fat and high-sugar foods. J Health Commun. 2012;17(1):90-104. - PubMed
  45. Niederdeppe J, Shapiro MA, Kim HK, Bartolo D, Porticella N. Narrative persuasion, causality, complex integration, and support for obesity policy. Health Commun. 2014;29(5):431-444. - PubMed
  46. Niederdeppe J, Roh S, Shapiro MA. Acknowledging individual responsibility while emphasizing social determinants in narratives to promote obesity-reducing public policy: a randomized experiment. PLOS one. 2015;10(2):1-11. - PubMed
  47. Puhl RM, Heuer CA. Public opinion about laws to prohibit weight discrimination in the United States. Obesity. 2011;19(1):74-82. - PubMed
  48. Puhl RM, Heuer CA, Sarda V. Framing messages about weight discrimination: impact on public support for legislation. Int J Obesity. 2011;35(6):863-872. - PubMed
  49. Puhl RM, Latner JD, O'Brien KS, Luedicke J, Danielsdottir S, Salas XR. Potential policies and laws to prohibit weight discrimination: public views from 4 countries. Milbank Quarterly. 2015;93(4):691-731. - PubMed
  50. Puhl RM, Suh Y, Li X. Legislating for weight-based equality: national trends in public support for laws to prohibit weight discrimination. Int J Obes. 2016;40(8):1320-1324. - PubMed
  51. Saguy AC, Frederick D, Gruys K. Reporting risk, producing prejudice: how news reporting on obesity shapes attitudes about health risk, policy, and prejudice. Soc Sci Med. 2014;111:125-133. - PubMed
  52. Thibodeau PH, Perko VL, Flusberg SJ. The relationship between narrative classification of obesity and support for public policy interventions. Soc Sci Med. 2015;141:27-35. - PubMed
  53. Thidobeau PH, Uri R, Thompson B, Flusberg SJ. Narratives for obesity: Effects of weight loss and attribution on empathy and policy support. Health Educ Behav. 2017;44(4):638-647. - PubMed
  54. Barry CL, Brescoll VL, Gollust SE. Framing childhood obesity: how individualizing the problem affects public support for prevention. Polit Psychol. 2013;34(3):327-249. - PubMed
  55. Barry CL, Gollust SE, McGinty EE, Niederdeppe J. Effects of messages from a media campaign to increase public awareness of childhood obesity. Obesity. 2013;22(2):466-473. - PubMed
  56. Chambers SA, Traill WB. What the UK public believes causes obesity, and what they want to do about it: a cross-sectional study. J Public Health Pol. 2011;32(4):430-444. - PubMed
  57. Clemons RS, McBeth MK, Kusko E. Understanding the role of pollicy narratives and the public policy arena: obesity as a lesson in public policy development. World Med Health Policy. 2012;4(2):1-26. - PubMed
  58. Frederick DA, Saguy AC, Gruys K. Culture, health and bigotry: how exposure to cultural accounts of fatness shape attitudes about health risk, health policies, and weight-based prejudice. Soc Sci Med. 2016;165:271-279. - PubMed
  59. Puhl RM, Luedicke J. Parental support for policy measures and school-based efforts to address weight-based victimization of overweight youth. Int J Obes. 2014;38(4):531-538. - PubMed
  60. Puhl RM, Neumark-Sztainer D, Austin B, Luedicke J, King KM. Setting policy priorities to address eating disorders and weight stigma: views from the field of eating disorders and the US general public. BMC Public Health. 2014;14(524):1-10. - PubMed
  61. Puhl RM, Luedicke J, King KM. Public attitudes about different types of anti-bullying laws: results from a national survey. J Public Health Pol. 2015;36(1):95-109. - PubMed
  62. Puhl RM, Latner JD, O'Brien K, Luedicke J, Forhan M, Danielsdottir S. Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies. Paediatric Obesity. 2015;11(4):241-250. - PubMed
  63. Puhl RM, Neumark-Sztainer D, Austin B, Suh Y, Wakefield D. Policy actions to address weight-based bullying and eating disorders in schools: views of teachers and school administrators. J School Health. 2016;86(7):507-515. - PubMed
  64. Skurka C. Communicating inequalities to enhance support for obesity-prevention policies: the role of social comparisons, age frames, and emotion. Health Commun. 2019;34(2):227-237. - PubMed
  65. Suh Y, Puhl R, Liu S, Milici FF. Parental support for policy actions to reduce weight stigma toward youth in schools and children's television programs: trends from 2011 to 2013. Child Obes. 2014;10(6):533-541. - PubMed
  66. Wolfson JA, Gollust SE, Niederdeppe J, Barry CL. The role of parents in public views of strategies to address childhood obesity in the United States. Millbank Quarterly. 2015;93(1):73-111. - PubMed
  67. Brochu PM, Pearl RL, Puhl RM, Brownell KD. Do media portrayals of obesity influence support for weight-related medical policy? Health Psychol. 2014;33(2):197-200. - PubMed
  68. Hoyt C, Burnette J, Auster-Gussman L. “Obesity is a disease”: examining the self-regulatory impact of this public-health message. Psych Sci. 2014;25(4):997-1002. - PubMed
  69. Lewis S, Thomas SL, Hyde J, Castle D, Blood RW, Komesaroff PA. “I don't eat a hamburger and large chips every day!” A qualitative study of the impact of public health messages about obesity on obese adults. BMC Public Health. 2010;10(309):1-9. - PubMed
  70. Christensen A, Meyer M, Dalum P, Kraup AF. Can a mass media campaign raise awareness of alcohol as a risk factor for cancer and public support for alcohol-related policies? Prev Med. 2019;126:1-7. - PubMed
  71. Nutter S, Alberga AS, MacInnis C, Ellard JH, Russell-Mayhew S. Framing obesity a disease: indirect effects of affect and controllability beliefs on weight bias. Int J Obes (Lond). 2018;42(10):1804-1811. - PubMed
  72. Australian Public Service Commission. Changing behaviour: a public policy perspective. June 12, 2018. Accessed February 25, 2021. Available at https://www.apsc.gov.au/changing-behaviour-public-policy-perspective - PubMed
  73. Ramos Sales X, Alberga AS, Cameron E, et al. Addressing weight bias and discrimination: moving beyond raising awareness to creating change. Obes Rev. 2017;18(11):1323-1335. - PubMed
  74. Stangl AL, Earnshaw VA, Logie CH, et al. The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(31):1-13. - PubMed
  75. Kumanyika SK. A framework for increasing equity impact in obesity prevention. Am J Public Health. 2019;109(10):1350-1357. - PubMed
  76. McLaren L. Socioeconomic status and obesity. Epidemiol Rev. 2007;29(1):29-48. - PubMed
  77. Skouteris H, Bergmeier HJ, Berns SD, et al. Reframing the early childhood obesity prevention narrative through an equitable nurturing approach. Matern Child Nutr. 2021;17(1):e13094. - PubMed
  78. Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813-821. - PubMed
  79. Ndumbe-Eyoh S. What would it take for health promotion to take structural racism seriously? Global Health Promot. 2020;27(4):3-5. - PubMed
  80. Obesity Collective. Response to national obesity strategy consultation, December 2019. Accessed February 25, 2021. Available at https://www.obesityaustralia.org/points-of-view/#statements - PubMed

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