Can anti-smoking tactics solve obesity crisis?
New guidelines from the National Obesity Forum suggest using "harder hitting" anti-obesity campaigns, akin to anti-tobacco campaigns, in the UK. The debate about whether to treat obesity like smoking is one that has played out in the US, with researchers still searching for the most effective way to improve health outcomes.
As a former smoker, Dan Gilmore realised the power of stark words and images in changing his behaviour.
"Somewhere along the line, people said, 'Would you please go outside and smoke,' or, 'I've got an allergy to smoking.' You started to feel societal pressure," says Gilmore, president emeritus of the Hastings Institute, a centre devoted to bioethics and public policy.
The in-your-face smoking campaigns of the past, he says, effectively convinced people both that their actions bothered others and posed grave danger to themselves.
When it comes to obesity, he says, "the public has not as thoroughly been terrorised."
But he's yet to find the right balance of "light stigma" to help motivate people without alienating them.
End Quote Scott Kahan National Center for Weight and Wellness
Unlike some other areas of medicine, the goal of obesity treatment is not necessarily to get to a normal weight. It's to move in a direction where your health is significantly improved”
Alienation is a big risk when it comes to anti-obesity campaigns. Research shows those initiatives that make people feel bad about themselves tend to backfire.
"Campaigns that focus primarily on body weight, or the number on the scale, or used hard-hitting controversial approaches to get attention were messages that tended to blame or stigmatise people for their weight," says Rebecca Puhl, deputy director at the Rudd Center for Food Policy and Obesity at Yale University. "Those were not found to be effective,"
"People are more responsive to campaigns that address specific health behaviour that people can engage in regardless of their body type."
Indeed, one ex-smoker and ex-dieter says there is already a level of stigma around weight.
"People wouldn't openly sneer at me because I was a smoker, but they do that because I'm fat," says Lesley Kinzel, senior editor at XOJane.com and author of Two Whole Cakes: How to Stop Dieting and Learn to Love Your Body.
And yet, she says, it's more difficult to pinpoint those who may suffer from obesity-related illnesses than it is to identify smokers.
"People want to associate certain behaviour with fatness, but in real life fat people exhibit a wide range of different behaviour in regards to their eating habits and physical activity. If you're a smoker, it's because you smoke cigarettes."
The many complex factors surrounding obesity, and the fact that obesity itself is not a behaviour but a state of being, makes comparing the two types of campaigns difficult, says Scott Kahan, director of the National Center for Weight and Wellness.
At the same time, he says, there are lessons to be learned from anti-smoking campaigns.
"Sometimes people fall into the trap of looking back at the anti-tobacco effort and say, 'What we did was shame people into not smoking, and did hard-hitting campaigns of not smoking,'" says Mr Kahan,
"But that's not the central part of what we did with the tobacco epidemic."
What proved successful in the US was a complex, multi-faceted approach, he says.
"Smoking was addressed from the top down and bottom up," he says.
"On the one hand there was education."
Some recommendations from the National Obesity Forum report
- "Harder-hitting campaigns similar to anti-smoking"
- "GPs should be encouraged to engage with patients on obesity and weight management issues"
- "Government initiatives should include greater focus on hydration in weight management and health outcomes"
- "Greater focus needs to be devoted to strategies supporting individuals who are already obese"
- "Greater promotion of physical activity outside of educational settings"
This came in the form of public awareness campaigns, the surgeon general's report outlining the dangers of smoking, and increased educational initiatives in schools and the work place.
On the other, he says, were changes that created "supportive environments to make it easier to not start smoking or to stop smoking," he says.
This included higher taxes on cigarettes, restrictions on how the products could be marketed and sold, and the creation of more smoke-free areas, such as in restaurants and bars.
Indeed, Kinzel stopped smoking when the expense and hassles of smoking began to mount. "At a certain point it became too inconvenient," she says.
While the US has seen big drops in smoking rates, obesity numbers have not dropped significantly, and in many cases continue to climb.
That has American researchers focusing not on changing numbers on the scale, but on encouraging healthy behaviours.
"The outward appearance of obesity is a distracter and a red herring," says Mr Kahan. "If you take someone who is significantly overweight and they work hard and do what they need to do and lose 10% of their body weight, more often than not they will see tremendous health and function improvements.
"At the same time, they're still really fat. We still point fingers of them losing weight, and that's not really necessary."
While the goal of anti-smoking campaigns was to stop people from smoking, campaigns devoted to obesity seek a less-tangible outcome.
"The goal of obesity treatment is not necessarily to get to a normal weight. It's to move in a direction where your health is significantly improved."
To that end, says Ms Puhl, campaigns should focus on behaviours to improve health, not body size.
Motivating people to eat better and move more has beneficial effects for everyone, she says, not just the obese.