Public health communication & the blurry line from anti-obesity to pro-ana

Public health communication is not easy. Various industries, special interest groups and lobbyists are only too willing to skew messages about health. As such, public health researchers and advocates tend to be sensitive to the different ways a health message can be appropriated.

However, public health advocates, particularly in the area of nutrition, are inconsistent in their concern that people will misuse health-related messages. If a piece of research suggests that something traditionally thought to be “sinful” – alcohol, chocolate, or fat – is not as bad as first thought, then anxious caveats will urge restraint. Yet, if a piece of research over-sells the benefits of something traditionally thought to be “saintly” – exercise or dieting – then there is silence.

Two examples illustrate the first response.

Example 1 – Health benefits of alcohol

Every so often a mainstream media source will pick up on some research that suggests that alcohol – usually red wine – can have some health benefits. Without fail a public health spokesperson or researcher will be very quick to either discredit the research or explain to the public that the research does not provide a license for unrestrained consumption.

For instance, public health nutritionist, Marion Nestle, laments in her book Food Politics that clear guidance is complicated by ‘the inconvenient finding that moderate drinking provides health benefits – alcohol protects against coronary heart disease.’ Whether this research still holds is beside the point, Nestle’s lament that alcohol could have health-benefits reflects a distrust of the public’s ability to negotiate complex or uncertain nutrition messages.

Researchers like Nestle in the US and Mike Daube in Australia are at pains to ensure the public does not misuse or misinterpret claims about the health-benefits of alcohol.

Example 2 – Relationship between weight and health is not as clear as first thought

In 2013, the Journal of the American Medical Association published an epidemiological study from Katherine Flegal and colleagues that found people who are obese grade 1 (BMI of 30-<35) had no increased risk of dying prematurely and overweight (BMI of 25-30) people may actually have greater life expectancy.

Stacy Carter and Helen Walls documented the fall-out of this res2014-12-01 16.22.32-1earch among public health researchers.

Walter Willett of Harvard School of Public Health was indignant. He described the research on NPR as ‘really a pile of rubbish’ and that ‘no one should waste their time reading it’. A UK National Obesity Forum representative told the BBC, ‘It’s a horrific message to put out at this particular time. We shouldn’t take it for granted that we can cancel the gym, that we can eat ourselves to death with black forest gateaux’.

Like the responses to research suggesting the health-benefits of alcohol, these responses to Flegal et al’s research highlight a deep anxiety that the public will misuse public health messages in a manner that undermines their health.

Anti-obesity or Pro-ana? So long as we’re skinny…right?

Despite knee-jerk concern that alcohol or weight-related research will be misused by publics, there is very little (if any) concern that anti-obesity campaigns will lead people to eat too little, exercise too much or that such messages will reinforce and legitimise disordered eating practices such as anorexia or bulimia.

Almost every time I lecture on critical obesity discourses someone will question why there is such a overwhelming focus on obesity and little focus on anorexia or bulimia. Someone will also point out that a lot of the anti-obesity messages can be construed to reinforce idealised expectations about body image.

Compare the use of computer-generated imagery in these two public service announcements (PSAs).

  1. Measure Up – anti obesity

2. The Mirror – anorexia

The parameters for the non-pathologised and non-medicalised body is very narrow, especially for young women. In addition to people questioning the differing responses to obesity and anorexia or bulimia, I have had two students tell me that they used weight-focused public health messages to mask damaging practices such as under-eating and over-exercising.

Last year, Dr Richard Newton from the Butterfly Foundation noted that an increase of children and young people with disordered eating and dieting behaviours coincides with ‘a society that is putting an increasing emphasis on avoiding obesity, controlling weight and shape through dieting’.

Psychiatrist Dr Peter O’Keefe also said that anti-obesity messages contribute to the ideal that ‘if you’re thin you’re good, if you’re not, you’re bad’.

These are serious concerns with real consequences for the lives of young people. Yet the zeal for preventing obesity and perceived urgency of the problem, gives public health advocates little time or reason to pause and consider the ways anti-obesity messages can be interpreted.

Sadly, if a piece of research suggests that it’s ok to eat a piece of cake, warnings and caveats are screamed from the rooftops. But if the research says exercise more, eat less, and lose weight, then there is only nodding agreement. After all, why give an inch when we are at war with our bodies – mine and yours.

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2 Comments

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  1. Adele Hite, MPH RD March 20, 2017 — 8:39 am

    Excellent discussion. I’ve noticed this same differential treatment. It seems to boil down to if science determines that you are allowed to enjoy something justified by a health benefit (chocolate, alcohol, a little more food), that’s “dangerous.” But message of restriction, careful choices, or limits are never “dangerous,” even though they are and even if the effects are not clinically labeled. I have a number of RD friends who are clinicians. They report seeing increasing numbers of individuals who simply don’t know what to eat. These are individuals who are not likely to be considered to have a typical eating disorder; they seem to actually want to eat–but they have eliminated so many food from their diet they are no longer eating anything besides a very narrow selection of food. They are frustrated, unhappy, tired, and hungry.

    I’m currently teaching a class, “Food Matters,” about the rhetoric of food issues and controversies, and my students have a very difficult time even imagining a time when we weren’t all obsessed with how we “should” be eating. Whether or not a person follows those internalized rules is beside the point to me. What have we done simply by installing that “should”?

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