Advertisement

Canadian Journal of Public Health

, Volume 108, Issue 5–6, pp e598–e608 | Cite as

A critical analysis of obesity prevention policies and strategies

  • Ximena Ramos Salas
  • Mary Forhan
  • Timothy Caulfield
  • Arya M. Sharma
  • Kim Raine
Qualitative Research

Abstract

OBJECTIVES: Public health policies have been criticized for promoting a simplistic narrative that may contribute to weight bias. Weight bias can impact population health by increasing morbidity and mortality. The objectives of this study were to: 1 ) critically analyze Canadian obesity prevention policies and strategies to identify underlying dominant narratives; 2) deconstruct dominant narratives and consider the unintended consequences for people with obesity; and 3) make recommendations to change dominant obesity narratives that may be contributing to weight bias.

METHODS: We applied Bacchi’s “what’s-the-problem-represented-to-be?” (WPR) approach to 15 obesity prevention policies and strategies (1 national, 2 territorial and 12 provincial). Bacchi’s WPR approach is composed of six analytical questions designed to identify conceptual assumptions as well as possible effects of policies.

RESULTS: We identified five prevailing narratives that may have implications for public health approaches and unintended consequences for people with obesity: 1 ) childhood obesity threatens the health of future generations and must be prevented; 2) obesity can be prevented through healthy eating and physical activity; 3) obesity is an individual behaviour problem; 4) achieving a healthy body weight should be a population health target; and 5) obesity is a risk factor for other chronic diseases, not a disease in itself.

CONCLUSION: The consistent way in which obesity is constructed in Canadian policies and strategies may be contributing to weight bias in our society. We provide some recommendations for changing these narratives to prevent further weight bias and obesity stigma.

Key words

Obesity policy public health weight bias 

Résumé

OBJECTIFS: Les politiques de santé publique font l’objet de critiques lorsqu’elles encouragent un discours simpliste qui peut contribuer aux préjugés liés au poids. Ces préjugés peuvent influer sur la santé des populations en augmentant la morbidité et la mortalité. Les objectifs de notre étude étaient: 1) de faire une analyse critique des politiques et des stratégies canadiennes de prévention de l’obésité pour en extraire les discours dominants; 2) de déconstruire les discours dominants et d’en étudier les effets pervers pour les personnes obèses; et 3) de formuler des recommandations pour changer les discours dominants sur l’obésité qui peuvent contribuer aux préjugés liés au poids.

MÉTHODE: Nous avons appliqué le cadre d’analyse WPR (pour «What’s the problem represented to be?») de Bacchi à 15 politiques et stratégies de prévention de l’obésité (1 nationale, 2 territoriales et 12 provinciales). Ce cadre pose six questions analytiques pour mettre au jour les hypothèses conceptuelles et les effets possibles des politiques.

RÉSULTATS: Nous avons mis au jour cinq discours dominants qui pourraient déjà avoir des conséquences sur les démarches de santé publique et des effets pervers pour les personnes obèses: 1) l’obésité juvénile menace la santé des générations à venir et doit être évitée; 2) l’obésité peut être évitée par la saine alimentation et l’activité physique; 3) l’obésité est un problème de comportement individuel; 4) l’atteinte d’un poids santé devrait être une cible de santé des populations; et 5) l’obésité est un facteur de risque pour d’autres maladies chroniques et non une maladie en soi.

CONCLUSION: La constance avec laquelle l’obésité est envisagée dans les politiques et les stratégies canadiennes pourrait contribuer aux préjugés liés au poids dans la société. Nous présentons des recommandations pour changer ces discours afin de prévenir l’intensification des préjugés liés au poids et de la stigmatisation de l’obésité.

Mots clés

obésité politique (principe) santé publique préjugés liés au poids 

References

  1. 1.
    World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Geneva, Switzerland: WHO, 2000; 0512–3054.Google Scholar
  2. 2.
    Curbing Childhood Obesity: A Federal, Provincial and Territorial Framework for Action to Promote Healthy Weights, 2011. Available at: https://www.canada.ca/en/public-heal th/services/health-promotion/healthy-living/curbing-childhood-obesity-federal-provincial-territorial-framework/curbing-childhood-obesity-overview-federal-provincial-territorial-framework-action-promote-healthy-weights.html (Accessed November 28, 2017).
  3. 3.
    Stephens SK, Cobiac LJ, Veerman JL. Improving diet and physical activity to reduce population prevalence of overweight and obesity: An overview of current evidence. Prev Med 2014;62:167–78. PMID: 24534460. doi: 10.1016/j.ypmed.2014.02.008.PubMedCrossRefGoogle Scholar
  4. 4.
    Bacon L, Aphramor L. Weight science: Evaluating the evidence for a paradigm shift. NutrJ 2011;10:9. PMID: 21261939. doi: 10.1186/1475-2891-10-9.CrossRefGoogle Scholar
  5. 5.
    Finegood DT, Merth TDN, Rutter H. Implications of the foresight obesity system map for solutions to childhood obesity. Obesity 2010;18:S13–16. PMID: 20107455. doi: 10.1038/oby.2009.426.PubMedCrossRefGoogle Scholar
  6. 6.
    Walls HL, Peeters A, Proietto J, McNeil JJ. Public health campaigns and obesity — A critique. BMC Public Health 2011;11(1):136. PMID: 21352562. doi: 10.1186/1471-2458-11-136.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    McPhail D. Resisting biopedagogies of obesity in a problem population: Understandings of healthy eating and healthy weight in a Newfoundland and Labrador community. Crit Public Health 2013;23(3):289–303. doi: 10.1080/09581596.2013.797566.CrossRefGoogle Scholar
  8. 8.
    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. PMID: 20525310. doi: 10.1186/1471-2458-10-309.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Kirk SFL, Price SL, Penney TL, Rehman L, Lyons RF, Piccinini-Vallis H, et al. Blame, shame, and lack of support: A multilevel study on obesity management. Qual Health Res 2014;24(6):790–800. PMID: 24728109. doi: 10.1177/1049732314529667.CrossRefGoogle Scholar
  10. 10.
    Beausoleil N, Ward P. Fat panic in Canadian public health policy: Obesity as different and unhealthy. Radical Psychol J Psychol Politics Radicalism 2009;8(1):5.Google Scholar
  11. 11.
    Puhl RM, Heuer CA. The stigma of obesity: A review and update. Obesity 2009;17(5):941–64. PMID: 19165161. doi: 10.1038/oby.2008.636.PubMedCrossRefGoogle Scholar
  12. 12.
    Sutin AR, Stephan Y, Terracciano A. Weight discrimination and risk of mortality. Psychol Sci 2015;26(11):1803–11. PMID: 26420442. doi: 10.1177/0956797615601103.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    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. PMID: 26246031. doi: 10.1016/j.socscimed.2015.07.023.PubMedCrossRefGoogle Scholar
  14. 14.
    Puhl RM, Schwartz MB, Brownell KD. Impact of perceived consensus on stereotypes about obese people: A new approach for reducing bias. Health Psychol 2005;24(5):517–25. PMID: 16162046. doi: 10.1037/0278-6133.24.5.517.PubMedCrossRefGoogle Scholar
  15. 15.
    Pomeranz JL. A historical analysis of public health, the law, and stigmatized social groups: The need for both obesity and weight bias legislation. Obesity 2008;16(Suppl 2):S93–103. PMID: 18978770. doi: 10.1038/oby.2008.452.PubMedCrossRefGoogle Scholar
  16. 16.
    Bombak AE. The contribution of applied social sciences to obesity stigma-related public health approaches. J Obes 2014;2014:267286. PMID: 24782921. doi: 10.1155/2014/267286.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Bacchi CL. Analysing Policy: What’s the problem represented to be? 1st ed. Frenchs Forest, NSW: Pearson, 2014.Google Scholar
  18. 18.
    Labonte R, Polanyi M, Muhajarine N, Mcintosh T, Williams A. Beyond the divides: Towards critical population health research. Crit Public Health 2005;15(1):5–17. doi: 10.1080/09581590500048192.CrossRefGoogle Scholar
  19. 19.
    Canadian Medical Association. Canadian Medical Association Recognizes Obesity as a Disease. Ottawa, ON: CMA, 2015. Available at: https://www.cma.ca/En/Pages/cma-recognizes-obesity-as-a-disease.aspx (Accessed November 28, 2017).Google Scholar
  20. 20.
    Canadian Obesity Network. 5As of Obesity Management Framework and Resources, 2013; Vol. 2013. Available at: http://www.obesitynetwork.ca/5As (Accessed November 28, 2017).
  21. 21.
    Report Card on Access to Obesity Treatment for Adults in Canada 2017. Canadian Obesity Network, 2017. Available at: http://www.obesitynetwork.ca/reportcard (Accessed November 28, 2017).
  22. 22.
    Bray GA, Kim KK, Wilding JPH. Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Jtev2017;18(7):715–23. PMID: 28489290. doi: 10.1111/obr.12551.Google Scholar
  23. 23.
    Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health 2013;103(5):813–21. PMID: 23488505. doi: 10.2105/AJPH.2012.301069.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Nutter S, Russell-Mayhew S, Alberga AS, Arthur N, Kassan A, Lund DE, et al. Positioning of weight bias: Moving towards social justice. J Obes 2016;2016:3753650. PMID: 27747099. doi: 10.1155/2016/3753650.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Munter A, Murumets KD. No Time to Wait. The Healthy Kids Strategy. Toronto, ON, 2013; 9781-460610145. Available at: http://www.health.gov.on.ca/en/common/ministry/publications/reports/healthy _kids/heal thy _kids.pdf (Accessed November 28, 2017).Google Scholar
  26. 26.
    LeBesco K. Neoliberalism, public health, and the moral perils of fatness. Crit Public Health 2011;21(2):153–64. doi: 10.1080/09581596.2010.529422.CrossRefGoogle Scholar
  27. 27.
    Thrive! A Plan for a Healthier Nova Scotia: A Policy and Environmental Approach to Healthy Eating and Physical Activity. Communications Nova Scotia for the Department of Health and Wellness, 2012; 9781-554574865. Available at: https://thrive.novascotia.ca/sites/default/files/Thrive-Strategy-Document.pdf (Accessed November 28, 2017).
  28. 28.
    Lefebvre CM, John RM. The effect of breastfeeding on childhood overweight and obesity: A systematic review of the literature. J Am Assoc Nurse Pract 2014;26(7):386–401. PMID: 24170411. doi: 10.1002/2327-6924.12036.PubMedGoogle Scholar
  29. 29.
    Friedman M. Mother blame, fat shame, and moral panic: “Obesity” and child welfare. Fat Stud 2015;4(1):14–27. doi: 10.1080/21604851.2014.927209.CrossRefGoogle Scholar
  30. 30.
    Lean MEJ. Chapter 5: Childhood habits and the obesity epidemic. In: Haslam DW, Sharma AM, Le Roux CW (Eds.), Controversies in Obesity. London, UK: Springer, 2014; 31–43.CrossRefGoogle Scholar
  31. 31.
    Maison H, Riley S, Markula P. Beyond psychopathology: Interrogating (dis) orders of body weight and body management. J Community Appl Soc Psychol 2009;19(5):331–35. doi: 10.1002/casp.1019.CrossRefGoogle Scholar
  32. 32.
    Yukon Active Living Strategy. Yukon Government, Yukon Community Services, Sport Recreation Branch, 2012. Available at: http://www.community.gov.yk.ca/pdf/ryals_final.pdf (Accessed November 28, 2017).
  33. 33.
    Frood S, Johnston LM, Matteson CL, Finegood DT. Obesity, complexity, and the role of the health system. Curr Obes Rep 2013;2:320–26. PMID: 24273701. doi: 10.1007/S13679-013-0072-9.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Chandaria SA. Chapter 8: The emerging paradigm shift in understanding the causes of obesity. In: Haslam DW, Sharma AM, Le Roux CW (Eds.), Controversies in Obesity. London, UK: Springer, 2014; 63–73.CrossRefGoogle Scholar
  35. 35.
    Kirk SFL, Penney TL, McHugh TLF, Sharma AM. Effective weight management practice: A review of the lifestyle intervention evidence. Int J Obes 2012;36(2):178–85. PMID: 21487396. doi: 10.1038/ijo.2011.80.CrossRefGoogle Scholar
  36. 36.
    Choose Program: Healthy Choices for Healthy Communities — Healthy Eating and Healthy Weight Guide. Government of Northwest Territories, 2011. Available at: http://www.hss.gov.nt.ca/sites/www.hss.gov.nt.ca/files/resources/healthy-eating-healthy-weight-guide.pdf (Accessed November 28, 2017).
  37. 37.
    Puhl R, Luedicke J, Peterson JL. Public reactions to obesity-related health campaigns: A randomized controlled trial. Am J Prev Med 2013;45:36–48. PMID: 23790987. doi: 10.1016/j.amepre.2013.02.010.PubMedCrossRefGoogle Scholar
  38. 38.
    Major B, Hunger JM, Bunyan DP, Miller CT. The ironic effects of weight stigma. ] Exp Soc Psychol 2014;51:74–80. doi: 10.1016/j.jesp.2013.11.009.CrossRefGoogle Scholar
  39. 39.
    Pearl RL, Dovidio JF, Puhl RM, Brownell KD. Exposure to weight-stigmatizing media: Effects on exercise intentions, motivation, and behavior. J Health Commun 2015;20(9):1004–13. PMID: 26222998. doi: 10.1080/10810730.2015.1018601.PubMedCrossRefGoogle Scholar
  40. 40.
    Pearl RL, Puhl RM. The distinct effects of internalizing weight bias: An experimental study. Body Image 2016;17:38–42. PMID: 26927688. doi: 10.1016/j.bodyim.2016.02.002.PubMedCrossRefGoogle Scholar
  41. 41.
    Bowen S, Elliott S, Brenton J. The joy of cooking? Contexts 2014;13(3):20–25. doi: 10.1177/1536504214545755.CrossRefGoogle Scholar
  42. 42.
    Boswell J. ‘Hoisted with our own petard’: Evidence and democratic deliberation on obesity. Policy Sci 2014;47(4):345–65. doi: 10.1007/s11077-014-9195-4.CrossRefGoogle Scholar
  43. 43.
    Live Well, Be Well: New Brunswick’s Wellness Strategy Action Plan (2009–2013). New Brunswick Department of Wellness, Culture & Sport, 2009. Available at: http://www2.gnb.ca/content/dam/gnb/Departments/sd-ds/pdf/Wellness-MieuxEtre/NewBrunswickWellnessStrategy2009-2013.pdf (Accessed November 28, 2017).
  44. 44.
    Healthier Together: A Strategic Health Plan for Newfoundland and Labrador. St. John’s, NL: Government of Newfoundland and Labrador, Department of Community Health Services, 2003. Available at: http://www.health.gov.nl.ca/health/publications/healthytogetherdocument.pdf (Accessed November 28, 2017).
  45. 45.
    Forhan M, Ramos Salas X. Inequities in healthcare: A review of bias and discrimination in obesity treatment. Can J Diabetes 2013;37(3):205–9. PMID: 24070845. doi: 10.1016/j.jcjd.2013.03.362.CrossRefGoogle Scholar
  46. 46.
    Ellison J. Weighing in: The “evidence of experience” and Canadian fat women’s activism. Can Bull Med Hist 2013;30(1):55–75. PMID: 28155520. doi: 10.3138/cbmh.30.1.55.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Kuk JL, Ardern CI. Are metabolically normal but obese individuals at lower risk for all-cause mortality? Diabetes Care 2009;32(12):2297–99. PMID: 19729521. doi: 10.2337/dc09-0574.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Sharma A. Why redefine obesity? Blog, 2017. Available at: http://www.drsharma.ca/why-redefine-obesity (Accessed June 2, 2017).Google Scholar
  49. 49.
    Sharma AM, Campbell-Scherer D. Redefining obesity: Beyond the numbers. Obesity 2017;25(4):660–61. PMID: 28349662. doi: 10.1002/oby.21801.CrossRefGoogle Scholar
  50. 50.
    Glenn NM, Champion CC, Spence JC. Qualitative content analysis of online news media coverage of weight loss surgery and related reader comments. Clin Obes 2012;2(5-6):125–31. PMID: 25586247. doi: 10.1111/cob.12000.PubMedCrossRefGoogle Scholar
  51. 51.
    Brochu PM, Pearl RL, Puhl RM, Brownell KD. Do media portrayals of obesity influence support for weight-related medical policy? Health Psychol 2014;33:197–200. PMID: 23668850. doi: 10.1037/a0032592.PubMedCrossRefGoogle Scholar
  52. 52.
    Freedhoff Y, Sharma AM. “Lose 40 pounds in 4 weeks”: Regulating commercial weight-loss programs. CMAJ 2009;180:367–68. PMID: 19221340. doi: 10.1503/cmaj.090071.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Summary Report: From Weight to Weil-Being: Time for a Shift in Paradigms? A Discussion Paper on the Inter-Relationships Among Obesity, Overweight, Weight Bias and Mental Weil-Being. British Columbia Provincial Health Services Authority, Population Public Health Program, 2013. Available at: http://www.phsa.ca/population-public-health-site/Documents/W2WBTechnicalReport_20130208FINAL.pdf (Accessed November 28, 2017).
  54. 54.
    Healthy families British Columbia Policy Framework: A Focused Approach to Chronic Disease and Injury Prevention. Victoria, BC: Ministry of Health, 2014. Available at: http://www.health.gov.bc.ca/library/publications/year/2014/healthy-families-bc-policy-framework.pdf (Accessed October 24, 2014).
  55. 55.
    James WPT. WHO recognition of the global obesity epidemic. Intj Obes 2008;32(Suppl 7):S120–26. PMID: 19136980. doi: 10.1038/ijo.2008.247.CrossRefGoogle Scholar
  56. 56.
    World Health Organization. Report of the Commission on Ending Childhood Obesity. Geneva, Switzerland: WHO, 2016. ISBN 978 92 4 151006 6. Available at: http://apps.who.int/iris/bitstream/10665/204176/l/9789241510066_eng.pdf?ua=1 (Accessed November 28, 2017).Google Scholar
  57. 57.
    Prince Edward Island Strategy for Healthy Living. Charlottetown, PE: Department of Health Social Services, 2002. Available at: http://www.gov.pe.ca/photos/original/hss_hl_strategy.pdf (Accessed November 28, 2017).
  58. 58.
    Wellness Alberta. A Wellness Foundation for Alberta: It’s About Health. It’s About Time. Edmonton, AB: Wellness Alberta, 2015. Available at: http://www.wellnessalberta.ca/position-paper.html (Accessed November 28, 2017).Google Scholar
  59. 59.
    Canadian Public Health Association. Making the Economic Case for Investing in Public Health and the SDH. Ottawa, ON: CPHA, 2016. Available at: https://www.cpha.ca/making-economic-case-investing-public-health-and-sdh (Accessed November 28, 2017).Google Scholar
  60. 60.
    Kyle T, Puhl R. Pervasive Bias: An Obstacle to Obesity Solutions. Commentary. Washington, DC: Institute of Medicine Roundtable on Obesity Solutions, 2014; Vol. 2014.Google Scholar
  61. 61.
    British Columbia Northern Health Position on Health, Weight and Obesity: An Integrated Population Health Approach. Prince George, BC: British Columbia Northern Health, 2012. Available at: https://northernhealth.ca/Portals/0/About/PositionPapers/documents/Health WtObesityPosition_20120730_WEB.pdf.
  62. 62.
    Dietz WH, Solomon LS, Pronk N, Ziegenhorn SK, Standish M, Longjohn MM, et al. An integrated framework for the prevention and treatment of obesity and its related chronic diseases. Health Aff 2015;34(9):1456–63. PMID: 26355046. doi: 10.1377/hlthaff.2015.0371.CrossRefGoogle Scholar
  63. 63.
    Alberta Health Services. Obesity Initiative. Edmonton, AB, 2011. Available at: http://www.albertahealthservices.ca/news/releases/2011/Page5670.aspx (Accessed November 28, 2017).Google Scholar
  64. 64.
    Kuk JL, Ardern CI, Church TS, Sharma AM, Padwal R, Sui X, et al. Edmonton Obesity Staging System: Association with weight history and mortality risk. Appl Physiol Nutr Metab 2011;36(4):570–76. PMID: 21838602. doi: 10.1139/h11-058.CrossRefGoogle Scholar
  65. 65.
    Bacon L, Aphramor L. Weight science: Evaluating the evidence for a paradigm shift. Nutr J 2011;10(1):9. PMID: 21261939. doi: 10.1186/1475-2891-10-9.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    WHO. GlobalPlan of Action on Social Determinants of Health, 2017. Available at: http://www.who.int/social_determinants/action_sdh/en/ (Accessed June 2, 2017).Google Scholar
  67. 67.
    WHO. HEALTH21: The Health for all Policy Framework for the WHO European Region, 1999. Available at: http://www.euro.who.int/en/publications/abstracts/health21-the-health-for-all-policy-framework-for-the-who-european-region (Accessed June 2, 2017).Google Scholar
  68. 68.
    Puhl RM, Liu S. A national survey of public views about the classification of obesity as a disease. Obesity 2015;23(6):1288–95. PMID: 25970728. doi: 10.1002/oby.21068.PubMedCrossRefGoogle Scholar
  69. 69.
    Kyle T. Reducing Weight Bias: Identifying Obesity as a Chronic Disease Helps, 2017. Available at: http://conscienhealth.org/2017/04/reducing-weight-bias-heres-pretty-strong-clue/ (Accessed June 2, 2017).Google Scholar

Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  • Ximena Ramos Salas
    • 1
  • Mary Forhan
    • 2
  • Timothy Caulfield
    • 3
  • Arya M. Sharma
    • 4
  • Kim Raine
    • 1
  1. 1.Centre for Health Promotion Studies, School of Public HealthUniversity of AlbertaEdmontonCanada
  2. 2.Department of Occupational Therapy, Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
  3. 3.Faculty of LawUniversity of AlbertaEdmontonCanada
  4. 4.Faculty of Medicine & DentistryUniversity of AlbertaEdmontonCanada

Personalised recommendations