In 2012, the Western Australian government released a penetrative health campaign that was akin to the graphic and shaming nature of anti-smoking campaigns. It shows a man who lives in a larger body reaching into the fridge to eat left over pizza while he pinches his abdomen and the camera pans to a shot of visceral fat on the bowel. It then takes us into this mans living room where the imagery and audio imply that the overconsumption of food will lead to a reduced lifespan, principally impacting his children. At the time, this was met with anger and discussion pieces that raised concern about this approach (ref).
Thirteen years on and it seems that some state health advisory groups not only have not learnt from this, but believe that despite the well documented harms that campaigns like this cause, it is worth re-launching. The South Australian Government has this week relaunched this campaign along with the fear mongering and unethical program.
The concern is that these campaigns are expensive, ineffective and harmful. A study conducted by the LiveLighter team outlines to run promote this program for 22 weeks was $2.5 million dollars in 2017 (REF). This program resulted in a 0.6kg weight loss over the 12 months, supposedly by decreasing the reduction of sugary foods by 0.3 serves and sugary drinks by 0.8 serves. What that means in real food is unclear. The survey they used for this analysis was unvalidated and did not include measures of foods. Further, the survey was biased towards sugary foods and beverages, so the participants consumption of fruits, vegetables, complex carbohydrates and proteins were not considered. They espouse that this would equal a healthcare saving of $3.2 million over the lifetime of the people involved. Unsurprisingly, this did not include considerations for increases in disordered eating and eating disorders in this sample.
Since the WA government launched this program, we have more data to help us understand why campaigns such as this are harmful and unethical. A systematic review (collation of available evidence) clearly outlines that public health messages such as those we see in LiveLighter make people feel like ‘failures’, ‘self-conscious’ and ‘bad’ about themselves and their bodies (REF). Further, messages such as these promote the thin-ideal as well as encourage behaviour associated with bulimia and restriction, particularly in young women (REF).
The thin-ideal or thin glorification is pervasive in our medical and public health systems. It suggests that smaller bodies are inherently healthier and that larger bodies are just smaller bodies without enough willpower. There are multiple flaws in this logic. Firstly, people in smaller bodies can and do develop metabolic syndrome (REF). Being in a smaller body and getting metabolic syndrome are not mutually exclusive. Further and more concerningly, what thin glorification perpetuates is the harmful assumption that people in larger bodies have poor health behaviours and that they are less worthy of care when something does go wrong. The devaluation of larger bodies is associated with the assumption that the control for their health was a choice they decided to ignore. It implies that because they believe their choices led them to have health issues, these health issues are less of a priority than others that did not play an active role in their health issue. This assumption is not only incorrect, it is discrimination. However, it persists as public perception and rooted in our medical system. Naturally this means that people in larger bodies often avoid or delay healthcare, which only exacerbates the negative health outcomes associated with chronic health conditions.
These harmful assumptions are called anti-fat bias or weight stigma. In the literature when accounting for factors such as body mass index, sedentary behaviour, healthcare avoidance and demographics, people exposed to weight stigma from a healthcare professional were more likely to develop hypertension, hyperglycemia and eating disorders (REF). This highlights the concern regarding a campaign such as LiveLighter.