) -- Unhappy with the slow pace of
public health efforts to curb America's stubborn obesity epidemic, a prominent
bioethicist is proposing a new push for what he says is an "edgier strategy" to
promote weight loss: ginning up social stigma.
Daniel Callahan, a senior
research scholar and president emeritus of The Hastings Center, put out a new paper this week calling for
a renewed emphasis on social pressure against heavy people -- what some may call
fat-shaming -- including public posters that would pose questions like this:
"If you are overweight or
obese, are you pleased with the way that you look?"
Callahan outlined a strategy
that applauds efforts to boost education, promote public health awareness of
obesity and curb marketing of unhealthy foods to children.
But, he added, those plans
could do with a dose of shame if there's any hope of repairing a nation where
more than a third of adults and 17 percent of kids are obese.
"Safe and slow incrementalism
that strives never to stigmatize obesity has not and cannot do the necessary
work," wrote Callahan in a Hastings Center Report from the nonprofit bioethics
Weight-acceptance advocates and
doctors who treat obesity reacted swiftly to the plan proposed by Callahan, a
"For him to argue that we need
more stigma, I don't know what world he's living in," said Deb Burgard, a
California psychologist specializing in eating disorders and a member of the
advisory board for the National Association to Advance Fat Acceptance.
"He must not have any contact
with actual free-range fat people," she added.
That view is shared by Dr. Tom
Inge, an expert in childhood obesity at the Cincinnati Children's Hospital
"No amount of teasing, probing
questions about what they wish they could do, or medications seem to help," Inge
said. "So if one is proposing to help them by more stigmatization, that would
seem at once both antithetical and unethical."
Still, Callahan, a former
smoker, argued that public shunning of those who lit up led to plunging rates of
cigarette use. People were asked to smoke outside and told directly or
indirectly that their "nasty" habit was socially unacceptable.
"The force of being shamed and
beat upon socially was as persuasive for me to stop smoking as the threats to my
health," he wrote. "The campaign to stigmatize smoking was a great success
turning what had been considered simply a bad habit into reprehensible
That same pressure could be
applied to overweight people, perhaps leading to increased efforts by people to
eat right, exercise -- and
actually succeed in losing weight, Callahan argued.
"The individual seems to be
left out of this," he told NBC News.
But the difference between
smoking and obesity is huge, said Burgard, the eating disorder expert.
"Deciding whether to smoke or
not is a behavior," she said. "The weight your body is is not a behavior."
Stigmatizing obesity targets
not just the act, but the entire person.
"It's a kind of identity you
have that is actually the very most intimate thing about you: your very body,"
Callahan does worry that
increased stigma will lead to more retaliation against overweight people in
employment and other areas. He frets about finding a way to pressure people to
do something about their extra pounds, but without making them feel too badly
"Can there be social pressure
that does not lead to outright discrimination - a kind of stigmatization lite?"
Callahan's theory has drawn
criticism, not only from obesity specialists, but also from other bioethicists.
There's already plenty of stigma heaped on the obese, said Art Caplan, the head
of the Division of Medical Ethics at NYU Langone Medical Center, and an NBC News
"Zinging the chubby does not
require a shift in our daily conversation," he said. "Plenty of Americans are
already more than willing to chide their fellow fatties about their weight."
Instead of shaming people,
social efforts should focus on forcing food manufacturers and marketers to stop
creating what's been termed an "obesogenic environment."
"Calls on each of us to take
more charge of our food behavior in an environment in which the promotion of
fast, unhealthy foods is omnipresent and celebrity chefs extol the wonders of
high-caloric meals on television hour after hour is to spit personal virtue
against a tsunami of marketing coming in the other direction," Caplan said.
Still, Inge, the medical
expert, says Callahan's call for more social pressure might play a role when it
comes to prevention, particularly with parents of kids
on the borderline of obesity.
"If we could somehow make an
impact with an edgier approach with young parents who for convenience
sake, or out of ignorance, poverty or whatever make very bad dietary and
lifestyle choices for their unwitting toddler, that might be something very
worthwhile," Inge said.
JoNel Aleccia, Staff Writer NBC News