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I received a request to write about an article titled “Graphic and grisly beverage warning labels stressing sugar content dangers could curb ob*sity*, study finds.”
The study found no such thing.
The study that the article was about divided 325 parents of kids ages 2-12 into two groups and sent them into a “naturalistic store laboratory.” Half were offered sugary drinks which had medically realistic pictures like a human foot more than half covered with gangrene with the message “Warning: Excess consumption of drinks with added sugar contributes to type 2 diabetes” or a human heart with the text “Warning Excess consumption of drinks with added sugar contributes to heart disease.” The other half were offered sugary drinks with a bar code. They found that there was a 17% decrease in the purchase of sugary drinks that had the pictures rather than the bar code. They concluded that “Pictorial warnings reduced parents’ purchases of sugary drinks for their children in this naturalistic trial. Warnings on sugary drinks are a promising policy approach to reduce sugary drink purchasing in the US.”
I’m not going to do a deep dive but I will say that there’s a lot wrong with this study (like the fact that the goal of the study, and thus the “right” action, may have been apparent to the participants who were shown the pictures with the labels, the ethical issues with using health conditions that people have as “gross out” pictures, the fact that the phrase “contributes to” is doing an awful lot of work to explain a complex and not fully understood possible relationship etc.) but at least they didn’t try to draw conclusions about body size change the way that the article does, because drinking sugary drinks and being fat aren’t the same thing.
Beyond that, existing research has shown that interventions like this, especially when used within an anti-fat context, drive shame and stigma, perpetuate eating disorders, and have little to no impact on weight or health (and it’s important to note that neither health nor weight outcomes were examined by this very small study.) The fact that this research was undertaken in the first place suggests that the researchers are either ignorant about the existing research, or do not care about the harm they might create. (The study does claim to have had a “weight stigma expert” but isn’t clear about who, so it’s quite possible that they were actually a weight loss industry representative.)
In fact, existing research shows that positive, weight-neutral messages about health improvement do the least harm and create the greatest benefit for people of all sizes. The interventions suggested by these researchers are wholly unnecessary, irresponsible, and potentially harmful.
The 2020 BEAT report found that interventions like these increase the vulnerability of those at risk of developing an eating disorder, exacerbate eating disorder symptoms in those already diagnosed with an eating disorder, and show little success at reducing “ob*sity” (BEAT UK Eating Disorders Association, Changes Needed to Government Anti-ob*sity Strategies 2020)
Campaigns that use higher-weight people and people with health issues as cautionary tales increase stigma, which studies have shown decreases healthcare engagement and increases disease risk. (Muennig I Think Therefore I Am: Perceived Ideal Weight as a Determinant of Health 2007)
Studies have shown that just reading news reports about the supposed health risks of larger body size leads to greater anti-fat prejudice, including greater support for/ willingness to discriminate against fat people. This held true even if an explicit anti-weight-stigma message was included. (Saguy et. al. Reporting risk, producing prejudice: How news reporting on ob*sity shapes attitudes about health risk, policy, and prejudice; Frederick et. al, Effects of competing news media frames of weight on anti-fat stigma, beliefs about weight and support for ob*sity-related public policies)
A study about three times the size of this one from the Rudd Center (which is problematic because, while they study weight stigma, their work is rooted in weight stigma,) found that messages with stigmatizing content received the most negative ratings and the lowest intentions to comply, while messages that were perceived to be most positive and motivating made no mention of the word ‘ob*sity’ at all, and instead focused on making healthy behavioral changes without reference to body weight, and that people responded most favorably to messages involving themes of increased fruit and vegetable consumption, and general messages involving multiple health behaviors.” (Puhl et. al. Public perceptions of ob*sity-related health messages)
Interestingly, the picture of the heart that they used to try to scare people is very similar to a picture of a healthy heart, ready for transplant that has also made the social media rounds as an anti-fat meme, making me wonder if they are simply trying to stereotype the existence of fat as bad without concern about the truth of physiological realities, or if they just assume people will be grossed out by a picture of a healthy human heart?
So this study is questionable but at least they were honest with their conclusions. I wish I could say the same for the article from FoodIngredientsFirst which bills itself as “the point of call for food and beverage companies to keep entirely up to date with trends in the food and beverage industry. We’re the leaders when it comes to food industry news, statistics, trends and analysis, offering insights into a huge range of diverse categories”
The article begins:
“Deliberately shocking consumers with gruesome images depicting wounds, disease and illness linked to ob*sity could be the key to tackling the ob*sity crisis, flags one recent study into sugar drink beverage labels.”
This is a great example of how media, through a lack of scientific literacy and/or an abundance of weight stigma looking for a place to happen, creates misinformation. The article states repeatedly that this study’s findings are about/will impact childhood “ob*sity.” But neither the study, nor quotes from the study’s authors back this up. Nor does basic logic since the health issues meant to be represented by the pictures are health issues that happen to people of all sizes (remember that “illnesses linked to ob*sity” are illnesses that people of all sizes get, that get labeled that way when fat people have them) and, of course, the study was in no way designed to determine what impact, if any, these drink choices might have on the eventual size of children.
Finally, “the key” …really? The (self-described!) “leaders when it comes to food industry analysis” think that “the key” to the (horrific) goal of ridding the world of fat people is some parents buying 17% less sugary drinks? Seriously?
And they aren’t the only ones who made these mistakes. A quick scan of the articles on the study’s media page on PLOS found that this mistake was made by large outlets (including WebMD) and media outlets of all sizes across the globe and in multiple languages.
Anti-fat sentiment is ubiquitous. The fact that it is easy to get funding for anti-fat research (far easier than to get funding for supporting the health of fat people) means that there is a ton of that kind of research. The fact that anti-fatness sells means that, in a world where media outlets count on eyeballs to stay afloat, anti-fatness is often written into fact, without benefit of logic or evidence. These types are articles and studies are always reader beware.
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More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Excellent article, Ragen!
The idea of using graphic and disturbing medical "porn" to instill awareness and caution is insane, unethical, scary and demoralizing. I can't wait to see photos of compound fractures in a ski shop, ghastly motor vehicle fatalities while renewing my driver's license, and, crispy burn victims as I pick out my new toaster oven.
But that would never happen. Not the blame, not the shame, not the condescension, not the horror. Why, it's wrong to even imagine that.
But you can do it if you're trying to fix or eradicate fat people.
Thank you. People have internalized this nest of oppressive media and cultural transmission until the cacophony is astounding and yet only a few of us point it out. At least a few of us are speaking up and writing to dissuade future minds from falling down these wells of oily influence. It does feel like others drill and drill and drill into me until they find a vulnerable spot where they can point to me, individually, as culprit to carry the fatness in my circle. If it was me all along, what a relief. How much cheaper and easier if I just die and they never need examine the suffering caused by culture, environment, and unsustainable stories. Until the next girl & woman like me emerges.