Criticising Stigma Whilst Reinforcing it: the Case of the Response to CRUK’s Anti-Obesity Campaign

Written by Rebecca Brown

There has been recent concern over CRUK’s (Cancer Research UK) latest campaign, which features the claim ‘obesity is a cause of cancer too’ made to look like cigarette packets. It follows criticism of a previous, related campaign which also publicised links between obesity and cancer. Presumably, CRUK’s aim is to increase awareness of obesity as a risk factor for cancer and, in doing so, encourage people to avoid (contributors to) obesity. It may also be hoped to encourage public support for policies which tackle obesity, pushing the Overton window in a direction which is likely to permit further political action in this domain.

The backlash is mostly focused around the comparison with smoking, and the use of smoking-related imagery to promote the message (there is further criticism of the central causal claim, since it is actually quite difficult to establish that obesity causes cancer). 

An open letter to CRUK, signed by academics and healthcare professionals, makes the point: 

Given that the dominant public perception is that weight gain is caused by a lack of willpower and that weight can be reduced easily and rapidly, when you frame people’s weight as the problem, instead of directly addressing the environmental factors you intend to change through policy, you are effectively telling people that cancer is their fault. Through making a direct comparison between smoking and weight, your campaign contributes to these assumptions, suggesting that it is a lifestyle choice. This belies the reality.

The signatories are correct to point to the need to address environmental factors to tackle obesity, and to question the usefulness of suggesting that, in order to reduce weight, individuals just need to make better choices and exercise some more willpower. But why state that the comparison with smoking suggests that obesity is a lifestyle choice? It is disappointing to see those concerned about the stigmatisation of obese people apparently content, in criticising CRUK for this transgression, to reinforce the stigma currently experienced by smokers. It seems, according to this thinking, smoking is a lifestyle choice and smokers who develop cancer (and other diseases) as a result, are at fault. Smokers, and those suffering from smoking-related diseases, are of course already targets of plentiful stigma. 

The authors might like to remember that many of the same socio-economic factors that are correlated with obesity are also correlated with smoking. Many people who smoke do so for a range of reasons, and some smokers would prefer not to smoke but find it difficult to stop; much as many people who overeat do so because of an interplay of different personal, social and environmental factors, and struggle to reduce their weight despite having a desire to do so. It is also worth noting that obese people are more likely to smoke (as well as engage in various other health-risking behaviours). So at least some of the time, when we are discussing those who smokes and whose who are obese, we are talking about the same people.

Unless it is clear that individuals are behaving in morally wrongful ways (e.g. causing significant and avoidable third party harm) it is inappropriate to use stigmatising campaigns in order to raise awareness and encourage behaviour change. To the extent CRUK do this, they should be criticised. But by reinforcing the stigmatisation of smokers in the course of defending obese people, the authors of the open letter are guilty of much the same thing.