Taeku Lee and J. Eric Oliver examined prevailing sentiments about weight-related issues in Public Opinions and the Politics of America's Obesity Epidemic (Cambridge, MA: Harvard University, 2002). Lee and Oliver sought to characterize Americans' attitudes about obesity to determine how attitudes and beliefs affect support for obesity-related policy changes. They asserted that the concept of "moral failure" is at the root of public opinions that hold obesity as a personal choice and responsibility. They posited that obesity violates the valued American trait of self-reliance. Characterizing people who are obese as lazy, undisciplined, and lacking self-control enables the public to hold them responsible for their condition, and may be used as justification for bias and discrimination. The authors also posited that when obesity is understood as resulting from a lack of individual motivation, there will be little support for such policies as government regulations, civil protections, or taxes to prevent and decrease it.
Lee and Oliver observed that because obesity in America is a relatively recent phenomenon, public opinions about it are still forming, and most proposed policy changes—including taxes on sugary or high-fat snack foods, strengthening civil protections for individuals who are obese, and increasing the availability of public land for exercise—are unsupported or actively opposed by a majority of Americans. In contrast, growing support exists for measures that regulate food advertising to children and that provide more nutritious school lunches. The authors attributed lack of enthusiasm for policy changes to low levels of awareness of the severity and scope of the problem as well as deeply held negative stereotypes about people who are overweight and obese. They assert that as Americans learn that the rapid rise in obesity during the past two decades did not result from moral failure, they will be more inclined to advocate policies aimed at preventing and reducing obesity.
Americans Feel Obesity Is A Lifestyle Issue
The view that overweight and obesity are matters of personal responsibility is reflected by the overwhelming public sentiment that obesity results from bad habits and lifestyle. A Gallup Poll conducted in 2004 found that three-fourths of Americans (75%) view obesity as a problem resulting from bad eating and lifestyle habits, while only 21% view it as a disease. (See Figure 11.12.)
Ironically, older Americans, who are the most likely to benefit from a change in Medicare policy that would cover treatment for obesity if it is considered a disease, were less likely than younger Americans to judge it so in 2004. Just 10% of people aged sixty-five and older considered obesity a disease, compared with more than one-third (34%) of eighteen to twenty-nine-year-olds. Women were slightly more likely than men to see obesity as a disease, 25% of women compared with 17% of men. Interestingly, individuals who described themselves as overweight and those who considered themselves "about right" or underweight were equally likely to define obesity as a disease in the 2004 poll. (See Figure 11.13.)
Americans Understand That Obesity Is A Public Health Problem
A June 2005 opinion poll conducted by the Harvard School of Public Health and supported by a grant from the CDC found that three-quarters of Americans at that
FIGURE 11.12 Public opinion on whether obesity is a disease or a lifestyle issue, 2004
The poll found that about one-third of Americans (35%) were monitoring the fat and carbohydrate content in their daily diets. Like the Gallup Poll, this survey found that while more than half (54%) of those surveyed considered themselves to be overweight, less than one-third (32%) were attempting to lose weight.
Americans are aware that being moderately overweight leads to serious health problems; however, they remain unconvinced that overweight and obesity lead to premature death. Half (51%) of the respondents in the Harvard poll thought that someone who is moderately overweight would be more likely than someone of healthy weight to die prematurely. Nearly three-quarters (73%) believed that a moderately overweight person would be more likely than someone of healthy weight to develop a chronic illness such as diabetes or high blood pressure.
In view of apparently conflicting reports of the supremacy of one diet over another, it is not surprising that the Harvard poll found differing sentiments about the credulity of obesity researchers and nutrition experts. About
FIGURE 11.13 Public opinion on whether obesity is a disease, by gender, age, and self-described weight situation, 2004.
In a July 14, 2005 press release, CDC Director, Dr. Julie Gerberding said the results of the Harvard School of Public Health Poll were very encouraging because they pointed to heightened awareness of the health risks associated with obesity. Dr. Gerberding asserted that, "Americans are not confused about the facts. They know obesity is a serious health threat and that being overweight can lead to diabetes, heart attacks, and cancer. As the survey shows, people also know they should be getting more physical activity each week and eating more fruits and vegetables, and many are doing so. That's terrific news. The survey shows that people are knowledgeable, and most of them are motivated, and we hope that people will take even more steps to achieve a healthy weight and physical fitness for themselves and their families."
TABLE 11.3 Public opinion on whether companies should be allowed to refuse to hire people just because they are significantly overweight, 2005
| TABLE 11.3 | |||
|---|---|---|---|
| Public opinion on whether companies should be allowed to refuse to hire people just because they are significantly overweight, 2005 | |||
| DO YOU THINK COMPANIES SHOULD BE ALLOWED TO REFUSE TO HIRE PEOPLE JUST BECAUSE THEY ARE SIGNIFICANTLY OVERWEIGHT, OR NOT? | |||
| Date | Yes, should | No, should not | No opinion |
| SOURCE: "Do You Think Companies Should Be Allowed to Refuse to Hire People Just Because They Are Significantly Overweight, or Not?" in Personal Weight Situation, The Gallup Organization, August 2005, http://poll.gallup.com/content/default.aspx?ci=7264&pg=2 (accessed January 14, 2006). Copyright © 2005 by The Gallup Organization. Reproduced by permission of The Gallup Organization. | |||
| 2005 Jul 7-10 | 16% | 82% | 2% |
Prejudice and Discrimination
While much research has documented instances of stigmatization, bias, and discrimination against people who are overweight or obese, a Gallup Poll survey conducted in 2003, reported that most overweight Americans do not feel that they have been discriminated against because of their weight, and the majority of Americans deny feeling prejudice against people who are overweight. Eighty-two percent of overweight survey respondents said they had never experienced weight-based discrimination, and an additional 4% said it occurred less often than once a year. Just 16% of survey respondents said that the fact that a person is overweight would cause them to respect that person less; however, 20% conceded that they would be less likely to hire an overweight candidate for a job. In 2005 Gallup Poll survey respondents reiterated their opposition to job discrimination. The majority (82%) said they thought companies should not be allowed to refuse to hire people just because they are significantly overweight. (See Table 11.3.)
Although the survey respondents said they were not prejudiced against people who were overweight, in 2003, 43% agreed that setting higher health insurance rates for significantly overweight individuals was justified. By 2005 the percentage of Americans that believed higher health insurance premiums were justified dropped to 37%, and 66% of respondents said they felt higher premiums were unjustified. (See Table 11.4.)
Another survey, Nearly One-Half of Americans Polled Believe Obese Workers Are Discriminated Against on the Job (San Francisco, CA: Employment Law Alliance, 2003), found that 47% of American workers believe obese employees suffer discrimination in the workplace. Thirty-two percent of those polled thought that obese workers were less likely to be respected and taken seriously at work. Thirty-one percent said overweight and obese workers deserved special government
TABLE 11.4 Public opinion on whether it would be justified to set higher health insurance rates for people who are significantly overweight, 2005
| TABLE 11.4 | |||
|---|---|---|---|
| Public opinion on whether it would be justified to set higher health insurance rates for people who are significantly overweight, 2005 | |||
| "DO YOU THINK IT WOULD BE JUSTIFIED OR UNJUSTIFIED TO SET HIGHER HEALTH INSURANCE RATES FOR PEOPLE WHO ARE SIGNIFICANTLY OVERWEIGHT? | |||
| Date | Justified | Unjustified | No opinion |
| *Asked of a half sample. | |||
| SOURCE: Do You Think It Would Be Justified or Unjustified to Set Higher Health Insurance Rates for People Who Are Significantly Overweight?" in Personal Weight Situation, The Gallup Organization, August 2005, http://poll.gallup.com/content/default.aspx?ci=7264&pg=2 (accessed January 14, 2006). Copyright © 2005 by The Gallup Organization. Reproduced by permission of The Gallup Organization. | |||
| 2005 Jul 7-10* | 37% | 61% | 2% |
| 2003 Jul 7-9 | 43% | 55% | 2% |
In "Do Unhealthy Americans Get Too Much Respect?" (Gallup Poll Tuesday Briefing, September 16, 2003) Gallup Organization health-care editor Rick Blizzard posited that while it may be "politically correct" not to discriminate against people who are overweight, as well as those who smoke or drink alcohol excessively, acceptance of behaviors which are to some degree controllable may be counterproductive. Blizzard worried that an over-reliance on research and development to identify "medical solutions" for every health problem, including overweight, coupled with a tendency to blame others for health behaviors and health problems would discourage Americans from assuming an active role in their own health by engaging in healthy behaviors.
Blizzard expressed concern that without peer pressure to reduce health risks by losing weight and exercising more, public sentiment relieves individuals of any personal responsibility for their health-related behaviors and tacitly reinforces the acceptability of overweight and obesity. He observed that Gallup data suggested that peer pressure to engage in healthy behaviors is low. Blizzard and many public health educators worry that the public's apparent indifference may undermine even the most aggressive attempts to combat the obesity epidemic in America.
In another commentary, Obesity Epidemic: Are Americans in Denial? (Gallup Poll News Service, May 24, 2005), Blizzard reminded readers that reducing the prevalence of obesity to less than 15% of Americans by 2010 is one of the principal public health objectives set forth by the CDC. He asserted that to accomplish this objective, "Medical professionals need to continue to work against the false perception that there is a 'quick fix' for obesity—and seek ways to improve Americans' self-discipline regarding the lifestyle changes that are the true long-term solution."
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