Public Reactions to Obesity-Related Health Campaigns

A Randomized Controlled Trial


      Despite numerous obesity-related health campaigns throughout the U.S., public perceptions of these campaigns have not been formally assessed. In addition, several recent publicized campaigns have come under criticism in the popular media for reinforcing stigmatization of obese people. Thus, research in this area is warranted.


      To systematically assess public perceptions of recent obesity-related public health campaigns in the U.S.




      The data were collected online in summer 2012 from a nationally representative sample of American adults (N=1085).


      Participants were randomly assigned to view 10 obesity-related health campaigns that were pretested and publicly criticized as being stigmatizing of obese people, or 10 campaigns that contained more-neutral content.

      Main outcome measures

      Participants provided evaluations of each of the campaigns regarding the extent to which campaigns were rated to be stigmatizing of obese people, motivating for improving lifestyle behaviors, and promoting of self-efficacy for healthy behavior change. Participants additionally evaluated the appropriateness of the visual content depicted in each campaign. Analysis was completed in 2012.


      Stigmatizing campaigns were no more likely to instill motivation for improving lifestyle behaviors among participants than campaigns that were more neutral (OR=1.095, 95% CI=0.736, 1.630). Stigmatizing campaigns were also rated as inducing less self-efficacy (adjusted mean difference = –0.171 SD, 95% CI= –0.266, –0.076) and having less-appropriate visual content compared to less stigmatizing campaigns (adjusted difference in probability = –0.092, 95% CI= –0.124, –0.059). These findings remained consistent regardless of participants’ body weight, and were generally consistent across sociodemographic predictors.


      This study highlights the need for careful selection of language and visual content used in obesity-related health campaigns, and provides support for efforts to portray obese people in a nonstigmatizing manner.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Puhl R.M.
        • Heuer C.A.
        Obesity stigma: important considerations for public health.
        Am J Public Health. 2010; 100: 1019-1028
      1. CDC. HIV prevention strategic plan through 2005. 2001.

        • Hilton S.
        • Patterson C.
        • Teyhan A.
        Escalating coverage of obesity in UK newspapers: the evolution and framing of the "Obesity Epidemic" from 1996 to 2010.
        Obesity. 2012; 20: 1688-1695
        • Puhl R.
        • Heuer C.A.
        The stigma of obesity: a review and update.
        Obesity. 2009; 17: 941-964
        • Schvey N.
        • Puhl R.M.
        • Brownell K.D.
        The impact of weight stigma on caloric consumption.
        Obesity. 2011; 19: 1957-1962
        • Carter S.M.
        • Rychetnik L.
        • Dietetics P.
        • et al.
        Evidence, ethics, and values: a framework for health promotion.
        Am J Public Health. 2011; 101: 465-472
      2. Puhl RM, Peterson JL, Luedicke J. Fighting obesity or obese persons? Public perceptions of obesity-related health messages. Int J Obesity 2012; doi:10.1038/ijo.2012.156

      3. Freeman D.W. Are Georgia's anti-obesity ads unfair to fat kids? 2011.

      4. Crary D. Do Georgia's child obesity ads go too far? 2011.

        • Stein K.
        Obesity PSAs: are they working as a public service?.
        J Am Diet Assoc. 2008; 108: 25-28
        • Katz D.L.
        Exploring effectiveness of messaging in childhood obesity campaigns.
        Child Obes. 2012; 8: 97-105
        • Guttman N.
        • Guilt C.T.
        fear, stigma, and knowledge gaps: ethical issues in public health communication intervention.
        Bioethics. 2004; 18: 531-552
        • Walls H.L.
        • Peters A.
        • Proietto J.
        • McNeil J.J.
        Public health campaigns and obesity: a critique.
        BMC Public Health. 2011; 11: 136-153
        • ten Have M.
        • de Beufort I.D.
        • Teixeira P.J.
        • Mackenbach J.P.
        • van der Heide A.
        Ethics and prevention of overweight and obesity: an inventory.
        Obes Rev. 2011; 12: 669-679
        • Lewis S.
        • Thomas S.L.
        • Hyde J.
        • Castle D.
        • Warwick Blood R.
        • Komesaroff P.A.
        “I don't eat a hamburger and large chips every day!" A qualitative study of the impact of public health messages about obesity on obese adults.
        BMC Public Health. 2010; 10: 309-317
        • Thomas S.L.
        • Lewis S.
        • Hyde J.
        • Castle D.
        • Komesaroff P.
        “The solution needs to be complex." Obese adults' attitudes about the effectiveness of individual and population based interventions for obesity.
        BMC Public Health. 2010; 10: 420-428
      5. Puhl RM, Peterson JL, DePierre J, Luedicke J. Headless, hungry, and unhealthy: a video content analysis of obese persons portrayed in online news. J Health Commun 2013; doi:10.1080/10810730.2012.743631.

        • Heuer C.
        • McClure K.
        • Puhl R.M.
        Obesity stigma in online news: a visual content analysis.
        J Health Commun. 2011; 16: 976-987
        • Pearl R.L.
        • Puhl R.M.
        • Brownell K.D.
        Positive media portrayals of obese persons: impact on attitudes and image preferences.
        Health Psychol. 2012; 31: 821-829
        • McClure K.
        • Puhl R.M.
        • Heuer C.A.
        Obesity in the news: do photographic images of obese persons influence anti-fat attitudes?.
        J Health Commun. 2011; 16: 359-371
        • Banning S.A.
        Do you see what I see? Third-person effects on public communication through self-esteem, social stigma, and product use.
        Mass Commun Soc. 2001; 4: 127-147
        • Huhman M.
        • Heitzler C.
        • Wong F.
        The VERB campaign logic model: a tool for planning and evaluation.
        Prev Chronic Dis. 2004; 1: A11
        • Allen J.
        New York anti-obesity ads pair soda, leg amputations.
        Reuters. 2012 10;
        • Hartocollis A.
        E-mails reveal dispute over city's ad against sodas.
        New York Times, 2010 29
        • McGeehan P.
        Blame Photoshop, not diabetes, for this amputation.
        New York Times, 2012 25
      6. Maisto M. Cheese makes you fat, says new ad campaign. 2012.

        • Atanasova D.
        • Koteyko N.
        • Gunter B.
        Obesity in the news: directions for future research.
        Obes Rev. 2012; 13: 554-559
        • Gelman A.
        • Hill J.
        Data analysis using regression and multilevel/hierarchical models.
        Cambridge University Press, New York2007
      7. Bureau USC. General demographic characteristics. U.S. Census Bureau, 2011.

      8. National Heart, Lung, and Blood Institute. How are overweight and obesity diagnosed? 2010.

        • Flegal K.M.
        • Carroll M.D.
        • Kit B.K.
        • Ogden C.L.
        Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999-2010.
        JAMA. 2012; 307: E1-E7
        • Crister G.
        Fat land: how Americans became the fattest people in the world.
        Houghton Mifflin, New York NY2004
      9. Gray E. Georgia anti-obesity ads say “stop sugarcoating” childhood obesity. Huffington Post 2012, Jan 3.

      10. Grinberg E. Georgia’s child obesity ads aim to create movement out of controversy. CNN 2012, Feb 7.

        • Puhl R.M.
        • Brownell K.D.
        Confronting and coping with weight stigma: an investigation of overweight and obese adults.
        Obesity. 2006; 14: 1802-1815
        • Vartanian L.R.
        • Novak S.A.
        Internalized societal attitudes moderate the impact of weight stigma on avoidance of exercise.
        Obesity. 2010; 19: 757-762
        • Libbey H.P.
        • Story M.T.
        • Neumark-Sztainer D.R.
        • Teasing K.N.
        disordered eating behaviors, and psychological morbidities among overweight adolescents.
        Obesity. 2008; 16: S24-S29
        • Amy N.K.
        • Aalborg A.
        • Lyons P.
        • Keranen L.
        Barriers to routine gynecological cancer screening for White and African-American obese women.
        Int J Obes. 2006; 30: 147-155
        • Puhl R.
        • Moss-Racusin C.
        • Schwartz M.B.
        Internalization of weight bias: implications for binge eating and emotional wellbeing.
        Obesity. 2007; 15: 19-23
        • Puhl R.M.
        • Peterson J.L.
        • Luedicke J.
        Motivating or stigmatizing? Public perceptions of language about weight used by health providers.
        Int J Obes. 2013;