Bioethics leader proposes bold and controversial approach to fight obesity epidemic

Daniel Callahan finds a lesson in the anti-smoking campaign

Arguing that obesity "may be the most difficult and elusive public health problem the United States has ever encountered" and that anti-obesity efforts having made little discernible difference, Daniel Callahan, co-founder and President Emeritus of The Hastings Center, proposes a bold and controversial approach to fighting the epidemic.

Callahan says that the public health community can learn from one of the most successful public health campaigns: the anti-smoking campaign. A primary strategy has been to stigmatize smokers, he says, making it clear that their behavior is not only unhealthy for them but is also socially unacceptable. While the public health community has decisively rejected the stigmatization of obesity, Callahan directly challenges that rejection.

In "Obesity: Chasing an Elusive Epidemic," an article in the Hastings Center Report, Callahan says that what he calls "stigmatization lite," if used carefully, could provide an important strategy in the strikingly unsuccessful effort to help the 67 percent of Americans who are overweight or obese lose weight. He cites estimates that no more than 10 percent of those who try to lose weight succeed in the long run.

Callahan does not deny that stigmatization can do harm, such as increasing the risk of discrimination in the workplace and health care. But he believes that that risk would be minimized by "stigmatization lite," in which people who are overweight consider the threat of discrimination itself as a danger to be avoided: "don't let this happen to you!" His aim is to complement, not replace, public health strategies that would bring to bear a strong government hand, making use of laws and regulations and subsidizing healthy foods, good medical counseling, and special efforts at obesity prevention programs for children.