Challenging Dogma

Friday, April 27, 2012

The PCRM’S Imprudent Approach to Obesity Prevention: Why Labeling, Blaming, and Shaming is an Ineffective, Harmful Tactic- Haley Hooks


In January 2012 the Physicians Committee for Responsible Medicine enacted a public health campaign targeted at reducing the obesity rate in Albany, New York. Two billboards on major highways now warn Albany residents that eating cheese is a health risk and contributes to the area’s high obesity rates. One billboard shows a man’s obese belly besides the blatant words “Your abs on cheese.” The other billboard features an obese woman pinching her thigh-fat next to the words “Your thighs on cheese” (1). The committee audaciously claims that the billboards are “a mirror, showing obesity as it really is, linking it appropriately to cheese, and making it clear that there is a problem here” (2). The PCRM president, Dr. Barnard, has also written a letter to members of the Albany school board, asking them to limit the dairy products served in school meals (1).

The PCRM directed its obesity prevention campaign at cheese because of its prevalence and health risks. The committee argues that New York State is one of the nations largest producers of dairy products and Albany County is home to several dairy farms. PCRM also points out that cheese is a prime target because it is typically 70% fat, high in saturated fat, and loaded with cholesterol and sodium. The committee rationalizes targeting the Albany school district because “school lunches… include an abundance of cheesy foods” (1). PCRM also argues that the increasing trend in obesity rates has directly corresponded with an increase in cheese intake (1)(2).

Consistent with the rest of the United States, obesity rates in New York are increasing. Nearly 63% of adults in Albany County are overweight or obese (3) and in 2009 it was named one of New York’s “fattest counties” (4). The New York State Department has reported that the state is in a childhood obesity crisis: one in four New Yorkers under the age of 18 is obese and the obesity rate for children has quadrupled over the past 30 years (3).

The increasing prevalence of obesity in Albany County and the rest of New York speaks to the need for a stronger public health approach to the epidemic. However, PCRM is taking an imprudent approach to tackling obesity; its narrow use of a singular, isolated objective has caused it to disregard the interrelated life style, psychological, and environmental issues with obesity. Stigmatizing and labeling obese individuals as being physically disgusting is heinous. By attributing obesity to cheese intake and advocating for a cheese-free diet, the campaign also falls victim to psychological reactance. PCRM’s negligent use of the fundamental attribution error is another problematic approach; by attributing obesity to one’s own individual behavior, the campaign is disregarding the powerful association between environmental factors and weight.

Critique #1: Labeling Obese Individuals as a Tactic to Endue Behavior Change is Stigmatizing and Demoralizing

The PCRM failed to significantly consider the negative impact of explicitly labeling obese individuals. Labeling theory was developed as an explication for why criminals behave differently than the general population. The central stance of labeling theory posits that the behaviors and self-identity of individuals may be directly affected by the words used to categorize and describe them (5-6). In relation to obesity, an individual is labeled as “obese” not because the person is necessarily fat, lazy, and weak-willed; the individual is labeled in that manner because society perceives the person as having the stereotypical behaviors of an obese individual and therefore treats the person accordingly. The obese label functions as a way to stereotypically differentiate the individual from the overall population, and in effect society treats the individual differently.

The PCRM’s campaign labels obese individuals as lazy, unattractive, and weak willed. This label stigmatizes obese individuals and shames them for being unable to control their weight. While shaming and stigmatizing obese individuals has commonly been used as a public health approach to control obesity, research has consistently shown that it is not a beneficial tool for reducing obesity or improving health (7-12). Rather, stigmatization of obese individuals poses serious risks to their psychological and mental health (7).

While the campaign was likely intended to promote behavior change, the way the message is depicted and disseminated will have subsequent adverse effects. The campaign’s problem based, negatively and individually focused, victim-blaming approach is likely to result in apportioning more blame, guilt, shame, and hopelessness on obese individuals. Negative reinforcement factors like the ones depicted in this campaign have been shown to cause obese individuals to deliberately avoid their weight problem because they do not want to be humiliated or made to feel guilty (8). The last thing that obese individuals need is a reminder of their undesirable weight status.

The paramount concern of stigmatizing overweight and obese individuals is the effect it has on their mental health. While excessive weight has not been shown to be necessarily distressing (7), the interpersonal mistreatment due to weight leads to concerning psychological and social consequences. Research has shown that the shame and social isolation induced by labeling obese individuals is significantly associated with depression (9). Emerging evidence also demonstrates that the frequency of weight stigma experiences is positively associated with the degree of depression (7). By stereotyping obese and overweight individuals, PCRM is intensifying the already conspicuous negative psychological and social effects of weight status.

Another concerning psychological ramification of PCRM’s ad campaign is the adverse effect it has on obese individual’s self-esteem. By portraying repulsive images of obese individuals, the add campaign is causing obese viewers to internalize the devaluation and negative images. As a mode of negative social feedback, this internalization can in turn alter or even damage their self-esteem by increasing feelings of body dissatisfaction, embarrassment about weight, and physical self-consciousness (10-11). Through invoking low self-esteem in obese individuals, PCRM is damaging obese individuals sense of self and disempowering them from striving to achieve a healthier weight.

By labeling obese individuals, PCRM’s ad campaign is not only negatively affecting obese individuals psychological and mental health, but also spoiling their social identity in the eyes of the general public. Through unequivocally shaming obese individuals as physically disgusting and weak-willed, the ad campaign is fueling the already pervasive social stigma attached to obesity (12). Obese individuals have become increasingly derogated and PCRM is exacerbating the issue by showing that it is socially acceptable to negatively stereotype individuals based on weight.

Critique #2: Faulty Use of the Attribution Framework Causes PCRM to Blame the Individual and Disregard the Role of the Environment

The architects of the PCRM campaign failed to consider the implications of the fundamental attribution error. Attribution theory suggests that people attempt to search for information that determines the cause for uncertain outcomes (12). It leads to a pervasive tendency on the part of observers to overestimate personality or dispositional causes of behavior and underestimate the influences of situation constraints on behavior (13). Conventional wisdom on the cause of obesity has not changed appreciably through the ages; it has long been socially acceptable to hold obese individuals accountable for their condition (14). Although research has consistently shown that body weight is in part determined by a complex interaction of life style, environmental, and genetic factors, there is a widespread perception that obese individuals are personally responsible for being overweight (10-14). The PCRM’s ad campaign is wrongly attributing obesity to individual behavior by associating it with a lack of self-control, laziness, and low self-discipline. This is reinforcing the fallacious notion that obesity is simply a disease under personal control.
The unattractive obesity ads also are amplifying the already prevalent social construct of obesity: that weight gain is due to a personal disposition, not a situation (10-14). It persuades viewers to believe that autonomy is sole reason for a person becoming obese and that the obesity epidemic should be tackled on an individual level. Through supporting the belief that obese individuals have freely chosen their unhealthy condition, the ad is amplifying the view that obesity is not attributable to anything other than free choice.

The PCRM’s belief that obese individuals can ameliorate their condition by simply focusing on changing their behavior is at odds with compelling evidence that propensity to obesity is to an extent determined by the environment (15-17). While PCRM has marginally considered the role of the environment by advocating for the Albany school board to limit cheese served in school meals, the committee is overlooking other environmental factors that contribute to obesity. The current environment in the US encourages consumption of unhealthy food through multiple avenues (15). Over the years there has been a dramatic increase in exposure to food advertising, especially commercials for fast food and convince foods. Advertising is a predominating medium by which human behavior is influenced, and the growth in food advertising has directly correlated with an increase in choosing higher-fat and higher-energy foods. Food pricing is another environmental factor influencing food choices. In terms of cost, fast food is now generally cheaper than fresh fruits and vegetables (16). Furthermore, a higher presence of supermarkets has been shown to be associated with a lower prevalence of obesity (17). By disregarding the role of advertising, food prices, and food availability, the campaign is limiting its potential for success.

By falsely attributing obesity to individual choices, PCRM is also negatively influencing the way obese individuals perceive themselves and their control over weight loss. In an environment flooded with cues encouraging eating unhealthy food and discouraging physical activity, sustained weight loss is increasingly challenging (18). By emphasizing that obese individuals have made the personal choice to over eat, the ad campaign is embedding obese individuals with the mindset that they have complete control over their behavior; if they decide to limit intake of unhealthy food (in this case solely cheese), they will undoubtedly lose weight. This false assumption will lead obese individuals to disregard the role of environmental influences and to believe that cycles of unsuccessful weight loss are merely due personal failure to change behavior. The ad’s faulty, narrow view of control over human behavior will likely cause obese individuals to feel helpless when they are unsuccessful at losing weight, which will further discourage them from attempting to do so.

Through presumptuously accusing obese individuals of being a product of their own behavior, PCRM is also contributing to the societal stereotype of obesity. Research has shown that the most significant predictor of greater stigmatizing attitudes is the attribution of obesity to individual behavior (19). The campaign’s communication of anti-fat messages is reinforcing the perception that body weight is within personal control and that the cause and solution for obesity resides within the individual. Thus, this message of personal responsibility is a key role in stigmatization and is justifying stigma as an acceptable societal response (7)(19).

Critique #3: PCRM Provokes Reactance Through a False, Controlling Message

The PCRM failed to adequately gauge the way the public would perceive and react to the campaign’s ads. By disregarding the public’s perception of the message, the campaign falls victim to psychological reactance. Psychological reactance theory hypothesizes that individuals become psychologically aroused when their perceived behavioral freedoms are threatened or reduced. The resulting reactance motivates attempts to restore the threatened freedoms (20). The degree of reactance induced is related to the explicitness of the message, the dominance of the person delivering the message, and the reasoning used to validate the message (21). Further research has shown that the magnitude of the request, the severity of the consequences, and the overall quality of the message also correlate with the extent of reactance (22).

PCRM is making a controlling and substantial request by implying that cheese should be removed from the diet. The campaign’s message, “Your abs/thighs on cheese,” attempts to control human behavior by arguing that cheese makes you fat, and therefore it should be eliminated from the diet. Highly controlling health-related messages are perceived as unfair and are associated with anger and less favorable judgments of source sociability (23). PCRM is also making a substantial request by inadvertently insisting that cheese should be removed from the diet. Cheese has historically been a large component of the American diet and suggesting that it should no longer be consumed is irrational.
The ad is also of low quality because the association between cheese and obesity is not supported by proven, scientific evidence, which further increases psychological reactance. Cheese intake alone does not cause obesity; by trying to persuade viewers that cheese makes you fat, the ad is losing credibility. Obesity is due to a complex interaction of genetic, life style, and environmental factors, not just eating cheese. While there has been debate over the role of genetics in obesity, specific genes have been shown to predispose individuals for weight gain and obesity seems to cluster in families (24). Physical inactivity and an excessive intake of solid fats, sugar, animal protein, alcohol, and refined carbohydrates are proven risk factors for overall weight gain (25). The increasing ‘obesogenicity’ of the environment- the prevalence of low cost fast food and advertisements for unhealthy, convenience food- is also a major force for the increasing obesity epidemic (14-16) (25). While the relationship between socioeconomic status and weight is complex, there is consistent support for the concept that low socioeconomic status is a risk factor for obesity (25). Most of the public has an understanding that there are multiple risk factors for weight gain and knows that cheese alone does not cause obesity. By disregarding the role of these other factors, the cheese-focused ad is directly limiting its trustworthiness and potential effectiveness.
Although the campaign was likely enacted with good intentions, the viewers will not see it that way. Because the ad’s message is controlling, poses a sizeable request, and does not have logical reasoning, a “boomeranged effect” will occur; individuals will seek to restore their threatened freedom by engaging in the exact behavior the ads aims to minimize (20). Most individuals who see the ads will likely think that they are competent and deserving of the freedom to choose to eat cheese. The irrationality of the ad’s argument will then motivate individuals to restore their threatened freedom by consuming more cheese. The ad’s negative message will also likely backfire on PCRM and cause source derogation- where reactance is followed by aggression or hostility aimed at the threatening agent (20). Because the ad is displaying false information, the committee may lose referent power and credibility and thus suffer diminished future influence in the realm of obesity.

The approach taken by PCRM may be one of the least effective ways to tackle the obesity epidemic. Physicians are taught to “do no harm;” PCRM needs to understand that insensitive words and pictures are harmful to health. There are better ways to educate and motivate people to make healthier food choices; ethical health campaigns do not sacrifice one health issue to promote another. In medical hegemology physical health tends to outrank mental health in “importance.” But as shown by the PCRM’s ad campaign, the line between physical and mental health issues is easily blurred, especially with the confluence of obesity, body image disturbance, and self-esteem. The PCRM is wearing blinders to these interrelated health issues in the dogmatic pursuit of an isolated, singular objective.

New Intervention: Using an Ecological Model to Change the Environment and Re-framing The Argument to Empower Obese Individuals

An effective public health approach to tackle the obesity epidemic will disseminate changes through multiple structural avenues and take into account the interrelationship between lifestyle and environmental risk factors. The proposed alternative obesity campaign will focus on empowerment and self-esteem as both the motivators and desired outcomes for behavior change, rather than emphasizing ideal physical appearance, which may perpetuate obesity stereotypes and chastise obese individuals. To avoid psychological reactance and labeling obese individuals, the new billboard message will use effective framing to empower obese individual to rise up against the stereotype society has attached to their weight. To prevent attributing obesity to individual behavior, PCRM’s campaign will be extended beyond billboard messages. Emphasis will be placed on advocating for policies and initiatives that promote larger-scale, coordinated community efforts that will reverse the environmental conditions that promote obesity in the first place. An effort to create structural, environmental changes that support responsible behavior will serve to improve health for all individuals, regardless of weight. Acknowledging the complex etiology of obesity will also help reduce weight stigma and its negative consequences.

Alternative #1: Defying Psychological Reactance Through Effective Framing

To prevent psychological reactance, PCRM should frame obesity prevention and awareness in a positive, empowering way. Framing theory postulates that successfully persuading individuals to do what you want them to do directly depends on the way you present your message. It refers to the process by which people develop a particular conceptualization of an issue or reorient their thinking about an issue. The art of framing denotes how even small changes in the presentation of an issue can produce drastic changes in opinion (26). The key aspects of a frame are a core position, a metaphor, a catchphrase, effective images and symbols, and a core value (27). Successful persuasion results when each of these components is used collectively to communicate an invoking message.

The PCRM can effectively reduce psychological reactance by having a billboard that utilizes a compelling image, metaphor and catch phrase and relies on an empowering core position and value. The replacement billboards will feature overweight and obese individuals (adults and children) engaging in physical activity with their thinner peers. The phrase “Your abs/thighs on cheese” will be replaced with the phrase “We have the power: Fighting obesity one step at a time.” By using the core value of everyone, regardless of size, is entitled to fun, obese and overweight individuals will see that they are not defined by their weight. The catch phrase and metaphor of physically fighting back against obesity will embolden overweight individuals to realize that they have the potential to rise up against their stereotype. The image of obese, overweight, and thin individuals exercising together will empower overweight and obese individuals to see that they are just as entitled to a state of physical and social wellbeing as their thinner peers. This frame will also help conjure up public understanding that weight does not define your personality or success and obese individuals do not deserve the stigma or label attached to their physical appearance.

Psychological reactance will be mitigated because the new ad’s frame of the argument is clear, high in quality, and it does not pose a threat to individual freedom (21-22). One of the main factors leading to psychological reactance in the initial ad was the invalid linkage of the obesity epidemic to just cheese consumption. Given that cheese is also a large part of the American diet, telling viewers to eliminate cheese from their diet was a substantial, controlling request. The new ad takes an empowering approach by linking physical activity to fighting back against the obesity stereotype. By considering other factors that lead to obesity, not just cheese intake, the new add will be perceived as relevant and rational. Because the new ad focuses on empowering individual to rise up against the obesity label, the viewer’s freedom will be enhanced, not be threatened.

Alternative #2: Refuting The Obesity Label By Encouraging Self-esteem and Empowerment

Labeling obesity has serious adverse individual and societal consequences. Labels contribute to lower self-esteem in obese individuals and exacerbate the already pervasive notion that weight is solely attributable to individual behavior (7-8). A good public health initiative must achieve weight loss without contributing to the stigmatization of obesity (8). To addressing the blame and shame caused by the ad’s labeling of obese individuals as outcasts, the new campaign will focus on empowering obese individuals to rise against the label attached to their weight. No matter how much the campaign encourages behavior changes, it will not be successful unless the target population believes it can make the required changes; empowerment and self-esteem are quintessential to evoking behavior change (28). Furthermore, when individuals feel good about themselves, they are more likely to engage in healthy activities.
A successful example of this motive at work is Florida’s “Truth” campaign- an initiative enacted to lower the youth smoking rate by motivating youth to rebel against the tobacco industry. The campaign’s theme, “truth, a generation against tobacco,” established the tobacco industry as a liar (29). Attacking the duplicity and manipulation of the tobacco industry became “Truth’s” rebellion. By successfully framing the tobacco industry as hiding the truth about smoking from teens, the campaign provoked youth to fight back against big tobacco. In doing so, it successfully decreased Florida’s youth smoking initiation rates (30).

This same framework can be utilized to empower obese individuals to adapt a healthier lifestyle. By replacing the phrase “Your abs/thighs on cheese” with “We have the power: Fighting obesity one step at a time,” obese individuals will see that they are not defined by the stigma attached to their weight. Inspiring obese individuals to rise up against the fat label will rekindle self-esteem and empowerment, which has a powerful effect on motivation. If overweight individuals do not believe they will succeed in adapting a healthy life style, they are much less likely to even attempt to do so (8). Research has shown that obesity campaigns focused on “blaming the victim” cause overweight individuals to be more sensitive about their weight and self perceived lack of athletic ability, which makes them less likely to participate in physical activity (8). Engendering empowerment and self-esteem through the campaign message is an indispensible component in ensuring overall success (7-8)(12). Inciting obese individuals to rise up against the obesity label and refute their stereotype will help enhance self-esteem and empowerment and aid in reducing and preventing obesity overtime.

Alternative #3: Using a Structural, Ecological Perspective to Elude the Fundamental Attribution Error

One of the main limitations of PCRM’s initial ad campaign is that it attributes obesity to individual behavior and disregards the role of the environment. By limiting its campaign to billboard advertising and minor advocacy to improve school meals, the initiative is curtailing its potential impact. This error can be overcome by broadening the campaign and basing it on the ecological theory. The major hypothesis of the ecological theory is that environmental and structural factors are critical determinants of individual behavior. The theory posits that altering physical environments creates better health outcomes (31). It suggests that by manipulating and adjusting the conditions in which people live, it is possible to influence health behavior, and thus, behaviorally related outcomes of population (31-32). The interrelated factors that constitute a structural, ecological model are (1) availability and accessibility of the product, (2) physical characteristics of the product, (3) social structures and policies, and (4) media and cultural messages (31).

In context of the obesity epidemic, the ecological theory argues that no matter a persons intent to lose weight and change their behavior, the commercial and structural forces in their environments are still powerful; individuals easily become caught in “accelerators” of the obesity epidemic resulting from the ubiquitous ‘obesogenic’ environment that encourages an overconsumption of food and discourages physical activity (33). By initiating structural changes in the environment, the campaign will overcome the obesogenic environment and create a setting where healthy choices are the easy choice. The new, alternative PCRM campaign will advocate for polices that limit access to fast food and enhance access to health food. The campaign will fight for imposing regulations that specify a limited number of fast food joints allowed in a certain radius. It will also actively support area farmers markets. To target youth, the new campaign will urge the school board to make school meals healthier by increasing fruits and vegetables and decreasing animal fats and added sugar, not just cheese. These policies and social structures will make unhealthy foods less available and healthier alternatives more available. To address “physical characteristics,” the new PCRM campaign will advocate for creating more parks and sidewalks, so communities have structures in places that encourage physical activity. To target the media’s contribution to obesity, the campaign will argue for eliminating junk food advertisements targeted at children. By taking an ecological based approach and arguing for structures that encourage healthy eating and physical activity, the PCRM campaign will control environmental factors related to obesity, and thus thwart the increasing prevalence of obesity in the Albany area.


Obesity has become a public health crisis in the United States. Despite continual prevention and treatment efforts, the prevalence of obesity has steadily increased over the past three decades (34). If effective measures are not put into place to control obesity, the current US generation may have a shorter life expectancy than its parents. It is predicted that if the US continues on its current trend, in only 15 years 80% of all American adults will be overweight or obese and health care costs attributable to obesity and overweight could range from $860 to $956 billion, which would account for 15.8-17.6% of total healthcare costs (35). Effective, ecological based structural solutions are crucial in the fight to advert the increasing prevalence obesity.
PCRM was right to tackle the obesity epidemic; however, their approach to the issues was ethically and structurally flawed. The committee’s ad campaign wrongly labeled obese individuals and fell victim to both psychological reactance and the fundamental attribution error. Instead of stigmatizing obese individuals, PCRM must engender them with the self-esteem and empowerment to fight back against their label. The committee’s billboard message is not only disempowering, but also implies a controlling and false message: obesity is due to cheese and cheese should be eliminated from the diet. To overcome the psychological reactance this induces, PCRM must frame its message in a way that does not limit freedom, but stimulates motivation. Most importantly, instead of “blaming the victim” and attributing weight to individual behavior, PCRM should advocate for policies and interventions that promote an environment that is more conducive to better weight management. Changing environments so that they support people in making healthy diet and activity choices recognizes that personal choice is only as good as the choices available. If the environment is dominated by unhealthy cues and burdens the community from being able to make healthy choices, the odds will be stacked against individuals being healthy.

1. Physicians Committee for Responsible Medicine. Fat-Focused Billboards Warn Albany Residents that Cheese Makes You Chubby. Washington DC: Physicians Committee for Responsible Medicine, 2012.
2. Physicians Committee for Responsible Medicine. Cheese and Obesity- Dr. Barnard’s Blog. Washington DC: Physicians Committee for Responsible Medicine, 2012.
3. New York State Department of Health. Obesity Statistics for Albany County. New York, NY: New York State Department of Health, 2011.
4. All Over Albany. New York’s Fattest Counties. Albany, NY: All Over Albany, 2009.
5. Goode, E. On Behalf of Labeling Theory. Social Problems 1975; (22)5:570-583.
6. Bernburg, J. G., Krohn, M. D., Rivera, C. J. Official Labeling, Criminal Embeddedness, and Subsequent Delinquency: A Longitudinal Test of Labeling. Journal of Research in Crime and Delinquency. 2006; 43:67-88.
7. Puhl, R. M., Heuer, C. A. Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health. 2010; (100)6:1019-1028.
8. O’Dea, J.A. Prevention of Child Obesity: ‘First, Do No Harm.’ Health Education Research 2004; (20)2:259-265.
9. Sjober, R. L., Nilsson, K. W., Leppert, J. Obesity, Shame, and Depression in School Aged Children: A Population Based Study. Journal of the American Academy of Pediatrics. 2005; (116)3:389-392.
10. Crocker, J. Social Stigma and Self-esteem: Situational Construction of Self-worth. Journal of Experimental Social Psychology. 1999; 35:89-107.
11. Myers, A., and Rosen, J. C. Obesity Stigmatizing and Coping: Relation to Mental Health Symptoms, Body Image, and Self-esteem. International Journal of Obesity. 1999; 23:221-230.
12. Puhl R. M., Brownell K. D. Psychological Origins of Obesity Stigma: Toward Changing a Powerful and Pervasive Bias. Obesity Reviews. 2003; 4:213-227.
13. Tetlock, P.E. Accountability: A Social Check on the Fundamental Attribution Error. Social Psychology Quarterly. 1985; (48)3:227-236.
14. Friedman, J. M. Modern Science Versus the Stigma of Obesity. Nature Medicine. 2004; 10:563-569.
15. Hill, J. O., Wyatt, H. R., Reed, G. W., Peters, J. C. Obesity and the Environment: Where Do We Go From Here? Science Magazine. 2003; (299)835:853-855.
16. French, S. A., Story, A. and Jeffery, R. W. Environmental Influences on Eating and Physical Activity. Annual Review of Public Health. 2001; 22:309-335.
17. Cummins S., Macintyre, S. Food Environments and Obesity- Neighbourhood or Nation? International Journal of Epidemiology. 2006; 35:100-104.
18. Gardner, D. M., Wooley, S. C. Confronting the Failure of Behavioral and Dietary Treatments for obesity. Clinical Psychology Review. 1991; 11:729-780.
19. Hilber, A., Rief, W., Braehler, E. Stigmatizing Attitudes Toward Obesity in a Representative Population-based Sample. Obesity Journal. 2008; (16)7:1529-1534.
20. Brehm, J. W., Brehm, S. S. A Theory of Psychological Reactance: A Theory of Freedom and Control. 1981; Academic Press: New York.
21. Shen, L., Dillard, J. P. On the Nature of Reactance and its Role and Persuasive Health Communication. Communication Monographs. 2005; (72)2:144-168.
22. Rains, S. A., Turner, M. M. Psychological Reactance and Persuasive Health Communication: A Test and Extension of the Intertwined Model. Human Communication Research. 2007; 33:241-269.
23. Miller C. H., Lane L. T., Deatrick L. M., Young A. M., Potts K. A. Psychological Reactance and Promotional Health Messages: The Effects of Controlling Language, Lexical Correctness, and the Restoration of Freedom. Human Communication Research. 2007; 33:219-240.
24. Cummings, D., Schwartz, M. W. Genetics and Pathophysiology of Human Behavior. Annual Review of Medicine. 2003; 54:453-471.
25. Swinburn, B. A., Caterson, I., Seidell, J. C. James, W. P. T. Diet, Nutrition and the Prevention of Excess Weight Gain and Obesity. Journal of Public Health Nutrition. 2004; 7(1A):123-146.
26. Chong, D., Druckman, J. N. Framing Theory. Annual Review of Political Science. 2007; 10:103-126.
27. Siegel, M. Public Health as the Art of Framing: The Importance of Perspectives, Paradigms, and Schemata in Public Health Practice. Boston University School of Public Health. Boston, MA. 19 January 2012.
28. Foster, G. D., Makris, A. P., Bailer, B. A. Behavioral Treatment of Obesity. American Journal of Clinical Nutrition. 2005; 82(supplement):230s-235s.
29. Project Truth. About Us. 2012. Project Truth.
30. Hicks, J. J. The Strategy Behind Florida’s “Truth” Campaign.” Journal of Tobacco Control. 2001; 10:3-5.
31. Cohen, D. A., Scribner, R. A., Farley, T. A. A Structural Model of Health Behavior: A pragmatic Approach to Explain and Influence Health Behaviors at the Population Level. Journal of Preventative Medicine. 2000. 30:146-154.
32. Swinburn, B, Egger, G. Preventive Strategies Against Weight Gain and Obesity. Obesity Reviews. 2002; 3:289-301.
33. Adler, N. E., Stewart, J. Reducing Obesity: Motivating Action While Not Blaming the Victim. The Millbank Quarterly. 2009; (87)1:49-70.
34. Center for Disease Control and Prevention. US Obesity Trends. Atlanta, GA: 2012, Center or Disease Control and Prevention.
35. Wang, Y., Beydoun, M. A., Liang, L., Caballero, B., Kumanyika, S. K. Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Journal of Obesity. 2008. 16:2323-2330.

Labels: ,


Post a Comment

Subscribe to Post Comments [Atom]

<< Home