Shame, Blame, and the Emerging Law of Obesity Control

Abstract

for their invaluable feedback and support; Jamie Hennelly, Nick Masero, and Lauren Nussbaum for their fantastic research assistance; and Dean Claudio Grossman for his unflagging support of junior faculty scholarship.

Shaming Vaccine Refusal

“…Finally, after the first three factors have been considered, a balancing of the negative impact of the purported stigmatization against the potential utility of shame-based sanctions (in terms of public health costs and benefits) may be appropriate. 89 As Burris notes with respect to tobacco denormalization:…”

“…94 It also counsels prioritization of facilitating social-ecological interventions (e.g., ensuring sufficient access to health care and public health services and other forms of social support) over individually-targeted, victimblaming behavioral interventions (e.g., punishments and rewards that put the onus on individuals to make healthier choices without necessarily making it easier for them to do so). 95 As noted above, parents who choose to decline or delay vaccinations -as opposed to those whose children are undervaccinated because they lack adequate access to affordable care -tend to be from higher socioeconomic backgrounds and have higher formal educational attainment. There could be spillover effects, whereby parents and children who lack access to vaccination are stigmatized by efforts aimed at parents who choose not to vaccinate.…”

“…Finally, after the first three factors have been considered, a balancing of the negative impact of the purported stigma-tization against the potential utility of shame-based sanctions (in terms of public health costs and benefits) may be appropriate. 89 As Burris notes with respect to tobacco denormalization: One could argue that smokers are not really relegated to a “them” status, that smoking does not supplant all other traits and is not automatically or durably associated with a range of negative stereotypes. Or one could argue that it satisfies all the criteria of stigma in a formal way, but that in none of the domains is the effect serious enough to rise to the level of stigma.…”

Stigmatizing the Unhealthy

“…Weight has also been a common target for stigma-based regulation. Take for example an anti-childhood obesity ad campaign that employed shaming messages such as “Warning: Chubby isn't cute if it leads to type-2 diabetes” and “Big bones didn't make me this way, big meals did.” 40 Many states require schools to assess students' BMI or fitness level. 41 The ACA also allows workplace wellness programs to single out obese employees by offering incentives, up to thirty percent of the cost of coverage, for losing weight or lowering cholesterol.…”

Health and Big Data: An Ethical Framework for Health Information Collection by Corporate Wellness Programs

“…44 In fact, some legal scholars have detailed how obesity as an unprotected status leaves an individual vulnerable to harassment, shaming, and even termination from work. 45 Similarly, workers who are smokers often face shaming and job insecurity. 46 Thus, an ethical wellness program is one that maintains an impenetrable barrier between the information it collects and the employer.…”