clinical obesity doi: 10.1111/cob.

12059

Diffusing obesity myths

X. Ramos Salas1, M. Forhan2 and A. M. Sharma3

What is already known about the subject
• Misinformation or myths about obesity can lead to weight bias and
obesity stigma.
• The myth/fact message format method has been used widely in
public health and social marketing strategies as way to reduce
stigma.
What this study adds
• Ten obesity myth–fact messages were developed and validated by
obesity experts.
• Obesity experts and health professionals supported these obesity
myth–fact messages but they did not perceive them to be sufficient
to change the deeply rooted negative attitudes and beliefs about
obesity.

1
School of Public Health and Canadian
Obesity Network, University of Alberta,
Edmonton, Alberta, Canada; 2
Faculty of
Rehabilitation Medicine, Department of
Occupational Therapy, University of Alberta,
Edmonton, Alberta, Canada;
3
CanadianObesity Network, and Faculty of
Medicine & Dentistry, Obesity Research &
Management, University of Alberta,
Edmonton, Alberta, Canada
Received 20 March 2014; revised 8 April
2014; accepted 10 April 2014
Address for correspondence: Ms. X. Ramos
Salas, Canadian Obesity Network, University
of Alberta, Li Ka Shing Centre for Health
Research Innovation, Room 2-126, Edmonton
Alberta, T6G 2E1, Canada. E-mail:
ramos-salas@obesitynetwork.ca
Summary
Misinformation or myths about obesity can lead to weight bias and obesity
stigma. Counteracting myths with facts and evidence has been shown to be
effective educational tools to increase an individuals’ knowledge about a certain
condition and to reduce stigma.The purpose of this study was to identify common
obesity myths within the healthcare and public domains and to develop evidence-
based counterarguments to diffuse them. An online search of grey literature,
media and public health information sources was conducted to identify common
obesity myths. A list of 10 obesity myths was developed and reviewed by obesity
experts and key opinion leaders. Counterarguments were developed using current
research evidence and validated by obesity experts. A survey of obesity experts
and health professionals was conducted to determine the usability and potential
effectiveness of the myth–fact messages to reduce weight bias. A total of 754
individuals responded to the request to complete the survey. Of those who
responded, 464 (61.5%) completed the survey. All 10 obesity myths were iden-
tified to be deeply pervasive within Canadian healthcare and public domains.
Although the myth–fact messages were endorsed, respondents also indicated that
they would likely not be sufficient to reduce weight bias. Diffusing deeply perva-
sive obesity myths will require multilevel approaches.
Keywords: Obesity stigma, myth/fact message format, myths.

weight bias and obesity stigma. A number of myths and

Introduction
Despite a better understanding of the causes and effective
treatment strategies for obesity, this chronic condition is
not effectively managed in the healthcare system (1). This is
in part due to the negative views and attitudes about
obesity, which are disseminated globally (2). These negative
views are manifested through myths and stereotypes about
obesity and/or prejudice towards people with excess
weight. Misinformation or myths about obesity can lead to
misperceptions about obesity exist that associate obesity
with ‘ugliness, sexlessness, undesirability and moral failings
such as lack of self-control, social irresponsibility, inepti-
tude and laziness across cultures and borders (2).’
Obesity stigma can affect a person’s mental health, their
interpersonal relationships, educational achievement and
employment opportunities, and ultimately lead to social
and health inequities (3,4). Many national and interna-
tional obesity organizations have identified weight bias as a

© 2014 The Authors 189

Clinical Obesity © 2014 World Obesity. clinical obesity 4, 189–196
190 Obesity myths X. Ramos Salas et al.
key barrier to effectively addressing the obesity epidemic
(3). Challenging myths about obesity and reducing obesity
stigma among health professionals and the public are
important in order to obtain support for effective obesity
prevention and treatment strategies and policies (5).
The myth/fact message format (MFMF) is a method used
widely in public health and social marketing strategies
(6–8) as a way to reduce stigma and increase knowledge
about a particular condition. The MFMF takes an incorrect
viewpoint labelled as a myth and remedies it with a counter
view labelled as a fact (9). Counteracting myths with facts
and evidence has been shown to be effective educational
tools to increase individuals’ knowledge about a certain
condition (6). To our knowledge, this method has not been
used as a way to directly confront widely held misconcep-
tions and myths about obesity in Canada. The purpose of
this study was to identify common myths about obesity
within the Canadian healthcare and public domains and to
develop evidence-based counterarguments that can be used
in future public health education campaigns.
Materials and methods
An ad hoc group of obesity experts and key opinion leaders
was established to provide advice throughout the project.
An online search of grey literature, media and public health
information sources was conducted to identify common
obesity myths. The following search terms were used on
Google’s search engine: ‘obesity’, ‘weight’, ‘overweight’,
AND ‘causes’, ‘consequences’, ‘solutions’, ‘recommenda-
tions’. An obesity myth was defined as a misconception
about obesity causes and consequences. The myths were
organized by source (websites). A team of three reviewers
who coded each statement reviewed statements about the
causes, consequences and recommendations for addressing
obesity. The statements were coded into the following
themes: (1) link between weight and health; (2) character-
istics of individuals with obesity and (3) obesity reduction
strategies. Myths about individual weight loss approaches
(i.e. fad diets and fallacies) were excluded from the search.
Only myths that were considered to contribute to further
weight bias were included in the final list.
These statements were tabulated according to pervasive-
ness and source. Consensus on the themes was reached
after the researchers shared their coding results electroni-
cally, and with final agreement reached during a conference
call with all reviewers. The original list of myths included
15 statements that responded directly with the original
themes identified by the reviewers of the grey, media and
public health information sources. The 15 statements were
sent out to experts in the areas of physical activity, child-
hood obesity and obesity prevention and management. The
experts recommended that the 15 statements should be
amalgamated into a list of 10 obesity myths due to consid-
clinical obesity
erable overlap in subject matter. The experts also suggested
key research studies that could be used to counteract each
myth.
Counterarguments were developed and sent for review by
obesity experts. Finally, the updated list of obesity myths
with evidence-based counterarguments was distributed to
all members of the Canadian Obesity Network (CON) who
had valid email addresses (n = 7221). The CON is Canada’s
only association of obesity professionals with a common
goal to reduce the burden of obesity on Canadians. CON’s
membership includes researchers, interdisciplinary health
practitioners, policy makers and individuals from govern-
ment, industry and non-profit sectors. The list of myths and
counterarguments was provided in the context of a survey.
The overall purpose of the survey was to determine the
pervasiveness of these myths in the healthcare and public
domains, and to assess the usability of the myth–fact mes-
sages as a way to address weight bias in the healthcare and
public domain. Participants were asked to respond to a
series of three questions designed to measure the profile of
the myth, the validity of the counterargument and the extent
to which the counterargument could influence weight bias.
The survey was open for 5 days.
Results
The statement of obesity myths and the matched evidence-
based counterarguments (Table 1) were sent to CON
members (n = 7221) for review in the format of an online
survey created using Survey Monkey. A total of 754 CON
members responded to the request to complete the survey
(10.4% response rate). Of those who responded, 464
(61.5%) of the members completed the survey. All 10 of the
obesity myths were identified to be pervasive within the
general public in Canada. The pervasiveness of the myth
was determined by calculating the percentage of partici-
pants who rated a high level of agreement that the obesity
myth was pervasive among Canadians. A list of the obesity
myths in the order of pervasiveness as perceived by survey
participants is found in Table 1.
Validation of the counterarguments was determined by
the response of participants who agreed that the
counterargument was fully valid or mostly valid with
respect to their knowledge of current evidence. A review of
the comments in response to the validation item on the
survey revealed no additional references to include or
errors in the interpretation of the evidence used to counter-
act the obesity myth identified in the public domain. A
summary of the validation results is found in Table 1.
Participants were also asked to indicate how effective
they thought the counterargument could be to reduce
weight bias in healthcare and public domains. This proved
to be the most difficult question to respond to as noted by
participant comments indicating that although they
© 2014 The Authors
Clinical Obesity © 2014 World Obesity. clinical obesity 4, 189–196
 Table 1 Summary of obesity myths, evidence-based counterarguments, validation and effect of counterarguments listed in order of perceived pervasiveness

Obesity myth Ranked Percentage Evidence-based counterargument Percentage of Percentage of

statement order agreement agreement about agreement for
with myth the validity of the counterargument to
counterargument. reduce weight bias.

© 2014 The Authors

Obese people are less 1 (93%) Research does not support the notion that overweight or obese individuals are substantially less active 93% 61%
physically active than normal weight Canadians. The 2007–2009 Canadian Health Measures Survey shows that only 5%
of Canadian children and adults meet the weekly recommendations for moderate to vigorous physical
clinical obesity

activity. However, the report also shows that overweight and obese children and adults with obesity are
not significantly less active their normal weight counterparts. Thus, for example, overweight and obese
girls aged 6 to 19 years have exactly the same minutes of moderate-to-vigorous physical activity
(MVPA) as girls who are neither overweight nor obese (between 44 and 48 minutes per day) (10–12).
Although overweight men and women may accumulate fewer minutes of MVPA per day, it is important
to consider that for the same amount of physical activity, overweight and obese individuals do more
physical work and expend more energy due to moving a larger body mass than their normal weight
counterparts. In addition, overweight and obese individuals may experience greater environmental,
medical and emotional barriers to being more physically active.
Body weight is a 2 (87%) Although the commonly used term ‘healthy weight’ suggests that health can be measured by simply 93% 67%
measure of good stepping on a scale, the relationship between body weight or body mass index (BMI) and health is

Clinical Obesity © 2014 World Obesity. clinical obesity 4, 189–196

health more complex. While at a population level increased BMI is associated with a greater risk for a wide
range of health problems, individuals can maintain good health over a wide range of body weights.
BMI or weight should be used in conjunction with other health measures to obtain an accurate indicator
of health. Individuals with excess weight, who are physically fit, report a better quality of life and have a
lower risk of morbidity and mortality than normal weight individuals, who are unfit (13–18). Whether or
not excess weight affects health is also related to fat distribution or ectopic fat. The health impact of
excess weight is also influenced by societal norms and discrimination, which can promote body
dissatisfaction and maladaptive weight-loss behaviours.
All obese people eat 3 (86%) Although an increase in the availability and consumption of calorie-dense foods and beverages is 89% 57%
unhealthy diets associated with increased rates of obesity in populations, the nutritional quality of diets consumed by
overweight or obese persons is not substantially different from that of normal weight individuals (19).
Many individuals with excess weight consume diets that are as healthy or unhealthy as those of their
normal weight peers. Therefore, it is important not to make assumptions about dietary habits of an
obese individual.
Anyone can control their 4 (84%) While diet and exercise can promote weight loss in the short term, long-term results of behavioural weight 84% 58%
weight with diet and management even in the rather ideal confines of a clinical trial are disappointing. Thus, behavioural
exercise intervention programmes focusing only on improving diet and activity levels generally do not result in
more than 3–5% sustainable weight loss (1,20) Although, this degree of weight loss can have
substantial health benefits, maintenance of even this modest weight loss requires continuous (life-long)
effort. The US National Weight Control Registry shows that maintenance of significantly more weight
loss requires a substantial reduction in daily caloric intake often paired with a rigorous daily exercise
regimen that would not be realistic for most Canadians.
Obese people lack 5 (81%) Studies comparing restraint and dis-inhibition between normal weight and obese individuals do not 80% 55%
motivation and support the notion that most obese individuals lack will-power or self-control. On the other hand, there
self-control are specific mental health conditions such as binge eating disorder, atypical depression or attention
deficit disorder that are characterized by lack of control. Given the high recidivism of weight-loss
efforts, many overweight and obese individuals lack self-efficacy and motivation to re-engage in
weight-loss efforts. This problem is further perpetuated by the lack of competencies and self-efficacy of
healthcare professionals in promoting and managing behaviour change in their patients. Together,
Obesity myths X. Ramos Salas et al.

these factors may lead to the misconception that individuals with excess weight are less motivated or
unable to muster the will-power to better manage their weight (21,22).
191
 Table 1 Continued

Obesity myth Ranked Percentage Evidence-based counterargument Percentage of Percentage of

statement order agreement agreement about agreement for
with myth the validity of the counterargument to
counterargument. reduce weight bias.

Forcing people to take 6 63% Tactics designed to force a person living with obesity to feel bad about the way they look, eat, move and 92% 71%
responsibility for their live their life are nothing short of weight-related bullying. Shaming or bullying stems from a belief that a
obesity is the best person with obesity is oblivious to their weight and shape and would benefit from societal pressures to
way to facilitate change their ways. However, research shows that shame does not catalyze health behaviour change; it
behaviour change. paralyzes it (4,23). The personal responsibility approach to addressing obesity has been used in North
America for decades and it has not worked. A shift in focus from personal blame to a focus on
empowering health starts by acknowledging the various biological, psychological, social and
environmental factors that contribute to obesity. This shift is more meaningful and provides an
opportunity to look at the shared personal and societal responsibility to promote health and well-being.
Personal responsibility is just one piece of a much more complex problem. Simply focusing on one
192 Obesity myths X. Ramos Salas et al.

piece of this problem issue will not be effective.

Suggesting weight 7 52% While indicators for the health of a population are necessary to assess the impact of interventions for 77% 46%
targets for a health promotion and to identify areas in which changes need to be made, setting population weight
population is targets may neither be helpful nor feasible. According to current estimates, even just a 5% decrease in
important. obesity prevalence would require a 75% reduction in the current rate of weight gain in the population
(24). Thus, although public health initiatives to promote healthy eating and active living have the
potential to improve the overall health and wellness of the population, available evidence on the
efficacy of lifestyle changes in weight management do not predict that there would be detectable
changes in the average weight of Canadians. Therefore, a focus on promoting ‘healthy’ weights, rather
than on improving overall health of Canadians may undermine the perceived benefits of health
promotion strategies.
Food bans and taxes 8 16% There is little evidence to support higher tax levies on foods deemed to be contributing to the increase in 75% 35%
are effective methods obesity rates. Although increasing the price of foods deemed to be of high energy content but low in
to reduce obesity. nutritional value may affect the purchasing behaviour of populations, how this translates into overall
caloric consumption and outcomes such as body weight and waist circumference of a population is not
known. Outright bans of certain foods in schools, recreation centers or other public or private venues
can influence the types of food consumed while on the premises but may merely shift the purchase or
consumption of the banned items off-site (25,26).
Efforts to reduce 9 13% Although traditionally efforts to tackle conditions that impact health and well-being are targeted towards 91% 64%
childhood obesity the person living with that condition, in the case of childhood obesity, it is critical that the system in
should focus only on which the child lives is included in these efforts. This includes parents, educators and care providers.
the children. Recent studies show that a parent-only approach to dealing with childhood obesity is at least as, if not
more, effective than parent-and-child strategies. Similarly, studies have found that targeting parents’
diets has a greater effect on the weight of their overweight children than trying to getting the children to
be more active. There is also accumulating data demonstrating a significant ‘halo’ effect on childhood
obesity from effectively managing adult obesity (25,27,28).
Obese people are less 10 11% There is no evidence that overweight or obese adults and children are less intelligent than their normal 85% 58%
intelligent weight peers. Although obese children may have more difficulty in performing visual-spatial tasks and
memorization of details, such findings do not indicate that they are not capable of performing such
tasks. When adjusted for educational and socio-economic status, associations between intelligence
scores and obesity or the development of obesity cease to exist. Weight-based teasing and bullying in
the schools by peers together with reduced expectations of educators can lead to academic
disengagement resulting in a reduction of post-secondary education, particularly among adolescent
females with obesity (29–35).

© 2014 The Authors

clinical obesity

Clinical Obesity © 2014 World Obesity. clinical obesity 4, 189–196

clinical obesity
endorsed the validity of the counterargument(s), they were
unsure that evidence statements would be enough to
change the negative attitudes and beliefs that Canadians are
perceived to have towards persons with obesity. Eight of
the 10 counterarguments were identified as having the
potential to reduce weight bias by 50% or more of partici-
pants. Less than 50% of respondents believed that myths
ranked number eight (food bans and taxes are effective
methods to reduce obesity) and number seven (suggesting
weight targets for a population is important) could be
positively impacted by the matched evidence-based
counterargument. A review of the participant comments
found that it was not the quality of the counterargument
that lead to a negative response but rather the complexity
of the topic or the participants’ perceptions – that no
matter what evidence existed, those who have negative
attitudes and beliefs about obesity will continue to support
taxation of higher fat, higher sugar foods and to promote
weight targets as indicative of health. None of the
counterarguments were thought to have the potential to
increase or endorse the obesity myth statement. The degree
of agreement associated with each counterargument is
listed in Table 1.
Discussion
This study produced a list of 10 obesity myths considered
to be pervasive within the Canadian healthcare and public
domains. To counteract these myths, 10 relevant evidence-
based statements were developed. Although the aim of
these counterarguments was to reduce weight bias, many
obesity experts and professionals surveyed in this study
believed the myth–fact messages would not be sufficient to
change deeply rooted misconceptions about the link
between weight and health, characteristics of individuals
with obesity, and non-evidence-based obesity reduction
strategies. This indicates that weight bias is deeply perva-
sive in Canada, not unlike other countries such as the
United States (4).
Research stemming as far back as the 1960s has demon-
strated that stigma has adverse effects on health (36). It is
recognized that policy makers and public health institu-
tions should combat stigma because of its adverse health
effects and consequences for social and health inequities
(37). However, despite its prevalence, weight bias and
obesity stigma are rarely challenged in our society, leaving
persons who are classified as overweight or obese vulner-
able to social injustice, unfair treatment and impaired
quality of life as a result of substantial disadvantages. This
study was a first step towards confronting widely held
misconceptions and myths about obesity in an effort to
ultimately address obesity stigma in Canada.
Our study is not without limitations that should be
acknowledged. We surveyed obesity professionals in order
© 2014 The Authors
Clinical Obesity © 2014 World Obesity. clinical obesity 4, 189–196
Obesity myths X. Ramos Salas et al. 193
to explore associative factors between obesity myths and
weight bias in the healthcare and public domains in
Canada. Therefore, conclusions regarding the relationship
between obesity professionals’ perceptions and the Cana-
dian population as a whole cannot be made. Another study
limitation is the low response rate to our web-based survey.
This could be attributed, in part, to technical and meth-
odological issues related to conducting web-based surveys.
The sensitivity of weight bias as a topic may have also
influenced the overall response rate.
However, survey respondents included obesity profes-
sionals working in diverse disciplines and sectors in Canada.
Their responses provide us with a broad view of the social,
cultural and institutional contexts in which obesity profes-
sionals live and practice. The majority of respondents
believed that obesity stereotypes and myths are pervasive
and deeply rooted in social and cultural attitudes and would
be challenging to confront. Although, many participants
validated and endorsed the proposed counterarguments,
they questioned whether dissemination of myths and
counterarguments could actually reduce obesity stigma.
This is an important finding to consider when developing
future obesity stigma reduction initiatives.
Theories on stereotype processing stipulate that stereo-
types are learned associations that are automatically acti-
vated when a person comes into contact with a stereotyped
group. In addition, non-prejudiced behaviour requires
intentional inhibition of automatically retrieved stereo-
types, which can only be achieved if individuals are moti-
vated to do so (38). There are internal (e.g. self-image
preservation) and external (e.g. social desirability) drivers
that can motivate individuals to inhibit their automatically
activated stereotypes (39). Intervention studies to influence
automatic stereotype activation have shown mixed results.
However, suppression interventions that use some type of
‘stereotype negation’ training as well as interventions that
promote counter-stereotypes and challenge dominant ste-
reotypes show some promise. This demonstrates that
counterarguments alone may not be sufficient to motivate
individuals to inhibit their automatic stereotypes. Multi-
level (intrapersonal, interpersonal and structural)
approaches are needed to reduce the effects of stigma
across system levels (40,41).
Based on a belief that repeating a stereotype, even though
it is counteracted with evidence, may actually strengthen
the learned stereotype by both strengthening the associa-
tion and weakening the evidence Yeh et al. (2013) argue
that it may be better to present just the evidence in order to
create a new learned association and change attitudes (40).
In their study, Yeh et al. used a 2 × 2 between-subjects
factorial study design in which participants (109 under-
graduate students enrolled in an introductory marketing
class) randomly received either the MFMF or the fact-only
message format. Since personal relevance was considered to
194 Obesity myths X. Ramos Salas et al.
be a potential, motivating factor that can consciously
inhibit the automatically activated stereotype and inten-
tionally activate non-prejudicial beliefs, it was also meas-
ured using a three-item scale. Personal relevance was
defined as having personal experience with mental illness
either by directly having a mental illness or having had a
mental illness or having a close loved one who has or had
a mental illness. Outcome measures included attitudes
towards people with mental illness and perceived learning
about mental illness. Familiarity with the content of the
message and age were considered covariates. The results
demonstrated that using fact-only messages is an effective
way to create positive attitudes towards mental illness.
However, the impact of the fact-only messages is mod-
erated by personal relevance. Although not statistically sig-
nificant, the study found that perceived learning about
mental illness was higher among those participants without
personal relevance and who received myth/fact messages.
The authors explain that this may be why social marketing
campaigns use the myth/fact message since the expected
outcome is increased learning about a particular health
issue. Thus, if the goal is to reduce stigma, this may not
be an appropriate method. Considering that over 60% of
Canadians have overweight and/or obesity, chances are
that most Canadians will have a personal relevance factor.
It is therefore important to consider the moderating
effect of personal relevance in future weight bias reduction
strategies.
A campaign to reduce weight bias may benefit from a
mix of programmes including training interventions such as
‘stereotype negation’ training and training programmes
that promote counter-stereotypes and challenge dominant
stereotypes (39). Social marketing strategies aimed at
reducing weight bias may need to be based on fact-only
messages in order to create new positive views about
obesity. Moreover, social marketing strategies that create
empathy for people with obesity by making the issue more
personally relevant may also be necessary. Yeh et al. also
noted that some of the most effective strategies to educate
people without personal relevance are those that create
opportunities for contact with people living or affected by
the stigmatized condition.
Interestingly, in our study, participants commented on
the fact that no matter what evidence is presented about the
complexity of obesity, those who have negative attitudes
and beliefs about obesity will continue to support simplistic
messages such as ‘eat less, move more, taxations of higher
fat, higher sugar foods and the promotion of weight targets
as indicative of health’. These comments indicate that
obesity stigma also exists among obesity experts and pro-
fessionals. More research is needed to explore how the
obesity label has been normalized historically through
dominant cultural and medical ideologies – mainly the
personal responsibility of health ideology that stipulates
clinical obesity
that obesity is self-inflicted and individuals should be held
personally responsible for their weight and health.
In 2013, a group of international obesity experts identi-
fied weight loss and control-related myths, presumptions
and facts (42). The authors argue that researchers and
obesity professionals must address distortions of research
outcomes that can happen in advocacy work because these
distortions can contribute to obesity myths. For example,
many evidence-based treatments may be beneficial at the
individual level but may not be appropriate for obesity
prevention public health approaches. We must be careful to
balance public health messages with existing evidence so
that we do not contribute to unintended consequences for
individuals living with obesity, including weight bias and
obesity stigma.
In summary, this study produced obesity myth–fact mes-
sages that could be used in future obesity stigma reduction
interventions. The impact of these counterarguments to
reduce weight bias was not tested in this study; however,
none of the counterarguments were identified as having the
potential to endorse or enhance weight bias.
Conflict of interest statement
This study was funded through an unrestricted educational
grant from the Public Health Agency of Canada to the
Canadian Obesity Network. The views and opinions
expressed in this article are those of the authors and do not
necessarily reflect the official policy or position of the
Public Health Agency of Canada.
Acknowledgements
MF and XRS managed this study and oversaw the consul-
tations with obesity experts and health professionals. MF,
XRS and AMS conceived the survey and analyzed the data.
All authors have reviewed and approved the complete
manuscript (including tables, figures and ancillary
materials).
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Ad hoc group of obesity expert and key
opinion leaders
• Dr. Arya M. Sharma, Chair of Obesity Research and
Management, Faculty of Medicine and Dentistry, Univer-
sity of Alberta
• Dr. Rebecca Puhl, Rudd Centre for Food Policy and
Obesity, Yale University
196 Obesity myths X. Ramos Salas et al.
• Albert Kwan, Policy Analyst, Strategic Initiatives and
Innovations Directorate, Public Health Agency of Canada
• Dr. Mary Forhan, Assistant Professor, Occupational
Therapy, Faculty of Rehabilitation Medicine, University of
Alberta
clinical obesity
• Dr. Michael T. Vallis, Associate Professor, Depart-
ments of Psychiatry and Adjunct Professor, Department of
Psychology, Dalhousie University.
© 2014 The Authors
Clinical Obesity © 2014 World Obesity. clinical obesity 4, 189–196