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(p. 273) Public Attitudes about Addiction as a Cause of Obesity 

(p. 273) Public Attitudes about Addiction as a Cause of Obesity
Chapter:
(p. 273) Public Attitudes about Addiction as a Cause of Obesity
Author(s):

Colleen L. Barry

DOI:
10.1093/med:psych/9780199738168.003.0041
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Subscriber: null; date: 19 January 2020

Obesity has become a pressing global public health problem. Excess body weight is the fifth most important risk factor contributing to the burden of disease in developed countries.1 In the United States, between 1980 to 2006, the rate of obesity among American children ages 6 to 11 years more than doubled (6.5% to 17%) while the rate among American adolescents ages 12 to 19 years more than tripled (5% to 17.6%).2 Over this time period, obesity has increasingly gained attention among the American public. Over 90% of the public believe that most Americans are overweight; 67% think that obesity is a major public issue; and 90% think that those who are overweight face discrimination or other ill treatment.3 And most Americans believe that the health consequences of being obese can be serious.4 Widespread attention may reflect the personal significance that the issue has for much of the public given that two-thirds of all Americans are considered to be overweight.

This chapter examines public attitudes about food addiction as a cause of obesity. It is vital to understand beliefs about this issue since public opinion can greatly affect policymaker views about the appropriateness and feasibility of enacting public policies aimed at solving the problem of obesity. Oliver and Lee5 found that individuals who attributed obesity primarily to bad personal choices were significantly less likely to support government obesity prevention policies than those who recognized factors external to the individual (e.g., societal, economic) as important contributors.

The concept of food addiction is probably familiar to most Americans. Popular cultural references to food addiction abound. Many of us think of ourselves as “chocoholics” or worry about becoming “addicted” to sugar, and best-selling diet guides make reference to carbohydrate addicts6 and sugar addicts.7 And clinicians note that obese patients often discuss their relationship to food in terms of cravings and withdrawal, using the language of addiction.

Yet despite popular culture references to food addiction, few Americans are likely aware of scientific advances toward understanding the addictive properties of foods.8,9 Likewise, the discussion of food addiction is still mostly absent in journalistic portrayals of the causes of obesity. While news media coverage of obesity has grown dramatically over the last decade, research indicates that discussion of food addiction as a cause of obesity is uncommon.

With colleagues, I analyzed the content of a 20% random sample of news articles focused on childhood obesity in 18 prominent news sources, including national and regional newspapers, national news magazines, and national and network cable news shows from 2000 to 2009.10,i While 53% of news stories identified individual behavior (i.e., parent or child behaviors related to food/beverages or exercise) as a cause of childhood obesity, we found that only 1% of news stories mentioned food addiction as a potential cause. This evidence suggests that the news media has not yet focused on food addiction as an important cause of increasing obesity rates. This has bearing on public opinion since news media framing can strongly influence how the public thinks about societal problems.11

Various public opinion polls confirm that most Americans attribute obesity primarily to personal behaviors, including poor eating habits and insufficient physical activity.4,5,12 Fewer Americans identify factors external to the individual, such as environmental and societal factors, as important causes (p. 274) of increasing rates of obesity.4 However, little evidence is available to help us understand Americans’ beliefs about food addiction as a cause of obesity, or how these views affect support for public policies to curb obesity rates. One public opinion poll from 1978 suggests a long-standing concern on the part of Americans about safety risks associated with the manipulation of food content. The Tobacco Institute asked respondents to identify two of three things on a list of 14 items that concerned them in terms of their possible effects on the health, safety, and welfare of themselves or their family members. Twenty-three percent identified food additives as a concern (notably, as compared with only 13% identifying cigarette smoking and 17% identifying automobile safety).ii However, no current polls provide data on how many Americans view the concept of food addiction as important in explaining increasing rates of obesity.

To address this gap, my colleagues and I included a few questions in the Yale Rudd Center Public Opinion on Obesity Survey (N = 1,009), a nationally representative Web sample surveyed from the Knowledge Networks panel in 2006/2007, to assess public attitudes about food addiction as a cause of obesity and public support for policies aimed at addressing food addiction. Knowledge Networks, an internet survey research firm, employs randomdigit dialing to recruit their online research panel, which has been shown to be representative of the US population.13 Unlike other telephone- and Internet-based research, Knowledge Networks surveys are based on a sampling frame that includes both listed and unlisted phone numbers and provides Internet/computer access to those panel members. The strength of its sampling frame and high completion rates have made Knowledge Networks an increasingly common mode for data collection in studies published across a number of academic disciplines.14,15,16 The purpose of this survey was to examine whether individuals’ beliefs about the causes of obesity affected support for specific policies aimed at stemming obesity rates. This survey was pretested to assess the reliability and validity of the instrument in November 2006. The survey completion rate was 75%.iii

To assess public attitudes about the causes of increasing rates of obesity, we showed respondents eight narratives as possible explanations for why Americans are more overweight today than in the past.12 Each narrative included a causal explanation for increasing rates of obesity, a fairness judgment, and a related emotional response to overweight individuals. One narrative describing food addiction as a cause read:

A big problem in the U.S. is that people get hooked on certain things and just can’t quit. When people get used to eating sugary, fatty foods, some can’t keep themselves from eating more and more so they become overweight. It’s not fair that this is true for some people, but others can eat whatever they want and not gain weight. People who are heavy must feel so helpless, having lost control over their own bodies.

I compared this narrative with other narratives emphasizing internal (e.g., bad individual choices) and external (e.g., a toxic food environment) factors to explain why Americans are more overweight today than in the past. The individual behavior narrative read:

A big problem with America is that people are unwilling to work hard or control their impulses. People who are overweight aren’t even trying to get healthier. Fat people can’t do their jobs well and cost us all more for their health care. So it’s unfair when those people make others pay for their lack of effort. When I see people who are overweight, they disgust me.

The toxic food environment narrative read:

A big problem in this country is that we’re surrounded by choices that are cheap and easy, but not good for us. We have become so used to eating fatty, sugary foods that healthy foods are lost in a sea of unhealthy alternatives. So people are overweight because processed foods displace natural foods and large restaurant portions replace reasonable meals. It’s not fair that it’s become so hard to find healthy foods at a reasonable price. When I see a person who’s overweight, I get angry at our society for allowing bad food choices to drive out the good ones.

For each narrative, respondents were asked, “[O] ut of every 100 Americans with weight problems, for (p. 275) how many do you think that this account explains a lot about why they are overweight?” They were directed to assign a number between 1 and 100 for each narrative. If a respondent assigned a given narrative a score of 10 or greater, the response was coded as an “important” explanation, and a score of 25 or greater was coded as a “very important” explanation.

Despite the lack of attention in news media coverage, the public viewed the food addiction narrative as important in explaining why Americans are overweight. Seventy-one percent of respondents viewed the food addiction narrative as an important explanation and 16% viewed it as a very important explanation. These proportions are comparable to views about the individual behavior narrative (i.e., 50% viewed it as important and 18% viewed it as very important) and toxic food environment narrative (i.e., 77% viewed it as important and 24% viewed it as very important).

Next, respondents were asked about their support for two obesity prevention policies related to food addiction. They were asked to identify on an ordinal scale whether they strongly supported, somewhat supported, neither supported nor opposed, somewhat opposed, or strongly opposed each policy.

  1. Policy 1: To require warning labels on foods with high sugar or fat content, indicating that such foods may be addictive.

  2. Policy 2: To use government funds to establish a national network of obesity treatment programs modeled on treatment for other addictions.

Policy 1, a regulatory policy, was assumed to require no additional taxes. For policy 2, respondents were asked whether they would support the policy if it meant that they would need to pay an additional $50 per year in taxes.

Sixty-three percent of the public supported requiring warning labels on foods with high sugar or fat content, indicating that such foods may be addictive. Only 40% supported the policy to use government funds to establish a national network of obesity treatment programs modeled on treatment for other addictions. A lower level of support for this policy was consistent with expectations given that it would require a tax increase.

Next, ordered logit regression models were used to examine how respondents’ health characteristics and political attitudes were associated with support for the two addiction-related policies controlling for individual demographic characteristics. Table 41.1 displays these results. Interestingly, one’s own personal health status (i.e., body mass index, exercise level, and self-reported health) appears to play a minimal role in explaining variation in support for these policies. However, political ideology and political party identification were important predictors of support for policies to address food addiction as a cause of obesity. Moderates were more likely than conservatives, and Democrats and Independents were more likely than Republicans to support the warning label policy. Likewise, moderates and liberals were more likely than conservatives, and Democrats were more likely than Republicans to support the tax-based addiction treatment program policy. In separate regression models that included respondents’ views about the narratives as well as all demographic and health characteristics and political attitudes, individuals scoring the food addiction narrative as important (as defined earlier) were more likely to support both policies compare with those scoring the individual behavior narrative as important. (Results are not shown, but they are available from author upon request.)

Table 41.1. Regression Results on Public Support for Food Addiction Policies

Warning Labels (Policy 1)

Addiction Treatment Programs (Policy 2)

Health characteristicsa

BMI 25–29

−0.157

0.0144

[0.150]

[0.147]

BMI 30+

0.0167

0.269*

[0.151]

[0.152]

Good health

−0.127

−0.318**

[0.132]

[0.132]

Fair/poor health

0.0155

0.00620

[0.191]

[0.192]

Exercise 1–2 times per week

0.132

0.258

[0.162]

[0.158]

Exercise <1 time per week

0.141

0.0645

[0.142]

[0.140]

Political characteristicsb

Moderate

0.303**

0.499***

[0.149]

[0.148]

Liberal

0.129

0.558***

[0.175]

[0.175]

Undecided/independent

0.627**

−0.320

[0.295]

[0.292]

Democrat

0.421***

0.588***

[0.144]

[0.144]

Note. Absolute value of t statistics in parentheses;

* significant at 10%;

** significant at 5%;

*** significant at 1%. Models adjust for individual demographic characteristics, including gender, age, race/ethnicity, education level, income level, employment status, and region of residence.

a The reference category for body mass index is <25. Reference category for self-reported health is excellent/very good. Reference category for self-reported exercise is 3+ times per week.

b The reference category for ideology is conservative, and reference category for political party identification is Republican.

BMI, body mass index.

Conclusion

Our findings suggest that Americans are open to thinking about food addiction as an important cause of obesity despite the lack of attention to this factor in news media coverage of the obesity epidemic. These results are consistent with research suggesting that the public thinks about obesity as a complex, multicausal problem.10 However, which aspects of a complex problem Americans are most focused on can have a big impact on policy outcomes. The public may focus disproportionately on one aspect of an issue—in the case of obesity, overweight individuals’ poor choices related to eating and exercise—to the exclusion of other causal factors. If new aspects of an issue that have received less attention are demonstrated to be important, public support for policy may shift.

Therefore, a relevant question for the public health community is whether to and how to encourage the public to think more about food addiction as a cause of obesity. Framing obesity in terms of food addiction is attractive in that it does not absolve individuals of responsibility—we all need to make an effort to eat well and exercise—but (p. 276) acknowledges the importance of external factors. Both differing individual propensities toward addiction and detrimental practices by the food and beverage industry to increase the addictiveness of food products contribute to the problem. Future lab-based experimental research can be useful in testing empirically the extent to which individual exposure to messages framing food addiction as an important contributor to obesity can help to increase public support for obesity prevention policies, including regulations targeting food content and to lower stigma toward obese individuals.

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                Notes:

                i. News sources included the three highest circulation national newspapers in the United States (USA Today, Wall Street Journal, New York Times); two high circulation regional newspapers in the Northeast (New York Daily News, Boston Globe), the Midwest (Cleveland Plain Dealer, Minneapolis Star-Tribune), the South (Atlanta Journal Constitution, Houston Chronicle), and the West (San Francisco Chronicle, Denver Post); the two highest circulation news magazines (Newsweek, Time); transcripts from morning and evening news programs for the three television networks (ABC Good Morning America and World News Tonight, NBC Today Show and Nightly News, and CBS Early Show and Evening News), a cable news program (Fox Special Report), and a PBS news program (NewsHour with Jim Lehrer).

                ii. Survey by The Tobacco Institute. Methodology: Interviews conducted by Roper Organization, March 4–March 11, 1978 and based on 2,511 personal interviews. Sample: national adult. (USROPER.78SMOKE.R06).

                iii. We report a sample completion rate rather than a sample response rate as is typical with Web-based panels.