I haven’t been one to mince words about how I think we need to increase the stigma around unhealthy eating in America. But even I think New York City’s new amputee anti-obesity ads are a bad idea—ineffectual, misleading, and a wasted opportunity to focus on more positive pro-health messages.
The ads, plastered in NYC subways, feature a diabetic man who lost his leg to amputation along with big cups of soda, in an attempt to get New Yorkers to think about ‘dietary habits that can lead to obesity.’ City healthy commissioner Thomas Farley told Reuters: ”These are hard-hitting images because we really felt we need to drive home a point that large portions are not completely benign.”
But the ads are misleading. It’s a long leap from bigger portions to leg amputation, but these ads imply a simple cause and effect between portion size and Type 2 diabetes. And while diabetes is a disease linked to obesity and poor diet, it’s not as simple as eat or drink too much, get fat, get diabetes and possibly get your leg amputated. In fact, while the popular conception is that obesity causes diabetes, scientists aren’t even sure it’s not the other way around—that diabetes causes obesity. These ads perpetuate a message that diabetes and obesity are inextricably linked, but Type 2 diabetes isn’t necessarily a ‘symptom’ of obesity or poor portion control, just as obesity and soda consumption don’t necessarily lead to diabetes.
And that’s the thing—most people know people with diabetes. Most of the people they know with diabetes don’t end up having limbs amputated. The message these ads give is too worst-case-scenario, to the detriment of its credibility. Sure, the ads inform us that “Type 2 diabetes … can lead to amputations.” But when that doesn’t jibe with people’s experiences, it becomes an extreme example at best—not the kind of thing I suspect leads to behavioral change.
The ads clearly take a page from the anti-smoking (or pro-life, or animal rights, or War on Drugs) playbook. Thy remind me of some of the graphic ads put out by PETA, or the kinds of warnings that are popular with tobacco. But scaring people into good behavior doesn’t work. Numerous studies have shown that people respond better to positive public health messages than they do to scare tactics, or messages that can be read as trying to limit their freedom of choice. Insofar as public health campaigns can have any effect on America’s eating habits and obesity levels, we’d do better with Uncle Sam in the role of healthy habit helper than public health nanny.
About 82,000 people have diabetes-related leg and foot amputations each year, according to NYC.gov. And maybe the fact that diabetes can lead to amputation will surprise a good deal of people. But you know what else might surprise folks? That diabetes can be reversed with a healthy diet. A campaign that focused on how people could counter diabetes or pre-diabetes through diet might not only shock people, though, but encourage behavioral change by focusing on actionable, positive steps. And yes, that’s a whole different campaign than trying to get people not to drink soda. But at least its a campaign that might actually have some positive effect.