5

Changing the Conversation around Representation in Media and Body Image

The fourth and final session of the April workshop included an overview of the session topic, followed by a presentation about the marketing landscape, and the barriers and opportunities it presents for addressing bias, stigma, and inequities associated with obesity. A facilitated question- and-answer period with workshop attendees and a final closing presentation concluded the session. Rebecca L. Pearl, assistant professor in the Department of Clinical and Health Psychology and Social and Behavioral Sciences at the University of Florida College of Public Health and Health Professions, moderated the session and provided opening remarks.

WEIGHT ATTITUDES, REPRESENTATION OF OBESITY IN MEDIA, AND CONSIDERATIONS FOR CHANGING NORMS

Pearl opened the session with a brief overview of the topic, beginning with the current landscape of weight attitudes and diet culture. She pointed out that society blames obesity mainly on individual choices, primarily poor diet and failure to exercise. These choices, she continued, are erroneously attributed to the presumed lack of self-control, laziness, and other unflattering personal traits of the person with obesity. At the same time, she observed, thinness is viewed as a sign of good moral character and is valued for reasons that go far beyond health. Shifts in female body ideals have occurred in recent years, she noted—from a purely thin ideal to one that also includes bodies with an athletic build. Nevertheless, she maintained, the value placed on leaner bodies and the devaluing or disparaging of people with larger bodies persist. Thin ideals are rooted largely in White or Eurocentric norms and values, Pearl added, and although cross-cultural differences exist in body ideals, there are more similarities than differences across racial and ethnic groups in the United States, and diet culture persists among people across the weight spectrum. Pearl explained further that, along with exercise habits, dietary restriction is often pursued as a means to achieving a thin ideal. The concept of dieting to be thin is different, she noted, from the concept of diet in relation to evidence-based interventions for weight management or other health outcomes.

Pearl shared results from a 2019 study of patterns in implicit and explicit attitudes on a number of topics, including weight (Charlesworth and Banaji, 2019). Despite increased attention over the past decade to such topics as body shaming, weight bias, and stigma, she reported that the study’s results indicate minimal improvement in population-level weight bias. This study, she elaborated, found that improvements had occurred in implicit bias related to sexual orientation or race, but that negative implicit attitudes related to body weight were the only form of bias examined that had worsened over time.¹ Much room for improvement remains, she maintained, in terms of shifting weight-related attitudes and norms.

Negative weight-related attitudes are problematic from ethical, social justice, and public health points of view, Pearl argued, because they contribute to negative body image (a risk factor for unhealthy weight control practices and eating disorders) and weight stigma and discrimination (which undermine mental and physical health) (Neumark-Sztainer et al., 2006; Pearl and Puhl, 2018; Pearl et al., 2015, 2020; Tomiyama et al., 2018). Weight bias and stigma have been linked to negative effects on access to health care and quality of care received, she added, as well as to direct effects on affected individuals (Figure 5-1).

Pearl explained that experiencing or internalizing weight stigma leads to psychological distress that is linked to adverse mental health conditions (e.g., depression, anxiety), as well as physiological stress (e.g., dysregulated cortisol) from experiencing weight-related mistreatment, such as bullying, discrimination, or constant criticism. These sources of stress can lead to

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¹ Recent data suggest that this increase in implicit weight bias has leveled off, with a slight decrease in such bias from 2017 to 2020. Overall, data suggest that this form of bias remained relatively stable from 2007 to 2020 (Charlesworth and Banaji, 2022).

coping mechanisms, such as engaging in unhealthy behaviors (e.g., overeating energy-dense foods, avoiding physical activity), she stated, further contributing to poorer health-related quality of life and increased risk for chronic disease beyond weight-related risks.

Pearl discussed how internalization of cultural beliefs, norms, and stereotypes may play a role in the relationship between weight stigma and less engagement in health-promoting behaviors. For example, she elaborated, if people with a higher weight believe that they are lazy, deficient in willpower, unathletic, or unwelcome in fitness spaces, they may have less self-efficacy or confidence to pursue health goals, leading to less engagement in health-promoting behaviors.

Pearl then turned to the topic of body image in the media, which she said reflects social norms and attitudes about weight, body image, and obesity. She pointed out that media also have the power to shape and change those attitudes and beliefs for the good, whether messages are disseminated via news stories, movies, television shows, cartoons, social media, public health campaigns, advertising, fashion, or other modes. Pearl went into greater detail about news stories in particular, which she said can help shift the narrative by highlighting the complexity of the contributors to obesity, including the role of social determinants of health and the impact of weight stigma and discrimination, instead of perpetuating the narrative that obesity is solely a matter of personal responsibility.

In addition to shifting the content and framing of news stories, Pearl called for shifting the images that accompany them. News stories about obesity often carry images that depict people with obesity engaging in stereotypical unhealthy behaviors rather than health-promoting behaviors such as browsing the produce section at a food store or being physically active. When the public sees the latter types of images, Pearl explained, they report less negative attitudes toward the people depicted, less desire to avoid them socially, and more positive feelings about the images overall (Pearl et al., 2012). When images are paired with news stories, she continued, they affect readers’ interpretation of and reactions to the associated content. She showed two mockups of a news article about a Canadian policy proposal to deny fertility treatment to women with obesity—one with a stereotypical, stigmatizing image of a couple with obesity (lounging on a couch, eating energy-dense, nutrient-poor foods), and another with an image of the same couple portrayed in a more positive way (engaged in friendly conversation on a bench outdoors). Participants who saw the positive image reported less support for the proposed policy, Pearl said, underscoring that images can powerfully affect attitudes (Brochu et al., 2014).

Pearl shared guidelines for media portrayals of individuals with obesity, which she said include image galleries intended to promote nonstereotypical,

bias-free depictions of people with obesity in the media.² The galleries are available to the general public, members of the press, and people working in the field, she said, and she encouraged attendees to use the resource to find images for presentations and call it to the attention of reporters writing stories about weight. The media guidelines also include information about representing individuals with higher weight as a whole person—both literally, such as not cropping parts of their bodies out of the images, and more holistically, such as focusing on the individuals’ relationships and career pursuits instead of defining their identity solely by weight. Advertising campaigns are increasingly showing “real people”—i.e., people of all shapes and sizes—Pearl observed, and she cited preliminary evidence from mainly college-aged survey respondents indicating that these types of campaigns have positive effects on body image and mood (Convertino et al., 2019; Rodgers et al., 2019; Selensky and Carels, 2021).

Pearl next turned to some positive examples in social media that have given voice to diverse individuals, encouraging them to participate in and lead conversations from which they may previously have been marginalized or excluded (Cha et al., 2022; Cohen et al., 2019; Fioravanti et al., 2021; Pearl, 2020; Puhl, 2022; Webb et al., 2019; Zavattaro, 2021). Positive body image content is present in social media spaces, she pointed out, highlighting body acceptance messaging and hashtags such as #BoPo (body positivity) and #curvy. Preliminary evidence suggests that these types of messages have positive short-term effects on mood and body image, she reported, although research in this area is often conducted in a relatively narrow way (i.e., people are shown a limited amount of content in a limited amount of time) instead of in a way that is more representative of the actual experience of being regularly immersed in social media. Pearl suggested that social media can also be used to elevate activism, such as garnering support for policies that prohibit weight discrimination, and to correct misinformation, such as narrow views about the causes of excess weight.

Pearl concluded her remarks with a summary of considerations, challenges, and opportunities for changing beliefs and social norms about weight and body image. First, diversity in body sizes shown in the media has certainly increased, but full representation of all bodies in the United States has not necessarily been achieved. Furthermore, the larger bodies shown may still meet other beauty ideals, such as having an hourglass figure, which she reiterated does not represent most bodies in the country. Another consideration is that, despite the intent of body-positivity messages to celebrate larger bodies, much of the content with these hashtags

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² Image galleries from the Obesity Action Coalition (https://www.obesityaction.org/educations-upport/resources/oac-image-gallery/) and University of Connecticut Rudd Center Food Policy and Health (https://uconnruddcenter.org/media-gallery/) (accessed January 5, 2023).

still promotes thin ideals. These considerations highlight the importance of including people with diverse lived experiences when creating content, Pearl contended, to avoid inadvertent stigmatization.

Lastly, Pearl stressed the importance of appreciating that weight intersects with other identities and of representing a variety of intersecting experiences. The experience of individuals with higher weight may differ based on their gender identity, she elaborated, or whether they are from a minoritized racial or ethnic background. Pearl concluded by reiterating that tremendous potential exists to harness the power of media to shape social norms for positive change.

THE IMPACT OF MARKETING AND MEDIA ON OBESITY

Ginny Levine, managing director of marketing for the U.S. Tennis Association (USTA), drew on her career in advertising as she offered reflections on the marketing landscape. She discussed her view that Generation Z will be a force for change in increasing representation in media, shared examples of USTA’s efforts in this regard, and highlighted a sample of brands that she would position at the forefront of changing the conversation about representation.

Media ideals of thinness have persisted for generations, Levine observed, and she suggested that this theme in media and marketing has led to “image conditioning,” inflating a false sense of reality and fueling biases that have become entrenched in society. She echoed Pearl’s comments about weight stigma and discrimination, giving the example of an entertainment celebrity who recounted her experience with being labeled as “fat” and therefore presumed to have lost control of her life. According to Levine, society has experienced image conditioning for centuries because the same ideals related to food, health, and beauty found in advertisements of the past still circulate today.

Levine pointed to the notion of a disparity between marketing messages that promote health and those that promote acceptance. While she applauded ads that promote fitness, she maintained that when they are stuck in what she called the old construct of selling a vision, their depiction of an otherwise healthy activity perpetuates images of unattainable fitness physiques. She observed that marketing about health and health behaviors is often presented in the style of a public service announcement or tied to science news instead of being framed in the same mainstream media culture as ads for food, clothing, and other consumer goods.

According to Levine, exposure to advertising content, including both traditional ads and content from social media influencers, is at an all-time high: she explained that influencers sometimes apply filters to edit their own images because, despite exceeding beauty standards, they still believe

they are not good enough. In an image-obsessed world, she observed, an average consumer can easily feel less than average and caught in a cycle of striving for the unattainable. For people with obesity, she said, those messages can exacerbate feelings of defeat and self-deprecation and are rarely countered by more representative images. Levine shared her outlook that positive shifts in marketing and media are forthcoming and hold potential to impact perceptions and conversations about obesity.

Levine turned to highlighting Lizzo, an American singer and songwriter whom she considers “the new force in body image,” for her challenges to traditional perceptions of obesity and emergence as a symbol for representation in this area. Lizzo’s messages to promote and mainstream body diversity are clear, Levine said, as she portrays herself as a larger person who lives and loves life and wants to be accepted like everyone else.

Levine explained that a relatively recent shift in marketing approaches has been driven by the coming of age of Generation Z—the first generation that has never experienced a world without the Internet, social media, and other technologies—as well as current world dynamics around climate concerns, the effects of the COVID-19 pandemic, and racial equity and social justice. She suggested that this environment leads to generational characteristics such as being more politically aware, collaborative, multicultural, and likely to test current labels and demand representation (CM Group, 2022; Dentsu, 2022). She asserted that the combination of these global dynamics and generational characteristics is forcing marketers to change their mindsets and accept a new generation that is setting new standards for inclusion, reevaluating inequities, internalizing their self-worth, and pursuing mental health and well-being. If marketers embrace this change, Levine maintained, “we can catapult the conversation” to change perceptions and norms about obesity, given the clear power of media and marketing to amplify either positive or negative body weight ideals.

Levine then described USTA’s initiative “The New and Next for Tennis” as an example of how marketers are reacting to Generation Z’s prompting of the marketing paradigm shift. Recounting her experience in helping to lead the charge to redefine USTA in tennis, she explained that the association was intentional about self-reflection in order to change the way it did business instead of simply devising a new branding campaign. Levine referenced qualitative research indicating that people believed USTA (and by extension, tennis) to be internally oriented, traditional, process heavy, complex, and slow to adapt. She contrasted these characteristics with those of a service-driven culture that meets the needs of individuals where they are, which she listed as others oriented, empathetic, helpful, seamless, responsive, and communal. She recalled that this exercise quickly led USTA to realize that it needed to move from an operating system that felt closed to one that felt open.

USTA’s new service role definition and aim is to make tennis and USTA “open to all,” which Levine assured the audience is not merely a marketing campaign but a gradual, significant shift in the organization’s way of operating. She explained that injecting relevance and culture into the game of tennis and elevating the diversity that exists by showing that people of all ages, shapes, sizes, and backgrounds already play and enjoy tennis sets the stage for changing perceptions. The first marketing campaign for “open to all” was intentional about the actors it cast, Levine added, with the goal of representing the diversity that exists among people. She acknowledged that this practice is not a new or complex idea but stressed that normalizing the existing diversity is the first step in changing perceptions.

Levine turned to highlighting several ad campaigns that she views as leaders in body diversity and representation. One is the Dove Real Beauty campaign, which she said initiated the conversation about representing body diversity, and also launched the era of brand purpose, which is defined by brands not only selling products but also connecting with consumers in ways that reveal the reason for a brand’s existence. Using Dove as an example, she explained that it sells soap and beauty products that serve their basic purpose, but also create an accessible experience that empowers people to feel like the best version of themselves.

Levine next spotlighted Fenty Beauty, which was launched by celebrity singer Rihanna and distinguishes itself by carrying a full range of makeup shades to suit people of every skin color. She noted that Fenty has revolutionized other major beauty brands’ approach to product development and marketing to address the reality of diverse skin tones throughout the population.

Levine cited Blink Fitness as a fitness brand that destigmatizes exercise and showcases body diversity in its campaigns, which she said often focus on how exercise can make one feel instead of on how it can change physical appearance. Emphasizing “mood above muscle” and using welcoming statements, Levine said, its campaigns convey that people of all fitness levels are welcome and encourage people of all body sizes to embrace their capacity for movement.

Finally, Levine highlighted Old Navy as a brand that has consistently promoted diversity in its styles, campaigns, and messages. Its Bodequality line was launched in 2021, expanding fashion to what Levine termed “true size inclusivity.” Its stores have eliminated plus-size sections, she added, to address the subconscious bias that is perpetuated by segregating people with obesity to a particular physical area of the store.

Levine concluded her presentation by summarizing her view that the combination of current cultural dynamics and the post-COVID environment is spurring a Generation Z that is reevaluating itself and demanding

change in representation in media and marketing. Changing this sector’s long-standing practices is incredibly difficult, she admitted, but those who can respond to the shifting climate “ultimately will win.”

PANEL AND AUDIENCE DISCUSSION

Following Levine’s presentation, Pearl and attendees asked her several questions about topics that included the culture of sport in the United States compared with other countries, marketing as a tool for childhood obesity solutions, challenges to improving representation in marketing, improving marketers’ sensitivity toward health equity and diversity, and the future of weight-related representation in media.

Culture of Sport in the United States versus Other Countries

According to Levine, the U.S. culture of capitalism and democracy allows marketers to focus on immediate gratification. With respect to other countries, she highlighted Norway as an exemplar of balancing moderation in all pursuits and focusing on community connections. Sports in that country are about spontaneous, unstructured play and a way of experiencing the world on one’s own terms, she explained, contrasting this approach with that of the United States, which reflects a construct of media, influencers, or superstars.

Marketing as a Tool for Childhood Obesity Solutions

Levine highlighted the important role of sports marketing in conveying that youth need to be engaged in play and can succeed in that space, and in illustrating that kids from all backgrounds and of all body types can engage in play. She referenced what she called “troubling statistics” about youth exiting sports and explained that a contributor to this phenomenon is a culture that pressures them to attain a relatively advanced level of play at a young age. As a result, she stated, youth opt out of activity because they feel they are not good enough. Levine suggested that marketing can educate parents about being part of the problem if they push their children to participate in sport in an overly structured and disciplined way that does not allow them to be kids.

Pearl noted that evidence of negative weight attitudes exists among children as young as preschool age, and that some children’s books and cartoons feature derogatory depictions of kids with higher weights. She stressed that weight is a leading reason for bullying and teasing in school. Thus she argued for intervening during early childhood to shape children’s beliefs and attitudes about weight and equip parents to talk about weight in healthy ways in conversations both with and without their children.

Challenges to Improving Representation in Marketing

Levine recalled that USTA chose not to show certain ads it had developed because consumer testing indicated that the way Black women were presented in the ads perpetuated simplistic perceptions of Black culture—“that people who are overweight are simply Black.” She observed that some marketers are uncertain about how to go about improving the representation of Black people and are “tiptoeing” around the issue, concerned that they will end up perpetuating the misrepresentation of a culture. Levine urged marketers to take risks and to get comfortable with the idea of increasing representation, which she suggested can be achieved simply by representing real people in real-life situations. Pearl maintained that this challenge emphasizes the importance of representation on the teams that create and evaluate marketing content.

Improving Marketers’ Sensitivity toward Health Equity and Diversity

According to Levine, marketers by nature have a difficult time removing their own biases from their day-to-day work and lack the training to address personal biases. The notion of equity in representation is coming to the forefront in the marketing domain, she observed. A reason for this shift, she maintained, is the emergence and ultimately the dominance of digital marketing channels during the past decade, which has forced marketers to pivot from a brand-centered to a consumer-centered approach. This shift has been difficult for marketers to navigate, she reiterated, as they have been challenged to change their business model relatively quickly.

Pearl maintained that identifying and managing one’s own biases is relevant for people working in all sectors as they attempt to step outside of their own experiences and be open-minded and curious about how other people experience the world.

The Future of Weight-Related Representation in Media

Levine reiterated that positive shifts in marketing and media have begun and shared the related observation that both mainstream and emerging athletic clothing brands are already starting to embrace body diversity and ensure the availability of all sizes of active apparel. She offered comments on how marketers can use data responsibly, contrasting the use of algorithms that channel users toward content similar to that with which they are already interacting—which she suggested can perpetuate biases over time—with the use of data to present users with content that is meaningful to them and helps them thrive.

WORKSHOP WRAP-UP

Following the discussion with attendees, Stella S. Yi, associate professor in the Department of Population Health, Section for Health Equity at New York University Grossman School of Medicine, delivered a final presentation. She summarized key points from each of the workshop’s four sessions (see the “Highlights from the Presentations of Individual Speakers” boxes at the beginning of Chapters 2, 3, 4, and 5) and offered her observations about a few overarching themes that had been conveyed.

Yi maintained that it is time to change how society views obesity. She asserted that dismantling structural racism, communicating more effectively, and changing mental models, if addressed simultaneously, would ultimately change social norms and views on obesity held by researchers, public health providers, policy makers, and society. According to Yi, society’s present energy and enthusiasm around foundational drivers of obesity holds exciting potential to drive changes in current systems, but also comes with a high level of expectation for executing some of these changes. Advancing obesity solutions calls for a focus on intersectionality and multisectoral collaboration, Yi stressed, as well as consideration of social norms and existing paradigms in institutions, and recognition that all people have their own identity and experiences that deserve to be heard empathically and represented.

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