Are Health Policy Preferences Really About Health? The Hidden Influence of Biased Media Portrayals

We all know that advertisers are skilled at manipulating our feelings—but what about our policy preferences? In the first scientific study to investigate the impact of images on public support for weight-related health policies, psychologists Brochu, Pearl, Puhl & Brownell (2013) instructed participants to read a news article describing a policy that would prohibit obese women from receiving fertility treatment. Researchers found that when the article contained a stigmatizing image of an obese couple, participants were more likely to support the policy than when it included a non-stigmatizing image of the same couple—implying that even seemingly irrelevant visual cues can trigger bias.

Weight stigma is well-documented in American society. The prevailing message in the media is that obesity is a matter of personal responsibility—leading to the mistaken assumption that obese individuals simply lack the proper motivation to adopt a healthier lifestyle.

Weight stigma may be intended to discourage unhealthy eating habits, but it is in fact linked to negative health outcomes such as depression, eating disorders, and social isolation. For this reason, the field of public health is especially concerned with reducing weight bias and its impact on broader policy debates.

For this study, Brochu et al. randomly divided 74 paid participants into three groups, all of which read the exact same article about a proposed policy to deny fertility treatment to obese women because of the medical risk. One group read the article accompanied by an image featuring an obese couple sitting on a couch eating junk food (reinforcing a common stereotype that obese people are unhealthy and lazy), another saw an image of the same obese couple sitting on a bench holding hands, and a control group read the article without any accompanying image. Participants then gave their opinions about the proposed policy, rating a series of statements on a nine point scale (one=strongly disagree, nine= agree completely).

Experimenters found that those who viewed the stigmatizing image (couple eating junk food) were on average more supportive of the policy (an average rating of 5.78 out of nine) than those who viewed the non-stigmatizing image (couple holding hands; average rating of 4.14 out of nine). They also perceived the medical risk of obese women to be higher (4.9 out of nine) than participants who viewed the non-stigmatizing image (3.69 out of nine). The survey responses of participants who read the article with no image did not differ significantly from either group. Researchers concluded that, with 99 percent confidence, the image content was a significant predictor of both policy support and perceived medical risk.

Both treatment groups cited the concern for medical complications as the basis for their position supporting the fertility policy. However, given that the article text was identical for all participants, this concern fails to explain the statistically significant difference between perceptions of medical risk. Instead, the experiment outcome supports a popular psychological theory known as the justification-suppression model of prejudice, which asserts that people subconsciously rationalize negative attitudes with more socially acceptable reasons. In this case, the medical risk may have served as a convenient justification for a bias against overweight individuals.

There was also no significant difference among groups in how discriminatory they perceived the policy to be. Additionally, neither the gender nor weight of survey respondents had an impact on the outcome of interest, although 44 percent of participants were themselves overweight.

These results have broader implications for policymakers concerned with preventing disparities in medical care and reducing weight-based discrimination. Although the experiment tested the impact of stigmatizing images in only one context with one sample of participants, it does begin an important conversation about the role visual images play in shaping judgments about stigmatized groups and policy issues concerning them.

Future research may also reveal how media portrayals can influence social and political values more generally—and encourage media outlets to exercise more caution when depicting representatives of disadvantaged populations.

Feature Photo: cc/(Tony Alter)