It’s not news that obesity is a growing health issue, but it’s an extraordinarily difficult problem to fix. There’s the policy layer--like should our government give such large subsidies to beef and corn--which is complicated but theoretically solvable. And then there’s the even more challenging component, the social dynamic, the things society doesn’t know how to process, like that people with overweight friends are more likely to be overweight themselves.
In a piece for The Atlantic, Amelia Rachel Hokule’a Borofsky tells the story of a doctor who attempted to change diets in the Cook Islands through gardening and a focus on traditional foods. But he also used another, more unorthodox approach to fighting obesity in his community:
Shame and ridicule are actually common ways to regulate behavior in small Pacific Island communities. He regularly said to his patients, "There is something wrong in a place where the parents are so fat and the children so skinny." He started monitoring what parents gave children for school lunch and posting it on the government notice board for everyone to see, and laugh at. Pretty soon shamed parents fed their children baked uto (sprouted coconut) instead of packaged instant noodles. This also meant that the parents ate the same healthier cooked food, and in smaller portions.
Many mothers in the Cook Islands feed their babies a bottle of warm water with two teaspoons of sugar, a path to diabetes. Dr. Thein refused to treat the infants or mothers if they fed the baby sugar water instead of breast milk or formula. He also made jokes about the "ugly babies" fed on sugar water bottles. His litany of shaming jokes was just part of how he operated.
In terms of exercise, he encouraged it but mostly he modeled it. Every morning and every evening he would walk around the island with his wife at a brisk pace. He stopped and visited as he walked, often asking, "What are you having for dinner?" He might then mention how canned corned beef causes premature ejaculation, to huge eruptions of laughter. Then he would continue walking.
There’s no question that shame can be a powerful tool in fighting obesity at the local policy level. Most of us probably remember last year’s triumph of the Scottish grade schooler Martha Payne, who, fed up with her sickeningly unbalanced school lunches, began posting pictures of them online. Unlimited portions of fruits and veggies soon followed.
The question becomes, could and should we leverage shame at the individual level of personal health? And does effective shame need to feel so humiliatingly public to work? It’s actually a problem stacked on a problem: At the present time, our apps simply don’t harness darker emotions all that well. Consider the inability to offer condolences to a friend on Facebook who lost someone they loved--do you like that post to show you care? Appification at its core harnesses positive reinforcement, but there are situations where positive reinforcement just isn’t the right tool.
Maybe I would be better off if my Nike+ Fuelband didn’t just applaud my good days but judged me harshly for a string of bad days, too. Gamification has created a kindergarten teacher syndrome that coddles with endless sheets of gold stars for every possible accomplishment. When, in reality? That dickhead of a P.E. teacher sure had a way with words, especially when he demanded another lap.
[Image: Girl via Shutterstock]