Interpretive Front-of-Package Labels: Assessing and Addressing Unintended Contributions to Weight Stigma

Introduction. Weight stigma has numerous harmful effects, but public health interventions often overlook and may even contribute to such stigma. Interpretive front-of-package labeling (FOPL) of foods and beverages is a policy-level intervention gaining traction globally. Seeking to influence individual behavior, interpretive FOPLs may inadvertently reinforce perceptions of personal responsibility for body weight, thus contributing to weight stigma. However, this possible effect remains largely unexplored. This dissertation investigates the possible effects of interpretive FOPLs on weight stigma and strategies to mitigate this effect. Methods. This dissertation uses experimental and observational methods to investigate the relationship between exposure to interpretive FOPLs and weight stigma. The first study constituted a randomized between-within-subjects experiment with US adults examining how different FOPLs impact weight stigmatization, whether weight-neutral content reduces stigmatization, and potential trade-offs between stigmatization and effectiveness. The second study examined whether evolutionary psychology-based mechanisms explain the effects of FOPLs on explicit weight bias. The third study examined associations between self-reported awareness and use of FOPLs and attribution of blame for body weight among Mexican adults and Mexican and Chilean youth. Results. In the first study, nutrient warning labels performed best at maximizing effectiveness and minimizing stigmatization. Additionally, removing references to obesity from health warnings labels reduced stigmatization without meaningfully reducing effectiveness. In the second study, none of the mechanisms examined mediated the effects of FOPLs on explicit weight bias. In the third study, FOPL awareness was not associated with attribution of blame for body weight, but FOPL use was associated with higher attribution of blame among Mexican adults and with lower attribution of blame among Mexican and Chilean youth. Conclusions. This dissertation suggests that interpretive FOPLs’ content and design are important for managing their contributions to weight stigma. Nutrient warning labels, the most common type of mandatory FOPL, seem generally unlikely to contribute to weight stigma, although differences by label design merit attention. Health warning labels that reference obesity may contribute to weight stigma, but contributions may be mitigated by omitting such references. Overall, policy makers have promising options for designing FOPLs that do not reinforce weight stigma while remaining effective at influencing behavior.