It is no secret that preventable diseases such as heart disease, diabetes, and lung cancer disproportionately affect African-Americans. The prevalence of stress, poor diet, lack of exercise, alcohol use, and smoking in the Black community has been largely responsible for the heavy disease burden African-Americans face as well as poor access to quality health services. According to the American Diabetes Association, 4.9 million or 18.7% of all African-Americans aged 20 years or older have diabetes and are 50% as likely to develop diabetes-related blindness compared to whites (1). On average, African-Americans are twice as likely as whites to have diabetes (2). The US Department of Health & Human Services has statistics that reveal African-American women having the highest rates of being overweight or obese compared to other groups with approximately four out of five African-American women being overweight or obese. In 2011, African-Americans were 1.5 times as likely to be obese as whites (2).
Therefore, it was commendable when historically black college Lincoln University voiced concern about “the high rates of obesity and diabetes, especially in the African-American community” (3) and decided to intervene to reduce the prevalence of obesity on campus and in turn in the overall African-American community. However, the methods used to accomplish this worthy objective stirred up some controversy. The University enacted a mandate that requires incoming students to submit their calculated BMI Score and those with a BMI of 30 or greater would be required to take and pass a “Fitness for Life” class in order to graduate. The class would entail physical activities as well as information on nutrition, stress, and sleep. University officials such as James L. DeBoy, chairman of Lincoln's department of health, physical education and recreation have emphasized that “students are not required to lose weight or lower their BMI; they must only pass the class through attendance and participation” (3).
The intent of Lincoln University’s policy to address obesity in the African-American community is noble; however, the means used to fulfill this mission have the potential to do more harm than good. The singling out the ‘fat’ incoming freshmen for enrollment in a fitness class violates many established principles of social science and theory. Lincoln University officials should be applauded for bringing the issue of rampant obesity in the African-American community on the agenda and for taking aggressive action, but their tactics to address the issue must be scrutinized and reconstructed in order to become more effectual. Lincoln University must empower its student with the tools to become self-efficacious, remove the negative labels placed on obese students, and address the environmental factors in the vicinity of the university that could contribute to the perpetuation of unhealthy lifestyle choices. Since Lincoln University is “committed to maintaining a nurturing and stimulating environment for learning” as delineated in its mission statement, the university should empower every student with the tools to incorporate healthy lifestyle changes into their daily lives by creating a university environment conducive to the health of its students.
The Negative Labeling Potential
The intent of Lincoln University’s intervention is to identify obese individuals entering the university who are at high risk of future health complications and require them to enroll into a healthy living class to reduce their future risks. The problem is that they are selecting a certain population and labeling them with the socially undesirable name ‘fat’ and thereby subjecting them to shame, humiliation, and isolation. Labeling theory posits that the self-identity and behavior of individuals may be determined or influenced by the terms used to describe or classify them (4). Furthermore, the person labeled incorporates the label into their concept of themselves (5). In other words, the person cannot think of themselves outside of the label that has been assigned to them and fulfills the prophecy of that label. In regards to labeling individuals as fat, particularly children and young adults, the evidence is clear: it does more harm than good. Researchers at UCLA found that 10-year-old girls told that they were ‘fat’ by those close to them were more likely to be obese at 19 than those who were never told they were fat, regardless of what they weighed at the beginning of the study(6). It seems as though individuals who are told that they are fat internalize that identity, causing them great pain and to quell it they often turn to food which perpetuates the vicious cycle.
So it seems as though Lincoln University did a great disservice to their incoming students by labeling them before they even get on campus as fat, especially the young women. Since this is a historically black university, many students entering Lincoln University will be Black students seeking to escape the label of being a “Black student” that may have been automatically given to them at their predominantly white high schools. Many students who attend historically black colleges (from experience) are seeking to just be a ‘regular’ student in a predominantly Black setting to escape the responsibility of having to be the spokesperson for the race. Therefore, as the obese Black students enter Lincoln University they will simultaneously lose and gain a label. Studies have proven that many Blacks people have internalized racism, particularly Black women which have lead to negative health outcomes (7-13). It becomes troubling to consider the harm this policy could do in adding to the burden of labels of its incoming students who are statistically more likely to be obese.
Potential to Induce Strong Psychological Reactance
Human beings generally enjoy the freedom of choice in selecting participation in activities. Whenever somebody threatens this choice or a human being’s autonomy they are risking psychological reactance. Psychological reactance is an aversive affective reaction in response to regulations or impositions that impinge on freedom and autonomy (14, 15). Psychological reactance elicits a response that seeks to restore autonomy, so if you try to force something upon somebody they are likely to counter by doing the opposite of what’s expected from them. This effect may be greater when promoting health behavior change in college students (16). Therefore, Lincoln University mandating that students must take a fitness class in order to graduate is likely to elicit psychological reactance because they are forcing students to take a class against their will. When young adults go off to college they relish the opportunity to exercise their new found freedom and autonomy away from the home where they can independently choose their major and which classes to take. However, if the university now requires students to take a class based on their BMI score then this is likely to generate a strong emotional response that will seek to establish autonomy. Students may then become more obstinate in their health habits and refuse to incorporate the lifestyle suggestions into their life simply because the choice was taken out of their hands. This form of rebellion may sabotage the intervention and actually cause people to gain weight rather than lose it. To demonstrate the phenomena of psychological reactance in this instance, one student enrolled in the class told reporters in a press release that right after she gets out of the Fitness for Life class she goes directly to ‘The Grill’ to eat fried chicken (17).
No Change in Lincoln University
After reading all the press releases on this controversial issue I did not come across any evidence that the university itself changed the campus environment to become more conducive towards health. Instead, the university expected students enrolled in the class to make all the changes and invest themselves into being healthy. The university did not announce that they were changing the food choices being offered which include selections from KFC and ‘The Grill’ which features fried mozzarella sticks, quarter-pounders, hot dogs and Jamaican beef patties (17). The university also did not reveal that they were remodeling the gym to accommodate more students; a sentiment that was expressed in a press release from a young man stating “If they want us to lose weight, expand the gym, don't tell us we won't graduate (17)." The university is sending a mixed signal when it proclaims they are interested in the health of the students but are not willing to invest the necessary resources to create an environment where students have healthy food choices and adequate exercise equipment. If the students were to see that the university was exerting the same effort and commitment they expected of them in the fitness classes, then it would create a more favorable environment to practice healthy behaviors.
Utilizing the tools social science theory gives us, the first step of the new intervention would be to require every student regardless of BMI score or waist circumference to participate in the Fitness for Life class. Secondly, the course would focus on fostering overall well-being and health rather than isolating obesity as the main culprit. This would ensure that all facets relevant to the health of college students are addressed such as alcohol and drug abuse, mental health and healthy relationships (18). The class would still have as a central theme of aerobic exercise because a significant amount of college students do not (19). However, the course would emphasis the behaviors that are going to be continued after the course’s completion. The current invention is overly focused on the issue of obesity because it is an easy target but there are other important health issues that affect students regardless of the BMI score. Thirdly, the course component would be accompanied by changes to the university itself, namely making the availability of healthy food on campus the norm and not the exception. To make exercise more feasible this intervention involves establishing a partnership with a local gym so that students will have the necessary infrastructure to work out. This would likely fit the university’s budget while expand exercise equipment to students. With this intervention in place the methods would support the goals of an overall healthier campus.
How the Proposed Intervention Mitigates the Current Flaws
The first step of including all students in the intervention would eliminate the stigmatizing label that was unceremoniously given to those with BMI’s over 30. This would essentially remove both the label and the shame from having to take the class while creating an inclusive environment where all are trying to incorporate healthy behaviors. No longer would students have to walk around in embarrassment with everybody knowing that they had to take, as one student enrolled in the class at Lincoln University put it, the “fat people class”. In essence, everybody would be labeled which would cancel out the detrimental effects of the negative label of being in the “fat people class”. Inclusion of all students in the class also corrects a potentially serious consequence of singling out obese individuals. When Lincoln University selectively chose obese individuals for behavior change modification, they simultaneously validated ‘skinny’ students’ health behaviors even if they were unhealthy. Only enrolling obese individuals into the class relays the message that only they have to change their habits while everybody can remain the same. Under this premise the conveyed message is as long as you are not obese then you are healthy—clearly erroneous and unconstructive. Encompassing all students in the class removes the potential for reinforcing negative health practices while sending the message that all students’ health, regardless of BMI, can improve.
The inclusion of all students would also significantly reduce the risk of psychological reactance. Although collectively the students’ choice would be taken away in deciding if they want to take the class or not, at least everybody on campus would have to ‘suffer together’. The resentment of being singled out would arguably be the biggest source of emotional opposition, so if that component was removed then the potential for psychological reactance would be drastically lowered. For example, I attended a historically black university and one of the requirements for everybody was to take and pass a swimming class to counter the stereotype that Black people cannot swim. Since this was a university-wide requirement, there were minimal complaints because we all had to take the course in something we could all agree was important. At first it seemed unreasonable that everybody had to take the course but once the time came everybody participated and made the most out of the situation. I suspect the same thing would take place if everybody at Lincoln University were required to take the course. To further decrease the possibility of psychological reactance, the alternative intervention would incentivize accomplishing health goals such as losing weight or lowering blood pressure by offering legitimate prizes. Because the intervention is taking away the students’ autonomy, it is imperative that we give them the possibility of gaining something so that they are not ‘gaining their freedom back’ through psychological reactance, but rather are regaining that sense of autonomy by achieving their health objective. This would transform the class from being one where people would go through the motions to striving to accomplish their health goals. The class would no longer be one that they have to take but one that they get to take.
Finally, the third part of the alternative intervention which involves the University making changes to the food available and improving access to gym facilities would signal Lincoln University’s commitment to the health of their students. Lincoln University would be holding itself accountable without expecting the students to be the only ones to change. This would create more buy in from the students and would likely lead to healthier behavior due to the environment now being more suitable for healthy behaviors. If the students see that the University is changing for the better then it could inspire them to do the same.
The prevalence of diabetes and obesity in the African-American community calls for immediate action to address the serious epidemic. However, reasoned action that is predicated on sound social science theory must be applied before rushing into the fray. Lincoln University’s attempt to reduce obesity and its associated complications on campus and within the greater community must be acknowledged for its impassioned approach to a serious problem. However, singling out ‘fat’ individuals in such a way may cause more harm than good according to social science theory. It adds negative labels to a demographic of people who already carry the burden of negative labels which increases the likelihood of psychological reactance to the intervention. Thus individuals may resent being labelled and react against the intervention by fulfilling the prophecy of a fat person. This could be in direct defiance of the university who itself has not committed to ensuring the most favorable conditions of health on campus.
Addressing the flaws of the intervention involves obligating every student on campus to participate in the Fitness for Life course. Instead of socially isolating and labeling obese individuals, this creates an environment of solidarity where the health needs of all students are addressed together. Including everybody and infusing incentives for participating in the class eliminates the stigmatizing label of being in the “fat people class” while increasing students’ willingness to participate. This coupled with the University changing its policy on food selection and exercise capacity will create an environment where together the University’s staff, administrators, and students are all invested in the health and well-being of the campus and greater community.
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