The importance of framing
The importance of framing is widely recognized, especially given the potential for frames to influence the policy environment . Frames have been described as a package that promotes a particular definition of an issue . More than defining problems, they also diagnose the causes of the problems, make moral judgments, and suggest resolutions . Frames are also used to identify who is affected by a particular problem as well as who bears responsibility for resolving a problem [19, 22]. If frames shape the inferences individuals make about a message , “framing” is the process that influences how individuals develop a particular conceptualization or reorient their thinking about a particular issue . The public is therefore subject to framing competitions waged by stakeholders who wish to control public opinion about an issue. Multiple actors contribute competing frames, because frames will dictate what response is required. Consequently, debates over public policy have been characterized as battles for framing . These framing competitions can have negative implications for forming policy, as advocates can become more concerned with promoting a preferred conceptions of the problem than with identifying the most appropriate and effective response .
Once a frame is accepted it will influence how to best approach the problem. Stakeholders thus have a vested interest in promoting a particular frame as superior . Strong frames emerge when they are perceived as the more compelling argument, or when they are thought to more accurately correspond with reality [21, 25]. In situations where empirical reality is complex, as is the case with obesity, strong frames often emerge due to a claimant’s rhetorical skill and credibility, and not because of evidence . Chong and Druckman argue that this can be a problem, as strong frames might be built on exaggerations or even outright lies that play on public fears and prejudices . In framing competitions considerable effort is expended to control the frame because of a phenomenon known as “framing effects.” Framing effects occur when small changes in how an issue is presented result in large changes of opinion . Importantly, alternative ways of phrasing an issue, even if modest, can significantly alter how an issue is understood. Research indicates that reframing an issue can shift public opinion, as well as the policymaking environment . In public health, tobacco control is often used as an example of how significant policy shifts can result from small changes in how an issue is framed [19, 28], although the importance of framing has been recognized in a wide spectrum of public health issues, from HIV testing  to gambling .
In order to make sense of the obesity policy cacophony, this paper argues that the problem of obesity should be reframed as caloric overconsumption. There are two broad rationales for this reframing. The first rationale deals with the problems accompanying the current frame obesity. In addition to having become politicized, obesity is an outcome and not a causea. As a frame, “obesity” does not identify any specific causes – and obesity certainly is not the cause of itself! Thus the frame obesity remains open to be interpreted and influenced by competing theories about what does cause obesity. This makes it difficult to identify or assess potential policies or interventions. The second rationale stems from the potential benefits of using the proposed frame, caloric overconsumption. The frame caloric overconsumption minimizes some of the framing competition by identifying a specific cause of obesity, energy input. Moreover, the frame caloric overconsumption will permit a more critical analysis of the various policies and interventions that can be used in obesity prevention.
Part of the problem with the frame obesity is that it is highly politicized . While politicization has increased attention to the problem of obesity, it has also spurred on the vociferous debate. There has been an ongoing discussion about the appropriateness of calling obesity an “epidemic”b[31–34], with critics arguing “epidemic” is simply used to capture the attention of media and policy makers [9, 11, 27, 33]. There has been controversy over the use of the population measure of obesity, body-mass index, which critics suggest is too crude of a tool to be useful , and can be used to bolster claims about the epidemic nature of obesity . Some have even suggested obesity is a myth perpetuated the weight-loss industry , including advocacy groups representing the restaurant and fast-food industry [21, 36]. Controversy resulting from the politicization of obesity has led some to question whether or not obesity is even a problem that needs to be addressed , shifting focus away from what types of interventions or policies might be worth implementing.
A more significant problem with the frame obesity is obesity’s complex etiology. As Mann has observed, the reality of obesity is too complex to offer an integrated explanation . Different disciplines offer a particular lens into the problem, but each is limited, confined to the epistemological and scientific underpinnings of the discipline. Given this complexity, with numerous causal pathways, it is inevitable that solutions to address obesity will also be complex . Add to the complex causes of obesity the frames proffered by industry, advocacy groups, and the media, and the resulting policy cacophony is not surprising. As Schlesinger notes, “it is easy to imagine policy makers becoming so enmeshed in complex contests about the meaning of obesity that they can never move on to designing appropriate remedies” (p. 787).
The framing contest is perhaps most obvious when considering the commonly noted formula that obesity is the result of a sustained caloric imbalance, where energy input exceeds energy output . While empirically accurate, and seductively simple , this formula is a great oversimplification and prone to distortion and erroneous assumptions . Consider, for example, how the food and beverage industry has focused on the role of physical activity (energy output) [1, 6, 42], often making little to no mention of the environmental determinants of obesity . There is even an outright rejection by some that overeating or energy input contributes to obesity [21, 36]. At most, industry groups emphasize energy balance, where the role of physical activity is on par with energy consumption . This corresponds with the industry’s position that there are no good foods or bad foodsc, provided individuals expend an amount of energy equivalent to or greater than the amount of energy they consume. To the extent that industry does recognize energy input’s contribution to obesity, the focus is on personal and parental responsibilityd, both in consumption behaviours and physical activity . Unsurprisingly, the industry has been found to support frames that promote autonomy, individual choice, and “common sense” consumption .
However, research is increasingly demonstrating that energy output actually plays a very small role in obesity [44–49]. Recent estimates suggest that 60% to 100% of obesity amongst Canadians is related to excess calorie consumption, and not inadequate energy expenditure . In fact, exercise and physical activity has been shown to play a limited – and sometimes counterproductive – role in weight control . While some research has shown that energy output can result in equal or greater weight loss than might be achieved with an equivalent reduction in energy input , increased physical activity can be accompanied by increases in energy intake in free living adults . This is not to suggest that exercise or physical activity is not important. It certainly is, and for a variety of reasons, including physical and mental health. But as a strategy for obesity prevention (or treatment), the evidence does not support physical activity as a promising solution, particularly at a population level. The proposed frame, caloric overconsumption, has the potential to change the policy environment by focusing on a specific cause of obesity, energy input.
If obesity can largely be attributed to caloric overconsumption, the discussion about obesity prevention policies should focus on the reasons why energy input has increased. One way to evaluate increases in energy input is to assess dietary behaviours. Diet is widely perceived to be a matter of personal responsibility, although there is little evidence to support this position [1, 37, 52, 53]. A review of the literature examining psychosocial determinants of dietary behaviour found generally low predictiveness (R2<0.3) , reflecting the fact that there are many factors that influence dietary behaviours, such as local food availability, food affordability, and social and economic environments [55, 56]. Indeed, in Canada, only 0.5% of Canadians were found to have an adequate diet using a comprehensive diet quality indicator . It seems unlikely that 99.5% of Canadians are consciously choosing to have less than optimal diets. The more obvious answer for why there has been an increase in energy input is that it is the consequence of the food environment .
Consider the fact that in 2002, 530 more calories were available for consumption in Canadians’ diets than in 1985 [44, 58], an alarming amount considering that an excess of 100 calories a day – the amount one finds in 10 jellybeans, one cup of soda, or a quarter of a muffin – might translate into over 10 lbs weight gain in a single yeare[59, 60]. Moreover, individuals systematically underestimate their caloric intake [61–63], as well as the number of decisions made about food each day. Of the estimated 220 daily decisions about food, individuals typically recall making only 20 . As Novak and Brownell argue, the overwhelming majority of such “mindless” dietary choices are vulnerable to the influence of the food environment [1, 64]. Overconsumption of calories therefore is simply a logical response to obesogenic environments that promote caloric overconsumption through cost [65, 66] portion sizes [59, 67], accessibility [68–70], the eating environment , information deficiencies , or even misleading or incorrect information . Given the reality that the food choices of many individuals are constrained by a multitude of factors [58, 74], it is difficult to accept the argument that most obese individuals rationally choose to overconsume, and thus are personally responsible for their obesity. By any measure, individuals have little to no control over their food environments [46, 75], environments scholars have characterized as toxic .
Confronting the toxic food environment should be the focus of public health departments, practitioners, policymakers, and researchers concerned with rising rates of obesity. Starting at the municipal level, ample can be done to change the food environment; New York City is an obvious example of such change . To increase public support for policies to limit the problem of excessive energy input, the frame caloric overconsumption must be accompanied by a concurrent understanding of food environments both as a risk to health and a risk beyond any individual’s control. Of course, the frame caloric overconsumption will not entirely eliminate the idea of personal responsibility in food choices. Instead, what it does is allow for a more critical discussion about how meaningful an individual’s food choices are. While an individual is able to make some choices (e.g., brand preference), the caloric content, portion size, convenience, cost, availability, and marketing of products, among many other variables, are all beyond their control. Reframing obesity as caloric overconsumption is the first step, making the case for why something needs to be done about the food environment.
The promise and challenges of reframing
The uptake of policies and interventions aimed at preventing obesity has been slow, as policymakers are left with the difficult task of sifting through competing evidence, assessing claims from a variety of stakeholders, and gauging public opinion. The frame obesity only serves to complicate matters. Because it permits the inclusion of policies that are aimed at energy output (e.g., tax incentives to encourage physical activity, modifying built environments to facilitate physical activity), the frame obesity simply adds more noise to the policy cacophony and presents an opportunity for industry to distort or exaggerate the role of energy expenditure. This is where the promise of reframing obesity as caloric overconsumption lies.
Lawrence argues that policy environments shift and become more conducive to accepting policy solutions when an issue is reframed as a systemic problem, particularly when risks are shown to be involuntary . This was the case in tobacco control . Tobacco companies historically have adopted a rhetorical framework that emphasizes personal responsibility for smoking to deflect any hint of culpability for tobacco-related harms. When new evidence emerged about the harms of second-hand smoke, however, the health consequences of tobacco use were no longer considered to be solely the result of individual choices. This resulted in a shift in framing dynamics in favour of tobacco control. For a similar shift to occur in obesity prevention it is not necessary to generate any new evidence, as there is ample evidence demonstrating the involuntary risks created by the food environment. Instead, what is required is for the frame caloric overconsumption, and its emphasis on food environments, to become dominant. This will help to minimize some of the framing competition by excluding energy output and notions of “balance”f, as well as other “causes” of obesity that have spurious or limited impact, such as genetics , that shift perceptions of risk.
There are several challenges facing the adoption of the frame caloric overconsumption. For one, the reframing strategy used in tobacco is not entirely translatable. Obesity prevention has a more complicated aim than tobacco control, which was concerned with a single harmful behaviour, tobacco use. Moreover, obesity has no obvious second-hand effects that immediately affect the health of others , is indirectly linked to numerous eating behaviours , many of which are not intrinsically harmful, and, unlike tobacco use, people do need to eat . Nevertheless, scholars have begun to identify some foods as “toxic”  or “pathogenic” , and the involuntariness of food consumption might even be characterized as “second-hand eating” in some instances. A second challenge is that reframing might have some unintended negative impacts, at least initially. The issue of obesity presently has considerable currency, politically and publicly, and it is possible that reframing could impede existing momentum. Similarly, the media might find the issue of caloric overconsumption less appealing than its sexier counterpart, obesity. That said, obesity will still remain the problem (outcome) needing to be addressed, the frame caloric overconsumption is simply a better way to understand why the problem exists and for identifying what preventive measures should be taken.
The greatest challenge, however, will come from the food and beverage industry. Even if policymakers are willing to address caloric overconsumption, they will continue to face the power of food and beverage industry . At present, the industry has been opposed to most, if not all, food policies that would bring about meaningful changes in obesity rates . It has also invested considerable resources to control the frame . Any reframing that places more responsibility on industry is likely to be met with considerable opposition. Industry can also be expected to emphasize the personal responsibility on the part of those that do overconsume. Controlling the frame will not require the industry to disprove that energy input’s role in obesity; the industry will simply have to create doubt. As frames do not require evidence, industry can dominate framing competitions by manufacturing uncertainty , a tactic perfected by tobacco companies. This is why generating more evidence to support obesity prevention policies is ultimately insufficient. Evidence requires interpretation and application, opening the door to further framing competitions, where the salient issue is often not scientific method or empirical facts but becomes about the credibility of claimants  or a struggle over morality . It would seem, in this regard, that the industry’s efforts are being rewarded. Obesity is still largely regarded as an individual-level problem, with obese individuals stigmatized as lazy (too little energy output) or undisciplined (too much energy input) . The enactment of “common-sense consumption legislation” (aka Cheeseburger bills), preventing claimants from litigating against food companies for causing obesity , suggests the food and beverage industry’s frames are also dominating politically and legally.
Notwithstanding these challenges, reframing holds considerable potential to shift the policy environment, particularly if public health advocates strategically present the frame of caloric overconsumption as a logical and foreseeable outcome of toxic food environments. Importantly, reframing will allow for policymakers to more readily decipher the current policy cacophony by identifying policies that will address energy input. Consider some of the more popular policies and interventions that are presently aimed at obesity prevention but would specifically address caloric overconsumption: tax schemes on “unhealthy” foods or ingredients, subsidies on fruits and vegetables, stricter labelling requirements, zoning by-laws to prevent high caloric foods being available near schools, banning marketing to children, and outright bans on some ingredients (e.g., trans fat). Aimed at caloric overconsumption rather than obesity, these policies promise to be more effective. Effectiveness would not be measured by reductions in obesity rates, which may take years to develop (and is a point on which many current obesity prevention policies fail), but by more proximal (and temporally closer) outcomes, such as reductions in calories consumed or diet quality. Moreover, if caloric overconsumption is understood as an involuntary risk, these policies could be framed as necessary to create a caloric environment that empowers individuals to make positive choices and avoid overconsumption. As such, these policies are likely to be more politically palatable and garner more public support  as they would promote autonomy and choice rather than infringe civil liberties, a complaint often levied against obesity prevention policies [9, 46].