摘要：Objectives. We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames—personal responsibility and the environment—and examined alternative frames for understanding and addressing obesity. Methods. We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate’s essence. Results. Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame—the taste-engineering frame—identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient. Conclusions. Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed. Obesity is a significant public health concern whose importance and intractability warrant a detailed analysis of the frames used in expert discourse. 1–3 The use of frames is critical to public health because they can determine the worthiness of a social health concern in the public eye, set the boundaries of public opinion and debate, 4 and influence the level of public and private investment a social health concern receives. 5,6 As with other social phenomena, obesity discourse has been dominated by the individualist, personal responsibility frame 7 even as individual approaches toward obesity have demonstrated limited effectiveness. 8 Because the only tools the personal responsibility frame proposes are those of educating the public about obesity, once this strategy has been exhausted, this frame has no other suggestions to offer. Moreover, the personal responsibility frame promotes ineffective strategies such as shaming and stigmatization, which can lead to further weight gain. 9 Developing alternative frames of discourse may be an important part of a paradigm shift that would enable research, practice, and politics to move away from the personal responsibility frame toward frames in which more creative obesity-prevention policies become politically feasible. Policies that aim to address systemic factors related to obesity strongly depend on the support of public opinion and policymakers. 10 However, previous opinion polls suggest that there is limited support for broad-based policies that target upstream factors. 11–16 The key is to identify alternative frames of obesity discourse that could help people see players and solutions within the environmental frame as easily as they see individuals in the personal responsibility frame. An important first step in identifying alternative frames is to consider the understandings of experts on obesity prevention, how these understandings shape their communications, and the impacts of these communications among the public. 17 This work is all the more urgent as there appears to be no published consensus on the causes of obesity, with major studies reasserting that the causes of obesity are “extremely complex” and “fiendishly hard to untangle.” 18–20 In light of such assertions, is it any wonder that the public refuses to go where experts dare not tread? Broad support for addressing the obesity epidemic is sure to be tepid when experts cannot clearly say what its causes are. Yet perhaps there is more of a consensus than these published reports are willing to acknowledge. The public health community’s responsibility is to find causal explanations for obesity that are both true to the science and clear enough for the public to embrace. Although the public is capable of recognizing multiple causes of disease, 21 the dominance of the personal responsibility frame in discourse forecloses opportunities to advance different perspectives of obesity causation. We addressed this gap in the literature by conducting one-on-one interviews with US-based experts who work in obesity. These interviews approximate a natural conversation about obesity prevention while prompting discursive reasoning within the context of potential alternative frames. These interviews examine core reasoning patterns to better understand how experts communicate about obesity prevention and to determine the basic content of the messages experts want to advance with the public and policymakers. 17 Two main objectives of the interviews are to (1) assess expert opinion on the problems associated with the dominant frames used by the public in understanding obesity and (2) examine whether alternative frames are in use by experts. Policymakers and media predominantly frame obesity as an issue of personal responsibility or as an environmental issue. 4,22,23 Far from being politically neutral, the personal responsibility frame is ideologically charged and politically consequential. 24–26 Such a frame places a special emphasis on the individual and the ability to make rational choices and exercise willpower to avoid becoming obese, 27 while denying the role of harmful social and structural forces. 28 As a consequence, the frame maintains the status quo by casting responsibility onto individuals 29 while deflecting the role of institutions. 25 Conversely, the environmental frame assigns responsibility to business, government, and larger social forces, often without specifying a concrete causal mechanism. 26,27 Perhaps because the causal role of the environment is unclear to the general public, news stories tend to promote individual behavioral change as a solution more often than changes in social or economic policies. 4,30 Similar to other social health concerns, there is significant cultural and political resistance to the idea of environmental causation of obesity. 27
