The Ethics Blog

A blog from the Centre for Research Ethics & Bioethics (CRB)

Tag: stigmatization

Overweight increases the risk of cancer – but what good does the information do?

Scale & measuring tape. Photo by Pixabay: https://www.pexels.com/photo/blue-tape-measuring-on-clear-glass-square-weighing-scale-53404/
27 May, 2025 / / 1 Comment

Authorities and researchers have a responsibility to the public to disseminate information about risks identified through research. Dissemination of information and education are also an important part of public health efforts to influence norms about lifestyle habits and support individuals in making informed choices about their health.

Research has found links between overweight and at least 13 different types of cancer, including colorectal cancer and postmenopausal breast cancer. Preventing and treating obesity could therefore lead to fewer cancer cases in the future. The European Code Against Cancer presents 12 actions individuals can take to reduce their cancer risk. These include lifestyle changes, protection from certain chemicals, participation in vaccination and screening programs, and maintaining a healthy weight.

This type of information suggests that preventive measures can be controlled and influenced by the individual. It is the individual who is expected to act. However, perceptions that individuals have control over the causes of cancer can lead to stigmatization and blaming of cancer patients, as well as the belief that the disease is self-inflicted. Such harmful effects of health information have been observed in previous campaigns aimed at raising public awareness of the link between smoking and lung cancer. Overweight and obesity are already stigmatized conditions. People with overweight and obesity face discrimination in all sectors of society, including healthcare, which can have negative physical and psychological consequences. Therefore, when informing about overweight as a cancer risk factor, it is important to consider the risk of reinforcing the widespread stigmatization of people with overweight.

In a new interview study, I and three other researchers explore how people with overweight are affected by health information about the link between overweight and cancer. Participants highlighted several ethically important factors to consider when communicating this health risk, such as the risk of stigmatization, the distribution of responsibility for treatment and prevention, and the need for empathy. Participants perceived risk information about the link between overweight and cancer as personally important. It concerns their bodies and health. However, the information was burdensome to carry. It felt tough to be singled out as high-risk for cancer. This was partly because they found it difficult to act on the information, knowing how hard it is to lose weight: “No one is overweight by choice.” The information could therefore have counterproductive consequences such as anxiety and overeating. It could also reinforce feelings of failure and increase self-hatred. Many participants reported negative experiences from healthcare encounters where they felt judged and misunderstood. Moreover, adequate support for weight loss is often lacking. The information thus becomes meaningless, they argued, and was perceived as offensive and patronizing.

The study participants contributed several suggestions for improvement. They called for information that includes the complex causes of overweight and clear guidance on how to reduce cancer risk in various ways – not just through weight loss, but also through alternative methods. They also emphasized the importance of healthcare professionals showing empathy and offering person-centred care that considers the individual’s unique situation and needs. This includes concrete and feasible advice, as well as support for patients in their efforts to improve their health.

In our article, we emphasize that health communication often lacks both ethical considerations and clear objectives (beyond the obligation to be transparent). Public health interventions should, like clinical interventions, be based on ethical considerations and principles where the positive effects of the intervention are weighed against potential negative effects (or “side effects”). Sometimes, some harm may be acceptable if the benefit is sufficiently great. But currently, the benefit of information about the link between overweight and cancer appears minimal or non-existent, making negative consequences unacceptable. Our conclusion is that such risk information for people with overweight and obesity, if it is to promote health and avoid causing harm, should be empathetic, supportive, and based on an understanding of the complex causes of overweight. By acting responsibly and compassionately, healthcare professionals and researchers can help improve health outcomes for this target group.

If you want to read our interview study, you can find it here: Perceptions of cancer risk communication in individuals with overweight or obesity – a qualitative interview study.

Want to know more?

European Coalition for People living with Obesity

Different links between overweight and cancer risk – Uppsala University

Written by…

Åsa Grauman, researcher at the Centre for Research Ethics & Bioethics.

Grauman, Å., Sundell, E., Nihlén Fahlquist, J., Hedström, M. Perceptions of cancer risk communication in individuals with overweight or obesity – a qualitative interview study. BMC Public Health 25, 1900 (2025). https://doi.org/10.1186/s12889-025-23056-w

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New insights into borderline personality disorder

Man in dark clothes walking alone on a hill beside the ocean. Photo: Polina Kuzovkova, from Unsplash.
1 April, 2025 / / 1 Comment

Individuals with borderline personality disorder (BPD) often suffer from strong emotions that change rapidly, from one extreme to another. They may fear abandonment and experience an inner emptiness. They may also behave impulsively and have suicidal thoughts or behaviors. BPD is often mis- or underdiagnosed and there is a tendency among clinicians to avoid the diagnosis.

Given the diagnostic complexity of BPD, it is important to establish a diagnosis. Recent therapeutic advances show that the disorder responds to treatment and that significant recovery is possible. Because mental health services prioritize major psychiatric disorders, such as psychotic disorders and mood disorders, individuals with BPD have significant unmet needs. The suicide rate for BPD is as high as 10%, mirroring that of schizophrenia, and the enduring impairments from the disorder are comparable to those of chronic mental illnesses.

Clinical decision-making regarding diagnosis can be challenging for healthcare professionals for several reasons and is surrounded by ethical challenges. Several studies have shown that stigmatization and negative attitudes regarding the diagnosis of BPD are still common. Healthcare professionals, including emergency room staff and multidisciplinary teams, have been surveyed. Results suggest that even specialized mental health professionals have more negative attitudes toward BPD patients than toward those with other diagnoses, such as depression. This is likely due to factors associated with the diagnosis itself, but it is also probably related to clinicians’ perceptions of BPD symptoms and their previous treatment experiences.

Stigmatization is also reinforced by research. Derogatory terms and attitudes regarding BPD are pervasive in academic work on the disorder. A particularly common example is the attribution of negative intentions to individuals with BPD, such as wearing provocative clothing to attract attention or seeking attention by choosing, for example, artistic careers. Yet, we are not aware of any empirical documentation suggesting that BPD is associated with clothing or with specific intentions regarding career choices.

Additionally, many healthcare professionals do not consider BPD to be a genuine diagnosis and believe it to be self-induced or self-diagnosed. Consequently, individuals with BPD are often not informed about their disorder or are told that they have another diagnosis, such as bipolar disorder, compromising the principle of transparent diagnosis and patient empowerment for informed and consensual care.

The diagnosis of personality disorder is sometimes used as a label for disliked individuals. This is hardly surprising, given that interpersonal relationship problems are the primary characteristic of these disorders. However, we cannot ignore the fact that personality issues are extremely common, and rejection based on perceived undesirability is not acceptable. We now have evidence from around the world that personality disorders occur in 6 to 12% of the population, with a much higher prevalence among psychiatric patients. Of course, these figures may prompt accusations of inappropriate medicalization of normal human variations, but this criticism must be questioned. Recent findings have shown that even relatively mild personality disorders are associated with greater psychopathology, higher use of health services, and higher costs compared to individuals without personality pathology, and this is an increasing trend.

In a new article, I challenge existing perspectives and discourses about the clinical reality of the disorder. I compared impulsivity, anxiety, hopelessness, suicidal tendencies and depression in BPD patients and the general population during the COVID-19 isolation in France. While all groups exhibited elevated levels of impulsivity and anxiety, statistically significant differences were found in the severity of hopelessness, suicidal ideation, anxiety, and depression. Specifically, individuals with BPD showed markedly higher levels of these symptoms compared to the general population sample. This suggests that BPD exhibits a distinct profile of chronic distress, exceeding the levels seen in general stress reactions or other disorders like depression or anxiety that are more recognized and accepted in society.

My own and similar studies suggest that there is a need for a critical reevaluation of the diagnostic methods for personality disorders such as BPD. There is growing concern that some healthcare professionals may underdiagnose personality disorders, possibly because such disorders are not perceived to be severe. This reluctance to diagnose, combined with inadequate training in diagnostic procedures, may contribute to a systemic failure to recognize and address the prevalence and impact of personality disorders. The healthcare system then risks perpetuating the misconception that diagnostic and communication challenges related to personality disorders are not significant.

Better diagnostic practices, coupled with more accurate case descriptions and better treatment planning, can ensure faster and more effective treatment. This would provide individuals with the opportunity for personal and clinical recovery. Furthermore, the process of communicating the diagnosis of BPD is fundamental to how people understand and interpret their diagnosis, which in turn can affect their hope for recovery and motivation to use healthcare services. In conclusion, there is room for significant improvement in how we approach personality disorders such as borderline personality disorder.

This post is written by…

Sylvia Martin

Sylvia Martin, Clinical Psychologist and Senior Researcher at the Centre for Research Ethics & Bioethics (CRB).

Sylvia Martin, Instability of the unstable, an observation of borderline personality disorder traits and impulsivity declaration during the pandemic, L’Encéphale, 2025, https://doi.org/10.1016/j.encep.2024.10.007

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