It's actually a meaningful distinction.

Guilt is: I *did* something bad. Shame is: *I* did something bad.

The point being that guilt is more a reaction to the action, and lends itself to correction, whereas shame is a conclusion about oneself which is much harder to overcome.

So, yes, I do agree that guilt is useful, and by extension I think your point is that we encourage people to feel no guilt about things they are doing that are wrong, in many ways, and I agree that it's inappropriate. If someone is overweight, they should not feel like they are a worthless person but they should feel like "there are better choices. " incidentally, I'm in this boat and that's the way I've come to start making better choices.

I will say that guilt is hard to manifest absent overt projections of values. I disagree with everyone here who says negative reinforcement does not work. That is simply stupid. We have tickets, fines, etc in addition to carrots such as ribbons and praise. Positive reinforcement works. Loss of privileges work.

Telling someone who is fat that he is unhealthy and needs to get his shit together should not be controversial. Obviously we should also couple that with “you can change, you can get healthy, it won’t happen overnight but one day you can look back on this and be proud of your health and body.”

I was going to say growth mindset but won’t for obvious reasons.

Several of us are clinicians. We've seen the studies that describing negative consequences of disease does not lead to behavior change, while teaching the patient to find positive outcomes of behavior change does work, and we've practiced that same technique (called motivational interviewing) with our patients and find it much more successful.

It's possible that the patients who would change because of negative possibilities have already changed (thus any reminders are not helpful) but I think it's a stronger thing than just that, I think it's something intrinsic to the psyche.

I'll use myself as an example. I am all too aware of the negative outcomes of being overweight, but that didn't keep me from getting overweight. The problem is not intent, it's not lack of knowledge, it's the need to stick consistently to a goal all the time. I finally took a page from my own book and started to think of positive things I want to do, like hike isle royale with my kids. I signed up for a flight for us and listed a weight 40 lbs lighter than I was, with the intent of getting to that weight. I've lost most of the 40 already in under 2 months so by the time this summer rolls around, I'll be both lighter and stronger than i originally anticipated. My diet and exercise are easy, because I have something I want to do. Before, it was too nebulous. So seeing desirable positive outcomes is a successful strategy, it's been well studied.

Now an actual negative consequence, like a heart attack, might have also kicked my butt in gear, but thankfully I didn't wait for that. What I will say is simply that negative consequences are experienced, whereas negative possibilities are only imagined, and most people struggle to imagine vividly enough to change our everyday behavior, ESPECIALLY when we don't really want to.

Both guilt and shame are not effective Behavior changers. In medical literature and psychology it is known that positive reinforcement is much more successful.

In medicine we speak of motivational interviewing, what we see is that when you tell patients the negative consequences of their behaviors they almost never change, meanwhile if you point to the positive consequences of behavior change they will often improve. For instance, I have many patients who tell me that the reason why they keep their diabetes under control, exercise reduce blood pressure, Etc is that they want to see their grandkids graduate from high school or college, Etc. In fact, even the examples I can think of where a negative consequence led someone to really change your behavior, when you talk to them they often identify that they're doing for positive reasons. For instance, I once showed a patient who was smoking how they were some changes as long x-ray, and he ended up quitting smoking on the spot, later he described that his main motivation was that he wanted to be around for his kids.

So, with the topic at hand, when you ask the question how do you get people to eat healthy and lose weight, beating them over the head with the consequences of that behavior does not work, it just makes you and them angry, and maybe depressed. Showing them potential benefits of more healthy eating is much more successful strategy, and also much more pleasant.

In fact, technically, it's not that you show them the positive benefits, you have to help them identify what they would appreciate about the healthier Behavior.