Second Opinion: Stop stigmatising obesity and start attacking the causes
It would be great if the debate could be about healthy weight and feel-good physical activity
Restrictions on marketing foods high in fat, sugar and salt, and taxes on sugar-sweetened beverages and high-fat foods are likely to have a greater impact on reducing obesity inequalities than campaigns targeted at individuals.Photograph: Bryan O’Brien
Obesity is big (excuse the pun) news again. When the World Health Organization (WHO) released new 2030 projections, media coverage went over the top. Headlines were so sensational – “Almost all Irish adults to be overweight or obese within 15 years” and “Fat man of Europe” – that the WHO issued a “clarification” saying “the study should be used with some caution as it . . . may not reflect the latest WHO forecasts”. The projections compared the statistical equivalent of apples and oranges. Different age groups and sample sizes were studied in different countries. Only the figures for Ireland, Poland, Portugal, and the UK were real measurements. All other countries used self-reported data that were unlikely to be accurate. While interesting academically, trend studies are no basis for public health policy.
The most reliable obesity statistics are given in the WHO’s Global Status Report on Noncommunicable Diseases 2014, which was published this year. These show that overweight and obesity levels went up by just one percentage point, to 66 per cent, in Irish adult males between 2010 and 2014, and by three percentage points, to 55 per cent, in Irish adult females over the same period. In 2014 more men in the UK and France were overweight and obese than Irish men, and more UK and Spanish women were overweight and obese than Irish women. So Ireland is not the fattest country in Europe after all. Unfortunately, stories based on facts would not sell as many newspapers or attract as many listeners and viewers.
Radio and television programmes rolled out obesity experts to issue dire warnings. Scare tactics are counterproductive. Exhortations have no effect on behaviour. Nobody will lose weight no matter how vociferously or earnestly experts repeat the numbers. Non-stop, bordering on obsessive, talk about obesity causes fatigue. Sensationalism stigmatises fat people and leads to risk-factor phobia and hopelessness. Obesity is rising fastest in lower socioeconomic groups and women of low educational attainment are five times more likely to be obese. Despite this, those from lower socioeconomic groups are less likely to respond to negative messages or to participate in obesity interventions, particularly when accompanied by scare tactics and dire warnings about their own and their children’s future health.
Education campaigns do not work either. A 2014 Obesity and Inequities report from the WHO recommends “first do no harm” when trying to prevent obesity. “Some public health interventions inadvertently make inequities worse. For example, education campaigns, if delivered without any structural support [such as fat and sugar taxes and displaying calories on menus] are likely to widen inequities.”
Low-income groups are less able to act on information, and lack of money is often their deciding factor when purchasing food. Indeed, “surveys show that low- income Europeans know what constitutes a healthy diet and it is the affordability, accessibility and availability of foods that create barriers for them”. Buying unhealthy foods may be the most feasible option for people on low incomes.
Earlier this year the Lancet identified a need to reframe our thinking on obesity. “The debate is becoming increasingly polarised with false and unhelpful dichotomies: individual blame versus an obesogenic society and . . . obesity as a disease versus unrestrained gluttony. Such divisive discussions are at best distracting. At worst, they are hindering progress and giving policymakers excuses for inaction.”
Irish policymakers have avoided introducing fat and sugar taxes because they believe, wrongly, that such taxes are regressive and will have a disproportionate negative effect on lower socioeconomic groups. In fact, population-based policies – such as restrictions on marketing foods high in fat, sugar and salt, and taxes on sugar-sweetened beverages and high-fat foods – are likely to have a greater impact on reducing obesity inequalities than campaigns targeted at individuals.
Finland has managed to halve the proportion of five-year-olds who are overweight or obese by implementing the WHO’s Health in All Policies (HiAP). Health is now integrated into the plans and strategies of all sectors, including education, childcare, transport and urban planning. Healthy Ireland: A Framework for Improved Health and Wellbeing 2013- 2025 aims to do the same job as HiAP, and needs to be fully implemented. It would also be helpful if the media could stop hyping up obesity stories. It would be great if local authorities did not get Coca-Cola to sponsor their bike-rental schemes. Above all it would be terrific if the conversations, debates and interviews on national radio and television could be about healthy weight and feel-good physical activity. Obsessing about overweight and obesity does not help anyone.
Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland council.