Recent public health campaigns have had a similar central message- obesity is bad! And although it has taken me a while to calm down and write my thoughts, I’m calling out these crazy campaigns!
The first campaign is the “One You” campaign by Public Health England (PHE). There are 2 aspects to this campaign.
Encouraging the food industry to reduce calories/fat/sugar in products, as well as encourage consumers to choose healthy options.
Encouraging the public to count/watch their calorie intake; recommending eating 400kcal at breakfast and 600kcal at lunch and dinner.
The second campaign is the Cancer Research UK (CRUK) anti-obesity campaign, which states that obesity is the second largest preventable cause of cancer after smoking. The message has been everywhere, radio and billboards (see below) especially, so you have probably seen it!
There are several problems with these types of campaigns. Here are a couple:
We CANNOT say obesity CAUSES CANCER (or anything really).
Studies to date have found correlations or associations between obesity and diseases such as cancer. However, that does not mean weight is the cause of disease. These studies have always failed to account for other things that may be causing disease or contributing in some way (we call these confounding factors or confounders). Factors like activity levels, vegetable consumption, sleep quality, stress levels, socioeconomic status, genetics and family history are never controlled for in these studies, but may affect disease risk and incidence. Cancer is complex and is not solely caused by one single factor. So even if it appears that cancer rates are higher among those in larger bodies, it is not necessarily due to weight. In order to make that claim we would have to run a randomised controlled trial (well actually several), and make participants gain weight, noting how many get cancer in line with weight gain. Of course that is VERY unethical. So sorry to tell you Cancer Research UK, but OBESITY DOESN’T CAUSE CANCER.
OBESITY IS NOT A BEHAVIOUR AND IT IS NOT PREVENTABLE.
Most public health campaigns are centred on education, informing the public about something important and helping them improve health as a result. These campaigns fail to do this. Saying obesity is bad and causes cancer is not helping people become educated- because it is factually incorrect- but also because weight is not a behaviour that can be modified to reduce disease risk.
Think of other public health campaigns that inform and educate:
Don’t drink and drive.
Eat 5 portions of fruit and vegetables every day.
Don’t take antibiotics if you have a cold/flu.
These are behaviours we can change with ease:
Get a taxi/ask someone to pick you up/drink at home/get bus home etc.
Include more fruit and veg in meals/snack on fruit/have glass of juice daily etc.
Go to pharmacy for advice before going to GP/don’t keep old anti-biotics in the house/trust GP advice on when to take etc.
But how is weight a behaviour?
Of course certain behaviours can contribute to our weight, but those same behaviours contribute to our overall health too. So weight is not really the issue.
But more than that, OBESITY ISN’T REALLY PREVENTABLE.
This diagram highlights some of the many factors that contribute to the obesity rates in the UK. It clearly shows that pointing out ONE single cause is impossible; many things are at play together.
(See it bigger here.)
There is an assumption that if we eat within calorie limits and exercise regularly we will be thin, but what about illness? Occupation? Financial situation? Access to food or equipment? Medication? Genetics?
Our society loves to make assumptions about people based on how they look, particularly if people are in larger bodies. Weight is just a number. It does not indicate how often a person exercises or eats veggies, nor does it say anything about that person’s story, their morals, goodness, kindness, humour or love. If you disagree, think about this- does every skinny person go to the gym everyday? Always eat their 5 a day? Never have a takeaway? Of course not- check your weight bias. It is literally nobody’s business what you weigh.
OUR SOCIETY IS FAT-PHOBIC!
Yup- I said it! As I mentioned above, we constantly judge people based on their appearance. We assume fat people are bad; they’ve done something wrong if they are overweight, right? Wrong. And the worst part of this fat-phobic attitude? It is having a direct effect on the health of individuals in larger bodies. People who are considered “overweight”:
They know when they are being fat-shamed and have emotional and psychological problems as a result, including increased rates of disordered eating, body dysmorphia, body dissatisfaction and poor self-confidence.
They are given on average 2 minutes less by their GP, with lots of research finding that doctors often stigmatise obese patients and have worse patient-carer relationships with them.
Those who are fat-shamed have poorer health outcomes (physiologically) than those who are not fat-shamed. Studies found that individuals who have been fat-shamed have higher blood pressure and other health parameters than those who have not. That means that if you are overweight and people give you shit for it, you become less healthy!
They engage less than others in screening and other preventative behaviours (generally because they get the “fat talk” from every health professional!).
Basically, we are not helping people who are in larger bodies become healthier. We are forcing them to feel guilty about how they look and because we say obesity is bad that seems to give us a right. But it doesn’t. And helping people to become more healthy is about improving behaviours, without aiming to change weight.
WHY? DIETS DON’T WORK!
This may come as a shock to a lot of you, but diets generally don’t work. In fact, over 90% of all dieting attempts fail. Usually, people lose weight initially but gain back the weight when they resume their normal eating pattern. Moreover, many gain additional weight after the diet, but I’ll talk more about that in my next blog.
I also wanted to note that the calorie content of your food does not indicate how nutritious, tasty or enjoyable it was. Although the PHE radio advert says that following the 400-600-600 rule will ensure you eat more “healthily”, I assure you it will not. So don’t waste your life counting calories! Your body has the ability to tell you when you are hungry and when you are full, if you let it, and every single body is different. Perhaps some of us do eat around 400-600 kcals at meal time, but for many that isn’t enough, while others may have less at meal times and have more snacks. Do what is right for your body, no-one can tell you what that is.
So why are we still telling people to lose weight? Why is the largest public health organisation in the UK still promoting the notion that weight is closely related to health? Unfortunately, I cannot answer that, but I had to set the record straight. Weight tells us very little about health.
What really matters?
Eating a variety of foods.
Including fruit and veg in meals.
Moving our bodies how and when it feels good.
Getting a good sleep.
Participating in health screening and other check-ups when you are invited.
Being happy and doing things you love!
These weight-centred campaigns are not what public health is truly about. Although I always say trust advice from trusted sources, this time they got it wrong.
I would love to hear your feedback on these campaigns and what I’ve said in this blog, so get in touch on social media!!
Lots of love,
Little O x