“The dominant cultural narrative regarding obesity fuels assumptions about personal irresponsibility and lack of willpower and casts blame and shame upon people living with obesity.”
(Obesity in adults: a clinical practice guideline, Canadian Medical Association Journal, August 2020)
Last month, the government published Tackling obesity: empowering adults and children to live healthier lives, a strategy which promises to ‘give everyone a fair deal’. At Centre for Mental Health, we are deeply concerned that the proposed approach is far from fair for people with mental health problems.
In principle, we welcome the Government’s intention to help people to live healthier lives. Improving the physical health of people with mental health problems is one of the Centre’s priority areas: we established Equally Well UK with precisely this in mind. The strategy also shows some promise in its ambition to create a more health promoting environment – limiting advertising of certain foods, for example – and in recognising that poverty and health difficulties, including obesity, are closely related.
in the space of over 4,000 words, the Government’s strategy alludes to mental health only once, affirming that ‘obesity can impact on mental health’
However, the strategy provides little to address the wider impact of disadvantage and discrimination. Instead, it aims to change individual behaviours with a campaign which urges people to lose weight to reduce the ‘burden’ on the NHS, by adding more information on calories to menus, and with the offer of an online weight loss plan. Those who experience the worst outcomes in mental and physical health often face multiple layers of disadvantage, including entrenched poverty, limited opportunities in work or education, discrimination based on ethnicity or disability, stigma and a lack of accessible services which respond to their needs appropriately (including access to digital resources). Overlooking structural disadvantage and focusing on individual responsibility risks perpetuating inequalities.
For very many of us, our ability to maintain a healthy weight is inextricably linked to our mental health. Yet, in the space of over 4,000 words, the Government’s strategy alludes to mental health only once, affirming that ‘obesity can impact on mental health’. This simple statement fails to adequately express the conclusions of the academic paper it cites, which describes a reciprocal link whereby depression is a risk factor for developing obesity just as obesity increases the risk of depression. To tackle health inequalities, we cannot ‘pick and choose’ from the evidence – a more nuanced and informed approach is required.
Worrying, too, is the proposal to introduce calorie labelling in restaurants, cafés and takeaways, which creates a dangerous hurdle to anyone at risk of, living with or recovering from an eating disorder
Those of us experiencing poorer mental health can find it difficult to maintain healthy weight or work towards the goal of losing weight. Lethargy and low motivation are experienced both as part of mental health problems and as side-effects of medication, which can also directly lead to weight gain. For many, emotional eating presents an accessible coping mechanism in lieu of other support. And long term physical conditions such as arthritis, asthma, fibromyalgia, and irritable bowel syndrome – which are prevalent amongst people with mental health problems – can affect a person’s ability to be active.
The absence of people with eating disorders from the strategy is especially worrying. Obesity is closely associated with disordered eating and is a risk factor for developing an eating disorder. Eating disorders have become increasingly prevalent in recent years, especially amongst children and young people, and Covid-19 has created uniquely difficult conditions around access to food, anxiety, isolation and service provision. In this context, a campaign which raises anxiety around obesity and encourages all of us to lose weight is extremely unhelpful. Worrying, too, is the proposal to introduce calorie labelling in restaurants, cafés and takeaways, which creates a dangerous hurdle to anyone at risk of, living with or recovering from an eating disorder (and there is limited evidence that this would impact choices at a population level). We must be careful not to impose measures that could encourage or facilitate unhelpful behaviours among people whose health is already at risk.
the strategy provides little to address the wider impact of disadvantage and discrimination. Instead, it aims to change individual behaviours with a campaign which urges people to lose weight to reduce the ‘burden’ on the NHS
Perhaps we can learn from the new obesity care guidelines published by the Canadian Medical Association Journal. These guidelines highlight the damage caused by stigma, stressing the need to shift towards person-centred outcomes and away from focusing on weight loss alone, to validate people’s experiences and to move beyond simplistic approaches of ‘eat less, move more’ by addressing the root drivers of obesity.
If its laudable ambition of improving the nation’s health is to be achieved, we urge the Government to:
- Avoid harmful messaging which could promotes shame, guilt and stigma
- Focus on healthy behaviours rather than weight loss
- Consult with experts, including people with lived experience, to risk assess the impact of proposals and campaigns on people with eating disorders
- Review the proposal to introduce calorie labelling in restaurants, cafés and takeaways
- Establish proactive, practical, compassionate support in communities to improve people self-esteem and encourage safe, sustainable behaviour change
- Address the reasons why people struggle to maintain a healthy weight, not limited to poverty, education, stigma, discrimination, access to exercise and leisure facilities.
