How to change the conversation about obesity: ‘It’s not a lifestyle choice’
It’s something we hear frequently from the media, health-care professionals, and public policy decision-makers: eating healthy and exercise are the keys to staying fit and staving off obesity. But this message is counterproductive to the goal of preventing obesity, experts say.
“The simplification of obesity as the result of unhealthy eating and lack of exercise contributes to the narrative that it’s a lifestyle choice that’s inherently driven by the individual,” says Ximena Ramos Salas, managing director of the Canadian Obesity Network. “It tells us that people with obesity choose not to be healthy and therefore it’s their problem.”
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It contributes to what obesity experts see as a dangerous stigmatization of overweight and obese people, and ignores the fact that obesity is a complex issue made up of a number of factors that extend beyond dietary decisions.
“The media talks a lot about the controllable aspect of obesity and offers little about the uncontrollable ones,” says Stuart Flint, a senior research fellow in public health and obesity at Leeds Beckett University in the U.K.
A recent study out of McMaster University found that there are 79 rare genetic syndromes associated with obesity — before that, researchers believed that number was closer to 20. But the factors extend beyond hormones and genetics to societal and even geographic elements.
Flint points to the fact that the proximity of a fast food restaurant is associated with how much we consume those foods. And not surprisingly, advertising also plays a part.
“People who have an abundance of fast food in their environment and are receiving more information about what’s on offer at those restaurants will be more likely to consume that food. We form attitudes through continuous and consistent reinforcement of messages, consciously or unconsciously,” he says. “People are essentially getting information they’re not asking for.”
Although that might make a solid case for ramping up the already pervasive conversation surrounding obesity, healthy eating and exercise that’s promoted in schools and espoused by the health-care community, it’s the underlying message that’s cancelling out the otherwise valuable lesson.
“The simplistic health narrative can be counteractive. We want people with obesity to exercise and eat healthily, but framing the conversation as obesity prevention contributes to them feeling like they’re being judged by their eating habits,” Salas says.
This stigma is a recurring theme that’s seen in schools, doctor’s offices and even on television — “an actor who is overweight will receive more negative experiences and is portrayed negatively,” Flint says. Research has also shown that the stigmatization leads to depression, anxiety and isolation, and can cause a person to avoid seeking help from a health-care professional. And it skews the message to the public who ultimately only hear that eating unhealthy foods will make them fat.
“The weight stigma is detrimental to people of all body weights because we all internalize those types of attitudes,” he says. “We’ve seen normal and underweight people who will also report body image concerns that are linked to the stigmatizing attitude on obesity. They’ll engage in under eating and over exercising to avoid putting on weight. Children as young as three have reported body image concerns.”
The answer, they say, is to reframe the conversation, starting with the fact that obesity is not a choice, it’s a chronic disease that needs to be addressed and treated in the same way we do heart disease or diabetes. And it’s a complex issue that goes well beyond food and exercise.
“The weight bias is affecting the health of the population and cannot be tolerated in policy,” Salas says. “It’s deeply ingrained in our society and we’re all part of it. We need to address it as a chronic disease, not a lifestyle choice, so we can change that narrative together.”
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