The BBC published a very interesting article yesterday (24/9/19) entitled “Obesity not caused by lack of willpower” The article was summarising the key findings of a British Psychological Society report), which is definitely worth a read for all fitness and health professionals.
Current statistics show 63% of UK adults are overweight or obese, and 26.9% are obese (rising from 14.9% in 1993). Public Health England state obesity is responsible for an estimated 30,000 deaths each year and can reduce an individual’s life span by an average of 9 years, in addition to increasing the risk of numerous diseases such as heart disease, colon cancer and type 2 diabetes. They report that overweight and obesity-related health issues cost the NHS an estimated £6.1 billion and the wider economy £27 billion. The point I’m trying to get across here is that overweight and obesity is a significant issue in the UK.
People often attribute obesity to lifestyle choices in which individuals are sedentary and over-indulge, lacking self-control and willpower – surely, if they only ate less and exercised more, they would get back to a healthy weight. The BPS cite research in which 90% of policymakers believed personal motivation was a strong/very strong motivator in those living with obesity. In fitness qualifications, for example, the energy balance equation is often used to describe the development of overweight and obesity; essentially reducing the issue to more calories ‘in’ over calories ‘out’. Whilst these qualifications have much more to say about obesity, this is the message students often take away with them – seemingly laying the responsibility for overweight and obesity solely with individuals.
The BBC article and BPS report essentially highlight that obesity is not a choice and fat shaming individuals only serves to make them feel worse about themselves. What I particularly like about the BPS report is its discussion on ‘weight bias, stigma and discrimination’ and how this perceived lack of personal motivation has permeated society, affecting policy decisions, campaigns, interventions and public opinion, reinforcing this stigma. They also highlight that the language used by healthcare professionals can have a huge (and often negative) impact on overweight and obese individuals.
This large increase in obesity since the early 1990s surely cannot be attributed to a collective loss of self-control and willpower in the UK population. What other factors may have contributed to this increase? One popular model is Dahlgren and Whitehead’s (1991) Social Determinants of Health Model:
This model basically highlights that the determinants of health are multi-faceted and complex, occurring at many different levels. At the centre we have ‘Age, sex and constitutional factors’, including personal characteristics (such as age, sex, and ethnicity) and constitutional factors (such as genetic, biological). The next sphere of influence is ‘Individual lifestyle factors’, or lifestyle choices, which would include factors such as poor diet and lack of physical activity.
But beyond these ‘individual’ spheres, you start moving into social influences. ‘Social and community networks’ refer to family, friends and our wider social circles. ‘Living and working conditions’ include access to, and opportunities in relation to, education, employment, health care services, welfare services, housing, public transport and amenities. It also includes facilities like running water and sanitation, and access to essential goods like food, clothing and fuel. The outer layer, ‘General socio-economic, cultural and environmental conditions’, refers to social, cultural, economic and environmental factors that impact on health and wellbeing, such as wages, disposable income, availability of work, taxation, prices, fuel, transport, food, clothing.
This model suggests that whilst an individual’s personal motivation and lifestyle choices undoubtedly impact significantly on overweight and obesity, biological and social/environmental factors also contribute greatly. To see how these factors can impact on overweight and obesity (and health in general), please have a look at The Marmot Review which identifies the many health inequalities in our society.
Rather than blaming and ‘fat-shaming’, we should perhaps try to understand the issues better instead if we are to help them meet their goals and address their needs.