UK’s ‘Shortsighted’ Obesity Strategy Could Cause More Harm Than Good
On July 27 the U.K. government unveiled a new £10m campaign to tackle what for decades has been dubbed the country’s “obesity crisis.” The reason for this decision being cited as Public Health England’s (PHE) recent claims that weight is, “the single most important modifiable risk factor” in increasing, or decreasing, your chances against Covid-19 if you should catch it.
The new policies aiming to tackle this include banning television advertisements for junk food before 9 pm, restrictions on online advertising, banning popular supermarket promotions such as buy one get one free offers and mandatory calorie counts displayed on restaurant menus.
The new obesity strategy, called Better Health, claims to “empower adults and children to live healthier lives” but the announcement has been met with a mixed response. Many have pointed out that it fails to address the fundamental roots of poor health: poverty and a lack of nutritional education. Along with concerns over the triggering impact some of its policies could have on eating disorders and existing fatphobic sentiments in society.
The approach also seemingly contradicts the government’s own “Eat Out to Help Out” scheme that is currently in effect nationwide. The subsidy offers customers 50% off when dining out and includes many fast-food chains across the country.
To tackle the issue of public health in a sincere and meaningful way some health experts are calling for a more holistic approach. Dr. Joshua Wolrich describes the strategy as “shortsighted,” saying, “the link between weight and health isn’t anywhere near as clear cut as people make it out to be and there are a lot of other factors. We know obesity is highest among areas of deprivation within the U.K. and we’re not looking at those socio-economic factors when we’re coming to these conclusions like obesity increases your risk.”
Part of the government’s announcement is to make cycling a more viable travel option for members of the public. Talk about greater investment in segregated cycle lanes and secure cycle parking, as well as developing low-traffic neighbourhoods, suggests the government has some grasp on understanding the need for safer and cheaper options in order to make health accessible to all.
But this is diminished by the plan for doctors to prescribe bike rides for overweight patients and direct them to use NHS-approved diet management apps. This approach isn’t groundbreaking and fits in line with Better Health’s additional aim to expand on the NHS’s policy of “social prescribing,” a tactic chosen over conventional medicine to treat depression, loneliness and other mental health conditions. But this relates to a more deeply ingrained issue overweight people often face with their GPs and raises serious questions about how these policies could be handled without having a detrimental effect on patients. The danger being, if taken too lightly, those with serious mental health issues who need to be clinically managed and are also overweight may end up being denied adequate medication and urged to exercise more instead.
Fatphobia is often an inescapable part of daily life for those living in bigger bodies and can have far-reaching implications in how they’re treated in education, work and when seeking medical advice. Individuals who are overweight regularly experience medical bias when going to their GP with the number on the scales often being used as a scapegoat for any non-relating symptoms.
The inherent issue with this perspective is that weight alone is not a reliable indicator of health. As British Olympian Elinor Barker says, “lighter is not always better. I was the heaviest I’ve ever been when I won the Olympics, at my lightest I could barely get through a training week. Education [is needed] over a number on a scale.”
The harmful discourse triggered by this announcement has already begun. The National Obesity Forum has called for regular weigh-ins to be introduced at schools in September in an attempt to curb childhood obesity. But the move has been criticized as irresponsible and lacking any real consideration of the impact it could have on children’s relationships with food. Experts warn it would only succeed in entrenching shame early on in children around topics of food and weight.
Questionable ethics aside, the fact is using fear and shame as a tactic to scare people out of eating certain foods has long been proven ineffective. It’s a strong motivating influence in the short term that doesn’t translate to lasting lifestyle changes.
Instead, the damaging long term consequences of this “tough love” approach most often leads to bingeing behaviors, secret eating, guilt, and can lead to mental health issues and eating disorders that can take a lifetime to unlearn. Eating disorders take hold especially quickly, become deeply internalized and take years to treat.
Currently, 1.25 million people in Britain suffer from an eating disorder and anorexia has one of the highest mortality rates among any psychiatric disorders.
The damaging long term consequences of this “tough love” approach most often leads to bingeing behaviours, secret eating, guilt, and can lead to mental health issues and eating disorders that can take a lifetime to unlearn.
The government has stated their awareness of this risk, saying, “we do recognise concerns about calorie labeling and are committed to striking a careful balance between educating people whilst not negatively impacting people with eating disorders.” But calorie counting doesn’t inform or educate people on the “health” value of the food being eaten either. This is because it doesn’t take into account the nutritional density of the food in question.
Taking a balanced approach, incorporating proper food education and encouraging intuitive eating is much more valuable and shown to have a more positive long term outcome on people’s health. This is because diets have statistically been shown to fail. The rate of recidivism on all diets is an estimated 97%, meaning that, for every 100 people who diet, an estimated three will manage to keep the weight off in the long term.
Eating disorders have already soared since the beginning of lockdown with record numbers of inquiries to eating disorder clinics and a 70% increase in calls to the eating disorders charity Beat. As Ulrike Schmidt, Professor of Eating Disorders, King’s College London and Consultant Psychiatrist at the Maudsley NHS Foundation Trust, explains, “lockdown has had an impact on all of our eating but those with pre-existing eating disorders have been especially vulnerable. We’re also seeing people who were getting better, but who are now relapsing.”
External factors such as isolation, increased anxiety and a loss of structure in daily routines are all driving forces and are only heightened when paired with an increased focus on social media and workout “glow-ups.”
Lockdown has had an impact on all of our eating but those with pre-existing eating disorders have been especially vulnerable. We’re also seeing people who were getting better, but who are now relapsing.
Othorexia and Exercise Exercise are also very real and destructive mental health issues that are on the rise in the UK and the rhetoric surrounding this campaign only adds fuel to the fire. The evidence points towards a need for a complete shift in how conversations around public health are approached.
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At the same time, mental health services have been under excessive strain during the pandemic, and demand is only set to increase further over the next few months.
One NHS report predicts demand for mental health services could increase by as much as 20% and providers predict infection control and social-distancing measures will mean they will be operating at a 10 to 30% lower capacity than normal. The report also cites, “particular concerns that the stark inequalities in accessing services and recovery rates that black and minority ethnic communities face will be exacerbated.”
This is particularly worrying as the new obesity strategy also says it aims to target Black, Asian and minority ethnic communities in particular, claiming that this is because they have suffered disproportionately high death rates during the pandemic. But the latest PHE and Office for National Statistics (ONS) reviews reveal people from these backgrounds are dying at a higher rate due to social and economic inequalities. A large contributing factor is that they are more likely to be working in low paying, high exposure jobs.
This conflict between the facts and the narrative being pushed shows a subtle shifting of blame, directing the responsibility of public safety on vulnerable individuals instead of government policy. Government policy that has already led to the U.K. having the highest number of excess coronavirus related deaths in Europe. As Tom Quinn, spokesperson for the U.K.’s leading eating disorder charity Beat, says, “[There’s an] implication that people with obesity are costing the NHS money and harming other people. If you lose weight to save lives, the implication is that you’re costing lives if you don’t [lose weight].”
Editor’s Note: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com. — In the Featured Photo: Weighing scales and tape measure stock image. Featured Photo Credit: Chaiyan Anuwatmongkonchai/Dreamstime.com