Does tackling obesity do more harm than good?

University of Auckland health education lecturer Dr Darren Powell, and PhD candidate George Parker ask: Do ‘anti-obesity’ strategies do more harm than good?

At the end of 2015, the New Zealand government announced its Childhood Obesity Plan, a set of 22 initiatives that target three groups: those who are already obese; those at risk of becoming obese; and, ‘all New Zealanders’. Of the 22 initiatives, eight focus on educational settings and seven on families, with an emphasis on interventions with pregnant women.

These ‘anti-obesity’ policies and practices tend to be dominated by fields of scientific knowledge, at the expense of critical social science perspectives. While scientific knowledge about obesity can be valuable, it is not the only or necessarily the ‘best’ form of knowledge about fatness.

An emerging field of social science scholarship is beginning to explore how obesity messages are socially constructed, the impact that ‘anti-obesity’ interventions have on people’s views of the body, health and weight, as well as the related impact on the physical, mental and emotional wellbeing of children, mothers and other groups.

For instance, researchers have examined what it is like for women to be on the receiving end of ‘obesity prevention’ strategies, such as diet and weight gain advice during pregnancy. Findings show that these tactics can be difficult to operationalise in the context of busy lives, but more importantly, that they fail to take into consideration the social stigmatisation of fatness.

This stigma, manifested in fat shaming and bullying within and outside of the health system, has been shown to be highly detrimental to people’s health and wellbeing, leading to self-loathing, excessive or sub-optimal eating and exercise behaviours, social isolation, avoidance of (or the desire to avoid) health care, anxiety, and depression.

Research has also demonstrated that fat shaming and bullying practices are prevalent in maternity care, a dynamic that ‘obesity prevention’ strategies risk legitimising and escalating.

In other words if ‘obesity’ is accepted as a serious reproductive health problem requiring intervention, then dislike and intolerance towards ‘non-compliant’ women can be viewed as officially sanctioned, or more problematically, as a social or moral good.

Further, many women embark on pregnancy already carrying embodied histories of fat stigmatisation and related body dissatisfaction.

‘Obesity prevention’ strategies that emphasise fatness as a health problem, and leverage off women’s maternal responsibilities to their babies to control their weight, can induce anxiety and be disabling for pregnant women.

The net effect is a perfect storm of factors for undermining women’s self-confidence and health-seeking behaviours at a time when they should be supported most, a significant distortion from the health promoting intentions of ‘obesity prevention’ strategies.

In the case of young people in schools, a range of ‘anti-obesity’ policies and practices are employed, including fitness activities, surveillance of lunchboxes, banning ‘junk’ food, measuring body mass index, writing food and exercise diaries, and a plethora of educational programmes and resources that aim to ‘teach’ children to make the ‘right’ healthy lifestyle choices.

Although on the surface these different strategies appear to be relatively benign, collectively they may be dangerous for young people.

A growing body of research sheds light on the ways these different types of school-based ‘anti-obesity’ strategies help to create and maintain a narrow understanding of health – one that emphasises individualism, self-surveillance, responsible consumerism and thinness.

A number of children perceive health as simply the result of eating, exercising and being thin, an understanding that ignores powerful social determinants of health and silences other cultural perspectives of wellbeing. Young people are also increasingly exhibiting body image dissatisfaction, an unhealthy obsession with being healthy, and fat-phobic attitudes (both towards themselves and others).

Schools are becoming sites where anti-fat attitudes and practices are encouraged and rewarded, rather than critiqued and contested. The unhealthy consequence is that fat children are excessively monitored, ostracised, teased, stigmatised, bullied and even blamed for being fat.

Social science research helps us understand how health promotion and disease prevention strategies intersect with, and are transformed by, social dynamics. By perpetuating fat stigma, the global ‘war on obesity’ can and does have harmful consequences for many individuals and populations.

The challenge for government strategies aiming to improve population health is to incorporate socio-critical perspectives to ensure intended, equitable and ethical outcomes.

Darren Powell is a Lecturer in Health Education at the Faculty of Education and Social Work. His research interests focus on children’s understanding of health, fitness and fatness, and the role of corporations in ‘fighting obesity’.

George Parker is a PhD candidate in Sociology at the School of Social Sciences, University of Auckland. Her doctorate examines women’s experiences of weight and diet-focused advice and interventions in reproductive health care, especially in the context of growing scientific interest in epigenetics and maternal obesity.

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