Obesity stigma is a barrier to action
It is time to change the prevailing narrative around obesity – that it is due to individual choice or personal failure – in order to reduce the continued serious threat to Australia’s health and wellbeing, says a national collaboration of more than 350 prevention researchers.
The Collaboration for Enhanced Research Impact (CERI), which comprises the Prevention Centre and four associated Centres of Research Excellence, is calling for a coordinated approach to tackling obesity that would see investment in creating environments that support people to lose weight and lead healthier lives.
“Almost 1 in 4 Australian children are already affected by overweight and obesity at the time of school entry. Yet clinical services are often few and far between around Australia, with long waiting lists, so that people can be denied access to good quality treatments delivered in a respectful way.”
PROFESSOR LOUISE BAUR
In a recent opinion article, researchers highlighted that people living with obesity are stigmatised and blamed, while in many cases obesity rates in Australia are being driven by biological predisposition combined with an obesogenic environment.
They were responding to the release of a report by the Weight Issues Network that highlighted what it is like to live with obesity in Australia, and called for greater empathy and understanding to improve the lives of those affected.
“Blaming people for living with obesity is an excuse for inaction at the macro-level where real population wide changes can occur,” said Prevention Centre Co-Director, Professor Lucie Rychetnik.
“We know obesity is causing a significant burden for both individuals and society, so it is vital that we make the economic and social adjustments needed to support people to change their lifestyle.”
According to the Weight Issues Network, there are more than one million Australian adults with clinically severe obesity (class III or class II with an obesity related disease). Yet there is limited access to public services to manage their complex needs, while shame presents a major barrier to people asking for help.
There is strong evidence from Australia and internationally that obesity is not a matter of personal choice, and is caused by multiple, interconnected factors. Research shows that the determinants of obesity are often set during preconception and through the first thousand days, while both food environments and physical activity environments influence risk behaviours for obesity throughout people’s lives. The stigma of obesity can also itself contribute to the development and exacerbation of weight gain.
Professor Louise Baur, Director of the CRE in the Early Prevention of Obesity in Childhood (EPOCH CRE) and also a paediatrician who provides clinical services to children and adolescents with high BMI, said she sees first-hand how young people and their families can be stigmatised due to obesity.
“Almost 1 in 4 Australian children are already affected by overweight and obesity at the time of school entry. Yet clinical services are often few and far between around Australia, with long waiting lists, so that people can be denied access to good quality treatments delivered in a respectful way,” she said.
“This relative lack of resourcing for clinical services and the paucity of trained health professionals working in the area of obesity are yet further examples of institutionalised health system stigma towards people with obesity.”
Her case study in an Australian based health service found that the prevailing paradigm among staff at executive, management and clinical levels was that obesity is a matter of personal choice. Blaming individuals is leading to a lack of clarity around obesity treatment versus obesity prevention, the research found.
Continuing debate over whether or not obesity is a disease further exacerbates the problem, as treating it as a disease can result in health services focusing primarily on obesity treatment and miss opportunities for obesity prevention, Dr Pearce said.
Rather, her research has recommended that health services should frame obesity as a social problem, as one of health inequality rather than a disease to be cured, that requires a range of responses rather than a one size fits all linear solution.
“My research demonstrated that clinicians working in health services are very aware of the problems in their patients related to obesity, but they are not supported by health service policies or systems to significantly change their practice,” Dr Pearce said.
“At the same time, policy makers understand the need for a population approach but not how to support prevention at an individual level.
“There is a clear need to bring these perspectives together, challenge the negative stereotypes around obesity, and recognise that this is a highly complex problem that requires the whole system to intervene.”