The obesity paradigm and the role of health services in prevention: a systems overview

A research project for the Prevention Centre by doctoral candidate Claire Pearce set out to map the current health services available in the treatment of overweight and obesity. Not long into her audit and interviews, she realised that there was a much bigger issue; and one she hadn’t considered.

“These clients with overweight and obesity have complicated lives, and each has a narrative behind their current health situation. And it’s not just that they eat too much, there’s a metanarrative of the health system failing those with overweight and obesity,” said Claire.

“I slowly realised that the reason health professionals aren’t telling us we’re fat, isn’t because they are not recognising it as a problem, but rather that they realise what a complex issue it is for each and every client that they see,” said Claire.

However, the dominant message of the medical system is that the issue of overweight and obesity is not one of complexity but rather that the condition is the individual’s fault – they just need to take responsibility and to make better choices.

“This is neither helpful nor correct. The way we frame obesity as a matter of choice and sit it within the disease-centric medical model prevents health services from playing an effective role in the prevention of obesity.

“It may also be used as a reason for inaction. For example, it’s the person’s choice; we can’t choose for them to change their lifestyle; we need to prioritise a choice between treatment and prevention.

“Health processes are often looked at through a reductionist lens, with the aim of repairing or solving issues linked with disease. This approach does not translate to obesity prevention; responses to obesity need to be multifactorial and tailored to the local environment and circumstances. Health services have a role to play in advocating for a population health approach as well as incorporating a prevention focus into clinical services,” said Claire.

While Claire’s research objective was not to come to conclusions or suggest solutions but rather explore and assess the landscape of health care around overweight and obesity, she is able to see that there is a possible implication for a kinder, more compassionate approach to the issue.

“A higher level of knowledge on the complex, multifactorial causes of obesity has been shown to lead to a less negative attitude to those people with obesity and can contribute to better outcomes,” said Claire.

Telling a client they are overweight won’t help to stop them being overweight and it can even contribute to the repeating cycle. The questions health practitioners ask need to be reframed and health practitioners might even need to be re-educated.

“People with obesity – on the whole – know that they are overweight. They may not understand the full extent of the impact on their health, but they will be aware of the stigma and discrimination that occurs because of the way they look. It’s important that we continue to question what ‘having the conversation’ does look like,” said Claire.

Education is required to help health professionals at all levels of the system to understand the complexity of obesity in order to reduce their negative views and to address entrenched biases.”

An ongoing study by the Prevention Centre into how the Australian community views government intervention for the purpose of health prevention, AUStralian Perceptions of Prevention Survey, found that 91% of those surveyed thought that people were responsible for their own health, showing that some health issues are more readily stigmatised by bias. However, the research shows that people also believe that governments play an important role.

“One of the executives I interviewed for my audit said, ‘At the end of the day, who has the responsibility? The individual does…I think the role of health services in preventing obesity is to point out the things that can go wrong,’ which shows that stigma is inextricably linked to the concept of choice.

“The shame that accompanies obesity can create blocks both in terms of people accessing health services as well as in health professionals feeling able to initiate a conversation about weight,” said Claire.