Wednesday 12 August 2020 9:26 am

An obesity strategy that stigmatises patients won’t work

Ben Littlewood-Hillsdon is chief medical officer at Doctorlink

At the end of last month, the government revealed an array of measures as part of its new obesity strategy to “protect against coronavirus and safeguard the NHS”. 

Unveiling a 12-week plan to get the nation fit and healthy, the Prime Minister spoke openly about his own brush with death, and the part his excess weight may have played in his Covid-19 hospitalisation. 

The intentions behind this campaign are worthy. It is undoubtedly true that the UK has a weight problem. Two thirds of adults in Britain are either overweight or obese and rates are soaring faster than any other western European nation. The government’s concern is that certain conditions more prevalent in patients with obesity will put additional pressure on the NHS at a time when services are already under strain from the pandemic. 

Read more: Lose five pounds for the government? It’s thanks to the government I gained it in the first place

So it makes sense to place obesity at the forefront of the agenda. But as a medical professional, I must judge the government’s policies on their effectiveness — and here I fear they will fall woefully short.

The new measures, which include labelling restaurant menus with calories and ending deals on unhealthy foods, show a lack of understanding about the triggers for obesity and the support those struggling with their weight will require in the long term. 

The very language of the campaign risks stigmatising patients. Phrases like “protect the NHS” and “war on obesity” make it sound like the patients themselves are considered the problem by the medical community, embarrassing and pressuring people who are already stigmatised in other areas of their life for being overweight.

Unfortunately, fiscal references such as “£100m saved if everyone lost five pounds” play directly into the negative narrative of weight as a measure of someone’s self-worth. Instead of motivating those with weight issues to seek help, it can trigger further cycles of excessive eating and exacerbate the problem. 

Our weight has never just been determined by the number of calories consumed. It is related to our physiology, not to mention our psychology, and there can often be complex and diverse reasons for someone’s troubled relationship with food. 

It is well known, for example, that ordering a patient suffering from anorexia or a low body mass to “just eat” will not help rid them of their eating disorder. Treating them requires hours of individual and group therapy, nutritional plans to promote a healthy weight, and endless support and kindness from friends and family. 

The same needs to be understood for many patients suffering from a high BMI. Pushing people to become more accountable for their health is no bad thing, but the “contract of care” must also include meaningful resources for those willing to engage. 

The government’s strategy does make promises to realise a range of therapies long proposed to tackle obesity. But there is little detail on how mass access will be enabled when the healthcare system is already under strain. 

Indeed, the UK already has one of the highest patient-to-doctor ratios in Europe, and the NHS waiting list is predicted to reach 10 million by the end of the year. If the government wants to take obesity seriously and support those suffering with weight issues, it is going to need to expand its offerings and be more flexible when it comes to alternative ways of accessing care such as digital provision — particular with regards to mental health support.

With each upcoming study, more information is being discovered about the interconnection between obesity and mental health. But so far there has been no notable mention of the underlying mental health triggers for obesity in the government’s latest dialogue. Nor have we had any guidance on what additional mental health support will be on offer to respond to the rise of anxiety and depression during lockdown, both of which are linked with disordered eating.

Along with many other health professionals, I fear that the suddenness of the obesity drive could itself be detrimental for mental health, by making individuals feel personally targeted. There is still so much judgement and stigma placed upon being overweight, and societal attitudes have a long way to go in understanding the many facets of obesity and its triggers. 

We need to encourage, inspire, and most importantly help those struggling by ensuring they have access to the most appropriate forms of NHS care. Calorie counts on menus and high-pressure messaging from the government risk doing the opposite.

Read more: DEBATE: Is the government right to focus on obesity as its top public health issue?

Main image credit: Getty

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