The antidote to body shaming

By Mathew Dick | Principal Lead – Public Health Nutrition

COVID-19 – a global pandemic we never expected. Over 2.5 million deaths globally, and over 114 million infections. The pandemic doesn’t discriminate. It is impacting all countries, all people and all ages. In Australia, almost 30,000 people have contracted COVID-19 and we have lived through varying degrees of restrictions, lock-downs and alarm.

For those living with overweight or obesity, the impact if they contract COVID-19 is greater than for those of a healthy weight. People with obesity are 4-6 times more likely to be hospitalised, and 2-4 times more likely to be admitted to intensive care. Alarmingly, there is a 33% increased risk of mortality too.

The need for change is now more urgent than ever, but it is not as simple as eating less and moving more. Obesity is a chronic disease. It is an epidemic and it impacts 1 in 4 children and 2 in 3 adults. Obesity is preventable, however over 210,000 Queensland children and 2.62 million Queensland adults continue to be impacted.

The evidence conclusively indicates that we cannot take our focus off preventive health and wellbeing. Now is the most import time to be precise in our collective focus on prevention. 

This World Obesity Day we are calling for people to work together for change. The message of World Obesity Day 2021 is every body needs everybody.  It is only when we band together to acknowledge obesity isn’t a self-inflicted lifestyle condition can we end the negative stereotypes and stigma that surrounds weight and empower a healthier narrative around it.

Bruce Bogtrotter is a boy living with obesity who Headmistress Trunchbull attempts to shamefully humiliate in Roald Dahl’s popular book,  Matilda.

The stigma of obesity is one that we can find across all mediums, even in our children’s story books.

The story in Matilda goes that young Bogtrotter is accused of stealing a piece of Trunchbull’s personal chocolate cake and made to eat an entire large cake in front of the whole school as punishment.

The fact it was the boy with obesity who Miss Trunchbull accused highlights the negative stereotypes that impact the daily reality of many people living with excess weight and obesity. The mental and physical health impacts of weight-based stigma can result in significant harm.

The simplistic narrative that body weight is entirely about personal responsibility and easily solved by eating less and moving more, is not the experience of many.

The truth is people living with excess weight and obesity are up against big obstacles to lose weight, yet there is a clear gap between public perceptions and the scientific evidence about obesity, which has serious impacts for those most affected.

A serious stigma

Stigma can have a devastating effect on a person’s mental and physical health, independent of their body weight. Evidence tells us it can cause an increase in depression, anxiety, social isolation and stress.  Most troubling, around half of children with excess weight and obesity are exposed to teasing and bullying at school and will experience many of the harmful impacts of stigma, including lower educational outcomes and poorer life opportunities.

It should come as no surprise that shaming does not motivate people to lose weight, but it can instead have the unintended effect of driving us to eat more and avoiding physical activity. 

Communities where excess weight and obesity is blamed on the choices of individuals, where labels such as ‘lazy’ and ‘lacking in self-control’ are common, are more likely to breed stigma. By contrast, there is less stigma in communities that appreciate the complex range of factors contributing to obesity.

Our understanding of the causes and contributors of obesity is still developing; however scientific consensus is that obesity results from a complex interplay between biology, genetics, social, environmental and behavioural factors. Some can be controlled by us whilst many cannot.

Stigma is outside of our personal control. Other factors outside personal control include having easy access to cheap and unhealthy food and drinks and their extensive and sophisticated marketing, limited access to public spaces for physical activity, reliance on cars and convenience and takeaway foods, and even our hormones that control appetite and energy regulation. Genes also have a role and account for up to 40-70 per cent of the likelihood of developing obesity. What we can control to some degree are the food and drinks we consume and our levels of physical activity.

We live in a physical, social, food and media environment that makes excess weight gain a more likely outcome compared to sustaining a healthy weight. Perhaps it is time to stop blaming and discriminating against adults and children with excess weight and obesity and put more emphasis on addressing the contributors that are out of our personal control? There are plenty of options available to create more weight-friendly environments that will benefit everyone.

A better way forward

The proposed National Obesity Strategy outlines a broad approach that recognises overweight and obesity is an issue that society needs to address as a whole. The proposed solutions acknowledge the complexity of obesity and do not place all the emphasis on information and education so that people living with overweight and obesity can ‘do the right thing’.

In fact, too much emphasis on information and education means we can miss the many other ways to build more weight-friendly environments.  Breastfeeding promotion, community facilities for active travel, appropriate health services, supportive workplaces, active living programs, reducing exposure to unhealthy food and drink promotions in public spaces and on television and online, and making healthier options more affordable and available are also needed.

Shifting our mindset

Imagine a society where the student living with overweight or obesity was not the one accused of stealing a piece of chocolate cake?

An important step we can take together is to recognise that changes in the physical, social, food and media environments over recent decades have been the major contributors to excess weight gain and obesity. This shift in mindset will help to change the stereotype that people living with excess weight and obesity only have themselves to blame.  Doing so is essential for implementing a broader range of effective policy and programs for prevention, early intervention and treatment and to reduce the significant mental and physical harm caused by stigma.