I normally spend too long trying to work out how exactly I feel about these topical issues that are currently being debated and miss the boat on sharing my views, so this time I decided to just get some of my thoughts out there.
The government has announced a new campaign that revolves around two main initiatives.
- GPs will ‘prescribe’ weight watchers diets
- Junk food TV advertisements will be banned before 9pm
Now I am generally in favour of the second point. I think without a barrage of adverts in the hours that children watch Tv it’ll be easier for parents to keep their kids away from high quantities of junk food on a regular basis. There have been other good initiatives along these lines too. Jamie Oliver’s healthy food in schools campaign for one. When you think about what we as thirty something year olds had for school meals vs what kids get to eat now it’s a massive improvement. I am massively in favour of making ‘healthy’ foods accessible to all children (and adults). There has been some bad with the good as well with a lot of extracurricular fitness and sports clubs being cut by schools and council run facilities. The cost of privately run sports and fitness clubs pushes their availability out of the range of a lot of low income households, so that a broad range of fitness activists are becoming less accessible to a lot of kids.
Obese people fit into two main categories. The first is people that simply exist in bigger bodies. They don’t eat or exercise in a massively different way to their lower BMI counterparts but they are genetically bigger, be it broader, more muscular, or fatter. The second are people that have habitual emotional eating behaviours. It could be a diagnosed eating disorder or simple a tendency to binge after an emotionally draining, or stressful day. Severe obesity (class 3) is strongly correlated with this second category.
The first action point that the government has announced, that is GPs prescribing ‘weight watchers’ diets, I am very strongly against. 95% of all diets fail. That is they fail in terms of losing weight and keeping it off. No doctor is ‘prescribing’ any other treatments that have a 95% failure rate. It’s absolute madness. The government and the GPs know the failure rate, so what is the play here ? Well you could argue that of the 35 million people in the UK that are overweight or obese, if every one of them was prescribed a diet then (and attempted the diet they were prescribed) 5% would succeed in losing weight and 1.75 Million people would no longer be within the obese category.
The problem with that is what happens to the ‘failures’. Around 90% of those dieters fail not because they don’t lose weight but because they gain it all back and very often more on top of it. The net change in weight of those ‘failures’ is very often a gain in weight. If the government’s aim is to reduce their bodyfat/weight then then government’s new prescription is on track to fail them badly and statistically very likely to leave them bigger than when they started.
The bigger issue for me is what happens to their mental health. Feeling like a failure causes a good deal of emotional trauma. Being told you are a failure by a GP is going to hurt a lot too. Seeing reminders of your failure in diet adverts, public health announcements, on TV, in magazines and newspapers, is going take its toll. Those without an understanding of the topic (or empathy in general) will say that this negative feeling will motivate the person to try again, to be successful on their next try. We’ve all seen marketing to that extent, but it doesn’t work like that.
If we look at those with eating disorders which makes up a big percentage of this group of diet failures. The ‘priory group’ estimates that nearly 10% of the population has a diagnosed eating disorder. Other mental health experts report that up to 67% of women suffer from an eating disorder or disordered eating of some kind. One of the biggest triggers for an eating disorder to manifest or worsen is following and ultimately failing a diet . If mental health professionals were consulted instead of GPs (who are by their very nature generalist) there is absolutely no way someone with eating disorder symptoms would be ‘prescribed a diet’. By the way at this point it’s probably worth mentioning that those suffering from eating disorders aren’t just a bit sad, they are seriously ill. They have the highest rate of mortality of any mental health condition . So the government’s new incentive is at best going to trade 1.75M obese people, for a similar number of people having symptoms of eating disorder or seeing their eating disorders worsen and with it a decline in mental health and increase in mortality rate.
If you are looking for a positive from the new government initiatives you could say that these failed diets often have short term success. So if we just take the COVID-19 crisis on its own, and we believe that the data that reads a correlation between obesity and the need for COVID-19 medical intervention/treatment means a definitive and significant causation. Then if the government get every obese person to try a diet then a lot of them could be at less of a risk of needed medical intervention/treatment for COVID-19 and ultimately less risk of death from it. By the time they regain the weight and/or develop an eating disorder the COVID-19 crisis will be over and they can deal with the fall out of what ever comes next. A short term solution to help get us through the COVID-19 crisis perhaps.
For me the new government initiatives:
- Are relatively cheap and easy to implement
- Demonstrate that they are doing something
- Put accountability back in the hands of the public (it’s your fault because your BMI is …)
- Help boost the economy through the diet industry (worth £2BN per year already and growing)
I think I much better approach would be to treat obese people exactly the same as everyone else.Referring back to the two main categories of people at the top of the discussion.I don’t believe that those that exist in bigger bodies need any kind of medical intervention.Patients with obesity experience judgment, bigotry, and discrimination in all facets of society, including health care settings and pushing more of this on those people is likely to damage body image and with it mental health (stress, depression, anxiety, etc). Obese people that don’t want to lose weight are healthier than obese people that do, so a little bit of self love and self acceptance is going to go a long way health wise. The Journal of obesity concludes: “Adults with Greater Weight Satisfaction Report More Positive Health Behaviors and Have Better Health Status Regardless of BMI”. Being body positive, fat positive and generally comfortable in your own skin is a healthy thing to be.
People that have habitual emotional eating behaviours should be grouped with other patients suffering from mental health issues.They should receive referral to a mental health professional and should begin ‘treatment’ on the underlying cause of their mental health problems and not a treatment based on just one symptom if it.
In order to find out who these people are that need mental healthcare without targeting obese people you simply have a conversation (wether face to face, physical survey or online) with everyone. You can survey people in NHS waiting rooms, GPs can have a conversation with patients when they see them and there can be much more public health notices focusing on mental health and getting people to talk about it.
The obesity epidemic isn’t an obesity epidemic at all. It’s partially nothing and partially part of the mental health epidemic.
A couple more related discussions
Does being obese increase COVID-19 risks?
The short answer is probably. Obese people tend to have higher levels of inflammation, especially if they have a lot of visceral fat (not all overweight people do and not all people that do are overweight). The main problem with a simple statement that obese people are at higher risk from COVID-19 is that the stats are hugely inflated by a few correlated factors:
- Older people have higher BMIs and older people have increased risks for COVID-19
- Poorer people have higher BMIs and have increased risks for COVID-19
- Obese people have higher levels of stress, depression and other mental health issues all of which are correlated with weakened immune systems and weakened immune systems are correlated with higher risks for COVID-19
- Disabled people have higher BMIs and are at greater risk for COVID-19
So when we adjust for age, socioeconomic factors, mental health factors, and physical health / disability factors the direct correlation between obesity and COVID-19 risk is going to be much much less, and maybe worth focusing a lot less on.
Isn’t the focus on obesity a good thing for Personal Trainers ?
My motivation for voicing these opinions and facts is largely personal. I see very few obese clients. It’s very rare that I see someone classified as moderate risk (class 2 obesity), and I can’t remember the last time I saw someone classified as high risk (class 3 obesity).
The reason for this isn’t that ‘fat people are lazy’ or ‘fat people don’t care about their health’ or ‘that fat people don’t want it enough’ or any of the other stigmas that are out there. It’s because we are grouped with the diet industry, the fitness industry, GPs, government advice, gyms, fitness marketing, fitspo social media accounts, etc and they are all using fear and fat phobia as the primary means to sell their products and none of them have any representation from obese people. Personal Trainers are not broadly seen as friends of obese people and the idea of an hour with one of us sounds like hell to a lot of obese people.
Nothing about the way a gym is marketed says that it is a place where obese people are welcome. Every marketing campaign involves slim, toned women and muscular athletic looking men effortlessly performing exercise in full sets of make up without a drop of sweat. Diet advertisements are the same. Slim folks sharing a joke over a salad. The marketing for ‘insanity home work outs’ is the only marketing campaign I can think of that showed the fact that working out is actually hard, and that people struggle whilst doing it and I can’t think of a marketing campaign for diet or exercise that has obese people in the foreground.
Nike hit the headlines last year when they put a ‘plus sized’ mannequin in a flag ship store. This looked like real progress to me. That was until I started reading how it was reported and commented on. There was a substantial minority that labelled it as ‘glorifying obesity’ and that Nike were telling people it was ‘ok to be fat’. Representation is not welcomed in the health and fitness industry by those that are already there.
Fat phobia in and around the health and fitness industry is preventing people from exercising. It screams loud and clear that ‘this isn’t for you’ and ‘you aren’t welcome in this space’.
For the many trainers and small fitness studio owners like myself that aren’t fat phobic and don’t operate off this script we struggle to speak directly to the people who need us the most. It’s assumed that we are just as judgemental as every GP they have spoken to about their weight, every (if any) fitness professional, any fitspo blogger, and any fashion or health magazine journalist who’s articles they have read. I would love to have a direct line of communication to show obese people that my studio exists very much for them, as much as any other body type. I’m not going to make them do anything they aren’t comfortable and the work outs are going to be tailored to their own abilities and are going to leave them invigorated and feeling good about themselves. They also, like all my clients get to dictate their goals. We don’t need to talk about weight loss every week or how many salads they have eaten and I won’t be throwing anti obesity slogans at them.
- Urquhart C, Mihalynuk TV. Disordered eating in women: Implications for the obesity epidemic. Can J Diet Pract Res 2011;72:e115-25
- Herzog DB, Greenwood DN, Dorer DJ, Flores AT, Ekeblad ER, Richards A, Blais MA, Keller MB. Mortality in eating disorders: a descriptive study. Int J Eat Disord. 2000;28(1):20-2610800010