When Do Obesity Public Health Messages Become Fat Shaming?

Siobhan Harris

Disclosures

July 11, 2019

How do you tell someone they are overweight? It's a touchy subject. Making people aware of the health risks without causing offence can be tricky.

Cancer Research UK has found that out after launching its latest campaign. It pointed out the link between obesity and cancer but it's run into claims of fat shaming.

Its series of adverts has obesity warnings on what look like cigarette packets, highlighting the fact that both smoking and obesity are risk factors for cancer.

https://twitter.com/CRUK_Policy/status/1146415952071929857

It made the point that obesity can cause 13 types of cancer and it's now a more common cause of bowel, kidney, ovarian, and liver cancer than smoking.

Fat Shaming Accusations

The backlash that followed came from many quarters.

A group of academics and nutritionists from institutions including the University of Cambridge and King's College London warned that the findings were flawed and might make people too ashamed about their weight to ask for help.

In an open letter to Cancer Research UK  the authors said: "Your campaign’s focus on weight as a leading cause of cancer is misleading. Body mass index is a crude indicator of health and while there is an association between higher BMI and cancer, the reasons and mechanisms for this are unclear."

People also took to social media with cries of fat shaming. "It makes people feel worse and responsible for their cancer," said one tweet: "Correlation is not causation."

'Judgemental and Unhelpful'

Chelle Bell is a plus size model and a proponent of body positivity. She thinks the campaign is "appalling and stigmatising".

"It's lazy and misrepresents the facts. There is obviously a correlation between obesity and cancer but there is no evidence to suggest obesity causes cancer," she told Medscape UK.

As for the comparison with smoking Chelle Bell says: "Putting a cigarette in your mouth is voluntary, it's just not the same as eating food which you need to survive. The campaign basically says if you are fat you will get cancer and it will be your fault, which is cruel and shaming."

Obesity, of course, is a complex and multi-factorial problem. There's more to it than eating too much and moving too little.

"Obesity can be a consequence of physiological factors as well as lifestyle choices. It is not something you should be blaming people for," says Aisling Pigott, a dietitian and spokesperson for the British Dietetic Association.

"Accusing people of causing their own cancers through being obese could be perceived as judgemental and unhelpful to those people who are already tackling their own complex issues around food and diet," she told us.

Making people feel bad about being overweight and obese may be counter-productive.

"If you are basically being told you are fat, you are going to die, it's not going to make you suddenly decide to eat healthily and go to the gym. It'll make you either eat more, go on a crash diet or stop eating altogether," believes Chelle Bell.

Too Sensitive

The campaign's message is bold but are people being too sensitive? Shouldn't people be made aware of the risks so they can do something about it? If the public health message is watered down to pander to people's feelings maybe it wouldn't be as effective.

Not everyone has lambasted the Cancer Research UK campaign.

One of them is Paul Aveyard, professor of behavioural medicine at University of Oxford who has researched smoking and weight loss.

"I don’t agree with the open letter. I don't think the campaign is in any way fat shaming. It is just passing on a hard-hitting message. If you have a weight problem it may be somewhat upsetting but the campaign is not stigmatising and doesn't apportion blame."

Another advocate for the campaign is Tam Fry of the National Obesity Forum. He says his organisation has been telling the government since 2002 that obesity is the new smoking in terms of health risks and now it has come to pass.

"The campaign is absolutely right. We've had 20 years of public health messages from the Government that have not succeeded. Now, you have got to step up the rhetoric and make absolutely sure the message gets home. It's tough love. The campaign is strident and because of that it's upset a lot of people," he says.

Policy Change

It’s the parallel between smoking and obesity that has caused the consternation. Cancer Research UK says it isn't comparing eating food to smoking. It's making a point about how policy change can help people develop healthier habits.

When Government smoking policy changed the rate of smokers dropped and fewer people developed smoking-related cancer.

Michelle Mitchell, the charity's chief executive said: "Like smoking, obesity puts millions of adults at greater risk of cancer and like smoking rates, obesity rates can be reduced with government-led change.  

"Smoking rates in the UK have dropped dramatically over the years, thanks to measures like higher tobacco taxes and marketing bans; now we need a similar approach to tackle obesity. Incessant adverts and price promotions can nudge us towards junk food, so we need the Government to build on lessons learnt from smoking prevention and put policies in place that make it easier for everyone to keep a healthy weight," Michelle Mitchell added.

Who Is the Campaign Aimed at?

If the campaign is aimed at individuals who are obese it has run into accusations that it doesn't fully cover the complexities of obesity and neither does it give any practical solutions.

"Health campaigns should ideally send helpful messages. A focus on positive health changes instead of negative health consequences are more favourable than blaming or implying a terrible diet and lifestyle is the cause of all cancer. You need to put a positive spin on it as opposed to a need to constantly blame those who are already struggling," believes Aisling Pigott.

What's more likely is the campaign is aimed at policy makers to raise awareness of the risks so changes will be made further down the line.

"With policy change you have to build momentum for the Government to listen. You need a co-ordinated campaign of winning hearts and minds among the public before politicians will act," explains Paul Aveyard.

He adds: "This campaign isn't aimed at individuals. It's trying to communicate the seriousness of a problem to politicians."

Role of Doctors

GPs are often at the sharp end of talk about obesity. They are well-placed to tell people about the risks and give them advice on weight loss or refer them to a weight management group.

They don't want to be accused of fat shaming either. Because being overweight is wrapped up in so many other psychological and environmental factors it can be a minefield for GPs.

Paul Aveyard has researched the role GPs can play. He says: "It's surprisingly easy for doctors to talk to patients about their weight. They can do it in 30 seconds. Our research found it was effective, popular with patients and easy to do.

"GPs sometimes don't mention it as weight is a touchy subject for many people. In the context of a consultation it's far less touchy than you would imagine. We asked people what they thought if their doctors had spoken about their weight out of the blue and more than 8 out of 10 said it was appropriate and helpful. If you talk in a normal matter of fact way and give them practical options for dealing with it, it’s surprisingly well-received," he advises.

"All medical professionals have a responsibility to support health messages in a sensitive way. You can't bring it up and say by the way you know you're grossly obese you need to lose weight. It's unhelpful and the language around obesity needs to be massively improved," says Aisling Pigott.

Tackled on All Fronts

Around 29% of the UK population is obese. The latest figure given by Public Health England for the cost of obesity and obesity-related-ill-health in England is more than £6 billion a year.

Many experts say obesity needs to be tackled on all fronts. It's not only a risk factor for cancer but for diabetes, coronary heart disease, and stroke. The individual has a role to play but that's only part of the solution. There also needs to be earlier intervention and policy change to improve the obesogenic society that we live in.

Yes, the campaign was controversial. Whether it was fat shaming or not is debateable. If it's aim was to make people aware of the link between obesity and cancer it was a runaway success.

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