'Something in the issue of obesity that captures the imagination in a negative way': Obesity in the body and the public mind
According to the Health Survey for England 2021, around 25.9% of adults in the UK are obese – one quarter of the population. Another 2021 survey found that around 12% of adults in Italy are obese. Such high rates are alarming - obesity is harmful to health in a number of ways, increasing the risk of heart disease, strokes, type 2 diabetes and some types of cancer.
However, before we can tackle the problems of obesity, we must identify the root. Rather than looking purely at the agency of an individual, speakers suggested, looking at the social and particularly the physiological causes would give the issue greater nuance, and help challenge the idea that those with obesity are simply guilty of a lack of self-control.
The causes of obesity
In a panel at the 'Positive Nutrition' event at the Italian Embassy in London on Wednesday, Professor Paul Gately, CEO of charity Obesity UK, emphasised the complexity of talking about obesity. The social context, he suggested, is vital.
The reason that the issue is shifting so much, said Gately, is because the parameters are always shifting depending on the context. For example, “it's complex in a family situation, so for families living in central London their rates of obesity in those areas are very different to families living in the West side of London in the more affluent communities, so within those families you have various degrees of risk profile of obesity.
“Then you can take it to community level, then you can take it to regional level, then you can take it to a European level and a global level.”
Access to support, as well as access to gyms and leisure and access to education, play a vital role in obesity. Many of those part of Obesity UK, which has around 25,000 members, felt that these things were lacking, preventing them from effectively managing their weight.
Obesity is also complex because of the importance of physiology in affecting one’s tendency towards it. Professor Francesco Rubino, Chair of Metabolic and Bariatric Surgery in the Faculty of Life Sciences & Medicine, King's College London, emphasises that the causes of obesity are far more closely linked to physiological characteristics than many people think.
When Rubino first became a surgeon, he did not want to do bariatric surgery (surgery that makes changes to the digestive system to help people lose weight) because “I was convinced that the way the surgery works is by making the stomach smaller and forcing people to eat less, in other words forcing a change in behaviour, and I thought ‘you don't want to do surgery to change behaviour’”.
Instead, he found that the surgery had a different, and significant, effect. The stomach, he said, controls both weight regulation and sugar metabolism. Thus, “when you change the anatomy of that organ you have the most profound clinical effect on . . .obesity.” People with this operation, said Rubino, experienced “the most sustainable weight loss I've ever seen.”
Obesity is ‘not a choice’, Rubino emphasised, but a physiological condition. The ability to regulate weight is not equal to everyone.
“We don't understand the physiology of obesity, we think we can regulate our very body weight at will, which we can't, it's not under our control. The centres that regulate body weight are located in a level of the brain called hypothalamus, which is far deeper than the cortex is, so there's no chances that you can consciously change your body weight regulation beyond a limited range.
“It's the same thing that happens with respiration. We normally breathe, and you don't have to think about it.”
There are several other physiological causes of obesity as well. “There was a study published just two days ago during my field that shows how people with obesity actually lack that switch, normally they have this in the brain after eating, after your gut sees the nutrients.” While most people would get a physical signal to stop eating once this has happened, people with obesity, Rubino suggests, would not.
Obesity and stigma
Gately, in his line of work, has encountered many obese people who feel responsible for their weight.
Obesity, he suggested, has been unfairly stigmatised because of the perception that it’s a personal choice. “We still have a belief that people living with obesity made a choice to be obese and therefore it is their fault, and therefore ‘why should they get the care of our healthcare system when they've chosen to be that way?’”
Even in relation to other conditions affected by lifestyle choice, Gately suggested that people are less empathetic towards obesity. “Interestingly they would never suggest cancer was a choice, despite the fact that a large degree of cancers are lifestyle related.
“And again they wouldn't say to people suffering with heart disease ‘well that's your choice because of lifestyle-related factors,’ when we know that lifestyle-related factors are contributors towards heart disease.”
Gately argued that cancer and heart disease are similar to obesity, in the sense that their causes are a combination of lifestyle factors with genetics and physiological factors. Yet people with obesity do not get the empathy that those with cancer or heart disease do.
“So there's something in this issue of obesity that captures the imagination of people, I would argue in a negative way . . . there is something in the way we visualise obesity as a problem and people living with obesity as a problem and so for me that's a big barrier.
“If we can break that barrier and see people living with obesity as humans that deserve the same quality of care that people might get from Francesco or other experts in our field . . . then I think we can take a step forward.”
Personal experience in his charity, Gately said, has convinced him how harmful this stigma can be. “I work with people living with obesity and talk to children and families, and they are often guilt-ridden about the poor choices that they have made.
“But why would we be surprised by that when the overall narrative is [that] your food choices are really bad and that's your fault?”
Rubino emphasised the same point. The stigma around obesity, he said, “comes from two things: for one, a misappreciation of the biological regulation; the second is this very widespread assumption that you can undo obesity no matter how severe.
“We tested this on 4,000 people in the UK . . . and people who actually have the belief that you can solve obesity just by lifestyle interventions are the ones who have the highest level of stigma.
“So here's the point: people with obesity are blamed twice, for getting obesity in the first place, and for not doing enough to undo the problem.”
