Have you seen the OB_S_TY campaign by Cancer UK? It caused quite a stir in nutrition circles when it was launched. I wrote most of this back when it launched but didn’t hit publish button. The focus on weight and health in isolation still bothers me so this is post remains very relevant. I know this campaign is well intended, aiming to get people to lose weight to reduce cancer risk. But I for one was uneasy with it and I wasn’t the only one.
It implies that obesity is a cause of cancer, like we understand smoking is. But I don’t think this is so clear cut as smoking. Many lifestyle factors are associated with cancer risk, obesity is one of them and many of those lifestyle factors are independently associated with weight gain or poor weight management. There may be some clear mechanisms for how obesity directly causes cancer however Cancer UK say themselves that: ‘It’s very clear that there is a link between cancer and obesity. But it’s still not completely understood how exactly obesity causes cancer.’ So correlation is a fact, but causation is not yet confirmed.
Yet their campaign implies just that. Can we categorically say that obesity is in itself is a clear cause of cancer, separate from the many factors that influence obesity? Can we motivate people to be healthier and thinner with this campaign? Or does it make it it harder for people to make real change?
Whilst lifestyle factors maybe the second biggest modifiable risk after smoking, in a public health campaign like this, should we focus on obesity in this way when obesity is so multifactorial and cancer is not one disease but many, some more associated with obesity than others.
Obesity is a complex thing, many lifestyle factors can affect our weight, those behaviours and factors can also harm our health, without significant weight gain. And increase our cancer risk. And some of the factors affecting obesity are out of our control.
Weight management is complex. There are many ways of losing weight that do not require eating a balanced or healthy diet, often the weight goes back on and long term behaviours are not changed. In this media world, driven a lot by simple messaging, the ‘battle against obesity’ is over simplifying the issue. To make weight the most important, overarching factor in any aspect of health is not helpful. It suggests that do whatever you need to do to lose weight because simply being a ‘healthy’ weight fixes health.
We know that this kind of approach to fatness is detrimental to those who are or perceive themselves as fat. If obesity is portrayed as the overarching factor in health then it follows that if “I can’t lose weight then I can’t improve my health”. Not true. And also “If I go to the doctor with this health concern will he/she tell me I just need to lose weight? I know I am overweight but I can’t seem to lose weight, maybe I won’t go.’
Of course, not all health professionals do this but in the minds of those who are overweight, with all the media attention and campaigns like this focusing on obesity in this way, it is easy to see how individuals may delay going to their GP. We also know that often people do not go to the doctor soon enough with cancer symptoms. For every person that loses weight on the back of this campaign is there another who feels less confident in popping along to see the GP over a concern that may be important, delaying a diagnosis?
I have seen strong views on social media that we shouldn’t shy away from telling people they are overweight and that this is more important than their feelings. My concern over campaigns like this and the whole ‘Obesity Crisis’ is not simply a fear of hurting someone’s feelings. It is the plain fact that there are better ways of empowering people to make changes that improve their health. That sometimes the ‘you need to lose weight’ approach actually does more harm to health than good.
It is important not to shy away from saying to someone that they need to make changes to their lifestyle to improve their health. Weight is not a behaviour, it is a product of many factors which are different to each person. Individual behaviours that are both associated with poor weight management and health outcomes should be addressed and changed. Move away from weight-centric health focus and look at changes for other positive effects on health. Measure it on blood pressure, on blood markers that have a real link to health, on improved nutrition, increased exercise, feeling more energetic, improved fitness….for everyone.
Many people who are obese have lifestyle factors and behaviours that are linked to cancer, but so do many people who are currently thin. If we always use weight to dictate where lifestyle change is needed and communicated are we not doing harm to those who remain thin despite lack of exercise, poor diet etc?
There has to be a recognition that obesity is multifactorial and, while personal responsibility is important, it is in fact everyone’s problem. Food manufacturers, retailers, advertising, television programmes, sports centres and clubs, schools, health visitors, government, workplaces…..everyone who in any way has influence to make it easier for people to be more active, normalise eating vegetables and fruit, stop food that is high energy but low in fibre and nutrients being the cheap and easy option, teach people to cook…..the list goes on and on. We cannot place all the responsibility at the feet of the individual, we must make our environment a place where healthier is an easy and desirable choice. Everyone can play a role in this.
And should we make those with cancer or have had cancer feel like maybe it was all their own fault? Or a cancer survivor or patient become fearful of food? Cancer is a cruel illness psychologically. We can all do things that reduce our risk but cancer is a myriad of different diseases with lots of risk factors and genetic elements. People who are thin get cancer too. The best thing we can do is aim to be healthy and active, things which give us tangible benefits on our immediate quality of life and fitness. It may also reduce cancer risk but there can be no guarantees. If unlucky then good general health can, in the face of that dreaded diagnosis, make a better starting point for the gruelling slog that is cancer treatment.
Nothing can improve our chances more than early diagnosis. If people are holding back visiting health professionals because of their weight and this campaign increases this reluctance then this is a negative impact. How do we measure the effects of a campaign like this?
Does scaring people who are overweight make people more successful in losing weight? Does it make them healthier? The evidence is building that actually that approach doesn’t work. Improving health at every size, making successful behaviour change something that gives benefits people can feel, better weight management can follow even if an ideal BMI is not achieved.
We have to empower people to change, let’s make it easier to be active, whatever size you are. Let’s make it easier to eat foods that are associated with lower cancer risk like fruits, veg, fibre containing foods like pulses. Let’s focus on improved sleep and better stress management. Let’s have messages that apply to everyone. Someone who is overweight may benefit more from these things perhaps and might help attain better weight management, but these messages are for everyone.
Don’t increase weight stigma. Chances are it will have the opposite effect.