Wednesday, 5 June 2013

'Attack on Obesity Starts Before Life': (At Least) 5 Problems

This is a guest post by George Parker:

5 quick-fire reasons why I have a problem with the public health approach reported in the New Zealand Herald today under the headline: ‘Attack on obesity starts before life’:

1.     The studies were based on animal experimentation (sheep) and there are still many questions about how or whether the findings of these studies translate to humans and human environments.  It is therefore way too early to use these studies as a basis for public health policy (this is leaving aside the ethics of animal experimentation that involves starving and/or force-feeding pregnant animals).

2.     The relationship between obesity and health is highly contested and we should question the very idea of public health interventions aimed at obesity prevention.  The study of obesity, the findings of those studies, their representation in the media, and their application into public health policies are all influenced by anti-fat bias – the socially constructed notion that fat is bad and that fat people are ‘lazy’, ‘greedy’, ‘stupid’, ‘out of control’ and ‘unproductive’. Anti-fat bias results in stigma and discrimination for fat people which is itself a health risk. For example, fat people report frequent dieting with both physical and psychological effects, avoiding recreation in public spaces, and forgoing health care because of the attitudes of health providers towards their fatness.  Variations in body weight should be understood as part of natural human diversity, and identifying and addressing anti-fat phobia should be a public health priority.

3.     Public health policies specifically targeting women as reproducers and mothers to improve population health are discriminatory on the basis of gender.  Such policies are a continuation of a long history of reproductive injustice that has resulted from the reduction of women to their reproductive organs, the elevation of the interests of fetuses over pregnant women, and the responsbilisation of women, particularly mothers, for social and health problems.  This in turn has justified, and continues to justify, the surveillance, regulation and control of women’s reproductive bodies including for example restrictive access to contraception and abortion, and policies and prosecutions aimed at foetal protection.  

4.     Public health policy focused on changing individual behaviour is influenced by neoliberal ideology that seeks to justify reduced state involvement in and responsibility for the population’s health and wellbeing by responsibilising the individual for health.  This is unjust - it masks and maintains vast and persistent social and health inequalities and other relations of power eg. racism, poverty and gendered social roles, that create the conditions for and determine poor health. It is no coincidence that the ‘attack on obesity’ by targeting women’s dietary choices before and during pregnancy is our dominant public health strategy at a time when solo parents welfare entitlements are being reduced; when affordable, safe, warm housing is difficult to secure; and when many families are experiencing food insecurity.

5.     Public health interventions targeting individual behaviours frequently translate, not into increased social support, but rather blame, guilt and punitive sanctions on those who fail to improve their health regardless of their material realities and social contexts. Not only is this unjust, it also fails as a public health strategy because it risks disengaging people from health and social services.  Women are especially vulnerable to anti-fat bias in health services and are already subject to increased surveillance and intervention because of their role in reproduction, particularly women marginalised by their socio-economic circumstances and due to racist systems of oppression.  The potential to disengage those women who could most benefit from health and social services is thus high and poses a significant threat to women’s and their children’s health.

(Related reading: Werewolf article: Policing Pregnancy, by Alison McCulloch)


Kay said...

Weight related health problems have increased in tandem with the social focus on body conformity that promotes dieting and surgery to fit an idealised body image. That ideal image has changed over time and formerly normal and attractive bodies, like Marilyn Monroe, would now be rated as obese on a BMI scale.

Children receive the impact of media images, and by ten years old many girls are dieting whether they "need" to or not. Diets pave the way for bigger problems like anorexia and bulimia later on.

The obsession with BMI (Body Mass Index) as a proxy for fatness ignores the fact that BMI doesn't measure fatness and has little relationship to healthiness. Neither fat nor high BMI necessarily mean unfit, and thin doesn't always mean healthy.

Many All Blacks and other professional sports players score as "obese" if you judge them only by BMI. A person may be thin and dying of cancer and be very unhealthy.

In the USA there is a movement for Health At Every Size that has good science and research backing up a moderate and balanced approach to exercise and eating, and ensuring that each person is assessed on their own merits.

The Lancet journal did a major meta-research project on how to improve the health of populations. The research found that countries and states with healthier profiles invested more in activity programmes and initiatives like pedestrian walkways, exercise classes in the parks, encouragement and access to using stairs in buildings rather than lifts, and a whole range of deliberate subsidised choices to get people moving more. Collectively supported activity increases healthiness, regardless of a person's weight.

Jenny Kirk said...

Sometimes Christy-George I think the answer is staring us in the face and no-one is looking - I see too many fastfood greasy food outlets, too many fizzy drinks, too many sweets and chocolates (and I see Cadbury has just increased the size of their latest lot of chocs) frozen icecreams are much bigger than they were when I was younger etc etc.
These things are everywhere, every day for everyone .... a few decades back they were a "treat" - something special to have on a special day like Christmas.
No wonder we're all getting fatter with all these "treats" so handy everywhere, every day.