The great obesity debate: divided we fall

Abstract

July 3, 2019, saw the rollout of a new advertising campaign by Cancer Research UK (CRUK) that aimed to highlight the link between obesity and a range of cancers, particularly those of the bowel, liver, ovary, and kidney, which are now more likely to be caused by obesity than smoking in the UK. The eye-catching adverts feature images of branded cigarette packets emblazoned with the caption “Obesity is a cause of cancer too”. According to CRUK, the aim was to compare smoking with obesity to “show how policy change can help people form healthier habits, not to compare tobacco with food”. The campaign has proven extremely controversial. While some have applauded CRUK for raising awareness and “simply stating facts”, other commentators in the press and on social media have branded the tactic as “misleading”, “dangerous”, and “stigmatising”. The most prominent criticism has been that it amounts to fat-shaming. Margaret McCartney, a general practitioner in Glasgow and an opponent of CRUK's approach told the BBC's Inside Health programme: “we know that obesity is multifactorial and we know that the people who carry the weight—literally—of this risk factor the most are already the most poor, and I'm really worried that this is going to lead to more stigmatisation of people who are overweight or obese”. An open letter signed by more than 60 researchers, public health professionals, and dietitians called on CRUK to change focus and “prioritise wellbeing over weight”, stating: “when you frame people's weight as the problem, instead of directly addressing the environmental factors you intend to change through policy, you are effectively telling people that cancer is their fault.” At the time of writing, an online petition linked to the letter that calls for the immediate cessation of the campaign had garnered more than 12 500 signatures. In the midst of this controversy, one might be forgiven for missing the publication of two reports that propose a standard of care for the treatment of adults with obesity, as well as a set of core clinical obesity-related competencies to be used in undergraduate and graduate medical education. The core competencies include a focus on evidence-based management and prevention of obesity, and a strong emphasis on empathy, with points including that the student “advocates for policies that are respectful and free of weight bias”, and uses language that is “nonbiased, nonjudgmental, respectful, and empathetic when communicating with patients with obesity”. The core principles of care also highlight the subjective and environmental context of obesity, stating: “Social determinants of health should be considered when developing a treatment plan, taking into consideration patients' home, work, and community environments; interpersonal relationships and family dynamics; stressors; and cultural preferences”. The reports are clear, comprehensive, and humane, and the authors hope is that their recommendations will be widely adopted. Obesity, and the tactics used to address it, are a matter of increasing urgency; on July 15, 2019, WHO released a report on global food security and nutrition which concluded that while 820 million people globally do not have enough to eat, overweight and obesity have continued to increase in all regions, particularly among school-age children and adults, with 672 million adults (one in eight) categorised as obese in 2018. The vigorous debate in traditional and social media about the CRUK campaign suggests that there is a rift in the way public health organisations and clinicians want to approach obesity. But both sides of the argument seem to have similar aims. In a radio interview on the topic, Linda Bauld, CRUK's cancer prevention champion, noted that the organisation took the issue of weight stigma “very seriously” but that it was pushing for substantive changes in government policy, including restrictions on junk food promotions in supermarkets and the implementation of a watershed for advertising of unhealthy foods. The open letter by opponents of the campaign also noted “like [CRUK], we're committed to challenging social and environmental influences on health”. The ultimate goal of most organisations interested in obesity is much the same—to promote an environment in which everyone can lead healthy lives, without stigmatising or alienating those who are overweight. In an era of outrage culture and fast news, division and controversy can divert attention from difficult problems such as urging governments—which are, in some cases, influenced by food industry lobbyists—to make meaningful changes to policy. While the debate rages on, corporations continue to profit from promoting an obesogenic environment, and meaningful policy change is too slow in coming.