Breaking the cycle of shame and blame for obesity

Obesity is defined by the World Health Organization as the excess accumulation of fat in the body which may impair health.
 
While I acknowledge there will be a minority of people living with obesity who appear healthy at present, the majority will develop a weight-related health condition over the course of time.
 
What’s interesting about obesity is that it affects people in different ways.
 
Some will develop metabolic complications such as type 2 diabetes, or polycystic ovary syndrome or testosterone insufficiency – both of which can affect fertility.
 
Others will develop functional complications such as premature wear-and-tear osteoarthritis of their weight-bearing joints, and others the psychological complications of obesity that include depression, anxiety and social exclusion due to years of bullying and discrimination.
 
One thing they all have in common, however, is that even a 5–10% reduction in weight can improve such conditions – with some complications of obesity improving significantly or going into remission with more significant loss of weight.  
 
The roots of obesity run deep, and the societal impacts deeper still. This is the theme for World Obesity Day 2020.
 
People with obesity are constantly shamed and blamed for their chronic health condition. This is because many – including doctors and policymakers – do not understand that obesity represents a disturbance of normal physiology. They see it as a simple lack of willpower, laziness, or a refusal to ‘eat less and move more’.
 
But, like all chronic health conditions, the root causes run much deeper.
 
Obesity is both a cause and consequence of many other chronic conditions and diseases. It is expected to have periods of relapse and remission and, given its progressive nature, lifelong management will be required.
 
The RACGP’s position statement on obesity prevention and management states that these causes can be genetic, psychological, sociocultural, economic and environmental.
 
It is time we break the cycle of shame and blame and revaluate our approach for addressing this complex chronic disease that accounts for 8.4% of the burden of disease in Australia.
 
While the heritability of obesity has been shown in twin studies and clinical practice, only a small percentage of patients have a purely genetic cause (eg leptin deficiency) or a purely medical cause (eg hypothalamic tumour) for their obesity. For the majority of patients at genetic risk of developing obesity, environmental factors (physical, social and economic) facilitate weight gain.
 
Obesity has been a national health priority since 2008, but its prevalence is still increasing. The proportion of adults aged 18 and over who were living with overweight or obesity increased from 63.4% in 2014–15 to 67% in 2017–18.
 
A quarter of children and two-thirds of adults in Australia were living with overweight or obesity in 2017–18. These rates have doubled in the last 10 years and, if that rise continues, three-quarters of the Australian population will have overweight or obesity by 2030.
 
Government leadership, including improved public policy and advocacy, can help reduce health inequities and stigmatisation by promoting the implementation of evidence-based prevention strategies. It can also ensure there is equitable access to effective treatments.
 
Treatments such as anti-obesity medications and bariatric surgery do exist; however, we need greater and more equitable access to both.
 
Recognising GPs’ key role in managing obesity, and providing them with ongoing education and support is also vital to prevention and management.
 
In 2018, the Select Committee into the Obesity Epidemic in Australia made a series of recommendations, including the formation of a National Obesity Taskforce. A series of 2019 consultations were undertaken via community forums that included people with the lived experience of obesity, community groups, researchers and clinicians. The information gathered will help inform the Council of Australian Governments Health Council later this year.
 
Echoing the RACGP’s position statement, we need to change the narrative from one of personal responsibility to one of shared responsibility. This includes individuals, communities, healthcare professionals, public health policymakers, industry, educational institutions, and all levels of government.
 
We need to shift the conversation from loss of weight to gain in health. People don’t choose to develop obesity; therefore the shame and blame needs to stop.
 
Organisations around the world are marking World Obesity Day on 4 March to push for more comprehensive solutions, treatment and collective responsibility for addressing this global epidemic.
 
Together, we can address the far-reaching personal, societal, and economic impacts of obesity and help create a healthier future.
     
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chronic conditions obesity overweight and obesity World Obesity Day