Nudge is not enough
How can we stop Britain becoming an obese nation?
According to Dr James Stubbs, obesity research expert who works with Slimming World, the current trend of relying on “nudging” people’s behaviour won’t be enough.
If humans were all as logical as Star Trek’s Dr Spock, it would be easy to stop people becoming overweight or obese.
“It is a little bit more complicated than that. We are a mixture of logic and emotion, and we also live in a complex environment which puts an awful lot of pressure on us,” Dr Stubbs explains.
“We are designed, in evolutionary terms, to protect ourselves from famine or environmental uncertainty.
“We have constructed an environment full of tasty, palatable, energy dense foods, yet we don’t have to expend that much energy anymore in order to obtain those foods.
“There is also quite a big push from a variety of agencies trying to sell us those products and affect our behaviour, which creates an ‘obeseogenic’ environment.
“We are trapped in a matrix where choice becomes really hard work. Losing weight is not easy, it is actually quite difficult, and managing your health is not easy. “
The challenge for public health cannot be overstated. Around 30 million adults are overweight or obese in the UK.
“We should take a shared responsibility for obesity,” says Dr Stubbs.
“That does not mean there is no personal responsibility, it means we should not be judgemental but be inclusive and realise we can deal with this problem.”
For more than 20 years Dr Stubbs has been studying the physiological and psychological responses people have to diet and exercise, identifying the key factors that make people susceptible or resistant to diet induced obesity.
He joined Slimming World after 13 years at the Rowett Research Institute where he conducted large-scale human trials into weight control and obesity.
“Behaviour change is tricky, and in the case of obesity you can see it as a relapsing condition,” he explains.
“How do you manage that journey and what do you do when you hit the hurdles? That is where community support and group support becomes critically important.
“Support groups create a safe environment where people can talk about their issues.
“Obesity is a highly stigmatised condition and if you look at the intensity of media messages and how confusing they are, it leaves people feeling bad about themselves.
“We also live in a very success-based society, one that is competitive and individualised. That is a bad recipe for behaviour change.
“We cannot treat obesity in the same way as smoking.
“In reality people feel threatened and they seek comfort. For someone trying to lose weight, where do you think they find comfort? It would be in food or your favourite leisure pastimes which are probably not very active. You get these little chaotic cycles, a vicious circle where stigma makes people self-critical, which undermines their pathways of attempted behaviour change.”
Dr Stubbs says Slimming World’s national network of community support groups means they are “ideally positioned to help people to engage in their own health not just making healthy choices, but to enact those choices”.
“Because there are so many pressures and forces pulling us in one direction, we have to understand how people work and what makes us tick.
“This is where compassion comes in, if you look at most people trying to give up smoking or reduce the fat content of their diet or lose weight, it is usually quite a long and faltering journey.
“In terms of Slimming World we provide a community infrastructure and the biggest network of support groups around the country where people can attend groups and share problems. It is supportive and non-judgemental.
“We have experts who can help people, but there is also that shared support, which creates an emotional safety net that people really need. When you are at that point of difficulty you need emotional support and have to learn to be kinder to yourself and recognise this is part of our common humanity.”
Another cause of obesity comes under the broad heading of psycho-social stress.
The triggers vary considerably from person to person, but there are stresses such as time pressure and conforming to social ideas which are unobtainable.
“We live in a society where we are much busier but less physically active than we have ever been,” says Dr Stubbs.
“We could construct a portfolio of stresses and people will respond to different ones.
“Sometimes people will have an argument or problems at work, or financial problems.
“We do know that the density and intensity of psycho-social stress has increased dramatically in recent years.
“Life is a lot less predictable these days; the unpredictability of life is much higher.
Dr Stubbs says organisations such as Slimming World can help the NHS deal with the obesity crisis.
A recent trial in Birmingham, called Lighten Up, compared a range of providers with existing NHS provision.
“Organisations such as Slimming World clearly came out as providing a much more comprehensive and effective approach,” says Dr Stubbs.
“We have the expertise, we have been in the business for 44 years, so we have honed and developed those capabilities, and we have built up a national network of support.
“This provides a more comprehensive approach to fundamental and sustainable behaviour change in the community"
“That does not mean we are better than the NHS, but that we should work with them.
“The government wants people to become much more engaged in their own health so that we can proactively address preventable illness rather than react to illness that is already established.”
There is controversy over how to define obesity. The American Medical Association was recently criticised for deciding to classify it as an illness.
“It should be looked at as a serious condition which in many cases has disease consequences. By targeting lifestyle and behaviour, you manage to prevent all those downstream consequences.”
Dr Stubbs says he chose to dedicate his professional life to tackling obesity because “it is one of the biggest health problems in the world and we had to make this relevant to people in the street”.
“This is too big a problem to leave alone.”