The Government must review their anti-obesity strategy to avoid collateral damage to those living with eating disorders
Managing weight is not always as simple as ‘calories in, calories out’, writes Baroness Bull. | PA Images
The Government has reiterated its intention to label foods with the number of calories they contain, despite a lack of strong evidence linking this to long-term weight loss.
The facts are clear: 67% of men and 60% of women in the UK are overweight or obese. Addressing the challenges this presents, to individuals and to health care services, is the right thing to do. But if strategies and campaigns are to be effective and to avoid unintended harms, they need to take into account the complex relationship between obesity and eating disorders and to recognise that managing weight is not always as simple as ‘calories in, calories out’.
Eating disorders are serious mental illnesses. With an estimated 1.25 million sufferers in the UK, eating disorders have significant impacts on individuals, families, health systems and wider society.
Anorexia – the eating disorder familiar to most – has the highest mortality rate of any mental illness. Obesity is not, in itself, a mental health disorder, but many people with eating disorders (especially binge eating disorders) are also living with obesity. Treatment is therefore not as straightforward as eating less and exercising more.
For some people, over-eating is undoubtedly the major contributor to excess body weight. But for others, the causes of obesity are far more complex: genetics, hormonal changes, psychological, environmental or social factors.
In certain circumstances, restricting what you eat will be the answer, but research shows that outside of holistic weight management programmes, dieting actually results in weight gain over time and can also lead to binge eating.
Recurrent dieting increases 18-fold the risk of developing an eating disorder. On the face of it, ‘eat less’ might seem like a logical message, but it may not be effective in the long term for those need to hear it and, at the same time, it can be dangerous for those who don’t.
The eating disorder charity, Beat, is among voices expressing concerns about the recently launched anti-obesity strategy and, in particular, about proposed legislation to require larger restaurants, cafés and takeaway chains to label foods with the number of calories they contain.
The key campaign message – ‘let’s do this’ – emphasises personal responsibility in a way that stigmatizes those for whom the root causes of obesity are more complex
Government has reiterated its intention to proceed on this without consultation, despite a lack of strong evidence linking labelling to long-term weight loss and lived experience clearly demonstrating that for sufferers of eating disorders, labelling triggers excessive exercise and unhealthy behaviours. Calorie counting is well recognised as one such behaviour, described by one sufferer as ‘an all-consuming obsession’ that began aged 12 and ‘took over my life for 20 years’.
The charity is also asking government to review the NHS Weight Loss Plan App, which does not restrict access to those under 18 or with an already low Body Mass Index, which promotes calorie counting and which assumes that weight loss is appropriate for everyone, despite the complex connections between obesity and eating disorders.
At the heart of government’s anti-obesity strategy is a flawed premise, that body weight is always entirely under volitional control.
The key campaign message – ‘let’s do this’ – emphasises personal responsibility in a way that stigmatizes those for whom the root causes of obesity are more complex. Implying that weight reduction is just about ‘getting a grip’ also implies that people who can’t lose weight cannot get a grip. This not only allows important contributory issues, like health and social inequalities, to be ignored; it also perpetuates discriminatory stereotyping and encourages weight-shaming, which is shown to increase the likelihood of weight gain.
The first principle of any public health campaign must be primum non nocere: first, do no harm.
Yes, we need an anti-obesity strategy, but it must be sufficiently nuanced and appropriately targeted to avoid collateral damage to those people at risk of, living with, or recovering from eating disorders.
In obesity, as in life, one size does not fit all.
Baroness Bull is a crossbench member of the House of Lords.