Weighting for change

Issue 20 | Spring/Summer 2007

Photography: Greg Ford

Like a square peg in a round hole, overweight people feel they often just don't fit in our modern society.

Monash health experts Dr Samantha Thomas and Professor Paul Komesaroff say current attempts to fix the problem are not working, and argue the medical profession and the community must fundamentally re-think their approach.

As a recent Monash survey has shown, the real life experiences of people with a weight problem are often confronting. They purchase a loaf of bread only to be questioned if they should be buying it at all, a trip on public transport is uncomfortable on seats that are too small and a first crush at school prompts bullying and name calling because “fat girls don't get boyfriends”.

The Australian Social Trends 2007 report, released by the Australian Bureau of Statistics, estimated 54 per cent of Australian adults were either overweight or obese, with rates increasing for men and women across all age groups over the last 10 years.

The report also indicated those with lower incomes, poorer education levels and higher relative disadvantage were more likely to be obese.

The situation in Australia is not unique. The scope of health and social problems related to obesity is widely recognised in most modern Western societies.

The main explanations for obesity – lack of physical activity and excessive food intake - are well documented and dominate public health approaches. People with obesity are told by policy makers, the media and society they are the architects of their own health problems, their condition is socially contagious, they are a burden on society and only they can bring about significant change.

Individual responsibility is, of course, appropriate, but it must be recognised that there are social and cultural components underlying the obesity epidemic. Despite the messages often promoted in the media and public health campaigns, voluntary lifestyle choices account for only a small part of the obesity problem.

Dr Samantha Thomas and Professor Paul Komesaroff.

Individuals have relatively little control over large scale social and cultural factors such as the physical environment and urban planning, financial pressures on families associated with increasing costs of housing and social services, ethnic and socio-economic disparities, the persuasive marketing of commercial diets and weight loss remedies, targeting of food advertising to children, a child's ability to influence parental food purchases, and the psychological impact of stigma and discrimination.

Only now are public health researchers starting to realise the message to “eat less and exercise more” may be deeply flawed and does more harm than good. Furthermore, there is now a substantial body of research, including our own, which suggests the stigma surrounding obesity may mean that people may be less likely to engage in healthy behaviours such as physical activity.

The social pressure to lose weight, coupled with a lack of structural support and engagement to do exactly that - for example targeted education programs, and a trained workforce of community health professionals - means many people living with obesity spiral into a reliance on expensive or extreme fad diets, invasive surgery and pharmaceutical drugs.

So what is the way forward? First, we need a better knowledge and awareness of the experiences of people living with obesity. This will help pave the way for discussions about more appropriate and effective public health campaigns, and may significantly enrich the resources available to professionals in public health, health promotion and clinical practice.

These messages must also be reinforced by a workforce of skilled, accessible and affordable health professionals able to provide long-term support for those seeking to change.

Obesity is a condition of individuals, families and communities. In order to make a difference we need to engage communities, encourage participation, give positive messages, listen to the experiences of individuals and communities and, above all, make these experiences part of the solution.

Dr Samantha Thomas and Professor Paul Komesaroff are based at the Centre for Ethics in Medicine and Society, Faculty of Medicine, Nursing and Health Sciences.