Obesity has long been a concern for health professionals. According to NHS Digital's Statistics on Obesity, Physical Activity and Diet, in 2016-2017 there were around 617,000 obesity-related NHS hospital admissions in the UK.
This was an 18% rise on the previous year, and over 130,000 more admissions than those due to smoking (484,700) [NHS Digital Statistics on Smoking] and drinking (337,000) [NHS Digital Statistics on Alcohol]. Individuals’ health issues are just part of the problem. In 2017 Public Health England estimated that the overall cost of obesity to society will reach £9.7 billion by 2050.
This is a troubling trend for our healthcare system and society as a whole, and one that is contributing to the mental health crisis, as issues such as poor body image and self-esteem are known to negatively impact mental health. This situation isn’t helped by the bombardment of images featuring unrealistic bodies through films, TV and social media, fuelling our quest for perfection. A recent BBC 5 Live body image survey of 2,000 adults showed more than half of 18-34-year-olds feel that social media and reality TV negatively impacted how they viewed their bodies.
So, what impact are these messages, statistics and trends having on our minds, and consequently our bodies?
“Obesity can occur due to a poor nutritional diet, a lack of physical activity, or more likely, a combination of the two,” says Dr Clare Roscoe, Lecturer in Physical Activity and Health at the University of Derby.
“Not exercising regularly has been reported to increase the risk of types of cancer, cardiovascular disease, coronary heart disease and type 2 diabetes, which are now occurring at much younger ages. Obesity from preschool age to adulthood is an increasing problem, and research [from the National Institute for Health and Care Excellence (NICE)] shows that those who are inactive as children generally follow this trend into adulthood.”
Dr Jacquie Lavin, Slimming World’s Head of Nutrition and Research, recognises the link between excess weight, diet and activity in her work. She says: “The members that come to us often suffer from a range of physical health conditions because of their excess weight. They also struggle with day-to-day activities, like playing with their children or walking upstairs, due to feeling out of breath or having difficulties with their mobility.”
The majority of patients admitted to hospital with obesity-related problems in 2016-17 were between the ages of 35 and 64, but Jacquie has seen an increase in younger people joining Slimming World.
“Eleven to 15-year-olds can come to a group free of charge with the support of a parent or guardian, and follow a tailored programme which was developed due to high customer demand.”
Mental health matters
For Jacquie, it’s important that mental health is prioritised alongside physical health. “So many emotions are wrapped up in food, and it’s sad to know some people feel so ashamed about their size due to the social stigma of being overweight. We really focus on improving self-esteem and confidence, because you can’t lose weight successfully if you are constantly telling yourself you are going to fail. Our first step is to help members believe that their worth is not their weight.”
Fiona Holland, Lecturer in Psychology at the University of Derby, recognises the danger of this societal stigma: “In parallel to the well-reported increase in the number of people being classified as overweight and obese in the past 20 years, there has also been an increase in the stigma and discrimination of people who are labelled in these ways (1). This labelling and associated stigma does not help and can lead to increased levels of depression, body image disturbance and lower self-esteem.”
As an Associate Academic in the Department of Psychology at the University, Dr Matthew Hall specialises in body image and how this can affect an individual’s self-esteem.
He says: “Body image can be central to identity. The desire to obtain the ‘ideal’ body means some people resort to, or develop, unhealthy behaviours such as anorexia and bulimia, taking performance-enhancing substances, consuming slimming aids or having cosmetic surgery.”
Anti-fat messages are common in the UK and can be perpetuated by the media, promoting stigma and discrimination, explains Fiona.
“In the UK, we live in a world where we approach fat people as though they have somehow failed. Blame is often cast upon individuals to change their shape and size. However, studies clearly show that there are so many non-controllable aspects to obesity. It’s simplistic to assume that ‘eating less and moving more’ will change everything.”
A survey of more than 2,500 members of Slimming World showed that over 40% had previously experienced some form of humiliation, judgement or criticism at least once a week due to their size.
People had been ignored by retail staff, mocked by passers-by, filmed or photographed by strangers and experienced verbal abuse.
So, what can be done to combat this widespread hostility towards people whose bodies appear to be outside of the ‘ideal’ aesthetic?
“The ‘body positivity movement’ confronts narrow Western beauty ideals that idolise muscular lean bodies for men and lean slender bodies for women (often white, young, cis-gendered and able too),” says Matthew. “It challenges this exclusionary culture by advocating for the visibility of bodies that do not fit mainstream beauty norms.”
“On an individual level, the body positivity movement aims to help people have self-compassion rather than focusing on self-criticism,”
Fiona adds: “Feeling compassionate towards ourselves and others is a key ingredient in a culture that fosters wellbeing for all. Research we conducted with women who experience life in fat bodies clearly showed that they had consistently dealt with a lack of compassion from others, including healthcare professionals (2).
“There should be less body shaming and less body focus (including positive comments and celebrations of thinness and the current standard of beauty), and more focus on our talents and strengths.”
Encouraging men to engage
Fiona acknowledges that the majority of body image research to date has focused on women. Traditionally, women’s main value was based around their aesthetic, leading to increased external scrutiny and self-criticism if their bodies were deemed ‘undesirable’.
Matthew’s research, however, points out that: “Body image and related behaviour, such as dieting, is conventionally associated with femininity but, given the health warnings of being overweight, many men do try and manage their weight. However, it is often framed in traditional masculine markets such as doing it to build muscle, aid sporting success or sexual prowess.”
Jacquie also sees this reflected in the Slimming World membership.
She says: “The majority of our members are women, but year on year we are seeing more men joining groups. We are seeing far younger men join, with reasons including the desire to get a partner, feel confident on holidays with their friend, buy off-the-peg clothes or for health concerns.”
“Once, a man’s identity was largely drawn from work, sports and family, but now men have the opportunity to choose from a variety of different identity discourses which can often be related to health and body image,” adds Matthew.
“Men’s increased concern with body image has also been fuelled by manufacturers searching for new markets in late capitalist consumer societies. Men, like women, are now encouraged to engage with their body as a project to develop the ideal ‘look’.”
Fiona agrees that the body positivity movement is relevant for all: “Body positivity seeks to move beyond defining people by their body and helps to support a platform for social justice that doesn’t marginalise anyone. It promotes a culture where everyone feels empowered to be an agent for themselves.
“Our world view is challenged by the body positivity movement, and we are asked to consider what we would lose and gain by taking a more inclusive approach; perhaps it might make us more human.”
- Latner JD, Stunkard AJ. Getting worse: The stigmatization of obese children. Obes Res. 2003;11:452–6.
- Holland, F, Peterson, K & Archer, S. (2018) Thresholds of size: An interpretative phenomenological analysis of childhood messages around food, body, health and weight. Journal of Critical Dietetics. February, 4 (1), 25-36