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17 August 2021updated 09 Sep 2021 8:05am

Should the national health conversation really centre on weight?

Diet culture fuels unhealthy habits, argues dietitian Aisling Pigott, and the government would do better to focus on health education rather than fixate on obesity.

By Aisling Pigott

Because I am a registered dietitian, many people assume this means I only eat broccoli and kale, and that I think everybody should be slim. In fact, I enjoy all food and I’m particularly interested in supporting people to have positive relationships with food. 

I’ve worked across a variety of clinical areas, with common themes prevailing. I’m struck by the observation that a societal drive for leanness fuels complex relationships with food and triggers unhelpful eating habits.

We talk about obesity as the biggest health issue in society, yet weight is a very crude measure of health. I often work with people living with obesity who can recognise that the onset of dieting was the trigger for their body dissatisfaction, unhealthy eating habits and subsequent weight gain in later years.

Dietitians hate diets. Admittedly, this is unfortunate given our title. But we absolutely despise the unrealistic expectations that diet culture brings. The promise and allure of a quick fix and magic weight loss sounds too good to be true – and that’s because it is. Many diets focus solely on weight loss, and are founded on the widely accepted perception that weight is inversely related to happiness and health.

For anyone worried about their weight or looking to lose weight, prescriptive diets and plans seem appealing. In my own experience, and for many of my clients, these are often a false economy. Many commercial diets or programmes offer a short-term fix for a lifetime condition.

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Dietitians working on obesity are often well-skilled at supporting their patients holistically to understand and address some of the complex issues they may have underpinning their desires to make changes to their weight. In my own clinical practice, many people I work with have forgotten or slipped away from valuing the importance of nourishing and feeding their bodies, as they are so caught up in the confusing and restrictive messages within diet culture.

The more you know about a condition, the less you understand. For many dietitians working in services supporting people living with obesity, this is entirely true. Weight is so complex, both at an individual and societal level. It is much more complex than a diet plan or exercise regime.

The pandemic has really highlighted the links between diet, body weight and health. We are bombarded with messages in the media about the links between obesity and risk of death and serious illness from very early on in life. The government has stressed this link and has committed to tackling obesity. This includes £100m that will go towards giving 700,000 overweight and obese people access to weight loss services such as apps, coaches and weight management courses, and a new financial rewards scheme for people who maintain healthy lifestyles.

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However – and here is the groundbreaking news – making people feel bad about their weight does not help them lose weight. In fact, it’s very likely to have the opposite effect. Studies show that exposure to weight bias can trigger physiological and behavioural changes linked to increased weight gain.

So, if making people feel guilty about their weight and shape doesn’t work, and diets don’t work, we need to question the wisdom behind national weight loss campaigns. I’m not saying health campaigns are not necessary, but destigmatising obesity and focusing on other health measures are likely to be crucial.

It’s not easy. In fact, it’s a bit of a tightrope between talking about weight and recognising that how we talk about weight is a big part of the problem. As a society, it’s time to consider how we talk about and to people living with obesity. The ‘F’ word (fat) and derogatory comments, self-deprecating or otherwise, are completely normal within many social circles. The medical model sees obesity as a simple ‘eat less, move more’ approach, which to any person living with obesity is patronising and perpetuates self-blame.

The political agenda to treat obesity is hard to understand – for many years, we have seen that access to healthy food, activity and health opportunities are not equal across all socio-economic groups. Obesity is part of that picture. People living with obesity are often looking for help and support, and I completely agree that they should be supported with specialist services. However, I would argue that we shouldn’t just be treating the end result. Much more needs to be done.

Food poverty and food insecurity in the UK is among the worst in Europe. People often view this as a separate issue to obesity, but it is a major contributor to rising obesity rates. Often, those living in food poverty or food insecurity are at greater risk of obesity, as many affordable foods will be high energy and of lower nutritional value.

In an ideal world, ending food poverty, increasing access to affordable nutrient-rich foods (for example, fruit and vegetables) and encouraging health education and cooking within schools and communities could have greater positive health impacts than putting the nation on a diet.

In many ways, I feel removing weight from the conversation – but instead empowering health at every size and focusing on health promotion – is likely to be much more effective than any weight loss campaign.

Aisling Pigott is a registered dietitian with the British Dietetic Association (BDA), specialising in nutrition, sports and exercise nutrition and early years nutrition. She describes her practice as “anti-fads and pro-health”, and aims to promote positive relationships with food.