The UK government urges us to ‘lose weight’. We urge them to drop the stick.

The UK government recently published its new policy paper, Tackling obesity: empowering adults and children to live healthier lives.

The story hit the headlines, in the wake of Covid-19, admonishing us to ‘lose weight’ in order to protect the NHS and save lives. And indeed this is a core message of the policy. It declares that Covid-19 is a “wake-up call” to the nation and we should, “use this moment to kick start our health, get active and eat better” – not only for our own wellbeing but for the good of the country.

Scrutiny from some wellbeing and healthcare practitioners has already pointed out the potential dangers the policy and its campaign pose for those of us with eating disorders – including anorexia, bulimia or binge-eating – as well as the glaring omission of psychological support in the proposed support measures.

But let’s not throw the baby out with the bathwater. The policy is well-intentioned and attempts to address some of the challenges we face when trying to reduce – or not increase – body-fat.

The pause in the carousel of life induced by Covid-19 has presented an opportunity for us to rethink many things, and the government’s review of their policy is ongoing. So, as the UK government urges us to ‘lose weight’, I’m picturing those horses on a carousel and imagining what a difference it could make by dropping the proverbial stick and proffering us a carrot instead.

Let’s take a closer look at the policy and how we think their Better Health campaign could be…well… better.

How is the UK government planning to tackle obesity?

The UK government has an initial strategy for helping us to ‘lose weight’ with seven key steps:

• A Better Health campaign – calling on us to take action and providing us with tools such
  as the NHS’s 12-week weight-loss plan;
• Expansion of the existing NHS weight management services;
• A public consultation on the current ‘traffic light’ symbols used on food packaging to
  show how ‘healthy’ the product is;
• Legislation for large businesses (and, initially, encouragement for small businesses) to put calorie content labelling on their food offerings;
• A consultation on calorie content labelling for alcoholic drinks;
• Legislation to end promotions of foods high in fat, sugar or salt. This would include promotions such as ‘Buy One Get One Free’ and product placement in-store and online;
• Also for such foods: a ban on TV advertisements before 9pm, and a consultation on introducing a total restriction on online advertising.

The policy paper sets out its reasons for these measures, which include the prevalence of overweight and obesity in the UK, the related risk factor for developing chronic health conditions, resulting pressure on the NHS, the effect of overweight on mental health, and,
instrumental to the making of this policy, the risk of complications if infected with Covid-19.

In looking after the nation’s wellbeing, the policy highlights the need to give more attention to preventative health measures. It indicates that it seeks to educate and empower so that we can take responsibility for our own wellbeing, the health of the NHS, and the lives of others.

How could the Better Health campaign be better?

Firstly, let’s start by saying: we welcome the intentions of the policy in supporting us all to make healthful changes, and that it recognises some of the difficulties we face. That said, to effectively support us, there are several elements of the policy that we think need a rethink.

Here are our thoughts:

Lose ‘weight’ to get healthier

But we’re talking about losing the measurement. It’s long been established (though unfortunately not yet taken up by the UK healthcare industry) that body-weight is not a good measurement of healthiness. Neither is BMI (Body Mass Index), particularly as our genetic make-up is different depending on ethnicity and gender. Yet, mystifyingly, the NHS weight-loss plan relies on the use of weight and BMI as measurements.

There simply isn’t a ‘one size fits all’ tool for measuring health, although body-fat is by far a more meaningful indicator. Encouragingly, Canada’s new clinical guidelines on obesity management (published this month) acknowledge the limitations of BMI and advocate a more holistic assessment of health rather than focussing on weight. This could be a positive influence.

There are other notable differences between the UK policy and Canadian guidelines, where we feel we Brits could follow the lead of our Canadian cousins.

Compassion over criticism

Although perhaps intended to inspire motivation, the message of the UK policy is more likely to produce feelings of guilt, shame or fear. By contrast, the Canadian guideline aims to do away with ‘blame and shame’, to really get to understand each patient, and to provide compassionate support. Canadian healthcare providers are advised to ask their patient’s permission to discuss obesity.

Compare this with the UK approach to proffer incentives to doctors for offering ‘weight-loss’ support and we can imagine the difference in how patients will feel themselves treated.

Human psychology tells us that feeling respected and in control of our choices is more engaging and empowering than having advice or instructions thrust upon us.

Take care of the roots

If one word sums up the approach of the UK policy, its: practical. However, many of these practical measures tinker away at the surface of the problem without taking into account what’s happening underneath.

In scouring the policy and the NHS weight-loss plan, I can see very little mention of psychological support – again something quite contrary to the Canadian guidelines. It’s well- known that obesity is a psychological as well as physical problem and those of us wanting to reduce body-fat would benefit, to varying degrees, from some kind of therapeutic support.

Part of our mind may well want to ‘stick to the plan’, but what do we do about the other part of our mind that really doesn’t fancy it? Shame, guilt and fear just make this internal dichotomy stronger; whereas therapeutic support can help to resolve it. Psychological support should be paramount.

Yet a significant part of the policy’s practical measures surround food-labelling. A consultation on the current traffic light system is welcome; seven years after its launch, obesity is still rising.

How can a food-labelling system adequately work if, when choosing our food, there are few ‘healthy’, palatable and satisfying alternatives on offer? It just means most of the prepared foods in our shops come with a free portion of guilt.

With extended calorie-labelling, are we now to go to a restaurant (Eat out, to help out), and see a tempting list of all the things we ‘shouldn’t’ be eating?

Food will always be something we want to take pleasure in. And that’s OK. Feeling guilty about it isn’t.

Rather than legislating on calorie content labelling, can’t we get to a root of the problem and enhance the quality of the food being offered in the first place? If we have more foods readily available that contain good quality protein, fibre and nutritious ingredients and omit the additives present in ultra-processed foods (that have a harmful effect on appetite and body-fat composition), we can then more easily find foods that make us naturally feel more replete, as well as emotionally satisfied.

Consequentially, smaller portions may then feel more satiating. I wonder: as appetites adjust – and to counter for all our different and varying calorie-intake requirements – perhaps restaurants could offer their dishes in two (or more) portion sizes.

Taking this further, is it time to move away from the idea of ‘starter, main and dessert’? If a restaurant menu simply had a variety of dishes (with different portion sizes), could we establish a new normal of simply choosing a dish and, if 20 minutes after eating it, we’re still hungry, we can order another? In this way, we could choose our food mindful of our hunger rather than out of habit.

But I digress; back to the policy: many of its surface measures rely on fear, shame and guilt and create a sense of being deprived.

Getting to the root – both in terms of what drives us to overeat and the food offerings widely available to us – will be a surer away to empower and enable change, and this will inform the surface measures that will make a difference in helping
us to reduce body-fat.

This is not to decry all the government’s surface measures. Adapting our environment to support our choices is an effective strategy, so thoughtful product placement can be really useful in nudging us towards healthful choices.

Overall, a move from restrictions to encouragement is likely to be more effective in assisting us to reduce body-fat, particularly when underpinned by a range of therapeutic support.

Where do we go from here?

It’s likely the UK government’s plea for us to ‘lose weight’ has brought up a mixture of emotions around the country – from guilt, shame or fear to scorn or rebellion. Emotions that are more likely to add to our collective body-fat than reduce it.

So let’s take this moment, brought about by Covid-19, to be kinder to ourselves – and others – and explore ways we can truly and compassionately support each other in changing our body-fat composition, and our health, for the better.

We’re all in this together and can find solutions together.

If you would like to reduce body-fat and have ideas about what would support you, do send us an email with your thoughts.

Sources

1) “Policy paper: Tackling obesity: empowering adults and children to live healthier lives.”
Department of Health and Social Care, UK Government, 27 July 2020. Retrieved 5 August 2020. https://www.gov.uk/government/publications/tackling-obesity-government-
strategy/tackling-obesity-empowering-adults-and-children-to-live-healthier-lives

2) “Start the NHS weight loss plan.” NHS. Retrieved 5 August 2020.
https://www.nhs.uk/live-well/healthy-weight/start-the-nhs-weight-loss-plan/?tabname=safe-weight-gain
3) “Obesity not defined by weight, says new Canada guideline.” BBC, 4 August 2020.
Retrieved 5 August 2020. https://www.bbc.co.uk/news/world-us-canada-53656651
4) “Canadian Adult Obesity Clinical Practice Guidelines.” Obesity Canada. Retrieved 6 August 2020. https://obesitycanada.ca/guidelines/