In Focus
Over a lunchtime in November, 2013, the centre for history in public health at the London School of Hygiene and Tropical Medicine showed three public health films about obesity from the 1960s and 1970s as part of their series History, Health, and Films. In the 1960s, 1% of men and 2% of women in England were classed as obese; today, 62% of adults and 28% of children are overweight or obese. According to the recent Foresight report, if the present trend continues, about 50% of the UK adult population will be obese by 2050. As we experience a global explosion in obesity, how do current educational initiatives compare with those of decades past? The British diet has changed over a generation, and people are eating less now than they did in 1970. The National Food Survey annual report showed that in 1970, the average daily intake was 2560 calories per person, in 2000, it had fallen to 1750 calories. However, thanks to motorised transport, both walking and cycling have decreased in this period. In 1967, 77% of adults walked for at least 30 mins every day compared with only 42% in 2010. So although there has been a reduction in overall intake, there nevertheless exists a caloric imbalance towards excess. In 1976, A Way of Life was designed to motivate young people to adopt healthier eating habits. The film suggests a light-hearted acceptance that some people are just “meant to be fat”. This attitude is falling away to be replaced with an emphasis on individual responsibility over one’s health and weight, something that the UK Government is promoting. In June, 2013, Public Health Minister Anna Soubry launched a consistent front of pack nutritional labelling system (the so-called traffic light system) to make it easier for people to make healthy choices about food products sold in major supermarkets. Individuals can also judge how much physical activity they should be doing with the UK physical activity guidelines, which are available from the Department of Health website. In recent years, this movement to responsibility has been accelerated by the quantified-self trend, in which individuals can monitor their weight and activity levels over time with self-monitoring apps and devices. Modern campaigns have tapped into this changing landscape. A big success was Change4Life’s #LoveNationalParks 2013 campaign in which people tweeted why they loved national parks in return for a pedometer. Change4Life also offers smartphone apps for tracking alcohol consumption and creating healthy family meals for £5. Even during economic downturn, and a decrease in real incomes, this fatalistic idea that people are born fat has been challenged. Rhetoric and attitudes towards obesity and losing weight have changed over the past four decades. In The Causes of Obesity (1977), an educational video www.thelancet.com/diabetes-endocrinology Vol 2 February 2014
for students of nutrition, people are divided into “fatties and thinnies”. Whereas in the past, educational films often relied on stereotyping and derogatory pigeonholing, now, campaigns are by and large positive and encouraging, and have websites and social media platforms allowing people to share stories and tips. In December, 2013, UK Equalities Minister Jo Swinson called for a ban of “fat talk”, arguing that unflattering terms can damage confidence and prospects. Findings of a study showed that stigma can cause anxiety, which triggers overeating and obesity. Investigators warn that modern campaigns should continue to emphasise the positive aspects of losing weight, rather than the negative aspects of being fat. In A Cruel Kindness (1968) a GP warns that “fatness begins at home” and overfeeding children is a “cruel kindness”, a notion that remains today. Initiatives for children do exist—eg, the Let’s Move! campaign launched by Michelle Obama to reduce childhood obesity in the USA by giving parents helpful information about healthy eating and ensuring families have access to healthy, affordable food. In the UK in 2006, ex-Chief Medical Officer Liam Donaldson warned that health authorities would consider removing supersized children from their families. That has now become a reality. In Wales in 2013, a 5-year-old girl who weighed more than 10 stone was taken into care. In a 2011 Lancet Series on obesity, authors argued that the rise in obesity could be attributed to people acting normally in an abnormal environment (a socalled obesogenic environment), and posited “priority should be for policies to reverse the obesogenic nature of these environments”, calling for government leadership and regulation. This idea is at the core of Obesity Action Campaign!, which lobbies parliament together with public and private engagement events to raise awareness of obesity and its adverse health consequences. The charity was launched in November, 2011, at the House of Lords by Dr Jude Oben (Fellow of the Royal College of Physicians Obesity Working Party), and like Let’s Move!, it aims to educate mothers about healthy eating before pregnancy and parents about the healthy feeding of children. The challenge facing health campaigns in the UK and worldwide are huge, and campaigns will need to evolve to address changing social attitudes and lifestyle behaviours to seriously change the trajectory of obesity. The National Obesity Forum has recently warned that the 2007 predictions underestimate the problem, and calls for hardhitting awareness campaigns, similar to those for smoking. A look back at the history of our behaviour provides a useful way of putting today’s challenges into context.
Wellcome Library (London)
Obesity and public health campaigning
The films are stored at the Wellcome Trust library, from the Moving Image and Sound Collection, and can be viewed online For the 2007 Foresight report see http://www.bis.gov.uk/ assets/foresight/docs/obesity/ obesity_review_final_jp_110310. pdf For National Food Survey data see http://webarchive. nationalarchives.gov. uk/20130103014432/http:// www.defra.gov.uk/statistics/ foodfarm/food/familyfood/ nationalfoodsurvey/ To watch A Way of Life see http://www.wellcomecollection. org/explore/sickness--health/ topics/obesity/video. aspx?view=a-way-of-life For Change4Life see http:// www.nhs.uk/Change4Life/ Pages/why-change-for-life.aspx To watch The Causes of Obesity see http://wellcomelibrary.org/ player/b17259204 For the study on obesity and stigma see J Exp Soc Psychol 2014; 51: 71–80 To watch A Cruel Kindness see http://www.wellcomecollection. org/explore/sickness--health/ topics/obesity/video.aspx For the Let’s Move! campaign see http://www.letsmove.gov/ For the Obesity Action Campaign! see http://www. obesityac.org/
Natalie Harrison 109
Over a lunchtime in November, 2013, the centre for history in public health at the London School of Hygiene and Tropical Medicine showed three public health films about obesity from the 1960s and 1970s as part of their series History, Health, and Films. In the 1960s, 1% of men and 2% of women in England were classed as obese; today, 62% of adults and 28% of children are overweight or obese. According to the recent Foresight report, if the present trend continues, about 50% of the UK adult population will be obese by 2050. As we experience a global explosion in obesity, how do current educational initiatives compare with those of decades past? The British diet has changed over a generation, and people are eating less now than they did in 1970. The National Food Survey annual report showed that in 1970, the average daily intake was 2560 calories per person, in 2000, it had fallen to 1750 calories. However, thanks to motorised transport, both walking and cycling have decreased in this period. In 1967, 77% of adults walked for at least 30 mins every day compared with only 42% in 2010. So although there has been a reduction in overall intake, there nevertheless exists a caloric imbalance towards excess. In 1976, A Way of Life was designed to motivate young people to adopt healthier eating habits. The film suggests a light-hearted acceptance that some people are just “meant to be fat”. This attitude is falling away to be replaced with an emphasis on individual responsibility over one’s health and weight, something that the UK Government is promoting. In June, 2013, Public Health Minister Anna Soubry launched a consistent front of pack nutritional labelling system (the so-called traffic light system) to make it easier for people to make healthy choices about food products sold in major supermarkets. Individuals can also judge how much physical activity they should be doing with the UK physical activity guidelines, which are available from the Department of Health website. In recent years, this movement to responsibility has been accelerated by the quantified-self trend, in which individuals can monitor their weight and activity levels over time with self-monitoring apps and devices. Modern campaigns have tapped into this changing landscape. A big success was Change4Life’s #LoveNationalParks 2013 campaign in which people tweeted why they loved national parks in return for a pedometer. Change4Life also offers smartphone apps for tracking alcohol consumption and creating healthy family meals for £5. Even during economic downturn, and a decrease in real incomes, this fatalistic idea that people are born fat has been challenged. Rhetoric and attitudes towards obesity and losing weight have changed over the past four decades. In The Causes of Obesity (1977), an educational video www.thelancet.com/diabetes-endocrinology Vol 2 February 2014
for students of nutrition, people are divided into “fatties and thinnies”. Whereas in the past, educational films often relied on stereotyping and derogatory pigeonholing, now, campaigns are by and large positive and encouraging, and have websites and social media platforms allowing people to share stories and tips. In December, 2013, UK Equalities Minister Jo Swinson called for a ban of “fat talk”, arguing that unflattering terms can damage confidence and prospects. Findings of a study showed that stigma can cause anxiety, which triggers overeating and obesity. Investigators warn that modern campaigns should continue to emphasise the positive aspects of losing weight, rather than the negative aspects of being fat. In A Cruel Kindness (1968) a GP warns that “fatness begins at home” and overfeeding children is a “cruel kindness”, a notion that remains today. Initiatives for children do exist—eg, the Let’s Move! campaign launched by Michelle Obama to reduce childhood obesity in the USA by giving parents helpful information about healthy eating and ensuring families have access to healthy, affordable food. In the UK in 2006, ex-Chief Medical Officer Liam Donaldson warned that health authorities would consider removing supersized children from their families. That has now become a reality. In Wales in 2013, a 5-year-old girl who weighed more than 10 stone was taken into care. In a 2011 Lancet Series on obesity, authors argued that the rise in obesity could be attributed to people acting normally in an abnormal environment (a socalled obesogenic environment), and posited “priority should be for policies to reverse the obesogenic nature of these environments”, calling for government leadership and regulation. This idea is at the core of Obesity Action Campaign!, which lobbies parliament together with public and private engagement events to raise awareness of obesity and its adverse health consequences. The charity was launched in November, 2011, at the House of Lords by Dr Jude Oben (Fellow of the Royal College of Physicians Obesity Working Party), and like Let’s Move!, it aims to educate mothers about healthy eating before pregnancy and parents about the healthy feeding of children. The challenge facing health campaigns in the UK and worldwide are huge, and campaigns will need to evolve to address changing social attitudes and lifestyle behaviours to seriously change the trajectory of obesity. The National Obesity Forum has recently warned that the 2007 predictions underestimate the problem, and calls for hardhitting awareness campaigns, similar to those for smoking. A look back at the history of our behaviour provides a useful way of putting today’s challenges into context.
Wellcome Library (London)
Obesity and public health campaigning
The films are stored at the Wellcome Trust library, from the Moving Image and Sound Collection, and can be viewed online For the 2007 Foresight report see http://www.bis.gov.uk/ assets/foresight/docs/obesity/ obesity_review_final_jp_110310. pdf For National Food Survey data see http://webarchive. nationalarchives.gov. uk/20130103014432/http:// www.defra.gov.uk/statistics/ foodfarm/food/familyfood/ nationalfoodsurvey/ To watch A Way of Life see http://www.wellcomecollection. org/explore/sickness--health/ topics/obesity/video. aspx?view=a-way-of-life For Change4Life see http:// www.nhs.uk/Change4Life/ Pages/why-change-for-life.aspx To watch The Causes of Obesity see http://wellcomelibrary.org/ player/b17259204 For the study on obesity and stigma see J Exp Soc Psychol 2014; 51: 71–80 To watch A Cruel Kindness see http://www.wellcomecollection. org/explore/sickness--health/ topics/obesity/video.aspx For the Let’s Move! campaign see http://www.letsmove.gov/ For the Obesity Action Campaign! see http://www. obesityac.org/
Natalie Harrison 109
