Public Health Not Public Shaming – Key Policy Asks

We are concerned by the Government’s policy paper “Tackling obesity: empowering adults and children to live healthier lives.” We are also disappointed that the Government have not yet responded to our concerns, despite the distress this policy is already causing those affected by eating disorders and the warnings we have previously provided about this approach to anti-obesity campaigns.

During the week that the Government announced their plans, mentions of obesity on the Beat Helpline increased by 165%. We have also had hundreds of people contacting us to tell us that they are concerned about the obesity strategy. One supporter wrote to us saying:

“I came to your website feeling distressed. I've been struggling with emotional eating all through lockdown. Then I hear on the radio news about the government campaign 'tackling obesity'. It made me feel a criminal for being overweight and I sat in tears.”

We understand the importance of addressing obesity, but it is vital that the public are not shamed into losing weight and that people living with eating disorders are not put at risk.

Beat is calling for:

  • An immediate review of the proposed obesity strategy to ensure that people with experience of eating disorders are not put further at risk.
  • People with lived experience of eating disorders and professionals from the eating disorder and weight management fields to be consulted with in the design of these evidence-based campaigns. 
  • The use of evidence-based campaigns that view obesity as a complex interaction between multiple factors, rather than an individual’s choice or something to be ashamed of.
  • Campaigns which avoid the promotion of crash dieting.

Policy Analysis 

“NHS weight loss plan” app

The free NHS 12-week weight loss plan is available for anyone to use, regardless of age, BMI, medical diagnoses, and mental wellbeing. Although the terms and conditions state that the app is designed for individuals over 18 years, if an individual inputs an age lower than this, they are simply notified that their age should be 18 or over, and allowed to change this and progress with the programme. Similarly if an individual puts a low BMI into the app, although the app states “this weight loss tool is not for you”, the button below says “Get started” and again the individual is able to continue with the programme. We are extremely concerned that this allows individuals for whom the app is not appropriate for and could be dangerous for, to engage with the programme. There is no element of safeguarding and this could be devasting.

Similarly, the app assumes that weight loss is appropriate for everyone, despite a more nuanced approach being needed. For example, many individuals with a diagnosis of an eating disorder may also be living with obesity, therefore specialist eating disorder treatment is necessary to help support people in this position with their eating difficulties rather than a weight loss app. The app promotes calorie counting, a significant reduction in the person’s calorie intake, and other behaviours common to those affected by eating disorders; it is concerning that these are being promoted on an NHS app, particularly considering the complexities around obesity and sustained weight-loss at a population level. We also know that one risk factor to developing an eating disorder is dieting or reduction in dietary intake, therefore promoting individuals to significantly reduce the number of calories they are eating without consultation and support from a medical professional is irresponsible.

Beat asks that: The UK Government and Public Health England immediately introduce safeguarding measures to ensure that the NHS App is not accessible to those who it is not suitable for.

The NHS App is reviewed as part of a wider review of the obesity strategy to ensure that people with experience of eating disorders are not put further at risk.

Calorie labelling

We are also concerned about the idea of including calorie labels in restaurants, cafes and takeaways with more than 250 employees. In 2018, we responded to a Government consultation regarding this topic urging the Government to reconsider this proposal and to listen to those with lived experience of eating disorders, many of whom shared their distress around this. It seems these voices were not heard.

Additionally, as described in our report on anti-obesity strategies, research has found that when making hypothetical food choices, individuals with anorexia nervosa and bulimia nervosa are more likely to order significantly fewer calories when the menu included a calorie count compared to when there was no calorie count stated, whereas people with binge eating disorder ordered food with significantly more calories when the information was provided. This suggests the policy will exacerbate eating disorder thoughts and behaviours, and increase distress for those affected by eating disorders. This is despite evidence suggesting that there is only a small body of low-quality evidence supporting the idea that calorie counts on menus leads to a reduction in calories purchased by the general population, and any effects that it may have on weight are unsustainable.

Beat asks that: People with lived experience of eating disorders and professionals from the eating disorder and weight management fields are consulted about calories on menus before any further steps are taken.

Reductionist and stigmatising language

Finally, we are disappointed about the use of reductionist and stigmatising language, particularly in the press release. Statements such as “The urgency of tackling the obesity time bomb” and “If we all do our bit, we can reduce our health risks and protect ourselves against coronavirus – as well as taking pressure off the NHS” imply obesity to be a “choice” and fail to recognise the complexities around living with obesity. They also lack nuance and fail to recognise that for many, weight loss is dangerous and potentially deadly. Messages like this may be heard by those affected by an eating disorder as something they need to engage with and of encouragement of eating disorder behaviours, despite the risks and distress around this.

This language also fails to consider the interaction between mental health difficulties and living with obesity, an omission that is also reflected by the scarcity of recognition around the importance of mental health.

Beat asks that: The Government takes steps to ensure that the language used in the obesity strategy and public health campaigns view obesity as a complex interaction between multiple factors, rather than an individual’s choice or something to be ashamed of.

Weight management services

We are pleased to see that the obesity strategy includes the proposed expansion of weight management services. We hope that these services include the appropriate psychological support for those living with obesity, and that assessment measures are in place to identify those with a diagnosis of an eating disorder such as binge eating disorder, in order to ensure that people receive the most appropriate evidence-based support.

Beat asks that: The importance of psychological support for those living with obesity and of identify those with a diagnosis of an eating disorder and offering them evidence-based support is taken into consideration with the expansion of weight management services

Summary

Based on these concerns, we urge the Government to reconsider its view not to engage further on this issue, and to carry out an immediate review of these dangerous proposals to ensure that people with experience of eating disorders are not put further at risk.