As I was emptying the dishwasher yesterday morning and preparing my breakfast, I was listening to BBC Radio 4 – the Today programme. Headline news, along with the alarming situation developing at the Syrian-Turkish border, was a call from the outgoing Chief Medical Officer for England, Dame Sally Davies, to ban snacking on public transport. This was just one recommendation in a report she has written as she leaves office. In the interview, which was about the childhood o-word* ‘crisis’, Dame Sally commented: ‘80% of weight is about what we eat and 20% about physical activity’. This statement together with the call to ban snacks on public transport spurred me to write.
Far be it from me to know all the complexities of public health. I’m the first to admit that I’m not a doctor or a scientist. However, I do want to offer something to this conversation given the work I do, which is to help people whose bodies have been policed, many of them since they were children. The result of this policing has been disconnection to the degree that they no longer trust their own bodies to guide their eating and exercise decisions. For some it leads to eating disorders. For most, a lifetime of dysregulated eating and body shame. I’m concerned that this kind of advice, while well-intentioned, will be counter-productive.
Is weight really as simple as 80-20?
I don’t know what Dame Sally was thinking when she said that. I’ll give her the benefit of the doubt. Perhaps she meant that of the small percentage of our weight outcome that IS within our control, 80% comes from what we eat and 20% from exercise? That isn’t what she said though. I copied her words down verbatim.
Weight science is massively complex and I don’t pretend to understand it. I’m not sure anyone does, fully. What I do understand though, is that it cannot be boiled down to a simple ratio of calories in vs calories out. Just take a look at this o-word map. There are so many factors involved. Genetics play a significant role (40-70%). That leaves 30-60% of our weight outcome to all other causes. This will include what and how much we eat and exercise, but also includes a myriad of other factors that affect our metabolism, for example: how much and how well we sleep; viruses; gut bacteria, stress (which elevates cortisol and signals the body to store fat), our history of dieting (newsflash, dieting is a consistent predictor of weight gain), exposure to artificial lighting and heating and so on.
I think it’s both interesting and important to note that it’s not just humans who are getting heavier. Animals are too, even wild animals and those in controlled laboratory environments. If this is the case, it’s not a simple matter of calories in vs calories out. Neither is it simply a matter of advertising or even food quality (though I’m not saying those aren’t issues worth discussing and exploring).
My biggest problem with this?
Framing the issue as a childhood o-word ‘crisis’ is problematic. I think it’s more honest and more helpful to say we have a health and wellbeing crisis. Non-communicable diseases are on the rise. So too are incidences of mental illness and general unhappiness in children in the UK. Our kids are some of the unhappiest amongst wealthy nations (even the kids of some poorer nations are happier than ours).
Reducing this down to a problem with weight with a ‘simple’ solution of weight loss is a bit like thinking we can solve the climate crisis by banning plastic straws.
I say ‘simple’ in quotation marks because even if weight were actually a problem – and there is no evidence that weight causes disease – there is no known, sustainable, safe way to make fat people thin people. There just isn’t (and I’m not even touching here on the social justice issue of wanting to eradicate a group of people). Intentional weight loss methods (any and all of them) result in weight regain for the vast vast vast majority of people who try them. The Australian National Health and Medical Research Council is so certain that any kind of lifestyle intervention in pursuit of weight loss will result in weight regain within 2-5 years, that they call it ‘Level A’ evidence. This is the same level of evidence for the statement that ‘smoking causes lung cancer.’
There is undoubtedly a correlation with being in a higher weight body and certain health conditions. Correlation means there’s a relationship between two or more things. It does not mean that the weight itself is, without doubt, the cause of the health conditions – and this is such an important thing to understand. Linda Bacon goes into this in some detail in her books and Fiona Willer of Health Not Diets and Unpacking Weight Science also does a fabulous job. I have a go at it here too.
Since thin people also get illnesses, focusing on weight means we’re not helping everyone to live healthier, happier lives – which is what I think Dame Sally Davies is deeply committed to. Focusing on health-promoting behaviours rather than weight, reduces stigma and improves health outcomes across the board.
The neoliberal, white supremacist approach is to make people believe that they are entirely responsible for their own outcomes. I don’t think we have grasped just how deeply ingrained this idea is. It absolves those in power of creating the conditions for wellbeing and leaves them free to pursue profit over the health of the planet and its inhabitants.
Yes, we do have control of our motor functions. We do put items in our shopping trolleys. We do choose to drive or cycle or take the bus.
But these choices are not always free.
They are made in a context. That context is often one in which people (or in the case of children, the parents) are juggling jobs to make ends meet; they don’t have time to prepare home cooked food, or even to sit down as a family to eat! Perhaps they don’t live in a place where there are safe, clean spaces to run around, or the roads are too clogged with traffic for it to be safe to walk to school. Perhaps they don’t have access to or can’t afford fresh fruit and vegetables, let alone the time or energy to prepare them.
Or perhaps the context is not one of financial deprivation, but time deprivation. With advances in technology, we’ve become more distracted, less productive, yet more busy and less emotionally available to our children and loved ones.
Instead of policing children’s bodies, which can lead to eating disorders, mental illness and discrimination, we have a much harder, more systemic task at hand. If what we want is for everyone to be healthier and happier we need to make deep changes to the way our society runs.
What sorts of changes? I think that’s material for a whole book (not written by me!).
My vision is of a society that is fair. A society in which everyone can have a decent standard of living without working themselves to the bone. One in which families have the time and resources to cook together and eat together; where children have clean, safe places to run and play outside. A society where there is a greater sense of the collective good. A kind society. A compassionate society. A society in which each person is valued for their unique contribution to the whole – whatever that may be, however they look, whatever their size, colour, gender, age or ability.
Let’s allow children their innocence. Let them have ownership of their bodies. Let’s teach them how to tune in to their bodies rather than follow external rules. Let’s provide them with the environment in which to make that possible.
Ready to get to work?
*I refer to ‘obesity’ as ‘the o-word’ because it is stigmatising and I am making a point about it. The BMI descriptors pathologise larger bodies and I do not want to perpetuate or reinforce those meanings yet still need to be able to refer to the topic particularly when I’m referring to articles that use it.