As the government clamps down on childhood obesity, scholars say feelings on fat are more important. Sally Webster asks which should come first.

The New Zealand government has just launched a campaign to tackle what is now a childhood obesity epidemic. The Before School Check (B4SC) programme will, by December 2017, refer on 95% of children classed as obese to health professionals in order to bring their weight down and exercise levels up. B4SC kicks off in July 2016.

Running alongside this move, however, is a just published Otago University study that focuses not on reducing fat, but on reducing new highs in anti-fat prejudice that its authors claim starts as young as 2 years old these days.

Balancing feelings about being obese with a clinical need to lose weight is a valid topic but not one usually documented as a global obesity mandate. The cutting Interim Report published and opened for consultation early this year by the World Health Organisation (WHO) Commission on Ending Obesity explains that the global primary focus is saving lives and money: ‘Childhood and adolescent obesity are [among] the leading causes of death worldwide and are estimated to cause cumulative economic losses of US$7 trillion during the next 15 years.’

Yet in the Journal of Experimental Child Psychology study, ‘Toddlers’ bias to look at average versus obese figures relates to maternal anti-fat prejudice’, Otago University’s Department of Psychology Professor Ted Ruffman and Associate Professor Kerry O’Brien from Monash University in Melbourne are more concerned about the rise of obesity prejudice and discrimination.

O’Brien even went as far as stating the prejudice, not the fat, is responsible for expensive social ills.

“Weight-based prejudice is causing significant social, psychological, and physical harms to those stigmatised. It’s driving body dissatisfaction and eating disorders in underweight populations; and social isolation, avoidance of exercise settings, and depression in very overweight populations. We need to find ways to address this prejudice.”

The work homed in on children between 2 and 3 years old picking up on their mother’s anti-fat attitudes. It appeared to prove several things: an aversion to looking at overweight people is not implicit in children, it is learned; children’s aversion to the same correlated strongly with mum’s level of aversion to excess weight; what mum’s body weight is doesn’t seem to have any influence on the toddler’s attitude.

Which issue is more pressing?  People’s feelings about being fat or the health requirement to lose it? A 2014 communique from Otago University named Associate Professor Tony Merriman as co-author in a study which shone headlights on half of New Zealand’s women being clinically obese and a third of boys and girls either obese or close to it. According to WHO, the definition of ‘overweight’ is considered to be a Body Mass Index (BMI) of more than 25 but less than 30; ‘obesity’ is defined by a BMI of 30 or more. BMI is a height to weight ratio.

It might be possible to attack both issues at once, suggested Auckland based Lifespan psychologist and director Steve Malcolm in an August article on diabetes. The most important thing for clients trying to lose weight to prevent diabetes was drilling down to their barriers to change. This meant first removing negative connotations, feelings and stigmas about being overweight.

“I question people on their barriers not to adhere to change: they might call themselves ‘lazy’ which actually has negative connotations and this leads to other negative thinking. What is deeper here is the clients’ barrier in their belief to change.”

This requires a positive environment.

Regardless, 80 year old nutrition veteran, former adjunct professor at Massey University and honorary member of the Paediatric Society of New Zealand, John Birkbeck, says people need to stop feeling sorry for themselves and take responsibility. Birkbeck is known for this controversial position.

“I still hold that obesity is a self-inflicted disease (or by parents for children) which has adverse consequences for later life and thus also for society because of the extra costs of healthcare. In no way should we try to ‘normalise’ obesity. So if young children consider over-fatness is a negative attribute, good. I wish parents were so enlightened.

“It is not a question of ‘slighting’ people, something like racism. It is a signal that we need to pressure people not to be overfat. But why do these researchers say the children are expressing ‘anti-fat attitudes of their mums?’ Is it because the mums are enlightened and aware of the adverse consequences, or is it a fashion thing perhaps?

But I don’t accept the word ‘prejudice’- that has a negative connotation akin to racism, sexism etc. The obese may need help in dealing with their problem but it is wrong to say we should accept it as ‘normal’. It isn’t.”

In the imminent clamp down on childhood obesity, the Ministry of Health’s Dr Pat Tuohy, Chief Advisor – Child & Youth Health, offer a contrasting opinion saying that they have most definitely considered people’s feelings in trying to bring weight down.

“The tone and context of the current obesity awareness campaign has been carefully crafted to attempt to reduce the risk of stigmatisation. Discussing overweight or obesity in a supportive way is legitimate and appropriate in a health care setting, or in a family setting – as long as it is followed by helpful, sensitive discussion and support to address the issue if that is what the child, young person or adult wants to do.”

At the coalface of dealing with excess weight in a health care setting are primary care givers such as general practitioners. From the perspective of one Auckland GP, compassion, respecting choice and the stripping away of personal prejudice are corner stones in the obese patient-doctor relationship.

Julie Anne Higham is based in Auckland and has worked in a range of socio-economic practices from Manurewa to Kohimarama.

“Most overweight and obese people are acutely aware of their weight, and of other people’s attitude towards it. Criticism and disapproval of those who are overweight is unhelpful and increases feelings of despair, hopelessness, isolation and depression. The technique of blaming and shaming is also ineffective in GP-patient interactions.”

Higham says a GPs efforts to empower and motivate these patients to lose weight includes a frank discussion of the health risks and likely consequences of their continuing obesity at the outset.

“However, mutual respect and trust are crucial to successful outcomes, as is looking at the person’s overall health and wellbeing rather than their weight in isolation. Goals and plans need to be patient driven, with the GP providing support, encouragement and advice regarding options.”

To learn more about the government’s obesity campaign and download WHO information on obesity visit https://www.health.govt.nz/our-work/diseases-and-conditions/obesity/childhood-obesity-plan

Image: with thanks to proventricks.com