Why obesity policy needs to change

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By Dr. Tammy Boyce

In England, more people are overweight than not, and around one in four adults are obese. The efforts of governments around the world to reduce the incidence of obesity usually involve some combination of the following:

  • Advice to improve diet;
  • Advice to increase exercise;
  • An attempt at working with industry to improve information or change food quality.

The Foresight Obesity map is beautifully complicated, identifying numerous causal factors. But with so many causes, where do we start with solutions? 

But despite all of this, obesity continues to rise.  Is there anything we can do? 


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Simplify the message

Typically, public health campaigns addressing obesity are twofold: you must eat well and increase your exercise.
To achieve population-level change, we first need to simplify the message to: EAT LESS.  If you want to make it more complicated, I’ll allow a slight modification – EAT LESS AND EAT BETTER.  

If you are an obese adult and have not exercised since high school, it’s easier to ignore weight loss advice entirely when you’re being told you must exercise and eat less to lose weight.

My strategy is this. We change the NHS message that to ‘maintain a healthy weight’ you need to balance the amount of calories you consume through food and drink with the amount of calories you burn through physical activity. Simplify it. Let’s just say: EAT LESS. 

We bombard the public with the message:

  • An average man should eat 2,500 calories a day (CAD).
  • An average woman should eat 2,000 CAD.          
  • An average girl aged 5-12 should eat 1500-1800 CAD.
  • An average boy aged 5-12 should eat 1700-1900 CAD.
  • An average teenage girl should eat 1800-2100 CAD.
  • An average teenage boy should eat 2200-2700 CAD.

After people have lost weight, tell them to exercise.

The Change4Life campaign emphasises eating well – reducing intake of fat, salt and sugar, and eating more fruit and vegetables – and moving more. Forget overloading people with multiple messages: ‘eat five portions of fruit and veg’, ‘reduce your carb intake’,  ‘don’t eat salt’.  Nope.  We need to concentrate on one thing: EAT LESS.
                                                                                           
After people have lost weight, tell them how to improve their diet.       

Michelle Obama’s ‘let’s move’ campaign to reduce obesity in children
is pushing the wrong message – it should be ‘eat less’.

Reducing calories VS increasing exercise

Increasing exercise does not directly lead to weight loss.  It makes you healthier, but it is not the best way to lose weight. The government’s latest review and recommendations on physical activity guidelines admits this:

“Text should clarify that physical activity is important to prevent weight gain and obesity but that to date there is insufficient evidence to identify the exact amount required for optimal benefit and the issue is  complex due to the confounding factors related to dietary intake and healthy weight gain due to healthy development of muscle and bone mass. At the current time, there is insufficient evidence to make a specific physical activity recommendation for either weight loss or weight management in children.”

Reducing calorie intake is the best way to lose weight, and the message we promote needs to reflect this.

Government and policy

Focusing on food intake doesn’t mean all the responsibility lies with individuals. Governments have a key role in creating environments where people are supported to reduce their calorie intake, by: 

  • Promoting cooking skills in schools, workplaces, where people gather.                                                                                                                            

Policies need to address the impact of the environment on individual choices.  The evidence base studying interventions that address interactions between individual behaviours and their external environment is poor. Governments need to fund research into these interventions, and look at their effects over the long term.  

The current messages are too complicated and thus easy to ignore, especially with the food industry always ready to cast doubt on any health promotion message that might dampen their sales (see Coke’s recent advert, which claims that chairs cause obesity, not sugary drinks).

It’s time to radically change our tactics. 

Change the message to EAT LESS – and make this easier. 



Dr. Tammy Boyce (@TamBoyce) works with DECIPHer as a Knowledge Exchange consultant.

4 Comments

  1. Ciaran Humphreys

    I welcome the focus on addressing the obesogenic environment. However, the opening statement is wrong, almost one in four adults in England are obese – the figure referred to relates to ‘overweight or obese’; concepts that should not be conflated.
    Change 4 life messages are a good step in the right direction from previous. It would be good to know what evidence there is that this two-word message (1) is better understood (2) is more likely to lead to behaviour change (3) is more likely to lead to the right change (4) results in weight loss. If not already done, perhaps an opportunity for a proper evaluation?

  2. Blog editor

    Thank you for pointing out the error in the opening statement*, this has now been corrected.
    *The opening sentence previously read “In England, more people are obese than not”.

  3. Clare Burgess

    I take your point about simplifying the message, but the single message “Eat less” is fairly joyless (and counter-cultural) and places the emphasis squarely on food as opposed to more general beneficial lifestyle changes. Is there evidence that exhortations to eat less do lead to long term weight loss (where needed) and good health? It seems intuitively unlikely that in cases of dysfunctional eating that has been sustained over years, the underlying issues of low self-esteem, reliance on food as a comfort strategy etc will be addressed by a food-only approach. In contrast, encouragement (and the provision of facilities) to take up an enjoyable and sociable form of exercise as well seems more likely to promote higher self-esteem, more engagement in leisure activities that don’t revolve around food, less reliance on food to deal with difficult emotions and circumstances etc. I’d also be interested in how reliance solely on eating less (in the absence of increased activity levels) fits with the evidence on metabolic changes as calorie intake falls.

    • Clare Burgess

      A quick PS to my comment above.
      Promoting enjoyable activities (dancing, walking etc) would also fit with the type of approach suggested by the Solution-Focused Brief Therapy approach – i.e. adding more of the helpful behaviours/activities in to daily life rather than focusing on keeping out the behaviours you’re trying to stop (e.g. smoking, over-eating).

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