People with Covid-19 who are overweight or obese have an increased risk of serious complications and death. In the light of this evidence, the government has launched a plan to address obesity, framed as a way of preventing as many casualties in a second wave of the virus. Boris Johnson’s own tummy was, supposedly, a driving factor.
“It was a wake-up call for me, and I want it to be a wake-up call for the whole country,” Johnson wrote in a Daily Express column. “The facts are simple: extra weight puts extra pressure on our organs and makes it harder to treat heart disease, cancer and – as we have found – coronavirus.” Measures include mandating calorie labelling on menus, ending discount deals on unhealthy food items, banning pre-watershed ads for junk food and expanding NHS weight-management services.
A Public Health England survey suggests that two-thirds of adults are overweight or obese. This is a serious problem that needs urgent attention. But if a second wave of coronavirus cases is expected this winter, is a few months really long enough to slim the country’s waistlines? Is this not, at minimum, a three-year objective? The government’s woolly, dissonant messaging – telling us to lose weight in the same week that we’ve been told to eat out more – hasn’t helped.
By positioning weight loss as a personal choice – count your calories, avoid the cheap deals – the government is building a bridge of string over a burning canyon. Psychologists have been writing for years about how obesity is not caused by a lack of willpower. Rather, it’s a product of emotional distress, poverty and inequality. What people can afford to eat, how much time they have to prepare food and how they eat are all measures of inequality.
When faced with an unhealthy environment, free will can feel like a fantasy. Every Conservative government since Margaret Thatcher has cultivated individualism over welfare, to the detriment of millions. Statistics show that 100,000 more children are living below the breadline than a year ago. Demand for NHS mental health services is increasing but, as a result of systematic cuts to trusts’ funding, so many people are in pain without anywhere to take it. The correlation between obesity, mental health issues and poverty is clear, yet attitudes towards people with obesity still hinge on a perceived lack of control: if you’re big, you’re greedy and unhealthy, and have no willpower.
When the message from above is that individual choices matter above all else, it’s unsurprising that we may view those who are bigger than us as occupying too much of our precious space. But that doesn’t make fat-shaming right or productive. Increasing the stress and shame that a person with obesity feels – whether that’s from an interaction on public transport, a GP consultation or a public health campaign – often leads to increased eating and decreased motivation to lose weight. This cycle of shame speaks to another body of evidence that is being wilfully overlooked: the correlation between obesity and trauma.
The major Adverse Childhood Experiences study found that more than 6 million obese and morbidly obese people are likely to have suffered physical, sexual and/or verbal abuse during their childhood. Millions more will point towards other types of childhood trauma as the cause of their weight issues: living with a mentally unwell family member, for instance, or an alcoholic parent. A considerable body of research now shows that PTSD is associated with an increased risk of women becoming obese. Still, we blame the individual – especially if they’re a woman.
I never used to have strong views about obesity. That changed during a work placement for my psychology MSc with a clinical psychologist working with prospective weight-loss (bariatric) surgery patients. Her job was to assess whether individuals were emotionally equipped to deal with such a major transition and whether they would need more intensive psychological support.
I observed many assessments with patients whose BMI put them in the “morbidly obese” category. For many, being in that room with the psychologist was the first time they had disclosed historic trauma. I heard descriptions of childhoods spent in care, sexual abuse within family settings, emotional neglect and violence that will stay with me forever. Many patients had mental health issues that they’d only received patchy care for. I had never previously considered that there would be such a clear connection between historic trauma and unhealthy eating habits, but of course it makes sense.
In the adverse childhood experiences study, many participants said that overeating had benefits during their early lives. Binge-eating became a source of comfort and protection from sexual abuse. Another connection between childhood sexual abuse and obesity might be a desire to “de-sexualise”, gaining weight as a means of protecting against more abuse. It’s clear that mistaking overeating for “just” an addiction overlooks the complexity of the problem. When food is used to manage emotional distress at an early age, undoing this conditioning as an adult becomes tricky.
Binge-eating, for instance, can be a compulsive but distressing feedback loop: a person may eat large amounts to feel better then, feeling disgusted with themselves for doing so, they may purge. The subconscious need to emotionally soothe with food in this way speaks of deep, unexplored shame and pain. Once that shame – literally weighing the body down – begins to be opened and accepted in a safe space, there is potential for learning how to re-route these destructive patterns.
Observing people talking about sexual abuse to a professional for the first time, I could see the visible relief they felt at being heard, but also the incredulity that their past experiences would be significant in this context. Remember, most of these women had a history of significant mental distress. Why weren’t they asked before about what had happened to them? Why haven’t they been helped to join the dots?
If we want to tackle obesity, we must think beyond individual choices, seeing the problem as one with structural, systemic roots. We need to think about what has happened to people, not focus on what is wrong with them or their choices. It seems unlikely that a political party whose policies have been the cause of such widespread distress will be capable of doing this.