Doctors are some of the worst offenders at blaming people for being overweight, an expert says.
Australia’s National Obesity Strategy, launched earlier this month, is designed to guide governments and others over the next 10 years in promoting healthy behaviours and supporting those living with obesity.
According to one international obesity expert, after decades of strategies that have – unsuccessfully – focused purely on prevention, the latest document includes at least a nod to the issue of stigma.
“Prevention has not really worked, and the nation as a whole has not grasped that,” said Adjunct Professor John Dixon of Swinburne University.
“This document has suddenly discovered that we need to address weight stigma. What we find is that most stigmatising conversations and discrimination and bias come from the person’s family, and next, from a healthcare professional. It’s frightening.”
He said the prevention focus in the newly-released document remains energy, improving nutrition and being more active
“The key thing is weight stigma, discrimination and so on,” he said. “Weight shaming and blaming is the problem – people say, ‘it’s their fault, they need to fix it themselves’ – and this goes right across the whole area from prevention through to management.”
The National Obesity Strategy lists two targets: to halt the rise and reverse the trend in the prevalence of obesity in adults by 2030, and to reduce overweight and obesity in children and adolescents by at least 5% by 2030.
Its development included reviews of evidence and recommendations from sources such as the World Health Organization, as well as drawing on the views of more than 2,750 Australians and organisations. It notes that the causes of overweight and obesity are “complex and deeply embedded in the way we live”, and that it is “not simply a lack of self-control”.
People find it very difficult to understand obesity, Professor Dixon said, in part because popular opinion failed to take into account metabolic programming and other inheritable factors that largely determine the likelihood of someone becoming obese.
“It’s a lot more than simply eating and exercising,” he said, “and the biology tells us that it’s not their fault, and that they are predisposed to it. Indeed, once they have gained weight, the vast majority – no matter how much they exercise or eat correctly – they won’t lose much weight. In fact, many of them won’t lose any weight.”
The strategy acknowledges people living with obesity experience stigma and discrimination within the health system and from health care professionals. Their concerns include the risk of compromising patients’ trust.
“GPs have a crucial role to play in discussing overweight and obesity concerns with their patients,” the document says. “However, GPs are often concerned about how to raise these issues. Barriers to effective conversations include appropriate language, lack of time, concerns about compromising mutual trust and rapport and about patient readiness. They also are concerned about patients’ mental health.”
Professor Dixon agreed.
“We have to consider, as practitioners right across the board: Are we doing any good at all? Are we having any net benefit versus net harm?” he said. “As doctors, as primary care physicians, as GPs, we need to change our view. When I see a patient, one of my things is to explain what this stigma is – that they’ve been impacted by this internalised stigma, and that it’s not their fault. They’re full of their own self-blame, and so forth.
“In the last part of this particular document it actually says we need to address stigma, we need to have equity in our management, and we need to design better pathways for specialist care, and particularly to include those that are more vulnerable.”
The National Obesity Strategy calls for exploring opportunities to better fund primary and public health systems in identifying and managing overweight and obesity, including MBS rebates and alternative funding models through the National Health Reform Agreement.
