The latest listener has a cover story promoting health at any weight. It describes the pressures and discrimination suffered by those who are above a healthy weight and advocates for a society where there is greater size acceptance. The argument is that weight and Body Mass Index are not ideal measures of health and that programmes that push for weight loss are doing more damage than good.
While I totally believe in the “health at any weight” concept I felt the discussion did not dig deep enough. It did not consider the wider determinants of health, namely the environmental and social context in which we live. Few would argue that today’s “obesogenic” environment promotes weight gain. The factors that encourage this include ready and easy access to energy dense/nutrient poor foods, aggressive and irresponsible marketing of fast food companies to hook kids on such foods “from cradle to grave”, a culture where sugary drinks and alcohol are normal and celebrated, and where cooking has been relegated to TV screens only (to name but a few). As well as promoting weight gain, such an environment promotes ill health. With some of the highest statistics in the world for conditions such as type 2 diabetes and bowel cancer our poor health sits alongside our status as 3rd fattest nation in the world. We cannot ignore the fact that in populations overweight and ill health DO go hand in hand; they are both symptoms of a society where the food supply is out of kilter with health needs. While there are certainly people (like the proponent in the article Andrew Dickson) who can maintain health at an “unhealthy” body mass index (BMI), experience tells me this is not the norm. Similarly, experience tells me that there are a lot of unhealthy people with a healthy BMI. I certainly agree that BMI is a not an ideal predictor of health!
To tackle the hideous stigma our society deals to those who are labelled as “obese” we need to go way beyond just acceptance. We need to tackle the big picture determinants that make it so easy for people to gain fat in the first place; we need to create environments where health is the default status rather something we have to swim against the tide to achieve.
The article made a swipe at the Healthy Food Guide and the “skinny, white, young, female, privileged nutritionists” who write for it. As a writer for the Healthy Food Guide I found this stereotyping and the lumping of us in the same camp as the irresponsible fad diets we see daily in the media highly insulting.
I manage “Appetite for Life”, a government funded healthy lifestyle and weight management programme delivered through general practice in the CDHB. Our prime focus is health gain and the achievement of a weight that supports this. We do not weigh, measure or use BMI. We celebrate the enjoyment of food and help participants to have a normal relationship with it.
The Healthy Food Guide is a breath of fresh air for health and healthy eating – like my programme it celebrates health and the joy of eating food that promotes it.
Acceptance of people no matter what their size, colour or religious belief is fundamental to a healthy society. So is providing environments, education and support to help them live long, happy and healthy lives.