Cancer Research UK (CR UK) states that their latest obesity campaign aims to stimulate a government policy response to ‘junk food’ advertising to children. Focusing on policy change rather than individual behaviour change is a laudable aim. However, the charity’s approach has been challenged by the public, researchers, and healthcare professionals.
CR UK’s national public facing ad campaign frames obesity as “the new smoking” with the tagline “obesity is a cause of cancer too”. They aren’t on their own: the CEO of the NHS, Simon Stevens, frequently uses the phrase “obesity is the new smoking”. But CR UK’s public facing campaign doesn’t make any reference to children or junk food, which are the stated target of the campaign. Experts are warning that comparing obesity to smoking is flawed and ultimately serves to stigmatise people perceived to be overweight or obese, and have a negative impact on their health.
A group of experts, including Dr James Nobles from NIHR CLAHRC West, Dr Oli Williams from King’s College London, Sarah Le Broq from Obesity UK and Dr Stuart Flint from Leeds Beckett University, met with CR UK’s marketing and policy teams in November to outline their concerns about the charity’s previous “OB_S_ _Y” campaign. This also compared obesity with smoking.
At the meeting, the experts clearly stated their position: this campaign would likely deepen prejudice against people perceived to be obese or overweight rather than supporting them, and was likely to have a negative impact on their future health.
Here’s that group’s five reasons why we shouldn’t be linking obesity and smoking:
- Smoking is a behaviour and bodyweight is a physical outcome. Comparing a behaviour and a physical outcome is counterproductive. The most effective intervention for smoking is to stop smoking. But everybody needs to eat, so this approach is impossible to replicate for diet. People can’t just stop “being obese”.
- Linking obesity to smoking frames it as a lifestyle choice. This message is so dominant that it is commonly believed by both people living with obesity and people who aren’t. CR UK’s testing of this campaign with the public may have shown that in general people didn’t find the message offensive. But the campaign reinforces the deeply held belief that weight management is entirely within an individual’s control, and therefore everyone has a responsibility to maintain a “healthy” weight. It is not that simple. The drivers of obesity are far more complex: a 2007 Government report outlined over 100 factors which contribute to an individual’s weight.
- Genetics have a big influence on whether or not someone has obesity. Some people are genetically predisposed to have a higher BMI and to be more resistant to weight-loss than others. The idea that with enough willpower anyone can overcome obesity is not the case for many people. See Giles Yeo’s Royal Institution talk for more on this.
- This campaign encourages weight stigma. This is clear from the response to it on social media. For example, see the responses to this tweet. Stigma is a highly ineffective way of reducing obesity. If it were effective, then the dominant anti-fat culture which we already live in would prevent people from putting on weight. Contrary to popular opinion, stigmatising body weight and size promotes weight gain because it increases the likelihood of responses like comfort eating and avoiding exercise for fear of being judged. These responses may also include avoiding interactions with healthcare professionals who would be able to offer support. Weight stigma has profound negative impacts on both mental and physical health and leads to discrimination.
- Sometimes using stigma in relation to public health messaging is deemed legitimate, but it isn’t legitimate for obesity. For instance, when the evidence on the damaging health effects of secondhand smoke were clear, this stopped people being able to argue that smoking should just be a matter of personal choice. Smoking was framed as unfairly damaging the health of others. Obesity is not the same because having a high BMI does not directly damage the health of others. However, the link with smoking encourages the same moral outrage. This creates a very hostile environment for people of higher weights.
These points were put forward clearly to the CR UK team in the November 2018 meeting, and have not been considered in the current campaign. This suggests that CR UK are aware of the potential harm that may come from their campaign.
Dr Oli Williams, Research Fellow at King’s College London, said:
“I sympathise with CR UK’s mission to force the government into action. For too long the message with obesity has been focused on individuals making ‘bad choices’ and our current Health and Social Care Secretary has been very open about his endorsement of this unhelpful position. So it is refreshing to see CR UK prioritising policy change and I appreciate why they felt they needed to revert to shock tactics to influence the government.
“And in reality the campaign is likely to be at least partially effective, because the public trusts the charity so there will be a lot of pressure on the government to act. But this does not mean that CR UK have taken the best approach to addressing the issue of obesity. What about the people this campaign ends up demonising, albeit inadvertently? Are they just collateral damage?
“From a health promotion point of view treating two fundamentally different issues as if they are the same is confusing and unhelpful. Comparing obesity to smoking is like comparing apples with oranges. Yes apples and oranges are both fruit and smoking and obesity are both issues that require policy action, but aside from that they are very different. We explained this to CR UK when we met with them but they have failed to take our advice.”
Sarah Le Brocq, Director of Obesity UK which represents 40,000 people affected by obesity, said:
“CR UK tested their campaign with a small group of people. Weight bias is so far reaching in our society, and internalised by so many people, that it is unlikely that a small test group would flag any concerns at all.”
Dr James Nobles, Senior Research Associate at the University of Bristol and NIHR CLAHRC West, said:
“It’s a real shame to see that our discussions with CR UK resulted in no difference in their current campaign. They continue to draw the public’s attention to the statements: ‘Like smoking, obesity puts millions of lives at greater risk of cancer’ and previously, ‘obesity is the greatest preventable cause of cancer after smoking’. Both of these statements, when broadcast to the public, reinforce the mantra that obesity is a choice.
“Obesity is not a choice. Two thirds of our adult population haven’t ‘chosen’ to live with overweight or obesity – it is a product of living in the modern world. CR UKs’ campaign, when framed in this way, suggest to the public that simply through changing our behaviour, we can reduce the population prevalence of obesity.
“Their aim was to encourage the government to introduce policies to reduce the impact of our obesogenic environment. We fail to see how this campaign will do that, but we do see first hand the negative impact that it has on people with and without obesity.”