For decades, research has been explaining and continues to explain the complex, structural causes of obesity and obesity-related non-communicable diseases (NCDs). That is why seeing the hype around Boris Johnson’s latest anti-obesity campaign is so depressing and exhausting. Obesity and diet-related NCDs are determined politically, commercially and socioeconomically. If this sounds vague, here are a few examples of where the root causes of diet-related NCDs are to be found: they are the austerity measures that push people into financial-, time- and food poverty. They are the food deserts in poor areas. They are the policies that have institutionalised food and drink industry lobbying. It’s the unsustainable and unfair global food system which exploits farmers around the world, destroys our health and our planet, while flooding markets with junk in order for a handful of people to make billions. In a nutshell: root causes of obesity-related NCDs are ideologically driven: they are about inequity, and about capitalism.
Of course, this paragraph has not provided a very clear explanation of the links between capitalism and obesity. But there is so much research that already does that! And even though the issue is complex, those researchers still offer ways forward. For anyone completely new to the ‘politics of NCDs’ topic, wondering why some people are criticising the new anti-obesity campaign, this would be my suggested initial reading list:
- Collin, J. and Hill, S. (2016). Industrial epidemics and inequalities: The commercial sector as a structural driver of inequalities in non-communicable diseases. In: K.E. Smith, S. Hill and C. Bambra, (Eds) Health Inequality – Critical Perspectives. Oxford University Press: Oxford, pp. 177-191.
- Glasgow, S. and Schrecker, T., (2016). The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health and Place. 39, 204-211.
- Guthman, J., (2011) Weighing In: Obesity, Food Justice, and the Limits of Capitalism. University of California Press.
- Schrecker, T. and Bambra, C., (2015). How Politics makes us sick: neoliberal epidemics. London: Palgrave Macmillan.
- Sell, S.K. and Williams, O.D., (2020). Health under Capitalism: A Global Political Economy of Structural Pathogenesis. Review of International Political Economy. 27(1), 1-25.
- Sparke, M., (2016). Health and the embodiment of neoliberalism: pathologies of political economy from climate change and austerity to personal responsibility. In: Springer, S., Birch, K., and MacLeavy, J. The Handbook of Neoliberalism. Oxon: Routledge. pp. 237-252.
Instead of recognising the structural, political root of the problem (and setting as a logical public health goal the reduction of social inequities), health policies across western countries, and particularly in countries like the US and the UK, have maintained that NCDs are a problem of individual behaviour. This framing, whether embraced consciously or not, is about safeguarding the currently broken system: ‘the system is fine, it’s the individual people who need to change’. This framing is misleading, as it takes obesity completely out of context. Even when inequalities are mentioned – acknowledging that indeed NCDs affects people from disadvantaged backgrounds disproportionately – the individualist framing tends to spin this difference as a matter ‘educating the poor’ which is condescending, unfair, and ignores the context of these inequalities. There is so much research that criticises this ‘individual responsibility’ framing, and that reflects on why health policies keep drifting back to this ‘individual responsibility’ approach, as if that was the only thing that can possibly be done. Here are a few examples:
- Ayo, N., (2012). Understanding health promotion in a neoliberal climate and the making of health conscious citizens. Critical Public Health. 22(1), 99-105.
- Baum, F. and Fisher, M., (2014). Why behavioural health promotion endures despite its failure to reduce health inequities. Sociology of Health and Illness. 36(2), 213-225.
- Carey, G., Malbon, E., Crammond, B., Pescud, M. and Baker, P., (2017). Can the sociology of social problems help us to understand and manage ‘lifestyle drift’? Health Promotion International. 32(4), 755-761.
- Mulderrig, J. (2019) The language of ‘nudge’ in health policy: pre-empting working class obesity through ‘biopedagogy’. Critical Policy Studies, 13(1), pp. 101-121
Finally, the fact that the ‘obesity problem’ has become so prominent in relation to the covid-19 pandemic shows the extent to which the UK government refuses to take responsibility for tackling the pandemic. Obesity is a risk factor for covid-19? Ok, that’s good to know. But firstly, that does not absolve the government of their responsibility to handle the pandemic (testing, tracing, providing clear rules, making informed decisions rapidly and taking responsibility for these decisions – none of which has been done competently). Secondly, dieting, especially weight-loss diets that promise rapid weight loss are inefficient and potentially dangerous, both for physical and mental health. In fact, the social pressures and stigma around weight has led to fat acceptance movements which – far from claiming that obesity is healthy – take a more holistic approach to health, including mental wellbeing, and denounce the oppressive capitalist patriarchal system in which thinness as a moral imperative is rooted. Here are a few examples of these critical approaches to fat studies:
- Colls, R. and Evans, B., (2014). Making space for fat bodies?: A critical account of ‘the obesogenic environment’. Progress in Human Geography. 38(6), 733-753.
- LeBesco, K., (2011). Neoliberalism, public health, and the moral perils of fatness. Critical Public Health. 21(2), 153-164.
- Rothblum, E. and Solovay, S., (2009). The Fat Studies Reader. New York: New York University Press.
Campaigns to encourage people to ‘eat well and move more’ have been around for ages, and they are not reducing the rising diet-related NCD burden. The special twist of this campaign, which is somehow presented to us as a kind of ‘epiphany’, is the personal ‘Boris as a success story’ touch, which frankly makes the whole thing even less palatable. Fundamentally, these kinds of campaigns continue to ignore the real causes of diet-related NCDs and obesity. And in this particular case, it also serves to distract from the government's incompetence in handling the pandemic.