As a nutritionist, I am often asked “What causes obesity?” The answer is initially simple yet becomes fiendishly complex. Most scientists will tell you that we gain weight because we eat more calories than we need. However, WHY we overeat or in some way fail to eat a healthy balanced diet is far more complicated. When I explain this, I am often met with derision from seemingly intelligent individuals who consider that anyone eating a less than perfect diet is unintelligent, feckless, wilfully negligent and that they are therefore beyond help. Why should the state intervene to make everyone’s life miserable for the sake those individuals who can’t control themselves? Here’s why what and how much we eat is not as simple as buying healthy food and eating it in moderation.
These are some of the statements I have heard directed at people who are overweight, obese or somehow don’t eat a healthy, balanced diet:
“People just don’t care about their own health”
“Why can’t they just eat more healthily?”
“Those who say they can’t afford to eat healthily are just making excuses.”
“Just cook from scratch.”
“Why don’t they MAKE time to cook?”
“People have a responsibility to educate themselves.”
Implicit in these statements is that the individual who fails to eat a ‘healthy’ diet and remain a ‘normal’ weight is personally responsible for their failings and that no external help or intervention should be required. Government measures like public health campaigns, reformulation targets for manufacturers, limits on portion size etc. are met with accusations of nanny statism.
Let’s examine these statements in turn and reveal the reality of the many barriers to healthy eating, with a little help from the Foresight report.
How people feel about being overweight?
Evidence shows that those who are overweight or obese are often stigmatised by employers, healthcare professionals and peers and that this stigmatisation may directly impact their health. In turn, the negative feelings resulting from such stigmatisation, can lead to feelings of worthlessness, depression, anxiety and comfort eating. Moreover, research, for example from Dr Linda Bacon’s group in the US, now suggests that those who are overweight or obese are by no means all unhealthy (and overweight people might even live longer than their counterparts with a ‘healthy’ BMI). So in short, people who are overweight and obese are not wilfully eating themselves to death and they are certainly not happy about the stigma they so unfairly receive.
Why it’s very hard to change what you eat
We are all different. Some of us love vegetables and some of us loathe them. Our taste bud sensitivity, especially to bitter tastes, differs; our experience of food variety during infancy, especially of vegetables, can determine food preferences for many years to come and our appetites and ability to sense when we are full both vary naturally. We are also variously responsive or unresponsive to certain foods and this is, in part, genetically determined. In plain language, I might be able to sit next to a chocolate cake and ignore it without another thought, whereas my friend might agonise, trying to resist the temptation, only to give in and eat it, even though she wasn’t hungry. In short, our ability to eat healthily in a world where unhealthy, palatable and supersized food is abundant depends partly on our genetics and our early life experiences and for many, is an uphill struggle.
The cost of a healthy diet
While many perceive a healthy diet, rich in fruit, vegetables, wholegrains and lean protein foods to be expensive, it doesn’t have to be so. It does, however, require a lot of shopping around to get the best deals, buying in bulk, storing food in the freezer/cupboard etc. This is impractical and virtually impossible for many on low incomes or for young people living away from home for the first time. People on low incomes aren’t feckless and lazy, as I’ve heard many say. If you live in a bedsit or shared house with limited access to a kitchen or storage space, you’ll find it far easier to go to a takeaway or to buy a ready meal. Couple that with limited car ownership among these demographics and accommodation that’s nowhere near a supermarket with limited funds for public transport, and the only option is often the corner shop (not known for cheap whole foods) or the takeaway, where you can buy a giant bag of chips for less than a pound. If you have to fill tummies as cheaply as possible, you go for the most energy dense options for the least money. Broccoli doesn’t get a look in.
The cooking skills gap
While cooking classes may recently have gone back on the curriculum, we have a generation or more that didn’t learn to cook. Even though I had Home Economics lessons (albeit in the dark ages), most of the time we made cakes and biscuits and didn’t learn useful things like how to make a basic tomato sauce or how to menu plan and budget for a week. Many people are simply not confident enough in the kitchen and those that do cook often stick to a limited menu. Add in a couple of fussy eaters and a reluctance to try new foods for fear of waste and you end up with a potentially very limited diet.
The time it takes to cook healthy meals
It is undoubtedly quicker to put a ready meal in the oven or microwave than it is to make a meal from scratch. With most adults working purely to make ends meet, it is a challenge after a long working day to spend an hour in the kitchen preparing a meal, even more so if there are young children to look after. It is both easy and not necessarily unhealthy to turn to convenience options but it’s important to know which options are the healthiest.
This is a tricky one. OF COURSE, it’s up to the individual to make healthy choices but as you can see, it’s not that easy, there are many barriers and some people have the odds stacked against them. So we need food manufacturers to reformulate products to make them healthier but still taste good – that will help us all; we need clearer labelling to make the healthy choices easier to identify; we need responsible retailers to avoid putting unhealthy foods in the line of sight of children so they don’t pester for them; we need healthcare professionals to treat all patients equally and not stigmatise the overweight and most of all, we need the Government to take food and health policy seriously. Read my review of the watered down Obesity Plan and what I think needs to be done. But we must start by dealing with inequality, food deserts and hunger – those living in poverty don’t eat unhealthily purely because they believe it’s cheaper to do so.
To sum up, what causes an individual to overeat or consume an unhealthy diet is not stupidity. The drivers and barriers are multifaceted, interrelated and extremely complex. There is no one solution. But doing nothing and blaming individuals is not an option.
Images from Public Health England and the Obesity Action Coalition