Changing obesity narrative could help to inform health policy

Obesity is a hot-button health issue. But what shapes our views on it? How do we look at obesity as a society, as health science researchers, as health policy-makers, as healthcare practitioners, as individuals?

With this in mind, Professor of Health Policy & Management Dennis Raphael, with former York Health Policy & Equity masters students Stella Medvedyuk and Ahmednur Ali, analyzed obesity literature and published their findings in Critical Public Health (2017). The researchers focused on how Canadian public health reports and clinical practice guidelines conceptualize and present obesity.

From left: Ahmednur Ali, Stella Medvedyuk and Dennis Raphael

Their conclusions could change the way we think about obesity: They reframe the narrative from obesity as a health issue by bringing to the fore important issues of the quality and distribution of the social determinants of health. They also argue that the way we have thought of obesity to date is in fact threatening health rather than promoting it.

“These dominant models divert attention from issues of the quality and distribution of the social determinants of health. They stigmatize overweight individuals. This stigma contributes to adverse health outcomes,” the researchers explain.

What are the social determinants of health?

The social determinants of health refer to the socio-economic conditions that shape the health of individuals and communities. These conditions, primarily a deepening class and income inequity, determine an individual’s access (or lack of access) to vital resources.

Chiefly aimed at informing policy, this perspective critically analyzes the inequities embedded in our society and the socio-economic factors that affect health, including income, education, employment, housing, food security, gender and race.

The social determinants of health refer to the socio-economic conditions that shape the health of individuals and communities

The social determinants of health refer to the socio-economic conditions that shape the health of individuals and communities

Research team analyzed and categorized existing approaches

The research trio studied traditional health sciences literature, which reflects dominant biomedical and lifestyle approaches, as well as critical obesity studies. The models were derived from two extensive narrative reviews of the last two decades of theoretical and empirical literature on obesity and health relationship. Analyzing the content thematically, the researchers examined how these models manifest in two major government reports and two clinical practice guidelines.

Next, the researchers categorized this literature as falling into five models or approaches that could be presented as a continuum, in which Models 1, 2 and 3 represents the mainstream approach and Models 4 and 5 represents emerging, critical perspectives.

Model 1: Obesity is the cause of adverse health outcomes; Model 2 Obesity shaped by the social determinants of health, is the cause of adverse health outcomes. Model 3: Obesity shaped by the social determinants of health, modestly contributes to adverse health outcomes. Model 4: Obesity, shaped by the social determinants of health, does not contribute to adverse health outcomes. Model 5: Stigmatization of obesity, rather than obesity itself, contributes to adverse health outcomes.

Above: A diagram depicting the different models

Models 1, 2 and 3, according to the researchers, do little to improve health outcomes. They should therefore be dropped by health sciences researchers and public health workers. Medvedyuk, Ali and Raphael provide three reasons for this conclusion:

  1. Emerging literature questions the adverse effects of obesity on health, proposing that health effects of obesity are overstated.
  2. Mainstream perspectives on obesity direct attention away from the primary causes of poor health outcomes, which the researchers pinpoint as the uneven or unfair distribution of the social determinants of health.
  3. Rather than improving health outcomes, mainstream perspectives on obesity achieve the opposite. “Well-meaning health sciences obesity researchers and public health workers are, in effect, stigmatizing individuals, blaming them for their own health problems, and promoting eating behaviours and public attitudes towards overweight people that threaten, rather than promote, health,” Raphael states.

Effect of stigma detrimental to health

This research underscores the negative effects of stigma on health. “Although these mainstream approaches are aimed at reducing obesity, the unintended effects of stigmatization – including victim blaming – of heavy people by health sciences researchers and public health workers and the public are detrimental,” the researchers say.

There are also adverse health effects associated with yo-yo dieting, weight loss drugs, surgical procedures and an increase in eating disorders.

Thirty-eight year old impoverished woman looking out window of low income home.

Although mainstream approaches are aimed at reducing obesity, the effects of stigmatization are detrimental

Emerging literature could drive public policy

Medvedyuk, Ali and Raphael press for an end to mainstream perspectives on obesity, currently reflected in and enacted through today’s health policy; these researchers urge policy change. Policy change could be informed by literature that illustrates obesity playing a minor causal role in chronic diseases of cardiovascular disease, respiratory disease and adult-onset diabetes. It could also be informed by literature showing how stigmatization and victim blaming harm, rather than promote, health.

Policy change could also be informed by emerging literature demonstrating how societies with a more equitable distribution of the social determinants of health have comparatively improved population health profiles and lower obesity rates.

The article, “Ideology, obesity and the social determinants of health: a critical analysis of the obesity and health relationship,” was published in Critical Public Health (2017). For more information about Raphael, visit his faculty page. To learn more about Raphael’s books on the social determinants of health, visit his author information page on the Canadian Scholars’ Press website.

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By Megan Mueller, manager, research communications, Office of the Vice-President Research & Innovation, York University, muellerm@yorku.ca

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