UK obesity campaign risked turning fat-shaming into ‘wilful political strategy’

New research has claimed that the Tackling Obesity campaign perpetuated the neoliberal view that good health is essentially a matter of individual achievement earned through lifestyle choices and behaviour. In so doing, the researchers say, it ignored the multiple structural and socioeconomic factors that contribute to obesity.

They go on to add that former Prime Minister Boris Johnson’s official statements at the time, which suggested that “small changes” were all that was needed for weight loss, both failed to match public health evidence, and created "a ripe atmosphere for government-sanctioned shame and blame”.

Published in the journal Sociology of Health and Illness, the research – Fat shaming under neoliberalism and COVID-19: Examining the UK’s Tackling Obesity campaign – analyses the language used by the government and its particular emphasis on ‘choice’ and ‘costs’.

“In neoliberal countries such as the UK, the onus of responsibility for good health is largely placed on the individual,” says Dr Tanisha Spratt, co-author and Lecturer in Sociology in the School of Humanities and Social Sciences, at the University of Greenwich, London. “It emphasises the importance of self-reliance and self-control when it comes to lifestyle and behaviour – which in turn means that poor health, along with poverty and other social ills, is often seen as an individual shortcoming and the result of poor lifestyle choices.”

Tackling Obesity was launched at the end of July 2020, days after a Public Health England report outlined clear evidence that the risk of hospitalisation, intensive care admission and death from COVID-19 was greater for those who were medically classified as obese or severely overweight. The campaign stressed the importance of tackling obesity to "improve the health of the nation", "offer greater protection against the impact of COVID-19" and "protect the NHS from being overwhelmed" in the event of a subsequent wave of the virus.

Former Prime Minister Boris Johnson played an active role in the launch, releasing a video through social media that drew parallels with his own experience of COVID-19, saying he had been “too fat” and had struggled to control his weight. He also said that he had since taken up jogging and had lost weight as a result.

The researchers say that, echoing the Change4Life campaign of a decade earlier, Tackling Obesity recommended that people swap unhealthy aspects of their diet for healthy items such as fruit. They continue that it emphasised the impact of obesity on the NHS, and that "If all people who are overweight or living with obesity in the population lost just 2.5 kg, it could save the NHS £105 million over the next five years".

“The Tackling Obesity campaign explicitly and repeatedly emphasised the costs associated with bodies with excess weight, reinforcing the idea that fat bodies are ‘expensive’, and, as a result, inherently unprofitable and unproductive,” says Professor Luna Dolezal, co-author and Associate Professor in Philosophy and Medical Humanities in the Faculty of Humanities, Arts and Social Sciences. “This sort of discourse positions individuals with excess weight as ‘irresponsible’ and ‘inconsiderate’, because not only do their ‘choices’ negatively affect them and their individual health but also the National Health Service because of the additional financial and resource burdens that their excess weight will incur.”

While the campaign did include recommendations aimed at societal level reform – such as the introduction of calorie information on some restaurant menus, and the curbing of advertising for unhealthy food – they focused upon an individual’s choice of food and not their ability to access healthier alternatives.

The researchers highlighted the apparent inconsistencies and contradictions with other government actions at the time, such as Eat Out to Help Out, which included a number of fast-food companies in its offer, and the lockdown restrictions that limited people’s opportunities to exercise.

They argue that using ‘shame’ and ‘blame’ as a strategy for motivating weight loss has rarely worked in past campaigns. And they also point out that surveys conducted during the pandemic had revealed that a significant number of people had reported an increase in weight for a variety of reasons, such as increased alcohol consumption, stress-induced snacking or comfort eating, and a more sedentary lifestyle caused by lockdown.

“While the goals of encouraging healthy eating and improving general population health are laudable, the Tackling Obesity campaign framed them as individually achievable and ignored the structural barriers that prevent some from implementing this advice,” says Professor Dolezal. “Most people simply cannot afford to routinely buy the prohibitively expensive tubs of pre-chopped fruit that serve as the visual paradigm for a ‘simple swap’ – and even for those who can, there is no guarantee that this would lead to perceptible weight loss.”

“The campaign concretely demonstrates how implicit fat shaming is being operationalised within this public health effort,” adds Dr Spratt. “Not only is the Tackling Obesity campaign both unproductive and ineffective, but it is also irresponsible in light of the available public health evidence on obesity and anti-obesity campaigns.

“Changes such as redesigning school curricula to include more physical activity, creating walkable cities and making healthy food options more accessible to those who cannot currently afford them offers a clear path to reducing obesity rates and better overall health in the UK, and do not risk shaming individuals for their excess weight. If the UK government is serious about prioritising weight loss in order to combat hospitalisation and death from COVID-19, these are optimal places to start.”

The report Fat shaming under neoliberalism and COVID-19: Examining the UK’s Tackling Obesity campaign is available via Open Access in the current edition of Sociology of Health and Illness.