Image Credit: World Obesity Federation

London

6th June 2018

Mr. Jamie Oliver

Benwell House

15-21 Benwell Rd

London

N7 7BL

Dear Mr. Oliver,

We are writing to you on behalf of a group of Registered Nutritionists and Registered Dietitians who hold concerns about your most recent campaign to influence policy on ‘childhood obesity’. By talking about “war” and saying “the future of the NHS is at stake”, we worry that you are contributing to a stigmatising and divisive conversation about weight. We are asking you to think beyond your intentions, to the potential impact and repercussions and reconsider how you communicate your message. When we contemplate what is meant by health, we cannot talk about physical health in isolation, and must also consider a child’s relationship with food and with their body in the conversation. Although many current health campaigns are focussed on weight, we are addressing this with you as we know that your impact and reach is wide and what you say has the potential to positively impact millions of people.

Children are particularly vulnerable to the consequences of weight stigma (bias or discrimination related to size), with higher weight children being 63% more likely to experience bullying. We know that children who experience weight based bullying or teasing are more likely to diet or to try to control their weight in other ways. Dieting and body dissatisfaction are risk factors for eating disorders. In one recent U.K. study of 16-year-old girls, 40.7% had some form of disordered eating behaviour (fasting, purging, or binge eating), 11.3% at a level compatible with a eating disorder diagnosis. Another study of 5-year old girls found that 34% were already restricting their food intake. And this is not a problem specific to girls; the eating disorder charity BEAT estimates that 11% of those diagnosed with an eating disorder identify as male.

These statistics aren’t surprising, considering that in our current culture we are so afraid of “obesity” that parents are engaging in weight-related talk with children as young as two-years old. Recent studies show us that, where a parent is critical of a child’s weight, however well-meaning, the child may be more likely to develop an unhealthy relationship with food and their body.

This isn’t happening on a small scale or in isolated cases – it’s estimated that 40% of parents have encouraged their children to diet. This is counter-productive given that body dissatisfaction and dieting are not only predictors of disordered eating, but of long-term weight gain.

Although unintended, campaigns and policies that focus on body size and weight, rather than health & well-being more broadly, contribute to weight stigma. Weight stigma has increased by at least 66% since the 1990s – far more than can be accounted for by the increase in body weight over the same timeframe. Weight-related stigma and discrimination is endemic in our society – 88% of people in a higher weight category who responded to a recent All Party Parliamentary Group survey reported having been stigmatised because of their size. Their experiences included bullying, teasing, missed job opportunities and being socially excluded by family and friends. Levels of weight bias in health professionals are particularly concerning – assumptions are made and conversations can be insensitive, leading to shame and healthcare avoidance.

In 2017 the World Health Organisation outlined the consequences of weight stigma in their report ‘Weight bias and obesity stigma: considerations for the WHO European Region’. These include:

– poor body image and body dissatisfaction;

– low self-esteem and self-confidence;

– feelings of worthlessness and loneliness;

– suicidal thoughts and acts;

– depression, anxiety and other psychological disorders;

– maladaptive eating patterns (disordered eating and eating disorders);

– avoidance of physical activity;

– stress-induced pathophysiology;

– avoidance of medical care

We are certain you’ll agree with us that there is nothing about weight stigma that is health-promoting, and may actively discourage people from engaging in behaviours that will improve health outcomes.

You have described action on children’s weight as a “war”. This language is ubiquitous – the idea of fighting a battle over children’s bodies primes children to be in conflict with food and their bodies at a time when they are vulnerable to perturbations in body image and self-esteem. By positioning body fatness as the enemy, we believe that your campaign is directly contributing to weight stigma.

Furthermore, the scientific evidence is clear that people can be metabolically unhealthy at a lower weight, and metabolically fit at a higher weight. For instance, people in higher BMI categories who engage in regular physical activity, eat 5 portions of fruit and veg a day, don’t smoke and drink in moderation have been shown to have a similar risk of disease as those who are of a ‘normal’ weight and also engage in those health promoting behaviours. This shows us that we can improve health and mitigate disease risk by focusing on behaviours, rather than a number on the scale.

We are all in agreement that we want the best for children; to enable children to grow up in the best possible health, and to empower everyone to live lives that feel meaningful to them. No one wants to put children’s health at risk. Over-simplified solutions to any health condition or behaviour are never helpful. Any work on improving people’s eating patterns needs to be rooted in action on the social and determinants of health. We agree that protecting children from commercial influences such as aggressive marketing – of both food and unattainable beauty standards – has a role to play. It’s also important to acknowledge that the food environment alone is not responsible for people’s relationships with food and their bodies.

We know that you can’t change the circumstances that people live in, and that you want to make a difference with the power that you do have. From the campaign point of view, we would love to see you refocus your message in more positive and inclusive ways. WHO recommend promoting body positivity, while simultaneously promoting the fun of movement and play, and the importance of eating a balanced diet for growing big and strong. We can learn from initiatives like This Girl Can, which inspired almost 3 million women to be more active, not by telling them that they need to change their bodies or to take action to prevent life-limiting diseases, but by showing them that a more active life is not only possible but is enjoyable too and encouraging them to take the first step towards enjoying a more active life, whatever their size or circumstances.

When it comes to eating well and having a healthy relationship with food, we think that celebrating the social value of eating together, encouraging people to explore food and ensuring that children see adults eat and enjoy a wide range of foods have much more long-term value than a narrow focus on demonising “junk food”. Parental role modelling of both a healthy balance of foods and a healthy relationship with food has consistently been shown to improve dietary variety.

We think it’s time to change the conversation on children’s weight and we call on you to:

Focus on health improvement rather than weight management – frame your message in a weight inclusive manner that promotes wellbeing for all.

Promote body acceptance and diversity which will lead to people feeling better about themselves and may make it more likely that they will engage in health promoting behaviour whilst also supporting their mental health

Advocate more strongly for reductions in underlying socioeconomic disparities that limit people’s lifestyle choices and lead to health inequality (access to adequate income, jobs, education, housing and food).

Sincerely,

Laura Thomas, PhD, RNutr., Sarah Dempster, RNutr., Helen West, RD., Rosie Saunt, RD.