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How the BBC2 documentary “Obesity: How prejudiced is the NHS?” misses the point about weight stigma.

Judy Anne Swift, with personal reflection from Eve Simmons

A small flurry of excitement rippled through our colleagues last night as we prepared for the BBC2 documentary “Obesity: How prejudiced is the NHS?” I didn’t actually watch until this morning and had purposefully kept away from Twitter beforehand (my favourite colleagues are a sceptical, critical bunch). Weight stigma, particularly among healthcare professionals and researchers, is a subject close to my heart and one which I have researched and presented on many times. I was nervous; this is not a subject that receives a lot of air-time and I dearly wanted the documentary to be sensitively handled and well balanced.

Professor Batterham is clearly passionate about bariatric surgery and it’s potential to improve health, and the shame she felt at being part of a system (the NHS) which serves people with higher weights so poorly, was affecting. Unfortunately, her repeated claims that surgery is “incredibly effective” were not balanced by any real coverage of the risks involved and this clearly rankled some healthcare professionals.

 

We were simply presented with unhappy, unhealthy people before surgery and happy, healthier people who have had surgery. This is shamefully crude, lazy, and actually serves to reinforce prejudice.

Prejudice occurs when people are pre-judged to have certain characteristics, beliefs and behaviours because they can be assigned to some ‘group’. In this instance, the ‘group’ is ‘fat’ and relates to higher bodyweight, but ‘group’ could also reference skin colour, gender, or age.  Common stereotypes about obesity include fat people are lazy, fat people are unhealthy, and fat people are unhappy.

But hang on a minute, isn’t there some truth in this? Isn’t obesity associated with low physical activity and poor health? Perhaps, but this is not relevant. Prejudice does not consider the individual and his/her own characteristics, but instead categorises the person based upon his/her bodyweight. So, fat person = lazy. Regardless of who they are and what they do.

Clearly this blind categorisation doesn’t bear scrutiny – some fat people are not lazy, some thin people are lazy – but it is deeply ingrained and easily perpetuated. The NHS clearly states that we all deserve respect as individuals but the extent to which NHS workers subscribe to negative attitudes was poorly covered. It was suggested that some healthcare professionals are ‘probably’ biased, but this does not represent the extensive literature which clearly demonstrates that even those with the very best knowledge and experience with obesity are biased.

For Professor Batterham prejudice in the NHS relates first and foremost to access to bariatric surgery. It is not for me to judge whether it is right or wrong for a person to choose surgery but at the very least the documentary should have covered the wider fat-shaming that makes it so incredibly challenging to be a larger person in society. When individuals make decisions about undergoing major surgery they take into account the potential benefits and risk, and the desire to ‘fit in’ must surely feature for many.

Professor Batterham’s lament “I can’t understand why we aren’t doing more?” resonates with me. But for me, the question isn’t confined to the availability of bariatric surgery. Why aren’t we doing more about prejudice in healthcare? Research clearly demonstrates that negative attitudes have direct and indirect effects on people’s health. Experiencing negative attitudes and prejudice have been shown to be associated with substandard healthcare and decreased utilization, psychological disorders, poor self-esteem and poor body image, and stress-induced pathophysiology. As a healthcare system, the NHS is there to serve the people and this mean regardless of size. Prejudice has no place. Full stop.

Coming to terms with my own prejudice ~ Eve Simmons

Last night, I recoiled in horror as I watched journalist Amanda Platell embark on a verbal bender in which she insulted, patronised and vilified the entire obese population. Somewhere amidst my utter disgust for the ignorant woman who infiltrated my TV screen, was a sharp sense of guilt. I myself am of course guilty of exactly the same vitriolic schpeil that I accuse Platell of.

It wasn’t until very recently that I was forced to become aware of my own intrinsic thin ideal. You see, you can’t make a full recovery from anorexia without confronting, and quashing, your fear of being fat. After a couple of years in recovery, I’ve given this very issue some comprehensive thought. The first question I asked myself being; what is it about ‘fat’ that is so terrifying? Or, even negative at all? Well, we’re constantly told that being obese is associated with poor health – so maybe it’s the fear of ill-health, and inevitably death, that perpetuates the terror.

Given that I regularly forget to take medication, remain unphased and continue to use factor 10 in the midday Mediterranean sun, I don’t think an overarching concern for my health is the issue here.

As much as it makes me loathe myself to admit it, my fat fear was rooted in one thing only: appearance. And once my fat phobia had set up camp in my anxious, neurotic mind, it morphed into something a little less hard to ‘police’. As the years went by, not did I not want to be ‘fat’, but I also didn’t want to be ‘fatt-er’. Which, in my case, meant any bigger than a size 8. It’s only a couple of years (and a shit tonne of therapy) down the line that I’ve explored the “fear” in depth and come to the conclusion that, of course, it had nothing to do with body image, “fatness” or indeed, food. A deep-rooted aversion to being the odd-one-out and a sheer terror when faced with rejection has left me afraid of the potential consequences of looking “different”. Perhaps, if the world hadn’t joined me in my rhetoric, it wouldn’t have taken me so long to realise that the only thing I had to fear was fear itself. Next time you silently judge someone for being larger than your average person, think about what it is exactly that you find so aversive. Chances are, it’s probably yourself.

Marmite for the mind?

Marmite, I bloody love the stuff. On toast, on crumpets, on scrambled egg (because I wasn’t keen on eggs as a child), on a teaspoon, as a hot drink. Love it. But I am under absolutely no illusion that it will prevent dementia. And to be fair, nor should anyone based on the ridiculously overblown media storm today (link).

I don’t want to accuse the authors of making false claims because they haven’t, but it seems that once again, the media has taken genuine research findings and twisted them horribly. This is the claim as stated in the abstract:

“we found that the neural response to visual patterns was reduced in individuals who consumed a yeast extract product rich in substances associated with the production of GABA (glutamate and B vitamins), but not in a control group who consumed a placebo substance (n = 14 per group)”

GABA (gamma amino butyric acid) is an inhibitory neurotransmitter, i.e. it has a ‘calming’ effect on the brain. Alcohol binds to GABAreceptors, so do benzodiazapines such as valium. The reason I say that this story is not news is that vitamin B12, present in high levels in yeast extracts like Marmite, is known to increase GABA levels (e.g. https://www.ncbi.nlm.nih.gov/pubmed/9249572), so the findings of this study should come as no surprise. It is perhaps more interesting that they managed to produce a placebo version of Marmite (apparently they used peanut butter, which in my opinion is no sort of substitute).

What is a surprise are the outlandish claims in the press claiming that this would have any affect on dementia, apparently not even mentioned in the research paper. As a scientist I find the misreporting of research really frustrating as it diminishes the impact of genuine scientific breakthroughs and leads to confusion and mistrust by the public.

Marmite is a fantastic food, but it is certainly no medicine for treating dementia.

By the Nourishment Network’s Katie Heath PhD – Biomedical scientist and pedant. Obsessive about the importance of evidence based medicine.

Bitter Sweet

Bitter Sweet: How Artificial Sweeteners Are Not Acceptable Alternatives to Sugar

In the war on the nation’s sugar intakes, public health officials and the Government have placed voluntary reformulation at the heart of their activity. However, new research from Dr Judy Swift’s research team at the University of Nottingham has demonstrated that public perceptions do not necessarily align with these public health messages.

All artificial sweeteners – the industry prefers to call them low calorie sweeteners – used in food production in Europe today have been subjected to rigorous safety testing, and are used in a wide range of foods, drinks, and even medicines.

Diet versions of fizzy drinks (referred to a sugar-sweetened beverages by researchers) are endorsed by health experts to encourage weight loss as they offer a useful compromise when tap water is unacceptable. Furthermore, current advice from Public Health England is to make ‘food smart swaps’ such as chilled deserts to sugar-free jelly, and fizzy drinks to juice-drinks (no added sugar).

However, research carried out by Dr Swift and her team suggests that artificial sweeteners are not considered a healthy choice.

In one study , which utilised data from digital spaces including open forums on Mumsnet, artificial sweeteners were described as “fake” and “far worse than sugar” while others stated that “I’d rather sugar than artificial sweeteners…” In addition, a strong theme emerged around distrust of the public health officials, the Government, the food industry and retailers in relation to public health sugar reduction efforts. {Update 05/04/17: a manuscript detailing this research is currently under review, Swift JA, Strathearn L, Morris A, Townsend T, Pearce J. Public perceptions of the United Kingdom’s public health sugar reduction efforts in digital spaces: a mixed methods study. Journal of Human Nutrition and Dietetics.}

In another experiment, which allowed participants to select from a range of different product scenarios, artificial sweeteners were considered unhealthier than sugar, maple syrup and honey:

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This is perhaps unsurprising as we have a tendency to favour the natural over the artificial; the ‘wisdom of nature’ heuristic. After all, nature is the result of eons of natural selection and therefore must be perfectly adapted.

It does, however, mean that innovations by the food industry may not be as well received as anticipated. It also underlines just how important it is that the health experts work with the concerns of the public when seeking to change behaviour, regardless of whether they agree or not.

Judy Swift, 29th March 2017

The Nourishment Network

Hello.

Welcome to the Nourishment Network. Thank you for finding us.

The idea of this blog, and the website in general, is to provide sensible, balanced information about nutrition, in a way that relates to how people actually eat. The Nourishment Network is a loose collaboration of academics, writers and food professionals, all of whom believe that a counterpoint is needed to the reductionist, risk management narrative that dominates the food and health agenda.

In our modern lives, we are bombarded by a huge amount of information about diet, telling us what we should eat, when we should eat it, and what hidden dangers lurk within our everyday choices. Yet despite this deluge, even experienced professionals struggle to give out definitive, consistent advice about what ‘healthy’ actually means. Although the scientific community and public health professionals endeavour to provide evidence based information, often the sheer volume of sometimes conflicting advice only leaves people more confused. What is sometimes forgotten is that people consume different foods for a variety of reasons, and it is completely unrealistic to expect every choice to be made with long term health in mind.

To make matters worse, public understanding of nutrition is clouded by a great deal of superstition and myth. Despite what many people think, food is not medicine, we are not what we eat, lemons do not detoxify your body, and sugar is not more addictive than cocaine. Although diet and health are certainly connected in many ways, we are a magnificently omnivorous species, capable of sustaining ourselves perfectly well on a variety of different diets. Often, carefully monitoring and controlling our micro/macronutrient intakes may well be of less value than just embracing a number of different foods. Striving to eat a varied, enjoyable and interesting diet is a simple piece of good advice that has been lost over the years, and when it comes to eating well, it is perhaps one of the most important.

The reality is that for many of us, our daily food choices are more about pleasure and sustenance than they are about long term health. Any advice about food will be of far greater value if it is given out with that in mind. The Nourishment Network will attempt to do this, drawing on the knowledge and opinions of our network of academics, chefs, writers and food professionals. We will try to cut through the overload of information, celebrate the joy of eating, and help calm some of the anxiety that our media’s obsession with health strives to create.

The next time a tabloid headline screams at you that an everyday food choice causes cancer, heart disease or dementia, this is the place for sensible answers and comment. And the next time someone is promising a miracle superfood that will transform your health if you eat it everyday, we will help calm some of the confusion and noise.

More than anything, we firmly believe that how and what you eat is your choice alone. Guilt and shame have no place in a healthy diet and they are certainly not welcome here. Unlike many sources of nutrition information, we promise never to judge anyone for their choices, their appearance, or the state of their health. All we want to do is keep you informed and aware, whilst remembering that pleasure and joy are the most important ingredients in any good relationship with food.

Anthony and Judy