Changing conversations about overweight and obesity

Maria van der Merwe, president of ADSA (Association for Dietetics in South Africa) says, “We can see from these outcomes that there’s a need for South Africans to shift societal perspectives on overweight and obesity and to start having different, better conversations about these serious conditions. For too long, a simplistic, and ultimately damaging, ‘calorie in- calorie out’ view has dominated the discourse. There’s also been a narrow focus on short-term weight loss interventions that research now proves, are not sustainable solutions. Overweight and obesity are complex issues; a convergence of biological, environmental, and behavioural factors that require a holistic response and can only be addressed effectively by multiple strategies. Simply telling people to ‘eat less and move more’ is completely ineffective. Trying out diet after diet, with your weight going up and down, is not healthy for your body or your mind. Shaming people who struggle with achieving a healthy weight and maintaining weight balance only harms them, it never helps. This is why, as a nation, we need new ways of thinking and talking about overweight and obesity.”

Healthy weight comes in many shapes and sizes

For a long time, the media and the multi-billion global diet industry have fed the perception of thin as the ideal body image for women and promoted unrealistic standards of beauty. This is increasingly being challenged, and there’s wider recognition of concepts such ‘Healthy At Every Size’ (HAES). Van der Merwe says, “Your best weight is not the thinnest you can possibly be, at whatever cost to your well-being. The focus needs to shift from indicators such as achieving a low BMI (Body Mass Index) to improving health, well-being and quality of life. The HAES movement recognises that people of all shapes and sizes can be healthy, and that your weight or BMI does not determine your health. With this perspective, you take the focus off achieving a ‘goal weight’ and put it on adopting healthy behaviours such as eating balanced meals based on a variety of whole foods, getting sufficient sleep, managing stress and enjoying being physically active. Another important aspect of concepts such as HAES is recognising that weight stigma and discrimination are damaging to people who are overweight or obese.”

Why the ‘fat-shaming’ has to stop

Research shows that people who are overweight and obese experience a range of detrimental impacts due to a range of discriminations that arise from stigma and bias. These impacts include high rates of depression and anxiety, social isolation, reluctance to access health care, avoidance of physical activity and chronic stress. “It’s particularly important to note that discrimination can inhibit people from accessing the medical care that they might need,” says Van der Merwe. “People who are overweight and obese fear being stigmatised including within the healthcare system and this leads to delayed diagnoses, delayed treatments, and poor adherence to treatments. We must strive for more supportive and inclusive environments, from playgrounds and workplaces to the doctors’ rooms and clinics. This means letting go the harmful and erroneous stereotypes and refraining from making judgements based on bias, not facts. For instance, obesity is a medical condition affected by several factors including genetics and metabolism. These are biological factors that have nothing to do with the willpower or the character of a person.”

The way forward

Recognising the complexity of overweight and obesity is key to South Africa developing improved strategies to reduce the prevalence of these conditions. Van der Merwe concludes, “There are many factors that need to be addressed such as improving access to healthy foods and empowering people to make more healthy eating choices. We need safer neighbourhoods and more resources so that all South Africans can easily include physical activity in their lifestyles. We need improved access to quality healthcare, including mental health services. On a personal level, we can embrace concepts such as ‘Healthy At Every Size’, and contribute to supportive and inclusive environments for people who are living with overweight and obesity.”