The recent news that obesity is the new smoking is not so much news, as a new way of saying the same thing that’s been said for years. I understand the chief executive of NHS England – Simon Stevens’ – point, and agree that tackling obesity, as with smoking, needs to be a concerted effort involving producers and advertisers. However, as behaviours go, there’s a huge difference between eating and smoking that needs to be recognised, and that is – we need to eat!
According to the World health Organisation worldwide obesity has more than doubled since 1980. Most of the world’s population now lives in countries where being overweight or obese kills more people than being underweight. How many ways will we frame this problem before changing our approach? Evidently, telling people to “eat less” and “take more exercise” isn’t working.
As a Nutritional Therapist I often meet people who are overweight or obese, or who have diseases directly related to these conditions – or related to a poor quality diet. Usually weight gain in adults is the symptom of a deeper underlying (often emotional) issue. Patients often say they feel unable to control their cravings, sometimes citing feelings of addiction when it comes to particular foods – the Holy Trinity often being doughy products, crisps and chocolate. Whether this is mainly a physiological addiction – or more of a psychological need for gratification – is debated, but it seems both play a role. Other common issues are: defiance, boredom, denial, lack of self-discipline, bad habits, apathy, low self-esteem (often stemming from childhood), stress, depression, relationship woes, work pressures, loneliness, unhappiness, lack of meaning, spiritual emptiness, family stress, use of food as a pleasurable reward, thoughtlessness ….or any combination of these, including others I’m sure I’ve missed. Unlike smoking, eating has an added level of complexity because the drive is so primal. Restricting food intake only increases our desire to eat, trumping conscious control of our intake. The hungrier we are, the more likely it is we’ll choose palatable (high fat, high sugar, high salt) foods.
For an adult, trying to lose weight or admitting to having an “over-eating” disorder can be extremely difficult without recognising the interplay of the above issues – each will be as individual as its owner. Taking time to listen to people and discover how other areas of their lives influence their eating behaviour, as well as fostering a deeper understanding of their own physiological drives, are often overlooked. I believe they are important links in solving the obesity puzzle. How can someone “fix” something if they don’t know where it broke, and why?
My training involved a good deal of listening and open questioning. We were taught to ask about past health history and diet, of course, but also about how the patient feels – and all that this word encompasses in their lives. Also, how much do they understand about the way their bodies and minds work? It’s not rocket science – it’s actually more complicated than that because we’re dealing with human beings and, as listed above, their vast repertoires of emotion and individual experiences.
We’re also dealing with food and someone’s ability to nurture themselves. Depending on how we view it, food can be delicious, joyful and potentially healing or guilt-ridden, forbidden and poisonous. Most of us tend towards the positive end of that spectrum of “good” to “bad” – which is helpful because without food we die.
Self-nurturing is often confused with self-gratification or hedonism. Being constantly told to “live in the moment” may only add to the confusion. For some, being totally in the moment means gobbling an entire family sized bar of Dairy Milk in one sitting. For others it means savouring the taste and texture of one delicious square of Divine 70% dark chocolate.
Acknowledging behavioural complexities always brings someone closer to understanding themselves – and IMHO will always beat handing someone a leaflet instructing them to “Eat-5-A-Day”! Unfortunately, this kind of support takes some time and consistency. Perhaps because of this it isn’t (yet) widely available on the NHS. More’s the pity as it would undoubtedly save money in the long term.
A questioning & listening approach to tackle obesity in children, called Motivational Interviewing, is currently being researched. Motivational Interviewing (MI) encourages the child to think differently about themselves. It fosters self-belief and provides, as the name suggests, motivational support to help them make positive and lasting changes. It often includes education of the parent as well as the child. So far, results from MI have been largely positive. To those of us already using similar approaches this is good news.
Education is key, and can be a great motivator when personalised. Most children could probably guess that doughnuts are not as healthy as tomatoes, but unless it means something to them, it’s just an obvious, boring and irrelevant fact. Again, consistency of messages – and time – are crucial factors.
It’s disheartening that children should have to think about their body size at all. As parents we believe we can shield our children from such grown-up concerns. But we’re often swimming against a tide of negative influences (from the food and advertising industries, TV and other media, friends and family, etc.) that erode our confidence and ability to parent as effectively as we’d like. Sometimes parents struggle with food themselves, unaware that this may be influencing their children too.
For a child it’s even more difficult to deal with weight gain than adults, because although there may well be some underlying issues at play, the biggest problem seems to be a lack of recognition that they are overweight at all! A study in March revealed, parents rarely spot that their own child is overweight or obese, let alone decide to do something about it. This is very worrying.
If you can’t tell whether your child is overweight by looking at them – check their BMI. The sooner you admit there’s an issue, the sooner you can help them. You don’t need to discuss it with younger children at all – but you should start considering action. That may mean looking first at your own attitudes and behaviour around food, and taking it from there. If they’re a teenager raise the issue of weight in the context of health, not looks. Be gentle, but honest. Make sure your partner and other family members are on board – and get professional support if you need it. Overcoming denial and accepting the well established consequences of overweight and obesity on quality – and length – of your child’s adult life are crucial in helping your child take increasing responsibility for their own future health.
As with smoking, simply telling people not to do something because it’s bad for them is unlikely to work long term.
Helping them to understanding the reasons for their behaviour, and motivating them to appreciate good food, their bodies and their lives, probably will.