Are we normalising obesity?

36% of UK adults think they are simply overweight when they are actually clinically obese. Being overweight involves a reference to those around us, and as the world is getting fatter, it's more difficult to notice the problem

(Corbis)

Since the 1980’s academics likes me have been complaining about the use of extremely thin models in the media as they can lower self esteem, encourage unhealthy levels of dieting and even promote eating disorders.

Thirty years later, even though eating disorders remain a big problem, the world has got fatter, with up to a third of the UK population now overweight. Concerns are additionally about obesity, diabetes, joint problems and reduced life expectancy.

This week slimming hypnotherapist Steve Miller commented on size 24 supermodel Tess Holliday: 'The last thing we want to see is a plus-size American barging into UK shores showing us how it's cool to eat junk, eat huge portions and love your fat…Tess challenges the fashion industry's preconceived idea of beauty and believes you can be gorgeous and fat which is ludicrous because fat isn't great - it's dangerous.'

His remarks on her appearance are irrelevant as beauty is of course subjective, but from a health perspective, is it good to normalise being obese, and is it possible to be both obese and healthy?

The new normal?

Parents now struggle to see that their children are overweight as they see them every day, and gradual changes are difficult to see. But they also can’t see their children’s weight problem, as it is no longer a problem if it is considered normal. In an international study published last month, more than a third (36%) of UK adults thought they were simply overweight when they were actually clinically obese.

The World Health Organization (WHO) regards childhood obesity as one of the most serious global public health challenges for the 21st century. They predict that 30% of women and 36% of men will be obese, with a BMI over 30, by 2030.

According to diabetes.co.uk, obesity is believed to account for 80-85% of the risk of developing type 2 diabetes, while recent research suggests that obese people are up to 80 times more likely to develop type 2 diabetes than those with a BMI of less than 22.

Being overweight involves a reference to those around us and if everyone is overweight then bizarrely no one is. And since ‘obesity’ became the domain of the super obese that we see air lifted out of houses on US TV channels, by comparison everyone we know is therefore thin. But not only does normalising obesity mean that we can’t see it, it may also make it more likely to happen.

People change their behaviour when they hit specific trigger points in their daily lives which offer a chance for them to reinvent themselves. For some, these are major life events such as having a heart attack or being diagnosed with diabetes. For others, more subtle incidents can do the trick. Not being able to find a dress to fit, jeans that won’t do up, struggling to fit the plane seat-belt or finding the stairs just too difficult. Making the world more obesity friendly helps those who are already obese to feel less stigmatised and improve their self esteem. And we know that body shaming doesn’t help people lose weight. But as clothes get bigger, seats get wider and lifts become the norm we may be at risk of creating more obese people for the future as we remove those little prompts that tell us ‘maybe it’s time to change’.

Can the obese be healthy?

Obesity is clearly linked to a whole range of health problems and reduced life expectancy. It is also associated with poor nutrition and inactivity. But as with all statistics, this is a matter of risk and probabilities. Obesity is a strong risk factor but not all obese people show all these health problems and not all have poor diets or live sedentary lives.

Several decades ago research in the US explored the impact of being ‘fit’ vs ‘fat’ on health outcomes. The results showed that as predicted ‘fat’ people were more ‘unfit’ and had poorer health. The results also showed that ‘thin’ people tended to be more ‘fit’ and have better health. But surprisingly the ‘fat AND fit’ people were healthier than the ‘thin AND unfit people’. Fat people could be fit and if they were, they were healthier than their thin counterparts. But they needed to be fit and it can be far harder to exercise when you are overweight due to stigma.

Many would agree that it is great to see someone such as Tess Holliday challenge 30 years of unrealistically thin fashion models. It’s also great to see a woman confidently celebrating her body even when she doesn’t match our so called ‘beauty norms’. But this is a time when we need whatever barriers we have to prevent future generations developing the weight problems of the present, so we shouldn't pretend excess body fat is healthy. What we really need are healthy weight people being fit and active and loving the way they are. But until that time comes, maybe by seeing an obese woman out there in the world actively engaged in an active life, those fat unfit people might be able to become the fat fit people and put the thin unfit people to shame for a change!

Jane Ogden, Professor in Health Psychology at the University of Surrey.

Her recent book The good parenting food guide: Managing what children eat without making food a problem is published by Wiley.