This is Part 3 of my Obesity in the UK series. If you missed Part 1, or Part 2, you can find them by following the links. 🙂 Like part two, this part addresses causal factors but with a greater emphasis on some indirect causes.
Beliefs, Perceptions and Stigmatisation
There is evidence to support that a potential driver of obesity is the failure of obese persons, or parents of obese children, to recognize themselves or their child as obese. In short, weight perceptions among obese adults in Britain do not match clinical definitions of obesity. Most obese adults do not describe themselves as obese. Another study of 2976 English children found that a third of parents underestimate their child’s BMI.
As more people in the community grow into the category of obesity, perceptions of “normal” for everyday Britons may be increasingly swayed. Even teenagers, were not immune to this warped self-perception in terms of weight: 39% of overweight teenagers described themselves as “normal”.
At first glance, these findings seem almost counterintuitive. However, in a society that stigmatizes obesity, it is no surprise that many do not wish to recognize themselves as “obese”.
Moreover, overweight and obese individuals who reported experiencing fat stigmatization gained 0.95kg over a year. In an image-obsessed world, many people are experiencing stigmatization due to their weight. Thus, paradoxically, this cruel, “skinny-culture” may be a factor driving more overweight individuals towards obesity.
At first glance, higher levels of obesity among low-income groups may too seem counter-intuitive. However, in the UK, as in many other high and middle-income countries, this is the case.
There is an existing or emerging inverse relationship between income and obesity. Attempts to explain these trends follow the assumption that in high and middle- income nations, the vast majority of the population is able to afford to be adequately fed. Thus, a very negligible proportion of the population will be underweight due to an economic inability to access food. What may be significant in understanding this is how socioeconomic factors drive the types of food that individuals and families consume on a regular basis.
Whilst the prevalence of childhood obesity and overweight in the UK has stabilized in recent years, children from the lowest socioeconomic groups have continued to exhibit increased levels of overweight and obesity in comparison to their counterparts from other socioeconomic strata. The outlook is similarly bleak for low-income adults. This points to the importance of appropriate education on diet. According to the HSE, lower income women exhibited a higher proportion of obesity: 26% – 31%, as opposed to 15% – 18% in the highest income quintiles. Men in the lowest income groups were also more likely to be obese: 29% – 30% were classified as obese, versus 23% – 24%.
Urbanization is shown to have an effect on diet. In a study examining obesogenic environments, it was found that individuals in the most deprived areas consumed significantly fewer portions of fruit daily; as did those living in densely populated environments. According to the World Bank, in 1985, 78% of people in the UK lived in urban areas, versus 82% today, a percentage that is expected to increase.
Furthermore, energy-rich, processed foods are cheaper to produce and thus cheaper to purchase. Many are increasingly marketed towards children from a young age. These subtle lifestyle changes may be driving many Britons transition into overweight and obesity, resulting in continued increased incidence.
Slightly distinct from the factor of income is that of income inequality. Studies show that national income inequality is associated with higher BMIs within obese populations, lower life expectancy and other negative health and psychosocial outcomes. It is theorized that life near the bottom of more hierarchical societies, such as the USA, results in higher levels of psychosocial stress than in more equal nations, such as Sweden.
Compared to many other high-income countries, the United Kingdom has a very high level of income and wealth inequality. Moreover, the gap growing: between 1985 and 2010 inequality rose by almost 25%, making the UK the most unequal country in Europe.
Thus, growing inequality may be one of the primary factors driving growing waistbands.