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Changing the cultural context of obesity

Posted by: , Posted on: - Categories: Health and Wellbeing, Reducing the burden of disease, Social marketing

Obesity can sometimes be hard to spot, even though it’s all around us. Take parents, who think their child is about the right weight, even when the child is actually overweight or obese – this happens to nearly one in four parents, according to the 2012 Health Survey for England.

The increased prevalence of obesity, compared with earlier decades, can have an insidious effect. If enough people around us are overweight, it may start to look normal. Academics have even mapped out the ways in which obesity could spread through our social networks, as friends and families influence certain health behaviours.

How do we change this? We know that the obesity problem is complex, driven by a cocktail of environmental factors which, combined, push us towards eating too much and exercising less. It’s important to address these factors – such as town planning and transport – as well as taking responsibility, as individuals, for eating healthily.

But I think as Public Health England (PHE), we have an even broader challenge on our hands: we have to help shift the social norms around weight. We need to challenge the perception that obesity is inevitable, and match this with effective support for those who want to lose weight. What does this look like in practice?

Our Change4Life social marketing campaign is a key part of this, and it’s been very successful at engaging with families: one million have signed up and have said it’s helped them to change their behaviours around food and exercise. The scientific principles that underpin the campaign reflect current insights into what helps to change behaviours: breaking down change into manageable, concrete and motivating steps (such as “Smart Swaps”), which can help to build confidence.

Another major role for PHE is to work with our local partners on a system-wide approach to tackling obesity. An important contribution to this will be the peer challenge programme, and the module on child obesity that we’re developing together with the Local Government Association. This will involve teams of practitioners and peers, working on site with local councils and partners, helping them to take stock of their progress and sharing the expertise of specialists as well as best practice from elsewhere.

We’re hoping to run three peer challenge pilots before the end of March to test and refine the process and work is well underway in developing the methodology and key questions for peer visits – addressing different aspects of childhood obesity agendas, such as leadership, evaluation, strategy. We know there’s a lot of enthusiasm in local authorities for this kind of support, and we’re hoping the pilots will provide us with a strong basis for more visits in the following year. Ultimately, the hope is that these efforts will become self-sustaining, and it’s with that in mind that we’re planning peer training at Warwick University next month – open to directors of public health, relevant PHE staff and others in local authorities.

Finally, we have to work with other parts of the health and social care system to amplify our public health message on obesity and healthy weight. Doctors, and GPs in particular, play a crucial role here. As this week’s report “State of the Nation’s Waistline” highlighted, GPs are in an ideal position to offer effective advice to overweight patients and support them to achieve – and sustain – a healthy weight.

That’s why PHE is supporting the Royal College of General Practitioners in developing a learning package for GPs and other NHS primary care professionals. The course aims to improve skills and knowledge in managing obesity.

These initiatives are part of our ambition to change the broader cultural context of obesity. We need to be confident that we can support individuals who are struggling with their weight with effective, evidence-based interventions, just as we do with smoking cessation. And maybe one day, academics will publish papers that show how these interventions can catch on and spread through social networks, as extended families and friends pass on the habit for healthy eating and exercise to one another.

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  1. Comment by Bren posted on

    Hello Kevin, Thanks for this great blog. I think the title cultural is the key and to be realistic about timescales for change. I think we also need to get the balance right with change and not stigmatising people, it is, as your blog says, confidence/growing the person's confidence with honest and positive messages, and positive support for the person.

    Best wishes,


  2. Comment by Lynne posted on

    Excellent article. I completely agree that health worker's interventions can have a positive effect on changing behaviours, however I feel that as an obese person myself, many doctors haven't recognised that one of the reasons so many middle aged women like myself are overweight and obese is because we have no time left for self-care. We know the rules. We all know how to eat and exercise. We also are very well aware we are fat because we can see it quite clearly! We are often looking after so many other people with no support, running homes and working that we prioritise everyone else because there is no-one else to do the caring, and self care is yet another pressure. A health worker ADDING to the pressure by putting pressure on the person to lose weight is not going to be helpful. Rather, taking the time to get to know the person and what goes on in their life would take the pressure OFF a little bit, allowing the person to consider self care for themselves. I think it would be helpful if health workers kept that in mind when addressing changing behaviour.