The shape of the future

What will your future hold?

            Will you be rich?

            Where will you live?

            What will your house look like?

            Will you have (grand-) children?

            And… Will you be obese?

Figure 1: Gain-Fantasy trade by BrokenCassette (http://brokencassette.deviantart.com/art/Gain-Fantasy-trade-200018366)

According to latest predictions released by the World Health Organization (WHO) at this year’s European Congress on Obesity (ECO) in Prague (Czech Republic), Europe will face a big obesity crisis by 2030 (European Society of Cardiology, 2014; Breda et al., 2015). These (so far unpublished) estimates are based on data from all 53 countries that compare the percentages of overweight (body mass index [BMI] over 25kg/m2) and obesity (BMI over 30 kg/m2) for both males and females in 2010 with the estimated levels of 2030[1]. In almost all countries the proportion of overweight and obesity in males was predicted to increase between 2010 and 2030. A few of those estimates indicate that the proportion of overweight and obese individuals is estimated to reach 75% in UK and 80% in Czech Republic, Spain and Poland. The highest calculated proportion of overweight and obesity was calculated for Ireland, in which 90% is estimated to become overweight or obese. The lowest proportions of overweight and obesity were estimated to occur in Belgium (44%), and the Netherlands (47%; European Society of Cardiology, 2014; Breda et al., 2015). One of the most impacting findings was that no ‘plateau’ in adult obesity rates throughout Europe could be found, as the increase in obesity levels seem to persist up until 2030 (Breda et al., 2015).

The need to prevent more individuals from becoming obese causes great social pressure. It conveys the message that being overweight or obese is not acceptable (Tomiyama & Mann, 2013). Avoiding becoming obese is already a priority for the general population. Research showed that among individuals who had lost at least 100 pounds after a gastric bypass surgery, nearly all reported that they would rather be blind or deaf than overweight, and all participants would give up being a multimillionaire if they could be of normal weight instead (Rand & Macgregor, 1991). So when imagining your future at the beginning of this article, it is very likely that most of you imagined being of normal weight (or even thin), and by no means thought of being overweight or obese in the envisioned future, even though statistically a large amount of us is headed that direction.

The strong social pressure to avoid being overweight or obese causes something called ‘fat shaming’. It means that being ‘fat’ is portrayed as a shameful thing, and is being made fun of. It is basically a form of discrimination against those who are overweight or obese. And although it has been studied less, weight stigma has been reported to be more socially acceptable, more severe, and in some cases more prevalent than racism, sexism, and other biases (Brochu & Esses, 2011; Puhl & Heuer, 2009; Tomiyama, 2014). Overweight individuals are negatively stereotyped, and commonly perceived as lazy, lacking in willpower, lacking in control, and unattractive (Brochu & Esses, 2011). And this is not only a common bias in adults: children as young as three years describe overweight children as “mean,” “stupid,” “lazy,” and “ugly,” (Cramer & Steinwert, 1998) and obese children are 1.6 times as likely to be bullied as children who are not overweight (Fogelholm, 2010).

One model, called the COBWEBS model (cyclic obesity/weight-based stigma) represents weight stigma as a “vicious cycle,” in which the stigma is perceived as a stressor and is likely to cause weight gain in the long run. Dealing with the stigma causes stress, which is oftentimes dealt with through coping behaviour, such as the release of cortisol (a stress hormone that promotes fat storage and eating), and increased eating behavior (Tomiyama, 2014) to deal with the negative emotions. This causes the individual to gain weight, which then exposes individuals to greater experiences of weight stigma, thus triggering the vicious circle of the COBWEBS model (Tomiyama, 2014). In other words, this means that once individuals fall prey to weight stigmatization, it is likely to cause a vicious cycle in which weight and stigmatization increase over time. Given the high prevalence of overweight and obesity, now and in the future, the processes governing weight stigma have the potential to affect millions of people (Tomiyama, 2014).

In all of the previous, one important health implication is ignored, which is that overweight individuals can actually be healthier than lean individuals. Weight and BMI are both not perfect measures of health. There even is evidence that obese individuals who are physically active have lower all-cause and cardiovascular mortality risk than sedentary, normal weight individuals (Fogelholm, 2010). Overall, of course, if we can prevent overweight or obesity from occurring, and prevent the 2030 crisis from happening, this is of great priority. But as a community we should ensure that we’re not trying to prevent weight gain from happening by shaming the fact of becoming fat. It is by no means an adequate public health intervention. The stigma can cause great stress and harm, and cause an individual to fall for the vicious cycle of weight gain and weight-based stigma. Instead we should promote healthier living by improved nutritional choices and increased physical exercise, less stress and more social support. This could, even in the absence of weight loss, improve the individuals’ health, regardless of their current- or future weight.

References:

Breda, J., Kiaer, T., Webber, L., & Kirby, T. (2015). Proportion of overweight and obese males and females to increase in most European countries by 2030, say latest projections by WHO. [PDF document]. Retrieved from: http://nhfshare.heartforum.org.uk/RMAssets/NHFMediaReleases/2015/ECO2015WEDSPRESSWHO4.pdf

Brochu, P. M., & Esses, V. M. (2011). What’s in a name? The effects of the labels “fat” versus “overweight” on weight bias. Journal of Applied Social Psychology, 41, 1981–2008.

Cramer, P. & Steinwert, T. (1998). Thin Is Good, Fat Is Bad: How Early Does It Begin?.  Journal of Applied Developmental Psychology, 19, 429-51.

European Society of Cardiology. (2014). Adult obesity predicted in almost all European countries by 2030. ScienceDaily. Retrieved May 27, 2015 from www.sciencedaily.com/releases/2014/05/140509110711.htm

Fogelholm, M. (2010). Physical Activity, Fitness and Fatness: Relations to Mortality, Morbidity, and Disease Risk Factors. A Systematic Review. Obesity Review, 11, 202-221.

Puhl, R. M., & Heuer, C. A. (2009). The stigma of obesity. A review and update. Obesity, 17, 941–964.

Rand, C. S., & Macgregor, A. M. (1991). Successful weight loss following obesity surgery and the perceived liability of morbid obesity. International Journal of Obesity, 15, 577-579.

Tomiyama, A. J., & Mann, T. (2013). If shaming reduced obesity, there would be no fat people. Hastings Center Report, 43, 4-5.

Tomiyama, A. J. (2014). Weight stigma is stressful. A review of evidence for the Cyclic Obesity/Weight-Based Stigma model. Appetite, 82, 8-15.

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[1] It must be noted here that, of course, the quality of the estimates depends on the quality and availability of the provided national data.