Tackling a weighty issue - Diabetes WA
 In Blog, Frontpage, Health, News

Picture: Obesity Action Coalition.

When it comes to talking about obesity, it is often tarred by stigma and negative connotations. According to The Obesity Collective, which advocates for better understanding for the overweight and obese community, there is a common misconception that obesity is the result of laziness and lack of self-control.

Obesity it is not a lifestyle choice and doesn’t come down to a lack of willpower — rather it is a serious and complex health issue that can stem from genetic, biological and societal factors.

In 2018, it was estimated that around 70 per cent of WA adults live with overweight or obesity, while one in four WA children were overweight or obese.[1] The rate of adult obesity in WA has seen a steady rise from 21 per cent in 2002 to 32 per cent in 2018.[1]

If the overweight and obese population continues to climb at current levels, the predicted costs to the WA health system will jump by 80 per cent in the decade between 2016 and 2026 from $338.7million to $610.1million. [1]

But when it comes to the challenges faced by people living with overweight or obesity, it is far more complex than just the health costs that can arise from carrying excess weight.

Living with overweight and obesity: what are the biggest challenges?

Weight stigma is a form of discrimination, where a person feels judged, ashamed, guilty and blamed for their size or weight.

Sadly, weight stigma – sometimes known as ‘fat shaming’ – is widespread and more often than not, people don’t realise they’re doing it.

La Trobe University Associate Professor in Psychology Dr Leah Brennan says the prevalence of weight stigma is rising just as fast as the rates of overweight and obesity.

“We know weight stigma is very prevalent,” Dr Brennan says. “You might think that rates of overweight and obesity are increasing, but the stigma might be decreasing, but actually it’s the opposite. At the same time as weight has increased across the population, the experience of weight stigma has also increased.

“I think it’s really tricky because I think on the one hand, we do have that message that obesity is the result of complex factors and the vast majority of those factors are out of the control of the individual.

“That message is starting to spread more broadly, but it does conflict with the other messages that we get about taking personal responsibility for our weight so I think even our public health system hasn’t quite worked out how we’re going to balance those two messages, so I think it’s hard for the general public to make sense of that as well. So I think that it’s a contradiction that people are trying to navigate.”

Dr Brennan adds that people with overweight and obesity experience weight stigma in various facets of their lives.

“We know that it occurs in medical settings, educational settings, employment settings, and even amongst family and friends, as well as out in the general public,” she says. “It’s also really easy to see examples of stigmatising situations on TV shows, in advertising – so we are bombarded with stigmatising messages about weight all the time, to the point where we don’t even notice it much anymore, because it’s become so normal.”

When it comes to public health campaigns that focus on tackling obesity using the confronting and graphic scare tactics often used in ‘quit smoking’ campaigns, Dr Brennan believes a softer approach is far more effective.

“While people may feel like stigmatising someone will motivate them to change their behaviour and lose weight, research shows the opposite to be true,” she says. “People who have been stigmatised are much less likely to be able to make healthy changes in their life. Making people feel bad about themselves and about their bodies is not a healthy way to sustain healthy behaviours.”

When it comes to taking a person-centred solution to tackle the rising rates of obesity, Health Consumers’ Council WA Engagement Manager Clare Mullen says that developing a supportive approach that understands where the individual is coming from is pivotal.

“It’s important for people to be active participants in discussions about what’s going to work for the individual, and how different peoples’ experiences might be,” Ms Mullen says. “It’s also recognising the really important fact that, we’re in an obesogenic environment, and so it’s about trying to support people who want to take action but also recognising how challenging that can be when their environment makes it very difficult.”

In 2018, Ms Mullen led a consumer engagement project, Is weight a weight on your mind?, which included a survey and call out for personal stories, which sought to explore peoples’ experiences with taking action to lose weight, and how they could be better supported by the health system to achieve their weight loss goals.

Results from the anonymous online survey – which received around 800 responses – showed that 66 per cent of participants had taken action to lose weight more than twice in the past year, with more than 40 per cent making five or more attempts.

The survey results also suggested that there are a lack of affordable weight loss options and services available, which became a barrier for people to lose weight.
“I wasn’t surprised by some of the feedback we received about weight stigma,” Ms Mullen says. “I do think that it’s an important part of how we move forward, because I think that stigma can act as a barrier to accessing health in the first place
and also to continuing to access the right support.

“I think that overweight and obesity is something that is really misunderstood at a community level, despite the fact that it impacts so many of us in the community. One of the strongest insights we took away (from the engagement project) is that this is very individual. What I was really struck by is that it’s very complex with a whole range of factors.

“I know there are some conversations happening about how there can be training for health professionals in approaching the topic of weight, and I guess we’ve heard, anecdotally, about a whole range of experiences.

“Some people say ‘I’m really overweight and no one has ever mentioned it to me’, and other people might say that a health professional tells them they need to lose weight, but then they’re not able to offer them practical support on how the person might do that.”

Clinical trials have shown that total meal replacement diets produce twice the amount of fat and weight loss in half the time than diets based on healthy eating[2]. Despite achieving rapid weight loss of around 10 to 30kg between six weeks and four months[3], total meal replacement diets have developed a reputation as being easy to follow initially, partly due to the fact that it can be effective in controlling hunger.[4]

But the addition of behavioural support strategies as part of a supported total meal replacement approach has been shown to better sustain the achieved weight loss between one to three years later compared to food-based diets[5].

“Very low calorie diets (meal replacements) have been used by many individuals to successfully lose weight,” Diabetes WA Dietitian Sheryl Moore says.

“This is because, put simply, total meal replacements are designed to be a straightforward exchange for the meal that a person would normally choose. This is a simple swap which can be relatively easy to do so for a short period of time.”

Looking at this evidence, the Committee recommended that the State Government looked to the results of the UK’s National Health Service (NHS) subsidised meal replacement program for people at risk of type 2 diabetes, and also believes this approach should be formally offered to Western Australians as an option to manage their type 2 diabetes.

Click here to read more about Diabetes WA’s person-centred supported total meal replacement pilot project.

1. The burden and cost of excess body mass in Western Australian adults and children report
2. Seimon et al JAMA Network Open 2019
3. Maston et al Behavioural Sciences 2020
4. Gibson et al Obesity Reviews 2014
5. Seimon et al JAMA Network Open 2019; Franz et al Journal of the Academy of Nutrition and Dietetics 2007.

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