Is ignorance of obesity really bliss? My story of bias

I started a journey at the start of this year with obesity which has consumed me in many respects. It started with a seemingly innocent encounter with an article in the Guardian newspaper. The general theme of this article was ‘how to get your mind, body and soul in tip top condition’. It resulted in my developing a programme and a research process which involved a mix of Talk Therapy, Fitness Training and Nutritional Therapy (https://www.trifactorhealth.ie/).

While I learned a lot during the process of research on Tri-Factor, what has mostly caught my attention during this year was obesity. In part this was due to the nature of some of the people we worked with in Tri-Factor, so I simply couldn’t avoid the subject matter.

I confess 100% that I was completely ignorant about obesity. Worse still, I will put my hand up that I had a fixed set of assumptions about people who are obese. Top of my list of biases was that it is a ‘lifestyle choice’, that all people with the condition choose to be in that place. And what usually accompanies that type of ‘black and white’ thinking is that it is easy to close the door and adopt an ‘us and them’ position. Curiously enough, that’s a disassociation place I have found myself on occasions in some of the encounters with the dispossessed and marginalised of our society when I have been offering help – with prisoners, with those with a drug addiction, with the homeless. I have been told that one of the processes of Heracles is uncovering areas which you didn’t know about before – but it’s galling to be faced with the truth of your own shortcomings.

The last year has served to inform me about obesity and some of the main findings of my research are as follows:

• The increase in obesity worldwide will have an important impact on the global incidence of cardiovascular disease, type 2 diabetes mellitus, cancer, osteoarthritis, work disability, and sleep apnea. (The latter point of sleep apnea was a real wake-up call for me to the potential killer that is obesity.)
• Research findings in Ireland suggest that disadvantaged communities have a higher incidence of obesity than their more advantaged peers and this applies to both adults and children
• There is a strong link between trauma, or Adverse Childhood Experience (ACE) as defined by the World Health Organization, and obesity. Adolescents coming from low income families who have experienced ACE are more likely to experience obesity, and thus the related longer term impacts on metabolic health into adulthood
• Childhood adversity is common across sociodemographic characteristics, but some individuals/minorities are at higher risk of experiencing ACEs than others. 
• Mental illness is a common comorbidity of obesity, meaning that if you have obesity, you are more likely to experience a challenge with mental health. Thus, people with obesity are more likely to experience depression etc. And obesity has a more pronounced impact on morbidity than on mortality – cold comfort for change, as the song goes.

And on it goes, and there’s plenty more where that comes from if anybody is interested…the truth be told, obesity is, instead of being a lifestyle choice, better seen a chronic disease which likely will require a lifetime of active management by those who are afflicted. It impacts different social groups differently, and I had the extreme good fortune to come from a privileged, educated group where I had a much better than average chance not to be obese. Another example of post-code lottery and being on the right side of the fence.

I confess that I never realised that, much like the climate change debate, that obesity is very much an issue of social justice and it will not improve without all elements of society deciding that something better is required. The best example of a system-wide, societal-change, model in the area of obesity is the Amsterdam Healthy Weight Programme which has resulted in materially lower levels of obesity among children.

And my response to my own prejudice on this matter? Well, I am now offering a psychotherapy clinic for those with obesity, paying particular attention to the link with trauma and adverse childhood experience. I continue to offer a wider intervention with others within Tri-Factor as mentioned earlier. There is also the possibility of continuing to develop research in the area going forward. And I will continue to advocate publicly for those with obesity, so that they do not get forgotten by ignorance, prejudice and bias, well knowing, as in my own case, how easy a position that is to adopt.

Is this enough? Will it serve to make any difference at all given the scale of the challenge? I have gotten to a position of some knowledge and understanding which I think warrants a response of sorts. Anyhow, I have planted a flag and I invite a response from anybody who reads this article. Thank you for your attention.