News & blog The Weight of Expectation: Q&A with Oli Williams Written by Alan Barker, Freelance Writer, British Science Festival A war has been declared on the ‘obesity epidemic’, but University of Leicester Research Associate, Dr Oli Williams, believes that current health campaigns aren’t working, and that we should take a radically different approach. In the Margaret Mead Award Lecture for social sciences at this year’s British Science Festival, Oli will challenge some of our most fundamental assumptions about what it means to be overweight. He made his case to Alan Barker. Sociologist Oli Williams will examine weight-based stigma at this year's British Science Festival Is it fair to say that we are currently experiencing an obesity epidemic? Well, a lot more people are classified as obese now than they have been previously. That’s certainly the case. But I suppose the more important issues are why this is – what’s driving it – and whether or not obesity should be a public health priority. I would argue that at the moment the most common ways that people think about and act upon obesity are inaccurate and unhelpful. But surely it’s obvious when someone’s overweight? I think people are obsessed with weight loss and that’s a big part of the problem. We know that the BMI scale – which is what your GP uses to categorise you as obese or not – is a very crude health measure. We know that physical activity is a much better predictor of health. For instance, there is good evidence showing that people who are categorised as obese or overweight – but who are also physically active – can experience the same levels of physical health as active people who have a so called ‘healthy’ BMI. So this would suggest that focusing on achieving or maintaining a ‘healthy’ BMI misses the point. Actually, if people are physically active, health can be achieved at all shapes and sizes. So why is the focus on people’s weight and not supporting people to be physically active? So we should be emphasising physical activity rather than losing weight? The focus should be on health, not weight. We should be doing more to make the healthy choice the easy choice for all, by addressing the social factors that largely determine people’s health and behaviour. And we’re not doing that? The approach we take in this country, and in lots of other countries, is to individualise obesity. If you look at the health campaigns – “eat less, move more, live longer” – the focus is weight loss and the responsibility for our health is put on us as individuals. It’s down to you whether you’re obese or not. It’s the most common approach to tackling obesity, and that’s because it’s the cheapest approach – but it’s also incredibly ineffective and unfair. These campaigns aren’t working. If individualising the issue was effective, it would have worked by now. What about taxation? Is the sugar tax going to work? It depends what you mean by ‘work’. This tax – it’s on sugar in soft drinks – is problematic. It seems good in one way, because it puts the emphasis on corporations to reduce sugar levels, and the money generated is to be invested in promoting physical activity. But ideally, you’d want that tax to make no money, because you’d want companies to comply. That would also mean no money for promoting physical activity. What we really need are taxes that generate money that can then be invested in reducing the inequalities that to a large extent determine people’s health. So how do we look at obesity differently? Well, as a sociologist, I can look at the evidence and I can see that obesity is inherently social. We see a clear social gradient in incidences of obesity: the poorer people are, the more likely they are to be obese. So the only way to tackle obesity would be to make poorer people richer? It’s not the only way, but reducing inequality is fundamental. I’m saying that the most effective solutions to obesity at a population level are social ones. Most people know that eating well and doing exercise is good for them. The problem isn’t a lack of knowledge; it’s a lack of capacity to act on that knowledge. And that’s largely socially determined. If you’re at the lower end of the socioeconomic scale, your capacity to choose healthy options is limited or compromised. But we don’t approach the problem socially. We individualise it. And what’s the effect of doing that? Once you individualise a problem, you moralise it. Essentially, you say, “If you don’t eat well, if you don’t move more, then you’re to blame for your own condition, and you’re to blame for the drain you’re putting on the NHS.” Once that blame exists – we could call it ‘victim-blaming’ because it blames people who are victims of circumstance – then we create a stigma around obesity that has a disproportionate and detrimental effect on people who are disadvantaged by social inequality. My research investigates the impact of making people who occupy these social positions feel the shame, the blame, the guilt that’s associated with obesity. And presumably you want to remove that stigma? Of course. I co-founded an art collective called Act With Love and we create work that promotes social justice. Our most recent project is called the Weight of Expectation and explores the social determinants of health and obesity. As part of this project, we created a comic that tells the story of how stigma associated with bodyweight and size gets under the skin and is felt in the flesh. The main message is that people need ‘Support not Stigma’. The Weight of Expectation is at Middleton Hall, University of Hull, on Tuesday 11 September, at 13.00. Book your tickets here.