Do weight perceptions among obese adults in Great Britain match clinical definitions? Analysis of cross-sectional surveys from 2007 and 2012

Fiona Johnson; Rebecca J Beeken; Helen Croker; Jane Wardle

doi:10.1136/bmjopen-2014-005561

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Do weight perceptions among obese adults in Great Britain match clinical definitions? Analysis of cross-sectional surveys from 2007 and 2012

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Re:Is self-identification as 'obese' really a public health solution?
Fiona Johnson
Published on: 3 December 2014
Is self-identification as 'obese' really a public health solution?
Ian Brown
Published on: 19 November 2014

Published on: 3 December 2014
Re:Is self-identification as 'obese' really a public health solution?
- Fiona Johnson
- Other Contributors:
  Jane Wardle
Dr Ian Brown rightly highlights the potential dangers of an atmosphere of stigma around weight, and suggests that rejection of the term 'obese' may be protective of body self-esteem (1). This is an important point, as the term 'obese' is clearly perceived as stigmatising by many, and perceived stigma has been associated with poorer weight outcomes as well as psychological distress (2). However, our perspective is that...
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Dr Ian Brown rightly highlights the potential dangers of an atmosphere of stigma around weight, and suggests that rejection of the term 'obese' may be protective of body self-esteem (1). This is an important point, as the term 'obese' is clearly perceived as stigmatising by many, and perceived stigma has been associated with poorer weight outcomes as well as psychological distress (2). However, our perspective is that the specific terminology used to discuss body weight may be less important than there being a common language shared between health professionals, the research community, media and the public. At present, clinically descriptive approaches to weight classification are severely out of kilter with the way in which the public perceives body weight, which must impede individuals' ability to access information and make informed decisions about their own health and lifestyle.
Meanwhile, a valuable asset in tackling weight stigma could be a far greater public understanding that there is no level playing field when it comes to body weight. It is well recognised in the research community that there are strong genetically-mediated predispositions that mean that some individuals are more susceptible to weight gain, and make the challenge of weight management in an obesogenic environment far greater for them. This fact does not seem widely understood by the public or discussed in the media (3, 4), and greater awareness of this could contribute to less judgemental (and self-blaming) attitudes towards difficulties with weight control (5).
Ultimately the best solution to the problem of high levels of population obesity lies in reversing the trajectory of the food environment, but progress toward this is minimal at present. In the meantime, the lack of effective channels of communication about weight must be a formidable obstacle to fostering the knowledge and skills required to manage the difficulties of living in an obesogenic society.
1. Brown, I. Is self-identification as 'obese' really a public health solution? BMJ Open. 2014 Letter (Response to Johnson F, et al. BMJ Open 2014; 4(11):e005561. doi: 10.1136/bmjopen-2014-005561) 2. Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in weight, waist circumference, and weight status. Obesity (Silver Spring). 2014 Dec;22(12):2485-8. 3. Beeken RJ, Wardle J. Public beliefs about the causes of obesity and attitudes towards policy initiatives in Great Britain. Public Health Nutr. 2013 Dec;16(12):2132-7. 4. Sikorski C, Luppa M, Kaiser M, Glaesmer H, Schomerus G, K?nig HH, Riedel-Heller SG. The stigma of obesity in the general public and its implications for public health - a systematic review. BMC Public Health. 2011 Aug 23;11:661. doi: 10.1186/1471-2458-11-661. 5. Meisel SF, Wardle J. 'Battling my biology': psychological effects of genetic testing for risk of weight gain. J Genet Couns. 2014 Apr;23(2):179 -86.
Conflict of Interest:
Authors of the original research article
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Conflict of Interest:
None declared.
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Published on: 19 November 2014
Is self-identification as 'obese' really a public health solution?
- Ian Brown, Lecturer
Johnson et al. [1] provide a benchmark figure for the low (and lowering) levels of identification with the term 'obese' in Great Britain. The stance of the article, not unreasonably, is that low self- identification is a problem for public health. An alternative conclusion might be that respondents have increasingly sophisticated appreciation of social desirability and demonstrate a valuable resistance to the negative st...
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Johnson et al. [1] provide a benchmark figure for the low (and lowering) levels of identification with the term 'obese' in Great Britain. The stance of the article, not unreasonably, is that low self- identification is a problem for public health. An alternative conclusion might be that respondents have increasingly sophisticated appreciation of social desirability and demonstrate a valuable resistance to the negative stereotypes and stigma of obesity. Is there clear evidence that self- identification as 'obese' is actually good for you? The 'benefits' identified are more about responding to healthcare diagnosis and healthcare advice. Accepting advice from a health professional, albeit dressed up in medical categories, is different from self-identifying as obese in a social survey. In the meantime the evidence is mounting that amplifying the stigma of obesity puts people at risk of chronic stress with negative implications for weight management and long term health [2- 3]. So, it is a serious and pressing question: is beating your self up, identity-wise, about obesity really a public health solution? It seems to have been a gently downward path for society to collectively gain weight. The obvious response for public health is to retrace the steps rather than point out a stigmatised self-identification route for individuals to take up a cliff face. (Metaphorically of course!) Finding the political leadership to tackle the interests vested in an obesogenic path may be the real problem for public health.
1. Johnson F, et al. BMJ Open 2014; 4(11):e005561. doi: 10.1136/bmjopen-2014-005561
2. Puhl R, Peterson R, Luedicke J. (2012) Motivating or stigmatizing? Public perceptions of weight-related language used by health care providers. Int J Obesity. doi: 10.1038/ijo.2012.110
3. Major B, Hunger J, Bunyan D, Miller C (2014) The ironic effects of weight stigma. Journal of Experimental Social Psychology 51, 74-80
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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