A Call for Lockdown on Stigmatising Policies
By Phaedra Longhurst, MSc, Dr. Amanda Raffoul, PhD, and Dr. Helena Lewis-Smith, PhD
The authors of this article wish to disclose that this article refers to terms of ob*sity and anti-ob*sity and discusses sensitive topics regarding weight loss and weight stigma.
The COVID-19 pandemic has been challenging for everybody. One particular stress relates to increased pressure to “better” ourselves during a time when we have time. However, this messaging has been counterproductive, as the boundaries between what is healthy and unhealthy have become blurred. Globally, we have spent increased time on social media, which features pervasive diet and fitness content, usually focusing on “ideal” bodies. We have also been inundated with weight stigmatising content (e.g., pre- and post- lockdown bodies), leading to feelings of guilt and shame about our own bodies. Simultaneously, we have had international leaders claiming ob*sity and “high weight” are the causes for increased COVID-19 mortality and negative side effects (Savage, 2020).
In particular, within three months since the relaxation of lockdown regulations, the UK government has swiftly shifted their focus towards anti-ob*sity measures. This is despite the pandemic raising unique challenges for individuals either with body image concerns and/or pre-existing eating disorders. For instance, 53% of adults and 58% of children reported feeling “worse or much worse” about their appearance following the (first) lockdown (Women and Equalities Committee, 2021). Research also finds that dieting and binging behaviours have increased among adults in the general population, whilst eating disorder-related medical admissions have increased (Otto et al., 2021; Philiipou et al., 2020). Further, individuals with eating disorders have experienced worsening symptoms throughout this time (Termorshuizen et al., 2020).
One of the newly introduced anti-ob*sity strategies involves large businesses (with 250+ employees) being legally required to display calorie information on all restaurant menus and food labels as a means to “help the public to make healthier choices when eating out” (Department of Health and Social Care, 2021). The Department of Health and Social Care (2021) argues that such measures “form an important building block in our strategy to support and encourage people” to achieve a “healthier weight”.
Evidence on whether calorie labelling is an effective public health strategy, however, remains mixed and (arguably) inconclusive. That is, calorie labels predominantly lack in yielding ‘desired’ effects at a population level and/or maintaining effects at follow-up (following 12 months; Kiszko et al., 2014; Petimar, 2019). Calorie labels may also exacerbate young adults’ relationships with food and their bodies, particularly if they already struggle with disordered eating (Raffoul, 2020). Moreover, the use of anti-ob*sity language and campaigning have been found to incite stigma, disordered eating, and health inequalities. As such, it is predicted that these strategies will be met with a variety of negative health and quality of life outcomes (e.g., unhealthy weight control practices, disordered eating and exercise; Diedrichs & Puhl, 2017). Accordingly, the UK-based eating disorder charity, Beat, has echoed concerns raised among the eating disorder community regarding these incentives and their potential negative impact (Beat, 2021a; 2021c; Quinn, 2021).
This all unfolds just months following the Women and Equalities Committee’s inquiry into body image, where the UK Government was advised to review why eating disorder rates were increasing in the UK, as well as re-evaluate their ob*sity strategy (Women and Equalities Committee, 2021). The Government was encouraged to prioritise fostering positive body image during childhood and adolescence, by introducing the topic of body image into the school curriculum through utilising media literacy and peer-focused content (e.g., peer support programmes; Yager et al., 2013). As such, the Department of Education was advised to reconsider other contentious anti-ob*sity measures such as the National Child Measurement Programme, which involves the measurement of height and weight among children aged 4-5 and 10-11 years (Department of Health and Social Care, 2020; NHS Digital, 2019) – an incentive which is argued to cause “harm to children’s mental health and could hinder the development of a positive body image” (Women and Equalities Committee, 2021, p. 6; Pearl & Puhl, 2016). Further, such weight stigma has been associated with weight cycling and disordered eating behaviours (Diedrichs & Puhl, 2017).
In light of this, Beat continues to campaign against these strategies in an effort to mitigate some of the harms that these new laws will pose. That is, advocating for a more integrated public health approach which is “developed in consultation with eating disorder experts, including people with lived experience” (Beat, 2021b). Further, in response to the significant increase in waiting times for eating disorder treatment within the UK – particularly among children and young people (NHS England, 2021) – Beat is extending expert advice and support. The Academy for Eating Disorders wishes to extend our support and express that we, as an organisation, oppose such weight-phobic and stigmatising strategies which are associated with harm to physical and mental health, and health inequalities. Please read more about these AED views in our 2019 position statement:
“The nine more truths about eating disorders: weight and weight bias”.About the Authors
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| Dr. Helena Lewis-Smith, PhD is a Research Psychologist based at the Centre for Appearance Research, within the University of the West of England, in the UK. Helena is known for exploring body image and developing interventions in education, community and clinical settings with children and adults. She is passionate about translating research which promotes positive body image into real-life social impact at a local, national, and global scale. |
Dr. Amanda Raffoul, PhD is a Canadian Institutes of Health Research postdoctoral fellow with STRIPED, the Strategic Training Initiative for the Prevention of Eating Disorders, based at Boston Children’s Hospital and the Harvard T.H. Chan School of Public Health. Her research interests include policy approaches to preventing disordered eating and eating disorders, and she is engaged in ongoing advocacy efforts in Canada and the US to promote body confidence among youth and young adults. |
Phaedra Longhurst, MSc is a research assistant at the British Association of Counsellors and Psychotherapists and a postgraduate student at the Department of Psychology, University of Exeter, UK. Phaedra’s research focuses on body image and appearance-related studies (e.g., eating disorders) and developing positivist, interventionist methods which promote healthier body image and prevent eating disorders. She is also interested in engaging with ongoing advocacy efforts to promote positive body image across under-represented identity groups, including neurodivergent individuals. |
References
Beat. (2021a). Advice for eating out with calorie labelling. https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/advice-for-eating-out-with-calorie-labelling/
Beat. (2021b). Eating disorder charity frustrated and disappointed about calorie labelling on menus. https://www.beateatingdisorders.org.uk/news/eating-disorder-charity-frustrated-and-disappointed-about-calorie-labelling-on-menus/
Beat. (2021c). Public health not public shaming. https://www.beateatingdisorders.org.uk/support-our-work/campaign-for-beat/current/campaign-public-health-not-public-shaming/
Diedrichs, P.C. & Puhl, R (2017). Weight bias: prejudice and discrimination toward overweight and obese people. In C.G. Sibley & F.K. Barlow (Eds.), The Cambridge handbook of the psychology of prejudice (pp 392-412). Cambridge University Press. https://psycnet.apa.org/doi/10.1017/9781316161579.017
Department of Health and Social Care. (2021, May 12). Calorie labelling on menus to be introduced in cafes, restaurants and takeaways. https://www.gov.uk/government/news/calorie-labelling-on-menus-to-be-introduced-in-cafes-restaurants-and-takeaways
Department of Health and Social Care. (2020). Tackling obesity: empowering adults and children to live healthier lives. Gov.UK.
Kiszko, K.M., Martinez, O.D., Abrams, C. & Elbel, B. (2014). The influence of calorie labelling on food order and consumption: a review of the literature. Journal of Community Health, 39(6), 1248-1269. https://dx.doi.org/10.1007%2Fs10900-014-9876-0
NHS Digital (2019). National child measurement programme, England 2018-19 school year [NS]. NHS England.
NHS England (2021). Children and young people with an eating disorder waiting times. https://www.england.nhs.uk/statistics/statistical-work-areas/cyped-waiting-times/
Otto, A.K., Jary, J.M., Sturza, J., Miller, C.A., Prohaska, N., Bravender, T. & van Huysse, J. (2021). Medical admissions among adolescents with eating disorders during the COVID-19 pandemic. Pediatrics, 148(4). https://doi.org/10.1542/peds.2021-052201
Pearl, R.L. & Puhl, R.M. (2016). The distinct effects of internalising weight bias: an experimental study. Body Image, 17, 38-42. https://doi.org/10.1016/j.bodyim.2016.02.002
Petimar, J., Zhang, F., Cleveland, L.P., Simon, D., Gortmaker, S.L., Polacsek, M., Bleich, S.N., Rimm, E.B., Roberto, C.A. & Block, J.P. (2019). Estimating the effect of calorie menu labelling on calories purchased in a large restaurant franchise in the southern united states: quasi-experimental study. BMJ, 367. https://doi.org/10.1136/bmj.l5837
Phillipou, A., Meyer, D., Neill, E., Tan, E.J., Toh, W.L., van Rheenen, T.E. & Rossell, S.L. (2020). Eating and exercise behaviours in eating disorders and the general population during the COVID-19 pandemic in Australia: initial results from the COLLATE project. International Journal of Eating Disorders, 53(7), 1158-1165. https://doi.org/10.1002/eat.23317
Savage, M. (2020, Dec 12). Boris Johnson’s drive to cut obesity rates ‘largely ineffective’. The Guardian. https://www.theguardian.com/world/2020/dec/12/boris-johnsons-drive-to-cut-obesity-rates-largely-ineffective
Termorshuizen, J.D., Watson, H.J., Thornton, L.M., Borg, S., Flatt, R.E., MacDermod, C.M., Harper, L.E., van Furth, E.F., Peat, C.M. & Bulik, C.M. (2020). Early impact of COVID-19 on individuals with self-reported eating disorders: a survey of 1,000 individuals in the united states and the Netherlands. International Journal of Eating Disorders, 53(11), 1780-1790. https://doi.org/10.1002/eat.23353
Quinn, T. (2021, Jun 3). Putting calories on menus will be devastating for people with eating disorders. https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/advice-for-eating-out-with-calorie-labelling/
Women and Equalities Committee. (2021). Changing the perfect picture: an inquiry into body image. House of Commons, UK.
Yager, Z., Diedrichs, P.C., Ricciardelli, L.A. & Halliwell, E. (2013). What works in secondary schools? A systematic review of classroom-based body image programs. Body Image, 10(3), 271-281. https://doi.org/10.1016/j.bodyim.2013.04.001