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Luli M, Yeo G, Farrell E, Ogden J, Parretti H, Frew E, Bevan S, Brown A, Logue J, Menon V, Isack N, Lean M, McEwan C, Gately P, Williams S, Astbury N, Bryant M, Clare K, Dimitriadis GK, Finlayson G, Heslehurst N, Johnson B, Le Brocq S, Roberts A, McGinley P, Mueller J, O'Kane M, Batterham RL, Miras AD. The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine 2023; 58:101962. [PMID: 37090435 PMCID: PMC10119881 DOI: 10.1016/j.eclinm.2023.101962] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.
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Affiliation(s)
- Migena Luli
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Giles Yeo
- Department of Clinical Biochemistry, Institute of Metabolic Science, Cambridge University, Cambridge, United Kingdom
| | - Emma Farrell
- School of Education, University College Dublin, Dublin, Ireland
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Helen Parretti
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, United Kingdom
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Stephen Bevan
- HR Research Development, Institute for Employment, Brighton, United Kingdom
| | - Adrian Brown
- Department of Experimental and Translational Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jennifer Logue
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal Team, University Hospitals and Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Nadya Isack
- Obesity Empowerment Network, London, United Kingdom
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - Paul Gately
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | | | - Nerys Astbury
- Nuffield Department of Primary Care Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, United Kingdom
| | - Kenneth Clare
- European Coalition for People Living with Obesity, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Audrey Roberts
- European Coalition for People Living with Obesity, United Kingdom
| | - Patrick McGinley
- Department of Finance, Maidstone & Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - Julia Mueller
- Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rachel L. Batterham
- School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- School of Medicine, Ulster University, United Kingdom
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Conley CC, Davidson LG, Scherr CL, Dean M. Developing theory-driven narrative messages with personal stories: A step-by-step guide. Psychooncology 2022; 31:2113-2121. [PMID: 36205027 DOI: 10.1002/pon.6047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Narratives are commonly utilized in health promotion and behavior change interventions due to their efficacy over didactic or expository interventions. While grounding narratives in behavioral theory may render them more effective, balancing the integration of theoretical and creative aspects of the narrative development process while maintaining authenticity is challenging. Thus, this manuscript describes a rigorous process through which researchers can intentionally integrate theory and personal stories for health interventions. METHODS The process for creating theory-driven narratives involves the following steps: (1) defining the purpose of the narratives, (2) selecting a guiding theory, (3) collecting personal testimonials, (4) immersing self into testimonials, (5) identifying central narratives and important variations, (6) considering additional theories, (7) piecing quotes into cohesive stories, (8) filling in the gaps, and (9) checking for resonance. RESULTS To exemplify this step-by-step process, we provide a case study from our research involving the development of a psychoeducational intervention to model information seeking strategies for managing cancer-related uncertainty among women who have recently tested positive for pathogenic genetic variants that increase risk for hereditary breast and ovarian cancer. CONCLUSIONS We discuss special considerations for developing theory-driven narrative interventions and reflect on how this rigorous step-by-step process can be adapted by other researchers.
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Affiliation(s)
- Claire C Conley
- Georgetown University, Washington, District of Columbia, USA
| | | | | | - Marleah Dean
- University of South Florida, Tampa, Florida, USA.,Moffitt Cancer Center, Tampa, Florida, USA
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Klevens J, Treves-Kagan S, Metzler M, Merrick M, Reidy MC, Herbst JH, Ports K. Association of public explanations of why children struggle and support for policy solutions using a national sample. ANALYSES OF SOCIAL ISSUES AND PUBLIC POLICY : ASAP 2021; 22:268-285. [PMID: 37180092 PMCID: PMC10174280 DOI: 10.1111/asap.12285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Purpose Despite evidence showing the importance of structural determinants for child well-being and the existence of policies that can promote child well-being, many communities are not adopting these policies. Limited awareness of structural determinants may explain this gap. This study establishes the public's recognition of structural determinants and their associations with support for policies that promote child well-being. Methods Secondary analyses of survey data collected in 2019 from a random sample of 2496 adults in the United States. This survey asked why some children "struggle" (e.g., do poorly in school, use drugs, or get involved in crime). Respondents could select individual (e.g., lack of effort) and structural (e.g., low wages) explanations. Respondents were also asked about their support for policies that are supportive of children and families. Results Stronger beliefs of structural explanations were associated with greater support for policies that strengthen family economics, family-friendly work, and afford access to high-quality early childcare and education. Beliefs in individual explanations were inversely associated with support for these policies. Conclusions These findings suggest increasing recognition of the structural determinants that hinder child development may help increase support for policies that are effective in improving children's outcomes.
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Affiliation(s)
- Joanne Klevens
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Treves-Kagan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marilyn Metzler
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
- TJFACT, Atlanta, Georgia
| | - Melissa Merrick
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary Clare Reidy
- Training & Organizational Development Department, Health Federation of Philadelphia, Philadelphia, Pennsylvania
| | - Jeffrey H. Herbst
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie Ports
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hill B, Bergmeier H, Incollingo Rodriguez AC, Barlow FK, Chung A, Ramachandran D, Savaglio M, Skouteris H. Weight stigma and obesity-related policies: A systematic review of the state of the literature. Obes Rev 2021; 22:e13333. [PMID: 34505334 DOI: 10.1111/obr.13333] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/24/2021] [Accepted: 07/24/2021] [Indexed: 12/24/2022]
Abstract
Weight stigma is an important issue colliding with obesity-related policies; both have population health and social impacts. Our aim was to conduct a systematic review of the peer-reviewed literature that combined the concepts of stigma, obesity, and policy. We searched PsycINFO, Medline, Scopus, and Google Scholar for peer-reviewed articles amalgamating terms relevant to stigma, obesity, and policy. Of 3219 records identified, 47 were included in the narrative synthesis. Two key types of studies emerged: studies investigating factors associated with support for obesity-related policies and those exploring policy implementation and evaluation. We found that support for nonstigmatizing obesity-related policies was higher when obesity was attributed as an environmental rather than individual problem. An undercurrent theme suggested that views that blame individuals for their obesity were associated with support for punitive policies for people living in larger bodies. Real-world policies often implicitly condoned stigma through poor language choice and conflicting discourse. Our findings inform recommendations for policy makers that broader socioecological stigma-reduction approaches are needed to fully address the issue of weight stigma in obesity-related policies. Efforts are needed in the research and policy sectors to understand how to improve the design and support of nonstigmatizing obesity-related policies.
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Affiliation(s)
- Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Fiona Kate Barlow
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Alexandra Chung
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Divya Ramachandran
- Boden Institute, University of Sydney; Weight Issues Network, Sydney, Australia
| | - Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Warwick Business School, The University of Warwick, Coventry, UK
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