a re-examination of what is really causing it
“There has been a shocking redirection of responsibilities onto individuals and away from the real culprits including poverty, childhood trauma, inequality, stressful environments and of course the powerful food industry”.
Graham Music, is a Consultant Child, Adolescent and Adult Psychotherapist.
According to one recent report 1 in 5 children are obese when they start primary school and one in 3 by the time they begin secondary school. Obesity is increasingly recognised as a major health issue and clear links exist between early obesity and a frightening range of health problems, such as heart disease, diabetes, even cancer and of course it has also been linked with serious cases of covid-19, especially fatal ones. Obesity in childhood is particularly important to avoid as, like the brain, the body, including adipocytes or fat cells, is forming in early childhood, after which fat cell numbers remain stable throughout the lifespan. Even when losing weight later in life, fat cells at best shrink, sometimes regenerate but their numbers remain stable, predisposing to later weight gain. Our adipocytes are crucial for signalling hunger and fight hard to retain weight so childhood obesity can set up a lifelong handicap.
Generally, we need to rethink our understanding, approach and attitudes to fat, to large bodies and linked health issues, in particular becoming more aware of how obesity is linked to socio-political issues, stress and childhood trauma. Otherwise there is real danger of taking a moralistic fat-blaming approach, or in other words, blaming the victim. Obesity is often described in alarmist language, such as ‘an ‘epidemic’ or ‘public health crisis’. Prejudice against fat is endemic, with common narratives often evoking disgust and blame, attitudes are often overlaid with social class and ethnic prejudice. Prejudice against fat is one of the last remaining allowable ones, a prejudice that most of us have our own personal relationship to.
“FAT SHAMING CONTRIBUTES TO BINGE EATING”
There are thankfully some alternative discourses, such as the Health At Any Size and Fat Studies movements, which critique many poor quality scientific claims, such as those which automatically equate high body fat and ill-health. Such movements have highlighted the overt discrimination in many health narratives about fat, including discrimination against fat black female bodies. Perhaps though these movements have not always taken seriously the real health effects of obesity.
There is quite enough shame around without fat-shaming, and shame cycles are common contributors to unhealthy patterns such as binge eating. Over the decades I have seen too many clients, often from a young age, and especially but not only female ones, full of self-blame, wracked with self-hate, feeling awful about their bodies and indulging in solutions which simply don’t work. For example, the science has been clear for decades that dieting only shows short-term gains as the human body strives for homeostasis, so as we consume less calories, our body responds by using less energy, hence in time feeling tired, weak and ‘hangry’ and nearly always, reverting to old eating patterns.
This is due to the well-known science about body set-points and how our body fights hard to protect fat stores, which is a big reason diets alone don’t work in the long-term. In fact, nothing in our evolutionary history prepared us for living in an environment where calorie rich food was so abundant and on-tap. Our bodies evolved to conserve energy via storing fat, and our adipose tissue (fat cells), are packed with masses of important goodies set aside for future use, such as vitamins and minerals. Fat cells are alive, communicating and signalling, and have been a brilliant survival-aiding resource for millions of years. They are though also big contributors to inflammatory processes, as obesogenic, and especially processed-food diets, in fact can lead fat cells to feel they are under attack, hence giving rise to inflammatory processes. Obesity is profoundly linked to an increase in inflammatory processes which are central to a range of illnesses, such as autoimmune diseases, diabetes, cardiovascular disease and many more.
“OUR LIFE HISTORIES ARE ‘LIVED’ THROUGH OUR BODIES”
I despair about much policy discourse and health advice, which is simplistic and prosaic, and centred on behavioural advice, like ‘consume less,’ ‘eat healthier’, and ‘move more’. Such an approach shows little understanding of basic biological processes, let alone the social, psychological, political and biological complexities of increased obesity levels. Shifting of responsibility onto individuals, whether parents or children, reinforces dominant medical individualistic models, giving rise to worryingly pathologizing discourses, blaming the individual, such as parents of obese children.
The area of science which I think is too often missed out is the very clear link between obesity and adverse early life experiences, and how life-histories and our socio/political/economic contexts are expressed and ‘lived’ through our bodies, as well as minds and behaviours. The links between ACE’s (Adverse Childhood Experiences) and health issues such as obesity, diabetes, heart-disease, metabolic syndrome on later obesity and general health, such as in adolescence, is incontrovertible. We can add to this new science about the obesogenic effects of stress, poor sleep, and the cascade of endocrinological and other effects following sympathetic nervous system activation.
“WE EAT DOWN FEELINGS”
When stressed, anxious or traumatised a range of things happen to our bodies, including less ability to self-regulate, as well as, when stressed, a drive towards more sweet, fatty and salty ‘obesogenic’ foods, which would have aided survival in our human ancestral past at times when energy conservation was vitally important. Indeed in experiments, those given stressors are much more likely to go for fatty, sugary foods than those in a calm state. We can blame people for being ‘weak-willed’ or lazy, but it is ‘our evolution what done it’, for sensible survival-based reasons.
Clinical experience adds plenty of important angles to these issues. The push to eat when stressed and anxious is a major factor, often in the form of ‘eating down’ feelings, self-punishment linked to high levels of self-disgust about body-shape in obese and non-obese people. Important here is the ‘addictive’ nature of eating and cravings, coupled with the addictive nature of much processed food. Our biological and psychological systems which drive us towards pleasurable experiences which aid the species’ reproduction, such as sex and food, are linked to the dopaminergic system and addictive processes. While in some clients we see too low a drive and ‘appetitive’ system, in others we see an addictively activated one, and more often one which has lost touch with ‘real’ needs, such as in drug, alcohol, and other addictions. The propensity for heightened addictive states of mind is massively increased in trauma, stress and abuse.
“Children, especially stressed ones, are especially vulnerable to temptations”
We should challenge belief systems replete with self-blame and factually dubious assumptions. Current discourse has remained primarily at the level of individual responsibility. The British Prime Minister, Boris Johnson, whose covid-linked scrape with mortality was probably diabetes/obesity linked, has naively exhorted us to, Tebbit-like, get on our bikes to exercise as well as eat better. This is not enough, especially when factors such as early adversity and its relationship to biological mechanisms are not taken into account, let alone the power of the food industry.
Particularly worrying are the obesogenic effects of easy to access high sugar/fat/salty foods designed to stimulate reward pathways. Food companies invest huge sums into researching exactly what quantities of, especially, sugar, fat and salt and which tastes, will stimulate addictive food urges and the likelihood of customers returning for more. Children, especially stressed ones, are especially vulnerable to such temptations. Alongside this, supermarkets invest vast sums in not only marketing but also product placement, such as where exactly to place, at what height etc, the high profit, less healthy more addictive processed foods. Calling for a ‘sin tax’ is a shocking redirection of responsibilities onto individuals and away from the real culprits including poverty, childhood trauma, inequality, stressful environments and of course the powerful food industry.
We badly need to develop non-judgemental, scientifically valid yet potentially liberating understandings, with the blame, guilt and judgement stripped out, allowing for macro-social, community, family and individual level responses that might lead to better overall mental and physical health, including the reduction in obesity.
According to government and other reports, obesity, including in childhood, has in most countries increased significantly in recent decades. Its increase in childhood is especially worrying, given how adipocyte numbers remain throughout the lifespan. A major worry for me is the links between obesity and cognitive deficits, not only on the elderly, which link to poorer attention, worse executive functioning and suboptimal verbal learning, This is on top of the cascade of serious physiological problems linked to obesity as life proceeds, from diabetes heart-disease and even cancer. This is really and truly deadly serious. Incredibly a recent government report suggested that obesity costs the NHS more than the police, fire-services and judicial systems combined. Given the clear link between obesity, covid mortality and a range of health issues, we cannot afford not to act.
Graham Music is a Consultant Child Psychotherapist at the Tavistock Centre and adult psychotherapist in private practice. Graham’s publications include Nurturing Children: From Trauma to Hope using neurobiology, psychoanalysis and attachment (2019), Nurturing Natures: (2016, 2010), Affect and Emotion (2001), and The Good Life (2014). He has passion for exploring the interface between developmental findings and clinical work. A former Associate Clinical Director at the Tavistock Clinic, he has managed and developed many services working with the aftermath of child maltreatment. He works clinically with forensic cases at The Portman Clinic, and teaches, lectures and supervises in Britain and abroad.