Medicalising obesity misses the point

A friend of mine wrote this in response to the Hive Mind Project on sugar and obesity and was willing for me to have it posted anonymously as an article. It really rang true for me as a perspective we had overlooked. I have colleagues who teach mindful eating that put self esteem and lack of judgment and criticism front and centre of their material. As a person who is overweight and not by choice I recognise the same battle with overeating and certainly know that my relationship with food is not straightforward and has links to the reasons outlined below. To reflect this perspective we have added four additional statements into the HiveMind debate to reflect the ideas in this project. They are:

• Medicalising obesity doesn’t do justice to the complexity of the issues involved. A good sense of self-esteem and self-worth are important too.

• The lack of focus by mainstream medical experts and the media on the importance of psychological health in obesity is disappointing.

• People frequently overeat to fill the emotional “black hole” in their psyche. It goes much deeper than self-control.

• It takes a well-adjusted non-needy person to eat well.

Have a read and see what you think.

This is just a brief reflection on the Scoop project about sugar and obesity. I was disappointed to see that it has fallen into the trap of assuming only medical and economic reasons are at the basis of obesity.

While your article does look at poverty and commercial over-supply of sugar dense foods and everything in the article is generally true there is little psychological understanding in there. GP’s and specialists and the mainstream health media cite these reasons all the time. There are other things about obesity though, which are also true, and I’d like to put some additional relevant factors on the table. There is another industry of psychotherapists, analysts, nutritionists and holistic practitioners who can tell these other stories.

Could the upswing in obesity not only be due to greater availability of cheap sweet foods and busy lifestyles, but also due to parenting being more disrupted and stressed when children are very small, (i.e. babies) so that attachment disorders are more rife in society than they used to be?

These attachment-hungry children in poor and in busy well-off homes (where both parents are now pursuing full time careers) may be reaching out more frequently to fill the emotional black hole in their psyche. Only, they are filling it with comfort foods and sweetness which will never do the trick, so the next day they reach for them again and again and again. It takes a well-adjusted non-needy person to eat well.

The complexity of citing poverty as a reason for obesity.

I also think the effects of poverty are more indirect than this article and other media articles suggest. Yes, poor parents buy cheap soft drinks rather than milk, say, but also poor parents are working three jobs and are more stressed, so less able to adequately mirror to their children that they are loved and wanted on this earth. I think we need to support children who live in poverty but not only to provide more money so the family can afford milk instead of sugary drink. The families need support so that babies are parented well and mirrored well by their significant carers. You only need to look at NZ’s child abuse and child murder statistics to see the stress which is happening in parent-child bonding. Poverty, insecure work and stress is just the thin end of this wedge. Aside from poverty most women I have worked with who have some kind of abuse in their background are fat. Why might that be? Could they be trying through food to recover the self-esteem which has been ripped from them? Or is their size an armour to protect them from further abuse? Is it a stress reaction to ongoing pain?

Just like other addictions (which often spring from the same early disappointments), you can tax and/or remove the sugar, but the psychological need will still be there. You can even re-educate the taste buds, but if the person has an attachment disorder they will find another way to get their comfort – perhaps turn to fatty foods, or alcohol or take up smoking again.

The public story and the media

Long lasting, non-addictive emotional support can be given and received but it takes longer treatment than a results-driven government usually wants to fund. The government has cut counselling services presumably on the basis they think investment in it “does not work” or at least that in terms of the social investment model it does not represent value for money. Earlier this year we found out that Canterbury DHB has cut spending on mental health by $160M despite overwhelming unmet need in the region.

The lack of interest mainstream medical experts show in alternative treatments, psychology as a tool and nutritional rather than pharmaceutical treatments is disappointing. The medical professionals manage to convey a polite disbelief that suggests the patient is prevaricating by engaging in therapy and if only they would eat less and exercise more the magic would happen. The trouble is, the patient has likely eaten less and exercised more on many occasions but the magic has happened for only a while.

Somehow the mainstream media seem to only follow this lead. A recent Listener headline implied it was digging deeper – Why it's so hard to keep fat off & what you can do about it was published in August this year – but it had all the same nutritional/medical focus. Many of us know this dilemma intuitively. It is emotional support we are looking for, not sugar (or nicotine) per se. The impact of these props are real - filling the emotional hole and easing pain. I’ve got a Home Science degree and a reasonable income – wouldn’t you think, reading Scoop’s article that I would know what to do and how to do it? It’s not that simple.

Possible solutions

What is needed is greater consciousness on the part of scientifically trained medical personnel and on the part of economically trained politicians of the benefits of attending to mental distress, as well as greater consciousness on the part of over-eaters.

I would like to see consciousness training in primary schools and different training for preschool carers so they can begin to help children deal with the black hole at their centre so they then don’t need to reach for sugar or fat in an attempt to fill the gap.

At the moment we indeed have a perfect storm with obesity but some of the meteorological elements keep on getting left out of the weather forecast.

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