Obesity: why it is increasingly important to fight stereotypes

Obesity

It is not easy to talk about it, yet it must be done. More than the slogan chosen this year on the occasion of World Obesity Day, the world obesity day (Let's talk about obesity) is asked for by the dimensions of the phenomenon: it is estimated that there are 800 million obese people in the world, three times as many compared to the 1970s, and that only in 2035 will they be able to reach almost two billion. True, the pace has varied from country to country, but the trend is clear everywhere. Without leaving home, in Italy, about 12% of the adult population is obese: if it is true that compared to the European average the figure is relatively good (minus 5 points), looking back we are no exception. In the last twenty years, as the Italian Obesity Barometer Report 2022 shows, obesity has grown by 40%. If we then look at children, the data, while remaining substantially stable over the last ten years, is even more worrying and today it is estimated that around 27% are overweight. If the percentages remain abstract and difficult to grasp, and translating into numbers, today in Italy there are about 25 million people with weight problems, more than a third of the entire population (and tending to be more in the south of the country). Talking about it, today more than ever, serves to shed light on the problem, to get to know it, and perhaps to fight it. But crunching the numbers is not enough.

There is no single cause of obesity

It is in fact undeniable that it is a problem in terms of health: excess weight is in fact known as one of the single conditions, by itself, capable of raising the risk of various diseases - diabetes and cardiovascular diseases in primis, but also some types of cancer - and responsible for about 2.8 million deaths a year. But talking about obesity is only partly medical and decidedly more social: the low level of education, as well as the low income, are in fact both factors associated with excess weight, and sometimes linked to each other. Low levels of education and income influence lifestyles, food choices, treatment options, helping to lay the foundations for all those behaviors identified as risk factors - or preventives - for weight gain. Although there are those who argue that the relationship between low income and obesity could go in the opposite direction, with income as a consequence of obesity, primarily due to the stigma associated with overweight people.

An honest discourse on the causes of obesity must necessarily take these factors into account, alongside lifestyles and biological factors, such as genetic predisposition. We need to talk about it, to also contribute to changing the outlook on obesity and, with this, the strategies to combat it. And considering numbers, trends and forecasts, we must do it more than ever. That's why you do it, that's why you need to overcome clichés , the promoters of World Obesity Day loudly repeat today. Starting precisely by showing that there is no single cause of obesity , and therefore there is no single solution and that to do the rhetoric of you asked for it.

Obesogenic environment

Thus, if it is true and it is undeniable that the lack of balance between income and expenditure - in terms of calories - is the main reason at the origin of obesity, as acknowledges the World Health Organization itself, revenues and expenditures are largely the product of social and environmental conditions. That is: they are not just personal choices, and they come from afar. On the other hand, the obesity epidemic itself has been repeatedly represented as the product of well-being: the improvement of social and hygienic conditions and economic possibilities has changed our way of life, including that of eating. The spaces we live in have changed and the offers on the market have also changed. The world out there has often become obesogenic, experts have been repeating for years now: it pushes us to eat more, worse, and move less. But do we remember? The arrival of ultra-processed foods, rich in salt, fat and sugar, and with a high calorie content, repeatedly under accusation, is the most classic example of how the offer - and marketing - can shape consumption and influence health outcomes. In this field, the case of the Republic of Nauru, in Micronesia, is particularly noteworthy, famous for being shot at the top of the rankings of the most obese countries in the world, thanks precisely to a change in eating habits that would have favored the consumption of ultra-processed foods . Not being able to grow food locally, the country has been forced to focus on imported foods, especially the less expensive ones, such as processed ones.

“Out of the control of the person”

To the social, environmental and genetic factors are added biological ones – such as genetic predisposition to obesity – stress, bad sleep and therapies that can favor 'accumulation of weight, offsetting the metabolism, the functioning of hormones and with these the feeling of appetite. Remembering the causes of obesity is needed more than ever, because it can help you look at the condition differently. Recognizing its multifactorial nature with different components - organizations have been repeating for some time and today again the promoters of the day - "outside the control of the person", the person is relieved of responsibility for the disease. Without denying the importance of contrasting actions that can still be undertaken to address and prevent the problem.

Talking about it is necessary to put a stop to the stigma and stereotypes that affect people with weight problems, which leads to discrimination, but also depression, anxiety, loss of self-esteem, refusal of clinical support, eating disorders, reduced physical activity, feeding the root of the problem. Sensitivity to the topic, at least among most activists and experts, has grown over the years, and on March 4 three years ago in the pages of Nature Medicine, a consensus statement appeared which drafted a series of recommendations to encourage an honest discussion on the obesity theme. The commitment , yesterday as today, is to encourage a dialogue that frees people with obesity from the narrative of lazy people, without willpower, who could only follow a diet and exercise more . The scientific evidence denies it, and it is time that at all levels – healthcare personnel, the media, patients, politicians – they start doing it, the authors hoped.