Bill Nichols

10 December 2014

Bill Nichols

019 All Headlines and No Narrative: The Obesity ‘Epidemic’ (December 2014)

Obesity headlines? You may have seen the recent attention-grabbing – if depressing – fusillade.

Here’s a quick rehearsal.  Nearly 30% of the global population, or 2.1 billion individuals, is overweight or obese.  (UK = 37%).  Collectively they cost the world economy ~$2 trillion, or 2.8% lost output, annually.  That’s less only than smoking and armed conflict (McKinsey, November 14).

One third of Year 6 UK primary schoolchildren is already overweight or obese (Health and Social Care Information Centre). More than 70% will become obese adults (Association for the Study of Obesity).   And 70% of obese youth also have at least one risk factor for cardiovascular disease (CDC, US).

Enough, you cry!  Your point?

Answer: it’s partly a communications’ challenge.  (And one we’re exploring at the Bucks Centre for Health Communications and Research (CHCR)).  Specifically this week’s visit to govtoday’s excellent London conference, Obesity: A National Epidemic, convinced me.

Under a heavy collateral data bombardment, I learned quite simply: there is no single narrative.  And without one, this epidemic (or pandemic) will always slip quickly off the news-agenda.  Why?

Villains and Heroes

For speedy analysis, I like the ‘villain-hero-conflict-solution-outcome’ tool. Try it on Ebola and you’ll quickly see why it stays so successfully on the agenda.  Its narrative is clear and effective.  But obesity?

First up, find a villain or ‘dark lord’?  Mmm: spoilt for choice.   You could fairly audition food processors, fast-food outlets, regulators, lobbyists, poverty/deprivation, the tax-man and (in the UK) the NHS.  Or try money out of your pocket. Some suggest that obesity and its consequences cost the NHS £10 billion annually.  If so, then this villain ‘robs’ everyone of over £160 per year. As Public Health England points out, revert obesity to 1993 levels and it will save at least £1.2 billion per year. (George Osborne, please note).

Lost already?  What about a hero?   OK there’s ‘Sir Health Of Well-Being’.  He’s a lovely chap. Very well-intentioned.  But lacks charisma.  Too ‘nicey, nicey’.   And be honest, humankind tolerates only so much good behaviour.  An individual, or single front or campaigning body, is required to lead the charge.

Next it gets byzantine: the conflict. This battleground is more complex than the Syrian Civil War or 3D chess!  Obesity, say the experts, is a consequence of: a) genetics, b) environment (we live now in an ‘obesegenic’ world), c) psychology, d) behavioural factors and/or e) some combination of the above.   Try pitching all that in the ‘elevator’!  In the current state-of-knowledge, it’s not even clear which dimension has the strongest weighting!

Solution?   Seriously, who knows?  There are far too many variables in play and issues outstanding.

So outcome?  A super-healthy society would be nice.  And pigs are flying in massed formation over my office.

Sadly, depressingly, we all ‘get’ the question.  But without a narrative, this looks set to drift – and escalate.

So, all joking apart, before you settle down to that Christmas turkey, obesity narrative anyone?

And do please leave a reply below!


6 thoughts on “All Headlines and No Narrative: The Obesity ‘Epidemic’

  1. David TebbuttDavid Tebbutt Post author

    I was born during the war. We had rations. We couldn’t buy much at all.

    Most of us were probably very healthy. But we lacked genuine comfort.

    So, we spent the rest of our lives making life more comfortable. Cars replaced legs and bicycles, fast food replaced meagre rations, restaurant food was a ‘reward’ whenever we wanted to celebrate, booze probably dropped in price in real terms, in fact lots of things became cheaper as a proportion of our income.

    So, the villain is an acceleration in comfort (or desperation, if “the poor can’t cook” story is even halfway accurate) and, with that, complacency. A greying population doesn’t want to look like Miley Cyrus or Cara Delevigne, so it doesn’t even have that “I want to look good” motivation. And, of course, that’s the part of the population that’s exercising the politicians and NHS.

    Perhaps when we were all paying our dues – National Insurance Contributions, Pensions, – Ha! We didn’t know we were just transferring a wodge of our cash to our parents, grandparents and, in some cases, the feckless.

    Sadly, the enemy is within. We’d prefer a comfortable ride while we can enjoy it, rather than a slightly less comfortable longer journey to our wooden boxes.

    And the hero is also within. We’re the only people that can change things. And, for many, it’s way too late. Once you’re past a certain point, it’s just about impossible to reverse your decline.

    Perhaps an image of a car rolling along the flat then getting onto a gentle slope that ends in a cliff. The fields at the top of Beachy Head would do nicely. As your car rolls to the precipice, you can whack the brakes on but, after a certain point, all that will happen is that you’ll skid over the edge.

    You face the same problem that the environmental/population people face: the clock for humanity is probably at about 1 minute to midnight (I don’t know) but who cares? (Not many.) Let’s just enjoy having kids and grandkids, plundering the planet for questionable satisfactions, and warming or polluting it (and, therefore us) to oblivion.

  2. Natalie RichardsNatalie Richards Post author

    From Natalie Richards

    Interesting comparison between the Ebola narrative and the obesity narrative Change4Life sought to establish. In both ‘Western Culture’ is the villain.

    For Ebola, the ‘West’ ignored the plight of Africans until a ‘one of us’ got sick. So the story goes. And it pricked our conscience, propelled us into doing something.

    For Change4Life, modern (Western) life got the blame. ‘It’ made us lazy; ‘it’ made us eat too much. And we did, well, nothing much. As the data tells us.

    The difference, to my mind? One narrative made us examine our behaviour; the other let us off the hook by transferring our responsibility to a thing, an external force. We’re the victim!

    The moral of the story?

    When we don’t recognise the part WE play in the narrative, we don’t change.

  3. Piotr SzulcPiotr Szulc Post author

    From Piotr Szulc (Poland)

    Your article is very current and compelling. Obesity is becoming a significant problem in Poland too. But fortunately it is still not as huge as in the UK or especially in the US.

    To highlight how serious it is in America I always use an example of a restaurant Heart Attack Grill. This ABC video footage briefly shows how “unlimited” access to food is as important to Americans as access to weapons.

    In terms of an effective narrative I would suggest conducting an anti-obesity campaign like this one in Australia

    Comparing huge amounts of food that people consume to narcotics is fairly reasonable.

  4. Alan Naismith

    I’m not sure the ‘villain-hero-conflict-solution-outcome’ tool works here. The view of many is that the problem relates to living in a society with a ‘grab-all-you-can-get’ mentality that also extends to a state-funded (free!) health service. The villains of this piece are the obese individuals themselves. And there is no hero!

    The attitude of many is to see obesity as normal and acceptable where any health-related downsides (and the costs) are dealt with by the NHS. The NHS itself is promoting obesity, having become a ‘get-out-of-jail-free card’ for those with irresponsible lifestyles. The stance taken by the Government and the NHS is to treat obesity as they would any illness, usually in a wholly non-judgemental way and this, for many, is almost a seal of approval of their behaviour.

    Over the last 40 years the proportion of the UK population who smoke has fallen from 45% to 18%. This is undoubtedly down to the awareness of how dangerous smoking is and a sea-change in society’s attitude towards smoking in public. A similar approach needs to be taken with obesity and with lifestyle-related ill health more generally. Indulging in a lifestyle that leads to obesity that affects others (e.g. impact on the NHS) should be seen as socially unacceptable!

    If the attitude of society towards obesity was altered such that the authorities and NHS were empowered to refuse to treat obesity-related conditions (certainly where the obesity could be shown to be entirely down to lifestyle)), or maybe charge for treatment, then individuals would be forced to take their lifestyles much more seriously. There would be no ‘get-out-of-jail-free card’.

    Of course, this raises all sorts of moral dilemmas about whether the NHS should treat smokers, alcoholics etc, but that’s another debate.

      1. Alan Naismith

        Not exactly – my argument is more about lifestyle. There are many reasons why someone might be obese. But a sedentary lifestyle, without exercise and regular over-eating that leads to health problems should absolutely be considered antisocial.


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