Obesity and the personal responsibility narrative – who benefits?

The narrative used to protect Big Tobacco and Big Alcohol has been dusted off to protect Big Food.

Almost 70% of New Zealand adults now classify as overweight or obese.[1] Is this because most of us can’t take personal responsibility or is there something else going on?

In the lead up to the 2020 general election, National party leader Judith Collins described obesity as a 'weakness' that people needed to own up to, and take personal responsibility for, rather than blaming ‘systems’ for personal choices.[2]

Aside from the temporary controversy that erupted, was Collins making a valid point? Was she using the personal responsibility narrative as a tool to gain votes because she knew that many people would agree with her?

Or was she using the narrative to divert attention away from decades of political inaction, and the influence of groups with vested interests, such as the food industry?

* NB. If you'd like to pursue a 'constructive' pathway to helping people control their weight, become a Weight Management Coach. Find out more here.

The responsibility narrative is ingrained in our psyche – what you are is your fault entirely. But is it?

Superficially, the concept of personal responsibility is appealing. We like to think that the world is reasonably fair and that as individuals we’re in control of what we do and what our outcomes in life are.

We tend to attribute our own successes to hard work and making good choices. In contrast, we often attribute the failures or struggles of others to making poor choices, not working hard enough, or not making sacrifices.

Take housing as an example. People who invest in property have seen their wealth increase phenomenally in a short period of time. This increase is usually attributed to hard work as well as making good choices and significant sacrifices to save the deposit and get on the property ladder.

Very rarely do property investors attribute their success to the ‘luck’ of being able to purchase when property was comparatively cheap and being ‘present’ in the market when it went ‘nuts’. The frustrations of those who now find themselves unable to purchase a house are often dismissed as; ‘if they just worked harder and sacrificed their ‘smashed avocado on toast’ lifestyles, they’d be OK’.

When such a framing is used then multi-factorial problems such as housing become defined as simple issues of making good choices and sacrifices versus making poor choices and not making sacrifices. Consequently, individuals are portrayed either as virtuous models of what we should aspire to be, or as victims of personal weaknesses who have no-one to blame but themselves.

This framing limits our consideration of other factors that might contribute to a problem, such as government policy.

We see the same framing used regarding obesity, as evidenced by Judith Collins comments. Indeed, the concept of personal responsibility is so well ingrained in our psyche that many of us believe that a lack of willpower causes obesity, from which the best treatments are simple; take responsibility, exercise, and go on a diet.

These beliefs limit our ability to consider the influence of factors such as government policy, the influence of the food industry, and the validity of the current approaches that are being used to address obesity.

If we’re serious about tackling obesity and helping people to lose weight, all these factors need to be considered and addressed.

Was Judith correct or pandering to an audience?

So, was Judith making a valid point? Can the fact that almost 70% of adult New Zealanders now classify as either overweight or obese be attributed to a dramatic reduction in people taking ‘personal responsibility’ for their weight?

It seems unlikely.

In Personal Responsibility and Obesity: A Constructive Approach to a Controversial Issue researchers Brownell et al (2010)[3] highlight several studies which point to an increase in people taking ‘personal responsibility’ over recent years; adolescents are now more likely to practice safe sex and wear seat belts, and are less likely to consume alcohol or ride with an alcohol impaired driver. Adults are now less likely to smoke, more likely to take vaccines to protect their health, and are more likely to complete formal education.

Growth in the diet and fitness industries suggests that people are actively trying to take responsibility for addressing their weight. Their lack of success however, and the global tripling of obesity since the 1970s points to factors other than ‘personal responsibility’, or a lack thereof.

Brownell et al also noted that the personal responsibility narrative has been central to inadequate government efforts to address the environmental factors that explain obesity.

This usage of the personal responsibility narrative isn’t new. It was used by Big Tobacco to fight and delay anti-smoking legislation – they denied that smoking was addictive and argued, amongst many things, that it was a personal choice and people could act responsibly if given the right information and options.

Similar arguments have been, and still are used by Big Alcohol.

Both Big Alcohol and Tobacco have successfully stonewalled regulatory change for many years by leveraging the personal responsibility ethos.

So, what are the environmental factors that Brownell et al allude to? And what have Judith and her political colleagues (in both the red and the blue teams) been doing about them?

What should we be talking about if we really want to address the issue?

Food availability:
Coinciding with the global tripling of obesity has been a dramatic change in the food environment. Food, that has been relatively scarce for the majority of human history, is now abundant, readily accessible and affordable – especially junk- and fast-food.

Food quality:
Where food was predominantly natural 40 years ago, today it is increasingly referred to as being ‘ultra-processed’.

In Salt, Sugar, Fat: How the Food Giants Hooked Us, investigative journalist Michael Moss revealed how the food industry adds vast quantities of sugar, salt, and fat to food products to make them more pleasurable to consume, and habit-forming.

Billions of dollars are invested into research and development to discover ‘bliss’ points – points where the optimal addition of these three ingredients has the greatest effect on the brains reward pathways to make them as habit-forming as possible.

For a can of soft drink – the bliss point is achieved with nine teaspoons of added sugar, not eight or ten – nine is the magic number. It might surprise you to know that the increasingly accepted scientific view of obesity is that it is caused by hedonic (pleasure-related) overeating that hijacks the brains reward networks, just like addictive drugs.

In a short space of time manufactured HFSS (high fat, sugar, salt) foods have become the default option for large sections of society. ‘Default’ simply refers to the option that is most available, accessible, and affordable.

‘Food’ marketing:
Additionally, HFSS foods are promoted at a grossly disproportionate rate when compared to healthy options.

McDonalds alone has been found to spend three times more to advertise its products than all advertising for fruit, vegetables, water, and milk combined [4]. Studies of supermarkets have revealed that fruit and vegetables made up less than 1% of all products promoted in high profile locations. In comparison, 43% of products located in high profile areas were made up of sugary foods and drinks [5].

When it comes to social media, the vast majority of advertising online is for HFSS products.

Making the default option the healthy option is the responsibility of government, not individuals.

Is the Government aware of the problem – or are they still in the dark ages?

Health experts have been advocating for government intervention to address the obesity epidemic since at least the 1990s.

In 2004, New Zealand’s Ministry of Health (MoH) published: Tracking the obesity epidemic: New Zealand 1977-2003. The report noted that:

  • Instead of aiming merely to slow down the growth of the epidemic, we may be able to realistically contemplate restoring the population Body Mass Index (BMI) distribution of the 1970s or early 1980s (when only 10% of the adult population classified as obese).
  • While communication of the healthy eating and active lifestyle messages should continue, it remains likely that any sustainable change will require policy intervention to reduce the obesogenicity of the environment, both with regard to child and adult obesity.

Fast forward 18-odd years, and 34.3% of kiwi adults now classify as obese according to the 2020/2021 National Health Survey. Unless there are significant changes, it has been projected that 50% of adults will classify as obese by the mid-2030s.

Since the 2004 MoH report, the government’s response to the obesity epidemic has relied simply on communicating the healthy eating and active lifestyle messages. Despite decades of advocacy, successive governments have avoided implementing any meaningful policies to make healthy food the default option.

When it comes to ‘responsibility’ it seems that it’s political responsibility that we’re lacking.

Think of it this way; the link between asbestos and lung cancer was well established by the mid-1950s but it wasn’t until 2016 that the Government banned the importation of asbestos products and materials. This was despite asbestos-related disease being the biggest cause of work-related fatalities.[6]

Smoking was first discovered as a major cause of cancer in the 1940s and 1950s,[7] but it wasn’t until the mid-1980s that the Government began implementing (albeit piecemeal) controls to try and restrict tobacco consumption. Significant legislation targeting the affordability of tobacco products was only introduced in 2010. [8]

The obesogenic food environment is directly linked to obesity (and therein a myriad of cancers, diabetes, coronary artery disease, stroke, mood disorders such as depression, as well as anxiety, low self-esteem, and suicide). How long might it take the Government to step up to this public health disaster?

Based on past performance, we could be waiting a while yet.

The question becomes; why have successive governments failed to heed the advice of public health experts?

Cui bono – who really benefits?

In The perils of ignoring history: big tobacco played dirty and millions died. How similar is big food? Researchers Brownell and Warner [9] provide some insight.

They suggest that the food industry, and its associated PR and lobby groups, employ the same tactics used by the tobacco industry. These tactics are used to fight regulatory changes, whilst presenting the industry as being concerned about, and actively engaged in addressing obesity.

According to Brownell and Warner, a tried and tested playbook is used which:

  • emphasizes personal responsibility
  • raises fears that any government action equates to a ‘nanny state’ that strips people of personal freedoms
  • pays scientists to raise ‘doubts’ about the links between the consumption of their products and harmful outcomes
  • vilifies critics by using totalitarian language to refer to them as ‘the food police’
  • denies the addictive nature of their products
  • denies their focus on marketing to children and young people
  • utilises significant lobbying resources to stifle government action by arguing that self-regulation is all that’s necessary.

Obesity and the personal responsibility narrative – who benefits?

When you’re aware of the playbook, it’s hard not to see it at work.

Judith Collins openly attributes obesity to a lack of personal responsibility. When taxes on HFSS products and restrictions on their advertising are advocated for by health experts; politicians or media spokespeople argue against the implementation of those policies on the grounds that they equate to a 'nanny state' approach.

In 2021 it was revealed that a major lobby group for the food industry, the New Zealand Food and Grocery Council (NZFCG), had paid a PR company $365,000. These payments coincided with the PR company publishing articles smearing the work of health researchers who were advocating for governmental regulation of the food industry. The author of the smear articles was the son of a former Member of Parliament while the CEO of the NZFGC is a former Member of Parliament herself. [10]

While politicians and lobbyists will publicly claim that the impact lobbying has on governmental actions is minimal, the reality is that successive governments since the 1990’s have allowed the food industry to self-regulate.

In 2019, Jacinda Ardern’s labour-led government resisted further calls to implement obesity reduction policies and allowed the trend of industry self-regulation to continue; much to the dismay of prominent health and medical advocates. This was referred to as 'astonishing negligence' by the country’s former chief health and nutrition advisor, Grant Schofield. Schofield describes the current food environment as the ‘pathological driver of tooth rot, diabetes, cancer, Alzheimer’s, heart disease, stroke, mental health problems’…and obesity.

When we scratch the surface, the personal responsibility narrative has a more sinister flavour. It is advanced by a powerful industry for its own benefit and enabled by politicians oriented on diverting attention away from their own inaction.

The narrative doesn’t benefit those struggling with their weight, or those of us who are trying to help.

As it’s now clear, we can’t rely on the government to make healthy foods the default option. While it’s important to reveal this deceptive narrative for what it is, it’s imperative that those who struggle with their weight are helped to navigate the obstacles to weight control and good health that the modern food environment throws at them.

People can’t wait for the Government to act, and the reality is that any top-down action isn’t foreseeable anytime soon.

A key focus for Weight Management Coaches is to help people understand and minimise their exposure to the perverse and unrelenting influence of food marketing. Coaches help people to understand the mechanisms by which HFHS foods become habit-forming and show people how to use these same mechanisms to replace HFHS foods with healthier alternatives.

Coaches help people to find and engage in non-food-related activities they find pleasurable and rewarding, so that HFHS foods can be removed as a default source of pleasure.

Weight Management Coaches care for the people they guide and support; they push back on the narrative that assigns blame to individuals for a problem created in large part by an industry with ‘questionable’ ethics, devoid of meaningful regulation.

New Zealand urgently needs Weight Management Coaches. Find out more about becoming a coach here.

References

1. Ministry of Health. (2021). Annual update of key results 2020/2021: New Zealand Health Survey.

2. Radio New Zealand. (2020, October 13). Judith Collins: Obese people must take responsibility for ‘personal choices’. RNZ.

3. Brownell et al. (2010). Personal responsibility and obesity: a constructive approach to a controversial issue. Health Affairs.

4. Harris et al. (2013). Fast food facts 2013: Measuring progress in nutrition and marketing to children and teens. Yale Rudd Centre for Food Policy and Obesity.

5. Obesity Health Alliance. (2018, November). Out of place – the extent of unhealthy foods in prime locations in supermarkets.

6. Povtak. (2016). New Zealand enacts national asbestos ban. Asbestos.com.

7. Proctor. (2013). The history of the discovery of the cigarette-lung cancer link: evidentiary traditions, corporate denial, global toll. BMJ Journals.

8. Ministry of Health. (2021, December 20). History of smokefree Aotearoa.

9. Brownell and Warner. (2009). The perils of ignoring history: big tobacco played dirty and millions died, how similar is big food? The Milbank Quarterly.

10. Murphy. (2021, March 3). Payment, apology in dirty politics case. Newsroom.