Cancer Research UK, the world’s largest independent cancer research charity, has a new anti-obesity mass media campaign which likens obesity to smoking. Billboards have started to spring up with the words ‘Obesity is a cause of cancer too’ emblazoned across familiar cigarette packets. The campaign has already attracted widespread criticism from members of the public, academics and healthcare professionals.
The campaign is seen to be reinforcing a simplistic view of obesity as a behavioural choice, which implies that people are personally responsible for their weight. In reality, we know that the causes of obesity are highly complex and involve genetic, physiological, psychological, and environmental factors.
We also know that blaming and stigmatising people for their body weight is extremely damaging for physical and mental health, and makes efforts to control one’s weight even more challenging.
However, Cancer Research have defended their campaign saying that it is about lobbying the government to implement tougher policies on the advertising of unhealthy foods to children (unhealthy foods typically refer to foods high in fat, sugar and/or salt or ‘HFSS’ foods). We currently live in an ‘obesogenic‘ environment where HFSS foods are readily available and extensively marketed. The extent of food-based marketing directed at children is of particular concern and has been shown to increase children’s food consumption.
So why make the link with smoking? Recent policy changes, such as banning smoking in public places, advertising bans and plain packaging, have dramatically reduced the prevalence of smoking. UK smoking rates are now at an all-time low. Cancer Research say they are comparing obesity with smoking because the government needs to take similar action in relation to food. If these approaches have been effective in reducing smoking, could they do the same for obesity?
However policies which result in greater regulation of the food environment tend to be unpopular. When the levy on high-sugar drinks (aka the ‘sugar tax’) was introduced in the UK last year, one newspaper ran a ‘Hands Off Our Grub’ campaign. Boris Johnson, the likely next Prime Minister of the UK, recently set out plans to review existing levies on HFSS foods and halt the implementation of any new ones. This is despite evidence indicating that the sugar tax has been effective in reducing sugary drink purchasing and consumption.
This is where drawing parallels between obesity and addictive behaviours such as smoking could potentially play a useful role. If people view certain foods as having similar ‘addictive’ properties, are they more likely to support and accept policies for tougher regulations on these foods?
This is a new area of research and there are currently only a handful of studies. In one study of almost a thousand adults from the US, people’s beliefs about the addictiveness of certain foods were found to be associated with greater support for obesity-relevant policies.
Specifically, people who believed that HFSS foods were addictive were more likely to support restrictions on food marketing to children, banning energy drinks, use of food warning labels, mandatory industry salt and sugar reduction, limiting sugary drink portion sizes, and a ‘junk food’ tax (an earlier study from the same research group had similar findings).
However, a survey of 479 adults from Australia and the US found different results. There was strong support for seeing obesity as a form of addiction – however, this did not translate into greater endorsement of public health policies for tackling overeating. Overall, the study found little support for restricting advertising and increasing taxation on obesogenic foods.
It’s also important to consider how linking obesity with addiction could impact on weight-related stigma. There is some evidence that viewing obesity as a ‘food addiction’ could help to reduce negative attitudes towards people with obesity, perhaps because addiction implies that someone has less personal control over their behaviour. However this beneficial effect was not supported by another study, and the existing evidence on this topic is inconclusive.
Finally, an obvious problem with comparing obesity with smoking is that they are inherently different. Most fundamentally, eating is essential for survival whereas there is no safe level of smoking.
This makes policies for regulating the food environment more challenging to implement in terms of which products should and shouldn’t be included. To date, these policies have focused predominantly on products with little nutritional value, such sugary drinks. How these policies are extended to other ‘unhealthy’ foods and drinks will require careful consideration.
Cancer Research’s campaign is flawed, but their ultimate aim to influence policy is important – we need to change the food and physical activity environments in which we live. There is some evidence that linking certain foods with the concept of addiction could be effective in influencing public support for obesity-relevant policies. The challenge now is to determine if and how this approach could be used in order to stimulate policy changes while minimising blame and personal responsibility for weight.
Dr Charlotte Hardman is Senior Lecturer in Psychological Sciences at the University of Liverpool, researching eating behaviour and the links between obesity and addiction.