Cut the Obesity Guilt Trips for Parents, Please

The Daily Express is doing a fine job of upholding a strong reputation for promoting fat shaming in the UK. The tabloid managed to find a sensational guilt trip in three Lancet articles this week on women’s health. The headline was: “Unhealthy lifestyles of mothers-to-be could wreck the lives of future generations.” But the real bottom line from these papers is that “few interventions have been made for preconception diet and lifestyle.”

In other words, healthier lifestyles might benefit the health of future generations. But so far, we have few proven tools to guarantee that potential parents can enjoy those outcomes. So the Express is going with a surefire strategy for making things worse – a guilt trip for parents.

Smug Lifestyles of the Healthy and Wealthy

One factor that feeds these attitudes is the designation of obesity as a “lifestyle” disease. People who are lucky enough to be biologically resistant to obesity may think, “I’ve earned this healthy physique with my healthy lifestyle choices.” Healthy self-esteem.

Now, it’s true enough that obesity rates have soared with the help of  lifestyle factors. But these lifestyle factors are all about the culture that surrounds us all. That’s why obesity is rising in all groups in parallel. Black, white, Hispanic, rich, and poor – every demographic is affected, even though other factors come into play.

Some demographics have higher baseline rates, but not strictly because of “lifestyle.” What’s at work in different groups are other stressors – like economic insecurity – that add to risk.

So assuming that prospective parents with obesity have done this to themselves, and can reverse it anytime they like, is simply a lie. Biology is the fundamental driver. Environmental triggers finish the job. Personal choices play a role, but no more than they do in any other disease. Blame and shame are both wrong and counter-productive.

Shift from Shame and Blame to Effective Support and Care

What we need is real help for young adults to reduce the impact of obesity on themselves and future generations. Finger wagging doesn’t count. Behavioral support – like the DPP – can help. But it’s not a miracle or a cure. It’s just a tool for slightly better outcomes.

More intensive obesity care can also help. That includes comprehensive obesity treatment programs, pharmacotherapy, and bariatric surgery. No cookie-cutter program can guarantee uniform success. Patient-centered care is the key. Surely better models for care will evolve, but we need good research to guide the way.

What we don’t need is more guilt trips for parents. Support and care – not blame and shame – paves the way to better health for all.

Click here for the latest series on this subject in the Lancet and here for an earlier series in Lancet Diabetes and Endocrinology. And then here, you can find further perspective.

Mother, Child Saving; sketch by Kuzma Petrov-Vodkin / WikiArt

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April 21, 2018