28 Sep 2021 Guest Blog: A Weight Neutral and Compassionate Approach to Tackling Obesity in Kirklees
In our latest guest blog, we heard from Alison Millbourn, Public Health Manager at Kirklees Council, to find out more about their ‘weight neutral’ approach in the borough in their bid to reduce the prevalence of obesity locally.
I have been involved in the delivery and commissioning of interventions to tackle obesity for nearly 20 years, and the bottom line is…..we are not making one jot of difference! Rates of overweight and obesity are continuing to rise, and yet we continue to commission services that we know are not effective in the longer term.
I had also become more and more disillusioned with the approach of blaming the individual themselves for their weight gain, when the Foresight Report published way back in 2007 used, for the first time, the term ‘obesogenic environment’. The report states that ‘the causes of obesity are extremely complex encompassing biology and behaviour, but set within a cultural, environmental and social framework’, acknowledging that alongside personal responsibility there is an ‘abundance of energy dense food and use of motorised transport’. This disillusionment led to me exploring with colleagues the practicalities of a more compassionate approach to tackling obesity. At around this time, I became aware of Doncaster applying a very interesting approach, which meant applying a ‘weight neutral’ stance to their work.
The weight neutral/compassionate approach is based on examples of good practice already in existence in Australia, where an esteemed Dietitian, Fiona Willer has used this rationale to develop her ‘Health at Every Size’ intervention. A weight neutral/compassionate approach is not weight centric. It driven primarily by compassion, takes blames away from individuals and fully acknowledges the mental and financial burden poverty and inequality places on people.
The evidence suggests that health gains are maintained over time, and that there are better psychological outcomes, unlike weight centric approaches that can lead to harmful weight cycling and dysfunctional relationships with food and body. The focus is very much about supporting healthy behaviours, eg, joyful movement, good nutrition, good quality sleep, etc. This is particularly important considering that approximately 90% of people need to improve the quality of their diet, and yet we are only having conversations with those with an increased weight or BMI.
We have agreed to pilot a weight neutral/compassionate approach alongside our traditional Tier 2 weight management service which sits within The Kirklees Wellness Service. We will evaluate this alternative model once the pilot is embedded. We are also ensure that we apply compassionate principles into our existing T2 service, acknowledging that this service will still be the preferred option for many. We are also rolling out the conversation with various partners and stakeholders to ensure that eventually, across the whole Kirklees system, we are all using the same approach and language, including using body positive images where possible.
So how does this new approach fit with the fact that we signed up to the Healthy Weight Declaration (HWD) in early 2019? Well, putting aside the title of the declaration for a moment, when we look at the individual commitments within it, none of them refer to weight or size, all of the commitments are focussing on good nutrition, increasing physical activity, and ultimately tackling a system that contributes to the ‘obesogenic environment’. Therefore the HWD is still relevant to our new approach, and the fact that we gained Cabinet sign off and support, gives us the mandate to progress this approach, albeit more compassionately that we had originally intended.
