Apocalyptic public health and the Saboteurs & Saviours of the “obesity epidemic”

Please remember to credit me if you make use of my original content.

This year I presented the findings from my first study for my PhD at the Weight Stigma conference in Prague, CZ and the International Society for Critical Health Psychology (ISCHP) conference in Loughborough, UK.  I won the prize for best student presentation at ISCHP, and having videoed my presentation for my own use, I’ve decided to share it.

This video shows only a short snippet of findings from a research project that took months to complete – not all of my findings have been included in this video, and there will be another phase to my research after this study too.

Abstract for the video presentation:

As part of the UK government’s work on tackling “obesity”, the National Child Measurement Programme annually measures the BMI of Reception (aged 4-5 years) and Year 6 (aged 10-11 years) children.  This study aimed to explore how discourses (re)produced within the programme construct responsibility, and how they construct gendered, raced, and classed identities.  Foucauldian discourse analysis was used to analyse NCMP materials including operational documents and communications to parents.  The first discourse, Apocalyptic Public Health, is characterised by constructions of “obesity” as a hidden but deadly disease, spread as a social contagion whilst dangerously difficult to spot by eye, which represents social and economic catastrophe to society as a whole.  This discourse serves to justify state intervention and encourages parents to conform to public health messages for the good of their family and of society.  Although this “obesity” apocalypse is regarded as harmful to all, those children and families who are marked as classed and racialised will be hurt more due to the arbitrary use of BMI, a White, middle-class concept that has been normalised as homogenous across social groups.  The second discourse, Saboteurs and Saviours, constructs the contrasting positions of those causing harm and those who will save us from it, positioning the intervening state as the agents of change, using surveillance and quantification of bodies as the solution to a problem caused by parents who are constructed as ignorant, uneducated, and in denial about their children’s fate.  These discourses hold real implications for the treatment of families with children marked as “overweight” or “obese”, and may serve to rationalise the implementation of charges for National Health Service treatment of those deemed to have “self-inflicted” illnesses.

As I state in the video, I reject biomedical terms such as “overweight” and “obese”.  I do not believe it is accurate nor scientific to claim that there is a “normal” weight range that is homogenous across all people, and consequently, there is no homogenous “overweight” either.  I also reject the pathologisation that accompanies labels of “overweight” or “obese”, as though these are not “normal” – I therefore use the term “fat” as has been reclaimed by fat activists, but as someone who does not experience size discrimination in any form, I am still considering and learning about the language around this topic whilst considering my epistemological position.

To reference conference presentation:

Gillborn, S. (2017, July). Mothering and the NCMP: Intersectional understandings of mothering and childhood body, health and weight management. Paper presented at the International Society for Critical Health Psychology Conference, Loughborough, UK.

Some things to bear in mind in discussions of “obesity”:

  • A lot of what you believe to know about “obesity” is false – for example, studies have shown that people in the “overweight” category actually have the longest life expectancy (Flegal, Graubard, Williamson, & Gail, 2005).
  • While “obesity” is in many studies correlated with illnesses such as heart disease, there is zero evidence to suggest or support that heart disease is caused by “obesity”.  The results of mainstream “obesity” research are frequently and persistently misinterpreted in the media, even after the authors of the original research have made efforts to correct misreporting (Lyons, 2009).
  • Much mainstream “obesity” research is completed by people with massive stakes in the diet industry, who often fail to declare their interests in their writings, and have huge money to make by sustaining the idea that fatness is abnormal and unhealthy (Lyons, 2009; Burgard, 2009).  It is rare to find researchers who are not paid consultants to the weight loss industry.
  • The correlation between “obesity” and the illnesses with which it is frequently conflated are not linear nor as simplistic as we are made to believe.  As little as 9% of the correlations between “obesity” and these illnesses are directly correlated, meaning 91% of the relationship between the two are not accounted for by the other variable; in other words, 91% of what accounts for a health outcome has nothing to do with BMI (Burgard, 2009).  It may well be that one of these extraneous variables is poverty and being poor, as being poor can result in higher body weight and poorer health for a huge number of reasons (including economic and social, such as less opportunities for free outdoor leisure time in more working-class neighbourhoods and families, and increased difficulty in receiving healthcare, again for a variety of reasons including lack of time, money, and stigma experienced from healthcare professionals.)
  • Weight cycling, the process of constantly changing weight which is the overwhelming result of dieting (with sustained weight loss failure rates remaining at 90-95% according to NIHTACP, 1992), has shown to cause many of the health problems with which “obesity” is associated (Lyons, 2009) – arguably, the ‘cures’ in the case of fatness are often more dangerous than the original ‘symptom’.
  • Health risks associated with “obesity” are lowered by physical activity, social support, good nutrition, access to medical care, etc, regardless of whether or not weight loss occurs; in contrast ineffective weight loss interventions cause physical and psychological damage (Burgard, 2009).  “If dieting was a drug to improve health, no doctor would prescribe it given its high failure rate” (Lyons, 2009, p. 77).
  • Based on the above two bullet points, it is arguable that it is the fight against “obesity” which is causing more harm to people’s health and livelihood, rather than simply allowing people to live at whatever weight they currently are (see Health At Every Size movement).
  • Advisors to members of UK government have previously said that “it might be helpful if more stigma is attached to obesity so that people made more effort to lose weight” (UK Parliament, 2004) – the NCMP materials themselves victim-blame fat children for their low self-esteem and mental health, and there seems to be an idea that shaming fat people will help them lose weight.  Shaming helps no one and does not improve health.
  • The National Child Measurement Programme was originally intended to be a ‘monitoring’ programme, meaning children would have their BMI monitored but never fed back to them and never with any guidance given to how to “improve” their health.  The National Screening Committee (NSC) claimed that if it were to be a screening programme, i.e. measurements taken and results sent to parents complete with related advice, this would have the potential to do far more harm than good.  Despite these concerns, the UK government made the NCMP a screening programme anyway, managing to bypass the NSC’s decision by instead passing it through as a part of policy (Evans & Colls, 2009).

The dominant discourses surrounding fatness are negative ones that are not only based on false “truths”, but have real implications for real people – but dominant is exactly what they are.  It is one of few topics I am still reluctant to discuss online, as I am often met with “there’s no argument to be had here – it is common sense that obesity kills”, and I understand why people believe that.  These false “truths” are reproduced almost weekly in newspapers and online news sources, but we must start challenging them.  Fatphobia is rife even within other activist spaces which argue to be progressive, and it is a very real form of discrimination, with fat women being paid on average less than non-fat women (while the same bias does not exist for men; DeBeaumont, 2009), and with the threat of having healthcare removed for fat people likely to hit Black and working-class families the most (discussed in the video).  If you are interested in learning more about this topic, I recommend having a read of The Fat Studies Reader (Rothblum & Solovay, Eds., 2009) – it is very eye-opening and extremely important.

 

To reference blog post:

Gillborn, S. (2017, July 15). Apocalyptic public health and the saboteurs & saviours of the “obesity epidemic”. [Blog post]. Retrieved from https://sarahgillborn.wordpress.com/2017/07/15/apocalyptic-fatness-and-the-saboteurs-saviours-of-the-obesity-epidemic/

To reference conference presentation:

Gillborn, S. (2017, July). Mothering and the NCMP: Intersectional understandings of mothering and childhood body, health and weight management. Paper presented at the International Society for Critical Health Psychology Conference, Loughborough, UK.

 

Burgard, D. (2009). What is “health at every size”? In E. Rothblum, & S. Solovay (Eds.), The fat studies reader (pp. 42-53). New York: New York University Press.

DeBeaumont, R. (2009). Occupational differences in the wage penalty for obese women. Journal of Socio-Economics, 38(2), 344-349.

Evans, B., & Colls, R. (2009). Measuring fatness, governing bodies: The spatialities of the body mass index (BMI) in anti-obesity politics. Antipode, 41(5), 1051-1083.

Flegal, K. M., Graubard, B. I., Williamson, D. F., Gail, M. H. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293(15), 1861-1867.

Lyons, P. (2009). Prescription for harm: Diet industry influence, public health policy, and the “obesity epidemic”. In E. Rothblum, & S. Solovay (Eds.), The fat studies reader (pp. 75-87). New York, NY: New York University Press.

National Institutes of Health Technology Assessment Control Panel. (1992). Method for voluntary weight loss and control. Annals of Internal Medicine, 116, 942-949.

UK Parliament (2004) House of Commons Health Committee: Obesity. Third report of session 2003-2004, volume 1.

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Prevent Duty: A state-sponsored attack on Muslim students

The government’s Prevent Duty has been around for 12 years, originally introduced by a Labour government.  It was the Conservative government in 2015 who made it a legal requirement of universities, amongst others, to abide by.  The Prevent Duty states that certain bodies have a legal requirement to prevent people from being draw into extremism, and is based on the “conveyor belt theory” of radicalisation.  This is the first problem.

This theory states that non-violent extremist views draw people into terrorism, but this, many believe, is completely inaccurate. Jeremy Corbyn, Caroline Lucas and George Osborne could all arguably be labelled as having radical, extreme views, but none of them are labelled as potential terrorists.  What do these three people have in common?  They are all white.

Prevent lists a number of ridiculously common traits, especially in university students, as potential signs of radicalisation.  These include: a need for identity, meaning, and belonging; a desire for political and moral change; and relevant mental health issues.  Who can honestly say they have no experienced at least one or two of these?  In my second year at university, I ticked all these boxes.  I suffered with social anxiety, which left me quiet and withdrawn.  I didn’t feel like I really belonged, and I struggled with my identity, particularly my sexuality.  I became interested in politics as the 2015 General Election came around.  Anyone who knows me now knows that this was the time in my life when I really threw myself into feminism.  I ticked every box, and I was a perfect candidate for “potential radicalisation” according to Prevent.  But I wasn’t referred, and I doubt I would be if that all happened now – because I am white, and Prevent, as so many do, ignores that terrorism can come in many forms, and not just the radical Muslim extremists the media likes to focus on.  In fact, in the USA, more people have been killed by white, domestic terrorists than by Muslim extremists since 9/11 – but the media, and Prevent, would prefer to separate issues of terrorism into ‘us’ and ‘them’.

 

The entire Prevent Duty focuses on what they call “Islamic extremists”, with one measly line about white supremacists.  We know that Prevent does not care at all about white people being drawn into extremism from groups such as Britain First and the EDL.  A three year old child was referred to Prevent.  A schoolboy who used the term “eco-terrorism” in a classroom debate about environmental activism.  A student who wore a ‘Free Palestine’ badge and asked if he could fundraise for children affected by the Israeli occupation.  A university student doing a counter terrorism course reading a book called “Terrorism Studies” in his university library.  All were Muslims, and all were referred to Prevent because Prevent has made teachers believe that Muslims with opinions are a threat.  Prevent has turned educators into informants and students into suspects.  Many of these students were explicitly asked “do you have any affiliation with ISIS?”  Police have even been calling Student Unions’ around the country asking for the details of members of their Islamic Societies, and universities have begun monitoring prayer room use. This makes it abundantly clear that this strategy is clearly singling out and spying on Muslim students.

 

Islamophobia is already a huge problem in this country, with there being a 200% increase in anti-Muslim hate crimes since 2012 and a 300% increase in violence towards Muslim women and girls since the attacks in Paris.  We already have Islamophobia embedded in our society, and we do not need it embedded in our institutions where students should be safe.

 

The University and College Union, a trade union for lecturers and academics, have policy stating that Prevent seriously threatens academic freedom and freedom of speech, and forces members to spy on learners, is discriminatory towards Muslims, and legitimises Islamophobia and xenophobia. Even the Chair of the Home Affairs Select Committee has said that he would abolish Prevent.

 

We must realise how these guidelines are embedding themselves within welfare services and how this is going to have a detrimental impact on the wellbeing, interests and educational experience of our students.  Just by being implemented, Prevent has already intimidated Muslim students into silence.  There is a very real fear amongst our students that any opposition to Prevent will land them in hot water.  We have had Muslim students decline to speak in opposition to Prevent and decide not to undertake research into its effect on Muslim students for the sole reason that they are scared it will end in them being referred to Prevent themselves.

 

Prevent is no more than racial profiling and state-sponsored Islamophobia.  PREVENT is not the solution.

 

Orginally posted on The Beckett Online, 15/02/2016

We’re sick of heteronormativity and cissexism – Inclusive sex & relationships education can save lives

TW: rape, child abuse, heteronormativity, cissexism

 

The government has repeatedly rejected calls for statutory sex and relationships education (SRE).  In doing though they are failing millions of people.

 

The sex education we currently give our students is not acceptable.  A quick google image search of the topic will return hundreds of images of the symbols for ‘male’ and ‘female’ intertwined.  When I was in school, we were shown how to put on a condom.  We were told that girls have periods, and why that is, and we were told how pregnancy can occur, and how to avoid it.  It was all very heteronormative and cissexist.  We were split into groups of “girls” and “boys”.  It all felt very secretive and very embarrassing.

I was never told that some people were attracted to people of the same gender.  I was never told that it was okay that I felt like I was attracted to people regardless of gender.  When I was 10, and I liked a girl, I knew I could never tell anyone. I thought “it’s not possible for girls to like girls, right?”  I had never been told by my teachers that it was even a possibility, so of course, I thought there was something wrong with me.  When a teacher discovered, when I was 15, that I had a girlfriend, I was told “you know that’s wrong, don’t you?”  I lost friends over having a girlfriend, because my friends were never taught that what I was feeling was “normal”.  If it wasn’t for my supportive family, I would have grown up confused, alone, and scared.  And many do not have the supportive family I have.  I was never told that what I was feeling was normal by my educators, and at times I was explicitly told that my feelings were wrong.  I dread to think how this must feel for children who are only attracted to the same gender, or for children who grow up feeling that they were assigned the wrong gender at birth by a society that thinks it knows individuals better than they know themselves because of what their genitals look like.  With more than 50% of trans youth attempting suicide before their 20th birthday, this is an issue we cannot allow to go untouched any longer.

Inclusive SRE can mean that LGBTQ* children grow up knowing that they are “normal”, that they are equal and worthy, and that they deserve love and happiness as much as anyone else and, importantly, that they have the right to self-define however they feel.  No child will have to grow up in silence about their identity, not realising that what they feel is completely acceptable and felt by many.

Up to 40% of all LGBTQ* youth attempt suicide.  Proper, inclusive sex and relationships education can stop this.

 

SRE has the opportunity to teach children, from an early age, about the importance of consent – a topic which is far too often being left to Students’ Unions to implement themselves, on an opt-in basis, to 18+ year olds; meaning the majority of people will never actually be taught about the importance of consent, and when they are, it is all too often too late.

A lot of people do not realise what constitutes rape and sexual assault.  A recent report by Professor Sarah Edwards discovered that around a third of men university students said that they would have sexual intercourse with a woman against her will “if nobody would ever know and there wouldn’t be any consequences”.  However, when the phrasing of this statement was changed to include the word “rape”, 13.6% of the men surveyed said they would do so – which, though still shockingly high, shows that an outrageous number of male university students have little understanding of what exactly “counts” as rape.

We hear a lot of “but everyone in their right mind knows rape is wrong” and “no one needs to be taught not to rape” – but I don’t buy this.  This goes for all people.  Everyone should be taught about consent, about what it is, and what it is not.  Because clearly, there is in fact a problem whereby a lot of people don’t know what consent is.  If we are teaching about sex in schools, we need to teach about consent, and proper and compulsory SRE would allow this.

Consent education from an early age can also, of course, teach children who are being abused that what is happening to them is not okay, and could encourage them to speak to someone who can help, be that a family member or a trusted teacher.

 

Proper sex and relationships education can save lives, and it is about time it was implemented properly in the UK.

We must support Junior Doctors

Tomorrow, junior doctors will again be taking industrial action against the government’s proposed changes to junior doctor and consultant contracts, and I stand firmly in support of them.

Junior doctors are currently covered by a contract that acts as a safeguard to prevent them from working dangerously long hours.  The contract has financial penalties for employers if it is not enforced, and therefore acts as a very reliable safeguard in keeping junior doctors from working long hours without breaks.

The Government plans to reduce the number of breaks per shift to just 20 minutes every six hours – this means that a junior doctor working an 11 hour shift will only get a single, 20-minute long break.  There is also no financial penalty attached to the Working Time Regulations (WTR) on which this is based, so employers will be under less pressure to ensure that junior doctors are actually getting the breaks they are entitled to.

Junior doctors’ current contract sets standard working hours as 7am to 7pm, Monday to Friday.  Junior doctors routinely work outside of these times in order to provide their patients with the high quality care they need.  When junior doctors work outside of these times, they receive a pay premium to reflect the impact that working outside of these standard working hours has on an individual’s personal life.

The Government, however, does not want to recognise the impact of working evenings and Saturdays, and so they plan to extend the standard working hours to 7am to 10pm, Monday to Saturday.  This means that 30 hours a week that are currently paid at a premium rate, would move into standard time meaning junior doctors will ultimately lose out.

I, and many others, absolutely reject and oppose these proposed changes.  The removal of junior doctors’ current safeguarding contract will result in working long hours with a very short break; this is not safe for the doctors’ wellbeing or for the patients for whom they are providing care.

The proposed extension of ‘standard’ working time would not value junior doctors’ time appropriately, and clearly underestimates the impact of working evenings and weekends as well as ‘standard’ hours on individuals’ lives.

The change, many fear, will encourage employers to see junior doctors as a cheap way of staffing, leading to them working fewer hours during the day, and more hours at evenings and weekends.

Tomorrow, junior doctors will take industrial action, striking in protest against these proposed changes and the detrimental impact they will have on junior doctors’ lives and on the healthcare we receive and value so very much.  From 8am onwards, junior doctors and students will be on the picket lines at all hospitals for a 24 hour picket.

Striking is an effective and important way of exercising the power workers have against unjust and unfair conditions, and we completely support the junior doctors’ decision to use strike action.  The British Medical Association (BMA), the trade union for doctors and medical students in the UK, argues that these changes are part of a wider attack on the NHS in the government’s pursuit to privatise our healthcare – something which we must stand firmly against, in the belief that healthcare is a fundamental human right which should be available to everyone, and not just those who can afford it.

Though the strikes are argued to be ‘very damaging’ for patients, we argue that the proposed changes will have a much more detrimental impact on both patients and junior doctors in the long-term.

It is so important that the public absolutely supports the junior doctors in their action and opposition to the government’s proposed changes, and encourage others to do the same.

No more ‘Blurred Lines’ – Consent workshops are making a difference at university

Trigger Warning: rape, sexual assault.

The young men in the media who refuse to attend consent workshops have a terrifying misunderstanding of rape.  In one picture, a 19 year-old, white, male student holds a sign which states “this is not what a rapist looks like” – in actual fact, the US Department of Justice estimate that around 75% of rapists in the US are white men.  But then again, we know that a rapist can come in any shape or size – any gender, age, ethnicity, a close friend or a complete stranger, etc.  Ironically, this is something this student would have known had he attended a workshop.

 

Put simply, consent workshops are important because a vast majority of students are confused as to what exactly consent is, and many refuse to believe how common sexual assault really is.  Consent, something which should be a very simple concept, has been sidelined as unimportant and plagued with misconceptions in the media.  Sex education in schools focuses on how to avoid STIs and pregnancy, but not how to have happy and healthy relationships.  Consent is seen as a ‘Blurred Line’.

 

“A person consents if they agree by choice, and they have the freedom and capacity to make that choice” – so a person saying ‘yes’ because they have been threatened or guilt-tripped into something is not giving consent.  Consent is active and enthusiastic participation, and it not simply the absence of a ‘no’.  This is what we teach in our workshops at Leeds Beckett Students’ Union.  We explain the damaging effect of rape jokes on a society that already treats rape as normal.  We hear ‘rape’ and think of a violent attack, committed by a hooded stranger in a dark alleyway, when really 90 per cent of rapes are committed by someone we know and trust – in most cases, this person is a friend or partner.  We fail to acknowledge these instances as ‘real rape’ because of our warped conception of what rape is – and often we fail to recognise what has happened to us in the comfort of a friend’s bedroom.

 

Our consent workshops are available to anyone who would like one, on an optional basis.  We’ve given them to SU staff, residential officers, society committees, students in general, and even had one taped by the BBC.  It is our hope that the majority of students will have attended one in the next academic year.  The workshops aim to teach once and for all what consent is.  We come from the angle that we are living in a rape culture that trivialises rape, and we believe that we can change this culture by changing people’s attitudes and knowledge about consent and making people understand what consent really is.  We do not believe that people who contribute to this culture, for example, by telling rape jokes, are bad people – they are simply caught up in the culture that we all live in.  It is only by educating people that we can challenge rape culture and end this problem once and for all.

 

 

Below are some examples of positive attitude and knowledge changes in people who have attended a workshop at Leeds Beckett compared to people who haven’t.

 

1

The correct answer to the above question is 90% – of people who have attended a workshop, 69% answered this question correctly.  The remaining 31% answered ‘78%’, which, although incorrect, is still an estimation that it is a high percentage of rapes that are committed in this way.

As for people who have not attended a workshop, only 25% answered this question correctly.

 

 

2

The correct answer to the above question is obviously Yes.  95% of people who haveattended a workshop answered this correctly, compared to 82% of those who have not attended a workshop.  Although this number is certainly not low, it’s still definitely not high enough in my opinion.  This is one of the common misconceptions that leads to rape, and is one instance where it is common for both the perpetrator and the person it happened to, to not to realise what exactly it was that happened.  If someone is a little tipsy, but in control, this does not mean incapacitated.  But, in cases where someone is incapacitated; no, they cannot consent to sex.

 

 

3

Of people who have attended a consent workshop, 96% feel confident that they would know where to go for help and support, and the remaining 4% are “unsure” with no people stating that they do not know where to go for support.  Unfortunately, of people who have not attended, 36% stated that they are not confident in knowing where to seek help and support.

This result indicates that as well as improving our knowledge and attitudes towards consent, Consent Workshops also improve our knowledge of where we would go should we ever need support if something like this ever happened to us.