The war on obesity: a social determinant of health

Issue addressed The weight-centred health paradigm is an important contributor to the broader cultural paradigm in which corpulence is eschewed in favour of leanness. The desirability to reduce body fat or weight or to prevent gaining ‘excess’ fat is driven by both aesthetic and health ideals. The ‘war on obesity’ is a broad healthbased set of policies and programs designed to problematise ‘excess’ body fat and create solutions to the ‘problem’. There is a substantial body of literature that claims to demonstrate the harmful effects of ‘excess’ body fat. Recent critiques of ‘obesity prevention’ programs have highlighted the importance of focusing on environmental changes rather than individuals due in part to the risk of harmful consequences associated with individualistic, victim-blaming approaches. Beyond this, there are suggestions that framing body weight as the source of health problems – known as the weight-centred health paradigm – is in itself a harmful approach. The range of harms includes body dissatisfaction, dieting, disordered eating, discrimination and death. Health promotion policies and programs that operate within the weight-centred paradigm have the potential to have a negative impact on the health and well-being of individuals and communities. So what? Health promotion practitioners have a responsibility to do no harm to people they work with. The ‘war on obesity’ is actually a war on fat people, and the casualties from such a war are felt both personally and by the community. Health promotion practitioners working within the weight-centred health paradigm need to be aware of the evidence that demonstrates the harms associated with working in this paradigm. There is a need for a more healthpromoting and compassionate approach to people's health that is based on evidence of effectiveness. The ‘health at every size’ paradigm offers such an alternative.