The evolving landscape of obesity: a journey to disease acceptance

To mark this anniversary, we investigate whether these milestones have contributed to a shift in the perception of obesity. And, through a focus on medical advancements, cultural movements and evolving social norms, we ask the question: will we ever reach a neutral ground, where individual health needs are always ‘on trend’? 

Historically, public perception of body weight has shifted between periods of stigmatisation and periods of greater acceptance. As far back as 20,000 years ago there is evidence of obesity representing fertility and motherhood. Between this period and the beginning of the 21^st century, many complicated factors have played into the perception of obesity, some of which continue to guide today’s narrative. With this historical context in mind, this article will primarily focus on medical and societal evolution of obesity in the last two decades.

But first, to understand the current landscape, we can start at the late 20^th century, a period in which thin, often unattainable body images were idealised. In reality, the world looked different; obesity rates were on the rise. In fact, the number of people living with obesity worldwide more than doubled between 1990 and 2022.

Despite the establishment of new obesity guidelines in this time frame, those looking for obesity care faced limited long-term options. Several factors contributed to this:

• Firstly, education for healthcare professionals on obesity was often lacking or inadequate;
• This, in turn, contributed to weight bias within the healthcare setting, which may have made people hesitate to attend consultations due to fear of judgement;
• The initial treatment approach often prioritised short-term weight loss (typically aiming for 5%), which frequently fell below individual goals and may have hindered long-term weight maintenance. This focus on short-term interventions, rather than sustainable long-term care options, is likely to have contributed to a cycle of weight loss and regain for many individuals

Obesity rates were at an all-time high, but attitudes towards obesity were falling short for those who needed support.

But there were signs of change to come.

The early 2000s witnessed a growing awareness of the impact of unrealistic beauty standards on mental health. Notable reports, such as the "Real Truth About Beauty," exposed how media portrayals of body image had created a culture of self-criticism. This ignited a movement towards "real beauty" campaigns, challenging the exclusive and often unattainable ideals previously celebrated in advertising and popular culture.

The seeds were sown for the obesity community to start rewriting the narrative.

In October 2015, The World Obesity Federation established the very first World Obesity Day, a landmark moment for those impacted by obesity. Around this time, the Obesity Society called for the introduction of people-first language, a non-weight-bias approach that refers to someone living with obesity, rather than harmful labels such as ‘obese’.

We explore the powerful impact of language here if you would like to explore this topic further.

The use of people-first language also needed to be reflected in literature and academic research, to combat the weight bias that prevailed in healthcare settings. In this period, only 6% of the total publications about obesity used ‘people with obesity’ vs ‘obese people’, the latter promoting a message of individual blame and responsibility.

However, early signs suggested that efforts to address public perception of obesity may have been showing positive results. A study examining public perception of obesity between February 2013 and March 2015 revealed a small decline in the proportion of the public viewing obesity as a 'personal problem of bad choices’, from 44% to 36%. Although it should be noted that the study did not explore the extent to which those responding considered obesity a disease.

Outside of literature, the body acceptance and positivity movement was gaining significant momentum. Social media platforms became a powerful tool for individuals to share their stories, challenge the societal norms from earlier years, and celebrate diverse body shapes and sizes. Influencers and activists championed inclusivity and self-acceptance, fostering a sense of community and empowering individuals to embrace their bodies. The mainstreaming of plus-size models in fashion and media further challenged traditional beauty standards and perhaps sparked a growing movement towards greater inclusivity for people living with obesity within society.

This shift was evident in various ways. In 2019, social media influencers were invited by the UK government to consult on effective ways to combat negative body image. Furthermore, the inclusion of the term "body positivity" in the Oxford English Dictionary in March 2021 signified a growing societal awareness of the term and its fundamentals. More recently, the Obesity Action Coalition were invited to consult on 2023 Oscar nominated film "The Whale" in a bid to ensure a more sensitive and accurate depiction of the lived experience of obesity.

At the same time, the understanding of obesity and its long-term management was growing, with the introduction of several obesity care options for those with a BMI of over 30. And it was needed; a US study showed that between 2009 and 2015, obesity care was rarely prescribed, and in fact, only 0.2% of those eligible, received treatment. Fortunately, innovation in obesity continued, and the last twenty years has seen the introduction of several treatment options that work differently based on individual needs. For example, healthcare professionals now have the option to prescribe oral treatments, injectable treatments or treatments that are taken every day, or once a week. What’s important is that these kind of treatments should only be obtained through a healthcare professional, who can prescribe based on individual circumstances, alongside long-term lifestyle changes.

With more treatment options became greater awareness, and not just from those affected by obesity. Recent reports have suggested that the interest in obesity care has also spiked in healthcare professionals. In fact, according to one report, the number of doctors receiving board certification by the American Board of Obesity Medicine has nearly doubled since 2020. In parallel, obesity guidelines have been updated to emphasise the importance of a multi-disciplinary team, expanded to include nutritionists and psychologists. This approach recognises the importance of tailored obesity management in a bid to improve the chances of long-term weight management.

However, despite these significant strides, the societal response to obesity remains complex. While the body positivity movement has gained significant momentum, it has made less of an impact on policy and legislation. Many countries still lack robust legal protections against obesity discrimination in the workplace and other areas of life.

For a deeper dive into workplace obesity discrimination, you can read more here.

As we recognise the 10-year anniversary of World Obesity Day, it is evident from the exploration above, that through increased awareness, research and advocacy, great strides have been made in the care of those impacted by obesity. But, with obesity rates projected to reach 1 billion this year, and high BMI a leading cause of heart disease, now is more important than ever to acknowledge the need for holistic obesity care.