Understanding Obesity through Sociology Dr Abir Youssef

Understanding Obesity through Sociology Introduction World Health Organization (WHO) definitions for obesity Causes of obesity Socio-economic Environmental Explanation Cultural – behavioral Explanation Ethnicity and Obesity Tackling Obesity Conclusions

Introduction Obesity is a major public health problem across the world. Obesity results from excessive caloric intake, decreased energy expenditure and/or from a combination of the two.

World Health Organization (WHO) definitions for obesity BMI = Weight kg/Height m² Underweight: <18.5 BMI Healthy weight: 18.5-24.9 BMI Overweight (Grade I obesity): 25.0-29.9 BMI Obese (Grade II obesity): 30.0-39.9 BMI Morbidly obese (Grade III obesity): 40 or above BMI

Causes of obesity The etiology of obesity includes both genetic and environmental factors There is no doubt that obesity is influenced by genetics. However, family members share, not only genes, but also diet, culture and many aspects of lifestyle.

The followings are the main factors: Environmental factors related to lifestyle and cultural or socio-economic conditions Psychological factors Metabolic factors May also be induced by drugs (high dose glucocorticoid) Secondary to a variety of neuroendocrine disorders

Socio-economic Environmental Explanation Obesity is strongly influenced by environmental factors, such as , poverty, housing condition, and work situation. A range of complex economic, environmental, social and cultural factors all have a part to play in the rise of obesity as a health problem. This entails not only considering the impact of social class position, ethnic origin and gender on the prevalence of obesity but also involves examining the implications of unemployment, poverty on the health and well-being of adults and children.

Housing conditions There is clear recognition of the association between poor housing and poor physical and mental health Housing conditions such as lack of safe play areas outside the home, overcrowding, are more likely to lead to unhealthy life styles, unhealthy diet, lack of exercise and depression, all of which can increase the prevalence of obesity. On the other hand the household appliances that make our lives easier bear some responsibility. People spend less energy in their daily activities because technical advances, such as central heating and modern appliances, ease their domestic work

Income Obesity is strongly linked to poverty. Poorer diets among poorer groups can be explained by the lack of opportunities, stress, and level of knowledge. Income has direct and indirect effects on health, as it tends to affect housing, diet and provision for the family. The indirect effect of income on choice of diet and eating habits, has been widely investigated, people from low-income households tend to eat less fruit, vegetables and high-fiber food and more sugar than people from high-income households.

Income Poverty and overcrowding can inhibit parental supervision of children and negatively affect their health in general and increase obesity. Unhealthy fast food is both available and affordable.

Work situation Work allows for the financing of household necessities and leisure pursuits and provides status and self-esteem for the individual. There is a decrease in energy consumption at work, as most of our jobs now require much less physical effort, compared with 1970.

Work situation Travel to work by cars and/or other modern public transport Calorie intake and the ambient temperature at home and at the workplace have increased.

Cultural – behavioral Explanation The Cultural – behavioral explanation of health inequalities point out class difference in beliefs about health health behaviour life-style Diet is influenced by both cultural preferences and disposable income; the prevalence of obesity is higher in manual than non-manual groups, where health is a matter of individual responsibility and free choice influences attitudes based on knowledge. Manual class people are more likely to adapt to fatalism, have short-term goals, low expectations of life and bolder attitude towards taking of risks.

Lack of public information Some people can not judge which products are high in fat and by how much. Food manufacturers display macronutrients in grams, when the correct way would be to express their contribution in energy.

Lack of public information Advertising gives children confused messages about nutrition, and can change their food preferences and buying behaviour. Subsidies of agricultural products play an important part, as children as well as adults, are influenced by cheap prices.

Ethnicity and Obesity Psychosocial factors associated with the incidence of obesity in ethnic minorities include inadequate social support cultural barriers to communication racism and discrimination stress and lack of knowledge language difficulties to understand the health promotion message. Ethnicity and the linked notion of multiculturalism impinge heavily on public health in Britain; the most ethnically mixed county in Europe Obesity is more common in South Asians men, and women, from all minority ethnic groups. South Asians are less likely to participate in physical activity with the lowest levels found in the Bangladeshi community, as well as amongst the minority ethnic groups; Chinese have the highest levels of consumption of fresh fruit and Pakistani adults the lowest.

Tackling Obesity on different levels individuals community local government national levels

Tackling Obesity Society-wide Approach Medical profession The WHO’s 1997 interim report argues that it is not enough to tackle obesity at individual level and that a society-wide public health approach needs to be employed. Medical profession Government should work with the food industry to promote a healthier diet for everyone from childhood to adult life. Management of obesity in Primary Care by a motivated well-informed multi-disciplinary team could achieve and maintain weight loss by promoting sustainable changes in lifestyle.

Tackling Obesity The government should work to reduce health inequality and improve the environment factor. Controlling safety and making the streets safe for walking or cycling. Promoting and improving access to sport and leisure facilities. Education programmes for all, advertising to promote healthy lifestyles and highlight the risks associated with obesity. The government should work to reduce health inequality and improve the environment factor. by improving the housing situation, deprived areas and supporting the needy such as the disabled, people with difficulties, or large families. Promoting and improving access to sport and leisure facilities, as well as encouraging physical activity, especially among children and disadvantaged groups.

Tackling Obesity Individual parents of overweight children should be helped to take responsibility and encourage healthy eating and physical activity.

Conclusions Obesity is not a disease, it is a public health problem and it is a risk factor for several chronic diseases. Understanding environmental factors can contribute to a better understanding of the nature of obesity as well as contribute to tackling it.