More of the same? Conflicting perspectives of obesity causation and intervention amongst overweight people, health professionals and policy makers

Abstract

This paper presents the findings of a qualitative study conducted in the United Kingdom of the perceptions of overweight individuals, as well as health professionals and policy makers working in the area of obesity prevention and weight management. In 2006-2007, we conducted interviews with 34 men and women (18-50 years old) who self identified as being overweight; 20 health professionals; and 9 policy makers. We explored their understandings of the causes of obesity/overweight; beliefs about factors that enabled or inhibited weight loss/gain; and opinions regarding effective obesity/overweight interventions. We found a range of views, which corresponded with biomedical and socio-ecological perspectives of health and disease. The lay overweight respondents viewed the problem of obesity arising from their personal shortcomings (i.e. motivational and physical), juxtaposed to blame-absolving accounts often involving specific challenges associated with day-to-day living. All respondents presented personal stories of complex battles of short-term weight loss and longer-term weight gain, usually characterised by a sense of failure. All expressed a strong sense of personal responsibility to overcome their weight problems, and looked to another not-yet-tried, technocratic weight loss programme to address the problem, despite all reporting past failures. Health professionals and policy makers on the other hand viewed obesity as a socio-ecologically determined problem, detailing social and environmental explanations. Health professionals were more inclined towards individual-orientated weight management interventions as effective responses. Policy makers considered environmental and social policy changes as most likely to make a substantial difference to current obesity trends, but considered it unlikely that such policies would be implemented without the political will and popular support. Our data highlight dissonance between policy maker, health professional and public obesity perceptions and points to a challenge for those who believe that wholesale systemic change is required if obesity trends are to be reduced or halted.