Cancer Research UK launched an advertising campaign recently which has attracted a huge amount of attention. As you can see in the picture, in case you haven’t seen the ad, the images are cigarette-style packs with the strapline “Obesity is a cause of cancer too…Like smoking, obesity puts millions of adults at greater risk of cancer”.
Many column inches have been written in response about the problems of presenting obesity as similar to smoking. Perhaps the amount of argument triggered by the ad campaign means the ad has done what CR-UK intended. At least according to one metric, of getting a national conversation started. Linda Bauld, Professor of Public Health speaking on behalf of CR-UK on BBC Radio 4’s programme “Inside Health” said that this increased awareness was one of the goals of the campaign. Professor Bauld was in discussion with the GP Dr Margaret McCartney who asked the question, “But who is aware of what?” I’ll come back to this shortly.
What’s the charity aiming to do?
Cancer Research UK is a charity whose activities include public awareness campaigns to inform people of the risk factors for cancer including the link between obesity and cancer. In the Radio 4 programme, Professor Bauld said that only 1 in 7 people were aware of link between obesity and cancer and that as a charity CR-UK have a responsibility to inform people of this link. She said that CR-UK are interested in cancer prevention, and argued that raising awareness of risk factors is a first step.
So far, so good
Taking the general issue for a moment, if a disease has a risk factor that is something we can do something about, it’s helpful for us to know that fact. Then we can each work out what to do about it, if we choose to take notice, believe what we’re being told and decide what practical steps to take. That’s a whole other can of worms.
But the CR-UK ad campaign has come in for a lot of stick partly because the complexity of the condition means that it is not simple to do something about suffering with obesity, and partly because of the campaign drawing a parallel with the much simpler issue of smoking (which as many have pointed out is a behaviour, not a complex health condition). And then there’s the potential of just adding more fire to the stigmatization of obesity.
What I’ve learned from talking to people with obesity
I’m not an expert on cancer or obesity. Both are complex medical conditions with a range of causes many of which are still to be understood. But what I have seen in people who’ve come for advice about losing weight when they have a lot to lose is that they are already aware, and not just aware; they are panicking.
So my experience is that many people are already extremely anxious. They’ve been warned by health professionals that serious health consequences will follow if they don’t lose weight. They may need an operation that will only go ahead if they can lose a certain amount. The people who’ve come to see me aren’t only panicking about their weight. They feel hopeless, despondent and shamed in to the bargain, which is a nightmare combination psychologically. Imagine feeling absolute panic about something you cannot change. Whenever you have a health consultation, you’re reminded of the urgency. What might it be like to wait at a bus stop showing a billboard that tells you the thing you can’t change causes a raft of illnesses you didn’t realise were on the list of things you might develop as a result of the condition you can’t reverse?
I think it’s not drive that people lack, but effective treatment options.
So my question about the CR-UK campaign is, if the aim is to raise anxiety in people who live with obesity, then what will happen once everyone with obesity is panicking (assuming that they aren’t already)?
The implication is that if only everyone realised the health risks of being overweight, there would be queues for effective treatments. But where should those queues form? At GP surgeries? Many GPs feel ill-equipped to provide accurate useful information and treatment about how to lose weight.
Public health messages would be more useful if they told the people who are already motivated – who have already crossed that Rubicon – exactly what will help them and how to do it or access resources to enable them to do it. In fact, CR-UK does have the Ten Top Tips leaflet which was developed in conjuction with Weight Concern and which outlines evidence-based changes which may help many people. But the Ten Top Tips won’t work for everyone. Developing an ad campaign about what the effective options are for people might really help, but with limited availability of bariatric surgery, weight loss medications and sophisticated psychological interventions, that would be creating a demand without a corresponding supply.
As Dr McCartney said, there is no evidence that these campaigns make a difference to people losing weight. That’s the bottom line. The national conversation has clearly begun, and let’s hope it bears helpful fruit rather than just the twitterstorm which is already raging. On the subject of twitter, I like the initiative by Ted Kyle, Zaher Toumi and others using the hashtag #obesityhelpnotharm, which is aiming to take this different, help-focused line. And while I’m on the subject, I’ve reviewed Dr Denise Ratcliffe’s extremely helpful book “Living with Bariatric Surgery” here, in case you’re contemplating or had surgery, or know someone who is/has.