Disapproving looks, disparaging remarks about their appearance, comments about the portions of food on their plate or the quality of their diet... People who are overweight or obese have all experienced, at one time or another, , the judgment of others. Indeed, even today, the idea that people with obesity are solely responsible for their situation is still widespread, as shown by the results of our recent survey on the subject.
However, as often, the reality is much more complex, and this simplistic view is not only inaccurate, but can also be dangerous: it is indeed very often at the root of the stigmatization of people in situations of obesity. To change our view of obesity and the people who suffer from it, education has a major role to play. But to improve the situation more generally, policies aimed at making our environment more favorable to health must also be put in place. And that's no small feat.
In France, at present, one in two people is affected by overweight or obesity. The latter, in particular, is spreading: it affects 17% of adults today, compared to 8.5% in 1997. Our country, however, remains far behind others: in the United States, for example, 42% of adults were in a situation of obesity in 2022. According to the scientific community, the origins of this increase are multiple. They result from recent and profound transformations of our living environments. Thus, industrialization led to the commercialization of foods containing more fatty acids and sugars than fresh products. This increase in caloric density has also been accompanied by an unprecedented development in food marketing, as well as an increase in food accessibility.
Diet and physical activity are two essential preventive measures in the fight against obesity and its negative consequences on health. Both of these behaviors are modifiable, which means we have the power to act on them. However, we also know that both relate to a multitude of individual, social and environmental determinants. Thus, beyond our modern environment which promotes weight gain, it is widely accepted that obesity is more common among people with a lower socio-economic level.
For this reason, it is simplistic to believe that how we eat and move is simply a matter of personal choice. It is known that in an "obesogenic" environment, people-centered interventions, such as nutritional counseling or physical activity recommendations, are of little long-term effectiveness. This is why the National Nutrition and Health Program 2019-2023 has defined as a priority objective to act on the environment, in order to make it more favorable to health.
However, a large part of the population, in France as in other countries, still attributes obesity to a lack of willpower. However, prejudices about will and stigmatization are linked.
Our recent survey of 33,948 NutriNet-Santé study participants found that nearly 38% of women and 54% of men surveyed agreed that obesity is "due to a lack of willpower. ".
This observation is worrying, because, as a collective of learned societies, associations and patient representatives points out, this belief is largely at the origin of acts of stigmatization towards people in a situation of obesity. On this subject, the figures are alarming: in France, in 2020, 56% of people questioned said they had already been stigmatized because of their weight. In question, mainly, members of their family, classmates, doctors or work colleagues. This stigma most often took the form of teasing, unfair treatment or discrimination.
The question of the stigmatization of obesity having now entered the public debate, it is urgent to find solutions to prevent it as well as to better protect the people who could be victims of it.
If our daily choices must be oriented in a direction favorable to health and weight maintenance, acting "upstream", on the determinants of these choices, could make it possible to prevent the continuous increase in obesity. From school to work, via transport or shops, the policies put in place must therefore promote environments that will facilitate, throughout our lives, food and physical activity choices favorable to our health and development. maintenance of weight within values considered normal.
This involves, for example, improving the nutritional quality of foods, regulating food marketing, making health-promoting foods more financially accessible, or even promoting urban plans that encourage the practice of walking and biking. But that's not all: you also have to manage to deconstruct the idea that obesity is due to a lack of willpower. And for this, education has a role to play.
Work that we have coordinated has revealed that people with a higher level of education adhere less openly to the idea that obesity is linked to a lack of willpower. More than the level of study, the educational content could play a decisive role. For example, health students adhere less to this idea of lack of will than students in other fields. Training on the multiple causes – genetic, social and environmental – of obesity would also reduce this belief, unlike training solely focused on the importance of diet and physical activity in preventing obesity. 'obesity.
Universities have become aware of the importance of better training health professionals on these subjects. Thus, the Sorbonne Paris Nord University has set up innovative educational experiments, involving patients directly in certain lessons, as part of the University Research Chair on the commitment of users/patients in the health system. This initiative reflects the desire to help health students better understand the patient's point of view.
As part of a tutorial entitled "Stigma in Care", a call was made on social media for people who have experienced this type of stigma to submit a proposal for intervention. Among the thirty or so proposals made, several dealt with the stigma associated with obesity, which testifies to the importance of this stigma in the context of healthcare.
A pedagogy centered on the care relationship and the experience of patients has also been implemented at Sorbonne University. This allows students to discuss their representations of stigmatizing pathologies and to meet patient associations. Finally, a podcast (Augusta's oath. I will think about bodies outside the norm), intended for health students and centered on the caregiver-patient relationship, was also produced in order to reflect on these questions.
However, while it is important to better train only health professionals, this will not be enough to modify our collective vision of obesity. To achieve this, other actions will have to be implemented, not only at the university, but also at school, in colleges, high schools, in the workplace, in medical offices, the media...
The stigma of obesity will only end when we all understand that our eating and physical activity habits depend primarily on social and environmental (especially economic) factors, rather than our willpower alone…
Alice Bellicha, Lecturer, Sorbonne Paris Nord University; Chantal Julia, lecturer at Paris 13 University, hospital practitioner, Avicenne Hospital (AP-HP), nutritional epidemiology research team, U1153 Inserm, Inra, Cnam, Sorbonne Paris Nord University; Jean-Michel Oppert, PUPH and head of the nutrition department at Pitié-Salpêtrière hospital, Sorbonne University and Mathilde Touvier, director of the nutritional epidemiology research team, U1153 Inserm, Inra, Cnam, Sorbonne Paris Nord University, Inserm .
