I recently went to a public health conference. In addition to leaving with the world’s most ironic dose of gastro, I came away thinking about what it means to be a fat person working in a public health landscape focused on obesity prevention.

An off-the-cuff tweet about the awkward feelings this provokes got more engagement than almost anything I’ve tweeted before. Maybe I’m on to something…

I’ve recently been re-reading Jill Stark’s excellent book High Sobriety about her year without booze. In it, she discusses the cognitive dissonance of being a health journalist writing about the harms of binge drinking, while herself having a troublesome relationship with booze. It’s a feeling I know well, both about alcohol and food.

I’ve worked in health policy for most of my adult life where the spectre of the ‘obesity epidemic’ always looms. Currently, I work in mental health and have extolled the virtues of a healthy diet and exercise for keeping mentally well.

In a previous job, I’ve sat with ex-sportsman while they discuss what it would take to get Australia’s sedentary obese people to hit the gym. I listened patiently as one man assured me that doctors just need to tell their fat patients to eat less and exercise more.

Aside from my experience being that my past GPs will manage to tie my E V E R Y S I N G L E health complaint ever to my need to lose weight, I couldn’t help but agree with the soft-spoken New Zealand academic who was with us:

“With respect, Bill, doctors have been telling us not to smoke for decades, but people still do.”

My doctors have told me for years I need to lose weight. So why am I fat?

Because nine times out of ten, a burger is going to taste better than a salad.

Well, that’s the superficial reason.

The real reason is more complicated and messy than any prevention message about ‘healthy choices’ can get to.

I started overeating before I was even a teenager. I had big emotions – some that I think are genetic but others that relate to some not so fun stuff that went down in my life. Food was a refuge for feelings I didn’t know how to describe.

I started a lifelong habit of binge eating where I would secretly hide so I could eat huge amounts in a short time. Food gave me both physical and emotional space from reality.

What my decades long struggle with food has taught me is that when people are sad or stressed, food can be an outlet. That’s why so many of the messages that health practitioners give about ‘simply’ making healthier choices fail. Because we have failed to address the underlying circumstances that lead to sadness and stress.

This is not just a mental health message. For years, we have spoken about the social determinants of obesity, without implementing the kinds of interventions that address them. If you live in a stressful environment – of poverty, discrimination, whatever – sometimes the healthiest choice can seem not like the one that salves your body but that eases your mind.

I remember trying to explain my binge cravings to my psychologist once, who thoughtfully pointed out that if the craving devil kept winning out over the healthy angel, there was probably a reason. There was something soothing about my ‘unhealthy choices’ and that in and of itself was something I had to listen to.

I tackled it by working hard to create an environment where it was easier for me to be healthy. To borrow from research presented by Mark Chenery at the conference I was at, I created healthy options for myself, removing the onus on myself to always make the right choice.

If we are to have any success in the battle against the bulge, we have to think about the environments and settings in which people are making decisions – conscious and unconscious – about their health. Lecturing about making good decisions isn’t enough. If anything, it makes the problem worse.

As long as we blame people for their poor choices, we stigmatise fat people. We make fat people feel worse, sadder and more stressed, and pushed into the warm embrace of food.

Image credit: @chibirdart