Children today are ‘drowning in a flood of unhealthy food and drink options’. The food we eat is driven by what is on sale and at what price, how it is marketed (including positioning on the shelf), what we have access to and how it is processed. Many deprived neighbourhoods are fresh food deserts or swamped by fast food outlets. Fat, salt and sugar content in convenience foods is determined by their manufacturers, not by their consumers. The shift to ultra-processed foods (now more than half of the UK’s average shopping basket) makes the same nutritional choices as a generation ago more fattening and health harming. There is even evidence these types of foods drive people to eat more and stimulate the same synapses as addiction. This sudden shift in diet has been mostly driven by industry, exacerbated by social circumstances rather than choices.
The concept of lifestyle disease stigmatises people with NCDs who need support
Huge progress has been made to destigmatise HIV and mental illness, so that people are more likely to seek help. Yet the continued shaming of a person with a ‘lifestyle disease’ makes them less likely to access services. More than half of people with diabetes in a US study reported perceiving stigma, reducing adherence to self-management and impacting their mental health.
That is not to say that healthcare professionals, and health policies, should not address behavioural risks such as smoking, alcohol consumption, diet and physical activity. But these should be addressed in the context of a person’s social environment rather than as issues of morality or willpower. With the label of individual choice removed, the person and their healthcare professional can work together more collaboratively to put in place the changes in the social environment – removing the stresses and triggers, providing strategies to access support – that could enable them to actually improve their health.
The individual lifestyle mindset hinders service and policy progress
Governments are less likely to channel resources to people who are perceived as undeserving. Surgery is already rationed for people categorised as obese, and public health efforts are concentrated on less effective health promotion and education approaches that target conscious processes, often exacerbating inequalities. In Germany and Spain, some treatments for obesity are restricted by insurance funds because they are deemed ‘lifestyle choices’ rather than clinical needs. Clinicians may also hold biases about weight that can impact their provision of care.
Awareness of health inequalities is low in public debate, and when the topic is discussed in the media it is usually presented through the lens of lifestyle differences, playing into the already existing frames of poverty as a moral choice. Reinforcing this language in policy discussion prevents better public understanding of the wider drivers of health and the policy solutions required to address them.