The ignored consequences of obesity and nutrition policies: How a focus on weight influences psychosocial wellbeing

Abstract

Background: Eating- and weight-related disorders, including eating disorders, disordered eating, and overweight and obesity, share many risk factors across all levels of the socioecological model. However, public health policies tend to focus primarily on the reduction and prevention of obesity, with little attention to the impact of such policies on disordered eating and related indicators of psychosocial wellbeing, including internalized weight bias, weight stigma, and body image. Young adults may be particularly vulnerable to weight-related policies, as they are in a critical period of developing lifelong dietary habits. Though a wide variety of population-level policies aiming to prevent obesity and improve nutrition have the potential to elicit unintended consequences (e.g., calorie menu labelling), little research has explored this phenomenon in real-world policy contexts.

Purpose: The objectives of this dissertation were to: (1) investigate the impact of provincial menu labelling policies on disordered eating, internalized weight bias, weight stigma, and associated indicators of weight-related and psychosocial wellbeing among young adults; (2) explore young adults’ feelings, perceptions, and experiences with calorie labelling policies, and; (3) develop a holistic framework for the prevention of eating- and weight-related disorders that draws on systems science and facilitates examination of potential unintended consequences of weight-related policies. Three manuscripts addressed these objectives through longitudinal analyses of data from the Canada Food Study, a mixed-methods study among young adults, and a critical narrative review.

Methods and results: The first manuscript (Chapter 4) is comprised of a longitudinal analysis that examined trends in the prevalence of disordered eating, internalized weight bias, experienced weight stigma, and associated indicators of weight-related and psychosocial wellbeing among Canadian young adults (n=689). Eight repeated measures logistic generalized estimating equations were conducted to assess changes over time for each of the outcomes of interest in relation to provincial calorie labelling policies in British Columbia (voluntary labelling), Ontario (mandatory calorie labelling), and Alberta, Quebec, and Nova Scotia (no labelling policy). The implementation of a calorie menu labelling policy did not significantly increase the odds of disordered eating, body image, internalized weight bias, experienced weight stigma, or other general indicators of mental health, though there were significant differences in these outcomes by sociodemographic factors, including gender, race/ethnicity, and weight perception. The second manuscript (Chapter 5) details a mixed-methods inquiry of young adults’ experiences with calorie labelling, with a focus on its implications for their relationships with food. Participants (n=13) were recruited from a campus-based menu labelling study and individual semi-structured interviews were conducted, followed by a survey assessing sociodemographic factors and risk of disordered eating and body esteem. The data were inductively coded and informed by social constructionist frameworks. Four key themes included: (1) participants’ support of and skepticism about labelling interventions, (2) the identification of knowledge and autonomy as mechanisms of labelling interventions, (3) the role of the individual’s and others’ relationships with food in experiences with labelling, and (4) disordered eating and dieting as lenses that shape experiences with interventions. The third manuscript (Chapter 6) presents a critical narrative review that posits the application of systems science concepts to consider unintended consequences for eating- and weight-related disorders in public health policy. Drawing upon multiple and often contradictory framings for policy approaches to obesity and eating disorders, the proposed theoretical framework outlines how public health nutrition policies can increase the risks of disordered eating, weight stigma, and related psychosocial constructs. Such a framework can be used to examine whether and how weight-centric approaches result in policy resistance (i.e., individuals are not successful in achieving “healthy weights”) and contribute to negative consequences. This framework will also empower researchers and practitioners to identify approaches to promote health holistically, including by reducing societal weight stigma and bias and its harmful implications.

Conclusions: This dissertation contributes to our understanding of how nutrition and weight-related policies may impact psychosocial wellbeing and eating- and weight-related disorders more broadly. The findings of the empirical studies and the development of a theoretical framework contribute to the scarce literature on how a focus on weight in public health policy influences psychosocial wellbeing among young adults in Canada.