An Open Letter to Cancer Research UK

Dear Michelle Mitchell,

We are writing to ask that you stop the current advertising campaign run by Cancer Research UK.

We are a group of academics, healthcare professionals, and experienced advocates who are committed to reducing weight-related stigma and discrimination (i.e. negative attitudes, stereotypes and behaviours experienced by people at a higher weight). For decades, advocates, researchers and clinicians have highlighted the importance of addressing the harmful effects of weight stigma and discrimination; your current campaign completely undermines this work. The campaign, which draws a comparison between smoking, weight and cancer risk, is not only inaccurate, it is harmful to people who are at a higher weight, including those with cancer.

** Please click here to sign our petition and call a halt to this campaign**

We want to be clear that, like you, we’re committed to challenging social and environmental influences on health. However, we believe this can be done without fuelling weight stigma and discrimination.

Your campaign’s focus on weight as a leading cause of cancer is misleading. Body mass index (BMI) is a crude indicator of health and while there is an association between higher BMI and cancer, the reasons and mechanisms for this are unclear.

Given that the dominant public perception is that weight gain is caused by a lack of willpower and that weight can be reduced easily and rapidly, when you frame people’s weight as the problem, instead of directly addressing the environmental factors you intend to change through policy, you are effectively telling people that cancer is their fault. Through making a direct comparison between smoking and weight, your campaign contributes to these assumptions, suggesting that it is a lifestyle choice. This belies the reality. As highlighted in the UK Government’s Foresight Report, weight is influenced by over 100 complex and interacting factors including genetics, the built environment and a vast array of psychological and social factors. Your approach is also counterproductive — research shows that compared with weight-neutral campaigns, weight-focused campaigns are ineffective at promoting health behaviour change.

While we support action on the food environment, as per the CRUK campaign aims, we believe that a different approach to smoking is needed. One key difference is that smoking could largely be controlled through policy change. Even with changes to the food environment, there will be diversity of body weight and size, in the same way that there is a spectrum of height and shoe size. Your rationale for the use of the smoking comparison is that the government has regulated tobacco and could do the same with “junk food”. However, by linking this to weight, you fuel the assumption that individuals simply gain weight by eating the ‘wrong’ foods, and that thinner people are healthy and less susceptible to ‘junk food’ marketing.

Implying that individuals are largely in control of and responsible for their body size (and therefore cancer) supports a culture of blame and plays into prejudices and negative stereotypes which drive the social exclusion, marginalisation, and inequality of an already stigmatised population. Weight stigma has increased at an alarming rate in recent decades. Among higher weight patients, 64% of men, and 67% of women report being stigmatised by their healthcare provider because of their weight. This is particularly concerning in relation to cancer; women report weight stigma as a reason for delaying or avoiding cervical, breast, and colorectal cancer screenings, citing disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, and unsolicited advice to lose weight as the main barriers. In addition, weight stigma has been identified as a barrier to accessing treatment in women with endometrial cancer.

The evidence is clear that weight stigma actively discourages people from engaging in behaviours that are known to promote health and reduce cancer risk, regardless of BMI, such as physical activity and eating nutritious foods. Rather, weight stigma has been highlighted by the World Health Organisation as playing a significant role in poor body image, depression, anxiety, eating disorders, and avoidance of medical care. Thus, contrary to the popular misconception, weight stigma is not an effective way of promoting health — quite the opposite .

Additionally, despite poverty and social inequalities having a dramatic effect on health and incidence of cancer, there is no mention of this in your campaign. This is particularly concerning given that your aim is to change policy. It’s been estimated that there is a 19 year difference in healthy life expectancy between people living in the most and least deprived areas of England. A person living in one of the most deprived areas is twice as likely to die from cancer compared to someone living in one of the least deprived areas. But instead of focusing on these important social determinants of health, your campaign focuses purely on weight.

We understand that influencing policy change related to the fundamental causes of health inequalities is not an easy task — successive governments have been informed about the complex determinants of body weight and yet the emphasis remains on pushing an individualistic, lifestyle-oriented narrative, most likely because this fits with the policies of austerity.

You have justified your current and previous campaigns — in spite of criticism from researchers, health professionals and the public — by stating that it was tested through surveys and focus groups. Weight bias internalisation, where people turn negative stereotypes inwards and engage in self-blame, is common across the weight spectrum. People may have agreed with your campaign because they truly believe the widespread notion that a high BMI is simply the outcome of people failing to take responsibility for their weight. Your campaign serves to reinforce this misplaced belief. Reducing weight stigma is not simply a case of being ‘sensitive’ about people’s weight — it means removing the structural and systemic prejudices such as this campaign. A more accurate and inclusive campaign likely to be more productive would emphasise respectful care for all bodies, empowering people to make health promoting changes, no matter what their BMI.

Lastly, we need to highlight the clear conflict of interest in your partnership with Slimming World. The Slimming World brand is ultimately committed to commercial gain, not improving public health. This partnership cannot be justified on scientific grounds as evidence demonstrates that these programmes are not effective ways of achieving and maintaining weight loss or preventing cancer. Therefore, as an evidence-based organisation your association with Slimming World misleads your patrons and the public more broadly.

We hope CRUK can take this opportunity to live up to their own values of equality, diversity and inclusion. This would involve:

• Most importantly, changing the focus of this campaign and publicly explaining why.
• Prioritising well-being over weight: delivering public health messages which are weight-inclusive and focus on empowering positive health promoting changes for every body.
• Ceasing to mislead the public by stating ‘obesity’ is a ‘cause’ of cancer and instead more accurately communicating risk, acknowledging that improvements to health, and reductions in cancer risk, can be made without changes to body weight.
• Making a commitment to end weight stigma (and other forms of discrimination) within the charity and among stakeholders.
• Lobbying government and applying pressure for action on the social and environmental determinants of health.

To this end, we have started a Change.org petition and have invited members of the public to share their experiences of how your new campaign has affected them.

We look forward to receiving your reply and, more importantly, seeing action taken to reduce the impact of this campaign.

Signed:

Helen West, RD, BSc PG Dip
Freelance Registered Dietitian, The Rooted Project

Laura Thomas, PhD, RNutr
Director, London Centre for Intuitive Eating

Sarah Dempster, RNutr
Registered Nutritionist

Rosie Saunt, RD, BSc
Freelance Registered Dietitian, The Rooted Project

Yoni Freedhoff, MD
Associate Professor, Department of Family Medicine, University of Ottawa.

Dr James Brown
Senior Lecturer and Director of Aston Research Centre for Healthy Ageing

Judy Swift, C Psychol, RNutr
Chartered Psychologist, Registered Nutritionist, former University of Nottingham

Oli Williams, PhD
Research Fellow, King’s College London

Stuart W. Flint, PhD
Senior Research Fellow, Leeds Beckett University

Giles Yeo
Principal Research Associate, University of Cambridge

Stacy Bias
Fat Activist and Campaigner

Fiona Quigley
PhD Researcher, Ulster University

Katherine Barrett, PhD
Researcher

Marita Hennessy
SPHeRE PhD Scholar, National University of Galway

James Nobles, PhD
Senior Research Associate, Bristol University

Sarah Le Brocq
Director, Obesity UK

Angela Meadows, PhD
ESRC Postdoctoral Research Fellow, University of Exeter

Deb Burgard, PhD, FAED
Psychologist and Activist, San Francisco Bay Area USA

Lesley Gray FFPH, MPH, MSc
Obesity Researcher, University of Otago, New Zealand

Maureen Busby, MSc MBPsS©
Researcher, PCOS Advocate

Zoe- Trinder-Widdess
Communications Manager, National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West

Professor Sarah Redsell
Professor of Public Health, Anglia Ruskin University

Melanie Voevodin
Dietitian, Policy Analyst

Anthony Warner
The Angry Chef

Esther Rothblum, PhD
Professor of Women’s Studies San Diego State University

Eva Pila, PhD
Assistant Professor, Western University

Wendy R. Dragon, PhD
Associate Professor, Wright State University

Professor Abigail C. Saguy
UCLA Sociology

Helena Lewis-Smith, PhD
Senior Research Fellow, Centre for Appearance Research, University of the West of England, Bristol

Nadia Craddock, EdM
PhD Researcher, Centre for Appearance Research, University of the West of England, Bristol

Fiona Sutherland, APD
Body Positive Australia Executive Comittee, Australia & New Zealand Academy of Eating Disorders

Rebecca Scritchfield, RDN, EP-C
Intuitive eating dietitian, exercise physiologist,

Nicholas Sharratt
Research Fellow, Centre for Appearance Research, University of the West of England, Bristol

Dr Claire Hamlet
Research Fellow, Centre for Appearance Research, University of the West of England, Bristol

Dimitri Pournaras PhD, FRCS
North Bristol NHS Trust

Fabio Zucchelli
Research Associate, Centre for Appearance Research, University of the West of England, Bristol

Jessica Rann, RD
Registered Dietitian, London Centre for Intuitive Eating

Marion Hetherington
Professor of Biopsychology, University of Leeds

Theodore K. Kyle, RPh, MBA
Founder, ConscienHealth

Pixie Turner, MSc, ANutr
Associate registered Nutritionist

Caitlin O’Reilly
Health Care Professional

Nancy Ellis-Ordway, PhD, LCSW
Mental Health Professional, Eating Disorder Therapist

Iréné Celcer MA, LCSW

Amy MacDonald, MScFN, RD
Public Health Advocate, Ontario, Canada

Peggy Elam, PhD
Clinical Psychologist

Kati Fosselius, MS, RDN
Director, Dietetic Internship, California Polytechnic State University

Stephanie von Liebenstein, MA
Founder and vice president of the Association against Weight Discrimination

Linda Bacon, PhD
Physiologist/Researcher

Marcella M Raimondo, PhD, MPH
Psychologist, Consultant and Trainer

Lucy Aphramor
Radical Dietitian

Christy Harrison, MPH, RD, CDN
Founder and CEO, Food Psych Programs, Inc.

Jaclyn Packer, Ph.D.
Social Psychologist

Judith M Larson, PhD
Licensed clinical psychologist, private practice

Meg McClintock B Nutrition& Dietetics (Hons)
Accredited Practising Dietitian

Susan Williams
Accredited Practising Dietitian

Paul Ernsberger, Ph.D.
Dept. of Nutrition, Case Western Reserve Univ

Krista Handfield, MSW, LCSW
Founder of Shape Center Ri.

Dr Peter WG Tennant
University Academic Fellow in Health Data Science, University of Leeds

Jeffrey Hunger, PhD
Assistant Professor, Department of Psychology, Miami University

Kerry Beake, BSc, Post Grad Dip
Health Professional, Fat Activist and Social Justice Advocate

Lily O’Hara, PhD, MPH
Associate Professor of Public Health, Qatar University

Louise Adams, MSc
Vice President HAES Australia

Joanne Rathbone
PhD Researcher, School of Psychology, University of Queensland