Laura Thomas
Nov 5 · 9 min read

To Everybody Who Supported Our Response to Cancer Research UK

We want to say a big thank you!

On the 5th of July 2019 a group of academics, healthcare professionals, and experienced advocates came together to publish an open letter to Cancer Research UK (CRUK) asking them to stop running their stigmatising ‘obesity is a cause of cancer too’ campaign.

The petition linked to the open letter was signed by more than 13,250 people and it was your support that put us in a position to contribute to the various media discussions inspired by the campaign and to raise our concerns on ITV news, in an article for the BBC and through receiving coverage in national newspapers, on BBC Radio 4’s Inside Health and in critical online commentaries (e.g., the Cost of Living blog). Most importantly, your support helped raise awareness about the harmful effects of weight stigma. This prompted CRUK to invite us to a meeting to talk about our concerns.

On the 18th September 2019, we met with representatives from CRUK to discuss the issues raised in the open letter. In preparation for this meeting, we wrote 6 action points that set expectations for future practice which we asked CRUK to commit to. These points were informed by dialogues we had with supporters of the open letter and had the aim of helping CRUK to avoid reproducing weight stigma. We shared these action points with CRUK representatives prior to our meeting — and have included them below this statement for you to see. In relation to the final action point, we regret that CRUK felt unable to co-write a public statement with us outlining their position on the negative reaction to their recent campaign and responding to our action points. As an alternative, CRUK wrote and shared meeting notes which they agreed we could share with you — we’ve also included these in full, underneath our action points.

At the meeting, the CRUK representatives were keen to stress that a full evaluation of the campaign was yet to be completed. However, it was quickly apparent that we were judging the success of the campaign by different criteria. They explained that the campaign was launched to coincide with the release of the Government’s updated Childhood Obesity Plan with the aim of influencing the debate in Parliament and in particular, lobbying for a 9pm watershed for television advertising of ‘junk food’. The CRUK campaign did raise some questions in the debate, and it was clear that the team we met therefore considered it to be, to some extent, a success.

Despite our differences in opinion, we are in full agreement with CRUK that previous health policies have not done enough to challenge social and environmental drivers of the well-documented rise in the incidence of people categorised with obesity. However, our point has always been — and remains — that an organisation as well respected, supported and influential as CRUK could influence these debates, and perhaps gain greater support for their cause, with a campaign that did not, however unintentionally, stigmatise and incite discrimination against people of higher weights.

The meeting facilitated a constructive discussion which enabled both sides to share their perspectives on CRUK’s recent campaigns and other areas of mutual interest. These discussions culminated in an agreement that weight stigma and discrimination need to be avoided. We look forward to maintaining an open dialogue and working together to achieve this aim.

We were encouraged to hear that CRUK have increased their engagement with external organisations and collaborators working across this field and that they are currently developing guidance for staff on how to avoid promoting weight stigma. We look forward to hearing more about the work that comes from this and hope that these processes can include a wide range of lived experiences, including those of people who are not engaged with weight management services.

While it remains to be seen whether this theory will translate into practice and, if it does, whether it would cause CRUK to view their recent campaigns more critically or to prevent a similar campaign from being created and launched in the future, we remain hopeful that CRUK will rise to the challenge. However, we also want to assure you that if this hope is not realised, we will respond with another collective challenge.

Finally, something the CRUK campaign did demonstrate was how widely accepted, and even celebrated, the discrimination of people of higher weights is in our culture — as well as how willingly people will defend this discrimination as being informed by ‘the facts’ and ‘tough love’. We must continue to come together and support each other to challenge weight stigma in all its forms. Thank you all for taking up this challenge — together we have achieved a lot. The task is ongoing but so is our commitment to the cause. Here’s to not accepting things as they are and to creating a culture where people of all weights and sizes are deemed worthy of respect and support.

Oli Williams, PhD
Sociologist, King’s College London and THIS Institute

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

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

Zoe Trinder-Widdess
Communications Manager, National Institute for Health Research Applied Research Collaboration West

Marita Hennessy
SPHeRE PhD Scholar, National University of Galway

Fiona Quigley
PhD Researcher, Ulster University

Maureen Busby, MSc MBPsS©
Researcher, PCOS Advocate

James Nobles, PhD
Senior Research Associate, Bristol University

Stuart W. Flint, PhD
Associate Professor in the Psychology of Obesity, University of Leeds

Sarah Le Brocq
Director, Obesity UK

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

Sarah Dempster, RNutr
Registered Nutritionist

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

CRUK Obesity Campaign: meeting between CRUK and the counter-campaign group

Action Points: written by academics, healthcare professionals, and experienced advocates

1. Do not re-run the stigmatising CRUK obesity campaign which led to our petition — signed by over 13,000 people calling for the campaigns immediate cessation. This includes not using imagery from this campaign to create materials for distribution in healthcare settings.

2. If creating another obesity campaign, involve researchers and patient groups specifically with expertise in weight stigma. Do not merely consult these experts but work with them to co-create a campaign that all parties endorse.

3. The negative reaction to the recent CRUK obesity campaign is not only because weight stigma is a form of ‘fat shaming’. The evidence demonstrates that weight stigma is discriminatory and a threat to individual and public health. This must be acknowledged in the design of future campaigns, as it is no longer credible for CRUK to claim similarly negative reactions are either unforeseen or unintended.

4. Target the social determinants of health in any future campaigns. Instead of using education as a rationale for promoting individual behaviour change, directly target government and corporations by highlighting how government policies and food industry tactics promote poor health and increase the risk of cancer.

5. Make CRUK’s relationship with Slimming World more explicit. Explain what steps CRUK have taken to mitigate potential conflicts of interest — specifically detailing what measures have been taken to ensure Slimming World’s corporate interests do not impinge upon CRUK’s commitment to evidence-based policy and practice.

6. Write a public statement with us which: outlines CRUK’s position on the negative reaction to their recent obesity campaign; acknowledges obesity as a complex issue influenced by a variety of biological, psychological, environmental and social factors and; explicitly states CRUK’s responses to each of the action points discussed in this meeting.

Meeting Notes written by Cancer Research UK

18 September 2019

Cancer Research UK — George Butterworth and Malcolm Clark (Cancer Prevention Policy); Katie Patrick (Health Info), Jessica Newberry Le Vay (Cancer Policy Research Centre)

Obesity researchers / clinicians — Oli Williams, Helen West, Laura Thomas, Zoe Trinder-Widdess and Sarah Le Brocq

Context

Cancer Research UK’s mission is to beat cancer and one of the ways this can be done is to prevent as many cases of cancer as possible. Reducing levels of obesity is a priority for us as excess weight is the biggest preventable cause of cancer after smoking in the UK.

No-one should feel to blame for their cancer. Obesity is a complex issue that can have many contributing factors; primarily the environment we live in but also factors including genetics and certain health conditions and medications. And weight can be a sensitive and highly emotional issue.

There’s no silver bullet for reducing obesity rates, and many things need to change in the food

environment so healthy habits are easier to maintain. We want to give children a better chance to eat healthily, stay a healthy weight and avoid cancer in later life. CRUK is pushing for swift and full implementation of Chapter 2 of the Government’s Childhood Obesity Plan — in particular, a 9pm watershed for junk food marketing on TV and online, and price promotion restrictions on junk food — to start reversing the obesogenic environment.

This meeting was part of CRUK’s obesity policy stakeholder engagement, with a particular focus on obesity communications and weight stigma. It was a constructive discussion which enabled both sides to share their perspectives on CRUK’s obesity work and areas of mutual interest, we intend to continue working together and sharing insights.

Meeting summary

The items discussed in the meeting were:

(1) The CRUK obesity health marketing campaign — the rationale and evaluation of the campaign as a whole, and in particular the most recent wave of activity in July, as well as the public’s reaction to the campaign.

(2) How best to communicate messages about obesity to the public and policymakers, and via

health professionals — including challenging prejudices, new work on language and framing,

and continuing to involve relevant stakeholders.

(3) The need for policy change to address the obesogenic environment and other social and

economic determinants of health — with the priority being population-wide policies, enacted

by or facilitated by Government.

(4) The need to reduce weight stigma across society — including the concern that people with

excess weight may not go to their GP with symptoms as they fear being stigmatised by

medical professionals.

(5) Clinical interventions for weight loss — access to bariatric surgery and other forms of

treatment; how to avoid postcode lottery of access/services; and importance of psychological services as part of treatment.

(6) How to continue a positive dialogue around these issues in the future.

CRUK also reported on progress of several internal initiatives:

Creating the right environment for policy change

In July CRUK published an article on its website giving further details of its ‘theory of change’. That document is accessible from www.cruk.org/endjunkfoodadstokids — which was the url featured on the obesity posters.

Obesity communications

As part of World Obesity Day 2018, CRUK helped develop and launch the Obesity Health Alliance’s policy position on weight stigma. An internal working group was set up to look at how these principles could be adopted within CRUK and what that would look like in practice across the different teams. The resulting guidance document has now been circulated across the organisation and is a starting point for further conversations and actions on avoiding weight stigma and communicating about obesity.

Separately, CRUK has been engaging with the Frameworks Institute and Guys and St Thomas’ Charity project on ‘changing the childhood obesity conversation to improve children’s health. `` The final report will be shared and discussed within the Obesity Health Alliance and internally, so we can collectively learn from the findings and assess what would be useful to adopt to enhance the effectiveness of future obesity communications.

In addition, CRUK has recently produced an internal briefing bringing together our existing work on how inequalities impact across the cancer pathway — from prevention, early diagnosis, treatment, survival rates and more. This paper will be used to inform future work in this area.

CRUK engagement with the obesity community

Through Obesity Health Alliance, and more directly through focus groups, and engagement with Obesity Empowerment Network, Obesity UK and other stakeholders, CRUK receives input from the community into its work and communications. Over the summer, Obesity Empowerment Network presented to a special meeting of CRUK’s Obesity Comms Group and led a discussion on the barriers people experience– building up our internal knowledge. We will seek advice, and listen and learn from others, as we keep pushing for Government-led change.

Clinical interventions on obesity

To date, Cancer Research UK’s obesity work has focused on population-level policy levers to reduce obesity prevalence. However, there is a growing opportunity for the health service to do more on clinical interventions for obesity. CRUK is currently reviewing the evidence of the effectiveness of weight loss interventions.

Actions

1) To include the meeting attendees within the wider informal stakeholder groups which CRUK

Policy and Information Directorate uses as a sounding board for its marketing campaigns and related communications.

2) To take on board the knowledge of these researchers (and others) within CRUK’s scoping

exercise on clinical interventions to prevent and treat obesity.

Laura Thomas

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