Why telling communities to tackle obesity backfires!
Over the years I have worked with many communities motivated to do something to improve the lot of youth in their community. After coming to see the importance of including young people in contributory and leadership roles, they’ve typically (together with young people) begun to zero in on particular questions, such as “why are so many local children ending up in Accident and Emergency Departments of local Hospitals at the weekend?” or “why are so many of our children suffering from diseases -like type 2 diabetes or metabolic syndrome- that were not seen in children before the 1980s?” Working with communities that want to do something about such issues is better than any University Degree in Political Science, or Sociology.
But the idea that an outside professional can walk into a community and tell them that they should do something about obesity, or anything else for that matter is both an extremely arrogant and potentially very dangerous one.
Taking childhood obesity as a case in point, my experience is that most communities don’t come cold to issues like this. The journey starts way back from those kinds of issues, and closer to the real roots of the issue which, as well as political, relates to the dislocation between children, their neighbourhood and their neighbours. After a lot of mobilisation around street play, and connecting young people with other young people and productive adult neighbours, often an issue that is of shared concerns emerges. An issue they care about enough to act on together. The issue may be childhood obesity, but it could just as easily be a million other things. The magic is not in the ‘topic’ the community comes up with, but rather the way they come to discern what matters, and in the fact that they come up with it themselves, by exercising the three powers of citizenship:
1. The power to decide there is a problem.
2. The power to decide the solution to the problem.
3. The power to act on the solution.
Leading by Stepping Back
It is important for helping professionals to figure out how to lead by stepping back. What are we stepping back from? We are stepping back from the impulse to take over any or all of the above ‘citizen powers’ so as to avoid the very real risks of transmuting civic work into professional interventions.
This is a critical ‘calling’ of an ethical professional: Primum non nocere-do no harm, an oath not just for medical professionals, but all helping professions.
After all, if our health is the hands of a doctor, our wisdom and knowledge is in the hands of a teacher; our neighbourhood disputes are in the hands of lawyers; our mental health is in the hands of psychiatrists; and our nutritional requirements are in the hands of mega-chain supermarkets. What is left for lay people, families and neighbours to do?
A Practical example
One community where I’ve been working in for over six years, has begun in the last year talking about childhood obesity, and recently they declared ‘sugar’ public enemy number one. At that stage they wanted to do something about it, because it is so clearly a major cause of childhood obesity, and it really felt like something they, as a community, could do something about using community power. The important point here is:
They exercised the power to decide there was a problem.
On an evening in late April, in the back room of a Community Centre I sat quietly with a group of nine local residents, who gathered to discuss the mater. The meeting opened with a concerned grandmother, saying: “isn’t this just a matter of parents taking more care, reducing the amount of junk food, and fizzy drink their kids are having, and getting them to walk to school, and watch less TV? I’m sorry to say this, and I don’t mean to blame the parents. But that’s what ABCD is all about, right? Taking responsibility- a ‘We Can attitude’!?”
A young mum who’s a member of a local mother and toddler group, responded: “Well, you know it’s not the simple, and no I don’t think that’s what ABCD is saying really. But that doesn’t much matter anyway. I mean, my sister who lives nearby comes to weight watchers here in this Centre, and three other women in her group have been working on doing just what you’re saying with their children, you know, watching their kids diet as well as their own. Now they’ve been told in the Weight Loss group to really watch sugar. And so they did, and what they’ve found is that unhealthy sugars are everywhere, and I mean pretty much everywhere, even in foods like yogurts! I mean I don’t know about you, but I always thought they were healthy, right?”
The older lady interrupts: “C’mon the food is clearly marked, just don’t buy the stuff with fat in it…I’m sorry I’m sounding very negative and I don’t mean to….but…”.
The young mum counters: “They took fats out of lots of food years ago, so you think just buy ‘fat-free’ or ‘low-cal’, right? But what they’ve done is put bad sugars in instead, like I say, even in what I thought was healthy food, there’s as much as five spoons of sugar in some juices, and more in smoothies, these sugars are making our kids fatter than the fats did, and sicker too.”
Another mother of three older children joins in:
“It’s true, just try reading the ingredients on packages to find out the number of teaspoons of sugar there are, but before you do, you better get yourself a degree in chemistry”
(The group laughs, and the Grandmother who opened the conversation, looks visibly surprised and concerned)
The mother of the three children continues: “And bring a calculator…and expect to double the time you need for shopping. The food industry has made it near impossible for us to choose a healthy diet, of course they tell us what’s in their products, they just do so in a way that renders common sense language into gobble-de-gook.”
Another older lady leans forward and simply says, “Aye, the girls are right, but while we’re waiting for the Food Industry to tell the truth, and sell less crap to us [she winks and everyone else laughs out loud], I’d like to talk about our allotment project, the Farmers Market and a new idea I heard last week from Sam and Jo, here, about a City Farm they’d like to start”. She looks to the two young people she brought to share their idea, and says: “That’s your cue guys!” And then we hear an idea that inspires everyone.
Then they identified a solution that they could work on, and they did. Exercising the three powers of citizens in associations.
Now I passionately believe that when we pick up a product and read the ingredients on the back of the packaging or wrapping we should, given the example we’re using here, clearly see the number of teaspoons of sugar contained in that food item and not: 5 grams of “malt syrup,” 5 grams of “invert sugar” and 5 grams of “glucose”, as we currently do. Which, by the way, is equivalent to just under four teaspoons of granulated sugar. I believe that’s a basic consumer right.
The main point I wish to make here is that we are not just consumers; we are primarily citizens that produce. Which is to say, in the pursuit of consumer rights, let’s not inadvertently hand over our citizen powers to well intentioned experts from whatever sector they may come. Otherwise we may become the ones who are consumed.
After all, is that not what obesity really is: the phenomenon of being consumed by food? When we come to see this as the challenge, rather than simply reducing the consumption of unhealthy foods, we will also see that the issue is not a medical one, but a social and political one. It is about power, and a sense of civic agency, and is therefore from the perspective of helping professions best addressed by doing no harm to civic muscle. Instead of lecturing people about health inequalities, smoking cessation, and obesity why not try starting with whatever the community cares enough about to act on, and walking with them as they proceed at their own pace?
This is extremely important education for us. One of the most critical aspects of modern culture where we are surrounded by “experts” governing so many key areas of our lives is the consequent lack of agency or control we feel.
The example given of how we can reclaim at least some of this (and maybe sometimes a lot!) over an issue by considering it together as a community is very inspiring indeed.
Chuffed to hear this resonates and that it useful. Thanks for taking time to comment;) Much appreciated! BW Cormac
We’ve organized our neighourhood (2000 households) and found lots of young teens (30ish) who want to be a group and a few (10ish) “20 somethings who want to mentor. They call the group Friday Night Besties. For almost a year they have build enriching, and in most cases activity based relationships.
Here is the Facebook page:https://www.facebook.com/groups/1622904851311766/
Thanks Cormac for sharing your words of wisdom – an excellent example of how individuals and communities can make their own “informed” decisions and choices. I would like to add that there are times when communities may lack the information they need to understand the consequences of a problem not dealt with. In my collaboration with village women in Kenya, “while I walked with them at their own pace”, I was able to share my personal experience with cervical cancer and provide some basic information about the implications of not being routinely screened. I also became aware of some of the cultural issues that were impacting the social acceptability of cervical specimen collection. It was through this rich information exchange that local village women ultimately made an informed choice on how they would address cervical cancer prevention in their village. Providing those of us who feel we can contribute to impacting health are: 1) prepared to share knowledge and power, 2) are committed to do no harm, and 3) respect that communities need to make their own informed choices, I feel there is a beneficial, supportive role we can play. Irene
Thanks so much for taking time to comment. I think what you describe is what we call traveling at the speed of trust. When you truly walk alongside people and build genuine trust then you can be heard and make an immense difference.
As you know people don’t care what we ‘outsiders’ know until they know that we care. Then we become ‘alongsiders’.
We both make the same point, perhaps with a different accent: follow the pace of those you serve before you take the initiative, follow theirs, and when the trust is deep and you’ve learned from them, then share your gift, not a minute before.