Larger than life

Angst ridden 30-something Bridget Jones starts each day on the scale, obsessively tracking her weight against social expectations. She vows to become svelte, only to confide her personal dieting failures to her diary the next morning.

Author Helen Fielding’s Bridget Jones’ Diary resonated with women near and far, even catapulting her London-based heroine onto the cinematic screen.

Like Bridget, Sara Kirk hails from the United Kingdom and could be described as being fascinated with weight management. If they ever had the chance to meet over coffee (or given Bridget’s lifestyle, a martini) Sara would have some comforting advice: “It’s not all your fault, Bridget.”

If Bridget is taken aback at the suggestion, she wouldn’t be alone — it runs contrary to conventional wisdom.

“For many years, we’ve looked at weight as an individual problem. It’s a personal responsibility — willpower, call it what you will. The general consensus still is that it is an individual problem, one that should not be medicalized,” says Dr. Kirk. “Actually, there’s a huge body of literature that’s coming out now that says we need to look at the culture and the environment.”

Dr. Kirk is a former registered dietician and an expert on the management and prevention of obesity. The new Canada Research Chair in Health Services Research is with Dalhousie’s School of Health Services Administration and is cross-appointed with the IWK Health Centre.

“For many years, we’ve looked at weight as an individual problem. It’s a personal responsibility — willpower, call it what you will. The general consensus still is that it is an individual problem, one that should not be medicalized,” says Sara Kirk. “Actually, there’s a huge body of literature that’s coming out now that says we need to look at the culture and the environment.”

“In my research I’m trying to understand what it’s like for the person who has a problem to go to a doctor and then be told it’s your own fault — just eat less and do more activity — because that’s how we treat obesity. But we must also recognize that there are other things at the core, our policies need to change,” she says.

Daily life has changed so dramatically in the past 50 years that most people have little opportunity for built in activity. The western ‘driving and convenience culture’ is seductive. “As humans, we want to take the easy way and it’s very hard to go against that,” she says.

Even the pace of change offers cause for concern. In the past 15 years, the number of people who are overweight or obese in Atlantic Canada has doubled — and Nova Scotia now has one of the highest rates of obesity in Canada. “If I look at Nova Scotia, slightly over 60 per cent of adults, and one in three children, are overweight or obese — and it takes about a thousand lives a year,” she says. “Certainly, with people developing a weight problem, it’s so easy to do now that it’s almost becoming normal.”

Her first Halifax-based study, funded through the IWK Health Centre, and focusing on the ‘obesiogenic environment’ in childhood, is up and running. The study is looking at the factors in the environment — access to green spaces, access to food — that may contribute to obesity in children in Nova Scotia. The next step is to measure the body mass index (BMI) of children and map this according to the characteristics of the environment. “We’re going to identify factors in the environment that actually contribute to childhood obesity, and then ask ‘can we do something to change the way that people respond to the environment?’”

She is also co-applicant (along with Renee Lyons, Atlantic Health Promotion Research Centre and Jill Grant, of Architecture and Planning) on another study, funded by the Heart and Stroke Foundation of Canada and CIHR. This research will use cutting-edge technology, including global positioning systems (GPS) to understand how children interact with their environments and exploring the intersection of community planning, physical activity and body weight. Studying the interaction of behaviour and the environment will help prevent obesity.

“Can we intervene earlier? If we can identify people before they become overweight or obese, can we get in there and actually stop them from gaining weight? And how do we equip health care specialists to do that well?” she asks.

There are known risk factors associated with obesity, such as having a parent who is overweight, having pregnancies close together and struggling to quit smoking. If these lifestyle issues could be attached to an electronic health record, the knowledge could be incorporated into the management of the health care system.

In the future, she would like to explore the attitudes of health care professionals toward people who are overweight or obese.

“There’s a real issue in that health care professionals hold unrecognized attitudes towards obesity and they don’t know what to do. The patient doesn’t like to discuss the issue because they feel bad enough about themselves. So, the easiest thing to do is ignore the situation, and it worsens,” she adds.

Literature supports the idea that health professionals, like the broader public, hold negative attitudes toward obesity and that patients with obesity may face discrimination. There’s evidence that people who are overweight or obese are less likely to receive certain tests, are prone to greater complications from treatment and face inadequate staffing and equipment during care.

Various avenues of research will provide answers for different aspects of the issue.  She expects huge implications for how we prevent and manage obesity in Nova Scotia and across Canada.

“We need to look at the politics around how we price, package and market food. We need the policy to change, like agricultural policy. For instance, corn syrup is in pretty much everything, because it’s cheap to produce,” says Dr. Kirk.

“I’m only half way through my first year here, but there’s a lot to be done,” she says. “The problem is that, as humans, we want to take the easy way. And I wonder whether we can actually put the genie back in the bottle?”

So, take heart, Bridget. You’re far from alone in your struggles. And now, not only does the dashing Marc Darcy like you ‘just as you are’ — you’ve also found a champion in Sara Kirk.
 
“We’ve got to move away from the individual and look at it as a societal problem and address it at multiple levels. We need to accept that there’s no one solution to the problem, it’s a complex problem and it needs complex solutions.”