People with obesity are commonly urged to lose weight by eating more healthily, cutting down on calorie intake and exercising more – but that advice overlooks a crucial problem.
It overstates individual agency – putting the person at fault because of poor lifestyle choices – and doesn’t take into account all the factors contributing to the obesity crisis. For instance, research has found that there are significant social determinants of obesity, such as poverty, stigma and loneliness.
A recent study of people in the UK has suggested that one way to keep obese people alive for longer is to encourage them to interact more with other people.
Why exactly might this be?
The study came to its conclusion using something called hazard ratios, a measure of how often a particular event happens in one group compared to how often it happens in another group, over time. It found that people who’re less socially isolated have a reduced hazard ratio of death from any cause (known as all-cause mortality). This means that people who’re more socially connected are less likely to die prematurely from any cause.
This is even more significant in people with obesity. Isolation has a bigger affect on the risk of death in people with obesity than those at a healthy weight. Those with obesity showed a four times greater reduction in mortality risk than people without obesity when their levels of social isolation fell.
We also know obesity leads to a higher risk of social isolation, which in turn has mental and physical health implications. So it’s not surprising that reducing social isolation amongst among people who are obese would reduce the risk of mortality.
However, the degree of change is perhaps unexpected. It means that tackling social isolation could make a bigger difference to those with obesity than other contributing factors. In fact, the study found a reduction in social isolation more associated with decreased risk of death than any other factor, including a healthy diet, physical activity, alcohol consumption, depression and anxiety.
Relationship between social isolation and obesity
Obesity is a medical condition where people have excessive body fat, as measured by their body mass index. Growing rates of obesity means some studies predict around 20% of the global adult population will be obese by 2030.
And the problem is worse in high income countries. Around 25% of adults in the UK are already considered obese, and the rate in the US could become as high as 45% by 2035.
This rise is intertwined with growing levels of social isolation and loneliness. Both increased during the COVID pandemic and and both are linked with a greater risk of mortality, just like obesity.
There is a two-way relationship between obesity and social isolation. In an attempt to escape feelings of isolation, people may consume more food and drink than usual, or eat more unhealthy foods such as chocolate, cake, biscuits – so called comfort foods.
Being isolated and feeling lonely can also lead to a reduction in exercise. Both excessive eating of unhealthy food and a lack of exercise will inevitably lead to weight gain.
On the other hand, obesity can lead to social isolation and loneliness, as people experience stigmatisation, rejection, discrimination, bullying, self-blame and reduced self-esteem. It can also engender a loss of trust in others, and a perception that social situations pose a threat, so are best avoided.
We also know obesity is associated with poorer mental health, especially in women.
Unsurprisingly then, obese people are more likely to isolate themselves, avoid spending time in public places and interacting with others. This can include an avoidance of health care settings, preventing those struggling with weight gain from getting the necessary support.
The most recent study demonstrates the significant damage that social isolation can have on those with obesity. The findings should not be interpreted as a signal that the sole answer to health risks of obesity is making social connections. However, the study should prompt a rethink of attitudes and approaches to obesity that focus exclusively on the individual’s diet and exercise. Research has shown that the traditional “eat less, move more” advice is simplistic and outdated.
Healthy eating and exercise should not be prioritised in obesity treatment at the expense of all other factors. To reduce the mortality risk of obesity, social isolation must be taken into account alongside healthy eating and physical activities. Tackling obesity, then, should include group activities and opportunities for regular social interaction in safe welcoming environments.
Andrea Wigfield does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
