Young women are at the centre of myriad public health concerns about their bodies. Fears about obesity, inactivity, unhappiness and social media have driven policy responses that target young women and their "problem" behaviours. But far too often these issues are seen as having competing agendas. In this complex environment, isn't it time for more joined-up thinking and for the voices of young women to be more clearly heard?
In August 2016, the publication of the British government's long awaited plan to tackle childhood obesity coincided with the launch of The Children Society's Good Childhood Report 2016. While one of these reports focused, among other things, on the need for increased monitoring and measurement of children's weight, the other highlighted the increase in young people's unhappiness as a result of significant appearance concerns. These reports should be seen as highlighting complex interwoven health issues.
However, it seems that disproportionate attention continues to be given to an apparent obesity "crisis". The British government's plan for dealing with childhood obesity was received with mixed reviews. The strategy was described in some quarters as a missed opportunity to "tackle the culture of unhealthy eating that is crippling the NHS". Others criticised policy makers for failing to take significant action to tackle the problem.
Criticism levelled at the report for not advocating strong enough action demonstrates the framing of obesity as a "moral crisis" and as the priority public health agenda upon which policy makers need to be seen to be acting.
Our research suggests that this urgency can come with serious risks. What is the evidence base upon which to act? The science of obesity remains uncertain, contradictory and lacks consensus over crucial issues such as the causes and most effective actions to counter it. The one thing we can say for definite on the subject is that it is complex.
So, in rethinking strategy, policymakers need to consider not just if interventions are effective, but also the potential harms and unintended consequences. Over the past decade, the framing of obesity through hyperbolic language of a "crisis" has not only strengthened the imperative to act quickly on the basis of whatever evidence is available, but has fuelled a moral panic which has led to increased surveillance of young people's weight, bodies and lifestyles, contributing not only to increased weight stigma but disordered eating and exercise practices.
We need to reject the separation of the mind and the body to properly reflect on the rising rates of ill health among young women who struggle with disordered eating and exercise – an often silenced part of the obesity debate.
Despite significant gaps in knowledge, there have been a series of policy responses and interventions which often share a weight-centric approach. Healthy bodies are generally seen as "slender bodies", with minimal visible "excess" flesh. The National Child Measurement Programme and the Childhood Obesity strategy's requirement to make it a "default" for health care professionals to "weigh everyone", will only strengthen this view.
This epitomises a broader trend towards reducing complex health issues to simple data categories and a focus on measuring weight and body size. Research demonstrates that not only are these methods of intervention problematic in terms of their reliance on blunt measurements, but they can also have harmful effects on young people in terms of their mental health, well-being and body confidence.
This is especially the case for young women.
The Good Childhood Report revealed that 34% of girls in the UK are unhappy with their appearance. A separate report from Girl Guiding UK (2016) found that young women's "fear of their bodies being criticised holds them back from doing everyday things they'd like to do". This included sports and physical activities that, ironically, are often suggested as key methods of tackling obesity.
Concerns over their own appearance, body shape and size are exacerbated by the bodies young women see on television, magazines, social media, computer games and health and fitness apps.
Add to that the continuous reminders of the need to measure their weight, to work on their bodies and to inspect what they eat, and we have a toxic culture of body surveillance that young women are expected to navigate daily. Is it any wonder that levels of unhappiness, anxiety and depression are increasing?
Their bodies, their voices
The British government's strategy raises further questions about who has the authority to speak for children. Whose knowledge counts when tackling the issue of childhood obesity? The Good Childhood Report and the Girl Guiding Survey are refreshing in their use of young people's subjective experiences. These voices are sadly absent from the official report.
Far more attention needs to be paid to the views and experiences of the children and young people whose lives these strategies and policies will affect. Social action projects can be a more effective way for local authorities to involve young people in making community decisions that affect them, listening to their views and taking appropriate action. Research with and for young people to imagine policy responses within the context of their everyday lives, could be the first step in developing more sustainable, youth-centred interventions. This is an approach to policy making that cannot happen in isolation.
Democratic policy processes need to provide safe spaces where young women can voice their health concerns and through which we can better understand how health is not simply the result of individual choice, but shaped by social context and inequalities associated with culture, social class, sexuality, geography, gender and ethnicity. We need to see these approaches increasingly adopted in the public domain.
Explore further: Opinion: Government's Childhood Obesity Strategy 'disappointing'