Kat.Schneider@uwe.ac.uk Page 24 of 24
Written Evidence Submission to the House of Commons Health and Social Care Committee
Inquiry into Food and Weight Management
- Respondent Names/Organisation: Dr Kat Schneider, Dr Ella Guest, Dr Helena Lewis-Smith, Emma Waite, Professor Elizabeth (Beth) Daniels; Centre for Appearance Research, University of the West of England (UWE Bristol)
- Contact Emails: car@uwe.ac.uk; kat.schneider@uwe.ac.uk; ella.guest@uwe.ac.uk; helena.lewis-smith@uwe.ac.uk; emma.waite@uwe.ac.uk; beth.daniels@uwe.ac.uk
- Date of Submission: 21 August 2025
Contents
About the Centre for Appearance Research
Connect with CAR on social media
To find out more about Dr Kat Schneider
Connect with Dr Kat Schneider on social media
To find out more about Dr Ella Guest
Connect with Dr Ella Guest on social media
To find out more about Dr Helena Lewis-Smith
Connect with Dr Helena Lewis-Smith on social media
To find out more about Emma Waite
Connect with Emma Waite on social media
To find out more about Professor Elizabeth (Beth) Daniels
Connect with Professor Elizabeth (Beth) Daniels on social media
What should the Government do differently?
About the Centre for Appearance Research
The Centre for Appearance Research (CAR) at the University of the West of England (UWE Bristol) is the world’s largest research centre focusing on the role of appearance and body image in people’s lives. CAR conducts interdisciplinary, applied research aimed at improving psychological and social outcomes for individuals affected by appearance-related issues, including body image, visible differences, and weight stigma. Through its collaborative work with policymakers, NGOs, educators, healthcare professionals, and global brands, CAR translates scientific evidence into practice and policy to support equity and inclusion across diverse populations. The Centre is internationally recognised for its contributions to public health and social justice, with a strong track record in developing and evaluating interventions that address weight stigma and promote body confidence.
To find out more about CAR
- Website: http://www.uwe.ac.uk/car
- Podcast: http://soundcloud.com/appearance-matters
Connect with CAR on social media
- Facebook: http://www.facebook.com/AppearanceResearch
- Instagram: https://www.instagram.com/car_uwe/
- LinkedIn: https://www.linkedin.com/company/car-uwe
About Dr Kat Schneider
Dr Kat Schneider is a Senior Research Fellow at the Centre for Appearance Research, UWE Bristol. Her work focuses on the intersections of body image, mental health, gender, and social justice, with a particular emphasis on addressing weight stigma in physical activity, sport, fitness, and healthcare. Dr Schneider leads and contributes to research projects aimed at reducing appearance-based discrimination and promoting inclusive environments for individuals of all body sizes. She has collaborated with leading organisations including Nike, the Dove Self-Esteem Project, and Laureus Sport for Good to co-develop and implement body image interventions across global and grassroots platforms. Dr Schneider is a Scientific Advisor for WINN UK, a research network that explores “health gains over weight loss” healthcare approaches and is committed to ensuring that lived experience and marginalised voices are central to efforts to reduce stigma and improve mental and physical health.
To find out more about Dr Kat Schneider
- Website: https://www.drkatschneider.com/
- UWE Bristol staff page: https://people.uwe.ac.uk/Person/KatSchneider
Connect with Dr Kat Schneider on social media
- Instagram: https://www.instagram.com/dr_katschneider/
- LinkedIn: https://www.linkedin.com/in/jekaterinaschneider/
About Dr Ella Guest
Dr Ella Guest is a Senior Research Fellow and Registered Health Psychologist at the Centre for Appearance Research, UWE Bristol. Her work focuses on the psychosocial impact of health conditions and injuries that affect appearance, with particular expertise in behaviour change, body image, and stigma. Drawing on her background as a health psychologist, she applies evidence-based methods to facilitate meaningful behaviour change that supports individual well-being, positive health outcomes, and broader societal acceptance of appearance diversity. She has contributed to initiatives promoting appearance inclusivity across society, including advising UWE’s Health and Well-Being Roadmap and supporting UWE Bristol Sport’s rebrand to encourage participation in activity for health and enjoyment rather than appearance- or weight-related reasons. She also played a key role in a university-wide appearance-acceptance project aimed at making the institution more inclusive, exploring how body dissatisfaction affects well-being, academic performance, and participation.
To find out more about Dr Ella Guest
- UWE Bristol staff page: https://people.uwe.ac.uk/Person/EllaGuest
Connect with Dr Ella Guest on social media
About Dr Helena Lewis-Smith
Dr Helena Lewis-Smith is an Associate Professor of Psychology at the Centre for Appearance Research, UWE Bristol. Her work focuses on the intersection of body image, eating disorders, health conditions, and social justice. She leads and collaborates on research projects that use evidence-based strategies to promote positive body image and appearance diversity across education, healthcare, online, and corporate settings. Her work involves global partnerships with schools, health services, businesses, and charities, with the aim of fostering a society that embraces appearance diversity. She has worked with leading organisations, including the NHS, the Dove Self-Esteem Project, and UNICEF, to develop scalable body image interventions for national and international implementation. Helena serves on the editorial board of Body Image and chairs the Research-Practice Committee of the Academy for Eating Disorders.
To find out more about Dr Helena Lewis-Smith
- UWE Bristol staff page: https://people.uwe.ac.uk/Person/HelenaLewis-Smith
Connect with Dr Helena Lewis-Smith on social media
- Instagram: https://www.instagram.com/helena.lewissmith/?hl=en
- LinkedIn: https://www.linkedin.com/in/dr-helena-lewis-smith-54bb771a9/
About Emma Waite
Emma Waite is a Research Fellow and Trainee Health Psychologist at the Centre for Appearance Research, UWE Bristol. Her work focuses on improving the lives of people impacted by appearance-affecting conditions, injuries, and treatment effects. She has particular expertise in the impact of social factors and social inequalities on health, as well as the intersection between LGBTQIA+ identities and appearance. She has worked on projects focused on promoting body acceptance, positive well-being, and inclusivity of all appearances, including delivering appearance-inclusivity training to staff from UWE Bristol Sport and conducting research with students to understand their concerns and experiences related to their appearance. She was a key member of the Appearance Inclusive University Initiative at UWE Bristol, which focused on improving acceptance of diverse appearances at university, including those that differ from the ‘norm’ or from idealised beauty standards.
To find out more about Emma Waite
- UWE Bristol staff page: https://people.uwe.ac.uk/Person/EmmaWaite
Connect with Emma Waite on social media
- LinkedIn: www.linkedin.com/in/ecswaite
About Professor Beth Daniels
Professor Elizabeth (Beth) Daniels is Director of the Centre for Appearance Research at UWE Bristol. A developmental psychologist by training, her research explores how media, sexualisation, and sociocultural influences shape girls’ and young women’s body image and psychological well-being. She is particularly interested in the protective roles of physical activity, embodiment, and social identity. Professor Daniels is committed to public engagement and science communication, regularly contributing to media, public talks, and outreach. She serves on the editorial boards of Body Image and Emerging Adulthood and has held editorial roles with Sex Roles and Psychology of Women Quarterly.
To find out more about Professor Elizabeth (Beth) Daniels
- UWE Bristol staff page: https://people.uwe.ac.uk/Person/BethDaniels
Connect with Professor Elizabeth (Beth) Daniels on social media
Relevant terminology
● Weight bias: Negative attitudes, beliefs, or assumptions about people based on their body weight.
● Weight stigma: Social judgement and stereotyping of people because of their weight, often leading to shame or exclusion.
● Weight-based discrimination: Unfair treatment of individuals because of their weight, such as being denied opportunities in work, education, or healthcare.
● Weight-inclusive approach: A model of care that prioritises health and well-being for people of all sizes without focusing on weight loss.
● Health at Every Size® (HAES®): A framework promoting balanced eating, life-enhancing physical activity, and respect for body diversity. It does not assume weight loss is necessary for health improvements.
● Fatphobia: Prejudice, discrimination, or negative stereotyping directed at individuals due to their body size.
Summary
This response addresses the Committee’s questions from a weight-inclusive, evidence-based perspective, challenging the effectiveness and harms of policies that focus on weight loss as a measure of health. Current strategies often fail not because individuals are not trying hard enough, but because the policies themselves are based on flawed assumptions. Most existing approaches:
- Do not work in the long term: Up to 95% of people regain lost weight within five years.
- Ignore the root causes of poor health: Factors like poverty, racism, trauma, food insecurity, and unsafe environments have a far greater impact on health than body size.
- Reinforce stigma: Weight-focused campaigns and policies often shame people in larger bodies, leading to worse mental and physical health outcomes, including depression, anxiety, and disordered eating.
- Drive people away from healthcare: Many people in larger bodies avoid the NHS because of previous negative experiences and discriminatory treatment.
- Overlook effective alternatives: Evidence shows that weight-inclusive approaches, such as Health at Every Size® (HAES®), lead to improvements in blood pressure, cholesterol, eating habits, movement, and mental well-being, without the need to focus on weight loss.
What should the Government do differently?
To create meaningful, lasting change in public health, we recommend the following:
1. Reframe health policy
- Shift away from using weight or BMI as the main measure of health.
- Focus instead on behaviour-based outcomes, like increased fruit and vegetable intake, reduced food insecurity, improved sleep, self-care, work-life balance, and increased access to joyful movement.
2. End weight-based targets
- Remove weight loss as a success metric from public health campaigns.
- Measure health through quality-of-life outcomes, not numbers on a scale.
3. Invest in weight-inclusive interventions
- Fund programmes based on weight-inclusive principles, which have been shown to improve physical and mental health without focusing on weight.
- Support local, community-led initiatives that promote inclusive, culturally relevant well-being.
4. Tackle stigma and discrimination
- Train all public health and NHS staff, as well as healthcare trainees, in anti-stigma, anti-racism, and weight-inclusive care.
- Pass legislation banning weight-based discrimination, as for other characteristics that contribute to inequalities (e.g., sex, gender, race).
- Ensure NHS services are welcoming to all bodies; this includes size-accessible chairs, gowns, and equipment.
5. Improve equity and accessibility
- Design NHS services with input from people living in larger bodies, especially those from racialised or low-income communities, as well as individuals with neurodiversity.
- Address structural barriers to well-being: improve access to green and blue spaces, safe environments, affordable healthy food, and trauma-informed care.
- Ensure all new weight-related treatments (including medications) are evaluated for long-term safety in diverse populations.
6. Educate on limitations of weight loss drugs
- Provide comprehensive information regarding the limitations of GLP-1 medications like Wegovy and Mounjaro including:
- Weight loss only lasts while the drug is taken; weight regain is common after stopping.
- Side effects include gastrointestinal issues, pancreatitis, depression, and bone/muscle loss.
- There is very little long-term safety data, especially for marginalised groups and individuals with pre-existing eating disorders or body image issues.
7. Redesign healthcare services
- Create weight-inclusive clinical pathways for common conditions (e.g., diabetes, hypertension, joint pain).
- Equip all NHS services with:
- Size-inclusive equipment;
- Trauma-informed, weight-inclusive staff training;
- Emotional support for patients and staff alike.
- Monitor and report on outcomes across body size, race, disability, and income to ensure accountability and equity.
Detailed information
Q1. Why are existing policies relating to food and diet seemingly not succeeding in reducing rates of obesity, and what should the Government learn from this, or do differently, when designing and implementing policy in future?
Summary of issues
- Weight-centric policies do not work: Decades of evidence show that most intentional weight loss interventions fail in the long term, with up to 95% of people regaining the weight within five years (Busetto et al., 2021; Mann et al., 2007).
- Physical activity levels have stagnated (Strain et al., 2024), in part because public discourse often positions movement primarily as a tool for weight loss, rather than promoting sustainable and joyful forms of physical activity for all bodies (Bevan et al., 2021). Further, the high costs associated with some forms of physical activity (e.g., gym memberships, Pilates) may make it difficult for people to engage with it. This is also related to the number of green spaces being reduced, thus limiting access to spaces for movement, particularly for individuals from lower socioeconomic backgrounds.
- BMI is not an accurate measure of health: Recent evidence from the British Medical Journal (Franco et al., 2025) supports decades of research showing that BMI is not a valid proxy for health (Bailey et al., 2025) and that doctors should provide high quality, evidence-based care reflecting individual preferences and needs, regardless of weight. BMI is also not an accurate measure of body fat or body composition.
- Policies often reinforce weight stigma, which in turn contributes to poorer health outcomes and deters individuals from engaging with health services (Puhl & Heuer, 2010) and engaging in healthy behaviours, such as eating a balanced diet and engaging in regular physical activity (Pearl et al., 2021; Zhu et al., 2022).
- Fatphobic public health messaging increases harm by perpetuating stereotypes, increasing body dissatisfaction, and contributing to eating disorders (Bacon & Aphramor, 2011). Please also refer to the House of Commons Women and Equalities Committee Sixth Report of Session 2019–21, “Changing the perfect picture: An inquiry into body image” (published on 9 April 2021 by authority of the House of Commons).
- Weight-inclusive approaches, like Health at Every Size® (HAES®), reject weight loss as a primary health goal and instead promote weight-inclusive health outcomes. Clinical trials show that HAES® interventions lead to significant improvements in physical health markers (like blood pressure and cholesterol), health behaviours (such as eating habits and physical activity), and psychosocial well-being (including self-esteem and body image). These benefits are achieved more effectively—and with fewer risks—than traditional weight loss interventions (Bacon & Aphramor, 2011).
- Weight bias and weight stigma are linked to increased rates of depression, anxiety, eating disorders, and suicidal ideation (Hatzenbuehler et al., 2009; Puhl & Suh, 2015; Shroff & Thompson, 2004; Thompson et al., 2005).
- Physiological effects of weight stigma include increased stress markers such as cortisol and blood pressure (Major et al., 2012; Puhl & Brownell, 2003).
- Weight stigma further contributes to disordered eating, weight gain, and avoidance of physical activity, undermining public health goals (Jackson et al., 2014; Sutin & Terracciano, 2013; Wertheim et al., 2001).
Recommendations
● Reframe health policy away from weight loss as a primary outcome and discontinue the use of BMI as a measure of health.
● Eliminate weight-based targets in public health strategy.
● Train public health professionals in weight stigma reduction and weight-inclusive approaches (e.g., HAES® principles).
● Invest in holistic health promotion that targets health behaviours, not body size.
Q2. Which public health interventions have been the most effective, either domestically or internationally, at reducing obesity or consumption of less healthy foods? What should the Government learn from them?
Summary of issues
● Weight-inclusive interventions, like Health at Every Size® (HAES®), have been shown to deliver physical and psychological benefits for individuals living in larger bodies—such as improved eating behaviours, self-esteem, blood pressure, and cholesterol—without focusing on weight loss (Bacon et al., 2005; Ulian et al., 2018).
● A meta-analysis found HAES® interventions significantly reduced susceptibility to hunger compared to control groups and performed similarly to weight-focused approaches in terms of body measurements and cardiometabolic markers, with no significant differences between groups for outcomes like blood pressure or cholesterol (Clarke et al., 2024).
● Fiscal interventions such as sugar taxes (e.g., Mexico, UK Soft Drinks Industry Levy) have reduced purchase of sugary beverages (Falbe et al., 2022) and increased population health (Blakely et al., 2020) but have not translated into significant changes in weight outcomes at the population level (Bes‐Rastrollo et al., 2016).
● Interventions that focus on community food security, such as subsidised produce schemes or improving access to nutritious food in deprived areas, address upstream determinants of dietary patterns more equitably. These types of interventions should be evaluated for their impact on health and well-being outcomes.
Recommendations
● Scale up and fund weight-inclusive, HAES®-aligned community health initiatives. Some examples include Doncaster Council’s Compassionate Approach to Weight (https://www.doncaster.gov.uk/services/health-wellbeing/doncaster-s-compassionate-approach-to-weight) and Nutriri (https://www.nutriri.org/).
● De-emphasise weight as a measure of programme success and population health and focus on quality-of-life and behaviour-based outcomes.
● Include people in larger bodies in the design and evaluation of health interventions.
● Improve public health messaging by moving away from simplistic directives (e.g. “eat less, move more”) that tell people what to change without supporting how to do it. These messages often ignore wider social and structural factors, place blame on individuals, and can lead to feelings of helplessness and disengagement. More effective messaging should focus on what people can do and provide practical, empowering support.
Q4. What action could be the most effective in reducing ethnic and social disparities relating to rates of obesity, and how could any barriers to implementation be addressed?
Summary of issues
● Weight is not the root cause of disparities; social determinants (income, housing, racism, food insecurity) are. Policies focused on weight ignore these root causes (Baez et al., 2023; Williams et al., 2024).
● Racialised and marginalised groups are more likely to face compounding stigma in health settings, reducing trust in services and worsening access.
● Weight stigma intersects with gender, race, and socioeconomic status, leading to compounded discrimination (Fikkan & Rothblum, 2012; Makowski et al., 2019; Puhl et al., 2008; Reece, 2019).
● Women and people from minoritised ethnic groups in larger bodies are disproportionately affected by weight-based discrimination (Cox, 2020; Fikkan & Rothblum, 2012).
● The cultural idealisation of thinness reflects deeper inequalities related to class, race, and gender (Diedrichs & Puhl, 2017; Meadows et al., 2022).
● Cultural assumptions in dietary and activity recommendations often fail to reflect lived experience (Hassel, 2014; Oyibo et al., 2018).
Recommendations
● Fund community-led health initiatives designed by and for racialised, marginalised, and low-income communities.
● Address structural barriers to physical activity (e.g., unsafe neighbourhoods, lack of green and blue spaces).
● Invest in anti-racism and anti-stigma training for NHS and public health staff.
● Implement universal design principles to make services accessible across size, race, and disability.
Q6. What challenges and opportunities do weight loss medications like Wegovy and Mounjaro present to the NHS and to individuals?
Summary of issues
● Originally for diabetes, not weight loss: Drugs like semaglutide and tirzepatide were developed to help manage blood sugar in people with diabetes, not for weight loss. They are not first-choice treatments for diabetes because of their serious side effects. Weight loss is a side effect, not the main purpose.
● Used at high doses to maximise weight loss (and risks): These drugs are marketed for weight loss at higher-than-recommended doses (or at the maximum dose), deliberately increasing side effects to amplify weight loss effects. This also increases the risk of serious health issues (Arillotta et al., 2023; Chastain & Meadows, under review; Suran, 2023). Malnutrition can result from appetite suppression caused by weight loss drugs, especially when healthy eating is not prioritised.
● Short-term effect only: People lose weight only while taking these medications. Once they stop, most regain a large portion—up to two-thirds—of the weight within a year (Rubino et al., 2021; Wilding et al., 2022). Any health improvements also tend to reverse. People need education and realistic behaviour change support to help them eat a more balanced, diverse diet and engage in regular physical activity; drugs alone do not achieve sustained behaviour change.
● Limited long-term safety data: These drugs are still relatively new, and we do not yet know their long-term effects, especially in groups often left out of clinical trials, like people of colour, disabled people, and those with complex health conditions.
● Known side effects:
- Common issues: nausea, vomiting, diarrhoea, constipation.
- More serious risks: pancreatitis, kidney failure, gallbladder disease, and medullary thyroid cancer, particularly in those with a family history (Anderson & Trujillo, 2010; Arillotta et al., 2023; Tobaiqy & Elkout, 2024).
- Mental health effects: depression, anxiety, insomnia, suicidal thoughts, potential for worsening of eating disorder symptoms (McIntyre, 2024; Suran, 2023).
- Additional concerns: muscle loss (Tinsley & Heymsfield, 2024), lower bone density (Jensen et al., 2024).
● Stigma and psychological harm: Promoting these medications as a “cure” for higher body weight reinforces the idea that larger bodies are inherently wrong and need to be fixed. This can worsen weight stigma and harm mental and physical health (Fahs & Swank, 2025). For some, using the drug may temporarily reduce stigma or offer relief, but that must be balanced against the physical and emotional costs and long-term health effects.
Recommendations
● Ensure any roll-out of pharmaceutical drugs is accompanied by rigorous and unbiased long-term evaluation, not funded by the pharmaceutical companies themselves.
● Thoroughly screen individuals for history of disordered eating, eating disorders, body dysmorphic disorder, and related mental health concerns (e.g., generalised anxiety, depression, etc.), prior to prescribing any weight-related treatment.
● Offer non-weight-centric support (e.g., behavioural coaching, trauma-informed care) as the main approach to health promotion (e.g., physical activity, balanced diet). For example, promoting physical activity through evidence-based behaviour change approaches is more effective, sustainable, and cost-efficient in the long term than relying solely on medical interventions such as GLP-1 medications. GLP-1s do not address the underlying psychological, social, or environmental barriers that prevent people from engaging in physical activity, nor do they build the skills or confidence needed for lasting change.
● Educate providers and patients on the limitations and potential harms of pharmacological approaches.
Q9. What changes might be needed to services, or additional support from Government, to ensure they are able to provide equitable access and take advantage of innovations in treatment?
Summary of issues
● Weight bias is prevalent among healthcare professionals, resulting in shorter appointments for patients in larger bodies, reduced education and engagement, and diminished willingness to offer care (Diversi et al., 2016).
● Individuals in larger bodies often avoid healthcare due to past experiences of derogatory treatment, leading to poorer health outcomes (Amy et al., 2006; Glauser et al., 2015; Phelan et al., 2014; Wear et al., 2006) and a significant cost to the NHS as a result of missed healthcare appointments, missed diagnoses, and misdiagnosis of symptoms.
● Weight bias among doctors has been found to be at least as pervasive as in the general public, affecting clinical decision-making (Sabin et al., 2012).
● Unlike other forms of discrimination, it is currently legal to discriminate on the basis of weight in the UK (Diedrichs & Puhl, 2017; Meadows et al., 2021).
● There is broad public support for legal protections against weight discrimination in countries like the U.S., Canada, Australia, and Iceland (Puhl & Heuer, 2011; Puhl, Latner, O’Brien, Luedicke, Forhan, et al., 2015; Puhl, Neumark-Sztainer, Austin, Luedicke, & King, 2014).
● Social policy and legal protections are urgently needed to address the systemic harms associated with weight bias and weight stigma (Diedrichs & Puhl, 2017).
Recommendations
● Redesign NHS services to support holistic health, not weight change.
● Implement weight-inclusive clinical pathways (e.g., for hypertension, diabetes, joint pain).
● Equip NHS services with:
- Size-accessible medical equipment and furniture.
- Training in weight-inclusive and trauma-informed care.
- Support for staff mental health to reduce burnout in high pressure environments.
● Collect and publish disaggregated data on outcomes by weight, race, disability, and income to monitor equity.
● Facilitate realistic, achievable goals that focus on adding enjoyable, positive behaviours rather than restricting, punishing, or shaming—approaches which do not lead to meaningful or sustained behaviour change and can lead to helplessness and disengagement.
Conclusion
“Obesity policy” has long operated under flawed assumptions—i.e., that weight is fully within personal control, that weight equates to health, and that weight loss is a sustainable solution. It is time to invest in a paradigm shift, from weight loss to health gain, from individual blame to systemic support, and from stigma to inclusion. With bold action, the UK can lead the world in building truly weight-inclusive healthcare.
Signatures
Signed: 
Date: 21 August 2025
Dr Kat Schneider
Role/Title: Senior Research Fellow, Centre for Appearance Research
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Signed: 
Date: 21 August 2025
Dr Ella Guest
Role/Title: Senior Research Fellow, Centre for Appearance Research
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Signed: 
Date: 21 August 2025
Dr Helena Lewis-Smith
Role/Title: Associate Professor of Psychology, Centre for Appearance Research
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Signed: 
Date: 21 August 2025
Emma Waite
Role/Title: Research Fellow, Centre for Appearance Research
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Signed: 
Date: 21 August 2025
Professor Elizabeth Daniels
Role/Title: Director, Centre for Appearance Research
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