Blaming someone for their ‘lifestyle’ disease? Experts want you to stop

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When the idea of a “lifestyle disease” was first introduced in the 1990s it sparked a self-empowerment movement: we held the power to change our life and health. There was potential to stave off the illnesses that scared us by making simple changes to our lifestyle.

But it also sparked the rise in stigma towards those who went on to develop those illnesses. They were, many seemed to think, to blame for what befell them. If only they had the willpower, they too could be paragons of good health like the rest of us, whose virtuous lifestyles mean we sail through life without so much as a sniffle.

Pointing the finger: blaming people for lifestyle diseases only leads to more harm.Credit: iStock

Forget the fact that lifestyle diseases disproportionately affect people in low socioeconomic groups: groups who often lack access to safe places to exercise or to green or blue spaces that might provide motivation to move; they also lack access to quality fresh food, let alone the ability to afford it; and whose financial stress can prevent them from seeking the medical care they need.

Throw stigma into the mix – something experienced by about 60 per cent of people with Type 2 diabetes, for instance – and the impacts ripple across virtually every aspect of a person’s life.

The internalised shame means people who experience stigma are less likely to see their doctor, less likely to follow through with a medical regime and more likely to have poor health outcomes. The effects go beyond health too. Stigma can negatively affect job prospects and the loss of social status resulting from stigma comes with its own emotional and physical health consequences (including chronically heightened cortisol levels, which can dampen immune function).

It is true that the combination of four healthy lifestyle factors – maintaining a healthy weight, exercising regularly, following a healthy diet, and not smoking – are associated with as much as an 80 per cent reduction in the risk of developing the most common and deadly chronic diseases, including heart disease, stroke, diabetes, obesity, metabolic syndrome, and some types of cancer.

Yet, the true causes of these illnesses are complex and experts are still trying to untangle them. They are not the result of personal failure.

Dr Nikki-Anne Wilson, a dementia researcher at Neuroscience Research Australia, has witnessed the stigma aimed at those with lifestyle diseases. She worries that the oversimplification of lifestyle messages can fuel stigma towards those suffering dementia in the same way.

It is a concern she outlines in a new paper, published in the journal, The Gerontologist.

“We don’t want to get into a position where we’re putting that blame on the individual for having not done ‘the right things’,” she says.

Internalised shame has multiple repercussions for those experiencing stigma.Credit: iStock

A 2020 paper, published in The Lancet, found that 12 modifiable risk factors accounted for up to 40 per cent of dementia cases around the world. The factors are social engagement, exercise, diet (i.e. midlife obesity), diabetes, high blood pressure, head injury, smoking, air pollution, depression, excessive alcohol, hearing impairment, education and social isolation.

While such findings have helped researchers to better understand brain health, some are easier to modify than others depending on circumstances and socioeconomic status.

Over 60 per cent of Australian respondents to a survey published earlier this year identified at least one barrier to engaging in dementia risk-reduction behaviours including financial, motivational, and time-based barriers.

“Positive lifestyle changes are really important, but there’s also this complex picture of dementia,” Wilson emphasises. “There are genetic influences and epigenetic influences and all these other things in the development of that go beyond lifestyle.”

About half of all Australian adults live with at least one chronic condition, many of which are lifestyle-related. These figures are expected to keep rising, meaning we are all likely to have people close to us affected, if we don’t already.

Stigma is typically the result of fear and, Wilson suggests, when we feel out of control we want to blame something – or someone. But, perpetuating the stigma keeps us stuck in a problem that hurts us all.

So long as we’re busy accusing one another of being lazy, gluttonous sloths, and intimating that the prevention of chronic conditions is our personal responsibility, governments may see less need to allocate funds towards solving them.

But, Wilson says: “We need more government help.”

That means supporting people at an individual level to make positive lifestyle changes, by providing safe spaces to exercise, investment in public transport, and more access to allied health, including dietitians. We also need support at a population level, Wilson argues (echoing the refrain of many other experts). That means taxing highly processed foods and sugary drinks as well as making fresh wholefoods more affordable and accessible. These are things that are going to “break through that inequity where we are telling people, ‘do this, do that’, but they can’t”.

Finally, we need to support one another by appreciating the positive impact of making lifestyle change and understanding that even the small changes we make can help. But also understanding that chronic diseases – including dementia – are complex conditions.

“While there are things we can do for our brain health, no one is ever responsible for the development of dementia,” Wilson stresses. “It’s a whole combination of factors. So, I don’t ever want to see someone blamed.”

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