The usual old cobblers about obesity
The London Evening Standard‘s Dan Jones - or is that Polly Filler - does a great job today of dragging out every prejudice about obesity in the book. So, for his benefit, here’s a bit of balance on the issue.
You are what you eat — and Britain is a tub of lard. We are currently the second-fattest country on the planet.
Well, that very much depends on how you measure 'fattest'. But it is well known that the Pacific island nations are generally much fatter than everyone else. In this table from the World Health Organisation, which lists countries by the prevalence of overweight and obesity, the Pacific islands are the easy winners, followed by the USA (no great surprise there). But the UK comes twenty-first on this list, just ahead of Germany and Canada, but some way behind Argentina, Greece, Australia and others.
|country||% overweight or obese|
|Micronesia, Federated States of||93.1|
|Venezuela (Bolivarian Republic of)||74.4|
|United Arab Emirates||66.9|
|Trinidad and Tobago||65.2|
By 2050 it is estimated that more than half of us will be clinically obese.
Estimated? Hmm... The Health Survey for England 2011 (published a couple of weeks ago) put the UK adult obesity rate at 24.8 per cent. That figure was down from the previous year, but up compared to the year before that. However, the figure has been hovering around the 25 per cent mark for some time now without showing signs of surging upwards. The 50 per cent figure seems downright alarmist, especially as other researchers have noted a plateauing in obesity in countries with a longstanding 'obesity epidemic'.
The term 'clinically obese' is usually deemed to mean 'obese to the extent of requiring medical intervention'. The phrase 'technically obese' would be nearer the mark. As a new study published in the Journal of the American Medical Association indicates, being overweight may be protective against mortality. (More probably, a range of fairly normal weights from slim to chubby make little difference to life expectancy.)
Our collective bellies are probably the biggest danger to British public health, with the Royal College of Physicians this week issuing just the latest warning.
Actually, it's better to look at particular conditions like type-2 diabetes and high blood pressure rather than obesity for a guide to health risk. There are as roughly as many people who are not obese who have diabetes in the UK as those who are obese. (The risk gets higher as you get fatter, but there are far fewer really fat people. And it's probably a lot more complicated than 'obesity causes diabetes'. More like 'obesity and diabetes have common causes'.) There is also a significant relationship between being from an ethnic minority and developing diabetes. Take away diabetes and high blood pressure and the apparent risks of obesity largely disappear. Working out the causes of those two conditions (and the treatment) is going to be far more effective than lectures about waistlines.
This is a most bothersome situation, since on an individual level both the cause of the problem and the solution are obvious. Every New Year diet article you read this month will try to convince you otherwise, but if you are obese it is usually because you consume too much sugar, processed food, unhealthy fats and alcohol. Change the way you eat — the American food writer Michael Pollan’s dictum “Eat food. Not too much. Mostly plants” sums it up — and you will get thinner and healthier. Fact.
I'm glad it's so obvious. Presumably Jones will be able to save us bothering with obesity services since it's all so bloody straightforward. As for Pollan's dictum, the devil is in the detail. What exactly is 'food', then? What precisely is 'too much'? Does that apply to all plants in all forms? After all, bread, rice, pasta and sugar are all plant products.
Yet few people can successfully swallow that advice. Dieting is hard; permanently changing the way you eat even harder.
Indeed. So, the solution is not in fact easy or obvious.
All that would be fine, and fatness a matter of personal responsibility, were it not for the fact that fat people are quite literally a burden on society. They are expensive to keep alive, straining an already-tormented NHS. So fat is a political issue. Moreover, since the lardiness of the population is highest in the most socially deprived areas, fat is also a social, perhaps even a moral problem.
The only canard about costing the NHS. Well, to the extent that fat people do get sick, they will also tend to die younger than everyone else. That means fewer years of expensive healthcare in old age, fewer pensions, less social care, fewer free bus passes and winter fuel allowances. In short, things that make you die younger save the state money in the long run. That's a fairly brutal way of looking at things, but it's the public-health lobby that tends to be the one pursuing that line of argument, not its critics.
The more I think about this issue, the more it seems to me that the best solutions for tackling fatness are the most fascistic. I used to think we should tax fat people but there are too many of them now: any party adopting such a policy would be committing electoral suicide.
Thank god for democracy, saving us from the likes of Dan Jones.
Now I think it is probably best that we punish the pushers. Proud as we were of the London 2012 Olympic Games, it was absurd that they were sponsored by Coca-Cola, McDonald’s and Cadbury. These are companies that should be ostracised for their contribution to a public health crisis, not rewarded with prominence at the biggest sporting event on earth.
Since the causes of this crisis are not as 'obvious' as Jones seems to think, then ostracising big companies is unlikely to help, either. Actually, in reality the biggest mugs in that whole sponsorship situation are these big companies ponying up billions to be associated with the Olympics with little prospect of a sales boost as a result. Does anybody seriously think that athletes are successful because they eat at McDonald's?
One of the biggest recent successes in public health has been against smoking. Punitive taxes on tobacco, better education about the health effects, a near-total ban on advertising and the marginalisation of smoking in public places seems to have worked.
Punitive taxes have aided smuggling but not had much effect on smoking rates. After all, if people really are 'addicts', then they will find the cash to feed their habit. Acceptance of the health dangers has certainly helped, as have changing fashions. The smoking ban has had bugger all effect, if the UK and Ireland are much of a guide, except to ruin the pleasure of smokers and non-smokers who want to drink together. Meanwhile, by demonising alternatives to smoking, like oral tobacco, smoking rates in the rest of the EU are far higher than in Sweden, where oral tobacco is widely used. Now the EU is suggesting a ban on e-cigarettes, despite the absence of any evidence that they are harmful. Instead of 'fascistic' crackdowns, making it easier to use less harmful alternatives would have a bigger public-health benefit.
Food presents a more difficult problem: unlike tobacco, we need food to live. But trans-fats, salt and sugar are all identifiable ingredients that can be taxed and banned.
Actually, trans-fats are less and less widely used in the UK. But where did they come from? They were a product of another misplaced scare story: that saturated fat caused heart disease. So foodmakers switched saturated fat for unsaturated hydrogenated vegetable oils. I suspect the trans-fat scare is overstated, too, but it is an unintended consequence of another act-now-think-later crusade. Salt is probably the second most vital substance for humans after water. Evidence that high salt intake is dangerous is much more flimsy than is commonly assumed. The longest-living nation on Earth are the Japanese - who eat a lot of salt. Salt has, for most people, only a marginal effect on blood pressure.
It’s disagreeable to argue that government should interfere in the contents of our stomachs, but as this January will show — like every New Year before it — we are as a nation incapable of slimming on our own. We need help, before we literally choke on our own jowls.
As a journalist, Jones is supposed to ask 'Is it true?' Instead, he has swallowed the public-health lobby's arguments whole. That really is disagreeable.