Obesity: searching for an inconvenient truth

In my last post I wrote about the transformation of Tom Watson, a British politician who has reversed his diabetic condition by losing 100 pounds. As I was thinking about him, and lamenting attitudes in society towards obesity, I happened on an article by Michael Hobbes in Huffington Post: Everything You Know About Obesity Is Wrong. Here’s an extract:

About 40 years ago, Americans started getting much larger. According to the Centers for Disease Control and Prevention, nearly 80 percent of adults and about one-third of children now meet the clinical definition of overweight or obese. More Americans live with “extreme obesity“ than with breast cancer, Parkinson’s, Alzheimer’s and HIV put together.

And the medical community’s primary response to this shift has been to blame fat people for being fat. Obesity, we are told, is a personal failing that strains our health care system, shrinks our GDP and saps our military strength. It is also an excuse to bully fat people in one sentence and then inform them in the next that you are doing it for their own good. That’s why the fear of becoming fat, or staying that way, drives Americans to spend more on dieting every year than we spend on video games or movies. Forty-five percent of adults say they’re preoccupied with their weight some or all of the time—an 11-point rise since 1990. Nearly half of 3- to 6- year old girls say they worry about being fat.

That just about sums up the problem. Blame. Personal failing. The piece is worth reading right through. It’s profoundly saddening. Fad diets that cause people to lose weight, only to put it on again. Stories of heartache and humiliation.

But ultimately the conclusion is that for many people the answers have always been clear. Eat less, eat sensible (if you can make sense of all the conflicting medical advice), exercise more, and on a societal level, ease poverty. You might not change your shape if you walk to the nearest shop rather than drive, or if you eat lentils instead of donuts, but your self-esteem will rise, your cognitive skills will improve, and you will be better placed to deal with the biggest scourge of the obese – the stigma. And of course, a decent education helps.

It’s undoubtedly true that the toughest task of all is to tackle society’s attitude towards the overweight. And I’m one of those people who struggles to override a bias that’s hard-wired from childhood.

But to suggest, as Michael Hobbes does in his article, that diets don’t work, that most weight gain is irreversible in the long term, and that we should therefore “change the paradigm” by getting healthier rather than thinner, is a questionable argument. If we’ve managed to shed a few pounds, should we be going to a meeting and declaring “I am fat. It’s been three years since my last cheeseburger”? Are we but a Mars bar away from perdition?

Not only is such a message bad news for Tom Watson, who has taken sensible action to reverse the symptoms of Type 2 diabetes. It’s also not my own experience. Fifteen years ago I lost four stone (fifty-four pounds). I have never regained that weight. Others, including Nigel Lawson, a senior minister under Margaret Thatcher, and the celebrity chef Tom Kerridge, have done likewise.

Hobbes seems to be telling us that once we get fat, there’s no way back, that we should just get on with it, and be happy with what we have become. He may have science on his side, but science, as we constantly discover, is a movable feast. While I agree with him that we should concentrate on eating healthily, nobody seems to agree on what healthy eating actually constitutes. Mediterranean? Vegan? Paleo? Take your choice. More a matter of belief than overwhelming scientific proof.

Equally, should we simply accept that once we’re fat we’ll always be fat? Not everybody can reconcile themselves with that reality. And people who have lived with the stigma of obesity for most of their lives cannot easily be expected suddenly to become fat and proud. If weight gain really is irreversible, then perhaps research needs to concentrate more on changing that reality. If people can hope for a cure for their cancer, why should they not be allowed to hope for an end to yo-yo-dieting?

Hobbes finds plenty of people to blame. The food industry, which pumps additives, preservatives and low-cost junk ingredients into our everyday diet. The health industry, which in the United States invests $60 billion a year on drug research and only $1.5 billion on nutrition research. The medical profession, in which most people think themselves expert on obesity and dole out advice that is often skimpy, misleading and downright cruel. They are all fair targets.

Blaming is easy, whether we point the finger at fat people themselves or the factors that cause them to be fat.

The Huffington Post piece uses America as its canvas. And the author paints with harsh colours. I like to think that in Britain we’re a little more compassionate. There seems to be a widespread underlying attitude in the United States that sits on the dark side of self-reliance and enterprise, two qualities that Americans see as essential features of their national culture: if you’re poor, sick or obese, it’s your fault. You’re a loser.

What our much-maligned “socialised medicine system”, the National Health Service, does for us is provide a reasonably consistent, non-judgemental approach towards obesity. Yes, there are surgeons who refuse to operate on the grossly obese, but that’s often because they assess the risk to the patient as unacceptable.

We have national programmes designed to tackle problems arising from obesity. Regular diabetic monitoring is one of them. We have screening programmes for aortic aneurysms, bowel cancer and breast cancer. Advice on nutrition is readily available.

But the NHS, increasingly cash-strapped and short of staff, can only do so much. It’s not enough. We’re starting to die younger, and obesity is playing its part.

The other day the London Times columnist Jenni Russell pitched in with her take on the latest demographics on life expectancy. She came up with one startling statistic. In the London Borough of Kensington and Chelsea, which is home to some of the wealthiest and poorest people in Britain, “a boy from the poorest wards will on average die almost 14 years earlier than a boy living 100 yards away in a wealthy home. The gap for women is more than five years”.

She also quotes statistics claiming that areas with the highest levels of obesity also had the highest proportion of Brexit voters. The link, she implies, between deprivation and resentment of an entity held to be responsible. People aged between 30 and 55, she claims, are dying of despair. Increases in poverty, street crime, welfare dependency and drug and alcohol abuse can all be attributed to the government’s austerity policy introduced since the 2008 financial crisis.

So there you have it. One country, that didn’t buy into post-Crash austerity, has a reasonably strong economy, but is emotionally inclined to let its weaker brethren sink or swim. Another, with an economy wobbling under the implications of Brexit, has imposed cuts in policing and social services, and is nibbling away at the foundations of its welfare state. In both, people are dying of despair. Not exactly easy ground for establishing universal inconvenient truths.

So if you’ve stayed with me thus far, you’re entitled to ask where I’m going with this.

The answer is nowhere. Because there is no single answer. If there’s a big picture, it’s that plenty – an abundance of food, energy, transport and medicines – brings consequences. Lots of them, and many of them adverse, including obesity. Just as we seek a simple solution for global warming, we yearn for an overarching solution to obesity. But there isn’t one, except possibly mass starvation.

We can appoint a fat czar, introduce compulsory exercise, develop yet more drugs to suppress appetite, introduce a universal minimum wage, raise food standards to eliminate the unhealthy stuff we’re encouraged to eat, abandon austerity, abolish capitalism, abolish socialism, reverse Brexit, get rid of Trump. We can also make mirrors illegal and shut down the social media.

But one final thought. Perhaps we should stop trying to rationalise a multi-faceted phenomenon. Tom Watson isn’t dying of despair, unless the current state of the Labour party is driving him over the edge. And yes, poverty drives people to junk food and hardens the arteries. But not everyone of limited means succumbs to booze, opioids and an excess of kebabs. Not everybody obsesses about their body image and craves the holy grail of physical perfection. Most of us just get on with our lives, even though we might be blighted by anxiety of one sort or another.

And if you want another big picture, it’s this.

Let’s say you could go back in time and ask some of our ancestors – living as they did one step away from famine, plague and random violence. If you were to ask them whether they would prefer to live in our time, where even in the wildest societies there’s a semblance of law and order, where some form of medical care is available in all but the remotest areas, and where they would have the option of eating themselves to death, I think I know what they might choose.