Confronting obesity – a response to Max Pemberton

In this week’s Spectator (12th October) Max Pemberton makes the case that Britain must urgently confront its growing obesity problem. He takes us through an anecdote about a patient in a GP surgery demanding a pill that will allow her to not digest fat along with a range of alarming statistics (£5bn a year additional costs to the NHS with 300 hospital admissions a year due to obesity). He writes about other costs – Ambulance services having to replace their fleets to deal with obese patients and hospitals having to buy new operating tables, trollies and scanners. Max points to the failure of public health policy in terms of eating five fruit and veg a day, and suggests we now plan around obesity – assuming it to the both norm – rather than confronting it.

So what should we do? Max suggests we need to confront patients about their weight to get them to confront the reality that they are eating too much and moving too little. He accepts that some people may be genetically predisposed to weight gain, but that changing lifestyle can deal with this. The problem, he writes, is that we aren’t trying to lose weight any more – it’s an attitude problem. We treat patients as consumers (literally here, I guess) and then we are surprised that they won’t take responsibility for their weight any more. Obesity is not a disease, Max writes, – it’s a mindset.

I hope I’ve represented Max’s piece reasonably above. Is he right?

On one level, I think he is. Clearly we can control our weight by eating less and moving more. But it may not be as simple as that. Obesity is important because it is a growing and expensive problem. But it also challenges the way we think about our environments and what it means to be human in a fundamental way. Where we locate the blame for obesity tells us a lot about how we see the world.

We can locate obesity as not being our fault as individuals through two strategies. First, we can say it is down to the toxic food and drink environment we have created for ourselves. It is sometimes hard to move in supermarkets or corner shops for booze and crisp deals, and then you get to the counter and they try and sell you cheap chocolate as well (even WH Smith do this at present – I can’t buy a newspaper without being offered a family-size bar of Cadbury’s). There are studies from the US showing that many local shops offer their local populations huge deals on cheap but largely nutrition-free food and drink, and so little wonder they get fat. Suppliers of sugary drinks and convenience foods pay shops to take their products and display them prominently, crowding out more healthy alternatives. On this view we are having obesity foisted upon us by the food and drinks industry and government turning a blind eye.

Equally, we can blame our genes. Max talks about this in his piece – and no doubt some people do have a higher propensity to store fat than others. Hey – this would have been a genetic advantage not that long ago when food was scarce, but now it’s everywhere (see above), we get fat because our bodies are super-efficient at storing fat for the famine that now never comes (for us in the West, at least). Again then, not our fault.

But these two explanations, as Max points out, take choice and responsibility away from us. But we don’t all deal with choice and responsibility in the same way. Talking about personality types is always a simplification – but work done by Margaret Archer and more recently Graham Scambler points to some of us being autonomous in the way Max describes, some of us depending on others for validation more, and some of us having such jumbled and chaotic personal narratives that we struggle to make and carry through good decisions. Now if I’m autonomous I make my own judgements, and presumably can be held accountable for what I do in the way Max describes. But if I’m more likely to be looking for validation from others, then their views and lifestyles will impinge much more upon me. It’s no wonder that people with weight problems may live with other people with weight problems (be them family or friends). We want to fit in. We don’t want to be the ones not eating crisps or puddings, or seem fussy about what we have for dinner. Equally, for those with chaotic life narratives, who struggle to be consistent or make good decisions, it’s easy to see how eating convenience foods or buying the chocolate when it’s on offer to you, become the everyday decisions. Especially when you are trying to down work (possibly across several jobs).

The key thing is that what we eat and how much we move is a complex mix of the above. I’m lucky in having a job that means that most days I can arrange time to eat reasonably well, as well as being able to afford my own exercise equipment, so I can get up early and try and keep my weight under control. I live somewhere where I can access a decent range of foods without too many problems. I’m also lucky in that my wife is an excellent cook, and so much of the food preparation falls to her (I try and do childcare to balance this up a bit). All of these things mean that I can be held to account in the way Max describes. But many (most?) people aren’t.

Yes, we need to do more on obesity, and adverts with cute plasticine characters aren’t going to fix it. We need to hold those marketing and selling us nutrition-free food and drink to account – hell, let’s tax stuff that is making us fat as we should be eating less of it anyway. But we also need to make sure that better alternative are available, and educating kids better about food at school (I’m appalled at the rubbish they get taught there about nutrition). And parents, yes, need to do more as well about helping their kids be healthier, in terms of both diet and lifestyle more generally. And so do doctors.

So Max is partially right. But in simplifying this down to choice and responsibility, he’s missing out large parts of the story, as well as not questioning how why our health services are treating us as consumers, or asking our governments to act in the better interests either. We need a bigger and more encompassing strategy – leaving all this to markets will just keep making us fatter and more unhealthy where we allow money to be made in that way. But we, and our governments can change the rules to move us more towards the right direction, and to more effectively help those that need more support.

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