Obesity and gross insults

‘Obesity has grown by almost 400 per cent in the last 25 years such that three-quarters of the adult population are now overweight or obese (around 22 per cent are now obese). England has witnessed the fastest growth in obesity in Europe and childhood obesity has tripled in 20 years.’ (1)

These are the kind of statistics headline writers kill for – yet last week, they were handed to them on a plate. The publication of the UK House of Commons Health Select Committee’s 150-page report on ‘Obesity’ came garnished with a press release painting, in its own words, a ‘bleak picture’ of our fat future, in which ‘the sight of amputees will become much more familiar…. There will be many more blind people. There will be huge demand for kidney dialysis…. Indeed, this will be the first generation where children die before their parents as a consequence of childhood obesity’ (2).

Shrill pronouncements about the cost to the nation (apparently up to £7.4billion per year, and rising) were followed by ‘solutions’ that are more soundbiteable than sane – from joined-up national walking and cycling strategies to annual ‘fat tests’ for schoolkids to bans on advertising junk food to children. This was swiftly slapped on to the front pages, accompanied by faintly pervy photos of podgy teenaged girls’ bums in too-tight hipster jeans or wobbly thighs at the side of the school swimming pool.

What a reception to give to a ludicrous, hysterical document, based on nothing more than junk science and a profound contempt for people’s capacity to make choices.

Take the obesity ‘epidemic’ – the starting point for the current levels of official concern. Rather than grimly accepting the contention that there has been a 400 per cent rise in obesity over the past quarter century, we should recognise that the definition of obesity and overweight, and its relationship with bad health, is far more complex than today’s anti-fat crusade implies.

The Body Mass Index (BMI), by which obesity levels are commonly measured, is acknowledged by many to be crude, imprecise, and, when taken on its own as a measure of health and wellbeing, meaningless. Any relationship between weight and diabetes, heart failure, cancer and other grisly diseases, which is presented by the document as proven, direct and inevitable, is in reality a highly complex correlation.

The document’s heavy focus on childhood obesity obscures the fact that the relationship between childhood and adult obesity – let alone childhood obesity and the potential health dangers facing an obese adult – is far from straightforward. The gloomy prognosis that ‘this will be the first generation where children die before their parents as a consequence of childhood obesity’ is a scandalous evasion of the real, known situation – that despite the apparent 400-fold increase in obesity that has already taken place, people are living longer, healthier lives.

The causes of obesity are also more murky than the health committee would have us believe. ‘At its simplest level, obesity is caused when people overeat in relation to their energy needs’, states the document (3). This chimes with a commonsense appreciation of the fact that, with food and alcohol becoming cheaper and more plentiful than in the past, people must be eating more. Yet in the small-print of the main report, the committee produces a puzzling statistic: ‘Even after adjustments for meals eaten outside the home, and for consumption of alcohol, soft drinks and confectionery, average per capita energy intake seems to have declined by 20 per cent since 1970.’ (4)

How to explain this? The data must be wrong, says the Health Committee. ‘[T]he data used for the National Food Survey are self-reported, and, notoriously, individuals are reluctant to report consumption of foods they regard as being bad for them’, admonishes the document, before calling for immediate reform: ‘it is essential that the government has access to accurate data on the actual calories the population is consuming.’ (5) Even disregarding the somewhat sinister implications of compiling a Gross Domestic Calorie Count, how the government is supposed to get such accurate information is anybody’s guess.

It is worth noting that the health committee is rather keen on disregarding figures that do not support its argument – and making up those that do. In the document’s summary, it bandies around some scary figures about the cost of obesity to the NHS: ‘We estimate the economic costs of obesity conservatively at £3.3-3.7 billion per year and of obesity plus overweight at £6.6-7.4 billion.’ (6) The main report gives an explanation of the convoluted way in which these figures were arrived at.

The total estimated cost of obesity is £3.3-3.7 billion, which is ‘£0.7-1.1 billion (27-42 per cent) more than the NAO [National Audit Office] estimate for 1998’ – yet this ‘should still be regarded as an under-estimate’. The additional cost for the overweight is calculated according to the following formula: ‘If in crude terms the costs of being overweight are on average only half of those of being obese then, with more than twice as many overweight as obese men and women, these costs would double. This would yield an overall cost estimate for overweight and obesity of £6.6-7.4 billion per year.’ (7) Got that? Meanwhile, a table in the appendix illustrates the fact that the UK spends a smaller proportion of its total healthcare expenditure on tackling obesity than the USA and many other European countries – not that you’d guess it, given all the bellyaching over the cost of obesity to the NHS.

As well as stuffing our faces with more (or is it fewer?) calories, our increasingly sedentary society is apparently to blame for obesity. Here, the arguments are well rehearsed – children watch too much TV, they don’t walk to school, and they don’t have enough healthy sports lessons within school. Quite why the select committee is so preoccupied with the Thatcherite policy of selling off spare bits of school field is unclear, as is why it thinks that introducing ‘dance or aerobics’ into PE is an ‘imaginative’ way of making the podgy kids more keen on sport.

Most bizarre of all, though, is the notion that a decade of officially sponsored risk aversion about letting children play outside or walk to school can be reversed by scaring them with the alternative risk of having an obese child; and the idea that children will be encouraged to take part in sport, not because they enjoy it, but because it is supposed to be good for them.

The argument that the UK is facing imminent Death by Chocolate is heavier on prejudice than evidence. The solutions proposed by the document are even less persuasive. It collapses together banal prescriptions that individuals should walk more and eat less with grand-sounding national schemes and targets, and with demands that every government department play its role in the war on obesity – from the Department of Transport (walking and cycling schemes) to Ofcom (junk food advertising) to reforming agricultural policy ‘to take account of the public health agenda’ (8).

Underneath all these grand policy plans and hyperbole, however, is a deep unease. It is known, even to the inhabitants of the strange world of the Commons Health Select Committee, that a major problem with official campaigns designed to exhort people to eat less and walk more is that They Do Not Work. What people eat, after all, is a matter of their choice – and if they choose to eat fattening, convenience foods, or to drive their cars instead of donning a cycle helmet, there is very little the government of a democratic consumer society can do about it. As the document ruefully states, ‘We acknowledge the responsibility of the individual in respect of his or her own health but believe that the government must resist inaction caused by political anxiety over accusations of “nanny statism”’ (9).

There are two conclusions that the government could draw from this. Either it could recognise that the obesity panic is overblown, and its role in reducing obesity is likely to be ineffective – and therefore pour its precious time and resources into a more edifying political campaign instead. Or (and more likely) it could take the route advocated by the health committee, and embark on a concerted campaign to undermine decision-making and choice, in the name of our own good.

Given how little is established about the causes and consequences of childhood obesity even compared to adult obesity, it is striking that the health committee focuses so heavily on children. From proposals for increased exercise targets and cookery lessons in schools to calls to ban junk-food advertising aimed at young children and bring in a labelling system ‘which makes choosing healthy foods easy’ (10), the clear message is that the war against fat must start with the young. Why? Because children cannot make sensible food choices in the way that adults can – they are victims of options offered to them by schools and the food industry, and easily duped into eating whatever tastes good, rather than what is good for them.

Of course, there is a lot of truth to this. Children cannot make proper choices; which is why, as a society, we trust parents and carers to make those choices for them. There is something seductive about the health committee’s imagery of a greedy food industry playing on our children’s infantile gluttony behind our backs, and out of our control – bribing schools into feeding the kids cheap chicken and fizzy pop, while infiltrating children’s TV breaks with advertising on the yumminess of burgers.

The message is that we are not to blame for our tubby children – it is Them, over there, with the money and power to set a whole generation upon a self-destructive course of over-indulgence. The problem is not the choices that we, as adults and parents, make; but the fact that we live in what the health committee calls an ‘obesogenic environment’ (11), where everything pressurises children into being fat. But hold on a minute – are we still talking about children’s choices here, or our own?

By focusing on children, the health committee manages to circumvent the obvious objection that adults should be seen as capable to make choices for themselves about what they eat. What this does, however, is to take parental decision-making clean out of the picture. The committee’s obsession with ‘pester power’ – advertising that encourages kids to nag their parents for this or that bit of junk food – ignores the simple reality that pestered parents do not have to (and often, do not) give in. Its obsession with school meals ignores the fact that parents can decide whether their child has a school meal or not.

By aiming much of its fire at the food industry, it presents a picture of parents trapped between their children’s demands and the enticing, unhealthy options presented to them by fast-food outlets and supermarkets; and indeed, non-parents who, through no fault of their own, have grown up without the ‘skills’ to opt out of this killer lifestyle themselves.

In our therapeutic times, this message has far more resonance than a straightforward official admonition to shape up. When the health committee squawks about the tiny amount of cash spent on advertising fruit and veg compared to the advertising spend of companies like Burger King, when it sympathises with the plight of time-pressured parents duped into buying convenience meals without scrutinising the salt and fat content, when it details, at length, how it was ‘shocked to find evidence that in its campaign for Walkers Wotsits, Abbot Mead Vickers advertising agency deliberately aimed to undermine parental control by exploiting “pester power”’ (12), it is easy to nod along, casting ourselves as mere victims of modern, sedentary, fat society. But we should appreciate just how insulting and demeaning this image is.

By continually emphasising the way in which the food industry’s impact upon children compromises parents’ ability to decide what their children eat, the health committee effectively reduces parents to the level of children. The power of the ‘obesogenic environment’ is apparently such that it disempowers us from making choices over what we eat, duping us all the time into thinking that we are making choices when in fact we are just riding the junk-food wave.

And by emphasising the issues of choice and control in relation to the particular food-buying decisions we make, the committee manages to redefine these crucial aspects of life into something minor and meaningless. Take this statement, for example:

‘Eating ready-prepared snacks or meals, whether pre-packed meals which are heated up at home, or food purchased from a restaurant or fast-food outlet, reduces a consumer’s choice and control over what they eat. When preparing a meal from scratch, a consumer will have full control over how much fat, sugar and other ingredients are put into the dish, control over what quantity to make, and over the portion size that is served. Buying a snack such as a bag of crisps, or a ready-prepared meal to heat up, effectively removes those choices. People eating out in a restaurant are even less likely to be aware of the fat or calorie levels of the meal they have ordered.’ (13)

Our choice, as adults, to decide how we live our lives without official prescription or interference is redefined as a child’s consumer option over what type of burger to buy. Control over our lives, in the sense of autonomy and responsibility, is reduced to the ability to know exactly how many grams of salt or sugar we add to a recipe. And for what? To fight a war against our own, healthier-than-ever bodies, and those of our beautiful children.

Read on:

spiked-issue: Obesity

(1) Obesity Report Published, House of Commons Health Committee, 26 May 2004

(2) Obesity Report Published, House of Commons Health Committee, 26 May 2004

(3) Summary, House of Commons Health Committee: Obesity, 27 May 2004

(4) Paragraph 70

(5) Paragraph 71-72

(6) Summary, House of Commons Health Committee: Obesity, 27 May 2004

(7) Paragraph 66, House of Commons Health Committee: Obesity, 27 May 2004

(8) Summary, House of Commons Health Committee: Obesity, 27 May 2004

(9) Summary, House of Commons Health Committee: Obesity, 27 May 2004

(10) Summary, House of Commons Health Committee: Obesity, 27 May 2004

(11) Paragraph 3, House of Commons Health Committee: Obesity, 27 May 2004

(12) Summary, House of Commons Health Committee: Obesity, 27 May 2004

(13) Paragraph 84, House of Commons Health Committee: Obesity, 27 May 2004