The dilemma of obesity

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The issue of obesity presents liberals with a dilemma. On the one hand obesity has serious health effects which have impacts not just on individuals but also on health service costs. On the other hand, body confidence campaigns encourage people to feel good about their bodies and condemn fat shaming.

So how can we, as a nation, reduce obesity while still respecting individual freedoms? Where is the balance to be found between societal and individual responsibilty?

We have been here before, of course. There were similar debates around seat belts, motorbike helmets and smoking. In all three cases public well-being eclipsed individual liberty. So the Government can enforce the use of helmets, against the will of any riders who don’t want to wear them, not on the grounds of the risk to the individuals but because of the huge cost to health and social services of dealing with accident victims. The harm to others is a collective harm.

George Monbiot was writing on this subject last week. He refers to this photo from 1976 of people sunbathing on Brighton beach, and says that it:

… appeared to show an alien race. Almost everyone was slim. I mentioned it on social media, then went on holiday. When I returned, I found that people were still debating it. The heated discussion prompted me to read more. How have we grown so fat, so fast? To my astonishment, almost every explanation proposed in the thread turned out to be untrue.

It seems 1976 was the turning point, and from then on people in the UK started getting fatter. He then demolishes several explanations that are often offered. We do not eat more today than in 1976; in fact, we ate more calories then. We do not exercise less than in 1976; in fact we get around the same level of exercise as we did then.  So what has caused the high levels of obesity that we see today?

Yes, we ate more in 1976, but differently. Today, we buy half as much fresh milk per person, but five times more yoghurt, three times more ice cream and – wait for it – 39 times as many dairy desserts. We buy half as many eggs as in 1976, but a third more breakfast cereals and twice the cereal snacks; half the total potatoes, but three times the crisps. While our direct purchases of sugar have sharply declined, the sugar we consume in drinks and confectionery is likely to have rocketed. … In other words, the opportunities to load our food with sugar have boomed. As some experts have long proposed, this seems to be the issue.

The solution is not to blame individuals for the choices they make. We are all being manipulated by a food industry that uses hidden sugar “to bypass our natural appetite control mechanisms” and uses psychological tricks to make us buy and eat more than we need.

Just as jobless people are blamed for structural unemployment, and indebted people are blamed for impossible housing costs, fat people are blamed for a societal problem. But yes, willpower needs to be exercised – by governments. Yes, we need personal responsibility – on the part of policymakers. And yes, control needs to be exerted – over those who have discovered our weaknesses and ruthlessly exploit them.

There is a challenge here for Liberal Democrats. Sugar tax is a starting point, although it should always be remembered that sales taxes are not progressive and hit the poor more than the rich. But the problem of obesity arises from much more than sugary drinks, and we need more radical controls on the food industry.

Although we should not be blaming individuals for their obesity we should also be promoting strategies to help people to reduce weight and eat in a healthier way. Public education is key to this. In my local health area doctors and other health professionals can refer patients to either Slimming World and Weight Watchers for a free twelve week programme. It works and is much cheaper than GP run weight clinics.

 

* Mary Reid is a contributing editor on Lib Dem Voice. She was a councillor in Kingston upon Thames and is a member of Federal Conference Committee.

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46 Comments

  • George Monbiot’s points deserve to be taken seriously. The manipulative habits of Big Food have been well documented since Vance Packard wrote “The Hidden Persuaders” in 1957. Packard was lifting the lid on a wider advertising backdrop but junk food pushing is particularly insidious. The debate should be about what sort of controls we need for the food industry, as ever learning from the successes and failures of other countries who have gone further down the road than the UK.

  • “”””Sugar tax is a starting point, although it should always be remembered that sales taxes are not progressive and hit the poor more than the rich””””

    True, but this is the fairest way of dealing with the issue. Levy taxes on the unhealthy elements of food as a means of paying for the costs those unhealthy foods cause for the NHS (in increased use) and DWP (in decreased employment).

    What are the other options? More education (aka Health Promotion)? It works, but much more on certain demographics, which is fine by me, but some Lib Dems get very tetchy about inequality. More regulation (aka Health Protection, aka banning)? It works too, but I guess would only really appeal to the authoritarian wing of the Lib Dems.

    The duty on tobacco works. Now smokers pay their way. They can smoke to their hearts content, and we can all be reassured that tobacco duty is paying (I think now maybe more than paying) the additional costs to state services they habit entails.

  • Martin Land 23rd Aug '18 - 7:05pm

    Whilst I understand the need for greater control I’m also troubled by doing so as a method of avoiding individual choice and responsibility. To me the strategy may have to be of much stronger legislation over food labelling and eventually, perhaps, the type of action taken against the tabacco industry.
    Papworth have helped solve my heart problems, but this involved losing 30 kilos, the hardest thing I’ve ever done in my life. Giving up smoking thirteen years ago was easy as it’s now relatively easy to avoid smoking and smokers but junk food…

  • We live in a world of perpetual summer. Calories are too easily picked up and many of us over indulge (I’m certainly one). I suppose the only way to change people’s eatting habits is to change the cost, make junk food expensive and good food cheap. That I’m afraid needs government action because the food industry won’t do it by choice or alternative we wring our hands and live with the consequences.

  • nigel hunter 23rd Aug '18 - 9:17pm

    Is there an organisation, campaign concerning re-introducing cookery into schools? Is it possible to be cruel to be kind in the sense of discussing at an early age the dangers of sugar and obesity to the child’s adulthood? This could be linked to the biological make up of a child as to how much fat the individual needs to maintain his/her healthy weight. Could not schools link up with the NHS to start the research? This way it is possible for to thrive together,.society and the individual The NHS would not have to deal with the health and financial problems of obesity whilst the individualwould be able to control his health.

  • I don’t really believe people are passive receptacles of combustibles who need the great and the good to police their eating habits or tell them what’s what. I actually think there are way too many puritan taxes at too high a level as it is and the obsession with what other people are supposedly doing wrong is every bit as unhealthy as anything it is they are alleged to be doing.

  • What some of you have missed is the point that we are being manipulated by food manufacturers through a combination of hidden ingredients and clever marketing. This was exactly the ploy used by the tobacco industry to get people hooked on nicotine and perpetuate the market. It is not just about individual choices, although they do, of course, play a part.

  • ‘It could be said that tackling air pollution interferes with the right of car owners to belch out fumes…. or in Victorian times fore a mill owner the freedom to poison the at from his mill chimneys.’

    Ah, there’s a rather simple difference between infringing on the health of others and eating yourself into an early grave. I don’t advise either, but only the former should see the government regulation to stop you.

  • William Fowler 24th Aug '18 - 7:24am

    I think a Corbynite solution is coming, a couple of hundred thousand food inspectors stationed in supermarkets at the checkouts with powers to stop large people from buying anything but healthy food… surely their high salaries and wonderful pensions will be balanced against NHS savings. With all the health scare stories, you never actually hear the chances of someones who eats mostly fresh food and walks five miles a day catching cancer or getting a heart attack.

    I do agree these large food companies have done some nasty stuff to our food (a friend reckoned the company owners are sociopaths) and given half a chance would probably spray fresh fruit and veg with a carcinogenic to make them last longer… but I think the solution is a full length mirror – look in it naked, wonder how you ended up in such a state and do something about it.

  • Daniel Carr 23rd Aug ’18 – 10:46pm………………….Ah, there’s a rather simple difference between infringing on the health of others and eating yourself into an early grave. I don’t advise either, but only the former should see the government regulation to stop you……………

    Look at obese parents;, in many cases it’s not just the adults it’s their children being fed the junk food. If parents were encouraging their children to smoke or drink alcohol before they reached 5 would that be acceptable?
    Junk food is every bit as addictive to the young as was smoking and as hard to give up.

  • Mary.
    I don’t think we are being manipulated in the way some suggest. I think, that if anything the bigger problem is living in a depressing overly monitored fundamentally oppressive country run by people who think it’s their duty to institutionalise moral panics. I don’t think a few extra big people is actually much of a social problem. Other things that do not concern me include whether they eat enough fibre, how often the exercise, and their vitamin intake.

  • Nonconformistradical 24th Aug '18 - 8:53am

    @Glenn
    “I don’t think a few extra big people is actually much of a social problem. Other things that do not concern me include whether they eat enough fibre, how often the exercise, and their vitamin intake.”
    In which case if such people require more (than those living a healtheri lifestyle) medical (and eventually maybe social) services or die prematurely while they still have children to be brought up (by someone) then presumably you are happy to cough up the funds…?

  • I am interested in the claims quoted in the contribution by Mary Reid originating from George Monbiot. Particularly the claims that we eat less calories now than in 1976 and take about the same amount of exercise.
    If this is true we need to find what the changes are over the years that have led to an increase in chronic health problems. I put it this way because I assume that this is really what the discussion is about.
    We cannot discuss regulating things unless we can be sure that we don’t make matters worse.

  • Noncomformistliberal.
    Yes and I’m a vegetarian. I personally disapprove of a lot of what people eat. However I think the tendency in Britain towards moral panics of all kinds is usually a by-product of class prejudices (the belief that the lower orders must be guided or otherwise policed to protect them from themselves) and is as often driven by the tight wads of the economic right as by the sometimes oppressively well meaning.

  • Paul Reynolds 24th Aug '18 - 9:48am

    The problem with the Monbiot view is that if capitalism is the only cause of obesity, the only way of solving the problem is to get rid of capitalism. After we have replaced capitalism in a great Monbiot revolution, and the extent of obesity has still not be solved, maybe we can start to look at other capitalist countries where obesity is not so prevalent and come up with some other theories.

  • James Belchamber 24th Aug '18 - 9:54am

    Obesity is a disease. Nobody should be bullied or shamed, or feel ashamed, of having a disease. Disease needs to be prevented, treated, and cured – and sufferers should be fully accepted for who they are, including their illness, even if they suffer from it for a lifetime.

    This is a good article, except that it sets up a false dichotomy in the first paragraph. We can both fully condemn fat-shaming, wholeheartedly support body-confidence, and take evidence-led steps to tackle disease.

  • Most of us are financially secure and I sympathise with those JAMS (and below) because the ‘filling’ cheap breads, chips and such are often as much a ‘financial’ as ‘life’ choice.

  • James Belchamber 24th Aug '18 - 10:12am

    @Andrew I am actually clinically obese. That should have no bearing on the facts, however.

  • John Barrett 24th Aug '18 - 11:03am

    “Obesity is a disease” – Is it? It may be for some, but for millions of others, I doubt it.

    If I (or most other people) eat too much, drink too much alcohol and do no exercise, over time I will become obese. I will not have caught a disease, I will just have behaved in the same way as millions of other on the planet who have chosen this as a way of life.

    The danger of accepting that for everyone it is a disease, is that people will naturally look to drug companies to provide the solution, as with many other diseases. In many cases this would make matters worse.

    Nobody would be asked to modify their behaviour on the grounds that it is not their fault and the NHS will once again be left to pick up the bill.

    If the best we can come up with is to say that we need more spending on the NHS, so that it can be spent so that everyone can do as they wish with regards to ignoring their own health, we will rightly be seen as not living in the real world.

  • I read the Monbiot article when it was first published and as with much of what he writes it is well researched and factual. The ‘Big Food’ industries have long pumped their processed foods with fat, salt and sugar and strongly marketed them starting with children upwards. Surely absolutely no one can deny this? When my children were young in the 1980’s/90’s for example I was appalled at the sugar laden nature of so called children’s breakfast cereals.

    Just as Tobacco companies market their highly addictive and dangerous product and for a long time funded ‘experts’ to deny the appalling health impacts of their lucrative sales product. Just as Oil Companies have funded opponents of alternative energy and climate change. The driving force of the Market is profit not public good as even Adam Smith noted.

    Having said that, Monbiot was wrong to just dismiss other contributory factors too. Back in the 1970’s of his Brighton Beach photo (and my teenage years) car ownership was far less and so most people inevitably did much more walking every day. My parents never owned a car and certainly didn’t have the money for taxis. Throughout the 1960’s and 1970’s if we went anywhere at all we walked to and from bus stops or simply walked quite long distances. I walked to and from Infant and Junior School – parents cars blocking the school gate simply was not a problem that existed in those days. Using ‘Just Eat’ and similar to get a wide variety of expensive (sugar, salt and fat laden) pre cooked meals delivered was a non existent option for anyone. Even had it existed most people did not have the surplus money -remember that, like car ownership, items such as central heating, fitted carpets, refrigerators and colour TV’s were only just starting to become a ‘normal’ expectation at the start of the 70’s.

    The ‘Western’ trend to obesity is very much a product of ‘affluence’ as well of the marketing strategy of big business. Health education and individual action can combat this (my eldest daughter is currently ‘blacklisting’ various foods marketed for my 8 month old grandaughter according to levels of sugar etc in some so called baby foods and yoghurts) but Government regulation is vital too (sorry Economic Liberals we disagree again!).

  • @John Barrett

    “I will not have caught a disease, I will just have behaved in the same way as millions of other on the planet who have chosen this as a way of life.”

    Just as if I stand next to someone with many diseases, drink dirty water or have unprotected -sex with some people – I will have behaved in the same way as millions of others on the planet who have chosen this as a way of life.

    Of course people who have accidents on the road should not be treated they should know that road accidents is a leading cause of death and injury. And most are the result of human error – they should be more careful.

    And as to treating depression – the leading cause of death in men under 50 – what a waste they should just pull themselves together or kill themselves – they obviously are failures who can’t cope with life and haven’t got much to live for anyway.

    Loosing weight permanently is probably more difficult than quitting smoking – more than 80% regain the weight they loose – very, very sensibly – after a famine (diet) we need to regain the weight. One mechanism is the hormone leptin that fat cells make.

    I think as a rule we help someone with disease. I think as a rule if someone is being pursued by a lion – we might take a gun and shoot that lion. I think as a rule if people are jumping over a cliff we at least erect a fence.

    i would humbly suggest we try and make things safer – 7,000 people a year were killed on the roads in 1970, under 1,500. Try and help people not get the disease – educate them about safer sex and better driving. And treat people HOWEVER they catch such a disease.

  • Daniel Carr 24th Aug '18 - 4:52pm

    @expats 24th Aug ’18 – 7:40am
    ‘Look at obese parents;, in many cases it’s not just the adults it’s their children being fed the junk food. If parents were encouraging their children to smoke or drink alcohol before they reached 5 would that be acceptable?’

    I think neither is acceptable, and when parents are giving their children only junk food to the point at which they become obese, it’s a matter for social services to look into.

  • @Glenn

    I think you are using the term moral panic here where it does not apply

    Moral panics are about when some sort of vice is linked (with weak evidence or more commonly no evidence at all) to a social ill, with a narrative that it’s getting completely put of control (again with no evidence)

    So video-games and violence, or legal highs in the youth, or the decline of church attendence, or burkas taking over society.

    Obesity is very different. There is now a very very clear and robust line of evidence which directly links over-consumption and insufficient energy expenditure with weight gain and eventual obesity, leading to a whole host of medical problems, leading to a significant additional burden on our health and social security system. Unlike in moral panics, there is repeated, overwhelming, and unambiguous evidence of all the above and robust extrapolations on what this will mean for our NHS and social security costs.

    If people got fat and ill and died prematurely by their own actions and that was the end of it, then I’d agree this would just be a moral panic (it’s up to individuals if they want to get fat and ill and die prematurely). But the outcome of getting ill has an impact on state (tax-payer) financed services, which means it’s of interest to us all. Taxing the things which make us unhealthy at their point of consumption mitigates all of that, since it means the person is paying for their own choices.

    The tobacco lobby tried to label the concerns about the links of smoking to illhealth as a “moral panic”. Just as fossil fuel lobbyists today use similar put downs to try and dismiss concerns about climate change

  • James
    I don’t think I am using moral panic in the wrong way.

  • @Glenn
    “”””I don’t think I am using moral panic in the wrong way.””””

    As I understand it, moral panic is “an instance of public anxiety or alarm in response to a problem regarded as threatening the moral standards of society”. I don’t really think people concerned about the cost pressures on the NHS from the increasing prevalence of obesity are regarding this as a threat to the “moral standards of society”.

  • P.S
    You can on on line and find articles on this subject from the Open University, UCLA, Oxford press and so on. The nature moral panics is to take an issue and to inflate it as a huge threat.

  • Malcolm Todd 24th Aug '18 - 8:34pm

    James Pugh
    “I don’t really think people concerned about the cost pressures on the NHS from the increasing prevalence of obesity are regarding this as a threat to the ‘moral standards of society’.”

    Oh, I think that’s precisely what they’re doing. The idea that obesity is going to bring down the health service is rather like the idea that immigration is overwhelming our public services: popular, simplistically attractive, conveniently blaming others for their misfortune, and almost certainly false.

  • @Glenn

    I think you’re talking about general panic rather than moral panic

    Do you think the serious concerns about climate change are a moral panic?

  • @Malcolm Todd
    “”””Oh, I think that’s precisely what they’re doing. The idea that obesity is going to bring down the health service is rather like the idea that immigration is overwhelming our public services: popular, simplistically attractive, conveniently blaming others for their misfortune, and almost certainly false.””””

    But a lot of the evidence about immigrants is contrary to the panic about immigrants.

    The scientific evidence (biological, clinical and epidemiological) about obesity is very robust, and it correctly models what obesity now does to the health service 20 or 30 years down the line.

    Do you view the serious concerns about climate change a moral panic?

  • James
    Climate change! Where did I say anything about climate change? Look squirrel!

  • @Glenn

    You didn’t say anything about climate change. I’m interested if you think the serious concerns about it are a “moral panic”. And if not, why not

  • James
    My feeling on climate change are that unless you stop all air travel, restrict cars, curtail population growth and essentially expect people to live in a pre-industrial state on local produce there is little that can be done. High tax on fuel doesn’t reduce consumption. It just makes it more expensive, I certainly don’t think a few pennies here or there will make a difference and I’m entirely unconvinced that an increase in the body mass of a percentage of the population is of any relevance to anything beyond personal health problems. The thing about climate change is that, quite rightly ,no-one has the stomach to solve it and are thus tinkering around the edges so as to look concerned.

  • Malcolm Todd 24th Aug '18 - 11:54pm

    James
    The health service doesn’t exist in a vacuum. People in poor health die earlier and save the rest of us a ton in pensions. Healthy people live longer until they eventually decline and then become costly in terms of healthcare.
    Before anyone piles in, I’m certainly not saying we shouldn’t care about people having poor health and dying early. But if you’re going to maintain that people’s unhealthy lifestyles are a burden on the public purse you need to take into account all the services they use and contributions they make, not just a selection of them. Have you got any figures that tell us that?

    And Glenn’s right – climate change in this discussion is a total squirrel. Just because you think one thing is a moral panic doesn’t mean you think everything is.

  • @John Barrett – “The danger of accepting that for everyone it is a disease, is that people will naturally look to drug companies to provide the solution, as with many other diseases”

    +1

    We are already seeing this with things like those fat-binding supplements you can buy. Should they be available on prescription? There is far more money to be made treating medical conditions on a chronic basis than there is in curing them.

    The way a lot of foods are sold is highly deceptive. Breakfast cereals are an extreme example – cereal for breakfast is the healthy option, right? Some are, but others (particularly those marketed at children) have a ridiculous amount of sugar added, such that they really belong on the confectionery aisle. Most parents would never knowingly allow a child to spoon that much sugar onto cornflakes, but when it’s added during manufacture it’s well hidden. That information is of course on the packaging, in very small print……

  • Malcolm Todd 24th Aug ’18 – 11:54pm…………The health service doesn’t exist in a vacuum. People in poor health die earlier and save the rest of us a ton in pensions. Healthy people live longer until they eventually decline and then become costly in terms of healthcare…………………..

    The same fallacy was trotted out by the tobacco lobby. Obesity causes problems that can need medical/NHS treatment from pre-puberty to old age.

    “Obesity is the new smoking”, said Simon Stevens, Chief Executive of NHS England. “It is a slow-motion car crash in terms of avoidable illness and rising health care costs.”
    He goes on to talk about the financial consequences of obesity for the NHS, “If as a nation we keep piling on the pounds around the waistline, we’ll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat.””Obesity increases the risk of a number of health issues, including heart disease, diabetes, musculoskeletal disorders, cancers, depression and anxiety. Severely obese individuals are three times more likely to require social care than those with a normal weight, resulting in increased risk of hospitalisation and associated health and social care costs.”

    I’d far rather trust the experience of a ‘professional’ than the opposite ‘saloon bar myth’.

  • Diane Reddell 25th Aug '18 - 11:02am

    I think the narrative should change obesity crisis to Being healthy in body and mind where people’s size is irrelevant and definitely less judgement by people who never have had a weight problem. Also some of the NHS narrative sometimes is fault blaming and focused on money rather than the well-being of citizens. We should have both physical and mental health gyms which are accessible to all. Most gyms do not cater for people with mobility disabilities. Also there should be a choice of exercise people can get on prescription – dance classes as well as gyms. Also there are conditions which make people look bigger such as lipodema, lymphodema, PCOS etc.

  • Daniel Carr 25th Aug '18 - 6:13pm

    @Geoffrey Payne 24th Aug ’18 – 11:54pm
    ‘Work remembering that the Spirit Level published in 2009 showed that the rate of obesity in a country is strongly related to how unequal it is;

    https://www.equalitytrust.org.uk/obesity

    Correlation does not equal causation. The graph proves nothing, and most of the Spirit Level is a joke to anyone who does serious social science research. Take it to any well-respected economist, political scientist or other social science quantitative expert and I guarantee they will tell you this is not good social science work.

  • Malcolm Todd 25th Aug '18 - 6:58pm

    expats 25th Aug ’18 – 9:26am
    You’re entirely missing the point of my comment, despite quoting the heart of it.

    Rather than repeating myself, I’ll refer you to some actual, peer-reviewed research (which is worth much more than the opinions of a ‘professional’, who may be an expert in health but not in health economics): this report, titled “Lifetime Medical Costs of Obesity”, concludes that:
    “Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.”

    The point is not to say we shouldn’t care about obesity. The point is that using supposed higher costs of the obese, with implied (or outright stated) moral disapproval of the individuals affected, to justify that concern, is misplaced. Even if healthcare costs were the only yardstick (and I’ve already pointed out that they’re not, though you ignored that), it’s almost certainly not a valid argument. The greatest reason for the ever-increasing pressure on health service budgets is not that we’re getting less healthy but that we’re living longer. It’s bizarre to blame those who are dying earlier for that.

  • @Geoffrey payne Obesity is more common in less equal countries. Correlation =/= causation. Or are you trying to say that fat people are lazy and this is the cause of their excess weight and low income?

  • > In other words, the opportunities to load our food with sugar have boomed.

    I think breakfast cereals, crisps and sugary drinks are red herrings (!). They all existed in 1976, along with cakes, biscuits, sweets, chocolate, ice cream…

    I visited Florida in 2001 and was shocked at the size of people in the US. Because it wasn’t so noticeable here then.
    I’ve always assumed the trigger was the proliferation of ‘fast food’ and ready meals.

    Isn’t the answer education? And cookery lessons in all schools?

  • Geoffrey Payne 28th Aug '18 - 5:03pm

    @TCO – there is no need to guess what I think and come up with nonsense. If you are really interested in the Spirit Level then read it. Of course like any research it is open to criticism but it is absurd to imagine it can be dismissed by a single line from someone who hardly knows anything about it.
    Of course there are people who would like to think it is easy to dismiss because for ideological reasons you would prefer it not to be true, rather like the libertarian climate change deniers.

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