Big Debate

Obesity: who’s to blame?

The individual? Society? Government?

If you’re fat, it is entirely your own fault? Or should our society, food industry and government take a share of the responsibility?

Leo McKinstry is a columnist for the Daily Express and Daily Mail and a regular contributor to The Spectator. Weighing 19st, he believes that the only person responsible for his obesity is himself.

Leo says:

I am writing this sitting at the desk of my home. The chair creaks under the weight of my 19 stone frame. In the waste bin are several chocolate bar wrappers and a couple of empty cans of Carlsberg Special Brew. To the side of my computer are a mug of sugared tea and a bowl of cereal, with a dollop of double cream on top.

Given all of this calorific excess, it is no surprise that I could be officially classified as a threat to public safety.

Leo McKinstry

In the eyes of the health lobby, I form part of the growing army of overweight and obese people who are putting the NHS under intolerable strain and undermining the morale of the nation.

The apparently inexorable expansion in waistlines is held to be an “epidemic” that is spiralling out of control. According to the Government’s own Foresight report of 2007, no less than half the population of Britain will be obese by 2050. Other studies have suggested that within 15 years, three-quarters of men and two-thirds of women will be overweight. Reflecting this mood of anxiety, the Royal College of General Practitioners called in September 2014 for a “state of emergency” to be declared on obesity. In apocalyptic tones, the RCGP’s Head of Nutrition, Rachel Pryke, warned that “we are in danger of destroying the health of a whole generation of children”.

To counter this problem, the health professionals have called for a nationwide action plan based on greater resources for weight management, more powerful awareness campaigns, sugar taxes, tighter food regulations, explicit labelling, health warnings, advertising bans on junk products and state subsidies for fruit and vegetables. “The Government must do more to restrict unhealthy food marketing and make healthy food more affordable,” says Laura Webb of the UK Health Forum.

But I think this interventionist approach is profoundly misguided. My own excessive weight is no one’s responsibility but my own. My weight is not the fault of the Government or Public Health England or the major food conglomerates.

I am 19 stone because I eat too much unhealthy food, drink too much alcohol and take too little exercise.

Leo McKinstry

I know precisely what I should be doing to lose weight, but I fail to do so because of my own inertia, negligence and complacency. Why am I unable to change? For exactly the same reason that smokers or drinkers or drug users find it difficult to abandon their harmful lifestyles: the present pleasure they derive from their habits outweighs the potential health risks in the future.

In the noisy demand for action on obesity, there is now a tendency to treat the overweight, not as autonomous citizens, but as passive, infantalized victims who need protection from the wicked food companies and constant support from the Government. Perhaps the most offensive illustration of this trend is the drive to have obesity classified as a disability, a move that, according to some campaigners, should be accompanied by making “appearance-based” discrimination a hate crime like racial or homophobic bigotry. This is carrying institutionalised victimhood to a grotesque new level. It is absurd to pretend that obesity is a disability or an infectious disease or an addiction. Overweight people ultimately have control over their bodies. Decisions not to exercise or to eat excessively are personal, conscious choices.

Moreover, there is a huge contradiction between wailing about obesity and at the same time bleating about prejudice against “fatties”. If obesity really is the public health nightmare that the professionals proclaim, then there should be a stigma attached to it, just as there is to alcoholism or drug addiction. But the reality is that the health campaigners have been indulging in far too much alarmism. Contrary to scaremongering, Britain is not gripped by a fat epidemic. The much vaunted Foresight Report of 2007 was based on data from 1993 to 2004. Yet since then the numbers have been flat or even, among younger people, going down. When Tam Fry of the National Obesity Forum produced a study in January 2014 that painted an even bleaker picture than the original Foresight Report, he was challenged by the BBC for evidence to back his claim. “We have no actual statistics or figures,” he admitted, but added that “a little exaggeration forces the message home.”

That sort of manipulation encapsulates the whole flawed approach of the public health lobby. The impact of obesity has been grossly overstated. Deaths from heart disease, for instance, continue their decline. Nor is there any evidence that expensive measures like weight management schemes have any real effect. Studies in the US show that less than 5 percent of people who participate in non-surgical weight reduction programmes will maintain any significant loss over a long period of time. Just as ineffective are counselling initiatives, like Cognitive Behaviour Therapy, which has been described by the distinguished psychologist Oliver James as “a form of mental hygiene. However filthy the kitchen floor of your mind, CBT soon covers it with a thin veneer of ‘positive polish’.”

Some of the anti-obesity nannying could slide into a form of state authoritarianism. This has certainly happened with the anti-smoking initiatives which now include brutal taxes, hectoring propaganda and extreme invasions of privacy, as highlighted by the ban on motorists even smoking in their own cars. We can now see intimations of the same outlook in the calls for heavy sugar taxes, calorie counters on menus, inspections of school pupils’ lunch boxes and compulsory weight checks for all children and adults. As the great Irish writer C.S Lewis once put it, “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive.”

As with smoking, the public health lobby justifies this destruction of individual liberty and disdain for personal responsibility by reference to the costs of obesity to the NHS. The annual bill for diet-related ill-health, we are told, now reaches almost £6 billion a year. But this kind of thinking is both morally and economically ill-conceived. If it is true that obesity is really a threat to longer life expectancy – children alive today will have shorter lives than their parents is one of the favourite mantras of healthy eating advocate Jamie Oliver – then the NHS will save a fortune, because by far the biggest burden on the health service is the treatment of the elderly, with over half of the NHS budget spent on patients over the age of 65. Therefore, in purely actuarial terms, premature mortality would actually save the state money. That again shows the flimsiness of the intellectual foundations underpinning the anti-obesity campaign. In the end, we all have to take charge of our own destinies.

Dr Max Pemberton is a psychiatrist with extensive experience of treating patients with eating disorders.  He believes that people over-consume for psychological reasons and therefore need a psychological approach to treat their obesity.

Max says:

I wouldn’t necessarily disagree with everything Leo McKinstry says – I certainly think that fat people need to take responsibility for their weight issues. Indeed, whenever I’ve worked in the addiction field, I’ve taken exactly the same stance with patients battling to stay off drugs – it is their life and the only person that could change their behaviour is them.

There is also a strong element of denial in what Leo says about his obesity. By simply saying: ‘I’m fat because I want to be’, he’s ignoring the underlying reasons for his self control.

Dr Max Pemberton

He’s given up. He lacks the sense of power and urgency to change his life. I wouldn’t say to a heroin addict, ‘Oh, well, you’re choosing to inject drugs every day, so just get on with it’. I’d see their habit as evidence of an underlying psychological problem that they are trying to address. In effect they may be self-medicating against depression, anxiety and trauma. A situation like this warrants help and intervention. I do not see obesity any differently. No one would choose the life that comes with chronic obesity. It’s not just dying relatively young that Leo mentions, it’s the years of disability that come before that; the strain it puts on the joints and the subsequent difficulties with walking, the strokes that leave people profoundly disabled, the complications of diabetes and so on.

By the same token, I’m also not a big fan of quick fixes such as surgery and obesity drugs.When broadcaster Jenni Murray admitted to undergoing bariatric surgery, I didn’t spare any punches in my reservations about her choice. In my professional experience, surgery of this kind is not only risky but can spell emotional disaster for obese patients. Why? Because it addresses only the physical symptoms of obesity (appetite) and totally disregards the most important tool of all – the mind.

It’s the mind that makes associations between what we eat and our emotions, between food and reward, or a sense of comfort.

Dr Max Pemberton

Over the years I’ve treated many patients who’ve had gastric bands. Many tell me they feel as if they’re being mentally tortured. A recent study of 17,000 people also showed that obese patients who’ve had bariatric surgery are actually at higher risk of suicide than those who have not. Around 20 per cent of individuals will find ways round the procedure, such as continually snacking or consuming very high-calorie foods. Research has also shown a 50 per cent increase in drug and alcohol addiction post surgery. I believe this is because individuals are forced to look for alternative crutches to provide the comfort that food used to provide. The reality is that we all like to think that, for every challenge we face, there’s a quick fix. It’s human nature to seek simple, one-off solutions, even if the issues are large and complex. But that doesn’t necessarily mean they work.

Human beings also tend to blame other people and events for their own failings. Years ago, fat people blamed their ‘glands’. When I started medical school, I patiently waited for us to be taught about these magical ‘glands’ that made people fat. I’m still waiting.

But while Leo puts emphasis on free choice, it would be terribly short-sighted not to consider the huge influences that society plays in fattening up the UK. You only have to turn on the television or open a magazine to be bombarded with contradictory messages about food – which is often marketed on a deeply emotional level. It is presented as a treat, something special and luxurious that will make us happy. We are also programmed from an early age to associate certain foods with love. Consider little Johnny being given a lollipop by his mother after grazing his knee. Is it any wonder that when we’re down and feeling unloved, we turn to fatty, sugary or processed foods as the antidote to negative feelings?

To complicate things further, at the same time we are told we must be lean. We are bombarded with images of the idealised body – toned, trim bodies that are unrealistic and unobtainable. Confused and torn, it’s so easy to see why so many people seek refuge in yet more food. The guilt we then feel only further perpetuates the idea promoted by diets of ‘good’ and ‘bad’ food when in reality, there is no such thing. All food is good providing it is eaten in the right quantities.

In my opinion, if people truly want to change their relationship with food, they need to change the way they think about food.

Dr Max Pemberton

They need better coping mechanisms for when the going gets tough. The most successful way of doing this is to use techniques from a type of therapy known as ‘cognitive behavioural therapy’ – or CBT for short. It was first developed in the 1960s and since then it has become one of the main methods used for helping people with a range of psychological problems. I often describe it to patients as being ‘retraining’ your brain.

Most people over-consume for psychological reasons. They therefore require a psychological approach to weight loss. Until we become more mature and enlightened about the whole obesity issue, I’m afraid fat will continue to dominate the health agenda for many years to come.

What do you think?

Anonymous Twitter user says:

“I am fat. It’s my fault but I have NEVER eaten double cream on cereal or eaten vast amounts of food. It’s my fault because I don’t limit myself to the tiny amounts of food I should consume to lose weight. I am aware that I also ‘eat my feelings’. I eat vegetables. I don’t eat crisps on a daily basis, chocolate or ever drink wine. Porridge for breakfast, 2 slices of bread and meat for lunch and a healthy tea. BUT I might have a magnum lolly at night or a bar of chocolate or a glass of wine. Things I know I need to avoid to lose weight.

“I kept a food diary for two years, I existed on fruit for breakfast, ham with melon for lunch and meat and veg for tea. I lost 6stones and felt fab but I couldn’t keep it up. My periods stopped, I felt ill.

“I am not very mobile due to an almost lifelong disability, not an excuse to be fat, but a good reason why it’s much harder to lose weight. As a wheelchair user, I regularly receive dirty looks which rightly or wrongly I perceive to mean that the person bestowing them is thinking ‘too fat to walk’. I often remark that I am going to get a t-shirt with ‘the wheelchair came before the weight ‘ printed on it.

“Stereotypical images of a fat person eating cereal and cream re-enforce the hatred fat people experience every day.”