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Thin people don’t just eat differently to fat people. They live completely different lives

One of the biggest lies about obesity is that it’s simply about eating too much and not doing enough exercise – problems are often far deeper rooted. 

This summer, I’ve spent the parliamentary recess reading improving books, learning Mandarin and nominating my celebrity friends to do the ice-bucket challenge. No, wait – of course I haven’t. Like most people, I’ve responded to having more free time by filling it with reality television.

My particular favourite is an American import called Obese: a Year to Save My Life. In the show, Chris Powell – a personal trainer who looks like a cross between a thigh muscle and a televangelist – takes on patients who need to lose half their body weight. On the whole, over the course of a year, they do. And as I’ve watched more of the programme, I’ve become convinced that behind the blindingly white teeth and unnervingly chirpy demeanour, Chris Powell is a stone-cold genius, and possibly even the man to save the NHS.

One of the biggest lies about obesity is that it’s simply about eating too much and not doing enough exercise. It’s instructive to note how, when people talk about the subject in public, often the person faux-innocently asking, “Why not just eat a bit less, then?” is carrying a little extra padding, too. The stark fact is that most of us are fat: two-thirds of Britons are overweight or obese.

That’s because our society conspires against us and our best intentions. Outside the big cities, a car is a necessity; soon you hop into it for even the shortest trip to the shops. We sit, or stand, still for hours at work. Our bodies, which evolved to savour sugar and fat as rare and precious sources of nutrition, are overwhelmed by fizzy drinks and junk food. Even as we get more puritan about alcohol, food remains the drug it is socially acceptable to consume in public: where a previous generation might have had a drinks tray in the corner office, we have a packet of Hobnobs in the desk drawer.

The truth is that thin people don’t just eat differently from fat people. They live differently. The morbidly obese need to raze their life to rubble and build it again from scratch. On Obese: a Year to Save My Life, the subjects take three months off work to concentrate on their exercise routine. The production crew goes through their cupboards, chucking out the crisps and doughnuts and filling them with whole grains and fruit and vegetables. They get classes in cooking healthy food that tastes of something (lemon juice and chilli are usually involved). Their living rooms are filled with treadmills and free weights. In some cases, their families sign a “contract” to support them. If they reach their target weight, they are given skin removal surgery – so they aren’t dragging round six square feet of the person they used to be.

Even taking into account the inevitable behind-the-scenes manipulation that goes on – this is American reality TV, after all – the results are extraordinary. But what consistently surprises me is why the people involved in the show became obese. For some, the weight crept on after a divorce, or the death of a child, or a bout of depression. For others, being overweight is part of a general feeling of lack of control over the course of their lives. One episode followed Jacqui McCoy, who went from 25 to 11 stone and who started overeating when she was raped at the age of 14. As part of the year-long transformation, many of those trying to lose weight speak to a therapist, and that must be one reason for the programme’s success.

“Obesity is a symptom,” is how Emma Burnell puts it. The Labour blogger had a gastric sleeve operation this year and has since lost eight stone. “Everyone who is overweight has a different reason.” She believes any policy response to Britain’s ballooning weight has to address the psychological as well as physical aspects of obesity. “It would have to bring in mental health, because, in my own experience, I knew all the good rules about food and exercise – but there was something stopping me.”

And this is where I think Obese: a Year to Save My Life has a lesson for the NHS. We already know that obesity costs the health service more than £5bn a year, both through increased rates of heart disease and other illnesses, and through the costs involved in adapting medical equipment for bariatric patients. Yet the kind of holistic, intensive intervention offered by Powell just isn’t available – our counselling services are overstretched, and the NHS deals far better with emergencies and acute cases than it does with chronic, complex problems and the need for preventative medicine.

Admittedly, gastric sleeves and bypass operations are available – though there is not enough capacity, as Burnell found out when her operation was outsourced by King’s College trust to a private hospital in Chelsfield. (In Wales, the health service plans to increase its bariatric surgery capacity from 80 to 300 a year by 2018 to cope with demand.) As for skin removal, it is defined as cosmetic surgery and is rarely funded by the health service. That means patients are given a second chance but saddled with excess skin that chafes, and gets inflamed, and perhaps infected. It’s certainly a disincentive to do exercise.

There’s an echo here of “Million-Dollar Murray”, Malcolm Gladwell’s celebrated essay for the New Yorker – in which he calculates that over a decade, a single homeless man called Murray Barr cost the state of Nevada a million dollars as he bounced around police stations and hospital emergency departments. “It would probably have been cheaper to give him a full-time nurse and his own apartment,” Gladwell concludes.

The same is true of the morbidly obese. It would cost the health service many millions to offer them intensive support – cognitive behavioural therapy, diet education, free exercise equipment, plus gastric surgery and skin removal where appropriate. But in the long run, it will cost more not to offer people a second chance. 

Helen Lewis is deputy editor of the New Statesman. She has presented BBC Radio 4’s Week in Westminster and is a regular panellist on BBC1’s Sunday Politics.

This article first appeared in the 27 August 2014 issue of the New Statesman, The new caliphate

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The Tinder dating app isn't just about sex – it's about friendship, too. And sex

The lines between sex, love and friendship are blurrier than ever, as I found out quickly while using the app.

The first time I met someone using Tinder, the free dating app that requires users to swipe left for “no” and right for “yes” before enabling new “matches” to chat, it was an unqualified success. I should probably qualify that. I was newly single after five years in a committed relationship and wasn’t looking for anything more than fun, friendship and, well, who knows. A few weeks earlier I had tried to give my number to a girl in a cinema café in Brixton. I wrote it on a postcard I’d been using as a bookmark. She said she had a boyfriend, but wanted to keep the postcard. I had no date and I lost my page.

My Tinder date was a master’s student from Valencia called Anna (her name wasn’t really Anna, of course, I’m not a sociopath). When I arrived at the appointed meeting place, she told me I was far more handsome IRL (“in real life”) than my pictures suggested. I was flattered and full of praise for the directness of continental Europeans but also thought sadly to myself: “If only the same could be said about you.”

Anna and I became friends, at least for a while. The date wasn’t a success in the traditional sense of leading us into a contract based on exclusivity, an accumulating cache of resentments and a mortgage, but it had put me back in the game (an appropriate metaphor – people speak regularly of “playing” with the app).

According to Sean Rad, the co-founder who launched Tinder in late 2012, the service was invented for people like me. “It was really a way to overcome my own problems,” he told the editor of Cosmopolitan at an event in London last month. “It was weird to me, to start a conversation [with a stranger]. Once I had an introduction I was fine, but it’s that first step. It’s difficult for a lot of people.” After just one outing, I’d learned two fundamental lessons about the world of online dating: pretty much everyone has at least one decent picture of themselves, and meeting women using a so-called hook-up app is seldom straightforwardly about sex.

Although sometimes it is. My second Tinder date took place in Vienna. I met Louisa (ditto, name) outside some notable church or other one evening while visiting on holiday (Tinder tourism being, in my view, a far more compelling way to get to know a place than a cumbersome Lonely Planet guide). We drank cocktails by the Danube and rambled across the city before making the romantic decision to stay awake all night, as she had to leave early the next day to go hiking with friends. It was just like the Richard Linklater movie Before Sunrise – something I said out loud more than a few times as the Aperol Spritzes took their toll.

When we met up in London a few months later, Louisa and I decided to skip the second part of Linklater’s beautiful triptych and fast-track our relationship straight to the third, Before Midnight, which takes place 18 years after the protagonists’ first meet in Vienna, and have begun to discover that they hate each others’ guts.

Which is one of the many hazards of the swiping life: unlike with older, web-based platforms such as Match.com or OkCupid, which require a substantial written profile, Tinder users know relatively little about their prospective mates. All that’s necessary is a Facebook account and a single photograph. University, occupation, a short bio and mutual Facebook “likes” are optional (my bio is made up entirely of emojis: the pizza slice, the dancing lady, the stack of books).

Worse still, you will see people you know on Tinder – that includes colleagues, neighbours and exes – and they will see you. Far more people swipe out of boredom or curiosity than are ever likely to want to meet up, in part because swiping is so brain-corrosively addictive.

While the company is cagey about its user data, we know that Tinder has been downloaded over 100 million times and has produced upwards of 11 billion matches – though the number of people who have made contact will be far lower. It may sound like a lot but the Tinder user-base remains stuck at around the 50 million mark: a self-selecting coterie of mainly urban, reasonably affluent, generally white men and women, mostly aged between 18 and 34.

A new generation of apps – such as Hey! Vina and Skout – is seeking to capitalise on Tinder’s reputation as a portal for sleaze, a charge Sean Rad was keen to deny at the London event. Tinder is working on a new iteration, Tinder Social, for groups of friends who want to hang out with other groups on a night out, rather than dating. This makes sense for a relatively fresh business determined to keep on growing: more people are in relationships than out of them, after all.

After two years of using Tinder, off and on, last weekend I deleted the app. I had been visiting a friend in Sweden, and took it pretty badly when a Tinder date invited me to a terrible nightclub, only to take a few looks at me and bolt without even bothering to fabricate an excuse. But on the plane back to London the next day, a strange thing happened. Before takeoff, the woman sitting beside me started crying. I assumed something bad had happened but she explained that she was terrified of flying. Almost as terrified, it turned out, as I am. We wound up holding hands through a horrific patch of mid-air turbulence, exchanged anecdotes to distract ourselves and even, when we were safely in sight of the ground, a kiss.

She’s in my phone, but as a contact on Facebook rather than an avatar on a dating app. I’ll probably never see her again but who knows. People connect in strange new ways all the time. The lines between sex, love and friendship are blurrier than ever, but you can be sure that if you look closely at the lines, you’ll almost certainly notice the pixels.

Philip Maughan is Assistant Editor at the New Statesman.

This article first appeared in the 26 May 2016 issue of the New Statesman, The Brexit odd squad