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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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Our treatment of today's refugees harks back to Europe's darkest hour

We mustn't forget the lessons of the Second World War in the face of today's refugee crisis, says Molly Scott Cato.

In the 1930s, thousands of persecuted people fled Europe. Our own press ignominiously reported these as "Stateless Jews pouring into this country" and various records exist from that time of public officials reassuring readers that no such thing would be allowed under their watch.

With the benefit of historical hindsight we now know what fate awaited many of those Jews who were turned away from sanctuary. Quite rightly, we now express horror about the Holocaust, an iconic example of the most shocking event of human history, and pledge ourselves to stop anything like it happening again. 

Yet as Europe faces its worst refugee crisis since the Second World War we are witnessing a deafening cacophony of xenophobic voices in response to people fleeing their own present-day horror. We must therefore reflect on whether there is an uncomfortable parallel in the language being used to describe those seeking asylum today and the language used to describe Jews seeking refuge in the 1930s.

Our response to the current refugee crisis suggests we feel fearful and threatened by the mass movement of desperate people; fearful not just of sharing what we have but also of the sense of disorganisation and chaos. Does the fact that these refugees are from Syria, Libya, Iraq and Afghanistan, and so not part of our continent, provide an excuse to allow them to be bombed at home or drowned during their desperate journey to safety?

We are not helped by the poorly informed public debate which—perhaps intentionally—conflates three quite different movements of people: free movement within the EU, irregular or unauthorised migration and the plight of the Middle Eastern refugees. While our misguided foreign policy and unwillingness to tackle change may give us a moral responsibility for those fleeing famine and conflict, our responsibility towards refugees from war zones is clear under international law.

Due to our commitments to the UN Refugee Convention, the vast majority of Syrian refugees who reach our territory are given asylum but the UK has taken fewer Syrian refugees than many other European countries. While Germany admitted around 41,000 asylum-seekers in 2014 alone, the UK has taken in fewer than 7000.

The problem is that any sense of compassion we feel conflicts with our perception of the economic constraints we face. In spite of being the fifth largest economy in the world we feel poor and austerity makes us feel insecure. However, when actually confronted with people in crisis our humanity can come to the fore. A friend who spent her holiday in Greece told me that she saw local people who are themselves facing real poverty sharing what they had with the thousands of refugees arriving from Turkey.

A straightforward response to the growing sense of global crisis would be to restore the authority of the UN in managing global conflict, a role fatally undermined by Tony Blair's decision to go to war in Iraq. Our role should be to support UN efforts in bringing about strong governments in the region, not taking the misguided ‘coalition of the willing’ route and running foreign policy based on self-interest and driven by the demands of the oil and arms industries.

We also need EU policy-makers to show leadership in terms of solidarity: to co-operate over the acceptance of refugees and finding them safe routes into asylum, something the European Greens have consistently argued for. The EU Commission and Parliament are in clear agreement about the need for fixed quotas for member states, a plan that is being jeopardised by national government’s responding to right-wing rather than compassionate forces in their own countries.

Refugees from war-torn countries of the Middle East need asylum on a temporary basis, until the countries they call home can re-establish security and guarantee freedom from oppression.

The responsibility of protecting refugees is not being shared fairly and I would appeal to the British people to recall our proud history of offering asylum. Without the benefit of mass media, the excuse of ignorance that can help to explain our failure to act in the 1930s is not available today. We must not repeat the mistakes of that time in the context of today’s crisis, mistakes which led to the deaths of so many Jews in the Nazi death camps. 

Molly Scott Cato is Green MEP for the South West of England.

Molly Scott Cato is Green MEP for the southwest of England, elected in May 2014. She has published widely, particularly on issues related to green economics. Molly was formerly Professor of Strategy and Sustainability at the University of Roehampton.