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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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Labour is a pioneer in fighting sexism. That doesn't mean there's no sexism in Labour

While we campaign against misogyny, we must not fall into the trap of thinking Labour is above it; doing so lets women members down and puts the party in danger of not taking them seriously when they report incidents. 

I’m in the Labour party to fight for equality. I cheered when Labour announced that one of its three Budget tests was ensuring the burden of cuts didn’t fall on women. I celebrated the party’s record of winning rights for women on International Women’s Day. And I marched with Labour women to end male violence against women and girls.

I’m proud of the work we’re doing for women across the country. But, as the Labour party fights for me to feel safer in society, I still feel unsafe in the Labour party.

These problems are not unique to the Labour party; misogyny is everywhere in politics. You just have to look on Twitter to see women MPs – and any woman who speaks out – receiving rape and death threats. Women at political events are subject to threatening behaviour and sexual harassment. Sexism and violence against women at its heart is about power and control. And, as we all know, nowhere is power more highly-prized and sought-after than in politics.

While we campaign against misogyny, we must not fall into the trap of thinking Labour is above it; doing so lets women members down and puts the party in danger of not taking them seriously when they report incidents. 

The House of Commons’ women and equalities committee recently stated that political parties should have robust procedures in place to prevent intimidation, bullying or sexual harassment. The committee looked at this thanks to the work of Gavin Shuker, who has helped in taking up this issue since we first started highlighting it. Labour should follow this advice, put its values into action and change its structures and culture if we are to make our party safe for women.

We need thorough and enforced codes of conduct: online, offline and at all levels of the party, from branches to the parliamentary Labour party. These should be made clear to everyone upon joining, include reminders at the start of meetings and be up in every campaign office in the country.

Too many members – particularly new and young members – say they don’t know how to report incidents or what will happen if they do. This information should be given to all members, made easily available on the website and circulated to all local parties.

Too many people – including MPs and local party leaders – still say they wouldn’t know what to do if a local member told them they had been sexually harassed. All staff members and people in positions of responsibility should be given training, so they can support members and feel comfortable responding to issues.

Having a third party organisation or individual to deal with complaints of this nature would be a huge help too. Their contact details should be easy to find on the website. This organisation should, crucially, be independent of influence from elsewhere in the party. This would allow them to perform their role without political pressures or bias. We need a system that gives members confidence that they will be treated fairly, not one where members are worried about reporting incidents because the man in question holds power, has certain political allies or is a friend or colleague of the person you are supposed to complain to.

Giving this third party the resources and access they need to identify issues within our party and recommend further changes to the NEC would help to begin a continuous process of improving both our structures and culture.

Labour should champion a more open culture, where people feel able to report incidents and don't have to worry about ruining their career or facing political repercussions if they do so. Problems should not be brushed under the carpet. It takes bravery to admit your faults. But, until these problems are faced head-on, they will not go away.

Being the party of equality does not mean Labour is immune to misogyny and sexual harassment, but it does mean it should lead the way on tackling it.

Now is the time for Labour to practice what it preaches and prove it is serious about women’s equality.

Bex Bailey was on Labour’s national executive committee from 2014 to 2016.