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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 5 things the Tories aren't telling you about their manifesto

Turns out the NHS is something you really have to pay for after all. 

When Theresa May launched the Conservative 2017 manifesto, she borrowed the most popular policies from across the political spectrum. Some anti-immigrant rhetoric? Some strong action on rip-off energy firms? The message is clear - you can have it all if you vote Tory.

But can you? The respected thinktank the Institute for Fiscal Studies has now been through the manifesto with a fine tooth comb, and it turns out there are some things the Tory manifesto just doesn't mention...

1. How budgeting works

They say: "a balanced budget by the middle of the next decade"

What they don't say: The Conservatives don't talk very much about new taxes or spending commitments in the manifesto. But the IFS argues that balancing the budget "would likely require more spending cuts or tax rises even beyond the end of the next parliament."

2. How this isn't the end of austerity

They say: "We will always be guided by what matters to the ordinary, working families of this nation."

What they don't say: The manifesto does not backtrack on existing planned cuts to working-age welfare benefits. According to the IFS, these cuts will "reduce the incomes of the lowest income working age households significantly – and by more than the cuts seen since 2010".

3. Why some policies don't make a difference

They say: "The Triple Lock has worked: it is now time to set pensions on an even course."

What they don't say: The argument behind scrapping the "triple lock" on pensions is that it provides an unneccessarily generous subsidy to pensioners (including superbly wealthy ones) at the expense of the taxpayer.

However, the IFS found that the Conservatives' proposed solution - a "double lock" which rises with earnings or inflation - will cost the taxpayer just as much over the coming Parliament. After all, Brexit has caused a drop in the value of sterling, which is now causing price inflation...

4. That healthcare can't be done cheap

They say: "The next Conservative government will give the NHS the resources it needs."

What they don't say: The £8bn more promised for the NHS over the next five years is a continuation of underinvestment in the NHS. The IFS says: "Conservative plans for NHS spending look very tight indeed and may well be undeliverable."

5. Cutting immigration costs us

They say: "We will therefore establish an immigration policy that allows us to reduce and control the number of people who come to Britain from the European Union, while still allowing us to attract the skilled workers our economy needs." 

What they don't say: The Office for Budget Responsibility has already calculated that lower immigration as a result of the Brexit vote could reduce tax revenues by £6bn a year in four years' time. The IFS calculates that getting net immigration down to the tens of thousands, as the Tories pledge, could double that loss.

Julia Rampen is the digital news editor of the New Statesman (previously editor of The Staggers, The New Statesman's online rolling politics blog). She has also been deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines. 

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