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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 future of policing is still at risk even after George Osborne's U-Turn

The police have avoided the worst, but crime is changing and they cannot stand still. 

We will have to wait for the unofficial briefings and the ministerial memoirs to understand what role the tragic events in Paris had on the Chancellor’s decision to sustain the police budget in cash terms and increase it overall by the end of the parliament.  Higher projected tax revenues gave the Chancellor a surprising degree of fiscal flexibility, but the atrocities in Paris certainly pushed questions of policing and security to the top of the political agenda. For a police service expecting anything from a 20 to a 30 per cent cut in funding, fears reinforced by the apparent hard line the Chancellor took over the weekend, this reprieve is an almighty relief.  

So, what was announced?  The overall police budget will be protected in real terms (£900 million more in cash terms) up to 2019/20 with the following important caveats.  First, central government grant to forces will be reduced in cash terms by 2019/20, but forces will be able to bid into a new transformation fund designed to finance moves such as greater collaboration between forces.  In other words there is a cash frozen budget (given important assumptions about council tax) eaten away by inflation and therefore requiring further efficiencies and service redesign.

Second, the flat cash budget for forces assumes increases in the police element of the council tax. Here, there is an interesting new flexibility for Police and Crime Commissioners.  One interpretation is that instead of precept increases being capped at 2%, they will be capped at £12 million, although we need further detail to be certain.  This may mean that forces which currently raise relatively small cash amounts from their precept will be able to raise considerably more if Police and Crime Commissioners have the courage to put up taxes.  

With those caveats, however, this is clearly a much better deal for policing than most commentators (myself included) predicted.  There will be less pressure to reduce officer numbers. Neighbourhood policing, previously under real threat, is likely to remain an important component of the policing model in England and Wales.  This is good news.

However, the police service should not use this financial reprieve as an excuse to duck important reforms.  The reforms that the police have already planned should continue, with any savings reinvested in an improved and more effective service.

It would be a retrograde step for candidates in the 2016 PCC elections to start pledging (as I am certain many will) to ‘protect officer numbers’.  We still need to rebalance the police workforce.   We need more staff with the kind of digital skills required to tackle cybercrime.  We need more crime analysts to help deploy police resources more effectively.  Blanket commitments to maintain officer numbers will get in the way of important reforms.

The argument for inter-force collaboration and, indeed, force mergers does not go away. The new top sliced transformation fund is designed in part to facilitate collaboration, but the fact remains that a 43 force structure no longer makes sense in operational or financial terms.

The police still have to adapt to a changing world. Falling levels of traditional crime and the explosion in online crime, particularly fraud and hacking, means we need an entirely different kind of police service.  Many of the pressures the police experience from non-crime demand will not go away. Big cuts to local government funding and the wider criminal justice system mean we need to reorganise the public service frontline to deal with problems such as high reoffending rates, child safeguarding and rising levels of mental illness.

Before yesterday I thought policing faced an existential moment and I stand by that. While the service has now secured significant financial breathing space, it still needs to adapt to an increasingly complex world. 

Rick Muir is director of the Police Foundation