Vintage cereal boxes: breakfast cereals have been especially implicated in childhood obesity. Photo: Getty
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How the lessons of the long war on tobacco can help us shape up on our new front line: obesity

The NHS is gradually waking up to the need to provide structured support to people keen to lose weight, just like smoking cessation services.

Last month, Dame Sally Davies, the Chief Medical Officer for England, published her annual report on the nation’s health. I was struck by her assertion that two-thirds of adults are now either overweight (body mass index over 25) or obese (BMI over 30). The statistic reminded me that in the 1960s, the peak of the UK smoking epidemic, 70 per cent of men and 40 per cent of women were smokers.

At such levels of prevalence, cultural perceptions alter. It appears normal for people to smoke, a conclusion subliminally supported by the ready availability of tobacco; by the provision of ashtrays in planes, trains and cars; by adverts in every form of media. We are witnessing a similar “normalisation” of obesity, with shop mannequins getting larger, “inflation” in clothing sizes and furniture design being altered to accommodate the new norms.

The historic smoking prevalence data came to mind because in February, figures from 2013 were published showing that the proportion of smokers in the English population had fallen below 20 per cent for the first time. The campaign waged against tobacco over the past 50 years tells us everything we need to know about effecting a similar reduction in rates of obesity.

The prerequisite is information. The tide started to turn against smoking following the publication, in 1962, of the first study to demonstrate persuasively the unequivocal link with lung cancer. The drip-drip of new health information gathered pace and by the 1970s the inexorable rise in smoking prevalence had begun to reverse. The strong links between obesity and conditions such as heart disease, stroke, diabetes and three of the four most common cancers (bowel, breast and prostate) are well established but have yet to lodge in the public consciousness. Most people are aware that being overweight is somehow not good for you but have only a vague idea as to the extent of the problem. I have several obese patients who have been shocked to learn that their weight poses comparable risks of disability and premature death to being inveterate smokers.

Information alone is insufficient. Losing weight is, for most, at least as challenging as quitting nicotine. Research is making clear that large “hits” of sugar, be it “off the spoon” or “hidden” in processed food, have addictive potential. The same may be true of fried foods. The NHS is gradually waking up to the need to provide structured support to people keen to lose weight, just as it devotes considerable resources to smoking cessation services.

The experience of tackling smoking suggests that wider measures will also be needed. Stiff taxation has made tobacco much less affordable. Advertising and shop display prohibition and stark health warnings on packaging have contributed to the message that tobacco use is no longer normal behaviour. Bans on smoking in public places – and soon in cars with children – also serve to marginalise the habit further.

The situation is more complex for obesity. Eating and drinking are normal activities and there is no single culprit product on which the government can train its sights. Having said that, there is good evidence that ministers could get to work on. Sugar in soft drinks (and added almost routinely to processed foods) makes a major contribution to overall calorie intake. There should be an immediate ban on any product being marketed as “low” or “no fat” – or, indeed, trumpeting its freedom from “artificial flavourings and additives” – when it is stuffed full of sugar instead. Breakfast cereals, particularly those aimed at children, are by and large a national scandal.

Several European countries have already introduced a “sugar tax” and the UK should follow suit, though the industry will resist it with vigorous lobbying.

Junk food is also under the spotlight. A neat piece of research published recently in the British Medical Journal established clear links between obesity rates and the density of fast-food outlets around people’s homes and workplaces and along their commuting routes. Will there come a time when diners consuming reasonably priced, healthy whole foods sit comfortably inside warm restaurants, while shame-faced burger munchers huddle beneath a shelter in the windswept car park?

In our efforts to tackle the obesity epidemic, we must take care not to stigmatise the overweight. A small proportion of obesity is genetically determined. For the rest, outward appearances are rarely indicative of simplistic so-called failings such as gluttony. Excess weight is driven by ubiquitous low-cost, energy-dense food, by time- and exercise-poor lifestyles and by a failure of education and information to keep pace with the rapid changes that food technology has brought about over the past three decades. Obesity can also be a manifestation of the same emotional wounds that drive more conventional addictions.

We need compassion for ourselves and for each other. But as the smoking epidemic smoulders towards its conclusion, we need to face the public health crisis that has grown in its wake – and we need to shape up fast.

This article first appeared in the 09 April 2014 issue of the New Statesman, Anxiety nation

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Why Angela Merkel's comments about the UK and US shouldn't be given too much weight

The Chancellor's comments are aimed at a domestic and European audience, and she won't be abandoning Anglo-German relationships just yet.

Angela Merkel’s latest remarks do not seem well-judged but should not be given undue significance. Speaking as part of a rally in Munich for her sister party, the CSU, the German Chancellor claimed “we Europeans must really take our own fate into our hands”.

The comments should be read in the context of September's German elections and Merkel’s determination to restrain the fortune of her main political rival, Martin Schulz – obviously a strong Europhile and a committed Trump critic. Sigmar Gabriel - previously seen as a candidate to lead the left-wing SPD - has for some time been pressing for Germany and Europe to have “enough self-confidence” to stand up to Trump. He called for a “self-confident position, not just on behalf of us Germans but all Europeans”. Merkel is in part responding to this pressure.

Her words were well received by her audience. The beer hall crowd erupted into sustained applause. But taking an implicit pop at Donald Trump is hardly likely to be a divisive tactic at such a gathering. Criticising the UK post-Brexit and the US under Trump is the sort of virtue signalling guaranteed to ensure a good clap.

It’s not clear that the comments represent that much of a new departure, as she herself has since claimed. She said something similar earlier this year. In January, after the publication of Donald Trump’s interview with The Times and Bild, she said that “we Europeans have our fate in our own hands”.

At one level what Merkel said is something of a truism: in two year’s time Britain will no longer be directly deciding the fate of the EU. In future no British Prime Minister will attend the European Council, and British MEPs will leave the Parliament at the next round of European elections in 2019. Yet Merkel’s words “we Europeans”, conflate Europe and the EU, something she has previously rejected. Back in July last year, at a joint press conference with Theresa May, she said: “the UK after all remains part of Europe, if not of the Union”.

At the same press conference, Merkel also confirmed that the EU and the UK would need to continue to work together. At that time she even used the first person plural to include Britain, saying “we have certain missions also to fulfil with the rest of the world” – there the ‘we’ meant Britain and the EU, now the 'we' excludes Britain.

Her comments surely also mark a frustration born of difficulties at the G7 summit over climate change, but Britain and Germany agreed at the meeting in Sicily on the Paris Accord. More broadly, the next few months will be crucial for determining the future relationship between Britain and the EU. There will be many difficult negotiations ahead.

Merkel is widely expected to remain the German Chancellor after this autumn’s election. As the single most powerful individual in the EU27, she is the most crucial person in determining future relations between the UK and the EU. Indeed, to some extent, it was her intransigence during Cameron’s ‘renegotiation’ which precipitated Brexit itself. She also needs to watch with care growing irritation across the EU at the (perceived) extent of German influence and control over the institutions and direction of the European project. Recent reports in the Frankfurter Allgemeine Zeitung which suggested a Merkel plan for Jens Weidmann of the Bundesbank to succeed Mario Draghi at the ECB have not gone down well across southern Europe. For those critics, the hands controlling the fate of Europe are Merkel’s.

Brexit remains a crucial challenge for the EU. How the issue is handled will shape the future of the Union. Many across Europe’s capitals are worried that Brussels risks driving Britain further away than Brexit will require; they are worried lest the Channel becomes metaphorically wider and Britain turns its back on the continent. On the UK side, Theresa May has accepted the EU, and particularly Merkel’s, insistence, that there can be no cherry picking, and therefore she has committed to leaving the single market as well as the EU. May has offered a “deep and special” partnership and a comprehensive free trading arrangement. Merkel should welcome Britain’s clarity. She must work with new French President Emmanuel Macron and others to lead the EU towards a new relationship with Britain – a close partnership which protects free trade, security and the other forms of cooperation which benefit all Europeans.

Henry Newman is the director of Open Europe. He tweets @henrynewman.

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