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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Will the collapse of the EU/Canada trade deal speed the demise of Jean-Claude Juncker?

The embattled European Comission President has already survived the migrant crisis and Brexit.

Jean-Claude Juncker, the embattled President of the European Commission, is likely to come under renewed pressure to resign later this week now that the Belgian region of Wallonia has likely scuppered the EU’s flagship trade deal with Canada.

The rebellious Walloons on Friday blocked the Comprehensive Economic and Trade Agreement (CETA). The deal for 500 million Europeans was at the final hurdle when it fell, struck down by an administration representing 3.2 million people.

As Canada’s trade minister, Chrystia Freeland, walked out of talks in tears and declared the deal dead, fingers were pointed at Juncker. Under pressure from EU governments, he had agreed that CETA would be a “mixed agreement”. He overruled the executive’s legal advice that finalising the deal was in the Commission’s power.

CETA now had to be ratified by each member state. In the case of Belgium, it means it had to be approved by each of its seven parliaments, giving the Walloons an effective veto.

Wallonia’s charismatic socialist Minister-President Paul Magnette needed a cause celebre to head off gains made by the rival Marxist PTB party. He found it in opposition to an investor protection clause that will allow multinationals to sue governments, just a month after the news that plant closures by the world’s leading heavy machinery maker Caterpillar would cost Wallonia 2,200 jobs.

Juncker was furious. Nobody spoke up when the EU signed a deal with Vietnam, “known the world over for applying all democratic principles”, he sarcastically told reporters.

“But when it comes to signing an agreement with Canada, an accomplished dictatorship as we all know, the whole world wants to say we don’t respect human right or social and economic rights,” he added.  

The Canadian Prime Minister Justin Trudeau was due to arrive in Brussels on Thursday to sign CETA, which is backed by all EU leaders.

European Council President, Donald Tusk, has today spoken to Trudeau and his visit is currently scheduled to go ahead. This morning, the Walloons said they would not be held to ransom by the “EU ultimatum”.

If signed, CETA will remove customs duties, open up markets, and encourage investment, the Commission has said. Losing it will cost jobs and billions in lost trade to Europe’s stagnant economy.

“The credibility of Europe is at stake”, Tusk has warned.

Failure to deliver CETA will be a serious blow to the European Union and call into question the European Commission’s exclusive mandate to strike trade deals on behalf of EU nations.

It will jeopardise a similar trade agreement with the USA, the Transatlantic Trade and Investment Partnership (TTIP). The Commission claims that an “ambitious” TTIP could increase the size of the EU economy by €120 billion (or 0.5% of GDP).

The Commission has already missed its end of year deadline to conclude trade talks with the US. It will now have to continue negotiations with whoever succeeds Obama as US President.

And if the EU cannot, after seven years of painstaking negotiations, get a deal with Canada done, how will it manage if the time comes to strike a similar pact with a "hard Brexit" Britain?

Juncker has faced criticism before.  After the Brexit referendum, the Czechs and the Poles wanted him gone. Hungary’s Prime Minister Viktor Orban muttered darkly about “personnel issues” at the Commission.

In July, it was reported that Angela Merkel, the most powerful politician in Europe, was plotting to oust Juncker. Merkel stayed her hand, and with German elections looming next year is unlikely to pull the trigger now.

When he took office in November 2014, Juncker promised that his administration would be a “political Commission”. But there has never been any sign he would be willing to bear the political consequences of his failures.

Asked if Juncker would quit after Brexit, the Commission’s chief spokesman said, “the answer has two letters and the first one is ‘N’”.

Just days into his administration, Juncker was embroiled in the LuxLeaks scandal. When he was Luxembourg’s prime minister and finance minister, the country had struck sweetheart tax deals with multinational companies.  

Despite official denials, rumours about his drinking and health continue to swirl around Brussels. They are exacerbated by bizarre behaviour such as kissing Belgium’s Charles Michel on his bald head and greeting Orban with a cheery “Hello dictator”!

On Juncker’s watch, border controls have been reintroduced in the once-sacrosanct Schengen passport-free zone, as the EU struggles to handle the migration crisis.

Member states promised to relocate 160,000 refugees in Italy and Greece across the bloc by September 2017. One year on, just 6,651 asylum seekers have been re-homed.

All this would be enough to claim the scalp of a normal politician but Juncker remains bulletproof.

The European Commission President can, in theory, only be forced out by the European Parliament, as happened to Jacques Santer in 1999.

The European Parliament President is Martin Schulz, a German socialist. His term is up for renewal next year and Juncker, a centre-right politician, has already endorsed its renewal in a joint interview.

There is little chance that Juncker will be replaced with a leader more sympathetic to the British before the Brexit negotiations begin next year.

James Crisp is the news editor at EurActiv, an online EU news service.