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22 October 2007

Chewing the fat

How it is important to avoid fatuous pronouncements about obesity if one wants to have a sensible di

By Martin O'Neill

CAESAR: “Let me have men about me that are fat;
Sleek-headed men and such as sleep o’ nights:
Yond Cassius has a lean and hungry look;
He thinks too much: such men are dangerous.”

Shakespeare’s Julius Caesar was able to see the upside of obesity in a way that would be unimaginable for our contemporary politicians.

Current rhetoric about the weight of the nation has, indeed, tended towards the hyperbolic and apocalyptic.

There is much talk of an “obesity time bomb”, and of an “epidemic of obesity” that challenges both the longevity not to mention the public finances of the nation.

In stark contrast to Caesar’s sanguine feelings about expanding waistlines, last week saw perhaps the most delightfully absurd pronouncement on this epidemic of fatness when Health Minister Alan Johnson claimed that obesity was a “potential crisis on the scale of climate change”.

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It is worth stopping for a second to appreciate the sheer silliness of Alan Johnson’s claim. It is certainly true that the spread of obesity may curtail the upwards progress of life expectancy in the developed world, and may diminish the quality of life of many of the world’s affluent citizens through contributing to life years spent coping with diabetes or coronary heart disease. But even this unhappy prospect pales into insignificance when compared with the dangers of climate change.

Flooding and extreme weather have the capacity to cause hundred of thousands of deaths throughout the world, whilst desertification and rising sea levels have the capacity to displace tens of millions of people from their homes, leading to war, famine and unpredictable political upheavals.

Obesity is a problem of the affluent, comfortable, and (overly) well-fed, whereas those who will bear the brunt of climate change are the world’s poorest and most disadvantaged.

If obesity is among the worst problems faced by a nation, then what this tells us is that this nation is actually doing rather well. Johnson’s remarks equate the lifestyle problems of the world’s wealthy with the real matters of imminent life and death that are faced by the world’s poor.

It does a disservice to the importance of action on climate change to bracket it alongside problems caused by eating too much and not getting enough exercise.

It is not so much that the government’s response to obesity is itself nonsensical, but that much of the way it is reported and communicated is hysterical or confused.

The report of Foresight, the government’s science think tank, on Tackling Obesities: Future Choices contains a good ideal of sober analysis about the social, environmental and physiological mechanisms that lead to obesity, together with different proposals for how the problem might be tackled.

But discussion of the causal processes that increase the likelihood of obesity seem always to be stuck in an overly simplistic dichotomy – either it’s a matter of individual choice, and hence nothing to do with government, or else it’s the inevitable consequence of modern life, and therefore something for which individuals are not responsible.

The Foresight report attempted to make a number of nuanced points, but the predictable reaction from the media was that this meant that obesity “is not the fault of individuals” or, as John Humphrys put it, somewhat mysteriously, on the Today programme, people are obese because “our biology is out of step with the abundance and convenience offered by the modern environment”. (As if we might have expected “our biology” to have kept up with the modern world, and are free of the responsibility to make better choices in any circumstance in which it has failed to do so!)

Reasonable debate about social problems related to problems of addiction and unwise choices seem stuck in a rather reductive ‘blame game’. But the plausible positions in this area are neither the unsophisticated determinist view that sees obesity as nothing at all to do with fault or choice, nor the avowedly tough-minded (but hopelessly simplistic) position that sees this as a realm of individual choice untouched by broader issues of social policy.

In fact, there is nothing inconsistent in thinking that certain problems can result from individual’s choices (whether those problems are obesity, addiction, alcohol abuse or whatever else) whilst at the same time allowing that certain sorts of environmental and social backgrounds make some choices easier than others.

The overly reductive question of that asks who is “at fault” or “to blame” for problems like these needs to be pulled apart. There are causal questions here that range over issues about social, environmental and psychological mechanisms.

There are also irreducibly normative questions about who should bear the costs of these problems, and what should be done by governments and by individuals to tackle them. Good answers here will be boringly complex (like the Foresight report itself). Easier answers tend to suggest lazy thinking, but easy answers make better headlines.

This is not to say that there is nothing with which one might quibble in the government’s Tackling Obesities report.

Firstly, there is the bizarre pluralisation: from ‘obesity’ to ‘obesities’: a piece of wilful jargon-making without justification.

Secondly, one needs to be very careful when reading research that makes claims such as “if current trends continue, most people in the UK will be obese by 2050”.

Social trends, like economic trends, are malleable, unpredictable and subject to reversal. For example, current trends in obesity are not themselves 45 years old, which might suggest the debatable wisdom of a projecting them 45 years into the future without severe caveats.

Conditional claims that turn around substantial hypotheticals such as this need to be read as what they are, not as confident scientific predictions for how things will certainly be. A bit of reticence in making some of these big claims could hopefully only add to the plausibility of the overall analysis.

There is one claim, though, that should be excluded from further debate without further delay, in part because it seems to be irredeemably subject to misinterpretation. Again and again we hear that the spread of obesity will lead to “children dying before their parents”.

This conjures up visions of a generation of obese children who will predecease their mother and fathers.

But what is actually meant is simply that, with the growth of obesity, life expectancy might drop in such a way that many people will die at a younger age than their parents did. Whilst this is still, of course, an unpleasant prospect, it isn’t quite the horrific vista of losing a generation to obesity.

If claims like this aren’t made carefully, they can sound shrill and alarmist – fine, perhaps, for grabbing headlines, but not so good for reasoned reflection on difficult matters of policy.

Alan Johnson’s remarks about obesity and climate change bring to mind an altogether more sensible pronouncement on fatness from George Bernard Shaw. As Shaw rightly pointed out, “no diet will remove all the fat from your body because the brain is entirely fat. Without a brain, you might look good, but all you could do is run for public office.” Alan Johnson might give a bit more thought to his public utterances if he isn’t to end up unwittingly proving Shaw to be all too correct.

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