The severity of this crisis means we need an overarching “obesity test”, now. Photo: Getty
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Why all new legislation should face an obesity test

Obesity is not a future theoretical threat, it is a present catastrophe.

David Cameron convened another COBRA meeting last week. Normally associated with terrorist threats and natural disasters, this time it was for a crisis in health. We’ve known about it for years, we’ve seen the catastrophic effects on individuals, we have had a plethora of advice on prevention and we have some frightening numbers of the cost to the economy. Were they discussing the greatest threat to the nation’s health and possibly economic security, ie obesity? No. Obesity, which has been blubbering for attention from politicians for a couple of decades, was elbowed aside by the far more fashionable ebola.

Obesity is not a future theoretical threat, it is a present catastrophe. In the past 20 years, the proportion of adults that are obese has risen from 13.2 per cent to 24.4 per cent among men and from 16.4 per cent to 25.1 per cent among women. Including being overweight, the numbers are far worse: 57.6 per cent to 66.6 per cent among men and from 48.6 per cent to 57.2 per cent among women. Most people have heard of the repercussions of being obese: diabetes, heart disease, joint problems, though less known tends to be the rising association with cancer. In 2007 the cost to the UK economy of overweight and obesity was estimated at £15.8bn per year, including £4.2bn in costs to the NHS. 2007 was also the year that the Labour government brought out its seminal Foresight Report on “Tackling Obesities” which set out to answer the question “How can we deliver a sustainable response to obesity over the next 40 years?” The project assembled evidence and expertise from diverse academic disciplines as well as interested organisations within and beyond government.

Eight years on, one fifth of the way through the report’s timeline, and it’s safe to say the situation has not improved. We’re still getting fatter and we still have fat-sugar-responsibility-blame demonising headlines on a loop. The Foresight Report rightly asked for a system-wide approach and a portfolio of policies to be put in place. Politicians can point to things that have since been done, but they are self-evidently inadequate. The approach has remained to piecemeal, to voluntary, to weak, to uncoordinated and to blaming.

In “Careless eating costs lives” we have responded to the obesity crisis by putting together a portfolio of policies, acknowledging both that only a cross-cutting, robust approach will suffice and that there are more avenues to explore. Where previous activity has been limited, we are calling for extended application; where schemes have been half-baked, we are setting out a considered whole-sector approach; where good things have begun, we ask for them to be embedded in law as the new foundations of progress.  For instance, the coalition government’s much debated voluntary “Responsibility Deal” has actually seen 713 different organisations and manufacturers sign up to one or more “pledge” to improve labelling, content, nutrition or workplace health. They have shown it can be done, so why not now phase in this deal as mandatory for all manufacturers, just as the Disability Discrimination Act was phased in over a period of years, allowing a reasonable amount of time for companies to adjust? Likewise, the ban on advertising unhealthy foods on TV aimed at children, needs to be now extended across daytime TV, not just during the early-afternoon. Having calories detailed on some menus now needs to become the norm, from KFC to Starbucks to Pizza Hut.

Above all, the severity of this crisis – the drain on individuals, economies and the NHS – means we need an overarching “obesity test”. All government departments need to consider the impact of proposed policy on eating behaviours and public health, to ensure it does not compound the crisis. This is essential because the causes are so complex and multifaceted. Health, education, business, treasury, transport, trade, farming and local government all have their part to play, but if the “obesity” question is not being asked, the unintended consequences of policy could be a more obesogenic environment than we have already.

If a new policy or initiative makes it easier to supply fast food, harder to walk to the shops, more difficult for schools to serve balanced meals, cheaper to buy junk grub then it should be rejected. Those are obvious. But due consideration should also be given to prevention: mental illness and counselling services, early years support and cooking classes are all vital to ensuring problem symptoms are tackled before they turn into the signs of excessive weight gain. One friend remarked to me that everyone in the over-eaters anonymous groups that she had ever attended had reported a history of abuse.

No, obesity isn’t as captivating as ebola. And as ever, those with the least resources, the lowest resilience, and often the easiest to ignore are the hardest hit. But with a tidal wave of calories surrounding us, we can’t go on ignoring obesity – because it will sink all of us if we do.

Julia Manning is Chief Executive of 2020health

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Erdogan’s purge was too big and too organised to be a mere reaction to the failed coup

There is a specific word for the melancholy of Istanbul. The city is suffering a mighty bout of something like hüzün at the moment. 

Even at the worst of times Istanbul is a beautiful city, and the Bosphorus is a remarkable stretch of sea. Turks get very irritated if you call it a river. They are right. The Bosphorus has a life and energy that a river could never equal. Spend five minutes watching the Bosphorus and you can understand why Orhan Pamuk, Turkey’s Nobel laureate for literature, became fixated by it as he grew up, tracking the movements of the ocean-going vessels, the warships and the freighters as they steamed between Asia and Europe.

I went to an Ottoman palace on the Asian side of the Bosphorus, waiting to interview the former prime minister Ahmet Davu­toglu. He was pushed out of office two months ago by President Recep Tayyip Erdogan when he appeared to be too wedded to the clauses in the Turkish constitution which say that the prime minister is the head of government and the president is a ceremonial head of state. Erdogan was happy with that when he was prime minister. But now he’s president, he wants to change the constitution. If Erdogan can win the vote in parliament he will, in effect, be rubber-stamping the reality he has created since he became president. In the days since the attempted coup, no one has had any doubt about who is the power in the land.

 

City of melancholy

The view from the Ottoman palace was magnificent. Beneath a luscious, pine-shaded garden an oil tanker plied its way towards the Black Sea. Small ferries dodged across the sea lanes. It was not, I hasten to add, Davutoglu’s private residence. It had just been borrowed, for the backdrop. But it reminded a Turkish friend of something she had heard once from the AKP, Erdogan’s ruling party: that they would not rest until they were living in the apartments with balconies and gardens overlooking the Bosphorus that had always been the preserve of the secular elite they wanted to replace.

Pamuk also writes about hüzün, the melancholy that afflicts the citizens of Istanbul. It comes, he says, from the city’s history and its decline, the foghorns on the Bosphorus, from tumbledown walls that have been ruins since the fall of the Byzantine empire, unemployed men in tea houses, covered women waiting for buses that never come, pelting rain and dark evenings: the city’s whole fabric and all the lives within it. “My starting point,” Pamuk wrote, “was the emotion that a child might feel while looking through a steamy window.”

Istanbul is suffering a mighty bout of something like hüzün at the moment. In Pamuk’s work the citizens of Istanbul take a perverse pride in hüzün. No one in Istanbul, or elsewhere in Turkey, can draw comfort from what is happening now. Erdogan’s opponents wonder what kind of future they can have in his Turkey. I think I sensed it, too, in the triumphalist crowds of Erdogan supporters that have been gathering day after day since the coup was defeated.

 

Down with the generals

Erdogan’s opponents are not downcast because the coup failed; a big reason why it did was that it had no public support. Turks know way too much about the authoritarian ways of military rule to want it back. The melancholy is because Erdogan is using the coup to entrench himself even more deeply in power. The purge looks too far-reaching, too organised and too big to have been a quick reaction to the attempt on his power. Instead it seems to be a plan that was waiting to be used.

Turkey is a deeply unhappy country. It is hard to imagine now, but when the Arab uprisings happened in 2011 it seemed to be a model for the Middle East. It had elections and an economy that worked and grew. When I asked Davutoglu around that time whether there would be a new Ottoman sphere of influence for the 21st century, he smiled modestly, denied any such ambition and went on to explain that the 2011 uprisings were the true succession to the Ottoman empire. A century of European, and then American, domination was ending. It had been a false start in Middle Eastern history. Now it was back on track. The people of the region were deciding their futures, and perhaps Turkey would have a role, almost like a big brother.

Turkey’s position – straddling east and west, facing Europe and Asia – is the key to its history and its future. It could be, should be, a rock of stability in a desperately un­stable part of the world. But it isn’t, and that is a problem for all of us.

 

Contagion of war

The coup did not come out of a clear sky. Turkey was in deep crisis before the attempt was made. Part of the problem has come from Erdogan’s divisive policies. He has led the AKP to successive election victories since it first won in 2002. But the policies of his governments have not been inclusive. As long as his supporters are happy, the president seems unconcerned about the resentment and opposition he is generating on the other side of politics.

Perhaps that was inevitable. His mission, as a political Islamist, was to change the country, to end the power of secular elites, including the army, which had been dominant since Mustafa Kemal Atatürk created modern Turkey after the collapse of the Ottoman empire. And there is also the influence of chaos and war in the Middle East. Turkey has borders with Iraq and Syria, and is deeply involved in their wars. The borders do not stop the contagion of violence. Hundreds of people have died in the past year in bomb attacks in Turkish cities, some carried out by the jihadists of so-called Islamic State, and some sent by Kurdish separatists working under the PKK.

It is a horrible mix. Erdogan might be able to deal with it better if he had used the attempted coup to try to unite Turkey. All the parliamentary parties condemned it. But instead, he has turned the power of the state against his opponents. More rough times lie ahead.

Jeremy Bowen is the BBC’s Middle East editor. He tweets @bowenbbc

This article first appeared in the 28 July 2016 issue of the New Statesman, Summer Double Issue