Being fat is the last social taboo. It is the actual elephant in the room

But would you be willing to wag your finger at an obese friend?

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The Independent Online

In a national push to help fight obesity, the chief executive of the NHS, Simon Stevens, has ordered GPs to identify patients who are putting on weight. This is not just some fashionable New Year-style headline. Stevens is trying to head off a danger which threatens to swamp the health service. We are the second fattest nation in Europe, (just behind Hungary) with almost a quarter of us classified as obese. Compared with a European average of 16.5 per cent.

According to Mr Stevens, (who has just lost three stone) we are “sleepwalking into a public health emergency”, – for with obesity comes diabetes, heart disease and the dismaying catalogue of health problems which will overwhelm our hospitals. So he is introducing a national programme to offer people a way to lose weight (essentially a regime of eating less and moving more). It is undoubtedly sensible – research has found that losing 7 per cent of weight can reduce the risk of diabetes by nearly 60 per cent.

This is the “little nudge” that Stevens wants to give us all to encourage healthier living habits. You might visit your GP for something completely unrelated, and, along with the reminder about smear tests and mammograms, you could find yourself being surveyed by the doc, and asked to cut down on the croissants. Weigh-ins at the surgery might become a customary part of each visit. This might work for some, but I suspect it won’t for many others. We are used to GPs telling us what is good for us, and then ignoring it. Saying yes to the GP and then forgetting all about it, possibly because the visit didn’t cost anything, is one of the demons of free universal healthcare.

Wouldn’t it be more appropriate for Mr Stevens to encourage all healthy, slim civilians to wag the finger of warning at people who have gained weight? The help of the community in national health campaigns cannot be underestimated. Indeed, communal scrutiny is a ferociously strong weapon; in India and Africa, millions have been cured of TB via a system known as directly observed therapy, where the patient must take their entire lengthy regime of drugs in front of a respected local person. The phenomenon of having someone outside the white-coated terrain of the hospital to check you are taking your medicine properly, has been remarkably successful. And as millions know, Weight Watchers also works because there is a similar communal push.

So how about the idea of getting you and me to tell friends that they should watch it, that they are looking a bit tubby of late, or (possibly even more cringemaking) that their children should probably slim down a touch? Social opprobrium, as those intending to drink and drive, or those wishing to light cigarettes indoors, know all too well, is a very powerful tool. I can’t think of the last party I went to where people smoked indoors.

But with weight issues? The TV turn Katie Hopkins may have made her name by being rude to people, telling them they are fat and unhealthy, but that just proves the difficulty of the arena. Being fat is the last social taboo. It is the actual elephant in the room; nobody wants to tell anyone that they are a) overweight or b) have put on weight. To this day I remember my mortification when (years ago) I congratulated a colleague at work on her pregnancy, only to be coldly informed that she was not expecting a baby. And I recall the moment at school when, having being teased about my spots, I replied to my tormenter with the devastating riposte: “Well, at least I am not FAT.” Cue tears, end of teasing.

But outside the schoolyard, should one really behave like a walking Weight Watchers campaigner, on permanent alert lest your friends, who you have invited over to lunch, have eaten too much chorizo? Pressing elderflower juice on someone because they are driving, or gently telling a friend that you’d rather they didn’t smoke in your house, because of your children, or your asthma, is one thing. Shaking your head as they reach for another mince pie (calories: 350) or smoked salmon slathered with cream cheese (calories: 270), and suggesting they do a bit of jogging tomorrow morning? Quite another. Yes, you might be doing them, and the community, a huge favour in the long run, but down here on the sunny streets of real life, will your friends thank you? Indeed, would they ever want to see you again? The conundrum is this. We all love and value our health service but are we willing to cast ourselves into the social wilderness to save it?