Dominic Lawson: We can seek a 'cure' for obesity. But it might be more effective to start stigmatising it

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The Independent Online

It was a visit to Peter Jones that made me decide to lose some weight. I couldn't find the right waist size for the pair of trousers I wanted; but when I asked the assistant if they would be restocking, he replied – a bit brusquely, I thought – "We don't make those trousers in a 42- inch waist. Sir." I felt humiliated, but it was a necessary humiliation.

I recall this incident only because of the national hand-wringing occasioned by the release of the Foresight Project's report Tackling Obesities: Future Choices. It's so serious that it's no longer obesity but "obesities." According to the state-funded report: "By 2050, Foresight modelling indicates that 60 per cent of adult men, 50 per cent of adult women and about 25 per cent of children could be obese."

Now when people start talking about what "could" happen, based on "modelling", we have to be extremely careful that we are not falling for yet another self-serving health scare. Moreover, the Body Mass Index (BMI), which dominates discussion of the issue of body weight, is not the medical gold standard its supporters claim it to be – and I don't just say that as a glowingly healthy fatso. As Paul Campos's The Obesity Myth points out, on current BMI definitions, George Clooney and Russell Crowe are "obese", while Brad Pitt and Mel Gibson are "overweight".

Nonetheless, the evidence of our own eyes tells us that there is a problem – you only have to walk down your local high street to see people who have shapes that scarcely seem compatible with the human form. The common sense response – other than stepping off the pavement to avoid being flattened – is to say that it's their right in a free society to eat themselves to an early grave, especially if it gives them pleasure along the way.

Campaigners such as the Foresight Project have a new point to make, however. They stress that the costs are not just borne by the over-eaters: "Without action, obesity-related diseases will cost an extra £45.5bn a year." This figure is almost certainly rubbish, and not just because it's based on "modelling": they will have included in "obesity-related" diseases all cardio-vascular conditions, even though many people who are not obese will suffer from such diseases.

On the other hand, it's true that the NHS – and therefore all of us, as taxpayers – will have to provide the funds to treat "obesity-related diseases". The same argument would not apply under an insurance-funded health service. As anyone who has bought private health insurance will know, premiums can be heavily influenced by perceived obesity. I'm not certain, however, that most people really would look after themselves better if they had to bear all or part of the cost of the repair work.

Eating lots of food is very pleasurable and the worst consequences can take many years to materialise. As humans, we are not good at deferring present pleasures to gain benefits in the distant future. In the language of economists, we employ a very low discount rate in matters relating to our own health.

Perhaps this is part of the reason why The Foresight Project declares: "The obesity epidemic" (it's catching, apparently) "cannot be prevented by individual action alone and demands a societal approach." What could this mean? I could suggest that all retailers follow the example of Peter Jones and refuse to sell suit trousers with a waist measurement above 40 inches. The "societal" message would be: if you want something that fits you, you'll have to make it yourselves, you fat slobs.

There are two problems with such an approach. First, most men no longer seem to wear fitted trousers, but instead waddle around in tracksuit bottoms with elasticated waists. Second, any such policy would be the grossest infringement of liberty, not just for the grossest people, but also for businesses, which are merely trying to supply the public with what they need to wear.

That, indeed, is the trouble with all the more radical solutions to this problem – statutory removal of personal choice and freedom is almost always more abhorrent than the alleged evils that it is designed to eradicate. This is not just an abstract point about the virtue of liberty. One thing we should have learned about the growth of the "nanny state" is that it has led to an ever greater transfer of responsibility from the individual to politicians and officials. If there was in the past a greater sense of self-restraint – in eating, as in so many other aspects of behaviour – then that would have been a function of the way people were brought up by their parents: it was not a gracious gift from beneficent bureaucrats.

It is a terrifying fact that more than a third of the nation's children never share the experience of eating with others around a table. They just take food when they want it – grazing, it is sometimes called, and there is indeed something primitive and animalistic about it. There are behavioural consequences to this, not just dietary ones: one of the virtues of the family meal at a fixed time is – or was – that it teaches that eating should not just be about the slaking of private appetites. If the Foresight Project really wants to examine "societal" approaches to addressing the problem, then it will have to address the way in which the family has evolved over the past half-century or so.

Somehow, I think it will not want to do that – and I can half-understand why. If you are a hard-pressed working single mother, you will hardly want to be told that you should feed your children not what they want and ask for – hamburger and chips – but a wide range of fruit and vegetables. That would require a degree of discipline which a diminishing proportion of parents seem able to exercise. I am hardly one to preach – how else did I become so overweight? – but it is unfortunately a fact that as a people, we have become less and less able to demonstrate self-discipline. This form of behavioural incontinence does not just apply to food; we see it in all spheres of conduct. Drug- addiction is simply the most upsetting form of it, not helped by the conventional view that this is an "illness" rather than a manifestation of moral weakness which can only be conquered by an act of individual will.

One word which did not appear in the Foresight Project's list of possible responses to the "obesity crisis" is stigma. This is a deeply unfashionable term, but it is vital. It is not ignorance that keeps some of our least-well educated from eating less often and exercising more. Everybody knows why they become overweight. The reason why obesity is more common outside the middle classes is because among the bourgeoisie it is considered naff to be fat and unacceptable to be grossly obese. Why else would Peter Jones refuse to stock trousers for fatties?

d.lawson@independent.co.uk

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