Leading article: Fat is a straightforward issue

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The Independent Online
Feeling porky? Tummy sagging? You have had the calipers out and pinched the flesh that sits just above your hips or, less painfully but more intellectually demanding, measured your BMI (Body Mass Index, or weight times height squared). Perhaps you turn out to be one of every eight men or one of every six women who are, clinically speaking, obese. The Independent - which takes no view on the aesthetics of size and simultaneously sees pulchritude in tight buttocks and opulent stomachs - offers this tip. There are two ways to lose weight, and quickly. One is to fall in love, or otherwise tumble into emotional spasm - for example by being fallen out of love with. This is not necessarily recommended since other parts of the body and mind can be left scarred. The other way to fend off obesity or shed those pounds (kilogrammes if you are younger and more metric) is even more simple. Stop eating. Stop drinking calorific drinks. Go for a walk every day.

The obviousness of the advice does not make it any less valid. Moreover, it only cost you the cover price of this newspaper - and very little time to read. So we have just saved you the need to go out and buy mountains of drugs and books and inflict miseries on yourself. Obesity is a disease of affluence; or rather of the maladjusment of mind-set and material opportunity. Yesterday the Royal College of Physicians responded to a government request for new guidelines on the use of appetite suppressants, which urged a much more conservative prescribing regime. The doctors did not, however, make the obvious point. People are asking for pills to stop them doing something they themselves could do by act of will: for the exercise of mind they are substituting chemicals - something far more morally scandalous than resorting to drugs for recreational pleasure.

Size has become an industry, a culture, a lifestyle and a universal preoccupation. In part this reflects the way we inhabit a universe of American concerns and assumptions. The American drama we consume features thin or at least well-proportioned people; in reality the United States is fatland. That disparity is just as obvious to Americans themselves, leading to a national obsession with weight which we are in the throes of importing. We need trade barriers against the American attitude of complaint that says: the culture makes me eat to excess, therefore I have a right to help - whether from doctors, counsellors, quacks or therapists. The American way - as with that country's epic and virtually fruitless battles against the importation of cocaine - is to ignore the causes of complaint but to attend merely to symptoms and supply. What we don't need here is the diversion of resources, especially public health resources, into research and therapeutic development for a self-induced condition.

Our maxim is: be fat and be happy - or else eat less and exercise more. Just don't complain. Fatties sometimes try rather half-heartedly to claim they are the victims of visual oppression. There is great celebration when Vogue prints a picture of a young woman who - to unprejudiced eyes - is merely ample but to fashion mavens looks a radical departure from the stick-insect norm. This is a puzzle. Large numbers of women are obese and even greater numbers are plump, well-endowed, voluptuous, Rubenesque (the adjective is in the eye of the beholder). They surely cannot all be an oppressed minority. If they are, let's anticipate a fattist insurgency, banners saying "I'm fat and proud". Of course obesity is a problem. Excess weight knocks years off life expectancy. One study even turned up a straight calculus of chips into extra months of existence - every pound increase in weight between the ages of 30 and 42 increased the risk of death within the next 26 years by one per cent. Work out the odds, and put your fork down. Other studies have suggested that exercise and cardio-vascular fitness are critical; the fit and fat may live as long as the thin. Either way there are two conclusions to be drawn. The first is for doctors. There is an increasingly large category of conditions which people take to general practitioners and clinics, which are neither disease as traditionally defined (tissue degeneration as a result of infection or ageing) nor straightforward accident. Nor are they unavoidably the consequence of lack of resources, for example the health problems associated with low income, bad housing or work in insanitary conditions. They stem instead from the way people choose to live. They are the afflictions of lifestyle and include conditions brought on by drug and alcohol abuse, smoking and eating too much. Doctors are not, generally speaking, expert in emotional distress. If people overeat because they are unhappy, they need to be referred to priests and therapists or urged to get friends or pets. To reach for the dexfenfluramine is a cop-out, as well as potentially dangerous in terms of side-effects, which according to yesterday's report may themselves be hard to spot. As the Royal College starchily puts it, the first response should be a combination of diet, exercise and behaviour modification. As an idea, behaviour modification has a chequered history. It is what Comrade Pavlov sought to do to his dogs and Profesor Skinner to his rats. With humans there is the slight matter of mind and intention, let alone volition and people's almost infinite capacity to kid themselves. To the question: do you sincerely want to lose weight, increasing numbers give the practical answer "no" - the effort is too great, or they simply enjoy eating too much. Let them live and eventually die, albeit a bit sooner than otherwise, with the consequences. And stop asking for magic-bullet drugs.