I am a bit scared to mention this but, as a GP working in London, I’ve not seen any patients suffering from hunger.
The Trussell Trust, which runs a large number of food banks, uses the strapline “Stop UK Hunger”. For them to say there is “hunger" suggests there are people suffering from lack of food and malnourishment. The number of food banks opening has led to concerns about the state of our country and questions about why there is an increased need.
Yes, I do see people who are malnourished. Who is to say at first if a patient is simply slim or if they are too thin? A pointy face, all angles, is the first thing I notice when malnourishment is a possibility. If it’s severe, I see that their elbow joints are wider than their limbs. I do a back examination and see parts of the spine not usually visible rippling under the skin.
This person has usually dipped below a normal size and their BMI is less than 18.5. It doesn’t always mean they are unhealthy, but it usually means there is something wrong.
I am always looking for loss of weight or low weight. I ask about appetite and weight all day long. Low weight is a red flag; it tells me to look further. But every time I have seen someone malnourished, they have had a clear medical reason for it: young men with chronic renal failure; women with type 1 diabetes; people living with a disordered relationship with food. Low weight in a child without a medical reason requires an urgent social services referral for possible neglect.
But in the UK, people are usually malnourished the other way around: obesity is an increasing problem and all the evidence suggests that low income is associated with being overweight, rather than hunger.
Public Health England data shows severe obesity has increased from 15 per cent to 26 per cent since 2000. In the lowest income bracket, 37.6 per cent of people are obese compared with 18.3 per cent in the highest. Or to put it another way, 38 per cent of people are obese in the most deprived areas of the UK compared with 20 per cent in the least deprived.
The food boxes that the Trussell Trust hands out will not help the obesity problem. They contain non-perishable items – as they must – such as pasta, rice, tinned vegetables and fruit, fruit juice and biscuits. According to the trust’s own statistics, 78 per cent of people using food banks do so because they have low income, benefit delay, benefit change or are in debt. The banks supplement a weekly benefits allowance of £73.10 – a figure that makes it very hard for so many to manage staying within a budget.
I actually tried ringing the Jobcentre to see what they thought about this issue. It didn’t feel great holding onto the automated line. “We will treat your personal information carefully. We will use it for any of our purposes,” recited the recorded voice, with chilling formality. After 10 minutes of phone menus, I heard, “If you are applying for a new claim for JSA you need to apply online, goodbye,” and the phone went dead. At least the line was free to call.
Food banks do have a place: they help out financially, albeit briefly. But trying to prove that the rise in food bank use is evidence for hunger is difficult to back up with data. The research on food insecurity in the UK has a curiously circular nature. Proposals have been launched in parliament by UKSSD, backed up by statements from the Trussell Trust and the Food Foundation. The Food Foundation’s Too Poor to Eat paper appears to be based on a UN document trying to develop a “food insecurity experience scale”. As far as I can gather, the UN research was based on telephoning 1,000 people in the UK in 2014.
I have never been asked for food vouchers (although I know other GPs have) and, in fact, I have never been handed any to give out. However, if I had been, and if someone had asked me for one, I would have given them one. Of course I would.
Then the food bank would have official authorisation by me that the patient should have non-perishable food, which is itself linked to poor nutrition and obesity. And that would give me absolutely no new information as to why (or whether) that person needed assistance.
Agencies are rightly tracking the rise in the number of people using food banks, but until they ask – really ask – for a bit more information from their clients (and the GP in me wants to weigh and measure them too) then we are no wiser at all.
People with a low income will continue to experience higher than expected obesity levels, and the food banks will continue acting as a sticking plaster, not shedding light on what the problem is, the size of the problem or how to fix it.
At the moment we are simply speculating, not taking action to help people at the root cause of poverty and food insecurity, and even obesity.
More political speculation. I’m tired of that. I want data.
Berenice Langdon is a GP working in southwest London
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