It is regrettable that the government’s anti-obesity strategy, which contains a number of welcome measures, has been framed has a sort of call to arms to save the NHS. “We owe it to the NHS to move towards a healthier weight,” declares the official policy document, and “Going into this winter, you can play your part to protect the NHS and save lives.” In other words, “Your country needs less of you.”
While banning pre-watershed advertising of junk food is a positive step, as are NHS bike schemes, this sort of language operates on the premise that overweight people are overweight because they don’t care enough. Don’t care about themselves and, more importantly, don’t care about others. Pitching weight loss as a sort of patriotic duty comes perilously close to telling an overweight person that their fat is costing lives. “Obesity puts pressure on the NHS,” the document tells us. Losing weight would “free up [doctors’ and nurses’] time to treat other sick and vulnerable patients”. In other words, “big hips sink ships”.
Of course, obesity-related ill-health is a huge problem for the UK. Almost two-thirds (63%) of adults in England are overweight or living with obesity – and one in three children leave primary school overweight or obese, with obesity-related illnesses costing the NHS £6bn a year.
But it is a complex issue and people carrying excess weight do so for many reasons. Shaming people (lowering their self-esteem) strikes me as an ineffective means of encouraging weight loss. Indeed, it is highly likely to have the opposite effect. If you use food as an emotional crutch, then this sort of public kicking is hardly going to enable you to cast your crutch aside.
There’s nothing complex about it, scoffs someone (we’ll call him Slim Jim) every time the topic of weight loss comes up in the media: eat less and exercise more. If I’d lost a pound every time I’d heard that, my struggles would be over. Again, the implication is that fat people are stupid, lazy or lacking in self-discipline, and probably all three.
I don’t think I am lazy. I’ve climbed to 18,000 feet, run a half-marathon (OK, jogged) and written three novels (one published). I can be lazy certainly, but surely all of us can.
I don’t think I lack self-discipline. It was arguably an excess of self-discipline that enabled me to starve myself in my 20s until my BMI dropped to below 15. It is more than double that now, but I don’t believe my character has fundamentally changed.
“But that’s an eating disorder!” cries Slim Jim. “It’s different for most people!” And it’s true, I have been diagnosed with an eating disorder, but then I’ve been diagnosed with lots of things. Were diagnoses dished out like Brownie badges (and in some contexts, they practically are), well let’s just say that I would be a very successful Brownie. Of course, there’s a spectrum of disordered eating, from the life-threatening at one end (anorexia has the highest fatality rate of any psychiatric disorder. Bulimia is also associated with a raised fatality rate and severe medical complications) to the yo-yo dieter at the other, but of the women I know, there are remarkably few who have an entirely relaxed and healthy relationship with food. And disordered eating is rapidly increasing among boys and men too.
Slim Jim’s argument betrays not only a lack of empathy but also a failure to understand the drivers of obesity and the nature of addictive behaviour. I’ll leave the scientists to wrangle over whether sugar satisfies their definition of an addictive substance, but what I will say is that for me it certainly feels like one. Telling people locked in an addictive relationship with food to just eat less, is like telling someone with mental health issues to pull themselves together, or a heroin addict to just stop shooting up. It isn’t helpful.
Or rather, it isn’t helpful to them. It is of course helpful to those who would rather not think about the many and complex causes of obesity. About the link between obesity and income inequality in rich countries, for example, a link which applies to drug and alcohol addiction and mental health problems too. In fairness, the government does acknowledge that “obesity is more common in people living in deprived areas”, but strangely their focus appears confined to reducing people’s weight, as opposed to reducing their deprivation.
None of which is to suggest that people should not be supported and empowered to take responsibility for their physical and mental wellbeing, but what’s needed is a truly holistic approach at both the societal and individual levels. I am currently enrolled on the Second Nature programme, which seeks to change people’s lifestyle habits by exploring the psychological and physical factors that underpin them. I’m only a few weeks in but so far the mixture of evidence-based research, group and individual support has been hugely helpful. I have lost a stone, but more importantly, I can feel my mindset shifting. I just hope it proves resilient enough to withstand the government’s campaign.
• Clare Allan is an author and creative writing lecturer who writes on mental health issues