I read today [OECD] that Britain has the highest rates of obesity, and fatness, in Europe and is the 6th most obese country in the world. There is also the terrifying statistic that the rate of obesity has doubled since the 1990’s and we face the serious prospect of this bankrupting the NHS. Obesity is a major risk factor, as we all know, for diabetes, cancer, hypertension, heart disease, stroke and dementia – this rate of change should alarm us – but it won’t.
For many years, most of my working life, I ignored a growing problem. This problem was the growing size of my belly and my increasing size. By the time I changed my lifestyle 6 years ago I had managed to create quite a respectable problem for myself. My waist was 35 inches, my weight was 14 stones and unfortunately not being a tall man my BMI was 31.6. I was quite clearly obese. This had crept up on me, I knew as I aged I was becoming less fit but I didn’t look that different to many other middle-aged men and nobody passed any adverse comments. As a doctor, I knew I was building up risks for myself but I was able to minimise these in my head. Nothing bad had happened, I don’t look that unusual, my blood pressure is OK, I still stay active – it really was easy to convince myself that this was no great deal.
Then came the rude awakening. Five years ago I was diagnosed with Type II diabetes mellitus with blood sugars so high I had the full range of symptoms and was started on metformin instantly, at a pretty high dose. I then went through the NHS’s education package. This told me to take my medicines, eat regularly and sensibly, and take a bit of exercise. With this, I was assured, the thing was manageable and I’d be fine. No-one took a blind bit of notice of the large, and obvious, wobbly bundle of fat I had around my middle even though this was the most conspicuous thing of my appearance. (If you want to imagine me then – not recommended – then imagine a potato with four cocktail sticks as limbs, that was me to a “T”). I sat on classes with other similarly shaped people and we all pretended that there was nothing amiss, nothing that eating a stick of celery couldn’t sort out. I went to the gym, where the rhythmical bouncing of my and my new friends’ bellies, while we tried to jog on the treadmills, was almost hypnotic to watch. Through it all no doctor, no nurse, no dietician, no-one said – for goodness sake get rid of that belly ! They were all too polite to mention it.
When I received the diagnosis a cold shiver went down my spine. I’d worked in an area where I’d seen the consequences of diabetes. I’d spoken to men about to have their feet amputated, I’d given rehab advise to folk after their stroke, I’d completed forms confirming that a diabetic man was now blind, and I’d consoled widows after their spouse’s fatal heart attack. I knew my mortality risk was now considerably increased and I knew some of the problems I might face. I also knew, from very cursory information gathering, that my poor diet and obesity were the main factor in this.
I decided to change, I was so scared and shocked, I knew I had to change. I went on a low carb diet and lost 3 stones, I kept on the diet and took regular exercise. I saw my waistline shrink, my belly disappear and my blood return to near normal. After a few months I came off medication and have remained medication free, and with relatively normal bloods, for the past years. A couple of my diabetic pals, who were equally shocked, did the same thing with similarly good results. But I meet my other pals, who were never troubled by the thought of their weight; still obese, still taking medication and now starting to experience the adverse consequences of this illness.
So I have a personal interest in this report of growing obesity in the UK even though I am a relative neophyte to the world of diets and healthy eating. What are we to do to try and stop this growing trend. It is clear that there are some things we can’t do.
We can’t reduce the availability of food. This is a non-starter, there is no way we can limit what people eat – they must do this themselves. If you don’t sell the double pack of Mars bars I’m smart enough to get around this by buying two packs as is everybody else. Attempt to limit things by smaller packaging could only work if we were happy to accept central rationing of our food, otherwise we just buy more of the smaller packets.
I don’t think that we will get around this by education. I don’t think that there is anyone left that thinks a Big Mac and fries becomes a healthy option because it has a gherkin in it. We all know that a salad is healthier than a bar of chocolate – education is the answer when ignorance is the problem. That is not the issue here.
I doubt we will have much success tackling our increasingly sedentary lifestyles. Anyone suggesting we get rid of the automobile, or suggesting we dig roads by hand or get rid of any other labour saving machinery, is unlikely to have a successful career in politics. We can suggest that people exercise and find ways to make it easier but, unless we are going to have forced marches then we need to find ways to make people want to do this.
The key in the affluent west is that we need people to want to be normal sized, to fear being obese. This is what we have lost. As I walked around I saw other people the same shape as me, it normalised my obesity. Chairs, cars, everything has been slightly adapted to suit the larger body, each step making it easier to be obese and, more importantly, making it easier to ignore your own obesity. I needed somebody to tell me – “Whoa ! You’ve got far too big there. That doesn’t look right” but even when I had fallen ill people were too afraid to mention it. They were happier to let me die earlier or loose my sight, or foot, than to be accused of “fat shaming”
We would prefer people to be comfortable in their obesity, than in any way upset – but this is precisely what we do not need. Discomfort might prompt thought and redirection and improvement to their health and life. I wish someone had spoken honestly to me, when I asked “How do I look ?” I wish they had said “you are getting fat” rather than lied with “Fine”. There is no need to be unpleasant about this we just need to be honest. We also need to be careful about attempts to actively normalise obesity. I noted, when in the supermarket today, this is not as strange and impossible idea as I had thought – three of the covers of magazines (directed to young women) were using obese models. It may be dangerous to promote anorexic stick insect ideals of beauty but it is equally dangerous to promote obesity as a good choice.
The problem of obesity has unfortunately got bound up in the gender issues of objectification of womenWe but obesity doesn’t affect only one gender. All of us are at risk when we treat our health and future in a cavalier way like this. There are many vested interests who would prefer us not to think about it; the food and pharmaceutical industries would be much happier we consumed more of their products and dealt with the consequences. The media and beauty industry can sell us their products either way, fat or thin models, it is of no concern to them simply which model sells more copy.
People are free to live as they wish, they are free to be fat or thin as they choose, but they must choose with adequate knowledge. We should not influence these decisions because of our political biases and we should net let people die early because we were too afraid to tell the truth.