Getting on Top of the Obesity Problem

Victoria Street 

SW1 

“Humphrey.” 

“Yes, Minister.” 

“I gather all these people have died of Covid not because Public Health England cocked up but because they were overweight.” 

“That is correct, Minister.” 

“Bur haven’t Public Health England known about this obesity crisis for decades and been taking measures to deal with it?” 

“Also correct, Minister.” 

“According to a letter I read in The Times last Friday from the Chairman of the National Obesity Forum, wittily surnamed Fry, the government’s new policies to tackle obesity are the same old things and will fail just as surely.”

“Not at all, Minister, not at all.  We can now reap the benefit of this lengthy experience and look forward to a panoply of successes.  You will recall the announcement of our public health plans last July with no less than 14 actions we will take.  The 13th was ‘We will take tackling obesity and malnutrition onto the global stage.’  World-beating, no less.” 

“Humphrey, that’s all very well but a simple chap like me would expect to see the measured results of our previous efforts, how they compared with expectations and whether they were value for money.  Back in 2004, The British Medical Journal was scathing about the government’s failure to collect any performance measures. To what extent are our 14 new initiatives based on a scientific evaluation of the old ones especially as, according to Mr Fry, they are much the same as the new ones?” 

“Ah Minister, far be it from me to suggest that in any way you might be taking an overly traditional view.  We are, of course, always led by the data. However we must not look back but bring hope, build confidence that the future will be better and brighter.” 

“You mean Public Health England really has cocked it up and can be expected to go on doing so?” 

“You may have forgotten, Minister, we have re-named it the National Institute for Health Protection.  It is now led by Baroness Harding so it cannot fail.” 

“No, I hadn’t forgotten but none of the 11 responsibilities we announced it was to have include obesity. Furthermore as valuable as Dido’s experience is, I’m not sure the Jockey Club is a fount of wisdom on obesity.” 

“One can be cynical, Minister, but we have made progress, school meals for example.  We have replaced junk foods with healthy foods. We have persuaded the marketers of fizzy drinks to reduce their sugar content.” 

“I’ve never really understood what junk foods are. A burger sold by McDonalds is junk food – right?  But exactly the same ingredients prepared by Mom in her own kitchen is healthy food?  And a bowl of cereal sugared by the manufacturer is junk whereas a bowl of cornflakes covered by a couple of spoonfuls of sugar is healthy?” 

“Well that’s roughly right.  If the food is advertised to children on television by profit-seeking corporations, probably not paying all their taxes in the UK, we have to hit back.  Labelling their products ‘junk’ is one way of doing it.” 

“So we are protecting the national interest, Humphrey.  Jolly sensible that. I have the same kind of concern with inequality.  It is clearly unfair that the deprived members of society are more likely to be victims of obesity than the more affluent.  We must do something about that.” 

“Yes, indeed, Minister.  It is truly shocking.” 

“Yet my Shadow colleagues tell me that our mishandling of the pandemic and the economy is causing starvation in deprived areas.  Queues at food banks have never been longer, Moms can only afford one meal a day for their families and we have failed to provide adequate compensation for missing school meals.” 

“All true, Minister.” 

“So why is it that obesity is most prevalent and growing fastest amongst the deprived who are also starving?” 

“Junk food perhaps?” 

“But thanks to the evil profit mongers, junk food is more expensive and the deprived don’t have any money.” 

“Our educational system is probably to blame, Minister.  We don’t explain calories very well and, as there are seven kinds, that’s not surprising.  The basic idea is that one calorie raises the temperature of one gram of water by one degree Celsius.” 

“Well that’s odd.  When I put a lump of sugar in my tea, the tea gets cooler. I suppose teaching evolution doesn’t help: the survival of the fattest and all that.” 

“Very droll, Minister. The truth is that we do not really know the answers to any of these questions.  For a start most of our scientists and civil servants, not being noticeably deprived themselves, do not empathise with those suffering from obesity which is, of course, a disease that should no more be blamed on its victims than we should tell those with mental health problems to get a grip.  In fact, obesity is a mental health problem.” 

“Which causes which?” 

“I’m talking correlation, Minister, not causality.  To quote from a 2006 academic paper, I happen to have about me, ‘Obesity is associated with an approximately 25% increase in odds of mood and anxiety disorders and an approximately 25% decrease in odds of substance use disorders.’” 

“So telling the obese to stop putting jam on their bread is about as useful and telling anorexics to buck up and start eating?” 

“Pretty much but the Skinifers who make the rules are offended by overweight folks filling up our hospitals and thereby costing the NHS millions of pounds. They insist we do something, or appear to do something, about it. The public is quite good at holding two opposing beliefs at the same time, e.g. ‘belief that [being] overweight is caused by the food environment or genes – both seen as outside individual control – was associated with greater support for government policies to prevent and treat obesity.’” 

“I can see why something must be done but surely if the obese are dying early that is saving the NHS money, not the reverse?” 

“The cost of the obesity crisis is indeed far from clear, Minister. It is all to do with comorbidities.  Would you like a briefing paper on that?” 

“Perhaps not, let’s get on with what I can tell the media we are doing.” 

“You can announce two crucial initiatives. The first arises from our recognition that this is a marketing problem.  The junk food industry uses marketing to harm the victims of obesity by spending money they cannot afford on food and drink they do not need.  Our answer, following Sun Tzu’s advice, is to take the enemy’s weapons and use them against him. We have engaged Sir Keith Mills to lead our £30M marketing campaign.  He is a top marketer, including the London Olympics so successfully – no obesity there.” 

“The other part?” 

“Ah yes, Minister.  We will be spending £70M on scales so that the obese can monitor their weight levels and get advice.  Obese people know they have a problem and want to do something about it. Watching their weight will provide the nudge.” 

“At least we can say they are on top of their problem...”