Its wrong to focus on obesity as a national risk like terrorism. The truth is far more complex, and solutions shouldnt be couched in warlike rhetoric
Sally Davies, the UKs chief medical officer, is right to highlight womens health issues. Her report, published at the end of last week, is comprehensive and thoughtful but her implicit claim, that obesity poses a threat to the nation comparable to terrorism, is concerning (she wants it to be elevated to the level of a national risk). This generated headlines but closed down the complex thinking thats desperately needed.
What is obesity? Is it one thing? No. It is an arbitrary number on a scale which counts people with a BMI of over 30 as obese. Bundled together in Davies figures are the overweight who, according to the US National Centre for Health Statistics, are not necessarily unhealthy. Health and weight are not the same. There is health at different sizes.
Is obesity a result of overeating? Yes, maybe, and no. Theres science and then there is the agenda of the various health, fitness and diet businesses mixed up in this. Sometimes fatness is the result of inadvertent repetitive dieting which can upset our metabolism. Sometimes its a result of eating the non-food foods that industry peddles. These drench our tastebuds with fat, salt and sugar combinations that overstimulate without giving a sense of satisfaction other than reaching the end of the packet. Sometimes it is because these same non-food foods take a too-quick journey through our body without being properly digested.
Sometimes, as epigeneticists are discovering, it is to do with changes that occurred two generations ago, when food was very scarce. Sometimes, as Tim Spector of Kings College London, proposes, it is to do with changes caused by early and frequent antibiotic use which alter the flora in our gut.
And then theres the psychology of it all. Sometimes its because the pressure towards restraint leads to rebellion, to a desire to gorge ourselves, as consumerism invites us to with beautiful food-porn programmes. Sometimes of course, fat is a form of individual protest in a world that valorises thin. Sometimes fat is a result of emotional hungers perceived to be too difficult to express any other way. Sometimes fat is a result of absorbing a family preoccupation with food and then contesting it. Sometimes fat, like anorexia, is an eating difficulty that shows. Most dont, but fat does.
We demonise fat while extolling thin as new kind of morality. It starts young. In playgrounds, girls as young as six are worrying whether they are too fat. In a couple of years they will be over the toilet bowl vomiting as a form of imagined weight control and they will binge to compensate for the nutrients theyve lost. They and their restrained or compulsive-eater classmates, who might be fat and might be thin, are manifestations of a world in which food has become dangerous. So much for the war on fat. It has created terror for girls so that, instead of getting to know how to respond to their appetites, they become fearful. That fear interrupts their capacity to eat when they are hungry and stop when they are full. These are foreign concepts.
Today, troubled eating is ubiquitous and grows with each generation. The women and men whose bodies sit comfortably within the proscribed normal may have equally unruly and chaotic appetites and eating difficulties. This is what needs recognising. We have disordered eating across the board. That is the true public health emergency. This requires thoughtful, skilled help for mothers, yes, but not through concepts like empowerment used in the report.
Mothers want to do right by their children. If they were to get useful help during pregnancy to address their own eating difficulties, they would then pass on non-troubled eating to their kids. That requires well-delivered psycho-social programmes, not admonishment.
So a great report, but lousy recommendations on troubled eating. We can do better. Dame Sally, can I come and talk with you?