Obesity by DJW
An undeniable problem…
It is difficult to deny that obesity is a problem in England today. An apparent inability to control one’s body size and shape is cited by millions as something that diminishes their enjoyment in life. We only live once, and a life spent battling “flab” can only be described as a wasted life. It is clearly far from ideal to look back in one’s 40s or 50s, as many do, on what should have been the best years of one’s life, knowing that one’s own lifestyle choices spoiled those years. For this reason, propaganda by the government and healthcare professionals on obesity and lifestyles is undeniably relevant, albeit objectionable from the point of view of individual freedom.
The flabbiness of the average adult body in England—not to mention the increasing flabbiness of children—can even be seen as some kind of figure or symbol of the decline of the nation itself. Take for example, the development of China. In the pre-war period, when China was known as “the Sick Man of Asia”—a phrase that referred to the polity or the economy rather than the health of the country’s citizens—the Chinese people themselves enjoyed poor health. In China’s Guangdong province, immediately adjacent to Hong Kong, life expectancy was only 31 years in 1949, but is now in the mid-70s. Most people in China now get enough to eat, as the economic transformation of the country is mirrored in an improvement in the health of the Chinese people themselves.
If we apply the analogy between the body and society to England, however, declining fitness levels seem to epitomise wider social and economic problems. Have we become the Sick Man of Europe? While life expectancy is pretty high, there are significant areas—whole city districts—where life expectancy is well below the national average. The impact of health on quality of life seems to have become an issue for much of the population. There has got to be something wrong, some kind of dysfunction, in society for such a large proportion of society to be struggling with their weight, and indeed for so many people in England to be drifting through life, allowing life to happen to them, seemingly unable to take charge of the most basic and controllable factor in a happy lifestyle, that is, maintaining control of their nutrition and exercise.
… although the risks of obesity are exaggerated
A glance around the streets of Britain is enough to show that there are many very fat people in our country, and that even adults who are not obese are generally larger than they would have been some decades ago. Britain is also noticeably fatter than most other countries. To a certain extent, obesity is a phenomenon of a wealthy society—and so larger people are becoming more evident in countries like China—and also a function of demographic ageing. A richer and older society is likely to be, on average, a fatter society.
It could also be that obesity as a problem is exaggerated, and that a wealthier society ought to accept the presence of a higher proportion of large individuals. Obesity is partly definitional. The idea that the weight of every individual can be assessed according to the body mass index (BMI) formula seems arbitrary at best, and has led to clearly healthy children, within normal weight ranges for their ages, falling under the attention of the ‘body police’ in schools. The BMI is worked out by dividing a person’s weight in kilograms by the square of his height in metres: any result over 25.0 is deemed overweight, and any result over 30.0 is deemed obese. It is acknowledged that such formulae are not applicable to bodybuilders or the very athletic—who have a higher proportion of relatively heavy muscle in their bodies. The BMI formula also fails to allow for differences between men and women (men and women of the same height are both required to fall within the same weight range) or differences between racial groups (with lower average BMIs in Asian populations). It is worth pointing out that any alternative formula (the US military recommends a body fat percentage of 18% for men and 26% for women) would also be arbitrary.
That there is little scientific analysis behind the BMI definition is shown by the fact that nutritionists now believe that being slightly overweight is good for a person’s health. It has been reported in the British press that, in terms of cardiovascular risk, there is no additional risk for people with BMIs between 25.0 and 27.5. Other studies have shown that life expectancy is higher for people who are “slightly overweight” than for the truly obese or even those within the prescribed weight range. This raises the question why we are being encouraged to fall within such a narrow range of weights: how can it be overweight to have a BMI of 27 if studies show life expectancy is better for individuals in this weight range?
It seems likely therefore that hysteria surrounding obesity is at least as much of a social problem as obesity itself. No-one would seek to deny that weight ranges above 20 stone are associated with heart attacks and many other health problems, but it is as absurd for health professionals to claim that a six-foot man is endangered by weighing 14 stone as it is for the same group of “experts” to claim that passive smoking is a risk to non-smokers. For those who are in dangerous weight ranges, the problem should be reconceptualised for what it really is: a personal problem, and not a problem for the whole of society. What we eat and how much exercise we do has to be fundamental to liberty. Claims that society is getting steadily fatter are also wide of the mark: logically, there has to be a limit to how fat the average will get, and figures for the UK show that the average has indeed peaked.
Obesity as a charge on the NHS
The promotion of obesity as a society-wide problem has its origin in the managerial state. The current prime minister, David Cameron, said in 2009 that he aimed to rename the Department of Health the Department of Public Health. This fits a longstanding trend for health professionals to involve themselves, not just in the treatment of sick individuals, but also in propaganda relating to health prevention. It is argued that the obese waste taxpayers’ money by requiring more healthcare than would otherwise be the case, thus justifying state propaganda in the area.
Statistics on the costs to the National Health Service (NHS) occasioned by obesity seem subject to manipulation. In May 2011, Mr Cameron stated that obesity costs the NHS £4bn a year, a figure he said would rise to £6.3bn by 2015. These slightly inaccurate figures seem to be derived from the Department of Health’s Foresight Tackling Obesities: Future Choices Project, which claimed NHS costs from obesity would be £3.9bn by 2015, with NHS costs from “elevated BMI” rising to £6.4bn over the same timeframe, and the wider economic costs of elevated BMI reaching £27bn by 2015. The methodology behind such calculations is questionable, as it includes people with conditions in which obesity is a contributory factor, as well as the direct treatment of obesity. The cost of drugs used in the direct treatment of obesity was only £47m in 2009, around 1% of the figure that it is claimed represents “NHS costs of elevated BMI”. Given that the role of elevated BMI below the level that is defined as actually obese has been increasingly called into question, it seems these figures are just an exercise in scaremongering.
Logically, obesity will cost the NHS something, but as long as there is an NHS it should occupy itself with the treatment of all the people of this country, and not with pointless propaganda on obesity, which is unlikely to make the population slimmer. Most of the health authorities in England have had to buy several super-strength “bariatric” ambulances to transport people weighing up to 70 stone, but the health service should simply have the equipment it needs to treat the people it comes into contact with. It is highly unlikely that the average weight in the UK will balloon up to 70 stone, but equally unlikely that media coverage and political propaganda will help in reducing average weights. Were people to be required to take out their own insurance in a post-state healthcare system, clearly the morbidly obese might be required to pay more, and hopefully a culture of self-responsibility would take hold, but as long as the NHS exists it should stop diverting funds from the treatment of patients into health propaganda.
Does the obesity industry give good advice?
Government studies show that only £116m was spent on obesity prevention in 2006/07, a small figure in the context of wider healthcare-related public spending in the UK, but still enough to provide a good living to “experts” in the field. More significant in terms of benefiting from the focus on obesity is the diet food industry, which now offers low-fat versions of most foods, as well as the various clubs that claim to be aiding slimmers to lose weight. This amounts to an industry in obesity-management advice straddling the public and private sectors. Yet it is questionable whether these experts, who have generally encouraged low-fat diets, have been giving the people of this country good advice on how to lose weight.
Firstly, the focus on low-fat foods has meant a proliferation of high-carbohydrate foods that have replaced fat with sugar. A glance at the labels of low-fat foods shows that they are generally full of carbohydrates, and if it were the case that consumption of low-fat, high-carbohydrate foods tended to help people lose weight, the British would be a nation of stick insects by now. This has led to something of a revolt in the dieting world, with the Atkins Plan and others now claiming that the secret to losing weight is cutting out the carbohydrates, as the body uses glycogen stores before fat, and so a diet high in carbohydrates tends to prevent the burning of the fat stocks that is required before a slimmer can change shape. There is a lot less prepared food that is appropriate for strict followers of the Atkins Plan—eggs, bacon, chicken, fish, beef, cheese and wine seem to be the only things that can be consumed on Atkins—but the undoubted results of the Atkins Plan have upset the obesity industry, now that the waters of expert advice have become considerably muddied, as the proponents of Atkins recommend a diet that is 100% at odds with the rest of the obesity industry professionals.
The result for the average person is simply confusion. Once it was fats that should not be consumed; now it is carbohydrates too, with some fats labelled “good fats”. It seems hardly surprising that very few of the long-term dieters in the country have managed successfully to stave off an expansion in their waistlines. One could make a much more compelling argument that the rise in obesity has been caused by the war on obesity, by encouraging people to constantly adjust their food intake, with metabolic rates thrown into constant flux as a result. One thing is clear: once a diet has been begun, it has to be stuck to, otherwise the dieter will gain a stone or more on the rebound once normal eating is resumed. It is this that probably explains the phenomenon whereby the most determined dieters seem to be the ones getting steadily fatter.
Exercise advice is also frequently wide of the mark. We need to exercise more, we are told, but generally an hour on the treadmill will not result in a change in body shape. This is because at least four hours are required on a treadmill in order to lose a pound of fat. Those who are not training at an Olympic level of intensity are very very unlikely to lose any weight at all in a gym.
Another solution propounded by some experts is obesity surgery. While libertarians are likely to approve of anyone having whatever surgical procedures he can afford—and hopefully pay for himself in the case of elective surgery—some of the surgical interventions on offer are of dubious efficacy. The gastric band operation that reduces the usable part of the stomach has been the choice of a number of celebrities, leading to fascinated media discussion as some of them appeared to put on weight following the operation. Such operations limit intake of certain types of food only, and are unlikely to limit consumption of ice cream and other easily digestible foods.
Obesity as badge of class
In one sense, it is rather sad that so many people in this country are spending so much money on diet foods, gyms—and even radical surgical interventions—with apparently little to show for it in terms of results. Why is the whole nation obsesses with body shape? It seems what is just a technical detail of life—variation in body shape and the (confusing) facts relating to nutrition—has become a badge of social class. Repulsive images of feckless welfare scroungers who cannot leave their homes, owing to the narrowness of the doorways (or the girth of their bodies), are relayed relentlessly in the media, dressed up as social concern. Clearly, there are rotund people in all social classes, but anecdotal evidence suggests that the more economically disadvantaged sectors of the population are proportionately more likely to “let themselves go” in terms of putting on weight. With whole cities, such as Rotherham, in the poorer North, attracting interest due to their weight problems, it can be seen that broad geographical and social faultlines underpin the rise in obesity in England.
There are two aspects to the cultural promotion of an obesity panic: the self-confidence such a campaign gives to the ruling elite; and the discouragement it generates among the obese, particularly among the working poor and those on welfare. From the Gramscian perspective, a social elite rules by virtue of cultural hegemony, not merely by force, and the rise of the therapeutic state seems to have replaced the nation-state in terms of providing ideological support to the ruling elite. The nation-state was a free country, where the state intervened more or less over time, in line with shifting geopolitical and economic objectives. But at no time did the nation-state intervene in the intimate fashion that is now being pursued by the therapeutic technocracy. Our most personal characteristics, which is what weight data are, are now subject to the tut-tutting of officialdom, which aims to measure the weight of all children in schools, to monitor the content of children’s lunchboxes at school, to remove children from homes where parents have allowed children to become obese, and to subject the nation to blanket discussion of body shape in the form of daily coverage on television and in the press. More important than the creation of jobs for health professionals taking part in the obesity campaign is its role in the creation of a world-view for the middle class, who see society through the prism of the therapeutic narrative.
This is a very clever form of cultural hegemony, as it humiliates the objects of state power—in other words, us, or the people around us. The real message of the obesity campaign relates to appearance rather than health, which is probably why the higher, but still healthy, BMI ranges fall under official disapproval. Those who are obese are, we are told (and it is difficult to disagree), ugly and repulsive in appearance, and are so through their own failings. Such people can hardly be proud of their human failings, and so prefer to hang their heads while the daily discussion of obesity is proceeding instead of demanding the right to manage their own lives. Those who are svelte are empowered by the continual berating of the obese, as it gives them a sense of moral superiority. While libertarians are not opposed to social inequality, to the extent that it emerges in free competition, cultural hegemony finds ways in which to justify the specific form that social inequality takes in any society. Could a 20-stone unattractive woman who has never held a job really dispute her position at the bottom of the social pile? Surely she knows she is where she is because she belongs there. Hence, what is an empowering discourse for the elite is a disempowering narrative for the “underclass”. It does not really make any difference that there are overweight people of all classes. As with all badges of social class, the final determination of one’s position in the pecking order is a combination of factors. The media then fill in the blanks, associating “fat” with the benefits culture and with poor parenting and with racism and a host of other negative traits to paint a picture of the undeserving poor.
There are clearly a range of cultural factors in the emergence of mass obesity, including food prices, the national cuisine (fish and chips are said to be less healthy than Mediterranean diets), and, I would argue, the tendency of the Anglo-Saxon cultures towards self-righteousness and sanctimony. The very promotion of the anti-obesity campaign probably plays a role in increasing obesity, as it enforces the constant diets and also demotivates the overweight. Once the overweight fail at several diets, they becomes losers, not just in the eyes of society, but, more importantly, in their own eyes, and so they adapt to and accept their status in society. Once obesity takes hold as a widespread social phenomenon in the working class, it retains its stigma, as an undesirable body characteristic has to, but it becomes no longer unusual to be obese, and so those who are obese can let themselves remain obese.
There are doubtless other social trends at work that encourage the rise in obesity. The rise in welfare dependency has created a social class running into the many millions who never expect to have to find work. Their expectations in society are minimal. It would be extraordinary for such people to find it within themselves to put great effort into life, and so, unsurprisingly, it seems that many such people have stopped trying in life. To this extent, obesity is largely in the mind: once people can no longer find the resources within themselves to struggle to better themselves, they are likely to decline on all fronts. People who have reconciled themselves to being obese have given up in life, and it has to be alarming that we are living in a society where the numbers who have so given up are so high.
The factors encouraging people to stop expending effort in what is their only shot at life range from the economic to the social, political and cultural. High property prices and low wages offer little in the way of incentive to the unskilled, who might as well adopt a less frenetic life on benefits. That immigrants have been brought in in such large numbers, as employers are said to believe that unskilled immigrants are harder-working than our native unemployed, has made it easier both for the state and for those on welfare for things to continue as they are. In social terms, the demise of the traditional family has also had an impact on households, as more single-person households are found and mothers or wives frequently have to go out to work. Meals should be a social occasion, shared by the family, and not a solitary affair performed in front of the television.
However, I would also argue that the discouragement of society by means of the promotion of multiculturalism and immigration has had a demoralising effect on the disadvantaged in England. In a nation-state, all individuals are part of the national story: we learn how “we” invented the steam-engine and how “we” conquered India. The post-national discourse is relentlessly negative, amounting to a blackening of the nation and its part in history, with no cultural bonds in place any longer to tie the lower orders to their social betters. The end of a national culture means we no longer live in a society, but in an economy alone. Those who are upwardly mobile in the economy have money, status and the motivation to put forth effort in life. Those who have no money are on the margins of national life culturally too. The underclass sense that they are society’s baggage. In other words, they are individuals whose very existence is bothersome to the elite, which is aiming to create a multicultural society. Quite simply, the English underclass correctly perceive and internalise that they are not wanted. Their cultural disempowerment becomes a psychological factor holding them back in life.
Of course, individual people should take charge of their lives, and there is no better place to start than with nutrition and exercise, because these areas are limited enough in scope to be managed by an individual person. But self-respect, which is what keeping fit comes down to, also requires us to demand the right to manage our own lives ourselves. People should not be told what to eat and how often to exercise, and parents should have an inviolable right to bring up their own children (other than in cases of child abuse). Obesity-related charities should be deregistered and told to function as commercial companies, if at all. No funding at central or local government level should be available for propaganda on obesity. The welfare system should stop subsidising the decline of the traditional family. English people should be encouraged to take pride in their national history and culture and to see themselves (correctly) as rather special in the history of the world as a result of our national achievements, and the state-funded promotion of cultural shame (also known as multiculturalism) in our schools should cease. The personal and psychological effects of social demoralisation vary from person to person, but cultural pride forms parts of what makes people aspire in life. These policies would probably be beneficial, but, in the end, we must never forget that a fat, but free, society is preferable to a slim one that is constantly intervened in by health, media and state experts.