My Mother’s memory lives on in the minds of those for whom she cooked. Her chocolate cake with its moist sponge layers haunts the taste buds of my best friend, her custard creams melted in my Father’s mouth, the smell of her macaroni cheese (Scottish variant) bubbling in the oven dish lingers in my nostrils, the mushroom vol-au-vent filling the highlight of Hogmanay hospitality when our neighbours came across for a nip of whisky. Her cabbage and onion, the stovies (I preferred them plain, without corned beef), the peelings she gathered from carrots, Swedes and potatoes to rot benignly on the compost heap. Food will forever be connected with nurture, with the sacrificial act of care, of painstaking preparation, the treat (the bar of chocolate that awaited me on the sideboard on arriving home from an arduous day at school). My daydream interrupted by a passenger taking the seat next to me on the bus, grudging the intrusion of a small part of my thigh over the arbitrary dividing line.
The social penalties of obesity are distressing and debilitating. We are subjected to a thousand petty ostracisms from seat sizes to the contents of clothes racks stopping before our size (segregated shopping for garments thus depriving us of one of womanhood’s sanctioned pleasures, the group outing to the High Street. The feelings of awkwardness at dragging them into the cramped quarters of our specialised outlets compounding the sense of exclusion they are oblivious to when we are expected to shower them with approval as they emerge from the changing rooms in a seemingly limitless succession of fashions. In stark contrast moreover to the three or four outfits that suit us if we are lucky). Constant prods to remind us (as if the looks of disgust and barbed comments from strangers did not constantly torment us) that our bodies exceed “normal” boundaries.
With the erosion of solidarity and the balking of the state at its welfare commitments, we are confronted with the paradox of ever-increasing regulation and surveillance on the part of government accompanied by ever greater reluctance to spend on care, the latter based on a pathological reluctance to increase taxes for fear of alienating the middle classes (whereas the hyper-rich, individuals and companies, more easily able to survive pressure on their accumulated fortunes, are lauded as generators of wealth – to attract new investments and protect jobs, we are told, we must not put the squeeze on them, profiting from our anxieties and insecurities). So the polarisation gains further momentum: the precariousness of employment in sectors once believed to offer rock-solid prospects unnerves us, renders us compliant, forget the final salary pension schemes, they constitute too great a drain on business, be prudent and save. The prospect of plummeting into the “underclass”, trapped on a “sink estate” where the shops have boarded up windows and gangs of knife-wielding teenagers prowl the dirty-needle-strewn streets provides a powerful incentive to tolerate any imposition on the part of our “superiors”. Thatcherism’s denial of structural inequalities triumphs in the rhetoric of “lifestyle choices”, so that the poor have only themselves to blame and their “betters” can congratulate themselves with impunity, their indifference to the fate of the less fortunate given moral justification.
The welfare state, so vaunted as the “European social model” was originally conceived to take care of the vulnerable, to compensate for inequalities, to redistribute benefits. The snobbery and prejudice concealed within the specious classification of “deserving” and “undeserving” was abandoned for a brief interlude of enlightenment when the population was in dire need of being replenished after the war. This particular expression of ill-informed condescension, callousness and contempt has returned in consumerist guise more virulently than ever before (compounded by the analytical tool of class falling out of favour). The sanctimoniousness and hypocrisy that pervade the debate about “self-inflicted” conditions (for which read lung cancer and diabetes inter alia) are particularly offensive. Drinkers and smokers pay a vast fortune in contributions to the Treasury in excise duties. If these were ploughed back directly into the NHS instead of being sucked into the black hole of government debt-servicing (or wherever the money ends up) there would be no need to contemplate the rationing of treatment. To refuse a patient care on the grounds of moral deficiencies (“she knew the risks and still persisted in puffing forty a day”) makes a mockery of any notion of equality, penalising those least able to transfer to the private sector (although, I reiterate, why should we if the health “service” was supposedly founded to assist us all regardless of whether we conform to a narrow definition of the “acceptable”?). Similarly, rumours abound of a tax on chocolate: why not tax the food manufacturers instead of punishing those of us who seek temporary solace from life’s buffetings in the sensation of Dairy Milk melting on our tongues?
The moral dimension has its utility for those who seek to keep costs down through deferring the onset of illness as long as possible (and who invariably bully the fat, equating extra inches with impending demise – as betrayed by that charming descriptive label “morbidly obese”). Not only does skinniness supply a compensatory mechanism to quell disaffection (“I might have been made redundant, but at least I haven’t let myself go”), but taking a pride in one’s appearance, reaping the rewards of complying with the standard has less obvious advantages for our elected masters. In her brilliant exposure of the ongoing oppression of working-class women and their resistance to being constituted as fair game for others to look down on Beverley Skeggs discusses compulsory (unpaid) placements for young mothers ostensibly to enhance their domestic skills, but in reality to make up for the shortage of servants in middle-class homes at the beginning of the 20th century. They were to develop a taste for drudgery and be grateful for the opportunity. Skeggs points out: “(…) how pleasure was used as a form of productive power. By trying to teach working-class women to take pleasure from bourgeois domesticity they could be induced to do it without direct, obvious control (…) if pleasure can be gained from that which is oppressive it is far easier not to notice the oppressive features of it. It also means that the women could produce themselves as acquiescent, rather than being produced by state regulation. The roles of the ideal woman were also productive, as they gave to women particular moral significance and responsibility, which gave them status, self-worth and pleasure” (Formations of Class and Gender, London, Sage, 1997, p46, emphasis in original). Similarly: “(…) the transmission of advice by the State [cf. statutory health warnings on cigarette packets, which some administrations are considering introducing on confectionery wrappers] is the means by which control of the family, and ultimately control of the population as a whole, is won. It is not a repressive intervention but an invitation to authority. Advice, like pleasure, represents a form of ‘positive power’ whereby power is exercised through norms, disciplining, manipulation of the conscience as opposed to power that operates through rules, prohibition and repression” (Skeggs, op. cit., pp47-8). Thus governments are free to reserve their more spectacular methods of repression to minority groups (by approving legislation to lock terrorist suspects up for months without charges, for example), bringing the rest of us in line in slightly more subtle, but equally insidious, fashion.
If that doesn’t work, however, there are always the more overt intimidation tactics: censure, abuse, revulsion, exclusion. Small wonder that reluctant dieters are unhappy, coerced into artificial deprivation in the midst of cornucopial abundance. We are all caught in a tug-of-war of conflicting impulses, the moral imperative to stay slim and the economic imperative to succumb to impulse buying as long as our credit cards have not maxed out. Advertisers have thrived on exploiting temptation as market niche and marketing strategy (they sell us things we don’t need, yet our entire economy would collapse if we were to pay their blandishments and crude appeals to our longing for status no heed). The obese are the victims of this exercise in dissimulation, viciously denigrated for our recalcitrance, our chronic “lack of discipline”. The drinker can camouflage the evidence of secret swigging on his breath. There is no extra strong mint to conceal our “vice”. We “wear” our weakness on our sleeve. Fat as a physical attribute is being constructed as the property of a single class, the “losers”, the “failures”, the pariahs (a moral category to which very few would voluntarily wish to belong, often conflated with the seething masses of the uneducated and poor, an economic categorisation, the spectre of being engulfed by which strikes such terror into our “superiors”). Make no mistake: fat is confused with sluggishness, immobility, being trapped, the opposite of the ethereal lightness and freedom, which supposedly encapsulate the postmodern reality.
Against this backdrop, “dissolving” fat effortlessly and painlessly is held up as the ideal. No remedy is too desperate to alleviate the suffering caused by failing to “fit in”. Jenny Hope (Daily Mail, 15th April 2005) heralded the latest such miracle cure in Wonder pill for slimmers ‘on the NHS next year’: “A ‘wonder pill’ that helps patients lose weight and give up smoking could be available on the NHS next year.
Clinical trial results show the multi-purpose drug cuts bodyweight by up to 10 per cent within a year as well as doubling the success rate of smokers trying to quit.
The drug, called Accomplia, could also slash the toll of heart disease by boosting ‘healthy’ blood fats and cutting dangerous ones”.
She quotes Dr David Haslam, chairman of the National Obesity Forum: “Although the cost of the drug has not yet been decided, Dr Haslam said it was ‘too expensive’ not to treat obesity. He added: ‘I’m optimistic because the economic case for treating obesity is so good. It can cost tens of thousands of pounds to treat a heart-attack survivor, or one person having a stroke, which was caused by the health problems related to obesity.
‘The cost of obesity drugs is a drop in the ocean by comparison’.
He said the multi-purpose drug would also save the NHS money by allowing patients to come off drugs for single conditions, such as blood pressure.
Results from a clinical trial published today in The Lancet medical journal show that taking a daily 20mg pill of Accomplia resulted in 40 per cent of overweight patients losing 10 per cent of their bodyweight.
In the trial of 1,500 patients in six European countries, a similar number lost 5 per cent of their bodyweight.
One third of patients took a dummy pill but only 12 per cent of them lost a tenth of their bodyweight – and they were more likely to drop out of the trial.
Most patients taking part had pot-bellies, carrying a high level of abdominal fat that increases the risk of cardio-vascular disease.
The drug increased levels of HDL, the protective good cholesterol, but triglycerides (harmful blood fats) fell.
Those who took the drug were also less insulin-resistant, making them better able to control their blood sugar levels. All the patients were asked to cut back by 600 calories a day but researchers said this accounted for only half the weight loss, which was as high as 20lb.
Side-effects included minor nausea, diarrhoea, dizziness and vomiting.
Since the study was carried out, further trial data on two years’ use has been released showing that much of the weight loss was maintained.
One in three patients lost 10 per cent of their body weight and 3in off their waists. Previous research found one third of heavy smokers treated for ten weeks stopped smoking.
Dr Haslam said: ‘The weight loss is very significant, yet it is only part of the benefits. Most importantly, there is a big reduction in waist circumference which is a marker for visceral fat, the fat in the abdomen which is particularly dangerous. It pours out poisonous substances which push up cardiovascular risk’.
Accomplia is the first of a new class of drugs called selective CB1 blockers. It works by blocking the primeval circuitry in the brain that regulates hunger and other urges such as alcohol cravings.
Dr Haslam said the data suggests the drug can safely be taken long-term, and some patients may need to use it for life.
‘When people stop taking it, their weight tends to go back where they started,’ he said”.
A lifetime of dependency on a chemical cocktail is therefore depicted as a breakthrough in keeping NHS costs down. Side effects a minor nuisance. The bean-counting mentality has taken root without so much as a whimper of protest. The pathologisation of fat continues unabated.
Julie Wheldon, in Fatbuster free-for-all, (Daily Mail, 29th September 2005) highlighted the scepticism of the medical profession triggered by losing their monopoly on a body of knowledge (which they correctly identify as the source of their social standing and power): “A powerful obesity drug has been made available over the counter.
Patients wanting to lose weight using Xenical previously needed a doctor’s prescription. But now they can simply go to Boots.
GPs expressed serious concerns about the scheme yesterday, warning that pharmacists would not have the necessary information on patients.
They also warned some patients may opt for the drug instead of trying to lose weight with diet and exercise first – the usual prerequisite for a prescription.
Xenical, also known as Orlistat, inhibits the absorption of fat in the intestine so the body excretes it instead. Users must stick to a low-fat diet, or face unpleasant side effects, including loss of bowel control.
The National Obesity Forum advises that only those who have tried for three months to lose weight through changing their lifestyle should receive the drug.
Now patients will be able to sign up for it at around 100 branches of Boots across the country.
They will have to enrol in the company’s weight loss programme, which costs £10 a week. They must also be classed as obese (…) As well as being able to get Xenical, they will also be advised on nutrition and how to increase their activity levels.
Boots said patients’ blood pressure and glucose levels would be measured before they receive the medication.
It said a pilot scheme in Manchester had been a success, with customers typically losing 6.5 per cent of their body weight over three months, increasing to 13.4 per cent after nine months.
Steve Churton, assistant pharmaceutical superintendent at Boots said: ‘People often don’t like going to their GPs about weight loss. By having this programme available through consultation with a pharmacist we are making it more accessible for those who want to try this effective approach to losing weight’”.
I have a certain degree of sympathy with Mr Churton, as it can be extremely unpleasant being chided by the doctor for one’s weight on every single visit for completely unrelated conditions, such as a dose of the sniffles. Self-medication is probably also unwise (fat hatred being so pervasive in our culture that underweight girls might be unable to resist purging their emaciated frames further). Mr C is, of course, staking a claim to expertise by chemists (a challenge to doctors’ exclusive rights to determine what is appropriate to improve a patient’s well-being) and, by linking the dispensing of the pill to attendance at classes, is casting a canny eye on a sure fire gain business opportunity. It is the refusal to even entertain the notion that not every overweight person is a heart attack waiting to happen within the wider context of body-loathing that contributes to our misery.
The holy grail of guaranteed weight loss, holding out the hope not of eternal life but the more earthly consolation of an eternally swelling bank balance has fired the imaginations of inventors since fat phobia was elevated to respectability. Richard Simpson, in How a wetsuit and a vacuum cleaner helped Anna regain her figure, (Daily Mail, 28th September 2005) attracted readers by the mention of a celebrity: “The speed with which Anna Friel regained her figure after giving birth to her first child did not go unnoticed.
Now the actress has revealed how she did it – with a wetsuit and a vacuum cleaner.
While the props might suggest a bizarre and potentially risky DIY regime, they are actually the components of a hi-tech alternative to liposuction which dispenses with the need for surgery.
Miss Friel, 29, gave birth to daughter Gracie in July and was immediately under pressure from studio bosses to have a ‘bikini body’ in time to film nude scenes by October.
So she turned to a machine called the Hypoxi Vacunaut, which is designed to give its user a non-surgical tummy tuck.
When she works out, Miss Friel pulls on a rubber bodysuit attached by three small hoses to the Vacunaut machine. This sucks out the air between the body and the suit, creating a vacuum around the stomach which is said to increase blood flow in that area.
The manufacturers claim the extra blood absorbs fat, which is metabolised and excreted in sweat, which in turn is sucked out by another of the hoses”.
Apparently she tortures herself on the contraption five times a week. This is the price of fame, unrelenting combat against the onslaught of time (and age) on the metabolism, scrutiny, monitoring, vigilance and never succumbing to a so much as a square of Belgium’s most popular export.
He continues: “It should, incidentally, be noted, that Miss Friel was given free loan of a Vacunaut machine at her home. Sessions normally cost around £400 for 12. She is not paid to endorse it.
Medical experts are unconvinced of its merits. Nutritionist Ros Kadir said: ‘I would be very sceptical about such claims. It reminds me of the old days of the sweat pants where liquid is simply sweated off – but replaced the next time you have a drink. The vacuum machine would have to be awfully powerful to draw blood into the area, and if it does that, I am concerned it would lead to burst blood vessels and internal bruising.
‘There are no short-cuts to weight loss – you just have to eat less and do more exercise’”.
The very next day (29th September 2005), a companion piece, The Vacunaut Report, appeared in the same paper, with writer Erin Kelly (29) giving it a test drive: “I’m walking on a treadmill dressed in a hugely unflattering black and red rubber suit, from which protrude tubes attached to a vacuum machine.
Welcome to the weird world of Vacunaut, the hi-tech exercise machine that’s whipped Anna Friel back into shape after the birth of her daughter, Gracie, in time to film sex scenes for her new film.
This futuristic regime took 20 years to develop and is the brainchild of an Austrian sports scientist called Norbert Dr Egger. A neoprene body suit is attached by three small hoses to the Vacunaut machine.
When it’s switched on, it removes the air between the body and the suit to create a low-pressure atmosphere, providing a vacuum around the stomach area.
This pulls blood directly into fatty tissue. The blood absorbs the fat and uses it to power the muscles during controlled exercise. The fat is metabolised and is then excreted through sweat, which is sucked out by a hose.
It bills itself as an alternative to plastic surgery. According to my instructor, who has an encouragingly trim tummy, the suit is padded with a network of 122 pressure chambers which are located in and around the abdominal and hip area.
Constant changes in pressure inside the suit mean the blood becomes enriched with fat from the stomach area, which is then burnt off as you exercise.
I’m simply expected to walk briskly while the treadmill is on an uphill setting.
Airtight at the wrists, neck and knees, the suit is stretchy but bulky, and I have to be helped into it and zipped up at the back by an instructor. It doesn’t smell particularly fresh. Maybe Anna Friel has her own personal Vacunaut suit which one of her celebrity assistants washes out overnight so it’s laundry-fresh every time she works out, but mine has a distinct locker-room whiff about it”.
In case you were wavering over whether to shell out: “The suit is made of hi-tech, man-made fibres, so inside it’s scratchy and sweaty. I instinctively want to tug at the tight neckline to let some cooling air circulate, but that would stop the vacuum effect and defeat the object of the exercise. I catch a glimpse of myself in the mirror opposite: my face is shiny and rapidly attaining the same pillarbox red hue as my suit. The results may be glamorous, but the process certainly isn’t.
However, after my first sessions, I do feel a little lighter around the middle and I’m surprised to see that I’ve lost an inch from my waist, dropping from 29in to 28in. But I wonder how much of that was water. I also wonder how much of the weight loss is down to the diet regime my instructor gave me: it involves eating lightly, not combining protein and carbohydrates, cutting out most sugary foods, avoiding certain vegetables which can cause bloating and all alcohol and severely limiting caffeine intake.
On such a puritan regime, who wouldn’t notice a slightly flatter stomach?”
Indeed. It is pricey, at £25 a session. The intrepid investigative reporter quizzed Lisa Worrell (21), an administration officer about why she puts herself through it: “So how did it come to this? The answer is that like most women, I was desperate to shift some stubborn weight from my stomach. I’ve always had a weakness for chocolate, but apart from that my diet is reasonably healthy and I avoid fatty foods.
So, when my stomach started looking distinctly bigger and a ’spare tyre’ appeared over the waistband of my jeans, I knew that my weakness had got the better of me”.
“Once you have finished the course, you are advised to eat in the same way and do ‘ordinary’ cardio-vascular exercise for three 30-minute sessions every week to keep the inches off”.
Ms Kelly herself was keener, but if her tempered enthusiasm did not persuade you to give it a whirl (or a conveyor belt jiggle) why not try the latest surgical technique? Roger Dobson (Daily Mail, 20th December 2005), in Desperate to lose some weight? Just swallow a balloon, sings the praises of the latest “advance”: “Swallowing a balloon could soon be the answer to a dieter’s prayers. The therapy works by curbing appetite in the seriously obese – and results of a recent trial have been startlingly good, with patients losing significant quantities of weight in just three months.
It is particularly exciting as it offers a non-surgical alternative to gastric bands and stomach reduction procedures – both of which are major operations.
Doctors first carry out an initial examination of the stomach with the help of an endoscopic camera, to check for abnormalities or obstructions.
The deflated balloon, made from a soft silicone material, is then fed down the throat and into the stomach.
Anaesthetic is put onto the surface of the throat to numb the tissue while the balloon is swallowed. Muscle-relaxing medication may also be used.
Once in place, the balloon is filled with 500ml of saline through a small tube that also goes down the throat and which is attached to a self-sealing valve in the neck of the balloon.
The tube is removed when filling is complete and the balloon floats around the stomach safely.
Once it is filled, the balloon is too big to get through the valve from the stomach to the bowel.
The trial by doctors in Rome shows that the whole procedure took only 10 to 15 minutes.
The idea is that the balloon reduces the working size of the stomach, without surgery. The theory is that the patient feels fuller and less need to eat.
The balloon has been designed to be used for six months. Any longer than that could be problematic as the acidic content of the stomach could have an effect on the silicone material. But if longer-term treatment is needed, a new balloon can be installed.
In the trial, the balloon treatment was used alongside a 1,000-calorie-a-day diet, and research showed that patients could lose 6lb a week (…)
But successful weight loss still requires effort from the patient.
‘You will have a much greater chance of maintaining your weight loss after balloon removal if you maintain and improve your diet and behaviour changes you made while using it,’ says Inamed [the manufacturer].
The system was designed for people who are at least 40 per cent above their ideal weight and who have failed to get prolonged success with other weight control programmes”.
In case we remained unconvinced by his sales pitch, Mr Dobson attempts to cow us into submission by bandying about the usual statistics: “It has been estimated that obesity accounts for 18 million days of sickness absence from work, and 30,000 premature deaths.
Each man and woman whose death could be put down to obesity loses, on average, nine years of life. Treating obesity costs the NHS at least £500 million a year, and the wider national costs of lower productivity are estimated at £2 billion a year”.
We fatties are so cost-ineffective, maybe we should just all be put to sleep? Oddly enough, if such eugenically-minded schemes ever were regarded as a serious course of action the diet industry may ironically prove our staunchest ally – where else could they rake in such giddying revenues from?
Julie Wheldon (Daily Mail, 5th December 2005) broke ranks with her colleagues for whom diatribes on binge-drinking have become something of a staple to highlight research done at the Texas Tech University Health Services Centre and Mayo Clinic in Rochester, Minnesota, in A few drinks a week ‘are a slimline tonic’: “A little alcohol now and again can help you stay slim, it was claimed yesterday.
Scientists said drinking a few times a week can cut the risk of obesity by 27 per cent compared to teetotallers.
But once drinkers start to overindulge, alcohol can have the opposite effect.
Among women, binge-drinkers and teetotallers are twice as likely to become obese as those who drink in moderation.
Researchers are unsure quite why small, regular amounts of alcohol help to keep drinkers’ weight down.
But their findings suggest complete abstinence may not be the best way to keep trim”.
Clearly, in the league table of transgressions, booze does not score as highly as a few spare tyres: “Scientists looked at more than 8,000 subjects who gave details of their drinking habits and weight as part of US national surveys between 1988 and 1994.
The study examined obesity levels by looking at body mass index – which is arrived at by dividing weight by height in metres squared.
Subjects who drank regularly were 27 per cent less likely to become obese than non-drinkers – particularly those who had fewer than five drinks a week.
But those who consumed four or more drinks a day were 30 per cent more likely to end up overweight and 46 per cent more likely to become obese. Project leader Ahmed Arif said: ‘The data gives no evidence to advise non-drinkers to start drinking alcohol to reduce body weight.
‘However, the evidence argues against complete abstinence among those who regularly drink alcohol’”.
Columnist Johann Hari (The Independent, 31st October 2005) chronicled his tribulations during a curative purge in More than he can chew: “I am a junk-food addict, scoffing KFC buckets and Wimpey Double-Burgers as casually as a butterfly flaps its wings. I may as well have a saline drip running lard into my veins. Once I found an old, cold Chicken McNugget in my bed and, reader, I ate it.
Sure, I tried taking small, incremental steps: every now and then, I would book a personal trainer, but each time, I left in despair after a few sessions. My last trainer handed me a small device that runs an electric current through your body to find out your Body Mass Index. It turns out I’m 35 per cent pure lard. If I were a sandwich, nobody would eat me, except me.
But then, this August, a sliver of salvation appeared on the horizon. A friend returned from a fortnight in a magical clinic in Austria, two stone lighter and eulogising about the theories of one Dr Franz Mayr. The late doctor practices something called ‘intestinal cleansing therapy’.
It’s simple: our bodies are clogged with toxins that damage our health, Mayr said, and they need to be cleansed and given time to heal. Once this happens, our bodies will no longer crave toxins and my pining for chicken popcorn will fade. His latter-day disciples include Sarah Ferguson, who allegedly paid £2,000 to be subjected to his structures for a week. I am a militant proselytiser for science and evidence – but when it came to my own diet, these principles disappeared and I booked myself for a fortnight in the Mayr Clinic”.
Welcomed by guides: “Then I was taken to the ‘restaurant’, and suddenly [Dr Mayr] did not seem so kindly. A bowl – no, a dribble – of soup was placed before me, along with a stale bread roll that had the texture of concrete. The woman next to me whispered, ‘I hear this is our last meal for the whole first week!’ I gave her such a severe glare that she physically recoiled”.
Staff member announced they would be given an eating plan the following morning. The bread a key component of the meals: “I was beginning to panic. ‘Excuse me,’ I said. ‘Why is the bread stale?’ ‘This is a good question,’ the hostess replied. ‘It is stale because we want to teach you to chew’.
Chew? Didn’t I learn that skill sometime before my first birthday? ‘No. Nobody in the Western world knows how to chew. Dr Mayr showed this. Most people today swallow their food after giving it one or two chews, and it enters the intestines very hard. This puts stress on the gut. Here, you will learn to chew each mouthful of food 40 times’. Forty? ‘Yes. Do not swallow anything until it is a thin liquid pulp. And you must not speak to each other or read when you are eating. This is distracting and wrong. You will sit in silence. And chew’”.
In the past, this approach was known as Fletcherism. Verily I say unto thee, there is nothing new under the sun, especially not when it comes to wacky theories about dieting. According to Hillel Schwartz’s excellent (and refreshingly tongue-in-cheek) Never Satisfied: A Cultural History of Diets, Fantasies and Fat, (New York, Anchor Books, Doubleday, 1990, pp124-34), Horace Fletcher had accumulated wealth in San Francisco as a manufacturer of printing ink and importer of Japanese art. An insurance company informed him in 1895 that he was too heavy for his height (5 feet 7 inches), his weight fluctuating between 198 and 217 lbs. His application for life insurance was therefore turned down. Smarting at the humiliation, he began experimenting with weight loss regimes. Schwartz writes: “As a marksman, Fletcher had invented a technique of snap-shooting without waste of effort or ammunition. He applied this to eating; the ammunition was food, the effort was digestion, the teeth pulled the trigger. Chewing was like taking aim.
The analogy was not all that good, since Fletcher’s new method of eating was neither rapid nor effortless. The ‘Great Masticator’ practiced an ‘industrious munching’ or one hundred chews to the minute. Most low-fibre foods could be dispatched in less than thirty seconds of chewing per mouthful, but shallots, for example, could take seven minutes. At dinner, Fletcher might slack off to 2,500 chews over thirty minutes, but generally a meal could be dispensed with after fifteen or twenty minutes and twelve to fifteen mouthfuls. Chewing, or fletcherizing, would convert ‘a pitiable glutton into an intelligent Epicurean’.
Fletcher was a hunger artist who counted movements of the jaw instead of days on the calendar. His was the slow fast of ‘a stomach trained down so fine that it was like a pair of apothecary’s balances, sensitive to the least inharmony’. Even milk and soups had to be chewed before being swallowed” (Schwartz, op. cit., p125).
Not that he had been the first to advocate such a strategy: “Laboured chewing had been directed against indigestion for many years. William Kitchiner in 1822 had specified thirty to forty munches for each mouthful of meat. Across the Atlantic, Sylvester Graham believed that natural foods would oblige people to exercise their teeth and prepare each morsel properly for the stomach, but he did not wax arithmetical (…) In 1885 another whole wheat cracker was put on the market with the specific appeal of being impossible to swallow without great jaw service. It was called, honestly, the Educator Cracker” (Schwartz, op. cit., pp125-6).
Schwartz beautifully captures the ridiculous extremes to which such punctiliousness can lead: “Like fasting, Fletcherism promised a ritual purification of the body. Perfect chewing, like perfect fasting, made the body clean as it made it light. The throat was ordained a filter, not a gullet; anything unable to be swallowed by physiological reflex at the back of the throat was never meant to be swallowed at all. Given the work of the teeth and the saliva, ‘If we swallow only the food which excites the sense of taste, and swallow it only after the taste has been extracted from it, removing from the mouth the tasteless residue, complete and easy digestion will be assured and perfect health maintained’. The more pre-digested the food flowing into the stomach, the less chance of strained intestines, constipation and a disrupted internal economy. We must all be ‘Competent Chauffeurs of our own Corpautomobiles’, and our exhausts must be inoffensive.
Fletcher verged on coprophilia. He weighed his faeces (2oz) and described them in dull detail. Healthy excreta were small and ashy, with ‘no more odour than a hot biscuit’. Since perfect chewing did away with most bulk – Fletcherites were forever pulling fibrous residues from their mouths – ‘there will be no invitation to discharge waste oftener than once in four or five days, when the response will be immediate, easy and final’. Fletcherite ‘mouth thoroughness’ was also an industrial education of the bowels. ‘By George!’ Fletcher exclaimed when criticised for his phrase ‘Dietetic Righteousness’. ‘Is there anything more sacred than serving faithfully at the altar of our Holy Efficiency?’” (ibid, p127).
Returning to the present day, Johann was made to undergo an examination: “‘I think, Mr Hari, we will put you on the T Diet,’ he said. I assumed he had 26 plans, running from A to Z, and he had plucked a special one for me. ‘What does this diet involve?’ I inquired. ‘For breakfast, you will have tea. And for lunch you will have tea. And for dinner you will have tea – with a hint of honey’. ‘Ah,’ I said. ‘And when will I eat?’ He paused. ‘You will eat tea – as you like. But there is a strict limit on the honey’.
I laughed out loud. He ignored me. ‘And I see you take anti-depressants, Mr Hari. You will stop taking them while you are here’. ‘I have been taking them for seven years – they are a serious medication,’ I spluttered. ‘You are at the bottom of a mountain,’ he warned, ‘and you will struggle to climb to the highest heights…’ ‘I am not stopping my anti-depressant without consulting my GP,’ I insisted. He shook his head and replied: ‘Very well. But you must learn this is not a depressing place’.
All my alarm bells were ringing. What sort of doctor was this? I staggered out to begin the Mayr Clinic’s programme of activities. They discouraged vigorous exercise – my philosophy exactly – so I was led to my room to have a rest (after being awake for three hours) and to have a warm hay liver pack laid on my stomach”.
His credulity was stretched to the limit: “Next, my timetable stated, I had an appointment in the clinic’s ’saline cabin’. I was shut into a chamber while simulated sea-air began to slowly surround me. I waited for 15 minutes, breathing this…and nothing happened. I felt exactly the same.
Three days passed in a blur like this, talking to disoriented people, trying useless ‘treatments’, and feeling my stomach digest itself. Soon, I had a Hiroshima-force headache. When I asked for an Aspirin, I was offered a tube. ‘Attach this to the tap and give yourself an enema,’ the nurse said”.
Such unhealthy abstinence naturally did not agree with him: “On day four, I awoke at three in the morning, drooling after a dream where I had drowned inside a gigantic strawberry milkshake. In a frenzy, I gathered up the fluff underneath my bed, and seriously considered eating it. I scampered down to the kitchen determined to raid it, but it had been fatty-proofed: even with all my strength, I could not break into the stock of stale rolls.
Enough. I demanded an appointment with the doctor and told him I could not take this any more. He stroked his facial hair and said, ‘I think you are lacking in courage, Mr Hari’. ‘No, I am lacking in food,’ I replied. ‘Very well. We will give you a meal’. A meal! I nearly kissed him. I went to the restaurant – and was given something that would barely constitute a snack in the outside world – a tiny chunk of pizza. I wept and realised I will never, never be thin.
In despair, I checked myself out. Yes, I was half a stone lighter – but how sustainable was a diet where I eat nothing? How credible was the science of ‘inner body cleansing’ anyway? But perhaps a small part of their theories turned out to be true.
At the airport, I looked at the succulent array of sandwiches and burgers – and something miraculous happened – I craved a fruit salad. I slowly, carefully chewed an array of berries and melons and kiwi fruit and gurgled with pleasure. The cravings for lard had leeched out of my system”.
If concentrated bouts of self-deprivation leave you cold, there is always the magic potion, stuff of fairy tales…Jeremy Laurance (The Independent, 11th November 2005), gave the low down on the results of research by Professor Aaron Hsueh, endocrinologist and expert in obstetrics and gynaecology, in Hunger hormone discovery boosts fight against obesity [note throughout the recourse to military vocabulary – fat is the enemy to be conquered and subdued]: “The discovery of a new hormone that suppresses appetite has been hailed by scientists who said it opened a new front in the search for a treatment for obesity.
The hormone, obestatin, is a sibling to ghrelin, which increases appetite, leading researchers to call them the ‘duelling hunger hormones’.
The find surprised scientists, who believed all the key hormones involved in appetite had been identified. But the discovery of obestatin could explain why treatments based on existing hormones have failed.
Researchers at Stanford University School of Medicine who injected rats with a synthetic version of obestatin found they ate half as much as rats given no injection. The treatment also slowed the movement of digested food from the stomach to the intestine”.
Apparently: “As the ghrelin protein stimulates appetite, scientists expected experiments in animals in which the gene was switched off would depress appetite. In fact, switching off the gene had almost no effect.
The discovery of obestatin offers an explanation. Deleting the gene for ghrelin also takes out obestatin. So the rats lost their appetite-stimulating and appetite-suppressing hormones at the same time”.
Mr Laurance recalls why we might weigh up tampering with our hormonal system: “Waistlines are expanding so fast that within 10 to 15 years it is predicted that obesity could overtake smoking as the UK’s biggest killer. There are 24 million adults who are classed as overweight.
The cause of the growth is an imbalance between the calories people consume and the energy they expend.
Although we are eating 750 fewer calories a day on average than 20 years ago, activity levels have fallen by 800 calories. Out of this small imbalance has come the wave of obesity. Numbers of obese people have trebled since the 1980s, with 22 per cent of men and 23 per cent of women now classed as obese”. How big a percentage of the population do we need to classify as “obese” before obesity is seen as normal? 100%? I suspect that as soon as it exceeds fifty, the threshold for obesity will finally be revised in favour of a saner estimation (the downside of which is that those who still qualify as obese will not have their lives made any easier).
Alok Jha’s article, Hormone raises hope of victory in war on obesity (The Guardian, 11th November 2005) opens more promisingly than most: “Neville Rigby, the director of policy at the International Obesity Taskforce, welcomed the discovery as another example of the fact that there was more to obesity than most people think. ‘It helps understand that it isn’t simply, as people would have it, a question of sloth or gluttony. There are clearly mechanisms at work in the body which differentiate why one person becomes obese while another person seems to be unaffected. As we understand more of the science of obesity, we have more sympathy for the people affected’”. So acceptance of our fellow human beings is conditional on whether we can exonerate them from “blame”, suggesting that they have no innate, intrinsic value beyond obedience to culturally imposed standards of physical attractiveness and constricting moral precepts.
Jha summarises Professor Hsueh’s work in accessible form: “He had been using the results of the human genome project to create a database of hormone receptors for which there were no known partner hormones. He then identified the ones that seemed most important biologically – the ones that have been conserved through evolution across many species.
The hunt led him to the gene that makes ghrelin, where he found DNA instructions for an unexpected hormone tacked on to the end.
Professor Hsueh set out to make the hormone, which he later named obestatin. ‘We purified this hormone in rats’ stomachs and tested its biological activity,’ he said. ‘To our surprise, we found that treatment with obestatin actually suppresses food intake. The food intake [dropped] by more than 50%. Bodyweight is more like 20% down. So the same gene codes for two hormones and these two hormones have opposing actions in bodyweight regulation’.
Prof Hsueh said his discovery had lots of potential uses. ‘Obestatin itself could have potential as an appetite-suppressing drug because one can use this small peptide by injection,’ he said. ‘The identification of the receptor for obestatin can also allow us to screen for new drugs that can also suppress appetite’”.
We have heard such claims before: “Obesity researchers have been here before with another hormone – leptin – which signals the brain to stop eating. In 1995 scientists discovered that, in mice, leptin had a near miraculous effect of reducing bodyweight by nearly a third. For a while it was hailed as a precursor to a wonder drug. But it never lived up to its promise on humans”. What is never questioned is the desirability of weight loss. It is completely inconceivable that someone might be healthy and content as well as flouting convention.
Once the newsworthiness of obestatin has faded in this era notorious for its short attention spans (another spin-off of consumerism whereby only the newest of the new is worthy of spending time, energy or money on), Alok Jha (The Guardian, 3rd December 2005) catalogues the latest big breakthrough in P57. Enough to put you off your food: “The story goes that, when the San tribe of southern Africa felt hungry but had no food around, they would chew on a plant called the hoodia gordonii. A few mouthfuls of this bitter-tasting succulent later, their hunger pangs would mysteriously disappear. Very soon, the plant will begin its journey to a plate near you. The remarkable appetite-suppressing quality of hoodia has attracted the attention of Unilever and, early next year, a clinical trial will begin on the active ingredient, a combination of molecules codenamed p57.
According to research carried out by Cambridge-based pharmaceutical company Phytopharm, the company that owns the worldwide patent on the extract, p57 suppresses hunger so well that it can make people eat 1,000 fewer calories per day compared to their usual diets. For a society facing the burden of a growing obesity epidemic, Hoodia gordonii is a mouth-watering prospect”.
Western culture’s aversion to the annoying distraction of appetites has only been fuelled further by pressure on budgets (not, please note, by genuine concern over our mental and spiritual well-being): “The search for the physiological reasons behind excessive weight gain and for a way to mitigate it occupies teams of scientists and public health officials worldwide. Much of the research has focused on working out which chemicals in the bloodstream control hunger.
There are two classes of anti-obesity drugs coming onto the market. One type, such as rimonabant, targets the areas of the brain which regulate how we feel, so that we end up eating less. The other type, such as xenical, prevents fat from being absorbed by the intestines. Hoodia seems to do neither of these things. According to Phytopharm, it seems to work as a genuine appetite suppressant. Behavioural studies on animals showed that even those which had their appetite severely suppressed by p57 seemed to show no change in mood or behaviour.
Phytopharm initially worked with Pfizer on bringing Hoodia to market. In 2002, a trial on 30 obese adults showed that the intake of people given the p57 extract dropped by 1,000 calories a day. But after spending around $25m (£14.4m), Pfizer dropped their work on the plant. Pfizer wanted to put p57 into a pill, but the extract was too complex to make artificially. In late 2004, Unilever stepped in, and in a £21m deal, said that it intended to commercially grow hoodia, an endangered plant in its native South Africa, and use the extract in its slimming foods”.
The complexities of our biology prove as exasperating to scientists as do the reasons for our recalcitrance in cutting down when we know it’s not good for us (underlying social causes resolutely overlooked, if not deliberately discounted, there’s no saving to be made in regenerating deprived areas where shelf after shelf of tinned and freezer chest after freezer chest of processed, additive-saturated rubbish seems more tempting than a brown, half-rotted cauliflower and the big supermarket chains have a vested interest in weeding out the shoplifters and protecting their premises from vandals, graffiti-artists and similar undesirables by default): “While p57 holds plenty of promise to help people without having to resort to pharmaceuticals, Prof Blundell [director of the Institute of Psychological Sciences at the University of Leeds] said that, as more of the mysteries of appetite regulation are cracked, more targets for treatments will become apparent.
Recently a new hormone was discovered to suppress appetite – obestatin. ‘It’s clear that there are many molecules floating around in our bodies doing things with some functional properties that we haven’t yet discovered,’ said Prof Blundell”.
That the well-meaning (I am being charitable here, as mentioned earlier, the amounts that could be raked in for finding a “cure” for obesity’s perceived ailment are potentially limitless) efforts of the likes of Professor Hsueh should not cause us to hold our breath in anticipation is demonstrated by as a short unattributed piece in the Daily Mail (2nd November 2005), Nature’s taste for fatty foods: “Scientists have come up with the perfect excuse to explain why some people crave fatty foods.
Liking items that are naughty but nice could all be down to the taste buds.
Until now, it was thought we could only experience five tastes: sweet, salty, sour, bitter and umami – the savoury flavour in mature cheeses such as parmesan. But now fat has been added to the list of tastes picked up on our tongues.
Writing in the Journal of Clinical Investigation, researchers from the University of Burgundy in France describe a protein on the tip of our taste buds that makes us crave fat.
They looked at how the protein – CD36 – drives taste for fatty foods in mice.
Two sets of mice were used. One had normal taste buds and one lacked the fat-sensitive protein.
Given the choice of drinking normal water or water enriched with a fatty solution, the mice with normal taste buds preferred the fatty water. But those with defective taste buds liked both drinks equally. The animals without CD36 also showed less interest in fat-laden foods.
The researchers’ findings could open the way for new obesity treatments, based on manipulating our sense of taste to deter people from eating fatty foods.
Other experiments showed that taste buds play an important role in starting digestion.
The mice with fat-sensitive taste buds produced bile, which helps break down fat, more quickly than the others”. Evolution’s harsh dictates hard-wired us for delectation in fry-ups to ensure our perpetuation as a species. We may be sedentary now, but in the days of animal skins and clubs boy did our mouths water at the smell of sizzling bacon (ah, and chips with salt and vinegar).
Deborah Orr, in Cut wheat, sugar and caffeine from you diet – along with enjoyment, (The Independent, 5th November 2005), comments on the emerging trend whereby Angst about acquiring an extra ounce transmutes into extreme fastidiousness about what people permit to pass their lips: “I’ve been troubled for ages by the behaviour around food I’ve noticed among some of the most attractive middle-aged women I know. Slender, toned, with the boyish bodies of teenagers, they are never happier than when browsing through the shelves of health food stores like Fresh and Wild. Constantly absolutely starving, and ever on the lookout for ‘healthy snacks’, they’re never actually on something as naff as a diet – though they might embark on a ‘detox’. But they’re never in much danger of putting on weight either, because virtually all food is off-limits due to its unhealthiness.
Cutting out sugar, caffeine, alcohol, wheat, gluten, yeast and dairy is usually just the start. According to the ‘detox guru’ Dr Joshi, beloved of Gwyneth Paltrow, even tomatoes should be given the big heave because they promote acid in the stomach. Likewise, fruit should only be eaten two hours before or after other food (unless you suffer from candida, in which case it should never be eaten), and proteins shouldn’t be eaten along with starches. Each day should start with a nice refreshing cup of hot water – with organic unwaxed lemon in if you defy the claims that citrus fruits are too acidic and can wait two hours for breakfast.
If this sounds somewhat cranky, you’ll be relieved to learn that one dietary physician at least is prepared to admit that it could even be dangerous. US doctor Steve Bratman suggests that people – particularly but not exclusively women over 30 – are becoming susceptible to a new sort of eating disorder that he calls orthorexia nervosa. Healthy eating, he says, can become pathological, and behaviour around food can become just as disruptive as any other sort of obsessive-compulsive behaviour. This may not yet be recognised officially as a medical condition. But there’s certainly rather a lot of it about”.
She rightly concludes that we are witnessing the birth of a new food-related syndrome not confined to adolescents: “(…) the massive emphasis on faddy diets and the liberation of women for being too fat (or too thin) are spawning new grown-up variations on mental illnesses that were bad enough when mainly confined to the young”.
Martin Hickman (The Independent, 14th November 2005) spreads the glad tidings that the dire warnings of anti-fat propagandists are having an impact in Britons winning the battle against obesity: “Two thirds of adults say they have improved their diet or exercise over the past year in a sign that the Government may be starting to win the war on obesity.
A poll of 2,000 adults for the National Consumer Council found that 63 per cent had changed their behaviour in the past 12 months with the deliberate intention of becoming healthier.
In an indication that the healthy eating message is getting through, the respondents were eating more fruit and vegetables, shunning salty food and cutting down on convenience meals.
If applied to the population of the UK, the findings suggest that about 30 million adults have tried to become healthier.
However, some groups, of society – the poor, the old and people living on their own – do not yet seem to be changing their diets.
The survey found that more women (66 per cent) than men (61 per cent) were likely to have changed.
Women under 34 were more likely to have sought out healthier ways while men over 55 were least likely to have made changes.
Almost half (45 per cent) of the people on lower income groups D and E had not changed their lifestyles”.
Robin McKie (The Observer, 16th October 2005) on the other hand reinjects a note of gloom in Health experts agree – emails are fattening: “Doctors have hit on a cunning plan to transform fatties into slimline wonders: stop sending emails.
Health experts believe millions of hours of vital exercise are being lost every week thanks to the explosion in electronic messaging.
Once we walked to a colleague’s desk to pass on a filthy joke or reveal what the boss and his secretary were doing on the photocopier room for three hours during the Christmas party. Now it is easier to tap a short note on the computer, hit the send button and the world knows in seconds what has happened. It’s great for gossip: bad for the figure.
As a result, Sport England, as part of its Everyday Sport campaign, is launching Email-Free Friday this week. Employers, it says, should introduce a ban on internal emails and get staff walking around their office – presumably to complain that they can no longer send emails.
‘We’re losing millions of hours of exercise through the explosion of email,’ said Dr Dorian Dugmore, a health adviser to Sport England. ‘People email colleagues who sit next to them, never mind those who work on the other side of the office. We have to change people’s lazy attitudes’. Increasing activity levels by 10 per cent could save 6,000 lives and £500 million per year, as well as leading to one million fewer obese people in England, it is argued.
The idea also reveals a growing antagonism felt by many bosses to electronic messaging. John Cauldwell, chief executive of Phone 4u, has banned his 2,500 staff from using email in the office. ‘We have email paralysis’, he said. ‘If you have a cancer, you have to cut it out’”.
The same subject matter treated in the Daily Mail (unattributed,17th October 2005), Weighty problem of workers who e-mail instead of walk, rounded out the picture: “[Dr Dugmore] said deskbound workers tended to exercise far less than the recommended minimum of 40 minutes a day.
‘We are now all familiar with the five servings of fruit and vegetables every day and now it’s time to start applying the same principle to our working lives’”.
No matter how strictly you observe the discipline, it is never enough (and that is precisely the point; ideals cannot be easily attainable in practice or they would lose their capacity to simultaneously motivate and demoralise): “Dr Dugmore said the average person would take the escalator from the train station, catch a bus to the office, take the lift to the right floor and sit at a desk all day.
‘A cocktail of couch potato and screen slave lifestyles could be a fatal combination’”. How long will it be before blogging and computer games are blamed for all the ills that beset us (not that the latter boast an unbesmirched reputation amongst self-appointed moral guardians concerned with protecting young people against corrupting influences as it is).
Having surveyed some of the options for burning away our calorie reserves should we be so inclined, let us now return to the debate on slashing health care expenditure. Professor Roger Williams set out his thoughts on the death of George Best (Daily Mail, 3rd December 2005): “Of course he deserved a second chance, not least because of research showing that 95 per cent of alcoholics who receive a new liver never drink heavily again.
George, unfortunately, was one of the five per cent who return to heavy drinking, although there was no way of knowing that. We are doctors, not gods – it is not up to us to decide who deserves to live or die; it is up to us to treat the sick to the best of our ability.
And, yes, that includes alcoholics. Indeed, around the world, alcoholic liver disease is second only to hepatitis C as the most common reason for a liver transplant.
True, it ranks lower in this country, perhaps because there is still a body of public opinion that sees this as a self-inflicted condition. But where does that argument stop?
Our hospitals are chock-full of people who smoke too much, eat too much, drive too fast, have unsafe sex, engage in dangerous sports and, yes, drink too much.
As doctors, do we just turn around and say ‘Sorry, but it’s your own fault, we can’t help you’? Of course we don’t. We do all we can to make them better”.
Professor Williams immediately pinpoints the crucial issue: the denial of health care is profoundly undemocratic. Allowing accounting principles and the desire to appease the taxpayer to take precedence over human welfare (why do we have medical care in the first place?) is pernicious in the extreme. Resources may be finite, yet surely treatment for all should be non-negotiable. If you introduce rationing, where do you stop? Failure to toe the line becomes literally life-threatening, slavish adherence to a misplaced ideal the determinant of all worth? I simply refuse to believe that doctors have eradicated every last vestige of compassion in order to please the managers and the target-setters. Or has the Hippocratic Oath been deemed irrelevant? If illness were wiped out medicine would be obsolete. Why should doctors be made to resent applying the knowledge they acquired so painstakingly?
Dr John Briffa, (Observer Magazine, 27th November 2005) disputed conventional medical views on assessing obesity in Hip service: “The fact that our collective mass has grown considerably of late has inevitably triggered warnings from health professionals about how this may swell our risk of weight-related conditions such as heart disease. Ideal weight recommendations traditionally come in the form of the body mass index (BMI) – calculated by dividing an individual’s weight in kilograms by the square of their height in metres. However, the usefulness of the BMI in judging heart disease risk has recently been called into question in a study in The Lancet, which found that, once factors such as smoking and exercise habits were taken into consideration, the BMI has no significant bearing on heart-attack risk.
This study is not the only research that has cast some doubt on the relevance of the BMI as a predictor of our propensity to disease and death. Earlier this year, the journal Circulation published a study that found that in individuals having surgery for heart disease (coronary artery bypass), mortality after surgery was lowest in individuals whose weight was categorised as overweight (BMI of 25 to less than 30) or ‘high-normal’. These results and those of the recent Lancet study clearly cast doubt on the appropriateness of standard medical recommendations that a ‘healthy’ BMI of between 19 and 25 is ideal in terms of heart health.
While research that asks questions of the received wisdom regarding the relationship between BMI and heart health is interesting, it is perhaps not as telling as research which seeks to establish the relationship between this measure of body weight and overall risk of death. Earlier this year, The Journal of the American Medical Association published a study stating that underweight and obesity (a BMI of 30 or more) were both associated with an increased risk of death. However, surprisingly, this study found that compared to those in the ‘healthy’ BMI category, those categorised as ‘overweight’ (a BMI of 25 to 29.9) were actually at reduced risk of death.
There is a growing recognition that it is not fat per se, but fat which aggregates around the middle of the body (’abdominal fat’) that is strongly linked with health issues such as heart disease. The Lancet study found that a higher ratio of waist circumference to hip circumference (waist-to-hip ratio) was very clearly associated with increased heart attack risk. Ideally, men and women should have waist-to-hip ratios no larger than about 0.90 and 0.83 respectively. From a health perspective, the evidence suggests it is an individual’s waist-to-hip ratio, rather than their BMI, that represents their vital statistic”. How often has the tyranny of BMI blighted the lives of perfectly healthy individuals, not to mention penalised them financially in the shape of hiked-up insurance premiums (of which more later)? I reproduce Dr Briffa’s deliberations to illustrate that even our most hallowed ideas are open to testing and revision and we should not be blinded into unquestioning acceptance.
The editorial in the Daily Mail, (28th November 2005) responded to the news in a slightly less blinkered manner than is its wont by admitting that other factors may be involved than simple gluttony (a lazy explanation if ever there was one), in Doctor’s orders?: “From Britain’s most risibly misnamed quango, NICE (…) comes somewhat nasty guidance. It suggests patients with ’self-inflicted’ illnesses, such as smokers and the obese, could be denied treatment.
At first blush, such an approach may seem reasonable enough. Should the late George Best, for example, have been given a liver transplant that might more beneficially have gone to somebody else?
But consider the risks if quangocrats influence the clinical judgement of doctors? Where do we draw the line? Should we deny treatment to people who indulge in dangerous sports? Or who choose difficult, stressful jobs?
No, a more sensible way of reducing strains on the NHS would be for NICE to focus on the avoidable threats to health created by 24-hour drinking or the sale of school playing fields, which is producing so many couch-potato children.
But that would mean embarrassing its political masters. Isn’t it much easier to indulge in moral posturing at the expense of patients who can’t hit back?”
On the letters page of the same edition, Roger Dollery spoke from the heart: “Another health authority is using the body mass index to limit operations. What they don’t tell anyone is that they are condemning people to a life of pain with no chance of an operation.
Ten years ago my wife was told by a consultant that she needed spinal fusion to cure her back pain – but they wouldn’t operate unless she lost three stones.
She had difficulty walking and this built up her muscles, so the diets she was on resulted in her weight increasing because muscle is heavier than fat.
Nobody could understand why her weight was not going down, but all they did was prescribe stronger painkillers. The result of these was increased lethargy.
Luckily we read (…) about Taj Medical Group arranging operations in India.
We have just returned from there, where my wife had successful back surgery. They did tests to ensure she was fit to undergo the operation, but they could not understand the use of BMI as a filter in the UK.
Recently, the Mail published the height and weight of the English and Australian rugby teams’ front-row forwards – and only one player had a body mass index lower than 30, the technical level of obesity.
I wonder of they know that if they’re injured in the UK, they might not be operated on?”
The cold wind blowing through the hospital corridors had nothing to do with the season. The dire predictions made by John Carvel (The Guardian, 2nd December 2005), in NHS crisis as deficits top £900m made for a depressing prognosis: “[Health secretary Patricia Hewitt] released confidential returns forecasting a collective overspend of £623m by the end of the financial year. A quarter of all the country’s trusts are forecasting deficits that total £948m”.
The therapy was to be drastic: “The department [of Health] said the hit squads – to be known as ‘turnaround teams’ – will be selected on Monday after a lightning tendering exercise over the weekend involving City accountancy firms. They will be instructed to cut spending to reduce the deficit to £200m by March without endangering patient safety. But quick and easy savings may be hard as trusts are already engaged in economies including ward closures, lengthening waiting times, recruitment freezes and the reduced use of emergency nurses”.
Carvel followed up with another report in The Guardian (3rd December 2005), Operations go-slow forced by NHS crisis: “In London, Staffordshire and other areas forecasting big deficits, NHS commissioners are trying to save money by quietly instructing hospitals to delay non-emergency surgery until the start of the new financial year in April.
The strategy is a response to health secretary Patricia Hewitt’s crackdown on overspending but it threatens the government’s drive to reduce waiting times.
Hospitals are being asked to meet the government’s target for a six month maximum wait – but only just. In many areas, cash-strapped primary care trusts (PCTs) are ordering consultants to introduce a five-month minimum wait unless there are medical complications”.
The overweight were the first to feel the pinch: “Within the last few days, East Suffolk PCT has been ordered by its health authority to abandon an attempt to delay paying its March salary cheques to contain its overspend. The trust said last month it would no longer provide hip replacements to obese patients, partly due to financial pressures”.
James Chapman (Daily Mail, 9th December 2005) explored the implications in greater detail in Eat, drink too much and NHS may deny you care: “Heavy smokers and drinkers and the overweight could be denied NHS treatment because of their lifestyle, it emerged yesterday.
Controversial guidance from the Health Service drugs rationing watchdog raises the prospect of them being refused help if their condition makes treatment ineffective.
Age could also be taken into account if it directly affects the success of a drug or procedure, according to a report by the National Institute For Health and Clinical Excellence.
Its findings triggered a huge political row, with Opposition MPs predicting it could encourage treatment rationing for vulnerable groups.
Details emerged just weeks after three health trusts in Suffolk announced that obese people would be denied hip and knee replacements on the NHS.
The guidance also follows Health Secretary Patricia Hewitt’s suggestion that hospitals could delay treatment to save money. Earlier this week, she said it was acceptable for NHS hospitals to make patients wait for up to two months if it meant reducing their debts.
Doctors say the risks of operating on obese patients are higher and the treatment may be less effective, with replacement joints wearing out sooner. But patient groups and MPs fear the latest NICE report could pave the way for cash-strapped hospitals to deny treatment to other patient groups in the future.
The report said: ‘If self-inflicted causes of the condition influence the clinical or cost effectiveness of the use of an intervention, it may be appropriate to take this into account’.
Dr David Haslam, clinical director of the National Obesity Forum, said: ‘This is the thin end of the wedge. If someone has got lung cancer are we going to say, ‘Bad luck mate, you’re a smoker’?
‘Or take sports injuries. If you play football and break your leg, okay, to a certain extent that’s because of your lifestyle. So where do we need to draw the line? If you are ill, you need treatment, full stop’.
Dr Haslam said he could understand why a morbidly-obese patient who might die on the operating table could be denied surgery for a non life-threatening condition. But he added: ‘These decisions must always be clinical, rather than financial’.
Liberal Democrat health spokesman Steve Webb said: ‘There is no excuse for cash-strapped hospitals denying treatment to people whose lifestyle they disapprove of.
treatment decisions involving people’s lifestyle should be based on clinical reasons, not grounds of cost. The NHS is there to keep people healthy not to sit in judgement on individual lifestyles’.
Tory health spokesman Andrew Lansley said: ‘There must be absolutely no discrimination in medical care unless there are clear clinical reasons to withhold it or clear evidence that treatment will not be effective.
‘The correct way to tackle poor public health is through effective public health policy. The Government has so far failed to protect public health, with worsening rates of smoking, obesity and sexually-transmitted diseases’.
Claire Rayner, president of the Patients’ Association, said the question of lifestyle choices and treatment was ‘awfully difficult’ and must be left to individual doctors.
She pointed to the case of George Best, who continued drinking after being given a liver transplant and died last month. ‘There are many people who felt it was not reasonable to remove the chance of a liver transplant from another man,’ she said. ‘So these are difficult decisions.
If someone eats a lot of salt because of their culture and they suffer kidney failure or a heart attack, are we going to refuse to treat them?
‘If someone crosses the road in a bad way because they are drunk and gets run over, would we refuse to treat their injuries?
‘If we start down that road, we will end up not treating sexually-transmitted diseases because you could say they are self-inflicted’”.
The chorus of condemnation from across the political spectrum made the NICE squirm, but not back down completely: “NICE insists there will be no ‘blanket ban’ on particular treatments for patients with certain lifestyles. But if lifestyle choices are such that they make treatment ineffective, that could be taken into account, a spokesman explained.
Dr Tonya Gillis, of NICE, said: ‘We are in no way making judgements abut people’s social and lifestyle decisions or choices.
‘The only time we are saying it’s permissible to consider lifestyle choice is when it’s going to mean that the treatment won’t work’.
The report was commissioned to consider whether social background, age or lifestyle choices should ever influence the care provided by the NHS.
It concluded that no priority should be given for treatment based on someone’s income, social class or social roles at different ages.
It said clinical guidance should only recommend a treatment for a particular age group where there was clear evidence of a difference in the treatment’s effectiveness for that group”.
The editorial in The Guardian (10th December 2005) took careful stock of the funding situation: “About one quarter of NHS trusts are in deficit and currently forecasting an aggregate deficit of £1bn.
Seasoned observers will say there is nothing new in this. NHS units always are in deficit in the run-up to Christmas and when trusts that are in surplus are included the deficit shrinks to £620m. But this year is different. First, the NHS is about to embark on probably the biggest changes in its 57-year history. The instability which Ms Hewitt hoped to create was not due to have started yet. It was supposed to happen with the launch of Labour’s sharp-elbowed market next April when financial flows to hospitals, ambulance services, primary care and mental health teams will be much more dependent on the number of patients they treat (…) Second, although there is a history of deficits, the pattern has been getting worse as a joint report from two government spending watchdogs set out in June. Third, the worsening financial situation comes despite the NHS already having received five record years of investment more than doubling its budget in cash terms to £75bn.
Certainly the top of the NHS is taking these developments seriously. For all the bullishness of Sir Nigel Crisp, the NHS chief executive, at this week’s launch of his annual report, his actions belie his assertions that the reforms are not unravelling. Budget hit squads (or in the NHS jargon ‘turnaround teams’) are being dispatched to 50 trusts in trouble to halt their escalating deficits. After eight years of calls to cut waiting times and waiting lists – which have been remarkably successful – the health secretary this week urged trusts in trouble to delay non-emergency operations, reduce other non-essential services and even leave capacity idle to ensure that deficits are reduced.
Even with these initiatives, the service may still be in trouble. Absurdly, the current system is in the middle of a radical restructuring of the 300 primary care trusts (PCTs) that hold 70% of the NHS budget. They are due over the next year to shrink by as much as a half with redundancies expected to reach 6,000. The 28 strategic health authorities are due to follow suit. More serious still, at a point when senior managers should be totally focused on planning the start of the new market, all chief executives, chairmen, and senior staff are being required to reapply for the new posts once the new structure is clear. Guess what most of their minds were focused on?”
As Antony Barnett and Solomon Hughes revealed in The Observer (11th December 2005), in ‘Stop spending’ memo reveals NHS cash crisis the sacrifices expected were significant: “An e-mail sent from the office of Sir Liam Donaldson, the Chief Medical Officer by Sarndrah Horsfall, chief of staff: “It promises to sound the death knell for a range of public health programmes set up to tackle everything from alcohol abuse and cancer screening to STDs and obesity. Health experts believe the spending freeze could even hit attempts to reduce deadly MRSA outbreaks in hospitals and affect contingency planning in the event of an outbreak of bird flu”.
In the same edition Jo Revill (This year’s NHS bill is £87bn…) drew on a paper drawn up by the King’s Fund to show how the money had been swallowed up: “Its analysis shows that much of it [the extra spending on the NHS] has gone on ‘hidden costs’. In the past year, around 29 per cent of the money set aside for hospitals and community services was spent on a technical change to NHS pensions, known as rebasing, which is the cost of transferring inflation-proofed pensions from the Treasury to the Department of Health.
The next biggest chunk, 27 per cent, went on pay increases for staff. Another 12 per cent went on staffing reforms – the cost of modernising contracts with doctors and staff, which are aimed at getting them to work more flexibly in return for extra pay.
Setting aside money for medical negligence claims took up a further 5 per cent. After all this was allowed for, just 2.4 per cent was left over for providing new beds and extra operations – barely above the rate of inflation”.
The article cited Alastair Forbes, professor of gastroenterology at University College London Hospitals: “He has another, deeper objection to the rationing of treatment: ‘As doctors, of course, we have to realise that we have a limited budget and that you can’t give every treatment to every patient. But to deny treatment on the grounds of cost alone, without looking at what that means for the individual – that leaves us on very shaky ground indeed’”.
The editorial, Put patients first, NHS hit squads are no solution asked questions about the financial shot in the arm: “Wards closed, operations cancelled, and treatment rationed – the bad old days of the NHS lurching from crisis to crisis are once again upon us. A predicted deficit of £620 million this year has been forcing managers to make tough decisions about cuts.
Yet, this year, the NHS will have received £87 billion – £22bn more than it did three years ago. Much of this has gone on pay rises. Healthcare staff, particularly those who have been historically ill-rewarded, had to be paid more or parts of the service would have collapsed. But questions over whether all the pay rises were justified remain. General practitioners have done very well out of their new contracts, some now earning around £130,000 this year. The government intended that its deal with GPs two years ago would modernise the service, but seriously underestimated how much it would cost. Nor has there been much sign that family doctor services have improved”.
Sarah Boseley’s Hewitt defends public spending curbs (The Guardian, 12th December 2005) indicated how the embarrassment factor had affected Ms Hewitt. She had played down the significance of the document on ITV1’s Jonathan Dimbleby programme, alleging: “The memo referred solely to the department of health budget which pays for public health campaigns and other centralised projects – not that of the NHS. Primary care trusts were not affected”.
Indeed: “Ms Hewitt insisted that the department would be pressing ahead with a range of recently announced public health programmes, including ones on obesity and sexual health”.
The storm had not died down altogether, however. In the Daily Mail letters page (13th December 2005), John B. A. Wood, trauma and orthopaedic consultant at University Hospital, Lewisham, London stood up for the principle of discriminating against the overweight: “Obese patients won’t be denied treatment on the NHS, but they might not get joint replacement surgery – for several reasons.
They present technical difficulties because of the mechanical effects of a large volume of fat under the skin, and often have hypertension and Type 2 diabetes. The risk of wound infection during an operation is slightly higher.
And joint replacements tend to wear out: any engineer will tell you that wear is related to the load applied.
Revision operations, even when they go well, don’t have the same success rate as first-time surgery. Most patients reduce or lose their symptoms when they lost their excess weight.
Weight loss is a fundamental treatment for osteo-arthritis, long before surgery is contemplated.
For six months, we’ve been conducting a trial at my hospital, treating obese patients with musculo-skeletal problems.
They see an orthopaedic consultant surgeon, a clinical dietician and a physiotherapist with the aim of helping them lose weight while controlling their painful symptoms.
Dietary advice and exercise programmes are devised, including non-weight-bearing activities such as swimming or aqua-aerobics. This is still treatment, but it isn’t surgery. It still costs money, but it’s simply good value for that money.
Injuries incurred while taking part in sport should not be charged for as it’s your choice to take part in sport. There should be sports injury insurance, just as there is for road users.
The NHS no longer has a blank cheque to treat everyone’s illness – unless the Government pays for free treatment for all at the point of delivery, which is now not the case. So don’t blame the doctors, blame the Government”.
Colin Brown (The Independent, 14th December 2005), noted with satisfaction the health secretary’s admission that Government policy was not perfect in Hewitt refutes ‘meltdown’ claim but says NHS is still failing: “She said reforms were part of the solution to the ills of the NHS, not its problem. ‘While some parts of the NHS are world-beating, the NHS as a whole is not,’ she said. ‘It still fails too many people, especially the poorest, most vulnerable and most in need’”. From the mouth of a New Labour cabinet minister, such a statement represents a searing indictment.
Simon Jenkins (The Guardian, 14th December 2005), performs his own diagnosis of the rot that has been permitted to set in (The NHS needs localisation, not regulated privatisation): “Not surprisingly people have wondered where all the money has gone. Half has been spent simply inflating pay and pensions. Average GP salaries are now over £100,000, with a contract that relieves staff of night duty. Some £6bn is being blown on a toys-for-boys computer which no one claims to need. Privately run hospitals are drawing down large sums of NHS money in profit, rent and contract payments. Meanwhile patients are facing cancelled operations and the closure of much-loved hospitals.
The national health service is doomed. It is simply too big. In its first quarter century it was left alone – and was popular at home and legendary abroad. In its second quarter century it was subject to constant political fidget, first by Patrick Jenkin, Norman Fowler, Kenneth Clarke and Virginia Bottomley, then by Frank Dobson, Alan Milburn and John Reid. Now Hewitt is threatening a blitz of hit squads, zero tolerance, market testing and payment by results”.
Again, the irony is that people of my generation who grew up during the darkest hours of Thatcher’s reign had loyally voted Labour in order to guard the NHS against Tory depredations: “Ten years after blood-curdling threats that the Tories would privatise the NHS, Tony Blair is doing just that.
Whether Britons are ready to dismantle such essentially local institutions as schools or hospitals must be doubtful. Choice, diversity, competition are words which Blair clones incant as they wander the corridors of Downing Street like Hare Krishna acolytes. But there is no sign that they understand the meaning. In August a Which? poll was unequivocal: 90% of people did not want choice, just a good hospital within easy reach.
No other western nation tries to run doctors and hospitals as a civil service centrally from the capital. Health is mostly a provincial or county responsibility”.
Now that the concept of restricting health care entitlements to the “deserving”, that is, non-smoking, non-tippling, slender members of the middle-class or above has been aired I fear that sooner rather than later implementing measures will be devised (perhaps euphemistically labelled “guidelines” or “recommendations”) and put into practice. Unless we take action now.
Still on a medical theme, Jeremy Laurance (The Independent, 29th November 2005), in Expanding bottoms pose problem for medical jabs, targeted our amply-cushioned posteriors as the butt (in both the British and American senses of the term) of a joke: “The expanding size of people’s bottoms is presenting doctors with a new medical challenge: how to get injectable drugs to where they are needed.
Injections given in the buttocks are unlikely to work because patient’s bottoms are too fat, researchers said yesterday. For drugs to be effective, injections must be delivered into muscle which is supplied with microscopic blood vessels, to maximise absorption of the medicine. But the larger size of the average backside means the muscle is now covered with a layer of fat and the standard needles fitted to syringes are not long enough to penetrate it.
Researchers gave injections with a tiny air bubble to 50 men and women and then observed what happened using a CT scanner. They found that only 32 per cent of the injections reached the muscle. In men just over half the injections were successful but in women only 8 per cent were.
Injectable drugs including painkillers, contraceptives and anti-nausea medication, have traditionally been given in the bottom because it offers a substantial pad of soft tissue.
Victoria Chan, from the Adelaide and Meath Hospital in Dublin, Ireland, said: ‘Our study has demonstrated that a majority of people, especially women, are not getting the proper dosage from injections to the buttocks. There is no question that obesity is the underlying cause’”.
Ms Chan, however, was not one to be interrupted in her stride by such an obstacle: “Drugs companies had designed their drugs so that the proper dosage was absorbed into the bloodstream from the muscle and if it was injected into fat tissue less of it would be absorbed. The answer, she said, was to use longer needles when injecting into the buttocks”.
In the Daily Mail, letters page (8th November 2005), David Bartram lamented our schizophrenic attitudes towards food: “Last month heralded the introduction of yet more food health-related labelling, this time concerning potentially allergenic ingredients in packaged foods. Is this a benefit to the health of the nation, or merely fuel to food-related neuroses?
In the face of a welter of recent guidelines and regulations aimed at fostering better health by improving our relationship with food, food-related health problems are steadily rising.
Eating disorders such as anorexia nervosa and bulimia nervosa are increasing while half to two-thirds of the population are, at the other extreme, either overweight or obese, predisposed to heart disease, type 2 diabetes and high blood pressure, to name but a few associated illnesses.
Food-related paranoia and hysteria is affecting our emotional well-being as well as our physical health.
It causes nervous checking of labels, perceived intolerances or allergies, the perception that any fat is incompatible with healthy eating, a burgeoning ’slimming industry’ based on spurious claims, assignation of moral values (’good’ or ‘bad’) to different foods, the myth of the need to ‘detox’, the anathema of GM foods, use of so-called functional foods such as cholesterol-reducing spreads, glycaemic indices, questionable health benefits of ‘going organic’, the confused perception that emaciation is the acme of body shape aesthetics, discordant claims for high-carb vs. low-carb diets etc.
It’s time for a new paradigm in food health education so we can enjoy all food again.
Moderation must be the over-riding theme: the concept that there is no such thing as bad food, just a bad diet – and that provided any single element of our diet is not eaten to excess, we should remain healthy.
Let’s put the fun back into eating – and the health of the nation will improve”.
Yet the gospel preached by the media does not fall on unreceptive, heretical ears, witness the Daily Mail on cereals no longer gracing our tables first thing in the morning (29th November 2005, unattributed, Britons go bananas for breakfast): “A banana for breakfast has become the choice of millions of health-conscious Britons before they make the daily dash to work and school, a survey reveals.
Clock-watching families find it impossible to sit down for a traditional meal to start their day so growing numbers are turning to the fruit as a healthy alternative.
According to trade magazine The Grocer, 2.5 billion bananas were eaten in the home last year – an increase of 2 per cent on the previous year – and a third of these were consumed for breakfast.
The Grocer said: ‘Bananas are quick and easy to eat and provide the health benefits that consumers want at the start of the day. This means they make an ideal breakfast replacement on hectic weekday mornings.
‘Consumers are eating bananas as a real alternative to traditional snack foods’”.
Of course, blaming women for their lack of restraint has never gone out of fashion (The Independent, 1st December 2005, unattributed), as shown, for example, by Diet warning to pregnant women: “Pregnant women who over-eat could condemn their children to a lifetime of weight problems. Two US studies said that children of women who piled on the pounds while pregnant were especially prone to obesity in later life. Experts agree it is important for pregnant women to put on some extra weight”.
John von Radowitz (The Independent, 28th November 2005) eagerly related how the slightest lapse could wreck the future of the unborn child in Mother’s diet can influence a child’s taste, says study: “Flavours experienced in the womb and later, in mother’s milk may have a significant influence on what children are willing to eat.
Research shows that the experience of food eaten by pregnant women and mothers can be transmitted to their foetuses and infants, according to a nutritionist, Julie Mennella.
Those first flavours can play a major role in determining a child’s later food preferences. The research suggests that one way to persuade children to eat their greens might be for mothers to eat vegetables themselves during and just after pregnancy”.
Apparently: “One French study had shown the children of mothers exposed to anise-flavoured drinks while breastfeeding were less likely to be put off the taste of aniseed than other babies. Similar research in Ireland found the same kind of results using garlic.
Other work involving vanilla, onions and carrots had shown that foods could flavour amniotic fluid as well as breast milk and they also influenced children’s tastes.
The effect is already well known in animals. A European study showed that newly weaned rabbits will make juniper berries their food of choice if the berries had previously been fed to their mothers.
Ms Mennella repeated the rabbit experiment with 45 human mothers, substituting carrot juice for juniper. The women were split into three groups. One was given carrot juice over several weeks during the last three months of pregnancy while another had carrot juice as the women were breastfeeding. ‘When the babies were at weaning we tested their acceptance of carrot-flavoured cereal,’ said Ms Mennella. ‘Not only did they eat more but when we looked at videotapes, the babies made less negative faces while eating’.
The same effect was not seen in babies of the third group of mothers who had not been exposed to carrot juice. They tended to turn their noses up when presented with the carrot-flavoured cereal.
Taste and smell are primitive senses developed according to evolutionary pressure to help guide us towards the most beneficial food sources, Ms Mennella told the meeting, organised by a baby food manufacturer, Nutricia. In times of scarcity, this means seeking out sweet tastes which act as ‘labels’ for high calorie foods. Unpleasant, bitter tastes, on the other hand, offer a warning of potentially harmful foods such as poisonous vegetables.
Mothers, Ms Mennella suggested, could help ‘programme’ their new-borns into knowing what is good for them through their own food choices”.
For once, however, men were also in the firing line (Daily Mail, 5th January 2006, unattributed, How smoking could make your son fat): “Men who smoke at a young age are more likely to have overweight sons, researchers have found.
The study, based on evidence from the UK and Sweden, suggests for the first time that fathers can pass the legacy of an unhealthy lifestyle on to their descendants.
The first study – of British men who had babies in the early Nineties – showed that those who took up smoking before puberty went on to have fatter than average sons. A similar effect was not seen for daughters.
A second team of scientists looked at historical records from a remote area of northern Sweden and found that people whose grandparents had eaten less between the ages of nine and 12 lived longer. The effect was gender-specific, with women passing the legacy on to grand-daughters and men to grandsons.
Chemical modifications to DNA are thought to explain how the impact of lifestyle and the environment is passed down through the generations.
In the past it was thought that such ‘epigenetic’ changes were not inherited, New Scientist magazine reports today.
Professor Marcus Pembrey, of University College London, which carried out some of the research, said: ‘The Bible says the sins of the fathers are visited upon his children unto the third and fourth generations’”.
The new insight into the influence of social factors upon genetics was expanded upon by Jenny Hope (Daily Mail, 12th December 2005), And if you’re overweight, you can blame it on your grandad: “Your weight and chances of becoming ill could be affected more by your grandparents’ experiences than those of your parents, say researchers.
The impact of stress, famine, over-eating and even smoking becomes embedded in the family’s genes – but they skip a generation, it is claimed.
The idea is based on research showing boys and girls suffering food shortages in childhood bequeath a longer lifespan to their grandchildren.
Obesity in children today might also be affected by whether their grandfather started smoking while still at school. Professor Marcus Pembrey, of the Institute of Child Health, University College London, said the notion of ‘environmental inheritance’ could explain modern epidemics of disease.
He said the new approach was a radical departure from conventional thinking, which only looked at genes inherited from our parents, coupled with lifestyle.
‘There are certain times of life when the environment can trigger a response, which has a ripple effect down the generations,’ Professor Pembrey said.
‘The benefits of understanding when this exists are very obvious from a public health point of view.
‘When looking for the causes of the current epidemic of obesity perhaps we shouldn’t just be blaming the lifestyle of this generation.
‘It could be obesity now is a response to lifestyles adopted by previous generations’.
Findings released today by Children of the 90s researchers in Bristol, along with research by Professor Lars Bygren at Umea University, Sweden, using records from the 19th century, show the impact of adaptation down the generations (…)
Professor Bygren looked at records on harvests and food prices and the health of families over three generations.
Professor Pembrey said: ‘He found the lifespan of the grandchildren seemed to be influenced by their parental grandfathers’ access to food, particularly during the grandfather’s slow growth period – between nine and 12 years old.
‘Children tended to live longer if their grandfather had endured food scarcity during this particular time of life.
‘I believe our results are signs of a response mechanism which has evolved in humans allowing us to adapt to different circumstances from one generation to another’”.
Roger Dobson and Tom Anderson (The Independent on Sunday, 11th December 2005) turned the spotlight onto research that corroborated something we had always suspected but which had always been brushed aside as making a virtue out of a necessity in Slim=sad. Fat=happy: “It is the body type that millions yearn for. They seek slender perfection, thinking it will bring sex, power and happiness. However, they should be prepared to be disappointed – and deeply depressed.
A new study has revealed that, rather than being content and confident, slim people struggle to deal with life’s woes. Anxiety and mental suffering often dominate their lives – to such a degree that they are much more likely to commit suicide than large people.
The startling new insight into the deep mental troughs many slender people sink into comes in a report led by psychologists at Bristol University. They teamed up with colleagues across Europe to study the lifestyles of thousands of people and the results were far less happy than rotund ones.
Over a 16-year period, the ups and downs of more than a million lives were examined and it was found that as a person’s body mass index (BMI) rose the risk of serious depression fell. And when the scientists considered more than 3,000 people who had committed suicide they found that their BMI was on average significantly lower than those who did not kill themselves.
Various other factors that could bias the results, such as socio-economic status, were taken into account.
‘We were quite surprised as there is a view that people who are overweight may be stigmatised and made to feel depressed,’ said Professor David Gunnell, of Bristol University, one of the authors of the study (…)
‘Our finding provide some support for the idea that fatter people are at reduced risk of the problems that lead to suicide’.
That did not come as a surprise to those who warn about the dangers of losing weight.
Joanne Roper, of Hugs International, an anti-diet pressure group, said: ‘Slimming makes you miserable. Dieting can bring people down and make them obsessed with their body image. You’ve got to be happy with what you’ve got and not worry about things too much. It takes work but if you can accept yourself as you are then you’ll be happy generally’”
Even the bullying and inferiority complexes the skinnies so desperately endeavour to instil in us do not wipe out our zest for life: “The pan-European study revealed that for each 5kg per square metre increase in BMI, the risk of suicide decreased by 15 per cent.
Exactly why is not clear, although there are a number of theories. Some research shows that people with insulin resistance, a condition associated with a raised BMI, may have a reduced risk of depression and suicidal behaviour.
Insulin resistance is associated with levels of serotonin, the feel-good hormone. One of the main types of anti-depressant drugs works by increasing the amount of serotonin.
It is possible, researchers say, that people who eat more have higher levels of serotonin, which may lower levels of depression. Other research has found a link between obesity and low levels of anxiety and depression.
‘High BMI appears to be associated with lower suicide risk,’ said Professor Gunnell. However, he added: ‘Since a high BMI is also associated with an increased risk of cardio-vascular disease, cancer, diabetes, and other important causes of morbidity and mortality, we would not recommend interventions to increase BMI to prevent suicide or increase levels of happiness’”.
Stuart Jeffries (The Guardian, 12th December 2005) parodied the news: “Psychologists at Bristol University have discovered that thin people are more likely to commit suicide than their fat counterparts. They discovered the average body mass index of 3,000 suicides was significantly lower than those who did not kill themselves.
How should the National Institute of Clinical Excellence (NICE) respond to this? By recommending that NHS counselling should be denied to thin depressives, obviously. If smokers, drinkers and overweight people can be refused treatment because their ailments are self-inflicted, then thin people must accept the consequences of their actions too. Thin people, just as much as fat, have to be responsible for their lifestyle choices. The point, surely, is not ‘diet and die’ but rather ‘diet and then die, Twiggy’”.
He cast aspersions on the study’s credibility with a twinkle in his eye: “Researchers at Clerkenwell University (i.e. me) are doing a rival study to find out if the Bristol psychologists are fat people with a grudge. We will be testing the hypothesis that this study is being published to undermine Nice’s nasty recommendations and to scupper government plans to issue so-called Fatbos which involve, I learn from my government source, keeping the 22% of the adult population who are obese indoors during shop opening hours.
Hazel Blears’ so-called ‘cake-shop curfew’, I can reveal, will follow Tony Blair’s announcement tomorrow of the creation of Asbos for under-10s or so-called ‘teeny tearaways’. ‘The challenge is to find new groups to stigmatise,’ says my source. ‘Hence Fatbos. Soon Hazel and Tony will be the only people without Asbos, which is consistent with government policy aimed at ensuring that neither of them should have to live in fear”.
He extracts every ounce of humour from inverting the clichés without, however, disputing them: “An obesity expert tells the Sunday Telegraph that parents obsessed with healthy eating and fad diets raise children who feel guilty about food and risk becoming binge eaters in later life. Surely the opposite might be true: they could risk becoming self-loathing anorexics. Some may even become obesity experts.
What will happen to such obese children when they go to hospital seeking treatment for fat-related ailments? Will they be refused it because their chubosity was self-inflicted? That would be so unfair! Surely parents should be refused NHS treatment if they raise children who overeat in order to compensate for mum and dad’s crackpot yo-yo dieting. You see, thin people are the problem in today’s society. Fat people are the solution”.
Jaya Narain gave the Daily Mail’s angle on the story (12th December 2005), in Dieters ‘have slim chance of happiness’: “Being slim has long been held as a key element in sexual attraction, success and happiness.
But a study shows that skinny people are more likely to be unhappy and commit suicide than those who are overweight”.
If only the following statement were true in the medium and long term as opposed to the few fleeting moments generated by the publicity: “The study will be a blow to the dieting business. It will also give credibility to the theory that the overweight really are jollier”.
Zoë Williams (The Guardian, 28th December 2005) was also inspired to comment in Gluttony is good for you: “Clichés only turn into clichés because they’re true. Otherwise, they just become a weird thing that someone in a bank once said to you. So I’m assuming that this will cheer you up, because I’m assuming that, at precisely this time of year, you’re probably quite fat. Or maybe just fat for you. No, no, don’t go out and change – you’ll be fine going out looking like that…
Scientists in Bristol have discovered that fat people are more cheerful than their peers. I thought this was just a revivification of the ancient (well…maybe 25-year-old) wisdom that says you shouldn’t go on a totally fat-free diet because your brain needs its fat surround to keep from crashing against your skull. That makes you depressed, apparently. But you don’t have to be obese to maintain this fatty covering; you just have to not be anorexic.
Nor is this a reworking of the slightly less ancient study that found that people with notable self-control, people who weren’t ‘appetitive’, were more likely to be depressed. The usefulness of this survey was opaque. It appeared to demonstrate that hedonists were happier than puritans. Nobody needs a scientist to tell them that. They just need to study the works of Chaucer. Or Dickens. Or watch EastEnders. The people enjoying themselves are the fat, jolly ones. The people who worry about how they look, and what people think of them, and what God might think, and whether drinking too much mead will turn out to be a signal that they are bound for hell – those people don’t enjoy themselves so much.
In fact, the new research is quite new. It merely asked whether fat people kill themselves. Are they prone to depression or anxiety? The answers were all no. Not only are you less depressed when overweight, it works in proportion. The fatter you get, the less likely you are to commit suicide. Of course it’s possible that you could be getting morbidly obese as an incremental form of suicide. Research doesn’t relate.
Doctors haphazarded a guess that thin people made themselves depressed with the effort of keeping thin. It’s feasible, I suppose, but there are plenty of fat people on diets who are making all that effort and failing, and they seem pretty cheerful. Lacking an explanation, we have to fall back on ‘comfort eating’. This is far from being a sarcastic catch-phrase, like ‘panic buying’ and ‘binge drinking’. You do actually gain comfort from eating (…)
Consider the pleasure that can be derived from food. There is: a) the comforting taste of something nice, generally with a heap of fat and let’s hope some brandy (sorry, it’s still close to Christmas); b) the more arcane pleasures of the gourmet, which are prissier and rarer; and c) the warped pleasure of self-denial. Naturally, people who go for the last band will be the most miserable. They have misery written into their DNA.
What makes this fat/happy curve so surprising is that fat people have a horrible time at the hands of society. This year it was revealed that they were less likely to land jobs, and doctors made moves to stop treating them for joint replacements. Next year it’ll probably be even worse. And they’ll still smile.
If there really is a direct correlation between body mass index and mental health, are we going to start charging skinny people for their own Prozac? Huh?”
This was not the first occasion on which the myth of a short, miserable life for the overweight had been contested, as Jeremy Laurance’s Overweight? Study shows you’ll live longer (The Independent, 21st April 2005) reminds us: “Fat people have won a healthy reprieve from a study which showed that those who are overweight tend to live longer than those of normal weight.
Doctors may have to rethink the definition of the ideal weight after researchers found that the risks of piling on the pounds do not become evident until people are extremely obese.
And the fashion world’s obsession with slenderness also comes under threat from the finding that being underweight is linked with a higher death rate”.
Mr Haslam is trundled in for his umpteenth appearance as expert: “David Haslam, chairman of the UK National Obesity Forum said: ‘The findings should certainly set us thinking. Even though we are getting fatter, in a society that is putting more emphasis on a healthier lifestyle, the impact may be lessened.
‘It does raise the possibility that we will have to change the criteria for what we regard as overweight’”. The latter prospect would be cause for celebration indeed.
Laurance dutifully puts it on record that: “There were 34,000 excess deaths among underweight people but there were 86,000 fewer deaths among the overweight than those of normal weight. The study (…) claims to be the most rigorous yet with the figures taking into account age, sex, race, smoking and drinking”.
However, reluctance to accept that the earlier figures were wrong is so ingrained as to necessitate the tired old mantra: “Extra weight increases the risk of diabetes and arthritis, but people have become more aware of the heart disease risks that obesity usually brings and of the need to keep fit, and recent evidence suggests walking may have increased.
‘The net result of these phenomena may be a population that is, paradoxically, more obese, diabetic, arthritic, disabled and medicated but with lower overall cardiovascular disease risk,’ the authors say. The researchers do not offer an explanation of why extra weight may prolong life but previous studies have suggested that the ideal weight increases with age. Older people need extra fat to tide them over when they fall ill and cannot eat normally.
The finding lends support to the theory that it is fitness not fatness that matters. But the researchers only looked at how long people lived, not at the quality of their lives”. The anti-fat brigade is not willing to make the tiniest of concessions for fear of losing its authority.
As Fiona MacRae’s Overdone the pud? (Daily Mail, 2nd January 2006) indicates, the results are being confirmed by other findings: “Stand on scales, look alarmed, pledge dramatic diet until pounds put on at Christmas are taken off again.
The scene is familiar but the ensuing effort may not be to everyone’s advantage, according to researchers.
A study of 33,000 adults has discovered that putting on a few pounds could actually lengthen your life.
And we could all be half a stone heavier than doctors recommend without harming our health.
The research (…) casts serious doubts on the way GPs in Britain judge healthy weights”.
The waiflike, semi-starved look may cost more than your happiness: “But while GPs use the [body mass] index as a general guideline to good health, the U.S. researchers have found that the average person classified as overweight in the UK actually lives longer.
Changing the current recommended BMI to 26 for men would allow the average male to carry 24lb more than is currently recommended. Women could quite happily tip the scales at half a stone more than suggested.
The study also found that adults with BMIs as high as 35 have the same life expectancy as those stick-thin people who have BMIs of 20.
According to the research, only those with BMIs over 35, equivalent to 17st 6lb for a 5ft 10in man and 15st for a 5ft 5in woman, face a marked reduction in life expectancy.
Researcher Dr Jerome Groninger, of the U.S. Congressional Budget Office, said: ‘This work does not support the idea that reducing weight alone would result in any large mortality risk reduction for most of the population’”.
The largesse of Dr Ian Campbell, president of the National Obesity Forum, stretched far enough to own up that the holy charts might have been defective: “But he admitted BMI is flawed. ‘It doesn’t discriminate between fat and muscle and doesn’t look at quality of nutrition and levels of physical activity, which leads to the conundrum of being fat and fit and lean and unfit’.
He added that other measurements of weight, such as the hip-to-waist ratio or the circumference of the waist, are more reliable”.
On the same page, however, we are discouraged from toddling off to the baker’s for that forlorn cream cake we allowed to languish in the display by Becky Barrow’s Insurance goes up by the pound: “Fat people are being forced to pay up to four times more for life insurance, a study suggested yesterday.
Companies which regularly penalise obesity are now lowering their target to include those who are merely overweight.
Policies covering critical illness or life insurance have significantly changed over the past year, with premiums rising rapidly for the fatter clients.
Kevin Carr from Life Search said: ‘Height and weight is one of the questions you are asked about when you fill in a form for a life or health insurance quote. If you are considered by the insurer to be overweight, they will often ask for a report from your GP and sometimes a medical examination.
‘The likely expectation is an increase in premium. Typically, we would expect a loading to start at 50 per cent’.
The premium goes up as weight increases. In severe cases, companies will refuse to offer any insurance at all.
Young people who are overweight face higher insurance premiums than their older counterparts. Mike Owen, managing director at Special Risks Bureau, said: ‘Insurers accept that people over 55 may well put on some weight as they age.
‘However, if you’re under 55 and severely overweight, you can be asked to pay 300 per cent more than the standard premium in some cases’.
About a quarter of his customers have had problems getting insurance because of their weight, through companies ‘cherry-picking’ the low-risk customers”. This is sheer bigotry, which would be prohibited by law if it were connected with any other physical characteristic such as finger length or eye colour. Thus the heritage of life-denying asceticism and the lust of the few for status at the expense of the many makes martyrs of us all.
For anyone interested in reading intelligent articles that expose and counteract the fat hatred so ingrained in our culture I wholeheartedly recommend the first Big Fat Carnival at Alas, a Blog, an excellent and much-needed initiative.