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In these days of voter apathy and eroded social solidarity, politicians seem to believe that the last vestiges of their beleaguered credibility rely on preaching the gospel of cost-cutting (which is one of the reasons why reports on their expenses, voted through pay rises and more than generous pension entitlements never fail to make them squirm). Tellingly, the vocabulary they employ draws on the imagery of dieting: slim or trim down, removing flab, becoming lean and mean. More and more the value of human life is portrayed as depending on whether the individual in question contributes to or constitutes a drain on collective resources (by which I am referring primarily to the health care systems, since the physical survival of every last one of us, fat or thin, inevitably relies on consumption). We have drifted into the era of the bean-counter where “rationalisation” and “efficiency” rule and there is no room for compassion, for ordinary frailty, for variety of experience, where the elite playfully cast off the constraints of convention leaving the rest of us trapped within boundaries more hopelessly than before, where mobility is held up as the greatest good, masking the depressing fact that fewer and fewer are able to benefit from it.
It is no coincidence that euthanasia and denial of treatment to prematurely born children have become the latest hot topics on the liberal agenda. After all, killing off the terminally ill or ultra-dependent at either end of the life course would save enough to warm the cockles of any accountant’s heart. Dominic Lawson (The Independent, 14th November 2006) eloquently cautions us about the dangers of being seduced by budget-pruning rhetoric dressed up as the epitome of disinterested rationality in Doctors, disabled children and euthanasia: “There seems to be a great confusion about what constitutes ‘a very ill child’. Many of the conditions which are frequently spoken of as illnesses are nothing of the sort. A person born with a severe physical handicap is not physically sick. A person with a mental handicap does not have a mental illness. In neither case is there anything to be cured.
A baby born with Down’s syndrome is not ‘suffering’ from anything. Accordingly, it could never correctly be described as a compassionate act to do anything to bring about the end of such a life. At the risk of sounding harsh, I think it is necessary to state clearly that those who wish to make it easier to destroy such lives are not thinking about the interests of the child: they are thinking about the interests of the parents.
The more interesting question is: how clearly are parents in such a situation able to assess their own future? As I know myself, when you are told that your newborn child has some kind of genetic abnormality, you are in no condition to make any sort of decision, still less one involving life and death. Most prospective parents have a horror of having a child with Down’s syndrome: but there are few, who, having had such a child, are not fiercely protective and loving”.
The anti-democratic rot has already set in when it comes to health care, however. Smokers struggling for their every breath are greeted with a shrug of indifference and a smug “Well, we did warn you and yet you kept on lighting up with your filthy yellow-stained fingers forty times a day”. Do not delude yourself: after the nicotine-puffers and alcohol-swiggers we are next in line to be sent packing on the grounds that our woes were self-inflicted. Your passion and vibrancy, your fury and creativity count for nothing. You are a statistic (an abstraction as worthy of pity as the random passers-by Harry Lime sneers at from his vantage point on the Riesenrad in The Third Man, as opposed to a real individual in flesh and blood glory, complete with foibles, blemishes and all), a burden, a nuisance, a throwback, a roly-poly degenerate, an uncomfortable reminder of the propensity of the human body to lay down reserves for times of hardship in the midst of unprecedented abundance.
We are already subject to a sustained attack in the realm of non-essential therapy. Maxine Frith reveals that beyond the much-publicised waiting lists for hip operations, rationing is the order of the day (The Independent, 9th October 2006), in Almost all NHS trusts fail on IVF pledge: “The financial crisis in the health service means that many trusts are cutting back even further on IVF provision, denying thousands of couples the chance of a family and resulting in a postcode lottery of care.
At least four PCTs have suspended all fertility treatment provision in the past six months, while others have cut back on the number of cycles and many have introduced restrictive criteria that make more couples ineligible.
Some trusts now have waiting lists of five years for treatment, by which time the success rates for many women will have plummeted because of their age”.
Decisions are taken on the basis of how neatly the recipient fits into a pattern of social “desirability”: “The National Institute for Clinical Excellence (Nice) ruled in 2004 that all PCTs should offer three cycles of in vitro fertilisation (IVF) to couples [note that the author does not specify whether these are nuclear-families-in-waiting – we are invited to fill in the gap, however, and assume that they are].
Nice set a small number of eligibility criteria, including that women should be between 23 and 39, and couples should have either a proven fertility problem or have been trying to conceive for three years”.
The gulf between the Government’s vision of what should be on offer and the reality yawns wide: “Four trusts have suspended treatment since May because of budget cutbacks and new patients in their areas cannot be referred for or receive treatment (…)
Two thirds of trusts – 68 per cent – offer just one IVF cycle per couple and 17 per cent provide funds for two cycles. Just six PCTs offer three cycles, but these trusts also have some of the longest waiting times for new patients. Only three of the trusts not yet providing three cycles said they had plans to reach the standard, and two of those did not intend to achieve it before 2010”.
Returning to the standardised eligibility criteria for a moment, who is likely to fall into the category of having “a proven fertility problem”? According to a piece in the Daily Mail (4th September 2006, unattributed), Fat men ‘are 10% less fertile’: “Men’s fertility is ‘significantly reduced’ if they are overweight, research revealed yesterday.
Carrying just an extra stone and a half can cut the chances of being able to father a child by 10 per cent, scientists found.
And being obese halves the odds, according to a study of 1,468 couples in Iowa and North Carolina published in the journal Epidemiology.
Last week it was suggested that obese women should be denied IVF treatment because they have less chance of conceiving. But these findings reveal that men’s fertility is also affected by extra weight – which it is thought affects sperm quality and causes hormone problems.
Adjusting the figures for other factors, such as smoking and alcohol consumption, the scientists concluded that ‘the men’s Body Mass Index was an independent risk factor for infertility’”.
Julie Wheldon (Daily Mail, 6th October 2006) picked up on the theme in Obesity could be the biggest threat to female fertility: “Obesity in women is threatening to cause a fertility crisis, doctors warned yesterday.
More than half of women attending fertility clinics are overweight but often unaware of the damage it is doing to their reproductive health, said experts.
With obesity rates forecast to rise to 70 per cent within a decade, doctors warned that the problem is a greater threat to fertility than the sexually transmitted disease chlamydia or conditions such as polycystic ovary syndrome.
Not only are severely overweight women more likely to struggle to conceive, they are more prone to complications in pregnancy and having babies with birth defects.
Professor Adam Balen of the Leeds Reproductive Medicine Unit said typically more than 50 per cent of women attending UK fertility clinics are overweight.
By comparison around one in three are there because of damage to their fallopian tubes – often triggered by chlamydia.
‘The overall percentage of women who attend infertility clinics with obesity is certainly greater than the number who have tubal damage due to chlamydia,’ he said.
‘The issue of obesity is of major significance to infertility clinics’.
More than half of all women are classed as overweight, a figure which experts say could rise to 70 per cent within ten years. Obesity levels are also soaring among the young, with 27 per cent of girls and 22 per cent of boys overweight.
The Royal College of Obstetricians and Gynaecologists is so worried about obesity it has devoted a special issue of its journal BJOG [British Journal of Obstetrics and Gynaecology] to the problem.
Editor Philip Steer, of Imperial College London, said many women and even doctors do not fully understand the impact of weight on reproductive health.
‘Maternal obesity needs to be recognised as a serious and growing health problem,’ he added.
The journal revealed how obesity increases the severity of polycystic ovary syndrome, which can make it hard for a woman to conceive.
Obese women who do conceive are more likely to have pre-eclampsia, suffer a miscarriage or require a caesarean than those of normal weight.
In addition their babies face a greater risk of birth defects and having obesity problems themselves as they grow.
The RCOG said yesterday it is convening an expert group to discuss how best to manage the problem.
Professor Balen, who edited the special edition and is also part of the expert group, said: ‘We need to be tackling the problems of obesity in childhood in order to reverse the trend that is leading to increasing rates of infertility and health risks in pregnancy to both mother and baby’.
This summer the British fertility Society was heavily criticised for suggesting that obese women should not receive IVF treatment on the NHS.
It said they should not be granted funding unless they have made efforts to lose weight.
The society also advised that women classed as severely obese should not get funding at all until they have reduced their weight.
Critics claimed this was ‘unjustified discrimination’.
Last week, a study suggested that women who fail to shed even a little weight gained in pregnancy face a higher risk of birth complications with their next baby”.
In other words, it is precisely the least fertile segment of the population that faces the prospect of being turned away (ostensibly) on grounds of a reduced likelihood of success. If we were considered to have any intrinsic worth this would not be allowed to happen. Instead, our feelings and aspirations are casually and callously brushed aside in a calculation that is entirely blind to the wish to lavish love on a wanted child. The medical establishment has done its level best to undermine our self-confidence, to browbeat us into conformity with the slenderness ideal with its ever-lengthening list of fat-related complaints and conditions (which most of us can recite effortlessly, having been reminded of them by a Greek chorus of friends and relatives, exasperation quivering in their voices as they bewail our impending doom in the guise of caring as well as by the media and the diet vultures circling relentlessly above). Our presumed ignorance and bloody-mindedness have kept us from shedding the pounds. Ostracism and ridicule have not eradicated us. Now the social deviance (literally) embodied in fatness is being classified as a genetic defect.
Consider the following report by Jonathan Thompson and Renee Knight (The Independent on Sunday, 5th November 2006), Eggs for sale, The booming business of sharing your fertility: “Victoria describes herself as ‘fun loving, generous and considerate’. The 29-year-old blonde is ‘naturally slim with good bone structure’, and an accomplished ballet dancer.
Danielle, 26, has wavy chestnut-coloured hair and blue eyes. A teacher by profession, she is ‘tall, athletic and outgoing’, and also a part-time model.
These are not adverts on internet dating sites. Victoria and Danielle are just two of a rapidly growing number of young British women rushing to cash in on the latest way to make money: the egg donation business.
The sale of eggs is illegal in this country, but in America, the industry is worth an estimated $4.5bn (£2.4bn). Donors with the right physical, personal and intellectual attributes can attract fees of up to $35,000 for their eggs, with some in the industry claiming that as much as $50,000 has changed hands. Prices are rising, too: in New York, average eggs are fetching $8,000. About 15 years ago, the comparable figure was closer to $1,000”.
What I find offensive here is not the sale of ova, but the stress on appearance with the implicit suggestion that intelligence and creativity are still unimportant attributes for a woman (presumably residing exclusively in the thrashing-tailed sperm) and, more particularly, that slimness is the would-be donors’ greatest asset, their strongest selling point.
Of course, unadulterated snobbery is also a factor. We can’t have the lower orders turning their much-reviled fecundity to pecuniary advantage, now, can we?: “‘In Britain, we have a culture of altruistic donation,’ said John Paul Maytum, a spokesman for the HFEA [Human Fertilisation and Embryology Authority]. ‘There is always a concern when you start paying large amounts of money for eggs, because it will change people’s motives for wanting to donate. If payment is attracting people desperate for money, it also raises questions about the quality of the eggs’” [according to this stunningly elitist logic the inferiority of the poor sullies their very genes, any well-meaning initiatives to improve their wretched lot are a complete waste of time and effort as fecklessness, indolence and underachievement are transmitted from one generation of wasters to the next; no talent can ever reside in such tainted matter, there is no point in wasting opportunity on scum, their plight is deserved, their natural inheritance].
The short insert demonstrated most clearly just how unwanted we are (along the lines of no one in their right minds would want a fat child, especially not if they are shelling out good money for a designer baby), We need to check your weight first: “Eggdonor.com is one of a number of US websites advertising eggs for sale to infertile couples, including eggs from British women. Prices can reach up to $35,000 for donors with desirable physical characteristics, good medical histories and proven academic records. Prospective buyers are shown recent pictures of the donors, as well as images of them as babies and adolescents. They also analyse everything from their height and weight to details of their grandparents”.
I am no peddler of simplistic conspiracy theories to the effect that the accumulation of fat is set to be deliberately and maliciously eliminated from the gene pool (even if it were possible to engineer out such a deeply ingrained trait to which we owe our survival as a species), but we are treated as pariahs in the reproduction stakes as it is (to be flippant for a second, if the chances of conceiving indeed drop in proportion to padded curvaceousness then give me the cream bun and fish supper method any day rather than the noxious chemical preparations we are encouraged to swallow without a second thought) – we might know we are sexy as we slip into our glad rags and more so than the gaunt clothes horses with their dangling arms and washboard ribs, but who lets us be? Our voluptuousness was once revered and worshipped. These days the Venus of Willendorf provokes shudders of revulsion. We are not heading for genocide, but are sliding into even less tolerance in a context that bristles with hostility as it is. Where finger-wagging prejudice is able to set the public policy agenda limiting our access to IVF, more aggressive interventionist steps could follow.
Perhaps we will be segregated from the “normals” or forcibly enrolled in fat camps on starvation programmes. The barbed words of one colleague still ring in my ears over a decade after they first tore into me. I issued the customary protestations about having normal blood pressure and low cholesterol (both of which still hold true) and that I was perfectly comfortable with my size. Her retort: “Yes, but we have to look at you”. The powers that be are contemplating the removal of “yob neighbours”, those who have attracted persistent complaints concerning anti-social behaviour into “sin bins”. The qualm-free sacrifice of the human rights of “underclass” families not prepared to buckle down and accept their lowly station through gritted teeth for the sake of upholding the rights to a quiet life on the part of the rest, a cheap solution compared with tackling poverty, chronic inequality, deprivation and the absence of genuine opportunities and prospects that lie at the root of such sullen and futile rebellion (we can’t alienate the middle-classes by putting up the council tax yet again, after all). Once the principle of ghetto-creation for the undesirables has gained acceptance, the definition of undesirable can be expanded at will. “But they are so gross, so ugly with their bulging bellies. They spill over the arm rests on the plane, they glisten with sweat whenever the sun so much as peeps out from behind the clouds, I can’t bear the sight of them, besides, they lower the tone of the neighbourhood and bring down the property value, couldn’t you just get rid of them?” Fat catchers patrolling the streets to round up those who have not yet been relocated and have broken the curfew (daylight hours, when our allegedly lumbering gait might cause distress, “Pass me the smelling salts, Archibald, I’ve just spotted a slob!”). Perhaps in the end the diet industry will save us. After all, if skinniness were the norm outside of glamorous celebrity enclaves where would its profits come from? Fattening us up again?
Mind you, we are slowly but surely gaining the upper hand in terms of sheer numbers (not that I am naïve enough to think that being in the majority counts for much, as indicated by the frustrations of womanhood in a world where maleness is still the default option with all the privileges such an exalted, power-saturated state of being brings in its wake), as Sarah Boseley (The Guardian, 11th October 2006) shows in her Fears for the future as figures reveal Britons are the fattest people in Europe: “Britons are the fattest men and women of Europe, beating Slovakia and Greece by a small margin and with every likelihood that the next generation will hang on to the title, if current trends continue.
Being overweight or obese is now the norm in the UK, with figures released by the government yesterday showing that two-thirds of men and almost 60% of women are unhealthily heavy. We are also passing on the problem to our children: if nothing changes, nearly a third of boys and girls under 11 will be overweight or obese by 2010”.
She continues: “The figures from the OECD, comparing the UK with 21 other European countries, emerged in a government document detailing the state of the nation’s health, what has been achieved, and targets for the future.
Offsetting such success stories as the drop in cancer and heart disease deaths are the worrying upward trends in obesity and diabetes, mental ill-health and alcohol-related disease.
Caroline Flint, the public health minister, said that the UK led Europe in obesity for a combination of reasons, some of which were cultural and associated with shopping and family habits.
‘It has built up over time,’ she said. ‘In the last 10 years or so, things seem to have got worse. It is partly what we eat but also what we do in terms of physical activity. It is complex. It is part of the way we live our lives and we have to think of 21st-century solutions’.
The government has set itself the target of halting the year on year rise in obesity among children under 11 by 2010. But it does not set a similar target for stopping the weight gain in adults, aiming instead to encourage people to ‘want to change their lifestyles and take responsibility for their health’.
Ms Flint said it was not part of her job to tell people what to do.
Instead, the government is looking towards incentives, such as a voucher scheme offering money off fruit and vegetables being tried out in Cornwall, and more subliminal approaches.
Next spring it will launch an obesity ‘social marketing strategy’, based on the most effective ways of targeting messages to particular groups.
The result of one such piece of research was anti-smoking adverts warning young people that the cigarette habit would leave them looking wrinkled and damage their sex drive.
She expressed hopes that supermarkets would help the crusade, showing parents how to prepare exotic fruits and vegetables in-store and allowing children to try them: ‘Parents are worrying about buying food in case the children aren’t going to like it. We have to be better at listening to people rather than assuming we know what they need’”.
What bemuses me about the idea of squandering money on an awareness-raising deterrent campaign is the underlying assumption that we are not being chivvied, bullied and bombarded from all sides with messages about jeopardising our well-being for the sake of the transitory melting sensation of chocolate on the tongue as it is. Only a thin person in a cushioned environment without a single fat acquaintance (who has been called names throughout childhood and whose hard-won, minimal confidence has been punctured repeatedly in adulthood by casual remarks) could imagine that an extra portion of moral blackmail might sway the recalcitrant pie-guzzler into casting those crusts aside. Here sheer, mind-boggling ignorance combines with prejudice to dream up a plan that will only increase our humiliation, pain, suffering, anxiety and self-recriminating guilt whilst further exonerating those who derive their kicks from picking on us by pretending that fat is a lifestyle pathology, the physical manifestation of a moral flaw (lack of willpower and discipline), heaping all the blame on the individual and blithely glossing over every other contributory factor (I do not subscribe to the fat spells misery and disaster ideology).
Martin Hickman highlighted the schizophrenic attitude of the British when it comes to eating in ‘Crazy’ relationship with food is killing us, says FSA (The Independent, 11th October 2006): “British people eat the worst food in Europe, the head of a Government watchdog warns today.
(…) Dame Deirdre Hutton, chairman of the Food Standards Agency, placed the UK at the bottom of European countries on nutrition and warned that all parts of society were eating badly.
She said a ‘troubled’ relationship with food caused mass obesity in the general population and made young girls consider going on diets. ‘It’s crazy,’ she said.
Yesterday the Government revealed Britain to be the fattest nation in Europe, with two-thirds of men and 60 per cent of women overweight or obese. Ministers said obesity would be the priority in public health and promised to launch a new strategy next year.
In an interview marking her first year in office, Dame Deirdre – who is locked in a battle with the food industry over processed food labelling – said: ‘I think the evidence to me suggests that the UK has really quite poor nutritional status.
‘And although it is particularly prevalent in the lower socio-economic groups, actually the higher socio-economic groups cannot kid themselves it is the only place where it happens.
‘So it is a broad society problem and the interesting thing is you can look at children as young as six or seven and see that they have a very strange relationship with food’.
The multinational food giants and Britain’s biggest supermarket, Tesco, are boycotting the FSA’s ‘traffic light’ labelling scheme in favour of daily percentages for salt, fat and sugar, even though independent surveys suggest the agency’s system is the easiest to understand.
‘The most obvious symptom of our nutritional status is obesity,’ explained Dame Deirdre.
‘It’s not the only thing – there are equal problems of under nourishment in some areas – but the most obvious problem is obesity coupled with things like high salt in the diet. And the rate of increase appears to be exponential – rather like it is in the US.
‘Although other countries in Europe are catching us up or at least showing a trend growing the same way, we nonetheless remain right at the bottom in terms of poor nutrition and obesity’.
She said the country’s difficult relationship with food extended to children.
‘You have got really young girls worried about being overweight – children as young as seven saying they want to put themselves on a diet. It’s crazy’.
Campaigners estimate that bad diet kills as many as 60,000 Britons each year – not far off the 80,000 deaths from cancer and 15 times the number killed on the roads.
Launching the Government’s Health Profile of England yesterday, Caroline Flint, the Public health Minister, said: ‘The rapid increase in adult and child obesity over the past decade is storing up very serious health problems for the future’. Although surveys in the past year suggest that Britons are improving their diet, the last official research in 2001 found that most people eat 2.8 of the recommended five daily portions of fresh fruit and vegetables a day.
Only half the households surveyed by the FSA in 2005 were cooking with raw ingredients every day. About six million people never or almost never cook fresh food”.
The leader in the same edition, A problem consuming Britain attempts to stir us out of our presumed complacency: “National self-image can be a deceptive thing. Economists tell us that Britain is in a healthy state compared with the rest of Europe. And we are used to hearing about the vibrancy of our cultural life. Yet when it comes to our physical health, the official data released yesterday shows that Britain is actually in a rather poor condition. As the head of the Food Standards Agency points out, we are now the sick man of Europe”.
The article comes full circle by citing the cost argument: “The Prime Minister was right yesterday to stress the importance of establishing the principle of ‘preventive’ health care here if we are to see any improvement. We cannot continue to regard the NHS as a ‘national illness service’ [what the bloody hell is it for, then, if not to treat the sick??]. The Department of Health predicts that 13 million people in England will be obese by 2010. With obesity-related illnesses already costing the nation some £3.5bn a year, this could eventually bankrupt the NHS. The success of the Cuban health service [which may work wonders, yet operates within an authoritarian society, which our Labour masters eye with evident envy, the more dictatorial aspects of which they attempt to emulate wherever possible] shows that when doctors focus not just on a patient’s ailments, but on their general lifestyle, the results can be astonishing.
But the real test for the Government lies in whether it can persuade Britons to eat more healthily. There has been some success. The quality of school meals has shown an improvement after the introduction of new guidelines. But the objectives laid out in the Government’s health White Paper of two years ago look distant. Many deprived areas are still fresh-food deserts. And the Government’s proposed ‘traffic-light’ system for food labelling has been rejected by the food industry.
The Government cannot force people to eat more healthily, but it can do a lot more to encourage it. And a good deal more than our national self-image is riding on the success of such efforts”.
That the stakes are indeed high is made clear by the Daily Mail in Epidemic of obesity ‘could ruin economy’ (10th November 2006, unattributed): “The obesity crisis sweeping Britain could damage the economy, researchers warn.
They say Britain became one of the most powerful countries in the world because of the health of its citizens.
But this could all be changed if talented professionals die early or retire because of sickness [once again a giveaway; only when fat threatens the “contributory classes” as opposed to the “scrounger classes” does it become a cause for concern worthy of pumping research funding into].
Professor Martin McKee said: ‘The Treasury has identified the cost of obesity to the NHS as a major problem but our research shows how much healthy people contribute to the health of the economy.
‘They remain in the workforce longer and are more productive while they are at work [note how other forms of moral pollution cluster around the “original sin” of fatness with overweight workers automatically branded as less productive, presumably due to the related evil of laziness].
‘This is vital as the overall age of the population rises and people are encouraged to retire later.
‘It is a waste of money investing in training people if they die at 35 [an unsubstantiated and wildly exaggerated figure surely, especially since another investigation into life expectancy that recently hit the headlines put Glasgow at the top of the early mortality league table with a life expectancy of 66 for men, putting the male residents of the city on a par with Albanians] or retire in their 50s because of ill health’.
The team at the London School of Hygiene and Tropical medicine, examined the link between health and wealth in rich countries, and found healthier people have higher earnings”.
This compounds the impression that we fat are not just punishing ourselves and ruining our own lives, but acting selfishly, nay, sociopathically by wrecking our nation’s prosperity: “About 30 per cent of financial growth in the United Kingdom between 1790 and 1980 can be attributed to better health and dietary intake.
Professor McKee said: ‘The overwhelming conclusion is that good health has benefits beyond the individual.
‘The true purpose of economic activity is to maximise social welfare and not simply to produce more goods and services.
‘Since better health is an important component of social welfare, its value ought to be included in measures of economic progress.
‘This has been done successfully in the United States. Similar moves in Europe could provide a new perspective on the investments made through their welfare states’”.
Shyama Perera in Thin people call fat people bad. So melt me down and save everyone a fortune (The Independent, 10th September 2006) assesses the psychological impact of the fat-disparagement bonanza: “Current policy initiatives to objectivise the fat are doing well. Despite my own gargantuan proportions I find myself tutting over every instance of muffin top among the young, and mature women with heavier thighs than Cherie Blair are immediately assigned a contempt rating.
My girlfriends report that they too have joined the witch-hunt – if only to offset their own lifelong anxieties about size by legitimately pointing the finger at someone who’s even bigger.
Where in the past it was unacceptable to pick on fat kids [an amnesty I ever noticed], the socially dysfunctional, or redundant mining communities fuelling sedentary lives with burgers and fries, one can now vilify them with the establishment’s seal of approval”.
She veers uneasily between orthodoxy and sympathy throughout: “How ironic that revulsion at a burqa and the doctrine it represents is outlawed in this country, but revulsion at the meaning inherent in a waist measurement is positively encouraged. Fattie-baiting is spreading across health departments like the Toronto Blessing. Fat people cost you money – fat people threaten your health.
On that basis, it is now acceptable to refuse them operations, IVF and any manner of medical condition they are deemed to have contributed to by dint of greed. Tonsillitis, Mr Jones? Too much passing traffic, that’s your problem.
Are these health policies new? No, they’re not. Doctors routinely refuse treatment where it compromises them, endangers the patient, or has low success rates within a particular demographic, whatever that demographic may be.
As for assertions about cost, the British Association for Parental and Enteral Nutrition reported last December that malnutrition costs the NHS £7.3bn a year. That’s twice the bill for obesity. If we then place obesity in context alongside vices of choice – binge drinking, drug addiction, smoking, keep fit (sic), and unprotected sex – the figures are even less scary.
Does that mean obesity’s OK? Of course it isn’t! It’s obvious even to a fool that excess weight puts the organs and joints under serious pressure, jeopardising the likelihood of a long and healthy life. It’s vital, then, that we’re given models for healthy and moderate eating.
The issue is this: the fat are being turned into crass objects of ridicule when they are an inevitable by-product of massive social and industrial change.
In the past 40 years, England has evolved from an active, manufacturing society to being computerised, service-led, and sedentary. Women have abandoned the kitchen and joined men in commuter hell. We work the longest hours in Europe. It’s a different way of being. While we’re acclimatising, there isn’t always space for menu-planning and elective exercise. It’s quicker and easier to buy Big Macs or to order a takeaway than it is to go to Asda, transport food home, and cook from scratch.
Meanwhile our children are locked away for fear of stranger danger. Football is banned in the street. Youth clubs have closed. Superstores have replaced playing fields. Inevitably, MySpace, MSN and PlayStations have taken over as leisure activities. We are a society in the throes of a major cultural revolution.
Within that setting, our behaviours may not be wise, but neither are they unreasonable. That’s why righteous protestations and pontifications that find fat people wanting will not only fail, but they will also backfire on those who moot them.
Finger pointing doesn’t work. Painting ‘Burgers Kill’ on fast-food boxes, or ‘Eating Chocolate Could Seriously Damage Your Health’ on every bar of Green & Blacks, will serve only to highlight human weakness, not to lessen it. Alongside those pariahs huddled in doorways over fags, a toke, or a bottle of meths, will we now find the overweight sharing pie and chips?
So why, when 47 per cent of women are a size 16 and over, and one in three men will be clinically obese by 2010, are health chiefs being pejorative instead of seeking solutions that appeal?
Firstly, the fat are an easy target within an cash-strapped NHS struggling to offer even basic healthcare. Secondly, drawing attention to people on the basis of size draws attention away from differences in race or religion: it’s a fairer form of discrimination. The obese have become a useful totem of societal ills – they take up too much room; they’re badly dressed; they shine on hot days and they’re ugly.
This is dangerous ground. Obesity is a general problem. Even posh mums are pushed for solutions when it comes to the frappucino generation – we can all think of examples. I wonder how they feel, being told that they’re a drain on society and bound to die blind of diabetes. It’s not the greatest call to arms. And it’s why health chiefs should think very carefully about the way they’re conducting current campaigns. By alienating the young, they risk doing more harm than good.
The Jamie Oliver approach of getting stuck in at the deep end is a positive one – leading by example and through celebration. His condemnation of lunchbox junk is expressed as caring, not as ridicule. ‘My dream is for our children to be able to cook their children a lovely roast,’ he says.
Our children may have as little time and inclination to cook as their parents, but Oliver’s approach is better than the fast food and M&S cook-chill example shown to my generation.
In the meantime, we have crossed a policy line that makes both fat and thin uncomfortable. Condemnatory pronouncements smack of fascism. Thin people good, fat people bad. Melt them down and save a fortune.
It’s not a new idea of course. The system already exists, administered by Bupa. It is everything Labour hates.
If I were a Tory I’d say this to voters: a teacher aged 50 needs a £6,000 hip replacement. She’s turned down because she’s too fat. On the same day, a new immigrant with HIV signs up for a lifetime of anti-viral drugs costing six figures. Both knowingly risked their health. Both are needy. Only one has put time and money into this community. We’d treat both, because they’re equal in our eyes. Labour didn’t.
Labour heartlands tend to be heavy on the heavy, as the survey on Britain’s fattest towns revealed. If the Government isn’t careful, it may not end up with fat bellies, but there’ll be a few fat lips”.
Her conclusion is just: we must mobilise our political weight before we are ground into total capitulation beneath the twin millstones of disapproval and shame, apologising for the crime of our existence, agreeing with our detractors as they herd us into the operating theatres for lipo-sculpting, excising our bounteousness like a cancer.
