Fat used to be just a feminist issue; these days it has become a national crusade.
The latest news that the government plans to issue letters to the parents of obese children, identified by its national programme of weighing school pupils, is the latest salvo in the UK’s ongoing battle of the bulge.
One might argue that the debate itself has now become as bloated as the overweight Britons it aims to help. One commentator spoke recently of the ‘obesity tsunami’, more dangerous, he claimed, than the threat of climate change. Certainly, it is hard to know which side is blowing off more hot air.
Aside from the rhetoric, however, more is being expended than simply words. Public finances are being allocated to the fight against obesity.
The issue is undoubtedly worrying — we are growing ever fatter and doing less exercise. The likelihood is that if we don’t spend public money now on preventing obesity, we will end up spending more later on treating the illnesses linked to obesity, such as heart disease, Europe’s number one killer. So, the government naturally feels obliged to do something.
But is the latest approach the best medicine? On a human level, can it be right to stigmatise fat children more than their peers already do with playground bullying? And, from the taxpayer’s perspective, could public health funds be spent more wisely?
The UK could take some inspiration from overseas — and, in fact, UK MPs have already taken ideas from Finland, including the weighing programme.
In the 1980s, Finland’s obesity rate was twice as high as ours — but in the years that followed, while Britain’s soared, Finland made dramatic progress in cutting both its weight problem and heart disease rates.
But, examined in detail, the Finnish example was about far more than just notifying parents about overweight kids. In a landmark pilot project in the region of North Karelia — aimed at reducing rates of coronary heart disease rather than obesity — extensive consultation was carried out into what forms of exercise the most obese parts of the population were willing to do.
Public funds were then targeted into helping these people, mostly older men, to do regular exercise.
Likewise, research into parental attitudes showed that the reason children did not walk or cycle to work was that their parents were worried that they would be travelling on their own in the dark Finnish mornings. So funding was provided to encourage friends to meet and walk or cycle in groups.
This targeted use of public money achieved impressive results and added a positive dimension to the debate. Indeed, a 2002 study concluded that Finns were far more satisfied with opportunities for physical activity than people in other countries, and also better informed about physical programmes.
One reason was that Finland had considerably better indoor and outdoor sports facilities. Looking at the dearth of sports facilities for children in the UK, it is hard not to conclude that we are focusing too much on sticks and not enough on carrots.
Combined with the current punitive attitude towards obesity is a short-term approach to health budgets. Last weekend, raids on NHS trust budgets, aimed at meeting politically driven targets, again made the news, suggesting that we rarely build preventative health measures into NHS thinking.
The National Institute for Health and Clinical Excellence will soon be asked to evaluate new medicines for treating obesity, and budgets will no doubt be allocated to such treatments.
This will almost certainly be needed, especially for extreme cases, and could revolutionise the way we treat obesity in the long term. But how much money could we save if we also enacted a ‘joined-up’ approach throughout the public services?
We know that the reasons for excess weight are complex and the solution amounts to more than eating less and exercising longer. This simple recipe fails to take into account the psychological and social causes tied up in the way we eat and the way we live — let alone Britons’ resistance to being told what to do.
Changing our attitudes to food will require more than giving a ‘top down’ signal. It will mean integrating healthy living into schools and communities, and supermarkets and restaurants changing the service they offer so that high-fat, high-salt or high-sugar options are a treat rather than the staple diet.
The author of the Finnish experiment described in the New Scientist how much the people of North Karelia had to change — it was not simply a question of getting them to switch from butter to margarine. What did they spread on their bread? Bear fat.
If cultural attitudes can shift that far in Finland, giving up our national love affair with TV dinners really doesn’t seem all that hard.
