Tue, Jan-24-23, 09:36
A couple of follow up articles in The Times:
Cake debate is no laughing matter — seriously
Snigger at comparisons with passive smoking if you must, but only if you’re blind to the scale of our obesity crisis
Yes, ban the office cakes. Obviously. The parallel with passive smoking made this week by the chairwoman of the Food Standards Agency, Professor Susan Jebb, is illuminating and apposite and I don’t understand the general outrage. Or the bizarre collective sense from the media that somehow the obesity crisis is funny.
Cancer isn’t funny, famously, and obesity is the second-biggest cause of preventable cancer in Britain. It increases the risk of 13 types of the disease we’re all most hysterical about and waste so much money trying to “cure”, including breast, bowel, womb, oesophageal, pancreatic . . . so why on earth, when a distinguished Oxford professor of diet and population health says bringing cakes into the office inflicts harm on others, is the universal response “Ha, ha, ha, but I like cakes, cakes make me happy”, and a load of stodgy pink recipes from desperate ex Bake Off contestants all over the TV news?
I have never been a big fan of cakes. Haven’t got a sweet tooth, although I do like cigarettes, illegal drugs and driving much too fast. But I don’t do them because they are dangerous for me and those around me. Although they don’t kill as many people in this country PUT TOGETHER as obesity.
You weep for the NHS in crisis, support the striking nurses and ambulance drivers (well, I do) and call for more money to be poured into the broken old socialist health dinosaur, but you don’t care that obesity costs it £6 billion (£6,000,000,000) every year, a total predicted to rise to nearly £10 billion by 2050. Which is an awful lot of nurses — 250,000, give or take. But, ha ha ha, you like a nice bit of cake in the office. So forget it.
Even people who are broadly cognisant of the scale of the obesity problem have argued with Jebb, saying: “But you don’t have to eat the cake, it doesn’t kill you by just sitting there in the same way passive smoking does.” But, a) I was never convinced by the passive smoking argument anyway — always reckoned it was a semi-fallacy whipped up (quite rightly) to hasten the end of smoking as a socially acceptable pastime; and, b) it does! It absolutely does.
Obesity kills by a conspiracy of silence, ignorance, corporate greed and corruption at all levels of business and government, just as tobacco once did. Despite all advice, there’s no movement on watersheds for TV junk-food advertising, product placement in shops or changes in packaging. All they’ve done is put calorie numbers on restaurant dishes which don’t mean a thing.
Look at the state we are in. This week alone we read in The Times about 16-year-old Kaylea Titford whose parents allegedly “killed her by letting her grow morbidly obese”, ordering five takeaways a week until she had a body mass index (BMI) of 70 and died “with maggots and flies on her body and milk bottles filled with urine around her bed”. And of Jeremy Clarkson, in his Sunday Times column, injecting himself weekly with a diabetes drug called Ozempic that has side-effects such as severe abdominal pain, gallstones and cancer and which some private quack has told him will suppress his appetite and help him lose weight.
That’s two people from the very top and the very bottom of the socioeconomic ladder dying, or misusing prescription drugs in the hope of not dying, from food they would prefer — if they could choose — not to eat. How is that not the same as passive smoking?
I have been campaigning about this for more than 20 years. Well, I say “campaigning”. I mean writing and making television programmes about it, always for money. I don’t do marching and shouting and civil disobedience. Partly because I have mouths to feed and partly because I think I reach more people my way. I’ve been doing it since half of British adults were overweight and a fifth were obese; now it’s two thirds and a quarter, respectively. And all I have met is anger, abuse and accusations of “fat-shaming”. From the right, because I seem to be after restricting people’s right to choose how they live; and from the left because, since obesity disproportionately affects the poor, I must be motivated by class hatred and snobbery.
In the main, I have tried to use humour and satire to make my point. In a documentary called Tax the Fat for Channel 4 in 2006, I advocated (quite preposterously) multiplying every UK adult’s annual tax liability by the square root of his BMI over 100 so that, literally, the fatter you are the more you pay. But it’s such an emotive issue that people go crazy and lose all critical faculty. The left took me seriously and said this would unfairly target the poor; the right took me seriously and said: “No new taxes.” But I was joking! Obviously! I was trying to say: “Look, it’s so bad we have to do something. This is clearly not it, so show me what you’ve got.” None of them had anything. They just went back to scoffing their office cake and complaining about funding.
In all the online lists of The Ten Worst Things About Giles Coren, “fat-shaming his son” is always around five or six (depending on what else I’ve been up to) because when Sam was four I wrote a column in Esquire magazine saying I didn’t care whom he ended up marrying or if he was gay or straight or what he did for a living, as long as he wasn’t fat. Again, it was satire, a look at where obesity sits in our plans for the future and our hopes for our children. But, at the most basic level, it is also true that I hope my child never suffers from a disease that will impoverish and weaken him and shorten his life. To say so was, and still is, considered outrageous. We are expected to show sympathy for fat people, above all. And I do! I have moved on from any notion I might once have had about personal culpability and now hold the government and “big sugar” (which pulled a nefarious con on the public by repositioning sugar as “energy” when it is, in fact, sloth, weakness and depression) entirely responsible. Which is why I am with Jebb all the way in calling on people to stop buying this poisonous shite in pretty packaging and forcing it into their ailing colleagues like corn down the diseased gullet of a Perigord goose.
An unrelated story in The Times on Wednesday celebrated a new wonder-drug proven to prolong the lives of mice, inspiring the dream (assuming we do all want to live longer) that it might work on humans. But do you know what is also proven to prolong the life of mice? Severe calorie restriction. Cut their intake by a third and they live up to 40 per cent longer. Before we plough billions into yet more drugs, shouldn’t we at least give that a go?
Forget cakegate! We need to take obesity seriously
Susan Jebb, professor of diet and population health at Oxford, compared cake in the office to passive smoking. Here she explains what she meant and why we must break the pattern of overeating
I'm looking forward to watching the new BBC drama Marie Antoinette but was a little dismayed this week to discover that I have been labelled as her antithesis (“Don’t let them eat cake”, Jan 18). The article emerged from a new health commission being run by The Times explicitly aimed at trying to encourage new thinking and to identify solutions to the long-term problems in the NHS. Key to this is to prevent ill health before it happens. That has to start by our being able to discuss ideas — which has certainly happened regarding cake culture in the office.
We can’t escape the fact that we eat too much. There’s little dispute about that. The laws of physics tell us that when we put on fat, it’s because we’ve eaten more energy than we have burnt. But why has this happened? It’s easy to forget that, as a society, we did not always look this way. Pictures from the postwar years, or our own old school photographs, provide a striking contrast to the way we look today. Yet we have not substantively changed our genetic make-up in this time and it seems unlikely we have had a national collapse of willpower.
In fact we’ve gained weight despite our individual efforts to avoid it. In the Health Survey for England, about half of all adults report trying to lose weight and there is a booming weight loss industry. Yes, we make choices, but these are shaped by the world in which we live. Long working hours and extended commuting leaving less time to prepare food at home have been blamed for the rise in convenience foods at home — an argument given further credence by the increase in cooking from scratch during the pandemic when people were working from home. We eat out more, where meals have more calories than similar items at home. Coffee shops have sprung up on high streets, vending machines have proliferated in public places and it seems we are never more than a few strides from a bite to eat. Hungry or not, the sight and smell of food primes us to eat.
Alongside these macro-environmental trends, research conducted by my team in Oxford, and others, shows the effect of our micro-environment on food-purchasing choices in the moment. In one of our experiments, a supermarket removed Easter eggs and related products from the most prominent places in selected shops in the run-up to Easter, although the products were still available for sale elsewhere in the store. In other matched stores, these items were available as usual, including on the end of aisles by the tills. Prior to the experiment, sales of chocolate in both groups of stores were similar and in both stores, people were free to choose throughout. In the stores with less prominent positioning, people bought 12 per cent more chocolate leading up to Easter than during the preceding period, while in the stores with (typical) layouts they bought 31 per cent more. This translated into fewer calories in the baskets of people in the trial stores.
Would you perceive that you had made a different choice because of this change in the store layout? Of course not. We all like to think we are rational, intelligent people who make free choices, yet this and other careful trials show that our choices are often strongly shaped by the environment, even though as consumers we are unaware. And this has locked us into thinking that if we educate people more they will make healthier choices — and to overlook the idea that if we change the environment we might get changes in behaviour.
The importance of changing the environment may also help to reduce the marked inequalities in health. People with an underlying vulnerability to weight gain, perhaps due to their genetic make-up, are more susceptible to these effects of the environment. Take another experiment: children watched food or toy advertisements prior to a cartoon. Afterwards children were offered a choice of foods to eat before returning home. Compared with children who had watched TV with toy adverts, children who had seen food advertisements ate more. This priming effect was stronger in children who were overweight or obese than children with a healthy weight.
This vulnerability to the environment is also revealed when people are overburdened with other pressures. When we are stressed or distracted we make fewer healthy food “choices” and, in the moment, don’t have the brain space to consciously think what we are eating. For some this might be an occasional episode, for others it’s the reality of their everyday lives. Attention to what we are eating is a finite resource.
Many people blame the food industry for tempting us into poor diets, but it’s more complex than that. As Henry Dimbleby described in the National Food Strategy, we are locked into a “junk food cycle” where we eagerly purchase more of some things, perhaps due to our biological drive to select high-energy, hyperpalatable foods, and so the industry promotes these foods because they are commercially successful. New food habits develop and our social norms and food culture shift — that may be imperceptible in the moment but it is very evident if we cast our minds back a decade or two.
Research and detailed policy work has identified a raft of interventions that could be deployed to help to prevent obesity. Rightly, many of these policies aim to change the commercial environment, which is likely to need laws to protect the most progressive businesses from competitive disadvantage. But in large part these are opposed because we persist in believing that individuals have free choice — forgetting, perhaps, that the marketing and advertising of food is explicitly designed to manipulate that choice, but for commercial rather than health reasons. Nudges to reposition foods, reduce portion sizes or increase the availability of healthier options are all, in effect, attempts to protect us from the unconscious drivers of our own behaviour.
The thought I offer is that if we considered obesity as something that, at least in part, happens to us, we would know ourselves better and find a more effective way to tackle the problem than the simplistic and largely ineffective rhetoric that relies on telling people to eat less and do more.
Rates of obesity have more than trebled since the 1980s. Obesity is putting a strain on our bodies and a burden on our overstretched NHS with higher rates of type 2 diabetes, heart disease and an increased risk of at least 13 types of cancer. During the pandemic we saw that people living with obesity were significantly more likely to be admitted to intensive care with severe Covid infections. Obesity is a serious health risk.
Of course I’m not arguing that cutting back on cake in the office is the solution to obesity on its own, but it’s symptomatic of a culture where cake is no longer an occasional treat. Sweet treats are embedded in our micro-environments and are no longer occasional indulgences but the norm.
We need to talk about how we, as a society rather than as individuals, can break out of this ingrained pattern of overconsumption. Perhaps we might start by knowing more about what drives us — against most of our best intentions — to eat more cake than is good for us.
Susan Jebb is professor of diet and population health at the University of Oxford