PHYSIOLOGICA - Normalising Obesity: A ticking time bomb?
The other day I did something which I rarely do; I went into McDonald’s. It’s a very rare treat for me, but when I do go I love their pancakes covered in syrup and I’ll buy a Mr Whippy ice cream to go on top (don’t judge, it’s an amazing cheat meal). While I was sat there, waiting for their funky new table service, I observed the people coming in, ordering, and then leaving. Almost without exception they were obese or at least very overweight. As a personal trainer who keeps in shape, it’s a condition for which I’ve held a professional fascination. Before anyone gets defensive, this post is not to going to be a fat-shaming rant, instead it’s an observation about the past, current and possible future levels and causes of obesity in the uk, including my own personal opinions.
So to begin, what is obesity? At which weight do you become obese? The current method of calculation is called the Body Mass Index, or BMI, and it’s what doctors and health professionals use to diagnose obesity and also to identify anorexia. It isn’t perfect, I myself am officially obese even though my body fat percentage is currently around 12% (which is pretty good). BMI uses an algorithm requiring body weight and height variables to arrive at a numerical rating. Below 18.5 is underweight, 18.5 - 24.5 is healthy, 25 - 29.5 is Overweight, 30 - 39.9 is Obese. It’s purpose is to identify those who are overweight, i.e. high body fat percentage, however it fails to take into account muscle weight, so sports people will often score high on BMI leading to misleading ratings.
So now we are clear on what BMI is, why then is it calculated? Surely not just to rate people’s aesthetics? Well no, it’s used every day in numerous ways. Several vocations require a person to have a healthy BMI rating; pilots, train drivers and others who have people’s lives in their hands and can’t run the risk of suddenly dropping dead, often their appointment to these roles will depend on their BMI rating. Restrictions are in place for obesity in regard to medical treatments, IVF and even skydiving - all require a healthy BMI rating before they can be undertaken. In addition to these limitations, BMI is used to diagnose an individuals risk of developing obesity related conditions. These include many cancers, heart and circulatory health (arthrosclerosis), diabetes, osteoarthritis and numerous others. All these conditions and more are directly correlated to a high BMI rating.
Levels of obesity have skyrocketed in the last 10, 20 and 30 years. I remember as a child seeing obese people as rarities, and when you did, it resulted in staring and whispering. Now, unfortunately it’s so commonplace that people rarely even notice.
Currently 28% or almost 1 in 3 adults *1, and worryingly 1 in 5 Children are obese *2. Remember, were talking clinically obese here, not just overweight - that number is much higher. So how and why has this happened, and in such a relatively short time? I think the answer is a complex one, but these main factors below must play a huge role:
Reduction in general activity:
Children move less and play less outside. Adults also do less. We drive more, take less leisure activity, have less active jobs; less manufacturing and more sitting, think I.T. office jobs, etc. Escalators everywhere mean we don’t even have to climb up a flight of stairs and public and private transport is ubiquitous. Overweight people are given ironically named “mobility” scooters to get around. Instead they should be encouraged to exercise and lose the weight which is often causing their immobility.
Dietary changes:
In the last 10 years, we’ve seen a fast food revolution. Bigger portions; think supersizing, king size chocolate bars, Convenience foods, drive through fast food service. The huge changes in the way we eat have to have a massive impact. With companies such as Deliveroo and Just Eat you can now have junk food; KFC, McDonald’s any pizza you like delivered straight to your door. You don’t have to move from the sofa. I’m half expecting a service which allows you to have someone bring the food in and then also shovel it into our slack chubby faces while we stare vacantly at the TV. I’m not sure I’m even joking.
Sugar - “Sweet powdered death?”:
Sugar is everywhere, from the fairly unsurprising 35g or 7 teaspoons of sugar in a can of coke, to an outrageous 5.5 teaspoons of hidden sugar in an apparently healthy Glacier Kiwi & Strawberry Vitamin “Water” *3. It’s very addictive, and hard to avoid in food unless you cut out processed food entirely.
Hyper palatability:
Foods are made deliberately hyper palatable. By that I mean some foods have been made so amazingly delicious and have such an incredible mouth-feel that resisting them is almost impossible. It’s a perfect marketing method, foods such as this have also been shown to be highly addictive. One in particular even boasts that “once you pop, you can’t stop” (answers on a postcard). These hyper palatable foods are no longer treats, they have become everyday staples. One high street coffee shop sells a White Chocolate Mocha “coffee” which contains 470 Calories, and 18 grams of Fat. A COFFEE!?! *4
Now we come across the problem as I see it. Due to this increase in incidence, obesity is slowly being normalised. It’s now common to see adults and children waddling down the street, and even massively overweight people pass with barely a glance. Doubling down, obese people themselves have started demanding bigger airline seats, larger sizes in clothing and even larger toilets to cater for their expanding bulk. Companies such as “Simply Be” and “Jacamo” are capitalising on the burgeoning market for outsize fashionable clothing. Fashion designers and magazines such as Cosmopolitan are featuring huge plus size models, the latter recently having Tess Holliday on the cover (see below). I find all this is very disturbing.
I acknowledge that reasons behind someone gaining morbid amounts of weight are varied and complex. They include mental health and self image problems, plus depression - amongst others, so we need to identify and treat these, but we also need to admit to ourselves that people are consuming too much and expending too little - we’re sleepwalking into a politically correct global health disaster.
Recently the UK government tried to tackle the problem and started an obesity public awareness programme. Predictably, there was a huge backlash from obese people and social justice warriors claiming it as fat shaming. Even trying to have a conversation about the dangers, in this case highlighting the fact that Obesity is now the biggest preventable cause of cancer, is met with indignation by the terminally offended. The NHS will take the brunt of the spiralling cost and is highly likely to increase the strain on an already overburdened system.
There are positives though, the recent sugar tax although criticised, but has made progress. Companies are beginning to reduce sugar, especially in those foods and drinks aimed at children, but there’s still a long way to go. Do we really need bigger and bigger chocolate bars, and a two litre bucket of coke at the cinema? I would argue not.
So in conclusion, where is this going? The rate of obesity has quadrupled over the past 25 years, and is set to rise to an additional 11 million more obese adults by 2030 *5. It’s been suggested that more financial contribution should be made to the NHS by those who choose to live unhealthy lives and make reckless life choices. I agree with this in principal, but it’s a slippery slope and it needs to be strictly monitored.
The huge success in reducing the amount of smokers worked by making it very expensive and more importantly socially unacceptable. Would a similar treatment work on the obesity problem - an NHS insurance premium on those who are obese, and a society less tolerant of obese people?
As I guiltily scraped the last of the syrup off my flimsy plastic knife back in McDonald’s, I watched opposite me as an obese child tucked into a second McMuffin, his equally obese mother sat next to him absorbed by her phone. It might work, but would we want to live in a society like that?
References:
*1 - World Health Organisation 2014 Study of UK Obesity
*2 - HSE Health Study England 2014
*3 - Values provided by: www.rethinksugarydrink.org.au
*4 - Values from: www.starbucks.com and www.calorieking.com (via: thethings.com site)
*5 - “Health and economic burden of the projected obesity levels in the USA and UK” www.sciencedirect.com. 378: 815-825.
Wikipedia - Obesity in the United Kingdom