Last month, Dame Sally Davies, the Chief Medical Officer for England, published her annual report on the nation’s health. I was struck by her assertion that two-thirds of adults are now either overweight (body mass index over 25) or obese (BMI over 30). The statistic reminded me that in the 1960s, the peak of the UK smoking epidemic, 70 per cent of men and 40 per cent of women were smokers.
At such levels of prevalence, cultural perceptions alter. It appears normal for people to smoke, a conclusion subliminally supported by the ready availability of tobacco; by the provision of ashtrays in planes, trains and cars; by adverts in every form of media. We are witnessing a similar “normalisation” of obesity, with shop mannequins getting larger, “inflation” in clothing sizes and furniture design being altered to accommodate the new norms.
The historic smoking prevalence data came to mind because in February, figures from 2013 were published showing that the proportion of smokers in the English population had fallen below 20 per cent for the first time. The campaign waged against tobacco over the past 50 years tells us everything we need to know about effecting a similar reduction in rates of obesity.
The prerequisite is information. The tide started to turn against smoking following the publication, in 1962, of the first study to demonstrate persuasively the unequivocal link with lung cancer. The drip-drip of new health information gathered pace and by the 1970s the inexorable rise in smoking prevalence had begun to reverse. The strong links between obesity and conditions such as heart disease, stroke, diabetes and three of the four most common cancers (bowel, breast and prostate) are well established but have yet to lodge in the public consciousness. Most people are aware that being overweight is somehow not good for you but have only a vague idea as to the extent of the problem. I have several obese patients who have been shocked to learn that their weight poses comparable risks of disability and premature death to being inveterate smokers.
Information alone is insufficient. Losing weight is, for most, at least as challenging as quitting nicotine. Research is making clear that large “hits” of sugar, be it “off the spoon” or “hidden” in processed food, have addictive potential. The same may be true of fried foods. The NHS is gradually waking up to the need to provide structured support to people keen to lose weight, just as it devotes considerable resources to smoking cessation services.
The experience of tackling smoking suggests that wider measures will also be needed. Stiff taxation has made tobacco much less affordable. Advertising and shop display prohibition and stark health warnings on packaging have contributed to the message that tobacco use is no longer normal behaviour. Bans on smoking in public places – and soon in cars with children – also serve to marginalise the habit further.
The situation is more complex for obesity. Eating and drinking are normal activities and there is no single culprit product on which the government can train its sights. Having said that, there is good evidence that ministers could get to work on. Sugar in soft drinks (and added almost routinely to processed foods) makes a major contribution to overall calorie intake. There should be an immediate ban on any product being marketed as “low” or “no fat” – or, indeed, trumpeting its freedom from “artificial flavourings and additives” – when it is stuffed full of sugar instead. Breakfast cereals, particularly those aimed at children, are by and large a national scandal.
Several European countries have already introduced a “sugar tax” and the UK should follow suit, though the industry will resist it with vigorous lobbying.
Junk food is also under the spotlight. A neat piece of research published recently in the British Medical Journal established clear links between obesity rates and the density of fast-food outlets around people’s homes and workplaces and along their commuting routes. Will there come a time when diners consuming reasonably priced, healthy whole foods sit comfortably inside warm restaurants, while shame-faced burger munchers huddle beneath a shelter in the windswept car park?
In our efforts to tackle the obesity epidemic, we must take care not to stigmatise the overweight. A small proportion of obesity is genetically determined. For the rest, outward appearances are rarely indicative of simplistic so-called failings such as gluttony. Excess weight is driven by ubiquitous low-cost, energy-dense food, by time- and exercise-poor lifestyles and by a failure of education and information to keep pace with the rapid changes that food technology has brought about over the past three decades. Obesity can also be a manifestation of the same emotional wounds that drive more conventional addictions.
We need compassion for ourselves and for each other. But as the smoking epidemic smoulders towards its conclusion, we need to face the public health crisis that has grown in its wake – and we need to shape up fast.
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