The more we learn about the drivers of obesity, the clearer it becomes that willpower alone won't work. Governments need to act
YOU can’t be fat and fit. That was the take-home message of a big study published last month, which found that people with obesity are much more likely to develop cardiovascular diseases even if they don’t have warning signs such as high blood pressure.
The busting of the “fat but fit” myth might be bad news for people who are already obese. But for society as a whole, it is good news. Over the past decade, obesity has gradually slipped off the health radar. It is now so commonplace that it has been normalised, and the idea that you can be obese without paying a heavy price has helped foster complacency.
In truth, the obesity epidemic is still a huge health issue. Every generation born since 1946 has been heavier than the previous one, and those at the extreme end of the spectrum are growing ever larger. Obesity puts people at risk of a long list of health problems, including heart disease, diabetes, cancer and mental health issues, and the fatter people get, the worse the prognosis.
At the same time, our approach to treating obesity has put too much emphasis on individual action – diet and exercise – and on pharmacological quick fixes that fail to materialise.
The more we learn about the drivers of obesity, the clearer it becomes that these fixes won’t work. We now know, for example, that genetic differences make some people more prone to overeating than others, a fatal problem in today’s obesogenic environment (see “The appetite genes: Why some of us are born to eat too much“). But there is also growing evidence that simple, common sense strategies can make a real difference to your waistline.
For example, making junk food less prominent in supermarkets or at buffets can make you less likely to eat it. Restricting the marketing of junk food limits its desirability, and borrowing food industry tactics – like putting cartoon characters on packets of raisins – makes healthy food more appealing to children. Paying people to eat better also works, at least in studies, as does taxing junk food. Tools like these have made obesity researchers cautiously confident that the tide can be turned.
But showing that they work in clinical trials is one thing. Rolling them out more widely is another.
There are a few positives. Next April, for example, the UK will start taxing sugary drinks, which should reduce obesity. Unsurprisingly, the move is being resisted by the drinks industry, which argues that it would harm small businesses and cost jobs. They are not saying, note, that it wouldn’t reduce obesity – surely an admission that it would.
Such corporate pressure often carries the day. In the US, the Food and Drug Administration wants menus to display calorie counts – a strategy that has been found to help people lose weight. The rule was supposed to come into force last month, but is being stalled by lobbyists.
The pattern is familiar from other public health debates that pit private interests against those of wider society, such as minimum alcohol pricing and plain cigarette packaging. Under these circumstances, corporations will always aim to privatise profits while socialising the risk.
Our new understanding of the causes of obesity makes it clear that we need to socialise the solution. The architects of today’s food environment – and tomorrow’s obese patients – need to decide whether protecting profits is really more important than sensible collective action.