Britain’s Obesity Crisis: All Aboard the Good Ship Fatso
This post comes with a health warning: if you are wider than you are tall, and are sensitive about your size, do not read further.
According to the British government, more people with Type 2 diabetes may soon be eligible for weight reduction surgery to mitigate the complications of their condition. Diabetes UK reckons that up to 850,000 people would qualify for the surgery, although the National Institute for Clinical Excellence (NICE), under whose guidelines the operations will be funded, reckons that the caseload will be in the tens of thousands. Many of those who will qualify are so seriously overweight that they can hardly walk.
NICE rather primly points out that losing weight without surgery is a better option. That must be right, but one wonders how many people in the Government’s hit list lack the means or desire to find their own solutions. Quite a few, I’m sure, and I’ve just seen evidence to suggest that the poor are not the only ones who could do with losing half their body weight.
I’ve just come home from a two-week Baltic cruise. Among my three thousand or so fellow travellers I had never seen such a concentration of fat people. Yes, fat. Let’s not beat around the bush with mealy-mouthed words like obese, overweight, chubby or rotund. These people were plain fat. Large numbers of them were exceedingly fat. And most of them didn’t seem very happy about it.
Here’s what I wrote on the boat.
They are people who might live next door. Or down one of those roads in leafy suburbia in a hundred British towns. Faces lined with discontent or disappointment, or maybe just lined. Or not lined, because every attempt by nature to chisel out facial wrinkles and crevices is snuffed out by increasing layers of compensating fat, slowly expanding over the years into wobbling bulk too voluminous to accommodate in a normal chair, too ponderous to allow long-suffering knees to carry without mechanical aids.
Nobody on the cruise – fat or not – looks particularly happy or intensely sad. Just an unsmiling blankness only lifted by the prospect of food. Mountains of it. Three times a day, or four if you count afternoon tea. At mealtimes, couples sit in silence, unless forced by a lack of space to sit with others. Then the conversation is about the weather, or how many cruises you’ve been on, and which ship is better, and how inconsiderate that the Murray match at Wimbledon abruptly gives way to some World Cup football match between far away countries of which we know little.
No love boat this. No wife-swapping, drug-taking or drunken binges. We have quizzes, dance shows, comedians struggling to bridge the generations. During the day, non-stop music on the pool decks. The “entertainment team” – Butlins redcoats reincarnated for the age of the cruise liner – struggle valiantly to animate the corpses laid out on the poolside loungers.
On a P&O cruise from Southampton, the sun may be reluctant to show its face, but what little there is has not yet set on the British Empire, however much the old country it leaves behind may have descended into feeble decline. The passengers are largely British, and overwhelmingly white. Apart from the officers, the crew are mainly from Goa, Kerala and the Philippines. An exception is the captain, who is from Poland. He is as far removed as it is possible to be from grumpy old Captain Smith of the Titanic. He looks like a teenager, and talks like a middle manager from a mobile phone company.
In the traditional dining rooms, there are kippers, kedgeree and devilled kidneys for breakfast, three-course lunches and four course dinners. Every three nights the dress code is black tie, or dark suits for those who couldn’t be bothered. I couldn’t be bothered. I resisted family pressure to wear a black tie on my wedding day because I didn’t want to look like the Yorkshire Ripper, and I’ve rarely worn that ridiculous getup – except in the pursuit of personal gain – ever since. A minor act of rebellion, shared only by a small group of Chinese passengers.
Those who can’t be doing with the leisurely pace of the formal dining rooms can gorge themselves to their hearts content on the buffet restaurants that are open all hours of day and night. This they do with enthusiasm and ruthless purpose as they barge their way to the refuelling stations. There’s something about queuing for food that exposes just a tiny bit of the inner predator. Just as when they aggressively sally forth in their cars, the meek and the mild reveal their hidden steel in pursuit of the steak and kidney pudding or banoffee pie. Nothing like three hours of starvation to bring out the caveman.
Why all the fat people? Well, you might think it’s the result of two or three cruises a year. But most people can’t afford that kind of expense. Perhaps the reason is this: if you’re faced with the task of decanting yourself into an EasyJet seat for a two-hour flight, thus facing the humiliation of being told that you have to buy an extra seat to accommodate your bulk or maybe even not being allowed on the flight because there isn’t a free seat next to you, why would you not avoid the hassle and go cruising instead? Even better if you’re wheelchair bound, and don’t want to go through the hassle of being hauled into your airline seat.
That doesn’t explain away the presence of such a large proportion of people whom you would categorise as fairly fat, as opposed to monstrously so. As I watch the outsize population wheezing their way to the next meal, or beached on the deck chairs reading Fifty Shades of Grey, I can’t help thinking of animals. Walruses, seals, silverback gorillas. Or pugs, whose jowly faces threaten to render the eyes, nose and mouth invisible. I wonder how many cruises it takes to reach that state, or whether a lifetime of booze, burgers and bread has inflated them slowly. Or even whether decades of misguided dieting and obsessive attention to the waves of conflicting “health advice” to be found in newspapers like the Daily Mail has brought them to this. Is it sugar, carbs, saturated fat, hydrogenated fat or fructose? Or is it boredom, despair, ignorance or lack of willpower? Is it someone else’s fault – the food industry, our parents or social deprivation? Or is it our own fault, a heretical thought in an age when there’s always someone to blame for everything?
Whatever the cause, as I look around at the younger passengers, slim, good- looking and full of energy, I wonder which of them will be the bloated cripples hobbling around the cruise liners in thirty years’ time. Statistics suggest that up to 25% of the population of Britain is seriously obese. In this temporary town, the proportion is more like 50%. I wouldn’t be surprised if this lot hadn’t accounted for the equivalent of the entire annual throughput of hip and knee replacements by a large national health hospital.
Perhaps it wouldn’t seem so depressing if the lardy army showed some sign of enjoying themselve. But no, most of them have the joie de vivre of undertakers on their third funeral of the day.
Now before those of you who know me accuse me of hypocrisy, I freely confess that I’m no sylph. I’ve struggled with my weight for most of my adult life. But compared with some of the people on this ship I’m a stick insect. I’m unlikely to be a candidate for gastric banding and I’m quite capable of playing three or four rounds of golf a week without the help of a cart. Like most of the people of the people on the cruise, I’m perfectly aware of what I have to do to lose weight and I understand the consequences of eating too much of certain types of food. By some miracle I managed to get through the fortnight without gaining any weight. Should I one day keel over one day with a heart attack, you will not find me blaming anyone but myself.
So should we be trying to save people from themselves by stapling off half their stomachs, or should we be letting nature take its course? No doubt some NICE statistician has calculated the cost comparison between saving the state the cost of all the artificial joints, heart bypasses and amputations and bearing the expense of caring for people who are thereby living longer. But is it the responsibility of society to save people from themselves?
If we are prepared to help alcoholics and heroin addicts to kick their habits, then I suppose we should extend a helping hand to people who can’t resist stuffing their faces. But let’s not kid ourselves that the grossly fat are suffering from some genetic condition that takes the responsibility out of their hands. There may be a tiny minority of people to whom that definition applies, but the vast majority are not victims. They are mature adults who make choices about the way they live their lives.
Unfortunately we live in an age when behind every corner lurks a lawyer desperate to give us a reason to sue someone. If we are stupid enough to trip over because we weren’t looking where we were going, we look for someone else to blame. If a doctor makes an error in good faith, our first instinct is to ask for compensation, as if money can truly compensate for the loss of a loved one. There is no such thing as bad luck – only perpetrators to find and blame. We are frightened, risk averse, responsibility averse and obsessed with health and safety. We see demons everywhere. Thanks to the acts of a few nasty individuals we can’t even glance at a child in the street without being subjected to dark, suspicious looks – especially if we happen to be male. We are obsessed with our rights and other peoples’ obligations.
The “obesity crisis” presents us with a moral dilemma. In a society with limited means that is committed to providing free healthcare for all, regardless of wealth and social standing, is it right that we should prioritise the downstream consequences of lifestyle choices over provision of the best available treatment for conditions that have nothing to do with lifestyle – brain tumours, breast cancer, motor neurone disease and so forth? And what constitutes a lifestyle choice? Unsafe sex, drinking, smoking, over-eating, extreme sports? Are the fat undeserving of the same resources as the unfortunate? Or is it against our western principles to allow no redemption for past mistakes?
No doubt NICE’s calculations are based on practicality, but it’s impossible to escape the moral dimensions of clinical decisions being made every day by doctors and hospitals up and down the country. To give a liver transplant to an alcoholic; to give the most expensive lung cancer treatment to a smoker; to spend £3000 on a gastric band to a person weighing 200 kilos. If practicality was the only consideration, we would have legalised assisted suicide years ago on the grounds that it saves the health service the heavy burden of palliative care. It is the moralists, such as the Church of England, that are resisting the legislation currently going through Parliament.
A couple of years ago I lost a friend to a brain tumour. He was 54, fit, energetic and full of life. A lovely guy. If I had needed a gastric band or a couple of knee replacements so that he could have had life-saving treatment, I would have cheerfully have waived my entitlement to those operations through the National Health Service and paid for them myself. The hundreds of fat people on that cruise could afford to spend thousands every year to sail the seas. The vast majority of them could also afford to pay for their new hips and gastric bands, or at least take out health insurance.
The fat are no less worthy than the thin. No less intelligent, no less kind, no less life-enhancing. They deserve the best quality of life they we and they can afford.
But the dilemma is not going away. As a nation we are getting fatter and less fit. So are most of the other wealthy nations. We all want low taxes, higher wages, protection against crime and terrorism, investment in infrastructure. Above all we want healthy lives.
Something has to give. In the UK at least, my guess is that practicality will win out over morality, and that within the next thirty years the founding principles of the NHS will be replaced with a colder, harder philosophy: you reap what you sow.