- BUT WHAT WILL BE THE FOLLOW-THROUGH TO THE NEW UK GOVERNMENT REPORT ON OBESITY?

October 19 2007: Somewhat scrambled messages – but finally a step back from knee jerk reactions – characterise the Foresight report released through the Department of Health this week.

The core message is that the number of obese people, as defined by BMI 30+, will more than double between now and 2050, rising to 60% of men and 50% of women.

Somewhat disappointingly, the report nails its colours to the mast of medicalisation (the tendency to push social and psychosocial phenomena into the camp of defined medical illness.)

“Obesity is a complex, multifactoral disease”, we are clearly told. However, there are for perhaps the first time within such a large, formal, governmental report, some tantalising hints towards some of the broader factors in play around all things surrounding obesity, overweight and dieting cultures.

Key quotes with this regard are worth stating verbatim:

“Although personal responsibility plays a crucial part in weight gain, human biology is being overwhelmed by the effects of today’s ‘obesogenic’ environment, with its abundance of energy dense food, motorised transport and sedentary lifestyles.”

 “Although the ultimate determinants of a phenomenon like obesity are essentially social, albeit through biological mechanisms….”

 “Clearly, important changes in these social determinants, whatever they may be, are unlikely in the absence of social, fiscal, or legislative change….”

“The causes of obesity are extremely complex encompassing biology and behaviour, but set within a cultural, environmental and social framework.”

None of this, however, is teased out, although one could argue that as the report is essentially predictive on overall trends, it is beyond its remit to stray too far into the realm of solutions.

Health Secretary Alan Johnson, somewhat in conflict with the first of the report’s observations above, commented “Solutions will not be found in exhortations to greater individual responsibility or in the futility of isolated initiatives.”

More potentially problematic is the report’s assertion that “These trends are broadly mirrored throughout Western Europe”. Whilst this contention is juxtaposed with certain statistical extracts, it more broadly flies in the face of some other epidemiological research.

Obesity can convincingly be shown to one of many “socially dysfunctional conditions” interwoven with the degree of inequality prevalent within societies. Thus one will find that the U.S. and UK experiences with obesity are not, in fact, being mirrored closely within, say, Scandinavian countries which, although relatively rich, play a premium on more equitable sharing.

Modern UK politicians of all party persuasions seem more comfortable operating within the language of “aspiration” than being seen in any way to be wedded to any notions of class (or, at the very least, tangible and systemic inequality). These are uncomfortable truths which perhaps need facing very clearly by politicians with regard to social phenomena such as obesity.

To be fair to the report, this collation of a pan-Western European experience aside, it does go on to state “There are also synergies with other policy goals such as increasing social inclusion and narrowing health inequalities since obesity’s impact is greatest on the poor.”

A final note of critique and caution must concern be sounded with regards to the report’s observation that “Some of the predictions reported are surprising, particularly the low estimated effect on life expectancy”. That obesity itself is predicted to remain a pretty marginal influence on overall expectancy always sits uncomfortably with the mass hysteria that it is another Black Death in the making. It is part and parcel of the broader empirical weakness of medicalising social conditions.

These points aside, the partial shift in advisory thought being presented both to – and disseminated from - the government is to be warmly welcomed, However, the ongoing proof of any core official shift in thinking away from still essentially medicalised and only culturally non-contentious ways, will, as always, be in the eating.