Thursday, January 08, 2009

The chance of cutting obesity? A big fat zero

The number of failed British government healthy-eating initiatives is expanding in step with the national waistline

They're not talking about me, are they, in that fatty campaign thingy, the one done by the Wallace & Gromit people? I'm not obese. This new government weight campaign, the one with the Stone Age people modernising and growing flabby, is for the fatties, isn't it, and we all know who they are. It's not going to work either, is it? Because the very people the campaign is aimed at will ignore it, won't they?

Well, yes, probably. Because the people it is aimed at really is you and me. Public-health campaigns such as Change4Life, launched last week, have the greatest effect if a large number of low-risk people change their behaviour; far greater than if the smaller number of high-risk people do. So, yes, it is you and me they are talking to.

That brings its own problems: while the benefit to society as a whole if lots of low-risk people eat slightly better is large in terms of savings for the NHS in future, the benefit to the individual is small. Which is why nearly all public health campaigns fail; and why I suspect that this one, all 75 million pounds of it, will as well.

A man with the marvellous title of Winton Professor of the Public Understanding of Risk, David Spiegelhalter, of Cambridge University, last year analysed for the Royal Statistical Society the effects of a campaign to reduce alcohol consumption. He showed that a 20-year-old man drinking a "hazardous" four units a day who reduced his intake to the recommended safe limit of one per day, will gain 73 extra days of life, or 20 seconds for each pint not drunk - which may seem a poor return for forgoing the pleasure. While ministers and public health officials give advice based on what is good for society, Professor Spiegelhalter concluded, "individuals receiving that advice may, equally reasonably, choose to ignore it".

We're tricky like that, we are - and we hate being told what to do by ministers. As the Government admitted four years ago, after a mammoth consultation exercise to decide what to put in a White Paper on public health, the overwhelming message was: go away. "First, people told us that they want to take responsibility for their own health", wrote John Reid, the Health Secretary at the time, after consulting 150,000 people in one way and another. Mr Reid was never a big fan of the bossy government agenda: "They were clear that many choices they made - such as what to eat or drink, whether to smoke, whether to have sex and what contraception to use - were very personal issues. People do not want government, or anyone else, to make these decisions for them."

Those were the days. Hark at Alan Johnson, the present Health Secretary, last week: "If we do nothing, by 2050 we could be living in a Britain where two thirds of men and half of all women are clinically obese... That is why we are doing something about it NOW."

The reason for the change (4Life) is that ministers have realised - and this happens every few years or so, hence the endless campaigns - that if the Government doesn't actively do something about public health, nobody else does either. The question is, when ministers do try to do something about it, do we listen?

For decades, doctors have been warning of an obesity "time bomb" and ministers have been launching healthy-eating campaigns - remember Virginia Bottomley's "three egg-sized potatoes a day"? Under Labour alone there has been a White Paper on "healthy behaviours", a "food and health action plan", the "5 a day" fruit and veg campaign, a "choosing health" White Paper and last year, "Healthy Weight, Healthy Lives; A Cross-Government Strategy".

Result: a great, fat zero. The nation's waistline has swelled with the list of public-health campaigns. When Mrs Bottomley was Health Secretary 13 per cent of men were obese and 15 per cent of women; in 2007 that had risen to 25 per cent of all adults. A third of children today are overweight or obese by the age of 11. It's our lifestyle: too many calories in, not enough exercise to burn them off. If present trends continue, by 2050, ministers expect levels of obesity to rise to 60 per cent in men, 50 per cent in women and 25 per cent in children, costing the economy 50 billion a year. If we cannot improve our public health, the NHS will become unaffordable. Simple as that.

So, what to do? Health ministers claim to be trying something completely new: not just a public health campaign but "a lifestyle revolution", no less, in Mr Johnson's words. Having persuaded food and supermarket companies to sign up, they plan to use "social marketing" techniques to penetrate the public consciousness.

Don't know what a social marketing technique is? Here's the scary thing - nor do they! If I could refer you to the website of National Social Marketing Centre - - you will see that the whole idea gets really boggy. The National Social Marketing Centre, you will learn, is a "strategic partnership" between the former National Consumer Council (NCC) and the Department of Health, set up two years ago after a report into the nation's health commissioned by the NCC, which recommended greater use of health-related social marketing, which is "the systematic application of marketing concepts and techniques, to achieve specific behavioural goals to improve health and reduce health inequalities". Which sounds to me like a public health campaign. And we know how effective those are...

When this campaign fails, and I hope it doesn't but I think that it will, ministers should be ready to legislate to force a change in behaviour. Smoking only dipped sharply when it was banned in public places. Strict food labelling, sugar tax, treadmills... I don't know. The makers of Wallace & Gromit might be able to come up with an idea or two. Gromit doesn't have a mouth.


My War Against Food Nazi Moms

It's not all the government's fault

It's madness: Feeding your child a sandwich made with white bread or a bag of Doritos could cost you custody of your children? I was at a parents' meeting at my boys' school one recent morning, talking to one of the new moms, an attractive, petite, divorced woman in her 40s. She was discussing her relationship with her ex-husband and how challenging it has been. There was a distinct sound of bitterness in her voice, not surprising when she mentioned that he left her for a 24-year-old. She told me that he had crossed a line with her kids on a recent visitation, and she was going to have her lawyer work on getting his joint custody rights revoked. She felt her case was ironclad, he had "obviously acted wrongly" and "anyone would agree with her." "What did he do?" I had to ask, bracing myself for some juicy gossip. Surely this would involve sex and drugs, his babe girlfriend naked, or strippers at the very least.

And then she told me her ex's transgressions. He had packed a non-organic lunch for her sons. Seriously. She went on to describe the brown bags loaded with Cheetos, Go-gurt, and a sandwich that was made with white bread. Because I stood there speechless, looking completely shocked with my mouth hanging open, she continued. She went on and on about the dangers of food additives and how they had exacerbated one of her boys' ADHD. She talked about how each morning when her boys are in her care she takes the time to poach Amish-raised, free-range chicken and then stuffs it into a whole-grain pita with hydroponic tomatoes and micro-greens and that her ex was obviously not fit to spend time with the kids because he was willing to put their health in such grave danger.

Obviously she mistook the look of shock on my face and considered me a kindred spirit when it came to militant healthy eating. I'm all for the benefits of a nutritious diet for kids, and I'm certainly no fan of Go-gurt -- which is essentially a single serving bag of yogurt that becomes a bomb when placed on a table and pounded, producing a dairy projectile capable of nailing a victim at 30 feet. But I couldn't help thinking that perhaps it was her husband who should pursue a custody change. Her reaction was manically disproportionate. It's not like junk food is akin to child abuse.

I just want to let the food Nazi moms in on what happens when your kids come to a house where junk food inhabits the pantry. They have no decision-making skills or sense of moderation when faced with the forbidden fruit roll-up. Like deprived animals, they are determined to consume the lifetime allotment of sugar they have been denied; all before pickup. I have seen one such child eat Swiss Miss Cocoa with a spoon directly out of the family-size container, only to move on to conquer a box of frosted strawberry Pop-Tarts. When faced with not one but three brands of chips, they become apoplectic and run from the kitchen clutching bags of Cool Ranch Doritos and French onion-flavored Sun Chips, later to be found in a corner curled up in the fetal position surrounded by wrappers, unable to state their name.

I get similar reactions from the kids who are denied cartoons, video games, or porn. (Okay, my kids don't exactly have porn, but South Park comes close, and I do have a book of Helmut Newton nudes.) They stand wide-eyed in front of the screen, unable to move as my boys beg them to come and play. And it's not just young children who have had all common sense denied out of them. I grew up in New Orleans when the drinking age was 18, and not strictly enforced. My freshman year at Tulane, it was almost a sport watching the students who came from the Northeast drink themselves into a vomiting stupor, like a bulimic at an all-you-can-eat buffet.

Sheltering children from every evil in the world does them a disservice; decision-making is a skill, learned with practice from the time they are small. At some point my boys will go out into the world and have to decide for themselves what is right and wrong. One would hope that by then they have ascertained that Krispy Kreme doughnuts are not really for breakfast -- and there are serious repercussions if you leave the mother of your children for a 24-year-old.


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