Do growing economies cause bigger bellies?
New obesity figures seem designed to scare us out of our greedy ways, and not just when it comes to what we eat.
‘Half of UK men could be obese by 2030’, declared the Guardian last Friday. The Independent weighed in with the more decisive ‘UK fat alert: 26million will be obese by 2030’. Over on BBC Radio 2, it was announced that ‘in 20 years, 40 per cent of us will be classified as obese’.
The cause of these scary headlines was the latest edition of medical journal the Lancet. In four special articles on obesity, the trends, causes and potential solutions to the ‘global pandemic’ were examined. There was no doubt about the motivation: ‘The aim of the Lancet’s Obesity Series is to state the case for action on obesity.’ Which essentially means scaring the living daylights out of us in the hope that we’ll buy into a whole bunch of policy ideas that the leading authors of the series have in mind. If this seems wearily familiar, it’s a strategy that has lots of parallels in the crusades against tobacco and climate change, both of which get namechecked.
What’s the basis for such horror headlines? The claims about the UK and the USA’s ever expanding waistlines come from a paper authored by a team including Claire Wang of Columbia University and Professor Klim McPherson of Oxford University. The paper shows what would happen if current trends are extrapolated into the future: ‘The trends project 65million more obese adults in the USA and 11million more obese adults in the UK by 2030, consequently accruing an additional six million to 8.5million cases of diabetes, 5.7million to 7.3million cases of heart disease and stroke, 492,000 to 669,000 additional cases of cancer and 26million to 55million quality-adjusted life years foregone for USA and UK combined.’ The additional medical bills that would run could be up to $66 billion per year in the USA and £2 billion per year in the UK.
This does, indeed, sound horrific. But hang on a minute: how reliable are these estimates? Wang et al do note in passing a paper from Obesity Review last year entitled ‘The levelling off of the obesity epidemic since the year 1999 – a review of evidence and perspectives’. The authors reviewed 52 studies from 25 different countries and found support for ‘an overall levelling off of the epidemic in children and adolescents from Australia, Europe, Japan and the USA. In adults, stability was found in the USA, while increases were still observed in some European and Asian countries.’
In other words, far from obesity rates skyrocketing, they’ve been stabilising. In fact, as I noted on spiked last December, the latest figures from the Health Survey for England ‘show that in 2009, 22.1 per cent of men were obese compared to 24.1 per cent in 2008 and 23.7 per cent in 2006… for women, the new figure was 23.9 per cent as against 24.9 per cent in 2008 and 24.2 per cent in 2006’. Yes, the most recent figure show a fall in obesity rates in the UK, though this may, of course, be a blip. A downward trend is much clearer among children. In 2004, 19.4 per cent of boys aged two to 15 were regarded as obese; in 2009, that figure was down to 16.1 per cent. The equivalent figures for girls were 18.5 per cent (2004) and 15.3 per cent (2009).
While this is alluded to by the researchers, it seems to have been widely ignored by headline writers. It is far from clear why the Lancet paper assumes that obesity rates will continue to go up when there is clear evidence that a fall in obesity rates is quite possible. When I raised the question in the press conference that launched the report, Claire Wang said that there was no cause for celebration while obesity rates remained high and that it seemed the downward trend was predominantly among better-off people. That doesn’t really justify the assumption that obesity will carry on climbing. This looks like policy-based evidence rather than evidence-based policy. It would be far more honest to say that it is impossible to know what will happen to obesity rates.
The figures, however, are then used to demand greater intervention in the name of tackling obesity. Here, as with the 2007 Foresight report on obesity produced by the UK government, there is less of an emphasis on changing individuals’ behaviour. Far from individuals being too morally weak to resist another mouthful of food, as might have been suggested in the past, the new paradigm is that we live in an ‘obesogenic’ environment where we are apparently surrounded with ever more opportunities to eat and endless attempts to persuade us to do so.
In that vein, a Lancet editorial says: ‘While business and industry, with their very different aim of making as much money as possible and with an enormous and expensive apparatus of clever advertising, are very effective at nudging people to buy and consume their products, non-regulatory measures to increase consumption of healthy food in isolation are unlikely to be effective.’ The chubbies of Britain are merely dim-witted schmucks, it seems, who are taken in by ‘clever advertising’. Thankfully, the health experts and campaigners are here, like knights in high-fibre armour, to demand that Big Food be regulated just like Big Tobacco has been.
Such campaigners are not the friends of the put-upon masses. Rather, having failed to convince many people of the wisdom of their policy prescriptions and the benefits of lifestyle changes, they’ve decided to go over our heads and appeal to politicians to bash big business instead.
One of the main authors of the Lancet articles, Boyd Swinburne of Deakin University in Australia, goes further, by arguing that economic growth itself – at least once an economy develops past a certain basic level – does not promote happiness and wellbeing but actually promotes obesity. His ideas about an obesogenic environment are also explicitly tied to environmentalism: growth and the free market have led to bad health and a screwed-up planet; big business needs to be put in its place. This looks like an agenda that has jumped on the obesity bandwagon.
Whether you have any sympathy for multinational corporations or not, the upshot will also be less choice for the rest of us. So, in terms of policy interventions, the most cost-effective according to the authors of the fourth Lancet article would be a tax of 10 per cent on ‘unhealthy’ food and beverages, followed by ‘traffic-light’ food labelling, reductions in ‘junk food’ advertising and teaching children more about food and why they shouldn’t watch so much TV. But taxation of foods that don’t have the official seal of approval is just a form of prohibition, while the expansion of food obsessions into schools is having a detrimental effect on education.
While the problem of obesity is greatly exaggerated, it does cause problems for a small proportion of the population; it’s not much fun piling on fat for no good reason. But in the grand scheme of things, this is a firecracker not a timebomb. Better research to discover the causes of extreme obesity and how best to treat it would be far more useful than using a leading medical journal to try to frighten policymakers into selecting from a set menu of regulation and illiberalism.
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