"Protect the NHS. Stigmatize fat people" (the government's obesity strategy in full)

Straight out of the blocks with the fat shaming. That's the government's obesity strategy:

“Mr Hancock, who is often tempted by his daughter’s lemon meringue pie, is adamant the whole country has to show discipline on losing weight just like it obeyed lockdown measures.”

It's your fault fat people. Your fault that the NHS is stretched. Your fault that people can't get to see the GP. Your fault that we've had a pandemic. Your fault that so many have died. Your fault.

The government has gone full on nanny state with this one as Boris and Matt litter the airwaves and news pages with exhortations about excess chubbiness. It's your fault fat people, lose some pounds, protect the NHS. Here's Matt Hancock again:

We will take action on obesity to further protect the NHS & improve our nation's health.

And there on a sofa is a fat person who has been trying so hard to lose some weight but keeps failing in tears. Why? Because the government is telling her it's her fault that old people died in care homes, that it's her fault the doctors and nurses can't see all the people they need to, her fault that £27 billion of the economy is frittered on the chubby and the paunchy.

And it's a lie. Really, a complete lie. Fat people are not an excessive burden on the NHS. Fat people are not responsible for our higher rates of Covid-19 deaths. Fat people are not a drain on the economy. Fat people are not to blame. And while we're about this neither is the food industry or Big Sugar, or booze, or fags. So why is it that we've launched into the fussbucketry of an obesity strategy as a seeming response to a pandemic?

Back in May I predicted that this would be how public health responded to the pandemic:

Sometime in the coming year there'll be a reckoning. Sadly it'll be the wrong kind of reckoning as the public health ideologues will be the ones asked to write it. What we'll get is how if we had better "general health" (code for not smoking, drinking or eating beefburgers) then we'd be less susceptible to an epidemic, followed by a redoubling of the same fussbucketry about your lifestyle.

This is all public health can do these days, it's populated by people who genuinely believe that we'll all somehow live pretty much forever if we change our lifestyles to the state-approved dullness they propose. And fat people have now joined smokers and drinkers as pariahs (and they already face a load of prejudice). It's fine for a slim person like Matt Hancock to run around shouting "let's get fit" like the Hearty Hemulen from Tove Janssen's Moomintroll books, but lots of overweight people try week in and week out to lose weight, they drop a few pounds then put them back on in a despairing cycle of struggle. Seeing Matt Hancock, a slim man, go on about how you should "show discipline" is simply sticking two fingers up at millions of people who struggle with their weight.

Only the very obese face health problems as a result of their weight. And there are a lot of very obese people. But it's not an "all population" problem requiring advertising bans, enforced calorie counts in restaurants and restrictions on fast food takeaways. Nor is it about stigmatising the food choices of the less well off - "ewww look at her with the McDonalds, no wonder she's fat".

So let's start by saying that being overweight, while it may affect our self-esteem in a world filled with pictures of perfect bodies, is not a risk factor in our mortality:

The bottom line from this study was that being obese (all categories combined) increased the chance of dying compared to those with a normal BMI, although this was not the case for overweight individuals (BMI of between 25 and 29) or the lowest category of obesity (grade 1) on its own.

Obesity only starts being a problem when BMI exceeds 35 - about 8% of the population (which is still a lot and worthy of attention) - and becomes a serious problem over 45 (about 1% of the population). The choice of BMI of 25 as the upper bound for normal weight and BMI of 30 for the lower bound of obesity are essentially arbitrary lines. The numbers, and the perceived problem, changes completely if you set the upper bound for normal at current median BMI (27-28) or the bound for obesity at the level it becomes clinically problematic (35).

And the argument for a more positive attitude to what we call overweight is seen in the finding that "...overweight was associated with significantly lower all-cause mortality." So the government exhorting you to lose a few pounds because you're 'overweight' serves no point except to stress out people who are living perfectly normal healthy lives and require no attention from the public health worrywarts. Being a few pounds overweight (on the basis of an essentially arbitrary and out-of-date measure) should not be a stigma yet that is the central aim of the government's obesity strategy, after all stigmatising smokers got people to quit didn't it?

Nothing I say here will change anything. Nobody really cares about whether there's actual evidence behind the government's nannying fussbucketry as it exonerates them (we mostly think we're not fat) by identifying the reason for the problems - with the pandemic, with the NHS, with the economy - it's those fat people over there: selfish, lazy, good-for-nothings stuffing their face without a single thought for Our NHS.

Protect the NHS. Stigmatize fat people. That's the government's obesity strategy in a nutshell.

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