"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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How to use misleading statistics in a bid for government funding - the LGA and public health at their finest

Terrible:

Council chiefs have warned of a ‘childhood obesity crisis’ as new figures reveal that the number of young people being treated for Type 2 diabetes has increased by nearly 50% in five years.

Not the statistic but the spectacularly misleading way in which this scary paragraph is framed. It is, I'm afraid, an absolute classic of the public health scare story genre - guaranteed to get media coverage but utterly deceptive.

So let's look at the numbers:

Figures from the Royal College of Paediatrics and Child Health show that 745 children and young people under the age of 25 received care for Type 2 diabetes in Paediatric Diabetes Units in England and Wales in 2017/18.

The first point here is that we're not talking about children here - unless we've begun categorising those aged 18-25 as children? Of the cohort in question (under 25 years old), a third -32% to be more precise - are adults i.e. aged over 18. Some of them may be obese and may have Type-2 diabetes but using these figures to claim an increase in child diabetes is simply wrong.

And that cohort? There are 17.4 million of them meaning that the 745 who have 'received care' for Type-2 diabetes represent a massive 0.004% of the population. There may have been an increase since 2015 of 50% but this is still not in any respect a crisis (except perhaps for the individuals most of whom will be over 18). Even with the more inflated Diabetes Association estimate of 7,000 under 25s who have received support for 'diabetes-related' conditions, the problem still only affects 0.04% of the cohort.

There has been a trend in public health using secondary factors to substantiate proposals for either new regulations, new taxes or more local government funding. Mostly this is because there's not really any evidence that child obesity is rising:





That's from King's College - here's the latest from the NHS itself:



Again no indication that child obesity is rising (indeed it has fallen for children arriving in primary school). So public health look for other statistics to peddle their hysterical fussbucketry, most commonly statistics like these on Type-2 diabetes that, while interesting, suffer from a whole load of flaws (changes in referral practice, greater awareness of symptoms, new centres and facilities to support diabetes) that mean the increase could be entirely unrelated to changes in the number of obese children and relate more closely to better diagnosis and more provision in the NHS system - both good things but no justification for advertising bans or bunging millions for local councils to splurge on useless obesity programmes.

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In which a posh grocery company discovers it sells junk food and McDonalds doesn't.

Chris Snowdon provides an insight into the evidence-free attacks on food advertising:

"...children's 'exposure' to HFSS food advertising has fallen by 37% since 2008 and that the average child sees a mere 11.5 seconds of it per day."

Those people who want to blame a mysterious and mythical thing called the "obesogenic environment" for children being fatter (and in particular advertising) are completely misinformed and, in promoting the myth, are misleading the public.

Doesn't stop 'em though:

Recent early-stage analysis of advertising data for May 2018, also done by the charity, found that on ITV1, Channel 4, Channel 5 and Sky One, around half (49 per cent) of all food adverts shown between 6pm and 9pm in May 2018 were advertising HFSS products. And that fast food and delivery brands accounted for more than a quarter (27 per cent) of those HFSS adverts.

Now this is truly shocking until you realise that (as one right on company discovered) HFSS covers everything from butter, bacon and cheese to home delivered pizza. And let's also remember that most children aren't ordering take-outs.

The causes of obesity are far more complex than "look at those adverts for junk food" but the media narrative focuses almost entirely on this message. Part of this is because public health people want there to be a convenient scapegoat for fat kids - it is not acceptable to point at parents and say "stop stuffing your kids with snacks and get them running about more". Even though eating too much and exercising too little is absolutely the biggest contributor to the rise in obesity. The poor fat people are victims of evil marketers and sinister food scientists - the advertising sucks them in, they cannot resist.

Of course this is nonsense but it plays to the other parts of the fussbuckets' narrative - snobbery. The "bad" foods are all foods that are enjoyed by the less well off - hence the shock for companies selling to posh folk when they discover that there's a whole loads of HFSS in artisan cheddar and fair trade unprocessed sugar. They thought it was all about McDonald's and cheap pizzas from the freezer shop:

Naturally, we were pretty shocked that a picture of some fresh groceries with a healthy mixture of fruits and vegetables, dairy, eggs and cupboard staples would flout TfL’s new junk food rules. But it turns out that TfL score foods individually according to a nutrient profiling model created by the Government. It’s a pretty crude measure and means that foods you would still think of as junk, like fizzy drinks with artificial sweeteners or low-fat fried foods, could in some scenarios comply with the new regulations.

Proof that anti-obesity campaigns are mostly about snobbish attitudes to "junk food" (defined as the sort of food common people eat) and nothing much really to do with reducing the weight of kids. But it's a delight that the pompous elitists at Farm Drop were really put out:

Last year, the fast-food chain was allowed to run a Happy Meal advert during children’s television and it passed the Advertising Standards Authority’s (ASA’s) standards for healthy food, which are the same standards TfL are now using for the junk food ban. According to the ASA, a McDonald’s Happy Meal is not a junk food product because 80% of the mains, and 100% of the sides are non-HFSS. But swapping out sugar for a sweetener or fruit for chips, doesn’t detract from the fact that this is still a fast food company promoting meals with fried foods to kids.

You have to laugh!

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"Aren't all these kids supposed to be fat?" Why the Government's child obesity strategy is wrong

Every lunchtime Parkside school opens its gates and disgorges starving pupils onto the streets of our village. Long queues form outside the chip shop and the butcher - wise locals hunker down until these hungry young people are gone. A day or two ago, someone commented to me about these queues - "you know," she said, "aren't these kids all supposed to be fat?"

Indeed, to listen to the fussbuckets we put in charge of our health services and the media who, without even a glance at any actual evidence, publish those folks' nannying proposals, you'd think that near every child was a barely mobile lard-bucket unable to do anything but plonk before a screen. The truth - at least from watching those queues is that you've got to work pretty hard to find a fat child. I'm sure they're there, just as they were there when I was at school. I'm even prepared to believe that, like the population in general, there are more chubby kids than back in the 1970s (when, incidentally, we consumed more sugar than we do today). But it doesn't look like a crisis to me.

All this hasn't stop a host of fussbuckets, urged on by a couple of celebrity chefs with brands to promote and books to sell, from deciding that they know better - either by targeting so-called "junk" food or else by creating a moral panic about the food industry. At the heart of all this is the idea that parents - especially working-class parents - are unable to resist promotions:

"It is near impossible to shield children from exposure to unhealthy foods"

So says Jeremy Hunt, the Secretary of State for Health. Let's examine this little sentence and extract its meaning. Firstly is creates the idea of an 'unhealthy food' when this is an entirely evidence-free assertion - there are no unhealthy foods, only unhealthy diets. Secondly, the statement exploits our innate desire to protect children - "shield" suggests that the child will be damaged by the very act of seeing a chocolate bar, a fizzy drink or a burger. Yet all these things are both pleasurable and healthy, consumed without risk by children and adults most of whom are not obese.

I try to understand why it is that we've created this moralistic stampede about eating? Part of me suspects that it's influenced by upper middle class snobbery about food, typified by David Cameron's old advisors Camilla Cavendish and Claire Foges. But there has to be more - as consumers we look for excuses to explain away what we think are poor choices. The result is the overuse of words like 'addiction' to describe a lack of willpower rather than a pathological condition. Plus, of course, the belief that we wouldn't have bought all that chocolate, eaten all that pizza, stuffed our faces with cake if it hadn't have been for capitalism and its evil minion advertising.

When we see the countline bars lined up by the checkout, we know exactly what the retailer is doing. That shops wants to upsell us, add a little more value to the purchase we're making - essentially free margin. If we succumb, it is not because the retailer has made us buy but because we've made a choice to add that Snickers to our shopping basket. Thousands of other customers successfully ignore the line up of sweet goodies and negotiate their purchase without adding a bag of doughnuts.

This doesn't stop the fussbuckets - "...parents find offers for sugary sweets and snacks at checkouts annoying" says Jeremy Hunt. I beg to differ. If parents really were annoyed then there'd be enough consumer pressure on the retailers to change the practice - that they haven't tells me that parents are only 'annoyed' when some poll asks whether they are annoyed.

The same goes for advertising. It's an easy target. You've heard it said - "if advertising didn't work, they wouldn't spend so much money on it. It's common sense that advertising bans will work." Not only is this a complete misunderstanding of what "works" means for the advertiser but it also raises some profound questions about whether we should ever be justified in banning commercial speech for entirely healthy products. It bears repeating that advertising doesn't act to raise aggregate demand either across the economy as a whole or for individual categories of good (even "addictive" ones like tobacco, beer and sugar).

Advertising works by maintaining or increasing levels of market share - we don't buy bread because of an advert featuring Haworth Main Street to the strains of Dvorak, we might buy Hovis because of that advert. When you see the Rolex advert on the Wimbledon scoreboard, you are reminded of the brand and, when you next buy a wristwatch, might consider that brand. And when Tony the Tiger roars "they're grrreat" in a Frosties advert, he's increasing the chances of you buying Frosties rather than competing products promoted by cartoon monkeys or large yellow monsters. Banning advertising serves no purpose other than to say "look we've done something" and, the more of it we ban, the more we undermine the media that require the advertising to keep afloat.

If there's a child obesity crisis (and I'm completely unconvinced) then we should look at why this is happening rather than lollop about bashing things to make us look popular - sales promotions, advertising, calorie information, cartoon characters. Let's ask some sensible questions instead like:

Why, when average calorie intake in the UK has fallen, are we on average heavier?

What has changed in every day environments that may contribute to this increase in average weight (hint - it's not advertising, checkout promotions, two-for-one offers or cartoon characters as these were all around when we were skinnier)?

What aspects of consumer behaviour have changed over this time - more eating out, grazing not set meals, time-pressured working women?

When we look at the reduction in smoking - in health terms a far more serious issue than a modest increase in obesity - the two factors that seem to be most important are good quality health information (today everybody knows smoking is bad for your health) and price. It seems to me that making food more expensive wouldn't be popular - VAT on food anyone - which is why we have this idea of 'good' and 'bad' foods. The problem is that taxing foods high in fat, sugar and salt either runs the risk of clobbering everything but leaf vegetables and chicken or else leads to substitution (if you can't get your calories from Mr Kipling's cakes, you get them from Mr Warburton's bread).

This leaves us with public information - telling people what a healthy, balanced lifestyle means and allowing them to make choices armed with this knowledge. This worked for smoking, has largely worked for alcohol and could have the same impact on diet. The problem is that a great deal of the anti-obesity campaigns are driven by low carb cranks rather than by seeking a consensus view from dietitians. I suspect, however, that this advice should boil down to: eat regular meals, avoid snacking, have a balanced diet including meat, veg and stodge, don't eat too many sweets. Essentially what our mums told us back in the 1970s.

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Sorry Hugh, there is nowhere in England where people can't buy cheap fresh vegetables

And they're off again on the food deserts line - all as part of Hugh Fearnley-Whittingstall's mission to lecture the life out of us about being chubby (and doubtless shift a few books while getting well paid to front a dire TV series):

When Julie, who collared me on the very first day of filming in Newcastle, took me to Church Walk in Walker, where she grew up, I began to get another insight into the problem. If you played a game of Hunt The Fresh Vegetables in this part of town, you could be looking for weeks.

This is the food desert lie. It has been around for a while - poor people are fat and ill because there are no shops selling fruit and veg on the corner. It is rubbish. Here's a handy little map showing why:



That's right folks - this terrible place with no fruit and veg is less than two miles from a massive ASDA super store. There's even a convenient bus service.

The rest of Fearnley-Whittingstall's argument is equally crass, featuring as it does the usual 'shoot the messenger' rubbish about advertising, a slew of snobbish nonsense about fast food takeaways, and an utterly ignorant reference to evolution. Even without the map, we know that the food deserts argument is rubbish because people have done the research:

When examined in a multi-level modeling framework, differential exposure to food outlets does not independently explain weight gain over time in this sample of elementary school-aged children. Variation in residential food outlet availability also does not explain socioeconomic and racial/ethnic differences. It may thus be important to reconsider whether food access is, in all settings, a salient factor in understanding obesity risk among young children.

This is from Helen Lee of the Public Policy Institute of California and, unlike Fearnley-Whittingstall's TV nonsense it's peer reviewed research in a top journal. She found that not only was there no link between child obesity and exposure to different sorts of food outlets but most poor communities had more choice and variety than upscale communities. If the kids are fat (and we can argue the point here) they're not fat because their mum can't buy a cabbage.

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You want to make food more expensive? For the children? Give us a break.

It is a rare consensus when all the leaders of Britain's political parties get together to agree on something important:

Among other proposals, they call for the tax system to be “used to make healthy food cheaper and discourage unhealthy choices both at home and on our high streets”.

The leaders also say the levels of sugar, calories, salt and fat in junk food should be lowered overall, while more training should be given to medical staff to help people with nutrition.

In a world where there are a thousand problems ranging from poverty and family breakdown to murders and robberies, all our political leaders can manage to agree on is that food should be made more expensive. And who does this affect - has somebody mentioned to these sanctimonious fussbuckets that it will be the poorest in society who will be hurt most by this policy?

We're told that we need more expensive food because obesity is one of the greatest health challenges of our time. Bigger than AIDs, more challenging than cancer, more cursed than malaria, more frightening than dementia. Yes folks, you need to pay more for your food because, damn it, you're all a bunch of lard buckets and the government needs to force you to eat properly. It's for the children.

Yes. The Children. Those children whose mums and dads won't be able to buy as much food as they did before because a self-righteous bunch of snobbish know-alls marshalled by a fat TV chef have decided this will be good for you. I know they'll tell you it's only "junk food" but this isn't true - it'll be bread and cheese and butter and bacon and cereals and burgers and orange juice and...over half of what you buy to make up a balanced diet for you family is what these tinpot health dictators call HFSS (high in fat, sugar and salt). And these jumped up nannies want it all to be more expensive - so your children (who almost certainly aren't fat) don't turn into obese whales and die before you do.

Worse, the plans aren't just about making the everyday food you feed your family more expensive, they'll make it taste less good by forcing the manufacturers to take out the sugar, salt and fat that gives it the great taste.

There is no obesity crisis. It is a manufactured moral panic based on flimsy (I'm being kind here) evidence that we're all getting fatter and fatter. We aren't - we're on average a bit heavier than we were in the 1980s but this is not unhealthy (it could be argued it's actually healthy). The figures are skewed by an ageing population - middle age spread is, as we all know, a reality - and haven't risen for a decade.

I'm probably shouting into the void here but we really need to tell Jamie Oliver, Hugh Thingy-Wotsit, Channel 4, the BBC, leaders of political parties who'll do anything for a cheap headline in the Guardian (every snobby fussbucket's favourite rag), and the massed hordes of public health campaigners to go take a running jump off a very high cliff. We don't need a load of rules telling food manufacturers what they can and cannot put in what they sell (other than ones to make sure it's safe). We don't need a bunch of prissy middle-class media sorts going around telling ordinary people - on the basis of no knowledge or expertise - what they can and cannot buy to feed their children. And, above all, we don't need a load more new taxes designed specifically to make food - food ffs, the basis of life - more expensive. Just leave us alone will you.

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Fast food shop bans - public policy as virtue signalling

Banning new hot food takeaways is a favourite policy of local councils these days. It's driven by a thing they call "wider determinants of health" (tip to aspiring nannying fussbuckets - this phrase should trip from your tongue nearly as often as "cost to the NHS") and, as I was told by Bradford Council's leader in January, the policy is self-evidently "common sense". I'm guess that this is another example of the words 'common sense' simply meaning 'not based in any way on actual evidence' - all I'd done is ask how the council intended to measure the effect of its policy on levels of child obesity (given this was the validation for its introduction). As there is no evidence and no means of measuring the impact of the policy, shouting 'it's common sense' is the only remaining fall back position.

And the evidence? Seems there ain't none:

The evidence that fast food availability causes obesity among children is even weaker. Of the 39 studies that looked specifically at children, only six (15%) found a positive association while twenty-six (67%) found no effect. Seven (18%) produced mixed results. Of the studies that found no association, five (13%) found an inverse relationship between fast food outlets and childhood obesity. Two-thirds of the studies found no evidence for the hypothesis that living near fast food outlets increases the risk of childhood obesity and there are nearly as many studies suggesting that it reduces childhood obesity as there are suggesting the opposite.

And I'm guessing that, since most of these studies merely assess correlation, anyone looking at these findings would have to conclude that the evidence doesn't support the contention that the availability of fast food doesn't relate in any way to levels of obesity in children (or indeed grown ups). All we get is a protected environment for existing fast food businesses and the active prevention of new businesses in this market. In the end we have a smaller economy and just as many fat kids. Evidence-based public policy? What we have is just public policy as virtue signalling.

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Obesity policy - snobbery dressed up as healthcare

So, yet again, the Guardian lays into the choices of normal people:

A ban on junk food advertising before the 9pm watershed is long overdue. It should be supplemented by a ban on promotions and price cuts for “sharing” bags of chocolates, as Action on Sugar urged last month. And the sugar tax on drinks could be extended to food products, with the revenue channelled into initiatives making fruit and vegetables more affordable and attractive to consumers. The government’s failure to force change means that the rest of us will pay the price – in ill health and higher taxes – as big food rakes in the profits.

I've given up pointing out that obesity hasn't risen for over a decade, that how we define obesity (BMI of 30+) has no scientific basis, or that individual ingredients - sugar, fat, salt - are not the reason why folk today are fatter than they were in the 1970s (when they ate a lot more sugar, fat and salt).

Now I'm just cross and irritated by the snobby, self-righteous people who write editorials in the Guardian, pontificate on daytime telly, and fill the minds of young doctors with utter tripe about diet and health. It really is the case that what these fussbuckets believe is that your choices - especially if you're one of McDonalds' 3.5 million daily customers in Britain - are wrong. Worse these snobby judgemental nannies want to slap on taxes, bans and enforced 'reformulation' - to take away your pleasure in food - simply because what you like doesn't match what they like (assuming they get any pleasure at all from their sad diets of spiralised vegetables, quinoa and bean sprouts).

It really is time that the vast majority of people who eat a decent diet - including sugary snacks, fizzy drinks, pizza and burgers - tell snobby Guardian writers and public health officialdom to take a hike. Obesity really isn't the number one health problem facing the UK and slapping on controls, bans and taxes that might (but probably won't) result in all of us losing a handful of pounds will not improve the overall health of the nation one iota. Most people - 95 to 97 out of 100 - are not unhealthily overweight and, if we want to do something about obesity, we need to direct the resources towards the relatively few for whom it is a serious issue. Right now we're squandering millions on a fool's errand of reducing the whole population's weight when, quite frankly, the whole population doesn't have a weight problem.

The truth, of course, is that grand public health fussbuckets have decided that, because they disapprove of the eating habits (and drinking habits for that matter) of less well off people, those people should be forced to pay more for their food. It's just snobbery dressed up as health care.

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Judgmental, immoral fussbuckets - an everyday tale of NHS management

This is, quite simply, wrong. Not wrong as in 'incorrect' but wrong as in 'immoral and indefensible':

Patients who smoke will be breathalysed to check they have given up before being referred, while those who are obese must lose 10 per cent of their weight.

Doctors claimed it was the latest example of rationing which is becoming 'more commonplace' across the NHS. The two trusts, East and North Hertfordshire and Herts Valleys Clinical Commissioning Groups, are trying to save £68 million this year.

Any patient who is obese – with a body mass index above 30 – will have to shed at least 10 per cent of their body weight before being referred for non-urgent surgery.

I know there are pressures on the NHS but singling out lifestyle choices for exclusion is not how we should respond to a lack of cash. Imagine for a moment that it's your Dad who's been told he has to quit smoking in order to have a hip operation or you Mum they're telling to lose a stone before they do her cateract operation. The people proposing these things - just to save a bit of cash - are ghastly, self-centred and uncaring, yet we're told every day how wonderful the NHS is and how it's employees are living saints. This proposal proves - once again - that the service is filled with judgemental fussbuckets.

It is time the Government put an end to NHS Trusts and Clinical Commissioning Groups implementing these policies.

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East Riding CCG: Nasty judgemental fussbucketing nannies.

You're in pain. You've already waited an age for the operation. And then you get a letter from some nameless, faceless official of the NHS telling you that because you're a smoker or a bit chubby you have to wait an extra six months. Just because the bosses of that nameless, faceless NHS bureaucrat disapprove of your lifestyle.

The measures have been introduced by East Riding CCG, which has denied that it is about saving money, saying it is to "encourage and empower patients to take greater responsibility for their lifestyle choices."

This won't save the NHS a farthing. It's just being used as a painful and unpleasant stick to beat up people whose choices the scummy fussbuckets in the East Riding NHS don't like. I've no issue if a surgeon or doctor says "look mate, there's no point in me doing this knee operation until you lose some weight" or "you should quit smoking if you want this treatment to work" where the evidence is based on the actual case, the real information about a real patient. But to impose an arbitrary delay - a nasty, uncaring delay that might kill people - just to make a point about their lifestyle is worse than unforgivable, the people saying it should be escorted out of their well-paid NHS jobs because they clearly aren't suited for a caring service.

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The measures have been introduced by East Riding CCG, which has denied that it is about saving money, saying it is to "encourage and empower patients to take greater responsibility for their lifestyle choices."

Read more at: http://www.yorkshirepost.co.uk/news/health/overweight-people-and-smokers-to-be-denied-surgery-for-six-months-in-four-yorkshire-hospitals-1-8763080

The measures have been introduced by East Riding CCG, which has denied that it is about saving money, saying it is to "encourage and empower patients to take greater responsibility for their lifestyle choices."

Read more at: http://www.yorkshirepost.co.uk/news/health/overweight-people-and-smokers-to-be-denied-surgery-for-six-months-in-four-yorkshire-hospitals-1-8763080

Obesity strategies ignore obese people

Some time around 1990 I was involved in some work for Bradford Health Authority that touched on the use of data to improve the impact of public health messaging - we were looking mostly at HIV/AIDS and diabetes. The difficulty for the health authorities came when we pointed out that AIDS really wasn't an 'all population' risk except in the very broadest of definitions. There were some groups in Bradford - gay men, intravenous drug users, African immigrants - where the risks were far higher. We suggested profiling and targeting so as to get the best value from the limited pubic health funding available (especially since there were extensive national media information campaigns about AIDS at the time). This was rejected because of 'stigma' or a risk of being perceived as racist or homophobic.

The consequence of this refusal to use profiling is a belief that, not only are the risks equal across society, but that public health strategies should be directed to the whole population regardless of the truth about those risks. This 'whole population' approach has been widely debunked with alcohol consumption (although its advocates continue to use models to pretend that the merest sip of the demon drink lead inevitably to ill health) and we see it also with obesity where the public health focus is on what they call Tier One Intervention - stressing the 'social determinants of health'.

With obesity, the result is that health funding is directed primarily to seeking behavioural change in the whole population - weighing children, getting shouty chefs to bang on about school dinners, browbeating restaurants to make portions smaller or offer salad, banning kebab shops anywhere near children and getting Lucozade to make their core product taste awful. This is despite the fact that 95% of the population isn't facing any serious health risk from our weight. We use 'scare statistics' about how two-thirds are 'obese or overweight' and then illustrate this with images of a 25 stone person rather than the reality that 'overweight' (BMI 26-30) really isn't anything that 'a little more exercise and fewer puddings' wouldn't sort out and probably isn't unhealthy either.

At this point the Guardian notices that the UK, compared to other places, doesn't do much bariatric surgery on obese people:

What’s going on? The procedure is the most effective way of helping people who are obese to lose weight and can have a radical impact on their quality of life. At approximately £6,000 per operation, it’s relatively cheap and saves the NHS significant amounts of money on more expensive procedures such as hip and knee replacements further down the line. But here in Britain, it is being reserved only for the most extreme cases.

This situation is entirely a consequence of stressing Tier One rather than looking at higher tiers. You could call this 'fat shaming' but I prefer to call it massively stupid public policy. There are around 5% of the population with a serious, health-threatening weight problem but public health is too busy making out that obesity is the biggest health problem in society (and getting schools to write unpleasant letters to parents about their children's weight) to do its job of helping those people who really do have a problem with their weight.

None of this Tier One effort makes a blind bit of difference to levels of morbid obesity. If you take the sugar out of fizzy pop, obese people just switch to another calorie-loaded drink or food. Campaigns about fizzy pop, pizza or burgers result in thin people changing their diets (and talking endless rubbish about 'low carb' or 'clean diet') but do not look at the reasons why some people - maybe one in 20 - are very fat. And the same goes for exercise - it's probably a good thing that active living promotions have helped shift a further 3-4% of the population into regular (the approved 30 minutes a day) physical activity but it isn't working for the 50% of folk who do next to no exercise.

For all that the NHS bosses say obesity is their number one priority, we see that actually doing something to help people who really are obese isn't included within that prioritisation. Instead we get an increasing pile of pointless and intrusive fussbucketry masquerading as an 'obesity strategy'. While all this righteous lecturing about food (and attempts to make out that it's not fat people's fault that they're fat by blaming the food industry) is going on, the option of targeting efforts on the very obese is ignored. Public health wants to change the behaviour of the whole society - despite most folk's behaviour not seriously risking their health - rather than help the people who, for whatever reason, are riskily overweight. It's perhaps time we started talking about the problem - and helping those with it - rather than making up a sort of moral panic about lots of people being a few pounds heavier than they used to be.

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Precisely.....

From the Daily Mash:

THE middle classes have confirmed that they do not eat takeaways, even when buying food at an establishment and removing it to consume elsewhere.

Responding to concerns that the increase in fast food shops is fuelling an obesity epidemic, middle class people have explained that the Thai, Korean and street food outlets near them are different because they are fancier.

Almost the entirety of government obesity strategy and all of that from campaign groups is predicated on food snobbery. Nasty, smelly stuff that poor people eat is bad for them. Interesting, diverse stuff we eat isn't.

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How public health promotes bad science

There's a pretty good article in Nature about the 'obesity paradox'. This is the consistent finding that, especially as people get older, being overweight seems not to be quite the health problem that we thought it was. The problem is that this sort of finding confounds the efforts of the public health business to push out a message around obesity - so they want those presenting this science to be silenced:

Some public-health experts fear, however, that people could take that message as a general endorsement of weight gain. Willett says that he is also concerned that obesity-paradox studies could undermine people's trust in science. “You hear it so often, people say: 'I read something one month and then a couple of months later I hear the opposite. Scientists just can't get it right',” he says. “We see that time and time again being exploited, by the soda industry, in the case of obesity, or by the oil industry, in the case of global warming.”

The person making this statement is a leading public health academic at Harvard not some sort of local council junior. The campaign message - being fat is unhealthy - cannot be undermined by inconvenient evidence that says this:

A team led by Katherine Flegal, an epidemiologist at the National Center for Health Statistics in Hyattsville, Maryland, reported that people deemed 'overweight' by international standards were 6% less likely to die than were those of 'normal' weight over the same time period.

This approach undermines science and results in bad policy-making. If it's the case that being overweight but not obese doesn't represent a health problem in most older people (in fact quite possibly the opposite) then we should say so not try to suppress the evidence because the public might be confused.

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Scribblings: museums, why Trump, slavery and fussbucketry (plus an odd airport)

First a cheat in that it's not a scribbling but I had to share it somewhere - the story of Denver International Airport's embracing of conspiracy loons as a marketing tool:

After being tortured for years by the ceaseless, incredulous questioning, airport officials have assumed a new stance on the subject. What started as denial and moved onto anger, then despair, has finally landed on acceptance.

"For many years the airport tried to fight against the conspiracies, and we constantly had to explain and disprove them,” says Stacy Stegman, senior vice-president of communications for DIA. “Over time we've kind of learned to love that there's a certain amount of strangeness associated with the airport, and it's kind of fun."

Absolutely wonderful stuff and top marks to the airport management. In the meantime we discover from Julia that some museums are more equal than others:

So all presumptuous would-be museum builders should think they won't get a warm welcome?

Well...

You'll have to read to find out why one museum gets the nod and other doesn't - politics is a good hint. And while we're in America Tim Newman's spotted a great article about how the liberal elite "gleefully bludgeons people with opposing views into silence" and concludes with hitting right on why Trump - despite being a hideous, self-serving, sexist sleazeball - has got down to, effectively, the last two for America's top job:

You don’t need to be a Trump supporter, a Republican, or a Right Winger to see that a self-selected wealthy elite browbeating swathes of the population into ever-more strict silence won’t end well.

That's about the sum of it. Trump's too flawed to win - looking more like he'll be flattened unless something drastic happens (and the Republican Party will suffer for selecting such a disaster) - but the problem remains (or in the UK, Remains).

On this theme A K Haart takes Strindberg as the text in suggesting that 'progressives' are something of a cult - a new religion:

It may be going a little too far to paint socialism as a secular religion but there are interesting parallels once we focus on behavioural control and blur the distinction between politics and religion. Socialism has its priesthood, evangelists, taboos and possibly sacred texts. The Communist Manifesto for example. It may not be a church but it has a collection plate where even the unrighteous have to cough up their compulsory donations, compulsion being essential to progressive ideas.

And with all religions it needs a devil and demons - you can join us here.

So much to the politics of now - what about work? There's lots of talk about the future of work and in parallel with the past of work and especially slavery. Which makes Demetrius's discussion of the subject quite fascinating:

In England into long in the 19th Century the Acts of Settlement applied by which people could be forcibly sent to what the law specified was their home Parish. Once there it could be the Workhouse and in those places and under the Poor Law of 1834 for those at the benches, in the fields or breaking rocks it was a form of servitude hard to escape.

Read the article, it opens up the question of what we actually mean by slavery. And why we need to own the robots rather than be sacked by them.

And finally a couple of updates from the febrile world of fussbucketry courtesy of Longrider and Dick Puddlecote:

I am becoming increasingly angry at this attitude that somehow we owe the NHS anything. We do not. We pay – handsomely – for this service and it owes us, not the other way around. Unfortunately, socialised healthcare leads us to this moronic thinking that other people’s health is any of our concern because the NHS may be needed to care for them in the event of a lifestyle choice. Well, the gentleman Allsopp observed is also likely a taxpayer and has paid for any healthcare he may need, but does he?

And:

Arnott once proudly boasted of the "confidence trick" she employed to con politicians into depriving private businesses of their right to determine their own policies on smoking in their premises. I hear that at the recent Royal Society of Medicine event, which Simon Chapman's fans all avoided, she was equally gushing about how she had conned parliamentarians into going for plain packaging.

Keep up the good work!

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Scribblings IV: On real ale, obesity, long life and settled science plus Notting Hill and French welders.

First a call to arms from Old Mudgie - or at least a reminder what the Campaign for Real Ale was set up to do:

CAMRA is not, and never has been, a generalised campaign for All Good Beer. If some of its members have at times given that impression, they have been wrong. It is a campaign to preserve and champion a unique British brewing and cultural institution. The clue is in the name, and it does what it says on the tin. There are plenty of great non-“real” beers out there, and CAMRA members should feel no shame in enjoying and celebrating them. But they don’t need campaigning for. Real ale does.

And he's right - real ale is the uniquely British product, something that Asterix can take the piss out of, that is central to our pub culture, and is at its best one of the world's greatest drinking experiences.

According to Grandad we have to ban obesity - 'tis the only way to solve the problem (given that studies have shown it's nothing to do with calories or exercise):

And because there is now a cure, they can start pushing for obesity to be made illegal. It will start with public transport and move on to pubs and offices but it's all for our own good. Soon fatties won't be able to even visit public open spaces because as we all know, blubber is now denormalised and we have to protect the cheeeldren from even the sight of a pot belly or a huge arse.

So it goes with science, hardly a day passes without what we thought was true not quite really being true at all. Unless it's climate science of course - as James reports:

Three professors co-teaching an online course called “Medical Humanities in the Digital Age” at the University of Colorado-Colorado Springs recently told their students via email that man-made climate change is not open for debate, and those who think otherwise have no place in their course.

I gather the students weren't even allowed to share sceptical thoughts in an online forum - any questioning of that 'settled science' and bang - off the course.

Meanwhile Julia exposes the inconsistency of cops and councils by spoofing that they're banning the Notting Hill Carnival:

The Metropolitan police had asked the council to shut down the famous August Bank Holiday festival after the huge crime rate and the stabbings.

Of course, the closure isn't the carnival (454 arrests, five stabbings, 100 assaults on police officers) but the Fabric nightclub (no arrests, no stabbings, two drug deaths).

On a broader note, Bill Stickers talks about his family and, in doing so comes up with this telling paragraph:

As well as all the “But you can’t say that!” voices crying out that we should not talk about certain issues, or even allude to said facts existence, there’s a ‘health’ lobby out there determined that we will all end our days restricted to ‘care’ homes, dribbling out our dotage, and subject to naught but pity as the Alzheimers inexorably robs us of our marbles, bowel and bladder control.

Living well is more important than living long, which isn't an argument for dissoluteness but rather an encouragement to enjoy the time we've got - we only get one go at it after all!

So driving round France in a camper van makes sense even when trying to get a petrol tank welded means meeting the health and safety rules:

We learn that welding metal petrol tanks is a slow undertaking: at least in France, you have to have a special approval as a welder, and rules require that the tank be washed thoroughly before any work can start, a process that takes a fortnight. And today we are told that no welder here or in the surrounding towns is prepared to take on the job.

I get the cleaning bit (welding and petrol don't mix well) but no-one?

Finally James shares why we die and want medical research we fund. There's a bit of a mismatch with about half the research we fund through donations going on breast cancer.

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What obesity strategies - if we have to have one - should look like.

I'm not sure we need an obesity strategy but I also know I'm in a minority on this issue. The cohorts of fussbucketry have crowded out much that is sensible (by which I mean informed by evidence) in public health so we're going to have such a strategy. And in Bradford it's going to cost you £2 million or so each and every year.

So, in the interests of getting a strategy that isn't infomed by nagging the hell out of everyone, here's how the Mayor of Oklahoma City did it:

On January 1, 2012, five years after he received national attention for challenging his city to go on a joint diet, he announced they’d hit their weight loss goal: A total of 47,000 residents had together achieved the mayor’s goal of shedding 1 million pounds, registering their achievements on the campaign’s site, "This City Is Going On A Diet."

The success came because of a massive public awareness campaign that educated and encouraged citizens to eat fewer fried foods and more fresh produce, and more importantly, a collective goal that spurred competition among local employers and businesses. The mayor, whose weight once fell in the obese range, lost 40 pounds himself. The CEO of Taco Bell even flew in to discuss how to steer people to the low-fat "fresco" side of the chain’s menu.

And this successful approach is being followed up with a strategy that aims to promote physical activity - not sports but just moving around more:

Partly using proceeds from a one-penny sales tax passed in late 2009, it’s now in the process of making a slate of improvements, including a 70-acre park that will link the city’s downtown with the Oklahoma River, a new streetcar line and river kayaking facility, a senior wellness center, and hundreds of miles of jogging, walking, and biking trails. It’s also making sure there are gyms in all grade schools and is narrowing all the downtown streets to add trees to wider, more pedestrian-friendly sidewalks.

Much better than banning fast food shops, soda taxes or obsessing about weighing five-year-olds.

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"It's better for health if everyone loses a pound or two" - introducing Bradford's evidence free obesity strategy

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The presentation from Bradford's public health officers began with an observation that, while obesity is a problem there was very little evidence showing which, if any, of the assorted interventions, actually made any difference. About twenty minutes later, having reviewed the full gamut of interventions without even providing even contested or limited evidence to support them, the presentation concluded with the argument that we had to do all these things (even the ones like new taxes, bans and so forth that we had no power to introduce). I guess the alternative is that we all become vast semi-mobile lard buckets for whom the only hope is very expensive bariatric surgery.

The problem is that what evidence we did actually see didn't support the officers doom and gloom. Once you'd got away from the conflation of overweight with obesity (done solely to make the problem an all-population problem rather than one for just a part of the population) we discovered the following:

1. Rates of obesity among children in Bradford had fallen for 5 year olds but remained static for 11 year olds.

2. There is a direct connection between rates of multiple deprivation - poverty in layman's terms - and levels of obesity (rates at 11 in wealthy Wharfedale were 8% whereas in poor Manningham hit 30%)

3. Although this was denied, there seems to be an acceleration in overweight in children from the Asian community from 5 years to 11 years.

It is clear to any but the ideologically blind that this requires a targeted approach for obesity combined with efforts to reduce levels of poverty. Bradford spends over £2 million on obesity interventions (that's just the council) but we've no idea whether any of these interventions are making any difference and we refuse to target the actually obese. The sheer stupidity of the policy was summed up by the strategy's 'clinical lead' (he's a GP) who, in dismissing my suggestion that we might target our efforts and actually look at the evidence, made the sweeping observation:

"I fundamentally disagree with Cllr Cooke's argument. It's better for health if everyone loses a pound or two."

The limited evidence we actually received was ignored in favour of signalling that we are "doing something" about obesity. This is despite that "something" being a strategy based on things like planning controls over fast food takeaways, fussing about portion sizes in restaurants and promoting inadequate dinners for primary school children. None of which ideas has any evidence demonstrating its effectiveness in reducing rates of obesity.

Put bluntly, we will (well not me but a majority of the Health & Wellbeing Board) agree to waste over £2 million of public money every year just to indulge an ideological, all-population approach to obesity that isn't justified by the data or supported by evidence. And if this is repeated across England that probably means over £200 million of your and my taxes spend to indulge the ignorant ideological vanity of public health. Why its not a scandal defeats me.

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The myth of the obesogenic environment

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The full article is gated but the abstract is unequivocal about the findings:

The prevalence of obesity has doubled over the last 25 years. We estimate the effects of multiple socio-environmental factors (e.g., physical demands at work, restaurants, food prices, cigarette smoking, food stamps, and urban sprawl) on obesity using NLSY data. Then we use the Oaxaca–Blinder decomposition technique to approximate the contribution of each socio-environmental factor to the increase during this time. Many socio-environmental factors significantly affect weight, but none are able to explain a large portion of the obesity increase. Decreases in cigarette smoking consistently explains about 2–4 % of the increase in obesity and BMI. Food stamp receipt also consistently affects the measures of weight, but the small decrease in food stamp program participation during the period we examine actually dampened the increases in obesity and BMI. Collectively, the socio-environmental factors we examine never explain more than about 6.5 % of the weight increases.

So can we now shut up about banning advertising, refusing permission for fast-food shops near schools and a host of other irrelevances. The rise in obesity is down to a more sedantry lifestyle and that our energy intake hasn't declined as fast as our metabolic need for that energy.

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So you're fat? It's not your fault you know.

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Or so says the Government's obesity 'tzar', Susan Jebb, professor of diet and population health at the University of Oxford:

"Obesity has increased so greatly over the last few decades. That's not a national collapse in willpower. It's something about our environment that has changed," she said.

"You need in some cases a superhuman effort to reduce your food intake. Is that their fault? I don't think it is."

Let's get one thing out of the way. This isn't complete bollocks but the environmental change that Professor Jebb thinks is the problem, isn't the cause. No-one is disputing that there are genetic differences in propensity for weight gain, we've known that for decades. Nor is anyone disputing that some people have less (or more) willpower than others, that socialisation - typically parental attitudes and diet - is important and that there is a mountain of misinformation about health and diet.

The problem is that our increased rates of obesity didn't take place in an environment of rising calorie consumption. And whatever fad or fancy you subscribe to in this debate, it is indisputable that the reason for weight gain is consuming more calories than you use. Any sort of calorie, your body doesn't make any distinction between sources. There isn't such a thing as an unhealthy food, just unhealthy diets.

Two things have changed. Firstly (and we'll get this one out of the the way) we are, on average, older and older people are, again on average, fatter than younger people. This isn't a problem (unless you see sub-optimal birth rates as a problem).

The other change is that we live a vastly more sedentary life than we did three or more decades ago. Coca-cola even ran an ad featuring these differences (and, as ever, ad men were spot on). And the environmental change is striking:

In 1970, 2 in 10 working Americans were in jobs requiring only light activity (predominantly sitting at a desk), whereas 3 in 10 were in jobs requiring high-energy output (eg, construction, manufacturing, farming). By 2000, more than 4 in 10 adults were in light-activity jobs, whereas 2 in 10 were in high-activity jobs. Moreover, during the past 20 years, total screen time (ie, using computers, watching television, playing video games) has increased dramatically. In 2003, nearly 6 in 10 working adults used a computer on the job and more than 9 in 10 children used computers in school (kindergarten through grade 12). Between 1989 and 2009, the number of households with a computer and Internet access increased from 15% to 69%. Other significant contributors to daily sitting time—watching television and driving personal vehicles—are at all-time highs, with estimates of nearly 4 hours and 1 hour, respectively

This isn't about whether we do that half hour of 'physical activity' we're encouraged to partake of - that's a red herring. This is about the totality of our lives, about the elimination of activity from more and more tasks. Think about putting a screw in - we've now replaced the screwdriver requiring a vigorous physical act with a power tool. Multiply that across everything from beating eggs through to buying a weeks groceries and we've a striking picture of decreased activity.

We can't deal with this problem (although it isn't really a problem, is it) by taking up jogging. Nor can we wind back from the efficiency and productivity gain - in every aspect of life - that technology brings. And we can't force people to take up a sport, go for bracing country walks or sign up to a gym - not when there's a great Netflix box set just out. We can begin to design environments that promote movement - not just at work bearing in mind that this takes up less than a fifth of a typical week. Plus we can (since we're talking about weight here) reduce our total calorie intake.

Indeed we have reduced how much we eat:



So, if we want to do something about the 'obesogenic' environment, we don't do it by banning fast food shops, taxing sugar or forcing children to eat almost completely nutrition-free salads for dinner. No, we do it by designing in physical movement - stairs instead of escalators, public transport instead of cars, proper going-out-of-the-office lunchtimes. A thousand and one little bits of change that mean people move a bit more.

It might just work. What I know for sure is that Professor Jubb's anti-food, anti-pleasure agenda won't make a jot of difference (except to raise the ire - and blood pressure - a people who want a little pleasure in their lives). And, remember, you all have agency - you can choose. You don't have to be fat. If you are, it really is mostly down to your choice.


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Fat girls, thin girls - our confusing message to young women about weight needs to stop.

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For a decade and more we've been told that the fashion industry, with its too-thin models and obsession with superficial image, has presented an unattainable body-image ideal to young people and especially to girls.

Here's an article from The Guardian in 2000:

British doctors yesterday called on the media to use female models with more realistically proportioned bodies instead of "abnormally thin" women who contributed to the rise in the numbers of people suffering from eating disorders.

A report by the British Medical Association claimed that the promotion of rake-thin models such as Kate Moss and Jodie Kidd was creating a distorted body image which young women tried to imitate. It suggested that the media can trigger and perpetuate the disease.

We have, since that time, been regaled with seemingly endless elaborations on this viewpoint - from the use of retouching in photography to cosmetic surgery - all repeating the accusation that the fashion industry presents an 'unhealthy' body image. Not only is there the direct link to eating disorders like anorexia or bulimia but we have suggested links to depression, suicide, underperformance at school and even sexual dysfunction.

Throughout this time a parallel world can be seen - one where girls are ever more overweight. Here, again from The Guardian:

The increase in obesity accelerated sharply in 2004, especially among girls, the survey said. Figures for the 11-15 age group showed the proportion of obese girls grew from 15.4% in 1995 to 22.1% in 2003. But in 2004 it shot up to 26.7%.

Over the same period, the proportion of girls who were overweight, but not enough to qualify as obese, increased from 12.6% to 14.8%. In 2004 a total of 46% of girls and 30.5% of boys were either overweight or obese.

So while we were ever more angst-ridden about Kate Moss being too skinny, the vulnerable cohort of teenaged girls was chowing down and piling on the pounds. If you asked these girls whether they want to look like Kate Moss they give the honest answer - yes - and then order another milkshake. The evidence suggests that skinny models have - at the aggregate level - had no impact at all on the weight of girls.

All this brings us right up to date with the latest piece of ridiculous nannying fussbucketry from Dame Sally Davies, the government's "Chief Medical Officer":

Dame Sally Davies wants the obesity crisis in women to be classed alongside flooding and major outbreaks of disease – as well as the threat from violent extremism.

So - despite the malign impact of Jodie Kidd - the female population are a bunch of unhealthy lard-buckets. So much so that the Chief Medical Officer wants to define it as a national crisis. So much for anything being the fashion industry's fault. But wait:

The use of plus-sized models in advertising campaigns may be fuelling the obesity epidemic, experts have warned.

A new study, by business and marketing researchers, suggested that using images of larger body types 'encourages the idea that being overweight is acceptable'.

Using fewer images of models who are underweight and aesthetically flawless can have a detrimental effect on the public's lifestyle and eating behaviour, researchers said.

Ha - gotcha! We can all relax - the use of fat models makes being fat seem OK meaning that all the girls are obese. Or at least the ones who aren't anorexic or bulimic because they want to look like a contestant on Britain's Next Top Model.

Perhaps what's needed here is a bit of balance. Instead of giving young women an message that they're too fat one day and too thin the next we should maybe try being honest about all this weight and health stuff. Such as that people who, on our standard measure, are overweight are likely to live longer than those at so-called 'normal' weight. And that so long as such folk are fit and active there really aren't any negatives to being what the nannying fussbuckets call "overweight".

What we need to stop is this implication that there's some sort of perfect weight - somewhere between Cara Delavigne and Adele. Instead we should focus on how active (not sporty but active) people are and whether their diet is balanced. We don't need sugar taxes, advertising bans or lectures from Dame Sally Davies. What we need is some common sense and a sensible, affirmative message to young women (and young men for that matter) about how to get healthy and stay healthy.

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