Website of the Department of Health

Changing Lives

Obesity is the product of a simple imbalance between energy intake and energy expenditure. Because it is a lifestyle disease, it requires us to change the way we live. Human beings evolved in a world of relative food scarcity and hard physical work – now energy dense food is abundant and labour saving devices abound.

Even the Fabians will have been affected. William Beveridge and Beatrice Webb discussed the future of the welfare state during two long walks over the Hampshire Downs – it was these discussion which greatly influenced Beveridge’s report. Today’s blue skies thinkers ponder over e-mail, or in interminable meetings, fuelled by an endless supply of caffeine.
 
Low-skilled manual jobs have shrunk in the factories, the farms, the docks and the shipyards. They are now more likely to be found in call centres and in the retail and services industry.

When Nye Bevan introduced the NHS, less than one in ten households had a television and less than a third owned a car – now one, if not two or three television sets are found in 98 per cent of all households and 19.5 million households own a car – 8.4 million have two or more.

Over the last twenty years, the number of children being driven to school has doubled - the majority of primary school children live less than a mile from their school, yet 41 per cent are driven by their parents, and this figure is rising.

Despite the abundance of information about how to protect our health, the straight-forward advice about what to eat, how often to exercise, how much we should drink, is easy to ignore and frequently lost in a cacophony of conflicting messages. To use Arthur C Clarke’s analogy, it is like trying to get a glass of water from Niagra Falls. 

As the “Know your units” campaign pointed out, the vast majority of people underestimate how much alcohol is in a glass of wine or a pint of beer and thus have little awareness of whether they are drinking too much. While many are probably aware that they should be exercising for half an hour, five times a week, only one in three actually does this in practice.

While most would be shocked by a newspaper story about a nine year old who weighs 14 stone, the distinction between being a bit overweight and obese is not always so obvious.

Research shows that only 17 per cent of parents with an obese child identified that child as having a serious weight problem, and the majority of parents overestimate the amount of exercise their child engages in and underestimate the amount of food they eat.

Many are discouraged or confused by over-medicalized terminology such as “BMI” and “the clinically obese,” and worry about the stigma that is attached to this subject. Messages about the importance of healthy living often don’t reach those most at risk.

Not Nanny State, Not Neglectful State

So how should a serious political party of the 21st century faced with these acute and growing problems react? The Foresight scientists highlighted the fact that for an increasing number of people, weight gain is inevitable and largely involuntary as a consequence of exposure to a modern lifestyle. They used the term “passive obesity,” and pointed out that it particularly effects the socially and economically disadvantaged.

Not every child is lucky enough to live in an environment that promotes good health. Not every family has a leafy back garden for their kids to play in. Not every family can afford to buy fresh organic produce from the local farmer’s market, or to put food on the table that their children will refuse to eat.

Our strategy made clear that in approaching this problem, we reject both the “nanny state,” which polices shopping trolleys and institutes exercise regimes and the neglectful state, which wipes its hands of the problem, and wags the finger in the direction of the most vulnerable families in the vague hope that they will do as they are told.

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It’s easy for politicians to stand on the sidelines accusing the impoverished, the fat and the excluded of only having themselves to blame. But before we evoke the Victorian notion of the deserving and undeserving poor – the very concept that Fabians have battled against over the years - we should take a moment to consider how complex these issues really are.  

Academics and medical experts do not say that children are “at risk” of obesity or poverty because of political correctness – they say this because it’s an accurate assessment of the situation. A child who grows up in poverty, and whose parents have little or no aspiration for them, who doesn’t get to go to the best school, who isn’t blessed with an inspirational teacher, is by any definition “at risk” of becoming a poor adult. It’s not inevitable, but without some help and support, it’s highly likely.

It is simply wrong to suggest that the only solution to deep-rooted problems such as obesity is for people to be more responsible. Of course people must take personal responsibility for their own actions. Nobody in their right mind would argue for personal irresponsibility.

But rather than engage in oversimplification, government has to develop and implement a sustained response to a problem that will have profound and long-term consequences for health and well-being and major costs to the health budget and the wider economy. 

Just as the government has a moral duty to tackle poverty and exclusion, so it also has aduty to address obesity. But this is not a licence to hector and lecture people on how they should spend their lives – not least because that approach simply won’t work.

Tackling obesity requires a much broader partnership, not only with families, but with employers, retailers, the leisure industry, the media, local government and the voluntary sector. We need a national movement that will bring about a fundamental change in the way we live our lives.

National Movement for Change

Our obesity strategy sets out how we aim to create a climate more conducive to promoting good health. 

We are clear that this is not something that government can do on its own. The state cannot and should not micromanage the choices that people make in their daily lives.

Many local community clubs, groups and organisations are already supporting people to lead healthier lives and be more active – particularly those people most at risk of poor health. From breakfast clubs to activity sessions in the local park to cycling initiatives and health checks. Industry groups and charities are also working nationally to promote better diets and more exercise.

Research tells us that people want practical support and information, not just from GP surgeries, but from the nurseries and schools their children attend. They want clear and consistent messages on what’s best to eat and how to stay healthy, delivered in a way that relates to the problems they face in their daily lives.  

Earlier today, I met with leaders from major health charities, retailers, the health profession and community action groups to discuss how we could form a national campaign that would help us change the way we live.

I have also written to 220,000 local activists who are already doing excellent work in their communities to promote good health to ask them to help shape this movement.

We are calling on everyone - from the smallest community keep fit class to the biggest retailers in the land - to join in this campaign to change the way we live our lives.

Retailers have extraordinary influence over the food people buy and they have a clear role to play, through the incentives they are able to provide, in encouraging healthy choices in the supermarket and on the high street.

As ITV and others have recognised, the media also has a role in reframing how we think about obesity, challenging instead of reinforcing the prejudices and extreme images that can prevent people from seeking help.  Research shows us that vilifying the extremely fat doesn't make people change their behaviour. Commentators who point and shout at pictures of the morbidly obese simply fuel the problem. Those whose seriously unhealthy lifestyles are not advertised by their waste lines will simply say: "Well that's not me. I don't need to change what I do." But if you present the message more intelligently - if you explain to parents that many children, regardless of their size, have dangerous levels of fat in their arteries or around their organs, and this may reduce their life expectancy by up to 11 years - then people respond. 

And as employers such as BT, Royal Mail and GlaxoSmithKline have shown, it is possible to promote health and wellbeing among employees.

Conclusion

In its infancy, the NHS grappled with acute and infectious diseases that could be treated or vaccinated against. But the Government cannot vaccinate against obesity, anymore than it can reverse the ageing process to relieve the burden on the NHS of demographic change.

The gravity of the obesity challenge demands that we grasp the true nature and complexity of its causes, and enable people to adapt their lifestyles in order to avoid the damage that obesity can cause.

The government commissioned the Foresight report because we wanted our best scientists to turn their minds to one of the most intractable problems of the developed world.

In the political battle between modern science and prejudice, I’m with the scientists.

To follow any other path wouldn’t just put our society at risk of obesity, it would put our health service at risk of decline.