Who is to blame for the obesity epidemic? And does blame actually solve anything?
Every so often I read a newspaper article or some online post about obese people and my heart sinks. People can be so cruel sometimes. Even if they are making a perfectly valid point, there is a right way and a wrong way to do it.
The overarching message seems to be that fat people are to blame. For the financial burden on the NHS, the state of the nation’s health, for the rising number of cancer deaths. And whilst I agree that obesity is a driving factor in all of the above, that doesn’t necessarily mean that obese people are to blame, does it?
What does the evidence say?
First, let’s define obesity. In medical terms, obesity is defined as having a BMI of over 30kg/m². People with a BMI between 25 and 30 are classed as overweight, and people with a BMI over 40 are termed “morbidly obese”.
[To be fair, the latter has become quite an old-fashioned term now and has been replaced. I can’t possibly think why!]
Interestingly, a lot of experts take issue with the use of BMI to measure obesity. It was first derived by a Belgian astronomer and mathematician almost 200 years ago. In 1972, it was first used to define obesity in a medical journal. Interestingly, the author himself wrote that BMI was “if not fully satisfactory, at least as good as any other”. So even he wasn’t convinced!
Before you get too excited, BMI does not necessarily overestimate people’s risk. If you are tall or have a lot of muscles (lean mass) then your BMI is probably overestimating your risk. If you are short and have less muscles (that would be) then there is a good chance that BMI is underestimating your risk. Well that’s just lovely!
What causes obesity?
Have you ever wondered why some people gain weight more than others? Is it because they are blessed with better metabolism and can put away 2 large pizzas and a bottle of coke every day without gaining a single pound? The answer is probably not.
The reason most people don’t gain weight is because they are taking steps to prevent it. No more excuses, it’s time we all face facts. People gain weight because they eat too much and don’t undertake enough physical activity. Now, there are a multitude of other factors that influence our weight, but these two are without doubt the two most important ones.
Studies show that people who eat out at restaurants or consume more takeaways are more are more likely to gain weight. People who have more than two alcoholic drinks a day are more likely to be obese as well. A 2015/16 study by Sports England showed that 26% of us are classified as inactive (doing less than 30 minutes of physical activity a week).
The reality is that human beings are not designed to function this way.
21st Century living
But let’s be real for a moment. Life is hard, and it keeps on getting harder. Most of us are struggling just to make ends meet. Almost everyone works in a job that requires them to be sitting for most of the day. Many of us get home from a hard day at work late in the evening long after the sun has set. We are tired. We have a tonne of responsibilities waiting for us at home.
So is it any wonder that we reach for the takeaway menu more often than we should? Or we shove a ready meal in the microwave and then eat it in front of the TV as a means of unwinding after a long day? How many people really fancy going to the gym after putting the kids to sleep, loading the dishwasher, tidying the kitchen and paying the bills?
The reality is that life is hard, and most of us are doing the best that we can. We all need to find ways to stay healthy in modern day society. A lot of people assume that people choose to overeat. Like they choose to smoke a cigarette or drink a bottle of wine. But that’s simply not true.
We all need to eat. Without food, we die. The same can’t be said about cigarettes or booze (although there have been times that I would have argued that my life couldn’t continue with either of them!)
The role of genetics
If you’ve got this far and you’re beating yourself up or are ready to throw in the towel, then don’t despair. I haven’t finished yet. We’re not quite ready to play the blame game yet. There’s more. There are other risk factors for obesity too.
First, there’s genetics. Our genes affect the way we store fat, metabolise food, and our lifestyle choices. I’ve already written a post on the obesity gene, so I won’t repeat myself.
But have you ever heard of epigenetics? It is the study of inherited changes to a person’s characteristics or traits (phenotype) without alteration to the DNA code. Basically the study of nature versus nurture.
Whilst we may inherit a genetic predisposition to obesity, that doesn’t mean that we will become obese as adults. A number of factors such as childhood development, the environment, medications, ageing and diet can influence this process.
For example, I’ve never been a particularly sporty person. My PE teacher in junior school never once picked me to be on the netball team, no matter how hard I tried. As a result, I gave up on sport quite early in life. I can remember being really enthusiastic, but unfortunately my enthusiasm didn’t make up for my lack of skill.
I was too short, I didn’t have very good aim, and I got tired quite easily. Looking back, I realise that this has a lot to do with my genetics. I come from a long line of short, overweight musicians. There are no sporting legends in my family tree. But if my PE teacher had chosen to reward my effort rather than my ability, I might have stuck with it more.
Just to be clear, I’m not blaming my PE teacher for my weight gain (even though Miss Franks was a total b**** and had it in for me). I’m just pointing out that two people can grow up in very similar circumstances and yet one gains a lot more weight than the other because of their genetic code. Equally, two identicle twins can end up with very different BMIs under the right set of circumstances.
Other causes of obesity
It’s not just genetics either. There are lot of other factors that influence weight gain. Certain medical conditions like hypothyroidism. Lots of different medications including contraception, antidepressants and steroids. Then there’s stress. I’m not going to talk about that today because I’m planning on devoting an entire blog post to it in the near future.
Your age plays a vital role too. My teenage son needs to consume approximately 2800 calories a day at the moment, but by the time he is 25 this will have dropped by 15%. The older her gets, the less calories he will need to consume, and unless he learns to adjust his diet, his waistline will soon start to expand.
Here’s some interesting facts for women. Menopause, previous pregnancy and sleep deprivation are all risk factors for obesity. I’ve had three children and that has definitely taken a toll on my body.
Finally, let’s talk about the fact that obesity is more prevalent amongst people with less formal education and lower socioeconomic status. I imagine the reason for this is complex and has a lot to do with environmental factors and childhood experiences. That kind of sucks though, doesn’t it. The people who are in most need of help to eat better and exercise more are the least likely to be able to afford it.
At the end of the day, does it really matter?
So who is to blame for the obesity epidemic, and more importantly, does it really matter? Does assigning blame help in any way? Or does it just serve to alienate people and discourage others from seeking help?
I can’t tell you how many patients of mine delayed seeking medical help because they were afraid that they were going to get “told off” for being overweight. Many of them put off blood pressure reviews or diabetes tests for this very reason and that is worrying because high blood pressure, diabetes and obesity all work together to significantly increase your risk of a heart attack or stroke.
So I ask myself, does it help to know that there is more at play here than just my lack of control over what I eat and my laziness when it comes to exercise? In a way it does. I have tried and failed at losing weight so many times in the past, and it helps to know that there might be number of reasons for that. Crappy genes. Three babies. Lack of sleep for a number of years (night shifts suck).
But at the end of the day, I’ve never found the blame game particularly helpful. I’m far more interested in what comes next. The reality is that we cannot change our genetic code or our pre-existing medical conditions. We can’t get any younger and whether we like it or not, menopause if inevitable for every woman out there.
There are things that are beyond my control. And then there are things that I have the power to change. I’m sick of the blame game. I’ve decided that no good can come from it, so next time I see someone trying to point fingers I am just going to ignore them. The end.
A final word from the Fatdoctor
And finally, to all those daily mail columnists and instagram influencers that insist on insulting obese people…
Here’s a thought. We have just entered an economic recession the likes of which we have not experienced in a very long time. Many of you are going to be made redundant, and then hard working people like me are going to have to pay the taxes that foot the bill for your unemployment benefits. Yet you don’t hear me moaning at you to grow up and get a real job, do you?
No sir, you don’t. I’m just minding my business, working hard to provide good quality non-judgemental medical care to all people, including you. Before you start calling out fat people in an attempt to make your voice heard, remember that smoking and alcohol and mental health conditions also put a huge burden on the NHS too.
So maybe just quit blaming people and do something useful with your lives instead.
Fat isn’t contagious but cruelty is.
Are you one of those people who likes to blame people for the obesity epidemic? Disagree with something I’ve said? Then let me know by leaving a comment below (you can agree with me too, if you prefer). If you’d like to know more about me, including how to subscribe to me mailing list then click here.