I have a friend who is obese. He lives in denial. He thinks of himself as a bit overweight – pleasingly plump – a natural and easily reversible consequence of enjoying the finer things in life. We have never had a serious conversation about his weight and certainly never used the word “obese”.
The word itself carries negative connotations. We avoid using it. He knows that I am a fitness professional, a certified nutritionist and founded Goal Master. Surely he knows that obesity is one of the most dangerous health conditions in the world. Am I not a true friend because I fail to confront him and at least offer to help?
Like my friend, many obese people are in denial. 28.7% of adults in the UK are obese. A further 35.6% are overweight. That’s 64.3%. Almost two out of every three adults. And there is no sign that the numbers will get any smaller anytime soon.
The common definition of obesity is a body mass index (BMI) of 30 or more. Calculating BMI is simple. Take your weight in kilograms and divide that number by the square of your height in meters – kg/m2. The definition does not work for everyone (such as people who are very muscular, because it does not distinguish between fat and muscle) and is imperfect (because it does not account for age or gender, among other things), but it is close to accurate for the vast majority of us.
Why do so many obese people live in denial? One reason is that obesity and its consequences strike much earlier than people commonly think as they gain weight. Here is a rather unscientific visual depiction of obesity borrowed from the internet which in my opinion is fairly accurate. Many people who resemble the second from the right would not think of themselves as obese. Yet they are and they live with all of the dangerous health consequences of being so.
Just how dangerous is obesity? Surely some obese people live to 90 or 100. Yes, some do, but most don’t.
Here’s a summary of what you already know. Obesity can cause or greatly increase your risk of:
- Heart disease (strokes and heart attacks)
- Liver and kidney disease
- Sleep apnea
- Depression, and
Let’s add Covid-19 to the list.
We know that 99% of deaths from Covid-19 occur in people with pre-existing conditions, including, principally, conditions associated with obesity – high blood pressure, cancer, diabetes and heart disease. Two thirds of people falling seriously ill from the virus are overweight or obese.
Closer to home, the BBC has reported:
- In a study of nearly 17,000 hospital patients with Covid-19, those who were obese had a 33% greater risk of dying than those who were not obese.
- A study of NHS health records found a doubling of the risk of dying from Covid-19 among people who are obese.
- A study of critically ill patients in UK intensive care units found that 73% were overweight or obese.
We know that losing weight is not easy, and that it’s even harder for people who are obese. The body’s signalling of satiety and hunger adjust following weight gain to make weight loss more difficult. While the physiological response to weight gain helps ensure survival in periods of food scarcity, it has a rather more sinister effect in periods of food abundance. Yet no one is truly incapable of losing weight.
So, what can be done?
Studies confirm that “fat shaming” does not work. Instead, it’s counterproductive. People who are shamed or suffer discrimination by reason of being fat actually end up gaining more weight than those who are not shamed.
Conversely, I believe that people should be allowed to eat as much as they want and to be whatever size they chose to be. In contrast to Covid-19, obesity is not a communicable disease. It cannot be passed on to others like a virus. In a free society, people should be permitted to be obese, just as smokers should be permitted to smoke, so long as they’re willing and able to pay the incremental health care costs themselves, whether through taxation of the products they consume or otherwise. They have a right to be free of public scorn and ridicule.
So, should we also make people who injure themselves in sport pay for their own incremental health care costs? In contrast to getting fat and smoking, regular sport improves health outcomes and longevity. Though I cannot prove it, my best guess is that the cost of treating sports injuries is far less than the cost savings from not needing to treat the illnesses avoided by regular exercise.
We need to address obesity for what it is – a public health epidemic that should be moved to the top of the public health agenda. Obese people need more support and compassion from society, from the health care system and most of all from friends and family. We need to provide more expert counseling and to create more incentives to lose weight and eat a healthy diet – even if that means imposing sin taxes on some food and drink and subsidising others.
We also need to educate. Virtually no one is ignorant of the health risks of smoking. Yet many people do not know the health risks of obesity or, if they do, they do not know their magnitude. Obesity should be front and centre of health education in our schools.
And the medical community needs to play a more proactive role. GPs frequently tell their overweight patients that they need to lose weight, but all too often they do not provide the tools their patients require. Professional help from dietitians, nutritionists and fitness professionals cost far less than bariatric surgery. And lifestyle interventions are far less barbaric than stapling stomachs.