People who are fat are now society's pariahs. If you are overweight you may have been excluded, humiliated or bullied. What's new?
The health secretary, Patricia Hewitt, indicated that NHS operations might be withheld from obese people unless they lose weight. A "means test" for NHS services for obese people is to be set at a body mass index of 30, even if someone has lost weight. Will the carrot and stick approach reduce the nation's weight?
My experience of obesity tells me that this approach has little chance of working for the "patient", but may well work for government.
As with drugs policy, coercion can motivate people to seek help. But punishing people to force change without offering effective support won't work. There is little available support for obese people.
Fat people don't want to be fat, but they want to be understood and to be heard. Many people have become reclusive, near mute in their shame because of the force of prejudice they have experienced. Yet little room has been given for anyone to speak for the obese of this country. My charity, The Obesity Awareness and Solutions Trust (Toast) was founded to give obese people a much-needed voice.
The British Social Attitudes Survey published in January revealed a hardening of attitudes among the general population towards giving obese people equal opportunity to NHS treatment. However, governments are highly attuned to opportunities for messaging. The health secretary would have not have stepped boldly into this controversial arena without sensing a mandate.
Television shows purporting to help obese people feed into this hardening attitude through their sadistic bullying. So-called diet doctors like Gillian McKeith ( described by Guardian writer Ben Goldacre as "a menace to public understanding of science") has built a successful career through lascivious dissection of the eating habits of the desperate. Shows such as McKeith's channel 4 series, Fat Men Can't Hunt, and Celebrity Fit Club, are almost pornographic in their capacity to exploit the shame of obese people while titillating the nation. These programmes have an ability to seduce obese people into exposing their vulnerabilities to millions. They submit to a mix of flagellation and pity from the slender puritans presenting them.
Nevertheless, before, during and after stories can help inspire. But inspiration to change cannot survive in a culture of prejudice and exclusion. The way these programmes talk at obese people as objects galls. They drip-feed prejudice into the national consciousness. A compassionate altruism has never been the objective of the multi-billion pound dieting industry. People can make lots of money from the private agonies of fat people.
The emphasis placed on personal responsibility, a theme of many of the government's policies, contributes to a narrowing of our understanding and a tendency to ignore the complexities of obesity.
Abstinence from all food is not an option. Most people with a food dependency find the word "obese" difficult. Many of those we help at TOAST tell me that the term is loaded with negative connotations- to them it means greedy, ugly and worthless. People have been embarrassed to admit that society's attitudes and their own self loathing externalises into censure of other fat people. Many fat people also carry a damaged identity, whose origins may be nothing to do with bad food habits. Certain foods provide emotional pain relief. Chemical, psychological, social and genetic factors all play a part.
The Department of Health is worried about the impact of obesity on the nation's health and the public purse. The annual burden is estimated at £3.1-£6bn (Health Select Committee Obesity; 2004). Radical measures including regulation of the food retail industry, as happened with alcohol policy, have been rejected as too risky economically and politically. Educational campaigns focused on retraining the young, or introducing narrow "healthy schools" measures, without major investment, are patterns of policy - laudable in intent but inadequate.
Obese people should be included in the groups of people represented by the Commission for Equality and Human Rights (CEHR). But I don't think we are at the point when obese people will rise up and march on Westminster. But look out, government! Quite a few might sign an e-petition to No 10 to say: "Don't exclude us from this debate, listen and understand who we are and why we are this way before implementing policies. We are as mad as hell and we are not going to take this prejudice any more."
