The head of the British Medical Association caused something of a ruckus this month when he shared his thoughts about how the nation might best tackle rising levels of obesity. Hamish Meldrum's observations came in two parts. First, he made an argument that obesity has fallen hostage to surgeons and pharmaceutical firms. Bariatrics, the medical branch concerned with obesity, is so new that it has yet to find its way into the OED. Its first surgical procedure was only carried out in 1954; today it's a multibillion-dollar industry. At the same time, drug companies are extending their grip on our food through nutraceuticals and unguents designed to stifle appetite. These products are the equivalent of proposing improved gunshot surgery to fix gang violence.
The bit that got Meldrum into trouble came from the second part of his thoughts, in which he noted that "doctors, teachers, social workers and other professional groups can try to help obese patients change their lifestyle, but it is very difficult to do this if people are unwilling to take any responsibility themselves". The solution, in his view, would involve straight talk from caregivers who should not shy away from calling the obese what they are: greedy.
Meldrum's view is widely shared and deeply flawed. To see why, consider this true story. In the middle of the last century, when apartheid was introduced in South Africa, black people were no longer allowed to use the same amenities as whites at the places they worked. In Durban, this meant black caddies at a white golf course could no longer eat at their work cafeteria. Durban's signature food, Bunny Chow, was invented by way of a response. It fused together Indian and European foods, combining curry in a loaf of bread, making something that was hot and could be eaten while on the run back to work.
It would be absurd to suggest, as apartheid's marshals did, that black people's dietary shortcomings were the result of indolence or incompetence. Instead we'd have understood that individuals' choices were governed by social rules and regulations. Today, common sense about diet points in the opposite direction. Nothing can be socially shaped. We're all free individuals swimming in an ocean of uncoerced choice. Yet those choices are shaped, every day, by the food industry, by the rhythm of our lives and by the architecture of the modern world, all of which induces us to snack, gobble and dash. In forgetting to think about how our environment shapes us, it becomes easy to think that our food is made for us. The difficult truth is that, increasingly, capitalism makes us for our food.
In so far as there is any social analysis about food, it circulates at the level of prejudice about what "chavs" eat. The prevailing view is that obesity is an individual and moral failing, and that the working class have only themselves to blame for being overweight.
Findings published in July by the food standards agency recently might have provided an antidote to this kind of thinking. In a large survey, the FSA found that people on low incomes were about as likely as higher income groups to be obese and overweight - but they were, on average, less likely to consume fruits and vegetables.
As an antidote, it didn't work very well. A moral panic, such as the one around working-class consumption, is not assuaged by fact or contradiction. Yet a shift in thinking is urgently needed if we're to tackle the social basis of weight gain in British society. The prescription for overweight Britain is clear: less bariatrics, more sociology; less morality, more politics.
· Raj Patel is the author of Stuffed and Starved: Markets, Power and the Hidden Battle for the World's Food System www.stuffedandstarved.org
