Belfast Telegraph

Sunday 20 April 2014

Maybe doctors should tell obese people they're gluttons

Super slim: Victoria Beckham is said to be a fan of the Alkaline diet

Maeve Binchy's short stories seldom featured a real villain – only a person not yet redeemed – but Maeve wrote one story describing a deeply nasty person: this odious character was a woman on a cruise and she was horribly spiteful to fat people. She got her comeuppance.

This I perfectly understood. Maeve felt very hurt, when young, by derogatory remarks aimed at the overweight, even though, paradoxically, she could be self-deprecating about her own weight problems. I've always had to fight the flab myself – and in recent years, the flab seems to have been winning – and smart remarks about two-ton-Tessie aren't always kind.

Neither are friends enthusiastically recommending a new diet – the Fast Diet is the one they're all on now – although the generation which once believed that a well-fitted corset from the lingerie department was the answer to thickening of the figure have now, bless them, passed away.

We live in a more sensitive age. We are enjoined not to offend. We are encouraged to tiptoe around certain delicate areas of the human condition. To notice race is racist; to differentiate sex is sexist; to observe age is ageist. To mention religion might be sectarian. At interviews for American universities, no questions about ethnicity, faith, sexual orientation or fertility status may be permitted.

And now comes the last frontier, which perhaps Maeve might have appreciated: the language used towards those of us who, shall we say, tip the scales at rather more than we should do.

Doctors worldwide are concerned about the terrifying expansion– no pun intended– in the condition of obesity. In the United States, airline seats are being made bigger, ambulance stretchers enlarged, and a variety of portals broadened to allow for the fact that the public is growing so enormous.

Some public health officials, in a number of countries, are saying that obesity will shortly be a greater threat to health and well-being than the tobacco habit ever was. In Britain, the National Institute for Health and Care Excellence (NICE), is so concerned about the £5.1bn annual health costs due to corpulence (41% of men and 33% of women being overweight) that they have asked doctors to tackle the issue as a priority.

But nicely (no pun intended).

Doctors, say NICE, should approach this matter of avoirdupois with tact and delicacy. It is, says Professor Mike Kelly, the UK supremo for public health, "a sensitive issue with patients".

Harsh words like 'obese', 'tubby', 'portly', 'fleshy' or 'well-upholstered', should not be bandied about because we might get upset and take offence. And you know what happens when the chubby tendency takes offence – they go off and stuff their face with cream buns for comfort. Doctors are instructed to use language which is strictly 'non-blaming'.

Stout folk should not be scolded for being the way they are. For this would be to impose an unpleasant form of social control: stigma. Stigma is something deeply cruel because it's a form of bullying.

Stigma was used in the past to discriminate against anyone who was different –travellers, unmarried mothers, people with epilepsy, even people who were simply unlucky, and superstitions arose that ill-luck was catching. So stigmatising the fatties is wrong.

I disagree. Stigma can be a useful incentive to behaviour change. Most of the ex-smokers I know finally quit, not, essentially, because of health warnings (everyone knows someone who has lived to 90 on a fag habit), but because they got fed up with the social stigma of being branded the kind of loser who has to egress outside for a drag on a gasper.

With stigma, we should differentiate between conditions that are involuntary, and behaviour that is chosen. People should not be stigmatised for who they are, for an illness, an inherited situation, a condition of identity.

But some behaviour should be stigmatised – and is stigmatised, actually: letting your dog poo in a public park, spitting infected phlegm, even, perhaps, littering clean environments.

Getting behind a steering wheel when plastered drunk is savagely stigmatised today, though it was once considered quite a lark.

So, if fatties become outsized simply because they are eating too much and not exercising enough, maybe a little stigma would be socially useful. Maybe it would galvanise the dumplings among us to get our acts together and lose a little lard?

To be sure, there is a certain genetic basis for body shape, and people who come from a long line of amply-sized ancestors find it tougher to look like Victoria Beckham (who apparently maintains her flawless size 8 figure by following the Alkaline Diet). And Maeve would be right about this: it isn't kind to mock and disrespect individuals whose natural, inherited body type is larger.

All the same, the dramatic increase in obesity in developed societies means that most chubbies get that way because they eat too much, and too much of the wrong stuff.

Be honest: it's down to plain old gluttony. Maybe doctors should just say so, instead of humming and hawing and constructing sentences of "non-blaming" advice for the weighty. Maybe airline seats should not be expanded and turnstiles not made bigger: maybe the Billy and Bessie Bunters should get the message – "Eat less, jumbo!"

In fact, I am striving, right now, to stigmatise myself with a little self-correction.

"Look at the cut of you! You're a disgrace! Move it, Podge, and lose some of those double chins!"

If the approach works, I'll duly advise the medical authorities – stigmatise.

'Most chubbies get that way because they eat too much of the wrong stuff'

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