Saturday, 16 May 2020

Hard cases make bad policy

In contrast to smoking, there has been a growing weight of evidence of a strong correlation between obesity and being at risk of dying from coronavirus. This has sparked a number of reports that Boris Johnson is planning to abandon his alleged “libertarian” instincts and promote an action plan to tackle Britain’s obesity crisis. A number of people have suggested that his own experience of the disease has somewhat spooked him, both into resisting a swift unwinding of the lockdown, despite the adverse consequences to the wider economy, and now into wanting to crack down on obesity. He has certainly struggled with his weight over the years, apparently scaling 17½ stone before being hospitalised, and there does seem to be a whiff of the zeal of the reformed smoker about this conversion.

However, on an international scale, things aren’t necessarily so clear-cut. Lower rates of obesity in France, Italy and Spain are often given as an example we should follow, but all of those countries have suffered very severely. In contrast, New Zealand, which has a higher rate of obesity than the UK, has hardly been touched, while the USA, often singled out for its high obesity rate, has still done considerably better than us overall, with the areas of the South and Midwest frequently seen as obesity hotspots being among the less affected regions. Germany and Sweden both have obesity rates little below ours, but both have had a much lower rate of coronavirus deaths.

The track record of measures using the price mechanism to affect eating and drinking habits has not been a good one. Neither minimum alcohol pricing, now in force in Scotland for two years, nor the sugar tax, have had any noticeable impact on the problems they were claimed to address. Indeed, very often the main impact is to put further strain on the budgets of poorer households.

If the price of one category of food or drink is increased, it is likely to lead to substitution with another, opening up the possibility of all kinds of unintended consequences. And attempting to divide food into “good” and “bad” categories can all too easily have perverse results, such as banning the advertising of natural and wholesome items such as orange juice, cheese and meat.

Another front in the war on obesity is the reformulation of food to make it contain fewer calories. However, the experience of recent years has shown that the potential here is fairly limited. If you reduce one undesirable item, you just end up increasing another to compensate. Less fat is more sugar and vice versa. Attempts to change the recipes of products such as biscuits and chocolate have simply made them much less palatable. Making food taste like sawdust is a pretty crude way of putting people off eating it. In reality, very often the only option is simply to reduce the portion size, and if you go too far with that people may just choose to eat two.

We may end up seeing new restrictions placed on businesses that make it harder for them to operate and make a living. One that has been proposed in recent years but so far rejected is requiring all food businesses, however small, to provide calorie counts on their products, which could be well-nigh impossible to achieve and drive them out of business. And there’s little evidence that calorie counts actually affect people’s choices. Indeed, in some cases people may choose higher-calorie options as they feel they’re getting more “bangs per buck.” Actually containing less food as such isn’t really much of a selling point.

It’s also likely that takeaways, which are a traditional bête noire of anti-obesity campaigners, will come under fresh assault. There’s no reason why takeaway food should be any less healthy than that eaten in restaurants or cooked at home, and this all too easily comes across as a snobbish condemnation of working-class diets and preferences. Indeed, there’s a strong whiff of class prejudice about the whole project. Clamping down on takeaways will also disproportionately affect ethnic minority communities.

If you look at the actual figures, the higher risk from coronavirus isn’t spread evenly across the whole population of overweight people; it is very strongly concentrated at the higher end. The widely quoted figure of a 37% additional risk applies to those who are morbidly obese, with a BMI of over 40. It’s not people just carrying a few extra pounds. Yet the danger is that the “war on obesity” will mainly comprise indiscriminate, broad-brush measures that affect a huge swathe of the population.

There is a clear parallel with alcohol, where consumption guidelines have been adopted and widely promulgated that tar even pretty light drinkers with the same brush as those with a major problem. Of course morbid obesity, just like alcoholism, is a serious health issue. But it needs to be tackled through a targeted approach, not by making everyone feel guilty. And nobody who enjoys a few drinks but is currently pointing the finger at the fatties should imagine that their pleasure will be left undisturbed.

Last week, we celebrated the 75th anniversary of VE Day. Throughout the whole of human history, it has only really been in the period since then that most people have easily been able to get enough to eat. Worldwide, there are now more overweight people than malnourished ones. This age of abundance is completely unprecedented , and it’s not surprising that the human race is taking some time to adjust. But, over time, it’s likely that obesity will tend to decline. The rate of obesity has already plateaued or begun to fall in most developed counties, and now there is a strong stigma against being seriously overweight amongst higher income groups. In the future that is likely to spread through the entire population.

It has to be questioned what right the State has to seek to control the behaviour of adults purely for their own good. As the great philosopher of liberty John Stuart Mill said, “The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.”

Against this argument is inevitably set the burden put on the NHS – and thus on taxpayers – by health problems arising from obesity. But it’s important to remember that the NHS was created to serve the people, not the other way round. The social compact on which it is founded depends on the assumption that people are fallible human beings, not saints, and it will be there for them whatever the cause of their illness. If we start making a distinction between the deserving and the undeserving sick we embark on a dangerous slippery slope. And it should always be remembered that, in terms of whole life healthcare costs, it is actually the clean-living who live into extreme old age who end up costing the public purse more.

So my prediction is that any “war on obesity” started by the government will be largely ineffective, will get a lot of people’s backs up, and will create a whole raft of unintended and undesirable consequences.

16 comments:

  1. A dilemma for the sanctimonious.

    Stan Glantz and John Banzhaf have been with the current antismoking movement since its beginnings in the early 1970s. Until both recently retiring from these posts, Glantz and Banzhaf headed the two largest antismoking groups in America (both groups beginning in the early-1970s), Glantz heading "Americans for Non-Smokers Rights" and Banzhaf, "Action on Smoking and Health". Both began as mechanical engineers. Glantz was then given a [fake] Professor of Cardiology at the University of California (San Francisco) to lend medical weight to his antismoking fanaticism. Banzhaf went on to Law with his favourite slogan - "Sue the Bastards". They both have massive egos, are megalomaniacal, are neurotic, have a superiority complex, and are media whores. They would both be considered as militant antismokers.

    Over the last nearly 50 years, these two have played a critical role in the character assassination of smokers. Through fraudulent "re-definitions" and highly questionable [agenda-driven] "research", smokers have been reduced to reckless addicts, killers of adults and babies, a burden on society that must be removed from normal society.

    Results in anti-smoking "research" from the 1980s in particular would be over-interpreted by the researchers for media impact. By the time they made it to a compliant, unquestioning media, headlines would further catastrophize research results. And by the time these headlines would make it to Glantz and Banzhaf's organizations, they would be further catastrophized. Banzhaf even had a section for paid members on how to get custody of the children if you're a nonsmoker and your spouse is a smoker. It's no mystery, then, why there's now a significant proportion of the [gullible] population, including politicians, that reacts to a whiff of tobacco smoke - even outdoors - as if they're being exposed to the plague or a military-grade bio-weapon. It reflects a mass-scale assault on mental and social health.

    So, what's become of these "superior" health advocates "blessed" by no exposure to tobacco smoke? Well, both are now obese.

    Glantz
    https://imgur.com/7dZSkhd

    Banzhaf
    https://imgur.com/qAmvk1M

    An interesting question is how these two would react to an anti-obesity movement (which I wouldn't agree with), having some of their own type of hostility directed at them? Would they be screaming "discrimination"?


    PS The rabid antismoker, Crawford, referred to in the previous thread was a long-time board member of Banzhaf's "Action on Smoking & Health".

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  2. Whilst I agree with most of your article especially that the State should not seek to control the behaviour of adults purely for their OWN good, I do not agree with you that it is wrong for the government to strive to give consumers more information so that they can make better informed decisions.

    This is done across most of the consumer market. Car manufacturers have to give reasonably accurage fuel consumption and crash test figures. Manufactures of electrical equipment have to give energy ratings. Brewers and vintners have to tell the consumer the alcohol content of their wares. So why shouldn't purveyors of food be required to give similar information? But it should be done in a neutral and informative manner without the hysteria and misleadinformationthat has characterised the anti-smoking and anti-drinking campaigns.

    On the question of obesity I don't think international comparisons are very meaningful. in CV19 obesity is very much a second or third order effect. The fact that obese Kiwis have suffered less is almost entirely due to their very effective response at the start of the outbreak.

    The panic about the obesity seems to be driven more by bad statistics than any real crisis. As Christopher Snowden pointed out: the fact that a boy can go from being an healthy 15 year old to an obese 16 year old overnight must cast some doubt on the meaning of the statistics.

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    1. I have no objection in principle to calorie labelling - my concern is more than it would make life impossible for small businesses preparing food from scratch. There may be a way round that, but the concern can't just be airily dismissed.

      It's also doubtful to what extent it would actually affect people's choices. I don't think alcoholic strength labelling makes much different to people's beer choices - in general, people want to drink a beer of a particular category, and aren't too bothered either way by small differences between beers within that category.

      I also wrote in that piece that there is an issue with excessive portion sizes (or at least a lack of choice of smaller portions) in out-of-home catering, but legislation would be a very blunt way of addressing that.

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    2. This is rather like the recent situation when someone died of an allergic reaction and the reaction was to insist that all allergenic ingredients had to be listed. My comment was that if I were selling sandwiches I would simply say that I could not warant them allergen free, and take the small loss in sales.

      In the same way the calory information would be that the product contains less than n calories. Small producers could set n to a billion and accept that they would lose sales to the most fussy eaters.

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    3. Small food outlets are finding it much easier to produce accurate nutritional information as there are plenty of online food databases. The problem is the time it would take to measure everything that's used and correlate the information. Fine if you're a sandwich shop but not so good if you have regularly changing menus and/or not worried about strict portion control. Re alcoholic strength, it's important to me in this new world of take home drink - higher ABV means more bang for the buck in general! 440ml cans of very tasty 7.4% Bad Co DIPA for £2 in Morrisons being one new favourite.

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    4. It's a lot easier to declare what ingredients are in a product than exactly how much there is of them. And I'm not sure that small businesses have that kind of cop-out from the declaration of allergens - small breweries certainly don't.

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    5. There is no 'opt out' for food outlets from displaying allergen advice. Businesses must display in writing a declaration about the 14 allergens, even if none are present in their food, which would be impossible unless all they sell is water.

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  3. "The fact that obese Kiwis have suffered less is almost entirely due to their very effective response at the start of the outbreak."

    Getting off topic, but I'd say it's much more to do with the fact that New Zealand has a much smaller and less dense population than the UK, and much less international contact.

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  4. Many good points.

    "If we start making a distinction between the deserving and the undeserving sick we embark on a dangerous slippery slope."

    This was seen in N#zi Germany, e.g., smoking.

    The last time the medically-aligned got to social prominence, they produced the Eugenics catastrophe of early last century that was first popularized in America and then in N#zi Germany. The Germans and Hi##ler were students of American Eugenics. It was taught in prestigious American universities and embraced/funded by the "educated" class and the mega-wealthy (e.g., Ford, Carnegie, Rockefeller). In addition to the primary breeding aspect, Eugenics also had a behavioural aspect. Eugenicists were anti-tobacco, anti-alcohol, anti-fatso (dietary prescriptions/proscriptions, regimented physical exercise).

    It has already been demonstrated that the medically-aligned are capable of a very nasty, destructive streak. Unfortunately, over the last number of decades the medically-aligned are - again - demonstrating a nasty streak. Contemporary Public Health has the same behavioural targets (i.e., tobacco, alcohol...) as its Eugenics forebears. They simply don't use the "E" word. Also important is the assault on anything resembling the Hippocratic Oath. Medicos of the last few decades do not take the Hippocratic Oath, if they take any oath, ceremonial or otherwise, at all. A very pertinent question is what moral code do contemporary medical practitioners operate by? You'd be hard pressed to find an answer. There was a similar attack on the Hippocratic Oath in the lead-up to the Eugenics era early last century. In the absence of the HO (e.g., "first do no harm"), the medically-aligned can rationalize all sorts of perverse, abominable conduct in the name of a "higher good" or "Utopian visions". The slippery slope over the last decade to, say, very late-term abortions and euthanasia are not good signs at all.

    What's been allowed to occur - AGAIN - is medical domination of society. Politicians have deferred to medical "authority". The medical establishment, including Public Health, speak as if everything and everyone is "their jurisdiction", as if they own the population which is an experimental quantity at their disposal - the medicalization of everyday life. This was the same mistake made during the Eugenics era. And so come the attempts at lifestyle/social engineering. Smoking is the prime example since it was the first cab off the social-engineering rank.

    Antismoking (prohibitionism) has been pushed by the unelected, unaccountable UN agency, the World Health Organization, since the 1970s. In the early-2000s, most countries signed up to the prohibitionist WHO Framework Convention on Tobacco Control. Tobacco Control has long degenerated into groupthink. It considers its views as only benevolent and infallible. Anyone questioning TC is considered a shill of [evil] Big Tobacco trying to thwart TC's "wonderful" work. TC has lavish 5-star conferences at national and international levels. Over the last number of years, TC has banned the media and public from its gatherings.

    And with the groupthink comes the escalating nastiness. Smokers have had ever increasing punishments directed at them for non-conformity, e.g., denormalization/leperization, more and more baseless smoking bans, ever-increasing extortionate taxes, denial of employment, denial of housing, denial of medical treatment. The perpetrators refer to these punishments as "help". It's a serious mess. The same would be expected for Public Health treatment of other targets, e.g., obesity.

    These Public Health nitwits with a god complex need to be told directly that they are not god.

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  5. Apologies, Peter?, for the longish posts, but your thread touches on quite a few interconnected issues.

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  6. It was a bright cold day in July, and the clocks were striking thirteen, and the pubs were still not open.

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  7. What about the known strong connection between being classed as overweight/obese and your probability of surviving a hospital visit or operation.
    There is a well known correlation between having sufficient fat reserves for your body to draw on and your chances of walking out of hospital.

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  8. There is one question that always perplexes me on the subject of the 'epidemic of obesity' and, as someone who is technically obese, it is this - why is it so difficult to find clothes 3XL or larger in standard shops?

    Recently I needed a new suit (first one for at least 10 years!) for my father's funeral and the only place I could find locally was a specialist shop on the other side of Birmingham from me. It is in Erdington, not in a main shopping centre and it provides up to 8XL. Now, if obesity was so rampant as we're led to believe, I'd expect the main clothing retailers to stock up to 4XL at least!

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  9. Professor Pie-Tin17 May 2020 at 09:17

    I'm with Ryan the plumber.Use your common sense.
    It's mainly fat nurses dying in the NHS at the moment so the rest of us could probably do with losing a bit of wood.
    Most of Africa is doing well because they don't go out every night drinking six pints and getting a fish supper on the way home.
    Especially in vindictive South Africa where you still can't buy booze or fags to dull the pain of living in a boring shithole like Joburg or Pretoria.
    Other than that the Covid-19 public and media discourse in the UK is now almost entirely the Brexit debate being re-enacted.
    It's amazing how many economic,legal and trade experts managed to get their epidemiology degrees so quickly.
    Same Remoaner cretins in the media and middle-class Twittersphere attacking Boris.
    Joe Public still giving Boris a huge lead in the polls and not blaming him for every single individual Covid-19 death.
    Blighty is a fat built-up country where it's mostly sick elderly people who have died in care homes where they've been shunted by families who don't want to look after them.
    Covid-19 is just a more efficient version of Harold Shipman.
    More people will die this year from being hit by lightning than from Covid-19 in anyone under the age of 40 with no underlying health problems.
    New Zealand is 2,500 miles from anywhere else and mostly populated by sheep.Of course it's easier to control a virus there especially when you turn the place into a police state.
    Ignore the white noise and enjoy the quiet summer before the virus returns with a vengeance in the Autumn.
    But by then we'll have a No Deal Brexit to take our mind off things.
    I can't wait for the wailing Jemimas fighting Pashmina Wars over the last carton of caramelized onion hummus on the shelf of their North London Waitrose every night on the TV news.
    Marvellous.

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  10. People hate the Nanny State, but the most successful people in the country are those whose parents could afford Nannys,

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    1. What we have now is really a Bully State, more like Dr Kurt Hahn than Mary Poppins.

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