Big Society

I was sitting in a client’s reception area when the guy came in. He was big, very big, and hadn’t seen his feet in a long time. Probably a salesman, he wore a suit. His stomach didn’t hang over his belt though. You could see it drooped down inside his trousers towards his knees. He was almost perfectly spherical.

It struck me as strange. Sure, you see huge people on mobility scooters in supermarkets, stocking up on pizza and ice-cream. You see them hobbling with walking sticks – slowly, painfully – over the roads in Leith, their hips and knees pulverised by years of moving a flab-mountain. You see them on buses in lumpy leggings, finishing one chocolate bar and starting another. But you just don’t see many massively obese people in business.

When I left my meeting, it was nearly lunchtime. On the way back to the office, I pulled into a petrol station to grab some grub. The big guy must have still been in my mind because I started looking round for something healthy to eat.

Chocolate. Sweeties. Doughnuts. Crisps. Pies, sausage rolls, steak bakes. Masses of fast, fatty foods, stapped full of sugar or salt. Not a sign of any fruit, or anything genuinely fresh or freshly-made.

I’m not a food snob, anything but. As a typical Scot, it’s been the work of decades to educate my palate to ‘enjoy’ brocolli et al. But I was taken aback to realise just how crap and strangely limited the selection on offer was – almost all of it produced by big ‘processed-food’ conglomerates. The closest thing to something ‘healthy’ was the fridge-ful of sandwiches.

Service station sarnies taste mostly of fridges, don’t you think? They have an unpleasant squishy texture too. But faced with the thought of your belly dangling down to your knees, you search for a simple sandwich – instead of the steak-bake, two sausage rolls and three fudge doughnuts you really want.

So, eventually, I settled for a cheese sub. It turned out to be one of those sandwiches cunningly put together to show the filling spilling out from the front. In reality, the back of the sandwich was more or less empty. It was all front.

That sums up modern Britain perfectly, doesn’t it? On the surface, we’re a functioning, successful society. But, behind this seeming surfeit, there’s a dread emptiness, a cheap and nasty cynicism, an intellectual vacuum.

We’re a world power. We’re best buds with the USA. We’re shooting at folks in far off places. We’re making sonorous pronouncements about foreign policy. We’re shaking hands with the Chinese. We’re hosting the Olympics… Our Prime Minister may even look the part. Cabinet sound-bites on debt reduction, public spending cuts and immigration controls might be meat-and-drink to the Tory faithful, and even palatable to many more.

But, in terms of new ideas, the cupboard is bare. The old elitist idea of ‘bread and circuses’ will do nothing for our complex, deep-set, social problems. Even the ‘Big Society’ won’t help a society that is getting bigger, and bigger.

Superficially, obesity is a simple problem. You eat more than you exercise; you take in more calories than you burn; your body stores that extra energy as fat; you put on weight. This can hardly come as a surprise to us in Scotland. Official statistics say that:

• around 2/3rds of Scottish adults are heavier than their healthy weight

• about a quarter of Scottish adults are obese – say about 1 million people, all at least a couple of stone (c. 30lb) too heavy.

• around 1 in 100 men and nearly 4 in 100 women are morbidly obese – about 100,000 people in total, perhaps anything from 6 stone (c. 100lb) to 12 stone (c. 200lb) overweight.

Apparently, some people do not realise they are fat. We can all be tempted to imagine it’s muscle making our Body Mass Index (BMI) so high. So, for the sake of simplicity, if you’re a man with a waistline over 37 inches or a woman with a waistline over 32 inches, you’re overweight. If your waist is over 40 inches (man) or 35 inches (woman), you’re obese. And the bigger your waistline, the higher the risk of diabetes, heart disease, stroke, osteoarthritis and some cancers.

But the cost is almost as frightening as the health risks.

It’s estimated the NHS in Scotland spent over £300 million on tackling weight-related disease in 2007-2008 – with £175 million spent on the consequences of obesity, notably diabetes and hypertension.

It’s also reckoned that the obese are 25% less likely to be in work. Or, if they are, they’re 50% more likely to be absent due to illness. Indeed, it’s claimed that 4% of incapacity benefits relate directly to obesity.

For Scottish women, there’s also a strong link between being poor and being fat. It’s even pre-figured in cultural eating habits of deprived girls where chocolate and chips feature strongly in their diets. So there’s social stigma, as well as health risks and economic costs.

None of this is news and, for grown-ups, you’d think the problem would be well within our individual control. Yet a shift of perspective is required to understand how such a huge problem has crept up on us so fast – as individuals and as a society.

Over millennia, the human body has been tuned to hunger. Our physiology and deep psychology were designed for times when food was scarce and we needed to conserve energy. As a result, when we get the chance to rest and take on easy calories, it’s hard to resist. But that’s what recent decades have created in abundance: the opportunity for indolence and indulgence.

Perhaps at a deeper level, food also fills the emptiness inside for some people. When eating may be one of life’s few fulfilling experiences, we have a society in emotional crisis.

So, what’s the answer? Spending huge sums of public money to adapt ambulances and hospital equipment so that super-fat patients can be handled safely? That seems as inevitable as it is nutty. Equally, with such powerful human drives at work, you have to guess that softly-softly nudges form health advice won’t make much impact.

At its most basic, society remains a system of incentives and disincentives. For example, in 2008, a study compared the cost of getting calories from different foods. Per 100 calories, cheap fatty sausages were 4p, lean meaty sausages 22p; sugary orange squash was 5p, fresh orange juice 38p. So, for many, the lure of cheap calories outweighs the distant indignity of being squeezed into an ambulance with the help of the fire-brigade.

More assertive strategies have been suggested: from taxes on fatty foods and sugary drinks to health-warnings on outsize clothes. The trouble is that, as the founder of Timebank Edgar Cahn observed, pizza can be delivered, but social outcomes can’t. Policy and public finance create the conditions for change: but real progress has to be co-produced at the community level.

We’d want to start young; subsidise nutritious alternatives, reward active lifestyles and offer incentives for healthy-weight. But, if we’re serious about tackling obesity, we’d also have to get serious about the structure of our food supply. We’d need to address the market forces and industry practices – all the cheap fats and sugars – that make nasty food so tasty. We’d need to look at legal definitions and marketing. We might need a whole range of action, education, regulation and even compulsion. And we’d probably enjoy it less than eating our greens.

Of course, none of us really wants the ‘nanny state’. As a nation, we’ve shown we’re more than capable of helping ourselves. To pies and doughnuts. The sad reality is, if the government doesn’t start to get heavy soon, the rest of us will.


A version of this article previously appeared in ‘The Scotsman’