Fat road to perdition

The death of an overweight 3-year-old opened the doors to a wave of simplistic hysteria about obesity, writes Vivienne Parry

'Three-year-old dies of obesity," screamed the tabloids last week, as the House of Commons select committee on health report into obesity was released. "Choked by folds of fat," said the Daily Mail. The implication was that a toddler, consumed by her greed for fast food, and unchecked by parents, was a foretaste of our fat future. We're all going to hell in a heavily reinforced handcart. Hmmm.

It was the lack of detail that was revealing. We know nothing of the child's family history or anything about her genes. For instance, it is known that errors in both copies of the gene that codes for the hormone leptin produced in fat cells, result in the body telling the brain that it is starving, no matter how much food has already been eaten. So the child eats and eats. Anything. Frozen fish fingers, rubbish from the bin, dry pasta, flour - driven by constant, unquenchable hunger. One of the children with this particular gene defect, cared for by Stephen O'Rahilly's metabolic disorders team at Cambridge, weighed 190lb at the age of eight, despite liposuction and surgery, and could no longer walk.

Surely a case for sympathy, understanding and the best that cutting edge science can offer in the way of research and treatment? But yet here's another child, with I bet you, a similar genetic cause for their illness, being blamed and shamed in a way that would make us blush were it to be applied to a child with, say, cystic fibrosis. They're both genetic diseases, but what's the difference? Fat.

We are deeply embarrassed by fat because we think it says something about our baser selves. We can control neither our destinies nor our bodies. We have given in to sloth and gluttony - both sins. Obese people deserve to be censured for surely all they lack is will and self-control. And now a sick child who has no more ability to control their condition than an asthmatic, is paraded as an example of the lack of self-will that will lead us all to perdition. It's nonsense. And pretty sick nonsense at that.

Last week's hysterical press coverage was, variously, "we're doing it to ourselves" or "it's being done to us by Big Food". We're all going to develop horrible nasties like Type 2 diabetes and heart disease and then die young and fat. Order larger coffins now.

Inconvenient evidence like life expectancy - along with butt size - increasing in the US, has been ignored. The implication seems to be that if only fat people became thin, they would magically become healthy. Can this magic thin wand also abolish poverty, smoking, alcohol and drug use - all closely linked with ill health? That's impressive.

And where was science in all of this? Both muted and strident. Most specialists in the field were at a conference in Prague, but even so, in the main, they were not consulted. The reason is that we all think we know about obesity; it's a simple energy equation - intake v output.

The reality is that weight regulation is incredibly complex science. It also has more attendant confounding baggage - psychological and cultural - than any other health issue. Meanwhile there was a lot of noise from generalists painting the blackest of future fat scenarios. One couldn't help feeling that some of them had spotted the obesity gravy train and were upping the ante lest it depart without them on board. There are grants a plenty in them there hills. Sorry, them there big-and-getting-bigger hills.

Big pharma revelled in the doomsday scenarios, seeing products previously dubbed "lifestyle" (anti-fat medications) being transformed into "medical need" ones with a few waves of that thin wand. Big food played the personal responsibility card and claimed it could self-regulate, prompting choruses of "I don't think so" from consumer groups.

Of course obesity is a real and significant problem which needs to be urgently addressed, and which should not be minimised.

But the headlines are getting a bit out of hand. Between 40% and 70% of weight regulation is genetically determined. Some of us are natural born fidgets consuming huge amounts of energy even when slumped in front of the telly; others are not. It's luck of the draw stuff. Yet rather than being informed by the complexities of the science here, obesity is in danger of being treated as a black and white issue in which the overweight are deemed greedy sloths seduced by Big Food. This simplistic view will create a climate in which the fat, or even the merely generously love-handled, no matter how fit, are consumed with even more self-loathing, while an obsession with body mass index fuels a further rise in the corrosive eating patterns of image conscious teenagers. Worry about kids being fit, not fat, and return them to daily compulsory sports.