Who's to blame for Britain's obesity epidemic?

As newspapers last week descended on an Ipswich bungalow to chart the extraordinary life of the world's heaviest man, a fierce debate broke out about how to respond to the surge in obesity in Britain. How much is it a self-inflicted condition? Should the NHS bear the cost of dealing with its effects?

Adapted fromThe Observer, Sunday 25 October 2009

At the age of 48 Paul Mason is immobilised by his own fat. The 70-stone (roughly 450k) man needs an operation to save him from obesity-related death and the surgery will cost the NHS around £20,000 and require the hiring of special transport to take him across the country to a specialist unit. Mason cannot work but needs a team of carers to wash, move and feed him as well as adapted doorways, strengthened furniture and other equipment inside his house. So over the past few years his condition has cost the state hundreds of thousands of pounds. Are we right to ask if this is a self-inflicted condition and question the cost to the taxpayer?Like illnesses caused by smoking and excessive drinking, some people feel that obesity is not an illness but a lifestyle choice and therefore something for which the NHS should not pick up the bill. The lack of sympathy directed at overweight people is concerning many campaigners who feel that a new area of discrimination is opening up.

Mason's case was uncovered in the same week that a US research team at the Johns Hopkins University School of Medicine in Baltimore, Maryland, discovered that overweight people were treated with a contempt that increased directly in line with their weight. The fatter the patient, the less respect they got from their doctor. (…)

Obesity is more than a few extra pounds: it is the accumulation of fat in the body that damages health and knocks years off life, increasing the risk of strokes, heart disease, type II diabetes, cancers and arthritis. (…) Once considered a problem only in high-income countries, it is now dramatically on the rise in low- and middle-income countries, especially in urban areas. Government statistics estimate that, by 2025, 41% of people in the UK will be obese and by 2050 it will be more than half.

NHS costs for treating the overweight are projected to double to £10bn a year by the middle of this century. The wider costs to business and other parts of society are estimated to reach £49.9bn a year. And the biggest fear is for children who, all the studies show, are far more likely to grow up into fat adults with all the health problems that extra weight brings if they are fat as children.

In Dundee this weekend one couple are waiting to hear if their newborn daughter can be returned to them after she became the seventh of their children to be taken into care over concerns for their welfare. The 40-year-old mother weighs 23 stone (146k) and the father is 18st (114K) and the council have been working with the family for some time to try to regulate their diet and exercise, but the parents' failure to comply is said to be a major, although not the sole, factor in the decision of social services that the children were not safe at home. The eldest of the children, aged 13, weighs 16st (102k). The family's lawyer, Katie Price, said they felt "victimised" and claimed that weight was 75% of the issues being held against them. "This whole case has been dreadful," she said. "Neither of these parents takes drink or drugs. They have a big, happy, noisy family which is prone to being overweight." (…)

When obese patients see their doctors they are told to lose weight, no matter the reason for the visit. The BMI (Body Mass Index) test is flawed – it would class a muscle man as obese as it doesn't differentiate between muscle mass and fat, so it serves no one but the insurance companies. (…) Fat women are seldom in positions of power or success…

"London prides itself on being diverse, yet there is almost a zero-tolerance on anyone of size. You cannot walk down the street without being verbally or physically assaulted."

The government has commissioned major studies on obesity. The largest was published two years ago, it blamed changes in work patterns, transport, food production and food-selling for the epidemic. In other words, everything, from computer games to the way our houses and streets are designed is working against people staying fit, well and slim.