Dr Emma Boyland starts a new series for Culture Matters about eating and drinking, and the politics and economics involved in moulding a culture of overconsumption.
It seems that barely a day goes by without mention of obesity in the news. It is called an epidemic, or even worse, a pandemic. Television generally is obsessed with the topic - programmes revolve around groups of overweight individuals trying to achieve weight loss, or show the extreme end of excess weight, highlighting the plight of those who cannot even leave their homes without drastic intervention. Though television of course has a flair for the dramatic, it is fair to say that excess weight is no longer something strange and unusual. Over 60% of adults in England were overweight or obese at the last count .
How have we got to this point? What has changed? Why can’t we seem to stop rising levels of obesity, never mind reverse them? If we can’t, is it really that much of a problem? This series of articles will seek to explore a range of issues related to eating and drinking culture, and the political maelstrom within which this issue sits. Politics influences so many things in our lives; can it really affect what we eat, when we eat, how much we eat?
In starting to understand how we got here, it usually helps to consider where we came from.
Feast and famine
Our ancestors had to contend with feast and famine. When food was seasonally available, they were well versed in eating as much as they could in order to lay down fat for the inevitable famine that would follow. The best and easiest things to gorge on were dense sources of carbohydrates, such as fruit. The sweet taste meant it was palatable and pleasant to consume, and the sugar content raised blood sugar and, therefore, insulin. Insulin worked to make sure immediate energy needs were serviced and most of the rest of the sugar was converted to body fat for longer term storage. Insulin is one of many contributors to the biological system (sometimes called the satiety system or satiety cascade) we have inside us that tells us when we’re hungry, and when we’re full. But who can’t remember a time when they’ve been in a restaurant, feeling full from the main course, and then seen the dessert menu and realised they could really do with some chocolate gateaux…? Clearly, the system is not fool-proof.
The energy balance equation tells us that if energy in > energy out (through exercise yes, but also our basic metabolism), then over time, weight gain will occur. And so the problem is fairly clear - we eat more than we need (we also do less physical activity than we need, but that’s perhaps for another series). We don’t have a period of famine to lose the excess weight accrued through this ‘gorging’, so we keep that weight and add to it as the years go by.
We’re not hunter gatherers anymore, but what sort of food culture do we have now? We have energy dense foods available 24 hours a day, 365 days a year. And we find it VERY difficult to resist consuming too much. The foods themselves have changed (become more energy dense, less fibrous and therefore less filling) and there is also more of it. Twenty years ago, an average serving of popcorn at the cinema would comprise around 250 calories, today it’s over 600. If there is more food available, we will eat more (and that’s not even going into the so-called “hidden calories” in such seemingly innocuous things as a Starbucks Latte). We’re a nation of plate clearers after all. But why do we need to eat when sitting watching a movie anyway? Because food has become inextricably linked to most of the pleasant things in our lives, socialising, celebrations, entertainment, and is also thought of as welcome solace when things are a bit dull (“here, take some sweets on the train, it’s going to be a long boring journey”) or not going so well (“broken up with a partner? Eat some ice cream and you’ll feel better!”).
Many of these associations are a result of highly effective and immersive food marketing, which has successfully infiltrated our minds and affected our relationships with food and eating. Budgets devoted to food marketing have risen exponentially (or, where they haven’t, this is usually a reflection of the marketing getting cheaper - e.g. on the Internet - rather than there being less of it) whilst food production costs have fallen. Improved farming practices, mechanisation of food production, and efficiencies in global trade, buoyed by the power of those with neoliberal capitalist ideals, have all meant an increase in the range of foods available and a relative reduction in their cost. These days, maintaining a food product or a brand in a competitive and crowded market requires substantial investment in commercial promotion.
Over the past 50 years the food industry has developed products which have met our needs for convenience, taste and budget in a competitive market which has heavily promoted these factors. And we bought into this vision of ‘more is better’ and have paid the price with our health (not to mention our environment, we’re the biggest nation of food wasters in Europe…while we’re still in Europe, that is…but I won’t get started on THAT). Government efforts to allow the food industry to the table to make decisions about public health initiatives, unsurprisingly, meant that legislation to improve the food environment have been shouted down and self-regulatory schemes abound. Is there evidence that these schemes achieve anything? Ask the industry themselves and they say yes. Ask objective researchers, they say no. So food marketing, and the wider food environment, remains resolutely “obesogenic” or obesity-promoting.
But even before the food marketers can get hold of us we can be exposed to factors that affect our susceptibility to weight gain. Is it all down to genes? Well, yes there is a genetic contribution to body mass, but our genetics have not changed dramatically in the 40 or so years in which the obesity epidemic has taken hold. So whilst our genetic blueprint may affect our risk of developing obesity, if the food environment does not permit (or more accurately, actively promote), over consumption, the obesity will not occur. You will also be familiar with the regular debates around women breastfeeding in public and how acceptable this is in our society. Well, in terms of obesity, it’s important that women are empowered and encouraged to feed their infants this way. Evidence suggests that whether or not we are breastfed may affect our ability to self-regulate intake, as with formula there can be a tendency for parents to encourage the child to finish the bottle. Also, we are more likely to be accepting of flavours if we have had more exposure to them - so an infant who has been exposed to vegetable flavours in the womb (transmitted through amniotic fluid) or during breastfeeding (transmitted in the milk) is more likely to accept those vegetables at weaning. We all want the best for our children, but it can be difficult, or impossible, to meet all of these challenges and mitigate the effects of the modern food environment in order to set our children up for a healthy life.
So what does all of this mean for us as a society? There are real economic costs at stake. Of course there are direct costs of prevention work, diagnosis and treatment services for those with overweight and obesity, but there are also indirect costs from lost output due to cessation of work or reduced productivity due to ill health and overall this adds up to several billion pounds each year in England. Can we afford to ignore this? And at an individual level, people with overweight and obesity are likely to experience weight stigma, have a higher incidence of anxiety and depression, and generally report a lower quality of life than normal weight individuals. With mental health budgets (along with all other budgets) being slashed, is this not a ticking time-bomb?
Obese children become obese adults, and therefore early intervention is crucial. Can politics help here? The Government’s long awaited childhood obesity strategy was due to be released in January 2016, then spring 2016, then summer…and now autumn is being suggested. In the meantime, a leaked version has already been severely criticised by public health groups for not going far enough. Add to this the post-Brexit fall out and a new Prime Minister, and frankly, it will be a surprise if it even gets launched at all. If it doesn’t, a real opportunity to get a handle on these issues has passed us by.