Obesity and the Constitution
Jack Ferguson on corporate food, benefits, class and the constitution.
Welfare reform has been one of the greatest successes of the current UK government. To those who have been the victims of their policies, this may seem counter-intuitive. But the fact is that their suffering was always the aim.
Aided by a cruel and vindictive media, the central goal has been to stoke resentment by stigmatising certain groups, in order to divide, conquer and spread moral panic. Working, no matter the quality or security of the work, is fetishised as good for people, and those who must submit to the discipline of employment are encouraged to hate and resent those who cannot find it, or are not physically or mentally able to.
As a consequence, the public in the UK has drastically misinformed views about benefits and their levels, and the government can mobilise support by being “tough” on claimants, while ignoring corporate fraud and tax avoidance on a gargantuan scale.
The latest instalment came last week with David Cameron’s announcement that he is investigating stripping benefits from those who are obese, smokers or have addictions, unless they submit to government mandated treatment programmes.
The Prime Minister was quoted as saying:
“Too many people are stuck on sickness benefits because of issues that could be addressed but are not. Some have drug and alcohol issues but refuse treatment. In other cases, people have problems with their weight which could be addressed, but instead a life on benefits has become the choice. It is not fair to ask hardworking taxpayers to fund the benefits of people who refuse to accept the help and treatment that could get them back to a life of work.”
The identification of these groups plays to the demonisation of the working class, portraying people as lazy, sitting around smoking fags, and further stigmatises addiction through a bizarre vision of it as some kind of personal lifestyle choice. However, it’s interesting to note that the lion’s share of the wide media coverage his proposals have received focused on obesity. “Obese to Lose Benefits” was the headline across many outlets, seemingly inevitably accompanied by a picture of a belly button bulging out between buttons of a shirt.
In fact, these are of course serious health concerns. Experts and charities were quick to condemn the comments, pointing out that threats and sanctions will do little to support people with complex health needs in improving their lives. But that, of course, is not the aim. Cameron’s attack on the unwell is part of the Conservative election campaign, scaring up votes by scapegoating.
But the prominence given to obesity in the narrative reflects deep-seated social beliefs about fatter people, their moral worth, and where responsibility lies for the ways we eat. Whereas more and more people understand that addictions are the result of complex circumstances and are often rooted in deep-seated trauma and abuse, people with a higher Body Mass Index (BMI) are still regarded as personal failures. Their bodies must be submitted to a disciplining regime in order to be able to submit themselves to the world of work.
This is despite the fact that the science of fat is in a rapid state of flux and transformation. Just this month, a paper published in the journal Open Heart argued that the diet advice issued in the US and the UK since the 1980’s was substantially wrong, and that:
“Dietary advice not only needs review, but should never have been issued in the first place.”
The authors argue that the evidence base for condemning saturated fats as the main culprit behind rising BMI’s was a very small number of studies of very unwell people, which was then extrapolated to apply to the population as a whole in a way that is scientifically suspect.
This comes hot on the heels of a growing understanding that there may be differences in types of body fat, with some leading to heath problems but others actually improving overall health and lifespan.
Does any of this mean the UK does not face a growing list of diet related health problems? Of course not, but it does point to why we are failing to address them. Fatness has become a moral panic, with fatter people depicted as a threat to society, shortening lives and costing the taxpayer due to their lack of self-control.
The term moral panic was developed by social scientists to describe episodes of intense public anxiety about threats to the social order, particularly centring on stigmatised or scapegoated groups. Perhaps the classic historical example is the European witch crazes of earlier centuries, when the fears of agrarian societies faced with social and ecological change were violently acted out on the bodies of innocent women. More recent examples include disproportionate fear of crime encouraging bloated police forces, and the massive inflation of the risks of taking various drugs (ecstasy in the 1990’s, mephedrone in the 2000’s).
In a moral panic, these fears are stoked and spread by what are called “moral entrepreneurs” – those in a position of power and influence, who speak publicly about the threat from the stigmatised group. Their motives for doing so are usually about strengthening their own social authority by portraying themselves as the defenders against the threat, and indeed personally profiting from any “solutions” that are adopted.
This tactic of creating an external enemy in order to reinforce your rule and cast yourself as the one to vanquish it is one of the oldest of power relations. The current UK government has deployed it adeptly as part of its welfare reform agenda, shifting public anger from those responsible for the economic crisis and mass unemployment, on to those unable to find work or too sick to undertake it. One of the main side effects of the mass demonisation of people with disabilities as scroungers stealing from the “hard working” has been the horrific rise in disability hate crime.
A growing chorus of academics and activists have argued that the “obesity epidemic” should be understood as a moral panic. They argue that the links between fatness and ill-health are far less clear-cut than they are simplistically portrayed in misleading diet advice, and that society should recognise that there are a range of healthy body sizes, without there being a norm that people should conform to. They argue that the creation of unrealistic body norms causes more ill-health, as people eat in a disordered way to try and pursue an unachievable goal. This profits the pharmaceutical-diet complex, a multi-billion dollar industry catering to the artificially created need for weight loss “solutions”, and overwhelmingly seeking to push medicalisation and drugs.
Critics’ case has been bolstered by the recent scientific developments regarding fat, and the growing awareness that it is not possible to design cross-cultural, one size fits all dietary advice that applies in all circumstances. Up until now, most mainstream responses to obesity have attempted to treat human beings and their food as interchangeable machines in need of fuelling, instead of real people facing difficult decisions in a context of declining access (physical and financial) to fresh healthy food, and increasing calls on their time – not least through the overbearing demands of employment.
This approach rejects the use of the term obesity epidemic – indeed, it is sceptical of medicalising the whole situation by using the term obesity. Those involved argue that fatness has become a stigmatised category, a social group open to pillory and oppression, similar in some ways to more familiar ways of sorting people into a hierarchy by race or gender. Indeed, those who suffer most from the stigmatisation of fatness are those for who it intersects with other ways they are marked out for different treatment – women and people of colour. They argue instead for reclaiming the word fat as a simple descriptor, like short or tall, and reject the use of euphemistic or medicalising terms in favour of the more simple fatness. The refusal to feel shame for describing yourself as fat is seen as a political act.
The way that obesity is calculated is itself suspect. The Body Mass Index is a flawed measure, designed in the 19th century to measure average fatness across populations. It was never designed to give an accurate measure of individuals, and cannot do so. It works by measuring body mass, and then dividing it by the square of your height. But there is in fact no scientific basis for this squaring of height, and as a measure it ignores many other factors, such as bone density, muscularity and the simple fact that larger people will always have a higher BMI based on this measure. In other words, it correctly measures some people as obese, but would also put many very healthy people into the danger zone as well. The line between “normal” weight and obesity is arbitrarily defined, again with little evidence that crossing over it makes substantial impacts on an individual’s health.
None of this meant to imply that there are not serious problems with the way the UK feeds itself, or how much physical activity we are able to undertake on a regular basis. But instead of talking about these social roots of health problems, which might require government action and expenditure to tackle, the focus is put on to fatter people. They are villified and cruelly mocked, leading to huge problems of mental health and eating disorders. In the process, the public grows to blame them for their size, and to see them as moral failures incapable of self-control. An easy group to target then, in search of cheap headlines and electoral advantage, by making uniformed voters resent the support that truly obese people need.
It’s well documented how hard it now is to receive approval from the government to be placed on sickness benefits. The privatised regime of testing, the Work Capability Assessment, formerly operated by ATOS, now US multinational Maximus, is designed to catch out claimants, and to designate the vast majority of those who undertake it fit for work. This entails unbelievable surveillance of the every day lives of the sick and disabled, and humiliating regular attendance of interviews where they are treated virtually as criminals. In this context, anyone who is receiving sickness benefits because they are obese is likely to actually have a serious health problem and need support, rather than just having sneaked over the BMI dividing line.
But because their health condition is seen as a sign of personal moral failure, and they belong to a group who it is seen as acceptable to demonise, they don’t receive the same sympathy that, say, a cancer patient deprived of benefits might do. (There are many people with cancer and other terminal conditions who have been deprived of income and hastened towards death by the inhuman assessment regime; the difference is that the government doesn’t proudly advertise this as a crackdown as they are attempting to do with fatness.)
In making the announcement, Cameron said that he had instructed government advisor Dame Carol Black to rapidly investigate “helping” people on benefits to get treatment, and what impact depriving them of income as punishment could play in this process. Black has been a key part of underpinning in government policy the failed idea that getting into employment is always and in all circumstances good for people’s health, no matter what the quality of the work or its conditions. This is blatantly not true, and the idea that forcing people with complex health problems on to zero hours contracts and workfare is a positive health intervention is laughable.
Then of course there is the very legitimate fear about what exactly the government means by “treatment programmes”. The mastermind of welfare reform, the Secretary of State for Work and Pensions, Iain Duncan Smith, is known for playing fast and loose with the lives of those who depend on his department for survival. Last year he made his own intervention on obesity, when he wrote to the Health Secretary asking for investigation of the possibility of mandating “liquid diets” for obese claimants.
The letter followed a meeting he held with representatives of private diet company Cambridge Weight Solutions, who market a range of soups, smoothies and rehydratable powders that their customers use to replace food and meals. They are advertised on the back of several prominent celebrity endorsements, but in meeting the government they sought access to a different lucrative market – claimants.
IDS was so impressed with this celebrity alternative to SlimFast that he wants it investigated as a possible sanction – get on this plan or lose your benefits. The problem he faced with the Department of Health is that the NHS and health professionals do not recognise the Cambridge Weight Plan, or any other form of gimmicky private diet commodity, as a real health solution, and will not authorise its use as government policy. For now.
The question remains however exactly what treatment programme David Cameron has in mind for forcing obese claimants to take part in, and whether we face the terrifying prospect of a government demanding its citizens starve themselves of nourishing food in order to receive an income, or even enforcing drugs and surgery. Given the laughable ineffectiveness of other welfare to work interventions, such as forcing the unemployed to work for no cost to employers under workfare schemes, the potential good this will do is hard to imagine, and it is easy to see how mandated treatment will be another excuse for private companies to fleece the public purse pushing failed “solutions”. The reality is that there is no effective simple medical weight loss treatment, and changing lives and bodies would require much more nuanced interventions across public policy.
None of the above is meant to imply there are not serious and urgent problems with the British food system. But welfare policy is clearly not the avenue to fix it. The simple fact is that most people in the UK live in what could be deemed obesogenic environments, places that have been made unhealthy through cumulative acts of government policy.
Decades of prioritising cars over people and bicycles in urban planning have turned British streets into rivers of kinetic energy which our basic survival instincts instruct us not to challenge. The food industry has been allowed to create ever cheaper, poorer quality commodities to feed us on a regular basis without any knowledge of what we are eating (see BSE, the horsemeat scandal). Such products have declined in price while the cost of fresh fruit and vegetables has remained stable. And of course, this is all in a context of economic crisis that has seen wages stagnate, unemployment rocket and job security vanish. People are left with very little time, money or energy with which to feed themselves properly, and are dependent on the products of an unscrupulous food industry. The media then demonises fatter people, leaving us insecure and unhappy – easy prey for the marketers of the pharmaceutical/diet industry.
In the very same week that Cameron made his attack upon fatter people, the government was heavily criticised for its relationship to the food industry and the key role it has been given in setting health policy. A study published in the British Medical Journal revealed the (in their words) “extraordinary” influence of corporations linked to sugar in shaping government diet advice and interventions. Companies such as Unilever, Mars, PepsiCo, Kellogg’s and Diageo have been given key roles in advising the government, and fund the assessment of the efficacy of government policy. This is a level of corporate influence that predates the election of the current government, and was just as prevalent under Labour. For example, between 2007 and 2010, private company Weight Watchers spent £610, 140 on assessing . . . whether it was helpful for the NHS to refer patients to Weight Watchers.
Food manufactuers and retailers have one clear goal – to sell more food. This is the reason that there has been a scientific outcry at the revelations of their influence over government, one that Cameron has to some extent sought to distract from by attacking fat claimants. When seen in this light, it becomes clearer why we are unable to get balanced scientific advice over how to truly eat healthily, since the process of devising it is fundamentally flawed. The food industry is systematically interfering in our ability to have a reasoned discussion.
All of this highlights the incredible role that the Westminster government has played in helping to transform its citizens into commodities and sites of accumulation, including in their own bodies. It seeks to submit all, no matter the life difficulties they have, to the disciplinary regime of work, or where work is not available, a miserable regime of surveillance and sanctioning. The ongoing privatisation of the NHS in England threatens to put everyone at the mercy of private companies pushing products of questionable health value, and their agenda provides multiple opportunities for profit from the likes of the Cambridge Weight Plan, or Maximus, who are shortly to get responsibility for assessing in work sickness claims rather than GP’s or real health professionals.
The need for Scotland to gain democratic control over all powers related to welfare benefits and employment law could not be starker. A nation with so many stark health issues to be resolved cannot allow itself to be put at the mercy of a government determined to use the sick as a scapegoat to increase their own power, and to subject them to nonsensical treatment regimes aimed at enriching shareholders rather than improving health.