We know that obesity kills, we know that obesity costs the global economy billions, what we don’t know is how to sustainably treat obesity to bring the former points to a manageable level. Or maybe some do but as yet nothing has been implemented to begin to counteract this growing epidemic. And an epidemic it is, I speak with clinicians about it, I speak with other writers, I have spoken with psychologists about it and last Monday I spoke on a BBC panel about it.
The reason for this panel was the Danish ‘Fat Tax’. This ‘Fat Tax’ has been put in place to drive up the prices of foodstuffs which contain saturated fats, foods that tend to be bought by low-income families, foods that tend to be bought by the obese or overweight. A logical outcome and hope for this would be that healthy foods become more accessible to beacon communities, an assurance we’re still waiting for the Danish government to make, and that awareness is raised with reference to saturated fats as people start questioning the price hike.
The panel comprised a quick word from a Danish MP, a Danish food manufacturer, a Danish member of the public, a KOL and writer (me) and last, but by no means least, an obese patient from Bracknell, England called Hazel. The first thing to mention is that was a good representation of the sub-section involved in the debate from the BBC, what was not so good was the lack of time the patient suffering from obesity had to speak about it. The chance, therefore, was lost to gain a precious and sorely needed insight into this stigmatised condition.
The panel session was only half an hour, with many points of view to put across, which is of course correct in line with freedom of speech. And freedom speech was most certainly reached by the Danish member public who angrily asked the patient why they should pay for their lack of control. This was, I felt wrongly, omitted from the podcast by the BBC and summed up the general consensus and on the somewhat pigeon-holed condition of obesity. Fruitless anger over a lack of control with no view or insight into the psychology or the lack of health literacy pertaining to the condition.
We know that obesity can be purely physiological, with links between Type 2 diabetes and obesity firmly established as one being a totality of the other, infinitely the causal element of the other. We know obesity can be caused by certain syndromes such as Momo and Cohen Syndromes respectively. We also know obesity can be caused by lack of health education & literacy, depression, insecurity, addiction and many other psychological conditions. However, these conditions are very rarely addressed or spoken about, with obese people socially scorned, in some cases met with disgust and as we saw in the BBC panel session, met with a questioning anger.
Please also note that none of the aforementioned have been described as a ‘non-medical’ condition. Mental health costs the global economy $16 trillion per annum and has finally been addressed by the WEF (World Economic Forum) for the first time ever this year, it’s time to list mental health as an NCD AND a medical condition. I would also include the discipline of psychology in this even though pharmaceuticals are not always involved in it’s regime. Why must a medical condition be defined by it’s use of drugs? Even when the causal element i.e. mental health can cause such tangible, physiological manifestations such as obesity. A condition which costs the NHS £4 billion a year, a figure set to rise to £6.3 billion in the next four years.
The fact that the most important person, the patient, Hazel, was literally brought in 30 seconds before the end of the broadcast did nothing to dispel or expand on the psychology of this disease. I, as a specialist, was brought in early to give the argument a balance, the public awareness as to how important health literacy and health education is, how it affects us all in the long run. How mental health issues are under treated or ignored and are causing a global economic deficit. How patients find themselves on drug regimes without the support of a palliative or mental health team. How, without proper social care in place, drugs tend to mask or deflate the problem as opposed to curing or enabling a self management of the condition, giving the patient a ‘sustainable treatment’.
As a specialist I research constantly, I brainstorm, I read white papers, blogs, articles but what is theory without the practical. What is all this knowledge worth if we can’t speak or listen to the people this knowledge is used and learnt for. Hazel should have been present in that conversation from the onset to give the angry Danish member of the public some empathy, the worried Danish food manufacturer some responsibility. Hazel, did however, briefly clarify the lack of health and nutrition education whilst growing up, leading to bad food habits, which in later life when health literacy arrived turned into an addiction. This clarification was a valuable and important statement.
Psychologists describe obesity as an eating disorder, and are usually called in when patients are morbidly obese whether the cause is physiological or not. So we see obesity reach a stage where the patient will eat until they literally die and the physicality of any existing, tangible, medical condition is no longer taken into account as a mental health team is set to work to find out why this person will eat until they die. So why is it listed as an eating disorder? Why not an addiction? With support groups and medical teams in place. With unhealthy food manufacturers held to account. If we were referring to leisure drugs would we say, well that’s their problem or would we be more accepting of the psychology and physicality of the addiction. Are the obese so vilified that society will not even give them this avenue of understanding?
Mental health and it’s tangible manifestations are here and affect us all, not just by causing a massive global downturn but also watching loved ones and friends being either too afraid to admit they have a mental health problem or being stigmatised when they do. So let’s listen to Hazel, let’s not get angry with her for a complex problem we don’t really understand and let Hazel put a human face on obesity, in fact let all patients put a human face on their illness. Human physiology does not end at the physical, it’s where the complexity of the human psyche begins. It’s where the totality of your patient begins, it’s where the effect of their illness and treatment lies. It is the human face of the disease.
For the BBC World Service panel on Danish ‘Fat Tax’ click here.
As with all Healthinnovations articles this is open to discussion and innovation.