Royal College of Physicians president Andrew Goddard insists that obesity ‘is not a lifestyle choice caused by individual greed’
Well, that’s bad news to start the new year. According to the Royal College of Physicians, I am suffering from a ‘chronic disease’.
It comes as a particular shock because I feel perfectly fine. Indeed, friends staying with us over the weekend commented on how well I was looking (and they know me enough not to be insincerely polite).
But what is my disease, according to the professional association of the nation’s doctors? It is that I am, on the official definition, obese: it is ‘obesity’ which they have said should be reclassified as a ‘chronic disease’ rather than as a ‘lifestyle choice’.
Admittedly, I am only just in this category. At 5ft 10in (1.78m) and weighing 15st (95kg), I have a Body Mass Index of 30.05, and 30-plus is the level defined as obese — one category up from ‘overweight’.
So what are the causes of my alleged ‘chronic disease’? According to the RCP’s president, Professor Andrew Goddard, they are ‘health inequalities, genetic influences and social factors’.
The first of these is his way of noting that in Britain today, obesity is much more prevalent among less well-off families. But that hardly describes my background. So does that mean my (narrowly defined) obesity fails to qualify as a ‘disease’?
As for ‘genetic influences’, I’m not sure what the Prof is trying to say. True, there are examples of obesity in the male line of my family. My paternal great-grandfather, Gustav, died on the operating table because he was too fat — there, I’ve used the unmentionable word — for the surgeons to operate on successfully.
And when he was Chancellor of the Exchequer, my father Nigel was mercilessly caricatured for his corpulence. But after leaving full-time politics he decided to lose weight and did so to remarkable effect (even explaining how, in The Nigel Lawson Diet Book).
Nigella Lawson, whose career is a homage to the joy of eating well
The point is, neither he nor I would have thought obesity was some sort of genetic affliction, like cystic fibrosis or sickle-cell anaemia. Those suffering from such genuine ‘chronic diseases’ have no control over their conditions, which do not result from any choices they exercise. Yet Professor Goddard insists that obesity ‘is not a lifestyle choice caused by individual greed’.
Well, it absolutely is in my case and, I guarantee, millions of others. I am greedy. Gluttonous, in fact. I adore consuming good food and plan my week as much around the meals I propose to enjoy as around my work.
Indeed, I staunchly — if self-servingly —defend the journalistic requirement for these two elements to converge: contacts will talk more freely over a bottle of wine and a generous lunch.
But while this may mark me down as a food-obsessive — I share this with my sister Nigella, whose career is a homage to the joy of eating well — it’s absurd to suggest this means we have, as a family, some ‘disease’ of genetic origin.
A much-needed corrective to this notion is to be published in the UK this week: Conquering Fat Logic, the English translation of a book by a German behavioural therapist with a background in nutritional science, Nadja Hermann.
She recounts how her family had been, through generations, not just obese but morbidly so. She herself weighed 23st 8lb (150kg) at the age of 30 — but she has since lost 13 stone.
Hermann writes: ‘Genes create a basic situation but they don’t oblige anyone to be fat. Several studies have shown that the carriers of so-called obesity genes have no differences in their metabolic rates. To say that some children have a genetic propensity towards obesity means only that they have an inherently larger appetite than naturally slim children, who feel hungry less often.’
More from Dominic Lawson for the Daily Mail…
Hermann also points out that those people who say they have restricted their eating to 1,200 calories a day but still can’t lose weight are deluding themselves: ‘A study carried out in 1992 investigated people described as ‘diet-resistant’.
‘These people claimed not to be able to lose weight, despite restricting their calorie intake to fewer than 1,200 kcal a day. But it turned out that, in their nutritional journals, they underestimated their average calorie intake by 47 per cent and overestimated their physical activity by 51 per cent.
‘The hard truth is that anyone who believes they ‘don’t actually eat that much’, then still inexplicably puts on weight, doesn’t have a problem with their metabolism but with their perception of their own eating habits.’
There is no doubt that it requires a great deal of willpower to stick to a diet, especially when it involves giving up favourite foods. But if we tell everyone who is vastly overweight that their extreme obesity is a ‘disease’, it can only increase their sense of hopelessness — and their refusing to admit that overeating is a choice rather than ineluctable fate.
Yet, Professor Goddard insists, in promoting the idea that obesity is a disease rather than a choice: ‘It is important that we remove the stigma associated with obesity.’
In fact, it is the absence of any stigma that makes extreme and morbid obesity more prevalent. Nadja Hermann writes that no one pointed out how overweight she was when she was at her scales-smashing heaviest, but when she began losing lots of weight, people were much more likely to question her behaviour.
Nadja Hermann, a German behavioural therapist with a background in nutritional science, has lost 13 stone in weight
‘When I was sick and almost bedridden at 150kg, no one expressed concern or commented on my weight. And then, when I lost 40kg, people started to get worried about my health. Why is it so socially acceptable to criticise someone for losing weight?’
I suspect this is more of a female issue. When a fat woman loses weight, it is resented by other women in her circle who liked very much being thinner than their morbidly obese friend. And her weight loss will be even more resented by those of her fat acquaintances who are intimidated by a display of resolve that they feel unable or unwilling to emulate.
It is important to distinguish between obesity (which, apparently, is my ‘chronic disease’) and morbid obesity: if I were to fall into this latter BMI category, my weight would need to spiral to at least 20st, or more than 127kg. That would truly be unhealthy and almost certainly shorten my life — as the term ‘morbid’ indicates.
But despite the near-hysteria in political circles about the ‘obesity crisis’, official figures suggest that barely 3 per cent of the adult population is morbidly obese. And it is not their great fatness that is a disease, but conditions which might be a result of it (such as kidney failure and type 2 diabetes).
For those many millions who are merely overweight, there is no medical issue whatsoever: still less should they be described as suffering from a ‘chronic disease’. If anything, they are the lucky ones.
In 2011, the respected U.S. publication Nutrition Journal, following a survey of 350,000 randomly selected Americans, concluded that overweight people live longer, on average, and those who are actually obese in old age tend to live longer than those of their contemporaries who are thin.
These obese elderly were also, said the researchers from California University, more likely to survive certain dangerous medical conditions, such as heart disease and type 2 diabetes.
The lead researcher for the survey, Dr Linda Bacon, concluded: ‘It is overwhelmingly apparent that fat has been highly exaggerated as a risk for disease or decreased longevity.’
I found this most reassuring, obviously. It also made sense to me: when we are seriously ill, we tend to lose great amounts of weight. That happened to me some years ago. When I recently saw a photo of myself at the time, I was appalled by how scrawny I looked. Yet that was probably the only time since my 20s in which my BMI index was anywhere near the level categorised as ‘normal’.
Now, on the borderline between overweight and obese, I am in robust good health.
And, frankly, I resent being told by the President of the Royal College of Physicians that I am suffering from a chronic disease. Physician, heal thyself: I’m fat as a fiddle.