Should we Nanny people about Healthy Diet and Exercise?

[RogerThat]

There are quite a few academics and policy makers eager to do so, here's a good speaker on the subject:

http://www.ox.ac.uk/news-and-events/the ... n-lecture#

[beardy]

There is an existing unbalance towards a bad diet by default. It would be reasonable for the government to take steps towards converting that to an unbalance in favour of a good diet by default.
It would not be reasonable for the government to micromanage peoples' diets.

However as all our main political parties are devotees of market forces and the word "choice" is uttered with unquestioning religious fervour, it can not really do much to interfere with the food supply in the UK. Also they are signing up to an ever increasing number of restrictions of their freedom to act in the form of world trade agreements.

Ultimately in a democracy where the people have the right to choose their government, that government can not tell them to eat what they dont want to.

If they were bothered they could enact a socialist style policy where only healthy food was subsidised or given free to the poorest (who tend to have the worst diet) and they had to buy their own junk at normal prices. Such policies exist in isolated places, such as food co-operatives running on state grants who buy and distribute fruit and veg very cheaply in poorer communities*.

Food banks are obviously well intentioned and relieve the hunger pangs of the hungry but look at what is always shown on the TV as their stock. Not something I would like to eat, processed, tinned and chosen for price and shelf life.
School meals make a big fuss about their healthy credentials but not something I want my kids to eat, again processed and reheated junk food.

What these ramblings are saying, is that it is in the government's power to directly improve the lot of the most needy and least free to make choices for themselves without imposing any compulsions but they dont give a damn about doing so!

None of the above (except the food banks) excuses that ultimately the responsibility is that of the individuals themselves (or their parents) to put the right stuff in their mouths or gives them licence to blame somebody else for their actions.
* The take up of these schemes is pretty poor and mostly those taking advantage of them are those who wanted fruit and veg anyway but at least it ensures they can afford to continue doing so.

Let us assume that the government do take some positive action to control the nation's diet for their own good. How long before some big multi-national sees the chance to make millions and gets important contracts and reshapes the mandated diet to suit their profits and dilutes it healthy character. Which is rather common in the world of school meals (note academies and free schools are looking set to be freed from meeting even those low standards in future).

[Vorpal]

I don't think it is reasonable for the government to restrict people's choices. I do think it is reasonable for the government to require better food labelling, and to implement programs that will educate people about diet, exercise and health.

But, IMO, the most important thing the government can do is to actively encourage active travel and outdoor activities. The European countries that do this successfully, such as the Netherlands and the Scandinavian countries also have among lowest obesity rates in Europe.

[Mark1978]

There is an existing unbalance towards a bad diet by default.

Absolutely. It's very easy to eat foods which are bad for you. Certainly in terms of convenience outlets that's often pretty much all they sell. You have to make a specific effort to eat healthily, something I don't always do.

[RogerThat]

Reading between the lines of these papers and recent lectures I think there are definitely moves afoot to introduce a formal contract between the morbidly obese and the NHS, in return for free health care. It's likely to be in the form of 'We have goals to set you, regarding weight loss and increasing activity, if you don't make even the minimum effort to achieve these goals then you may have to take Health Insurance to cover part of your health care'.

I'm not particularly in favour of coercion, but if you look at the parallel with 'Back to Work' schemes there is a marked improvement in success stories, rather than let people lead wilfully feckless lives on benefits. The problem with wilfully obese people is they genuinely believe that the Nhs can 'fix' all their obesity related health problems, heart disease, diabetes, obesity related cancers, ect, ect, so there is no need to modify one's excesses. Alcoholics are pretty much denied access to liver transplant surgery, it's very likely that the morbidly obese will soon be denied access to many treatments (many women are denied fertility treatments) unless they lose weight first.

The hard reality is that we're probably at saturation level now, when the fall out from this generation of over eaters hits home in a few years time the cost to the nation, in terms of providing free health care at point of need will be utterly intolerable. There's only two solutions I can see: raise taxes significantly (extremely unlikely) or rapidly change the eating and exercise patterns of a sadly sedentary and obese population (67% of men and 54% of women are now in this category).

I don't like idea of 'social contracts' per se, but I have a strong feeling that it's likely an inevitable end game for Health Care in the UK, unless we're willing to start paying for our care via insurance based provision or rapidly change our ways.

[Vorpal]

IMO, a problem with something like 'social contracts' is that many obese people have underlying mental and emotional issues that range from extremely low self esteem to depression and clinical disorders. While there is a certain amount of catch-22 in these problems, unless people are fully supported in dealing with mental and emotional problems, such contracts are unreasonable. The state of health care when it comes to mental and emotional issues in the UK is very much reactionary, and really only sufficient when it comes to crisis care.

[axel_knutt]

People know that poor diet and lack of exercise are bad for their health, just as they know that smoking is unhealthy. Education and advice don’t work, and won’t work because it’s not what people want to hear.

Smokers pay a heavy tax which makes some contribution to the cost of their healthcare, so I think that increasing the NI contributions for people who have poor-lifestyle related conditions such as obesity might be reasonable, but I can see problems with taxing “junk food”. Firstly, people who do a lot of exercise need a lot of high calorie food, and secondly it’s a myth that your diet can’t be healthy unless you’re cooking everything from scratch. There are no end of grossly obese foodies on Secret Eaters who are absolutely convinced that their diet must be healthy simply because they’re gourmets who cook everything from scratch, on the other hand, I eat a mix of processed and non-processed foodstuffs and my diet meets all the current guidelines by a country mile.

[661-Pete]

I wonder where exactly is the threshold between 'healthy food' and 'junk food'? There may be a certain measure of overlap. For instance, cheese, cheddar cheese especially, is often a constituent of what are considered fairly 'healthy' meals, but it is very high in fat, very high in salt, very high in calories. We often make a home-made veggie pizza, using a bought-in base (lots of calories in that too!) with a topping usually of tomatoes, spinach, mushrooms, olives, garlic and herbs - and a layer of cheese on top. We've dropped that from our menu in recent weeks, because I'm still hoping to lose weight and we agreed that pizza is one of the 'bad boys'. But one can't deny that our recipe for it has a lot of 'healthy' attributes to it.

But I agree - we have a lot of 'foodie' sort of items cooked from scratch, aside from the now-set-aside pizza - and they're undoubtedly high in calories. And some of the bought-in ready-meal stuff, smoked fish for instance, can be a good healthy option, and not too hot on the 'bad' calories. Provided you read the labels.

Whether people need to be 'nannied' - very emotive, I might say contentious, word there! - I don't know the answer. We failed to stop people smoking by gentle persuasion, so the government had to step in with legislation, and it has worked to a degree. But as has so often been repeated, everyone needs to eat.

Surprisingly, my school (back in the 1960s) had a tuck-shop, virtually a disaster area as far as healthy eating was concerned! I don't suppose they exist nowadays. Yet you hardly ever saw an obese kid back in those days. What has happened? Perhaps it's the supermarket that has happened, replacing the tuck-shop....

[axel_knutt]

I think that the difference between healthy food and junk food gets defined to suit people's own personal agenda, but as Ben Goldacre said recently, "There's no such thing as an unhealthy meal, only unhealthy diets". The point is that you're not going to make yourself unhealthy with just one meal, it's about what you eat year in, year out.

This is from the video lecture linked at the top of the thread:

Pizza isn't one of the main culprits, it's about in the middle, but I eat nothing in the top third bar a few biscuits. The FSA have a system called the Nutrient Profile Score, which is a means of condensing the nutrition value of foodstuffs into a single index number, the higher the number the less healthy. Ofcom use it to decide which foods can be advertised to children (anything with an NPS over 6 is banned). The NPS for my diet overall is -9, and I manage that with a mix of processed and non-processed food, but I don't buy alcohol, fizzy drink, fruit juice, crisps, chocolate, cake, processed meat etc., and I eat tons of fruit and veg.

[RogerThat]

IMO, a problem with something like 'social contracts' is that many obese people have underlying mental and emotional issues that range from extremely low self esteem to depression and clinical disorders. While there is a certain amount of catch-22 in these problems, unless people are fully supported in dealing with mental and emotional problems, such contracts are unreasonable. The state of health care when it comes to mental and emotional issues in the UK is very much reactionary, and really only sufficient when it comes to crisis care.

The majority of practising Psychologists would argue that low self esteem and depression are the 'side effects' of obesity, rather than the genesis of the problem. I think essentially you provide as much 'guidance' as you like, but as with the long term unemployed, if there's no 'carrot and stick' element to weight loss then why would anyone wish to restructure a life of indulgence! Body image and dysmorphia are a very major force in mental illness in the 21st century. My own concern is that if we don't start to make inroads (and I'm talking about really going for reductions on obesity, by persuasion or coercion) then the Health Service will simply collapse at point of need, as we've seen the first flourish of collapse over the last 18 months.

This gives the private sector the perfect opportunity to realise their long term goal (especially in light of TTIP which will Not exempt health care in England and Wales) in order to restructure the entire mechanism to a pay as you go, insurance levied operation. The cynic in me imagines that the current administration is tacitly turning a blind eye to chronic obesity and poor dietary information in order to accelerate this process. The Transatlantic Trade Agreement is going to open up Health Care provision to the lowest bidder. Which could be a disaster for essential services.

Let's face it, they've done worse things!

[Audax67]

Izzat Miriam Margoils? Poor darling'd be mortified to know she was bad for our health.

Anyway, even with the knowledge that was forcibly administered when I turned diabetic I voted no, but that doesn't mean I'm against informing the public or banning dangerous additives. Nagging, that's what I'm against.

[RogerThat]

Izzat Miriam Margoils? Poor darling'd be mortified to know she was bad for our health.

Anyway, even with the knowledge that was forcibly administered when I turned diabetic I voted no, but that doesn't mean I'm against informing the public or banning dangerous additives. Nagging, that's what I'm against.

Study after study reveals that simply offering 'guidance' or providing information is very ineffective. Carrot and Stick has been very successfully managed in getting people back to work, albeit controversial. Obesity now kills more people than smoking. It's way past the time when we needed to get serious about a morbidly obese population. The clue is in the adjective 'morbid'!

It will kill you, a lot sooner than you might have ever imagined...! And now the good news...

[Audax67]

If they're daft enough to ignore the advice natural selection will do the rest. As Dorothy Parker put it, you can lead a horticulture but you can't make her think.

Incidentally, while the beginning of the mass obesity psychosis was arguably the FDA's Food Pyramid of the 70s, Political Correctness has also had its effect. It has become almost as unacceptable as Clarkson's vapourings to make fat people aware of their size.

BTW, what proportion of the price of a pack of cigs is tax? The price has little effect on the addict but the govt. gets lots of money from it. The profit from a tax on unhealthy foods might be shuttled into looking after the elephants.

[RogerThat]

I'm sorry to hear that you were forcibly administered. It's often the case that the patient is unaware of the seriousness of their illness and what it may mean to their mortality if ignored. But it's a clear example of an 'intervention' to save lives. Sooner or later, an intervention is going to take precedence over 'individual rights', we all have a social contract with the state, but it's only recently we have been made aware of the true meaning of that contract.

The provision of free health care at the point of need is almost unique in global terms (most countries who provide 'Universal Health care' can only do so by a combination of high taxes and compulsory insurance schemes) . If it is to continue to be free, and not part paid for by medical insurance then it's high time the morbidly obese and the obese realise that it's not a privelege to be roughly abused. Some sort of 'contract' in return for free health care is now likely inevitable. What form it takes remains to be seen, but all other attempts to educate and restore the health of the nation have proved essentially futile. Higher taxes and an insurance levy are the only options I can think of in order to continue to facilitate free health provision at point of need.

[axel_knutt]

The profit from a tax on unhealthy foods might be shuttled into looking after the elephants.

But if you tax obesity directly you avoid penalising people like cyclists who eat a lot because they're burning it all off, a tax on food is an indirect disincentive to get more exercise.