News today that Westminster Council in London have proposed plans to cut benefit aid to individuals who refuse to follow a doctor’s advice to attend exercise classes. In the UK a doctor can refer a patient to a privately run fitness class to help them to lose weight, or prescribe leisure activities such as swimming.
Health professionals, such as GP Dr Lawrence Buckman, have called this a “draconian and silly” idea. It also seems incredibly unfair, considering how much, or how little, attention is given to the causes of obesity and poor diet.
Poor Diet and Obesity Costs More
One of the great advantages of a state run health service is that we can determine how much lifestyle risk factors cost the country financially. What may come as a surprised to you is that in the UK, and most probably in the USA too, the ill effects of poor diet and obesity costs more to treat than that of smoking and alcohol consumption combined.
According to data gathered in 2006/7 and published in 2011, poor diet and overweight / obesity costs the NHS (British National Health Service) a total of £10.9 billion ($17.7 billion) a year, whereas alcohol and smoking costs £6.6 billion ($10.73 billion). This figure is set to rise rapidly though.
“The NHS costs attributable to overweight and obesity are projected to double to £10 billion per year by 2050.” – Dr Bryony Butland et al, 2007
However, while there have been major campaigns to tackle smoking and alcohol in recent years, with the banning of advertising of both products, banning drinking in public places in some towns and a national banning of smoking in public places, very little is done to stop the manufactures of junk food from advertising and marketing their products.
This latest idea from Westminster Council seems putting the blame onto those who most need help. We know that we live in an “obesogenic environment” and that most people who are overweight or obese have been exposed to a variety of social, urban, economic and commercial factors that has ultimately changed their attitudes to food. While it is easy for us to simply say that overweight and obese people chose to consume too much food and lead sedentary lifestyles, the reality of the situation is more complex. People often require a lot more help than a doctor “prescribing” a dose of exercise. As we know, simply exercising will not lead to rapid weight loss anyway. More importantly, for exercise to be effective it has to be done on a regular basis to a relatively high level of intensity, and it has to be combined with a healthy diet.
We have spoken with a fitness instructor (who wishes to remain anonymous) who has in the past been a part of the exercise referral scheme in the UK. He found that a majority of individuals sent to him were uninterested in exercising and would do the bare minimum to get through the class. Very few of them lost weight and the drop out rate was very high. He had the same problems trying to encourage some of his clients to exercise as school PE teachers have trying to persuade their students to exercise. Some people are simply not interested.
When a person is addicted to smoking or drinking alcohol, the solution starts with tackling the root causes of the addiction. People need to come to terms with why they behave in a certain way and learn to change their attitude and mindset before they can start to quit drinking and smoking. Food is addictive for many people and the constant temptation to eat more, which is driven by advertising on television, in newspapers and magazines and on the high street is very hard to beat.
Tobacco and Alcohol Advertising in Sport
It is hard to imagine the time when cigarette companies sponsored sporting events, but it was only in 2003 that the UK banned advertising at sporting events. We used to have the Embassy World Snooker Championships, Benson & Hedges Cup (a one day cricket competition), and many Formula One teams received sponsorship from tobacco companies.
Alcohol is still advertised in sporting events, we still have the Carling Cup (rugby) and Hennessy Gold Cup (horse racing) and while new laws have seen a reduction in tobacco and alcohol advertising, fast food seems to be replacing them.
Between 1993 and 2001 Carling sponsored the Premiership (UK soccer top league), and Budweiser are the current sponsors of the FA Cup. Worthington’s (UK brewer) sponsored the FA league cup between 1998 and 2003, they replaced Coca Cola who sponsored it from 1992. This all seems a far cry from the healthy days when the Milk Marketing Board sponsored the League Cup!
How To Control Junk Food Advertising?
Nobody wishes to live in a “Nanny State” and many people object to the idea of cutting benefits for those who do not exercise enough. However, this really only leaves one alternative government intervention, and that is to set tighter controls on the advertising of junk food. Not just on television, but also at sporting events such as football matches and international athletics events.
People are continuing to eat their way to an early grave. And with the rising cases of morbid obesity and type 2 diabetes, many people are living very restrictive lives in their later years. Lack of mobility caused by obesity can lead to depression which makes the problem all the more harder to tackle.
“poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.” – Scarborough et al, 2011.
Maybe rather than punishing people for not exercising enough, local councils should be running support groups that are more like Alcoholics Anonymous than Boot Camp. Past studies have shown that some people have more success with weight loss when they are a member of a weight loss support group. If a government really wishes to tackle the obesity problem with a “joined up approach”, it needs to tackle the source of junk food and understand why some people overeat while others do not.
In the Foresight report which was published by the Government Office for Science one of the key issues suggested was:
“the need to avoid ‘knee jerk’ responses and regulation which may bring unintended consequences“
It seems that Westminster Council have not read this report. Maybe it is time government departments and councils read the literature that is provided before coming up with new strategies? Punishing those who are already struggling is not the answer.
References and Further reading
Obese who refuse to exercise ‘could face benefits cut’ - BBC News, 3 January 2013
“Challenging Obesity: The science behind the issues” by Heather McLannahan (Editor), Pete Clifton (Editor), 2008. Oxford University Press.
Weight Loss Clubs May Be The Best Way To Lose Weight – MotleyHealth.com, July 13th, 2010.
The economic burden of ill-health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006–07 NHS costs, by Scarborough P, Bhatnagar P, Wickramasinghe KK, et al. J Public Health (Oxf) 2011;33:527–35.
Law ends UK tobacco sponsorship – BBC News, 31 July 2005