Let them eat cake

by Tracy Purbrick
Primary Care Dietitian

It’s that age old dining dilemma. You’ve remained teetotal and skipped dessert, whilst everyone else has continued to plough on from pudding to port. Do you magnanimously agree to just split the bill and cough up for the unwanted additional expense?

Or do you risk the communal disdain by whipping out your calculator and only paying your dues? A fine conundrum indeed. But what if we were to magnify the pounds at stake by a dozen or so decimal places? With a budget of over £90 billion, issues of obvious inequity become all the more galling. And that folks, sums up the current (dys)functioning of the NHS; a service touted as free for all, but of course, actually paid for out of all of our taxes. How much harder it then becomes to dig that little further into our pockets to cover for those who expect everyone else to pay for the consequences of their excesses. So obesity, with all its rampantly increasing healthcare demands, is the metaphorical dinner companion, who at shared expense chooses king prawns and caviar, whilst everyone else scrimps by on scampi and chips.

Incredibly though, the obese en masse appear to be outraged at the notion that their burgeoning demands on healthcare should be rationed. Indignant, as though this was some part of a petty moral crusade against fat people; not what it clearly is - an inescapable consequence of finite resources.

Now I actually have some sympathy for smokers. It might be much more politically correct to deny them medical care yet, in fairness, they actually give quite generously to the kitty. In fact, if obese people also paid proportionately more, no one would begrudge them as many new knees or heart bypasses as a surgeon could suture.

But whilst they continue to dip their chubby little hands ever deeper into our share of the national coffers, of course those who get up to exercise at dawn or display a modicum of dietary restraint are going to feel resentful. Clearly then, in the name of all that’s fair, a way of drawing a few more pennies out of the sloth rather than the svelte is called for.

Now before I hear that old refrain, that taxing fat people is taxing the poor…….it isn’t! Rich people nowadays, are pretty much just as fat. Besides, rather than just upping the taxes, it could just be a redistribution by charging more for those things generally correlated with getting fat and discounting those associated with being slim. Fast food and computer games could be amongst those things in the former camp, whilst fruit, vegetables, and gym memberships could sit in the latter. How’s that for positive social engineering? A little tinkering, no net increases in taxes, and they might even lose some weight into the bargain.

Indeed, the ideal is obviously that we all shed any excess poundage, thus not only improving costs, but also our own physical and mental wellbeing. The recent government strategy, ‘Healthy Weight, Healthy Lives’, has some useful ideas for achieving this. However, it is mainly geared towards kids, who are largely victims of their adult ‘carers’. In terms of the grownups, it’s pretty much limited to making the built environment less obesogenic, chucking in a few health screens and improving nutritional information.

Whilst for some, improving cycle lanes and nutrition labelling may push their energy balance back into meltdown mode, all too many obese people already know that a pork pie isn’t lean cuisine. Unfortunately, they just don’t care! Or rather, they might like to be slimmer, but not as much as they’d like another slice of cake, thank you very much.

The Government’s answer to this recalcitrant clan is somewhat ambiguous. In one breath, they are underlining the importance of individual responsibility, but in the next they are suggesting stooping to bribery aka, ‘payments, vouchers and other rewards’. Throwing more of our good money after bad. Apart from the ludicrous logistical impossibilities of such a scheme, there surely comes a point when the proverbial towel should be thrown in. You can lead a horse to water and all that.

As dietitians most of us have seen hundreds, if not thousands of overweight patients over the years. For every handful of patients who take our advice on board and genuinely make changes to their lives, there is always at least one, who utterly refuses to countenance any form of change. These are the ones with chips on their shoulders as well as in their cavernous mouths. The ones who feel deeply entitled to eat whatever they want and still be slim. That they are visibly otherwise, is merely an affront of Mother Nature. These are the people who lap up stories on fat viruses and fat genes, but resolutely, never a word of advice.

So on this point, I believe the Government needs to get it’s thinking straight. At some point, individual responsibility does indeed have to kick in. Once you’ve redesigned the built environment, taken to task the enabling food and drink industry and offered any advice and emotional support needed. If someone still wants to self destruct via their oral orifice, nothing anyone can do and no amount of money is going to stop them. And for these time wasters, who rob the more deserving of dietetic and other healthcare time I say ‘so long’ as they are being taxed on it, let them eat cake!