Everywhere I read that obesity is a medical problem. It is not. Not unless motoring is also a medical problem. Both obesity and driving have bad health, hence medical, consequences, but they are lifestyle choices. Of all the philosophical and religious constructs invented by human beings, for me, the only sensible and intelligent place in the forest to sit is in the chair marked existentialism. Simply put, existentialism states that human beings find themselves in a material universe, including our material bodies, and are faced with the inevitability of choice.
The clever thing is that choice isn't optional. There are many things I cannot choose; I can't choose to have been born in a different place or a different time. I can't choose to have a wonderful voice or a magical athletic talent. But there are many other things I can choose, indeed, everything which is not inevitable is subject to choice, even if whoremaster man* denies it.
We know that body mass is a function of food intake and exercise, both of which are under voluntary control, even though millions of people may deny it. The recent ‘discovery’ of a ‘fat gene’ exemplified yet again the scientific illiteracy of our media. Farmers have been selectively breeding their livestock to maximise meat production long before gene theory was even elucidated. No one doubted the existence of genes which predispose people to weight gain. The scientists have added to the knowledge of the genome, they have not, and would not, claim to have ‘discovered a fat gene’. Even the most efficient food-converting human will lose weight if they eat less than they burn. Hence the Mars® bar diet.
I noticed that a common multipack had bars of 246 calories each. Four a day with black coffee and water would cause me to lose weight. I've always loved Mars bars ever since I was a little boy when they cost four old pence. It was an interesting experience and I made a number of simple discoveries and one which was more unexpected. I lost 1 kg in 10 days. I discovered that the environment is replete with food smells and opportunities to buy food and consume snacks. Twice in the 10 days I had to have a meal with a friend for social reasons, for example, a curry after the cinema, (I deleted two Mars bars that day).
The diet was very simple and cheap, and saved me lots of shopping and food preparation time. I recognised that there is a difference between being hungry and not being full. It must surely be very exceptional over the hundreds of thousands of years during which human beings have evolved, that whole populations have existed where nearly everyone eats until they are full every day. The most startling discovery was that on the days when I laid my head on my pillow having successfully stuck to my diet I felt a great sense of achievement and control. This is presumably how anorexics feel.
So that's it. Obesity is a matter of choice, no matter how anyone might deny it. Clearly in our food-saturated society, where food is cheap, enjoyable, and sociable, these choices are more difficult to make for some people than others, but that observation applies to almost every human activity, and does not detract from the truth of the original proposition. Obviously, living on chocolate is not a serious dietary proposition; merely a device to point out that weight loss is simply a matter of numbers. If you eat less than you burn you will lose weight. It is possible to lose weight while still eating chocolate; it all depends on the quantities involved.
My patients usually recognise that they are overweight; usually they concede that this is bad for them, but much more rarely do they acknowledge that their weight is under their own control. Without the third mental step, no progress can be made. I think this is where we were with smoking 40 years ago, when many regarded smoking as a fact of life. Now, nearly all smokers recognise that they choose to smoke. Human beings have to choose even if they do not acknowledge to themselves what they are doing. This is the existential human predicament. It's one of the things that make life and freedom both interesting and difficult.
The predicament for the profession is that if we offer to solve problems which are not amenable as well as end-stage social pathology, we set ourselves up for failure and disappointment.1 More importantly, we disable the citizen from taking control of their own life.
Footnotes
↵* “This is the excellent foppery of the world, that, when we are sick in fortune, — often the surfeit of our own behaviour, we make guilty of our disasters the sun, the moon, and the stars; as if we were villains on necessity; fools by heavenly compulsion …. an admirable evasion of whoremaster man.” (Edmund the bastard in King Lear 1.ii.125)
- © British Journal of General Practice, 2008.