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Gastric bands for all? Let’s try changing our food culture

November 27, 2014

“The liberals are telling us all to stop “fat-shaming” … now all the people most likely to criticise a pernicious food industry are being silenced by their political allies.”

Today we hear that NICE (National Institute for Health and Care Excellence) have recommended an increase in gastric bypass surgery for obese patients, believing this will save money in tackling obesity. When a quarter of the population are obese, you can see their logic. The catch is that it would cost £12bn, the Daily Mail estimates.

When looking at that figure, you can’t help wondering if there isn’t a cheaper way. We’re not dealing with an epidemic in the usual sense; this isn’t a disease which spreads unchecked and ravages whole towns because we have no cure. We have had the cure forever, and the problem is constructed by us. The healthcare system can do little to help stop obesity on its own. Introduce a system of gastric bands by default, and you create a culture that accepts their usage without question, just as we accept the widespread use of statins without question.

If we want to reduce obesity, we need to start seriously analysing our relationship with food. To illustrate the point, here is the daily eating habit timetable. Every food I’m about to mention, bar the salads, are foods you should watch out for, as often times they’re ones we don’t even think about – so you eat / drink them indiscriminately, sometimes to replace fattier or more sugary things you eat few of. This might mean you actually consume more sugar or fat via the replacements. This is an increasing problem with “health foods” which just replace fat with sugar and call themselves low fat or avoid a red traffic light on any of their products, even when the calorie count is just the same.

Breakfast. Either it’s a fatty breakfast of fried food or a carbohydrate one of cereal or toast. In this country our traditional breakfast options are scant. We don’t eat salad, or soup or rice. Instead, we’ll eat stacks of toast covered in butter or peanut butter, or something quick to fry (most likely, bacon). Children eat cereal with milk and often must eat a reasonably hefty amount on their parents’ insistence. They won’t eat the whole oat stuff, so as some compromise their parents buy sugary cereal, which is then washed down with fruit juice drink claiming to be one of your five a day, but which also contains a large amount of liquid sugar. Adults will drink tea or coffee with milk and sugar.

11 o’clock. This is usually where people take a break. Only an two hours before lunch, “break” in this country means time to eat, at least for all the non-smokers. Some will eat their lunch early or a substantial portion of it. By this time you’ll have had anything from two to a half dozen more cups of coffee or tea with milk and sugar. If you’re having a snack, it won’t be a piece of fruit, it will be a chocolate bar or crisps. We tend to think that this is our pick up for the day, and the rest of it is planned to be healthy. If you had a substantial breakfast, you will have been led to believe by popular perception that your stomach is now lined with some indestructible super forcefield that negates the effect of everything you eat from now on.

Looking at the chocolate bars, you’ll notice that they’re all hideously expensive for what you get. We all buy the larger ones because you can save rather a lot of money by buying in bulk… In theory. Actually, you eat more of the thing than you intended. Then, because it’s not a single use bar, when it disappears it feels like you’ve lost a staple from your cupboards rather than finished a snack, so you stock up again. You would probably save money if they were more expensive, because you’d buy far fewer. That said, they’re all sitting there in their shiny packets, looking so inviting. Even the ones you don’t like that much. And there”s always something new. Life’s about new experiences, so you wouldn’t want to miss anything. At the same time, it would be disappointing if you didn’t like it. So to be on the safe side, you buy two, something new and one of your favourites.

Lunch. Those who ate half their lunch now have a sadly depleted one, so buy some more. Those who brought lunch in walk past a shop with a display of sandwiches, looking temptingly grab-able and both fresher, more varied and tastier than the portion of hastily made, overcooked and under-seasoned pasta they brought in. Additionally, the shop has a meal deal including crisps and a sugary drink. Maybe coke, or one of these drinks claiming to be vitamin filled or like water. Smoothies are essentially a piece of fruit which would once have been considered a snack. These days, that’s a drink. But the sugar in that doesn’t count because it’s fruit sugar and fruit sugar doesn’t count. Fruit sugar must be the anti-calorie, because fruit has fibre and vitamin C in it.

Not even the sandwiches themselves are a safe bet, since no matter how much salad they have in, a double or triple set of sandwiches is about as much bread as you should have in a day. If you go home and have bread or had toast for breakfast, your carbs are way up and you don’t notice because breakfast is supposed to be toast and lunch is supposed to be sandwiches. And who has soup or stew in the evening without bread or dumplings? Culture, tradition and expectation shape our meal choices (indeed, our options) far too much.

Mid-afternoon. Someone in the office brings in doughnuts or biscuits, or someone holding an event somewhere on a campus tries to coax people in using something tasty. There’s a chance someone has a birthday or someone has received a food gift they can’t eat, and chocolates or birthday cake will make the mix. More tea or coffee with milk or sugar to wash that down.

The temptation is there so everyone eats a few; if you refuse, people want to know if you’re sure and repeatedly offer them to you. Eating is social and eating foods that are known to be “bad” for you is a bonding experience, like “we’re all being naughty together”. If you don’t eat, that makes people feel worse about the fact that they are. Rather than questioning themselves whether they need to eat, or accepting someone’s choice to act differently to them, it’s more comfortable to try and compel others to join in, since that will lead to them doing something desirable, rather than abstaining which is undesirable.

If you refuse because you’re trying to cut down your fat, sugar or carb intake, in the eyes of your peers you’re instantly “on a diet”, which means you have succumbed to the evils of the fat-shaming media and are developing an eating disorder. Everyone rushes to tell you how you don’t need to diet. Evidently, watching your intake is something you’re only supposed to do when it’s too late.

It’s the end of the work or school day. Walking home, a child probably gets a portion of chips with with their pocket money. There are no child size portions at the chip shop. The child will be having dinner within the next two hours, but that is neither the responsibility of the vendor nor do the parents necessarily know that their child is filling up on chips and then eating a full meal just afterwards.

An adult on their way home from work will see advert for one of the famous fast food outlets. Whatever plans they had to eat vegetarian chilli with steamed broccoli falls out the window with a splat, because by some remarkable coincidence, that very outlet is never less than fifty yards away. The kicker is, even if you don’t like that particular food, the food “type” gets stuck in your head; a burger these days is considered as much a type of food as fruit is. So, even if you don’t want the Gargantuan Triple Chicken-Beef-Dog Gutbuster, you’ll still be reminded that the other Dog outlet further down the road does something similar that you like.

Maybe you go to eat with a friend. The portions are massive, but you can’t share, because that would be so cheap of you and they might be hungrier than you. Besides which, you want the variety – a few chips and a bit of burger and bun etc. There is no option to do this, you must have masses of everything or nothing of something. Your burger comes with a single salad leaf and you tell yourself that at least you’re having something healthy today. That one leaf you envision soaking up the gallon jugs of fat you’ve consumed.

We choose an absolutely gigantic meal and because we like to match what other people are having, we get more or less healthy food than we intended to match them. If you haven’t gone for fast food but gone home, you’ll start snacking on something like peanuts while waiting for dinner. If you’ve gone to a restaurant, you’ll think you might as well have a starter. If you’re at an all-you-can-eat buffet, you’ll want to get your money’s worth, which involves getting ridiculously full, close to feeling sick. On top of which, if you’re with friends and family, it’s like a competition to see who can pack away the most and get more out of the establishment.

If you’ve gone to a friend’s or family member’s house to eat, they’ll probably fry and roast things in butter, just for you, so that it tastes the best it can. They’ll attempt to feed you at every opportunity, feeling like a bad host if they don’t and you feeling like a bad guest if you don’t accept. People will look at you like they worry for your sanity if you don’t want to snack on crisps or devour piles of cake. In a family gathering, someone will probably decide that someone’s too skinny, doesn’t eat enough or has a weak character because they can’t or won’t eat a family sized portion of food all for themselves.

If you’re eating fast food, you’ll get chronically thirsty, especially with the salt that compliments them so well, and which you can no longer go without because you have been salting your food since you were eight and everything from your bread to your condiments is chock full of it. You feel like a cheap bastard for ordering water, so you get one of their sodas. That always seems to help everything slip down.

It certainly does; studies show that whenever we perfectly balance the amount of sugar in our food with the amount of fat, our ability to tell when we’ve had enough is impaired. There’s a reason why the amount of sugar in sodas have increased and you can now buy great buckets of the stuff; people buy and eat more if they have more. Using high fructose corn syrup instead of sugar makes it extremely sweet, which we like and get used to, so we buy and drink more of it. It does so cheaply as well. Getting people to buy massive drinks that look good value but are actually ludicrously expensive for glorified sugar and water works out in the best interest of the company.

If you are a child, dinner time probably won’t be fast food. It might be take-out, but even if it isn’t, it might as well be; some kind of cheap processed meat or pizza alongside a giant portion of ready cut (oiled and salted) fries will come your way, with the merest trace of a piece of sweetcorn, if your parents worry about that sort of thing. Your evening meal drink will probably be a glass of milk, because what you really need in a meal dominated by fat and protein is an extra glass of pure fat and protein. They’ll be some talk of calcium, though just about everything is fortified with vitamins and minerals like calcium these days. You will be told to finish all your dinner, or your won’t get pudding. Your reward for eating too much is to eat more.

Bearing in mind, no one has any idea what an appropriate child’s portion is. Or an appropriate adult portion, for that matter. When we have less than we perceive we can reasonably get away with, we hate to have less. On top of which, the more we become accustomed to having, the more we can pack away. We see what we get in food outlets and we think that’s about right, ignoring the fact that these portions have got bigger, and that a business stands to gain from giving bigger portions; it’s better value for him, as well as getting more business. The trouble is, if his competitors up their portion sizes, so must he if he wants to keep up.

After work and dinner, or before dinner, you may go for a drink or have a few at home to unwind. We now know that these aren’t exactly calorie free, but nutritional values aren’t written on alcoholic drinks, only alcohol content. No number, no worries. If it’s a night of heavy drinking, we then have to “line our stomach” so we’re not ill, have a greater desire for and less resistance to junk food, are more likely to eat right before bed, eat more than once in the night and eat strangely to avoid or cure a hangover. I’ve known people to sit around eating whole bags of bread.

By this time, the day is a write-off in terms of health. There’s no point exercising. Besides, you’re too full anyway. Who ever heard of someone getting fat overnight? You can afford to have one unhealthy day. That in mind, some kind of sweet to finish of that meal might be in order. This will be late at night, right before bed.

The next day, you might try to make up by eating salad. But salad on its own is dull and at this point you have no idea how to even begin cooking a light, healthy meal. So you put about half that salad in a bacon sandwich. Then your day is instantly unhealthy and once again there is “no point” trying to make it any better. That day is also a write off, and there’s no time to exercise in between all the other work that needs doing, a substantial proportion of which will involve sitting about.

You go to your doctor for a blood test, and she says you have high cholesterol, so they’ll put you straight on the statins. She’ll weakly advise a change in diet, knowing there’s a good chance you won’t listen because it’s such unwelcome news and she doesn’t want to be too harsh; or, you’ll get the hard night and they’ll frighten you off ever come back to the doctor again, sitting their in their 40” waistband asking you why you’re so obese. As though you made some kind of gigantic faux pas. The assumption is you ate biscuits constantly, but the truth is that in our world, you don’t need to. No one believes you have a slow metabolism, and while eating their way through a huge chunk of fat or protein a day, tell you that you should eat better.

We’re taking people with faster metabolisms as symbols of normality. Whatever they can eat, other people must be able to without any problem. Meanwhile, what they eat and in what quantities becomes steadily worse and all the people with average metabolisms are shuffled sideways into keeping up with them, then punished and insulted when the result is different.

Everyone wants to act as though obesity is this thing that affects the weak, no matter how common it gets. I’ve been in a McDonald’s that was built with toilet doors are so narrow, no obese person could get in, as if to disassociate themselves from obesity and say “Oh, no. No fat people come in here.”. Maybe this was just an accident, but it got me thinking that fast food outlets can treat fat people how they want even though they are a major market, because the company knows that these people are the ones who will always be back for more regardless, like an addict to an abusive drug dealer.

Meanwhile, all the liberals of America (and increasingly, beyond) are telling us all to stop “fat-shaming” – that we’re fat-shaming by suggesting that it’s not, in fact, in anyone’s best interest to keep eating like this. Every fast food industries rub their hands together at this, because now all the people most likely to criticise a pernicious food industry are being silenced by their supposed political allies, of all people.

Contentedness in oneself only works insofar as there are some things we can’t change. The fact that we’re getting fatter is something we certainly can change and we should try, because I doubt there’s any truth to the argument that we’d all be happier if we just let ourselves be any old weight, or health or level of fitness. You don’t tell depressed people to be proud of being depressed, because no one wants to be. You help them. We keep working on ways to make them better, because it’s not an identity when it stops you functioning.

If you’re in hospital, or not leaving the house, clearly your function is hugely impaired. I think perhaps with the best will in the world, these liberal people underestimate the extent to which a moderate excess of fat can create serious problems in later life. Type two diabetes doesn’t only effect the morbidly obese; we’re all living longer, and people are likely to live to their 60s. That’s when the health of their youth will count. The elderly need so much health support, the more we can reduce unnecessary problems, the better.

That it is a person’s “choice” to be fat is an argument the fast and snack food corporations have been making for years, to protect themselves from state regulation and censorship in their marketing, as has happened with cigarettes repeatedly over the years. Worse, whereas there are non-smokers not appealed by cigarettes in the least, there are no non-eaters. Everyone from Marks and Spencers to Tescos to KFC throws food in our face from our televisions – the richer and fattier the better, for these are the more marketable and can carry the largest profit margins because of their desirability. These are not foods that need to be advertised. They sell themselves on their own merits far too much as it is.

With a McDonald’s on every corner and in every home, how can anybody be expected to switch off from food? When all the cheapest, quickest foods are made so by the addition of copious sugar, salt, and fat, how can the harassed low-income families be blamed for their children’s obesity? They barely have time to read the traffic light labels, and those are dying a death as it is, because regular people “hate being told what to do” by experts. These voices of fire and brimstone and pointing fingers never capture a public’s imagination as much as a colourful, carefree advertising campaign about how wonderful the world is when it has coke in it. Fast food vendors indirectly tell you what you want to hear; that you can do what you want and everything will be all right.

The same friends, family, colleagues, peers and acquaintances who will judge you for being fat judge you equally for not joining in with them while they eat the very things which are likely to make you fat. Our condiments add to our total calorie count and we don’t add them, because they “aren’t food” and we only have a splash. Though some of us have a splash, then another splash, then a dollop of three other things and use it as a seasoning in cooking, every meal. We can’t be bothered to count calories because it’s a giant great faff – and because it seems neurotic. Calorie counting is, in fact, on the diagnostic criteria for anorexia.

Think about that – taking care to make sure you know how much unused energy you’re storing in your body – in a society that gives next to no guidance on food types and portion sizes other than the occasional weak, nagging or disputed snippet of advice from disparate sources, or total myths in the diet column of some vapid magazine or tabloid – is indicative of anorexia. That’s the food culture we have in this country. We boast and complain and our own consumption, shame and reassure other people about theirs. It is not so much a fat culture as a conflicted, self-contradictory culture of total confusion and paranoia resulting in apathy and deep scepticism.

Every single person, fat, thin, professional or lay, needs to rethink their everyday attitude to food. People like me with our little blogs, scientists, doctors and journalists are popping up all over the place, rationally suggesting it might be time for a rethink, and everyone’s reaction is to yell: “You’re trying to ban burgers! You’re going to ruin everyone’s fun! I’m fine, I don’t need to do any of this crap…” Then run off and complain to the Mail when obesity starts costing us all big time.

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