Tackling obesity must become a national mission

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This winter, food feels ever more like a minefield. The rich obsess over carbs and gut bacteria, sporting blood sugar monitors as the latest accessory. The poor are trapped on cheap food that has been industrialised beyond recognition. Our supposedly developed world contains the bizarre spectacle of people who are fat yet still hungry.

Luckily, solutions are at hand. In fact, 2024 could be the year we start to turn the tide on obesity. Science is making increasingly clear the ways junk food impacts our biology — and providing new drugs to help. Cash-strapped governments are realising that obesity imposes unacceptable costs on life chances, health systems and productivity. And some brilliant initiatives, in both Europe and America, are demonstrating that we can grip this crisis in ways which may even pay for themselves.

Until now, politicians and doctors have been nervous about telling citizens what to eat. Politicians emphasise freedom and “lifestyle”; doctors I have interviewed have been cynical about whether their patients will ever lose weight. But the belief that people should be free to choose their own poison is increasingly challenged by the evidence that some products are addictive.

Research has found that certain combinations of fats and sugars give our brains a dopamine hit similar to that of nicotine and alcohol: lab rats given cheesecake can develop a lethally overwhelming desire for it. Other work suggests that junk food may tip some very overweight people into hormonal imbalances, which keep them hungry. One recent UK survey suggested that fewer than 0.1 per cent of the population were following all current healthy eating guidance. “Treats” are now being consumed every day. “Public education” alone won’t turn the tide.

The arrival of appetite suppressant drugs such as Wegovy is a game-changer. The puritan in me has been reluctant to embrace the arrival of something that seems to require so little effort, and I am wary of potential side-effects. I’ve also been alarmed by some GP friends who report patients requesting Wegovy “for the weekend” — a quick fix to look svelte on a night out. But helping people escape from the junk food cycle is a moral and financial imperative. And I’ve started to meet people who have found the initial weight loss got them out of a rut, providing a spur to improve both their diet and levels of activity.

These new drugs also seem to have made medics more open to the possibility that patients can both lose weight and keep it off. Doctors, who regularly ask patients if they smoke, are becoming much braver in broaching the sensitive subject of weight. In the UK and US, pioneering clinics are prescribing fresh food as medicine. In Pennsylvania, one health insurer has started a “Fresh Food Farmacy”, which provides 10 healthy meals and 20 hours of cooking workshops to diabetic patients and their families. The programme is designed to break through the challenges faced by those who have little access to good ingredients. The resultant savings on hospital bills improve the bottom line.

The fatalism surrounding obesity has been extraordinary. We were told at one point that it’s genetic — but no epidemic on this scale can be explained by genes. Those who urge tough measures have been accused of “fat shaming”, even though the impact on health is unambiguous and it hits the poor hardest. One in three English children now leaves primary school overweight, and kids in the most deprived parts of the country are more than twice as likely to be obese than in the most privileged areas. And we have been urged to see consumers as saps: I remember being told, when I was working on the sugar tax on drinks in 2015, that people would never go straight from fizzy drinks to water — they would only switch to “diet” alternatives.

Campaigners have refused to accept any of this. I recently visited a London primary school where half the children’s families were poor enough to be entitled to free school meals. We sat down to lunch at a long trestle table where sharing platters of sliced carrots and fruit were laid out enticingly. I watched the kids rush to the serving hatch where a chef from a top restaurant was encouraging them to try just one thing they hadn’t tried before. The only drink was water. The staff ate with the kids, and talked about the little garden where they’re growing herbs. It was one of 190 schools supported by Chefs in Schools, a charity that is changing the culture, helping schools install kitchens, grow food, cook from scratch and teach kids, parents and staff alike.

The ambition is colossal, and it should be spread. Schools, childcare centres, hospitals and other public institutions provide a huge opportunity to improve what we eat. In Denmark, government and business have co-operated on legislation that has boosted to 60 per cent the proportion of publicly procured food that is organic. In Copenhagen, that proportion has now hit 90 per cent, with costs kept down by using more beans and less meat.

Other local action is beginning to take effect: some UK councils are banning fast-food outlets from operating near schools. The consensus paves the way for greater national leadership: on advertising restrictions, and prescribing.

Correcting course now feels possible, in a way it didn’t before the pandemic. As it becomes increasingly obvious that obesity is a drag on economies, a brake on productivity and a dampener of life chances, curbing it will become a competitive advantage. Countries that don’t take serious action to reduce the weight of their populations will soon be presiding over societies in which the poor continue to be at the mercy of the junk food cycle, while the rich pay a fortune to escape it. We will turn the corner.

camilla.cavendish@ft.com