You will not be surprised to know that I spend almost no time on so-called social media. They must have some utility since so many people are said to live a large part of their lives on or in them, but I find there is more than enough information for my mind to cope with in old-fashioned things like newspapers, television and the wireless (and a strictly limited number of their offerings). But that limited source seems to provide me with plenty of food for thought. Talking of food, this week the word 'fat' struck me as an interesting subject.
Those three letter words so often turn out to be rather venerable and fat has its origins as a noun in Old English and similar northern European tongues, applied to the part of animals which must have been perceived as most nourishing. From there it came to be used as an adjective to describe the appearance of a well-fed animal, including us. Of course, it could be used as a derogatory term though there have been times and societies in which it seems to have been looked on favourably.
My poor mother gave up her rations during the war to ensure that I was well nourished, to the extent that at the age of four in comparison to my friends I was sufficiently well-covered to be called 'fatty' for a time. The term my mother used was puppy-fat, and I lost it when I went to school and spent my days running around. However, keeping weight under control has been a life-long struggle, a battle between greed for tasty food and vanity, two unworthy sentiments that lurk within me and, I suspect, many other people.
Fat came to my attention last week in two different circumstances. The first was seeing footage of striking pickets and interviews of their trade union representatives on the television, and the shocking obesity of so many. Even though my early reading as a child included books about Billy Bunter, the Owl of the Remove, and laughing at them, I know that it is unkind to tell people that they are fat and to make fun of them on that account.
On the other hand, over decades as a doctor it was my responsibility to explain to patients the harmful consequences of obesity and how to manage the condition. Difficult, as these patients never came to see me because they were overweight – rather the condition that brought them to me was caused or exacerbated by their obesity. This experience tells me that people are rarely happy to be fat and almost all wish to be thinner.
The second circumstance was reading accounts of the bowdlerizing of the children's novels of Roald Dahl, and the arguments around changing an author's work to avoid giving offence to or upsetting readers. As a writer, I often ask other people to read my pieces before I submit them, so know they can always be improved, but I would rather resent someone changing them without my consent. Dahl is not in a position to complain (I'm sure he would have!), so I suspect commercial interests are overcoming any scruples among the holders of his copyright.
I believe publishers employ sensitivity readers, a type of sub-editor, who will check manuscripts out and ferret for words that may rustle feathers; I wonder what their qualifications are. Sensitivity is a feeling that is very variable and hard to quantify. I assume they would claim to know what children or other people think, as Thomas Bowdler did with respect to protecting Christian sensitivities at the end of the 18th century. No point raging: it is a sign of our times, but we must not forget that though much writing is intended to provoke emotions, these emotions can sometimes be harmful.
Fat, and by that I mean the chemical material in plants and animals of that name, is essential to our well-being. It contains several vitamins, A, D, E and K, that are essential to life and it provides over twice the calories per gram than does the same amount of protein or carbohydrate. You can understand why we instinctively find it tasty and why evolution led animals to lay it down to see us through periods of shortage in winter. Unfortunately, humans in the prosperous world retain this habit during periods of plenty. Some of us are genetically more efficient at absorbing and storing it and some at using it, but there are important environmental factors that can modify these genetic influences. You will know what they are: exercise levels, dietary habits, certain illnesses and some drugs.
I commented above on the 'shocking' obesity of some people I saw on television, some of whom were apparently NHS employees. Perhaps 'shock' overstates my reaction since I was far from surprised. My shock relates to the understanding that these are people who above all should be aware from daily experience of the adverse health effects of obesity. Many would take the comforting view that their body shape is simply genetic and indeed it is common experience that we tend to look like our parents. But when I qualified in medicine in the 1950s, I recall that fewer than 1% of my fellow students and almost no nurse was overweight. This is not my experience from visits to hospital over recent decades. Unfortunately, we are bound to give advice to our patients and it is difficult to give advice on diet if we are overweight ourselves – our patients rather may feel reassured that it's not so bad if their doctor is also fat. As WH Auden said:
Give me a doctor partridge-plump
Short in the leg and broad in the rump
An endomorph with gentle hands
Who'll never make absurd demands
That I abandon all my vices
Nor pull a long face in a crisis,
But with a twinkle in his eye
Will tell me that I have to die.
Well, fair enough when faced with mortal illness. As we get older and perhaps wiser, we can make our own risk assessments and act accordingly. But when we fall ill we do need someone to help us and better if that person can give convincing and evidence-based advice.
Obesity in the young is probably the greatest current public health problem in the West, but increasingly so in parts of Africa and India among the wealthy. In the West, paradoxically, it is inversely related to social circumstances, the poorest and most deprived being most at risk. Once established, it is hard to overcome, and it leads to diabetes, coronary heart disease and clogging of arteries. It is thus strongly associated with early mortality and poor recovery from a multitude of serious diseases, as for example Covid-19. Most importantly, it is preventable – there are no obese immigrants on those boats in the English Channel.
Being fat is not a matter for shame nor is it an excuse for demonisation or cruel humour, but it is a condition to which many of us are prone and which puts a huge burden on the NHS. Our experience of the war in Ukraine and the looming climate crisis should incentivise us to deal with it seriously; these times provide an opportunity for new government leaders to get to grips with reality for a change, and start nudging us into a sustainable lifestyle, as I hope to discuss in my next article.
Anthony Seaton is Emeritus Professor of Environmental and Occupational Medicine at Aberdeen University and Senior Consultant to the Edinburgh Institute of Occupational Medicine. The views expressed are his own