Time for a hard look at a ‘soft disaster’

As the health select committee enquiry into obesity draws to a close, each of us must decide how we will contribute a healthier future, says Kath Dalmeny

Imagine for a moment that diet-related diseases like diabetes, coronary heart disease and cancers of the digestive system carried people off in days rather than decades. Like an outbreak of E.coli food poisoning, the path from diagnosis to serious illness or death would take just a few days.

If diabetes took effect as quickly as E.coli, a national emergency would have been announced at the first cases of morbid obesity and type II diabetes turning up in children and teenagers. Teams of epidemiologists and risk analysts would have been helicoptered to the scene. A respected lord or retired judge would have been appointed to undertake a major enquiry, making pronouncements daily in the national media. We would now be well on the way to removing the most serious risk factors that have caused so many of our children to develop the first signs of diseases that were once associated with middle age.

But precisely because diet-related diseases take many years to develop, through a cumulative process of poor diet and unhealthy lifestyles, we seem to have no sense of urgency, and little impetus to take action. We issue some public education leaflets, talk to industry about whether they might consider reducing salt in processed food, and add a few free apples to children’s lunchboxes. Yet the effects of our relative inaction are creeping up on us inexorably and are accumulating into problems of a proportion that dwarfs the localised (although unarguably serious) effect of an outbreak of E.coli food poisoning.

Slow-to-develop problems like obesity and type II diabetes are sometimes dubbed ‘soft disasters’. They do not arrive suddenly in our awareness but emerge slowly, year-on-year. We get used to the problem being around. We don’t see how it is has grown. Only when we travel to America do we understand what our fellow citizens can expect – perhaps within the next decade.

Obesity and diabetes are like global warming. Each individual calorie cannot be held responsible for weight gain; each individual car cannot be held responsible for climate change. But collectively, the calories and car emissions produce outcomes that affect us all.

Prompted by the chief medical officer’s description of obesity as a ‘ticking time bomb’ – a description echoed recently by the chair of the Food Standards Agency, Sir John Krebs – we would do well to study how we treat ‘sharp disasters’ like E.coli for lessons on how to tackle ‘soft disasters’ like diabetes and obesity.

When the helicopters arrive at the scene of an E.coli outbreak, the investigators set about examining the whole food chain. They talk to the caterer, and the butcher’s shop that supplied the suspect meat. And when the source of infection is identified, the inspectors are likely to work back along the whole food chain to the farm, the wholesaler, the abbattoir, the lorry drivers and waste disposal companies. They will speak to environmental health officers, meat inspectors, local authority officials and training staff. They draw up changes to procedures and regulations, so that poisoned meat cannot end up on people’s plates.

If we extend our analogy to childhood obesity and type II diabetes, our inspectors would be asking how excess calories, sugar and fat had found their way into children’s diets, and why physical activity had become a difficult choice for children. They would talk to parents, caterers and the shops that sold the suspect foods. And then they would work back along the food chain to the farm, the wholesaler, the vending machine operator, the school caterer. They would interview teachers, dentists, food manufacturers, and advertising agencies. They would speak to developers and planning departments to discover how towns could have ended up without safe play spaces and safe walking routes to school, and why so many of those routes are lined with fast food outlets.

But now we do have inspectors. Over the past few months a House of Commons health select committee enquiry into obesity has gathered evidence from health professionals, physical activity specialists, consumer groups, government officials, academics, supermarkets and the food and advertising industries.

And rightly so. The broad range of people who gave evidence reflects the broad range of people who must now share responsibility for improving people’s diets and lifestyles. The enquiry is taking a ‘whole food chain’ approach to tackling the problems and is one of the first signs that we have begun to wrestle with this particular soft disaster. We can look to government for a strong lead, but the responsibility for action lies with all of us. Whatever our expertise, we must all work out how we will contribute to a healthier future for our children.