Shock and awe campaign fails to measure up

 

HAVE YOU picked up your free measuring tape from your local pharmacy yet? Safefood, an all-island food safety body, has distributed some 250,000 measuring tapes to pharmacies as part of a campaign to encourage people to measure their girth to see if they are overweight. Radio and TV advertisements have been rolled out to drive the message home.

Sounds reasonable so far? But take a minute to click on YouTube and look at the campaign video. Prepare for the apocalyptic music before the narrator tells us in a doom-laden voice: “We are all in the grip of an epidemic.” It is also claimed that Irish people “are rapidly passing it on to others”.

And the following appears in the literature accompanying the campaign: “Two in three people on the island of Ireland are carrying excess weight, yet only 38 per cent recognise they have a weight problem. That means a great proportion of the population are in denial, (my italics) putting themselves at increased risk of well-known diseases such as heart disease, diabetes and some cancers. This campaign issues a wake-up call, asking people to take a hard look at themselves, to find out their own waist measurement, and to ‘stop the spread’.”

So, the 66 per cent of us with a waist size greater than 32 inches (women) and 37 inches (men) are in denial and are rapidly passing on our weight issues to those around us. (Full disclosure: I am one of those who has failed to “stop the spread”, having struggled with my weight for about 10 years now.)

Welcome to 21st century public health promotion. It appears many long-accepted principles of good medicine have been sacrificed to the “shock and awe tactics” of a military campaign. It’s now time to root out the greedy insurgents who spend their days scoffing cream buns and refusing to exercise. And if they don’t change their ways, there is the unspoken threat of another campaign with the whiff of penalties, sanctions or perhaps worse to follow.

All of which would be bad enough if it could be scientifically proven that all cases of obesity were due to personal selfishness and laziness. But it is an undeniable fact that a substantial minority of overweight people can point to other factors that contribute to their extra weight.

Thousands of people in Ireland are prescribed beta blocker drugs to prevent them having a heart attack or stroke. But beta blockers are known to slow down the body’s metabolism and can make it difficult to lose weight. Thousands more take anti-depressants and other psychoactive drugs which as a side effect add to a person’s weight.

What about the many Irish people with either undiagnosed or poorly treated thyroid disease? An underactive thyroid indisputably causes weight gain as do other hormonal imbalances. Then there are genetic factors: a recent paper in Nature Genetics claims to have identified a gene that contains a “master switch” that causes weight gain.

According to one of the researchers from Oxford University, the KLF14 gene “seems to act as a master switch controlling processes that connect changes in the behaviour of subcutaneous fat to disturbances in muscle and liver that contribute to diabetes and other conditions”.

Meanwhile, separate research shows a rapid increase in global “fat stigmatisation”. According to the lead author, this is because public health campaigns are sometimes perceived as being critical of individuals rather than the environmental and social factors that lead to weight gain.

Well, the Safefood campaign certainly fits this model. It is built around negative moral messages. It seeks to induce guilt by playing on the supposed denial of Irish people. It wrongly equates weight problems with infectious disease by the gratuitous use of the word epidemic. It is crude, insensitive and stigmatising.

But most worrying of all, it opens the door to a type of dangerous thinking that is but a step away from the denial of medical care to a vulnerable group of people. There can be no place for this odious form of health enforcement in Ireland.