Up a rickety staircase at the Newarke Houses Museum in Leicester, England, hangs a portrait of Britain’s first obese man, painted in 1806. Daniel Lambert weighed 335kg and was considered a medical oddity.
Too heavy to work, Lambert came up with an ingenious idea: he would charge people a shilling to see him. Lambert made a fortune and his portrait shows him at the end of his life: affluent and respected – a celebrated son of Leicester.
Two hundred years on, I am in a bariatric ambulance (an alternative term for obese, favoured by doctors because it is less embarrassing for patients) investigating why the United Kingdom is in the midst of an obesity crisis. The crew pick up a dozen Daniel Lamberts every week – 335kg is nothing special; it is at the lower end of the weight spectrum, with only the 508kg patients worthy of mention when a shift finishes.
As well as the ambulance, there is a convoy of support vehicles including a winch to lift patients on to a reinforced stretcher. In extreme cases, the cost of removing a patient to hospital can be up to £100 000.
But these people are not where the heartland of the obesity crisis lies. On average, in the UK, we are all 19kg heavier than we were in the mid-1960s. We have not noticed it happening, but this glacial shift has been mapped by bigger car seats, swimming cubicles, XL trousers dropped to L (L dropped to M). We are an elasticated nation with an ever-expanding sense of normality.
Greedier as a race
Why are we so fat? We have not become greedier as a race. We are not, contrary to popular wisdom, less active – a 12-year study, which began in 2000 at Plymouth Hospital, measured children’s physical activity and found it the same as 50 years ago. But something has changed: and that something is very simple. It is the food we eat. More specifically, the sheer amount of sugar in that food, sugar we are often unaware of.
The story begins in 1971. Richard Nixon was facing re-election in the United States. The Vietnam war was threatening his popularity at home, but just as big an issue with voters was the soaring cost of food. If Nixon was to survive, he needed food prices to go down, and that required getting a very powerful lobby on board – the farmers. Nixon appointed Earl Butz, an academic from the farming heartland of Indiana, to broker a compromise. Butz, an agriculture expert, had a radical plan that would transform the food we eat and, in doing so, the shape of the human race.
Butz pushed farmers into a new industrial scale of production and into farming one crop in particular: corn (maize). Cattle were fattened by the immense increases in corn production. Burgers became bigger. French fries, fried in corn oil, became fattier. Corn became the engine for the massive surge in the quantities of cheaper food being supplied to US supermarkets: everything from cereals to biscuits and flour found new uses for corn. As a result of Butz’s free-market reforms, US farmers, almost overnight, went from being parochial smallholders to multimillionaire businessmen with a global market.
By the mid-1970s, a surplus of corn led to the development of high- fructose corn syrup, a highly sweet, gloppy syrup that was also incredibly cheap. It had been discovered in the 1950s, but it was only in the 1970s that a process had been found to harness it for mass production.
High-fructose corn syrup was soon pumped into every conceivable food: pizzas, coleslaw, meat. A silent revolution of the amount of sugar that was going into our bodies was taking place and the general public was clueless that these changes were taking place.
By the mid-1980s, health experts such as Professor Philip James, a world-renowned British scientist who was one of the first to identify obesity as an issue, were noticing that people were getting fatter and no one could explain why. The food industry was keen to point out that individuals must be responsible for their own calorie consumption, but even those who exercised and ate low-fat products were gaining weight.
Moreover, there was something else going on. The more sugar we ate, the more we wanted and the hungrier we became. At New York University, Professor Anthony Sclafani, a nutritionist studying appetite and weight gain, noticed something strange about his lab rats. When they ate rat food, they put on weight normally. But when they ate processed food from a supermarket, they ballooned in a matter of days. Their appetite for sugary foods was insatiable: they just carried on eating.
Professor Jean-Marc Schwarz of San Francisco Hospital, who is studying the precise way in which the major organs of the body metabolise sugar, says the effect sugar has on different organs in the body is only now being understood by scientists.
The organ of most interest, however, is the gut. According to Schwarz and Sclafani, the gut is a highly complex nervous system. It is the body’s “second brain”, and this second brain becomes conditioned to wanting more sugar, sending messages back to the brain that are impossible to fight.
David Kessler, the former head of the US government’s most powerful food agency, the Food and Drug Administration, and the person responsible for introducing warnings on cigarette packets in the early 1990s, believes that sugar, through its metabolisation by the gut and hence the brain, is extremely addictive, just like cigarettes or alcohol. He believes that sugar is hedonic – eating it is “highly pleasurable. It gives you this momentary bliss. When you are eating food that is highly hedonic, it sort of takes over your brain.”
In London, Dr Tony Goldstone is mapping out the specific parts of the brain that are stimulated by this process. According to Goldstone, one of the by-products of obesity is that a hormone called leptin ceases to work properly. Normally, leptin is produced by the body to tell you when you are full. However, in obese people, it becomes severely depleted, and it is thought that a high intake of sugar is a key reason. When the leptin does not work, your body simply does not realise you should stop eating.
Leptin raises a big question: Did the food industry knowingly create foods that were addictive, that would make you feel as though you were never satisfied and always wanted more? Kessler is cautious in his response: “Did they understand the neuroscience? No. But they learned experientially what worked.” This is highly controversial. If it could be proved that at some point the food industry became aware of the long-term detrimental effects their products were having on the public, and continued to develop and sell them, the scandal would rival that of what happened in the tobacco industry.
The food industry’s defence has always been that the science does not prove its culpability. Susan Neely, president of the American Beverage Association, a lobby group for the soft-drinks industry, says: “There’s a lot of work to try to establish causality, and I don’t know that I’ve seen any study that does that.”
But it looks as though things might be changing. According to Professor Kelly Brownell at Yale University, one of the world’s foremost experts on obesity and its causes, the science will soon be irrefutable and we may then be just a few years away from the first successful lawsuit.
Legislation against the food industry
The relationship between government and the food industry is far from straightforward and the relationships are not always kept at arm’s length. Professor James was part of a World Health Organisation committee to recommend global limits on sugar in 1990.
As the report was being drafted, the US secretary of state for health, Tommy Thompson, flew to Geneva to lobby on behalf of the sugar industry. “Those recommendations were never made,” says James.
Anne Milton, the minister for public health in the UK, says that legislation against the food industry is not being ruled out, because of the escalating costs to the National Health Service. Previous governments have always taken the route of partnership. Why? Because the food industry provides hundreds of thousands of jobs and billions in revenue. It is immensely powerful. “Let’s get one thing straight,” Milton tells me, however, “I am not scared of the food industry.”
And I believe her, because now there is something far bigger to be frightened of. Eventually, the point will be reached when the cost to the health service of obesity, which is now £5-billion a year, outweighs the revenue from the UK snacks and confectionery market, which is about £8-billion a year. Then the solution to obesity will become very simple. – © Guardian News & Media 2012