A lot of people are getting a lot fatter than is good for their health. If you want to know why, Robyn Toomath’s new book Fat Science is a fine place to look. Toomath is an endocrinologist with decades of treating the effects of obesity, notably Type 2 Diabetes; she was also a co-founder of the pressure group Fight the Obesity Epidemic. The first part of the book is home ground for her; the physiology of obesity and the staggering – to the layperson – ineffectiveness of diets, exercise, and drugs in undoing the years of overconsumption. The rest of the book tries to explain why people have got so much fatter in the last forty years or so and what should be done about it.
People have not become fatter because their genes have changed. They have become fatter because of the environment – the obesogenic environment, as Toomath would have it. The rich world, and increasingly the not-so-rich world, have too much food and the wrong type; it is full of fat, sugar, and salt; it is amazingly cheap; it is marketed to children as well as adults; and it is everywhere.
Giant food firms make a fortune from selling this food and, Toomath thinks, they don’t really want to stop. We cannot rely on them to reverse the obesity epidemic. Governments don’t like to regulate and plump for ineffective policies such as encouraging walking school buses. Nor is there much point in nagging individuals to change their ways. Toomath’s answer is to change the environment by making the junk food and drink harder to get and more expensive, by restricting advertising, and by `food sovereignty’, that is reclaiming control over the food system from the free market.
Would the tax and regulation policies reduce obesity? Maybe. Might be worth a try. That’s all one can actually conclude from the chapter on how governments can `flick the switch’. Toomath cites some modelling and extrapolates from tobacco control; it’s all less than decisive, although as she points out, it is unreasonable to demand decisive evidence before intervening in obesity.
Much more shaky is Toomath’s mysterious attachment to food sovereignty, which seems to be a goulash of unrelated ideas: dislike of multinational corporations, favouring small producers and traditional foods, opposing land grabs in poor countries, and wanting governments to have the power to regulate markets in food and drink. Whether or not food sovereignty is a coherent ideal, Toomath doesn’t really say what it’s got to do with obesity. She complains that rich countries waste a mass of food but it seems odd for an anti-obesity campaigner to prefer it to be eaten. Traditional food in my home country, England, has its charms but it isn’t as healthy as untraditional quinoa. Toomath isn’t keen on New Zealand’s dairy exports but why is it a food sovereignty problem to have a rich country making milk to sell in poorer countries? The US and EU have more food sovereignty than New Zealand but they have used their powers to encourage overproduction of unhealthy food. In short, more food sovereignty might mean more obesity. What, then, was Toomath thinking of? Probably this: without food sovereignty, governments would not have the power to regulate unhealthy imports. But it isn’t really the power that Toomath wants for governments. It is the exercise of power in a particular way. The sovereignty is just a means to that end.
Suppose Toomath’s policies would reduce obesity. That doesn’t mean they are justified. Would taxing junk food, regulating portion size, restricting density of fast food outlets, or controlling marketing make people better off? Would it wrongly interfere with their choices?
Toomath argues that when people become overweight or obese, it is not because they have made free and rational choices. The food producers find all sorts of ways to sell consumers the stuff they produce. Children are big consumers, and they don’t make rational choices. Most dramatically, all free choice is a myth because science supposedly tells us that our choices are just responses to biological urges (p.155).
Toomath’s critique of the rational consumer is a curate’s egg. The part that is excellent is about children; no rational honest person could seriously suggest that they would tend to make respectable food choices on their own. On the other hand, her half sentence announcing the biological end of free will is better passed over.
Somewhere in the middle are the adults. Toomath criticises free market ideologues who say that supply simply satisfies pre-existing demand. Look at corn, she says: farmers grew vast amounts of corn and only then figured out how they would sell it. But free-marketeers don’t really have to say that supply must meet pre-existing demand. If you can think of a new clever use for something that I had never thought of, nothing need be dubious about my decision to buy it. Who twenty years ago would have thought to want apps comparing the prices of insurance?
More importantly, what about the policies that try to make unhealthy food and drink less attractive by making it more expensive and harder to get? Don’t they just make people worse off, especially people without much money? Toomath tells us what of course we all know: fast food is cheap, convenient and, to many people, pretty tasty. These are reasons to eat fast food and they are to be weighed against the health disadvantages. Toomath cites mutton flaps, wildly unhealthy food exported from New Zealand to Tonga. For her, it is an example of the bad effects of free trade; Tongans eat them because they are cheap (p.103). But why isn’t that the point? Tongans don’t have as much money as New Zealanders so why think they are making a mistake when they buy mutton flaps? If you took away one of the limited options they have, how would that make them better off?
I don’t think obesity is always the outcome of free rational choice. People wouldn’t try to diet as much as they do if they weren’t ambivalent about their food choices. But policies could still reduce obesity and make many people overall worse off. After all, there are worse things than being fat. Surprisingly, Toomath agrees. She says, `If you eat nutritious food, do as much exercise as you can, don’t smoke and treat the complications of obesity you will maintain good health’ (p.41). Would Toomath’s preferred anti-obesity policies do more good than harm? After reading Fat Science, I still don’t know.
Martin Wilkinson is associate professor in Politics and International Relations at the University of Auckland