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Sunday, 28 July 2013

Blurred lines..

I today read with great mirth the story of a New Zealand man who has been informed that he is too fat to be allowed to stay in the country. The gentleman in question is a South African chef whose 20 stones and 6 pounds is deemed by the authorities to be an "unacceptable standard of health". Despite having lost more than 30 kg since arriving 6 years ago, he and his wife now face expulsion from the country because the authorities are threatening to refuse renewal of their visas. There's something about chefs but that is a discussion for another day.

Quite how they define overweight is not clear but apparently 30% of the New Zealand population is overweight. Citing his increased risk of developing diabetes, high blood pressure and heart disease, the authorities claim he presents an unacceptably high potential burden on their health service. Reasonable.

I find the story amusing because I can't imagine the EU being overly happy about our government seeking to follow suit. Racism and sexism have both been roundly dealt with over the years but fattism (it warrants two teas if you'll forgive the pun) has hitherto been granted a wide berth (bugger, I've done it again). Such is the extent to which we pay lip service to Brussels. It is also amusing on account of the obvious double standards with the implication being that it is ok to be overweight provided you're not an immigrant - legal or otherwise. I question legality because it has come to light that British estimates of immigration figures are just that. Estimates - and not particularly scientific ones at that. The fact is, nobody knows - and to finish a favourite saying in our house - and nobody cares.

Of course the way in which we now label people as being overweight is highly contentious anyway. Body mass index is merely a ratio of weight to height. It takes no account of the ratio of fat (fat) or protein (muscle). I don't think it would be accurate to label your typical British Lion rugby player as being overweight. Or, to put it another way, I don't think I'd like to be the one to tell him.

Of course, there is a serious point here. It seems as though ours isn't the only health service with finite funding. The difference seems to be in their approach. It is a brave move but at least it seeks to provide more clarity to the boundary lines. The awful sales jargon dictates that you can't manage it if you can't measure it. In English, this just means that you have to draw a line in the sand so that people know where they stand.

The New Zealand rate of 30% needs comparison. Only Tamworth in Staffordshire boasts a higher figure (30.7%). There is almost a badge of honour in being labelled Britain's fattest town and I can't get the "Tales of Tamworth Pig" out of my head - perhaps I just read too much for my own good in my dim and distant. The British average is a very respectable 23.1% so by comparison with our Antipodean cousins we are positively starved over here - well perhaps that's overstating things somewhat.

When it comes to the global hierarchy of obesity though, the New Zealanders have, like Thursday's child, far to go. Predictably, the United States boast a figure of 35.7% of adults at the latest count. That is particularly sobering when you consider that their percentage was just 13% in 1962. That represents a lot of food consumption in 50 years.

Amazingly though, even the United States don't hold the crown. That belongs to the country immediately to their south. Mexico is the real deal. A diet rich in soft drinks laden with sugar is responsible for this feat. It results in an estimated 70,000 per year dying from the effects of diabetes.

The problem is really an ethical one in the end. Has any government the right to dictate how big or small we are allowed to be? In one sense they can. Let me explain. If you advertise a service as being free at the point of contact, you are surely entitled to attach conditions provided you don't happen to be a charity of course. Given the recent admission by the current NHS chief executive that the NHS budget is likely to be over £30 billion in the red by 2020, it is clear some tough decisions will need to be made. The real challenge is: Who is going to step up to the plate and make them. Let's face it, it won't exactly be a vote winner. Its the sort of policy you want in the smallest font available tucked away at the foot of page 691 in your manifesto.

While last week was dominated by the did he or didn't he get lobbied by the tobacco industry relating to David Cameron, I'm quite sure the soft drink industry is lobbying them like mad. Judging by their ubiquitous presence in the vending machines which occupy our hospitals, they appear to be doing a good job of it too. Anyway, I must sign off because, you guessed it, dinner beckons - fresh vegetables from the garden, naturally!