Obesity. Why Boris Johnson has got it wrong.

A brief off-the-cuff analysis

Boris Johnson on obesity

What CNN said

“Boris Johnson’s latest strategy to fight coronavirus aims to make Britain healthier”.

“Johnson’s government launched its Better Health strategy in an effort to combat the country’s high obesity levels amid the pandemic.”

What Johnson said

On 11 August, he posted a video of himself on Twitter.

“I was too fat.” 

“I’ve always wanted to lose weight for ages and ages”

“And like […] many people, I struggle with my weight.”

“If you can get your weight down a bit […] and protect your health, you’ll also be protecting the NHS”.

“We want […] to understand the difficulties that people face (with their weight).”

Why Johnson said that

COVID-19 attacks people who are in less than optimal health more fiercely. This includes obesity, but obesity is more complicated than carrying excess baggage. It is also about existing health disparities in society, disparities that became exacerbated by the first wave. That means that it is about poverty and air pollution, about racial discrimination and marginalisation, too, so it is about the whopping level of inequality Johnson’s country suffers from. 

With the second wave of COVID-19 likely ahead of us and many people having gained weight during the lockdown, Johnson is keen on raising his finger and tell the subjects what they must do to protect the NHS, the NHS about which so many people are worried that he will sell it off to the highest corporate bidder with no concern for the people who work there and the people who receive care there.

Food availability forgotten

Abundance

People like Boris Johnson live in abundance. They can order any kind of food in and they will get it, avocados and all. The rest of us, well, we aren’t all so lucky.

The lockdown

The stockpiling caught many people by surprise. Has Johnson seen the disappointment and quiet desperation on the faces of the people who wanted a tin of tuna or two or some sardines and found that they were all gone? So was all the salmon in the coolers.

Has he any idea how many people were eating lots of rice and tortilla chips and pasta and cheap cookies during the first weeks of the lockdown because they had no choice? They can’t build up food supplies at home. They had to cope.

Food deserts and poverty

There are areas in which predominantly poor people live. They have fewer options for food-shopping and the food in such food deserts tends to be more expensive. Because people have no choice, the supermarkets know that they’ll buy it anyway.

Has Johnson any idea how many people consume lots of rice and pasta and bread and cheap cookies and instant potato mash all the time because they have to?

It is often said that poor people do not have pots and pans or poor people don’t know how to cook. Poor people can have all the pots and pans in the world and may be former chefs but it will not help them if they do not have access to good food.

They get tins from food banks, too. Tinned sugared peaches, tinned sugared rice puddings and custard, instant noodles, cheap rice, tinned tomatoes, baked white beans in tomato sauce, tinned sausages or spam (or tuna), tinned spaghetti, orange juice, some cookies or chocolates. No leeks, no cheese, no salmon, no broccoli, no mackerel and no apples or grapes. No nuts. No avocados or pizzas or lasagnes or sushi or quesadillas. No vitamin and mineral supplements to make up for any deficiencies.

Corporate greed forgotten

The need for proteins

We all need a certain amount of protein in our daily food. This is not a weakness of poor people, but it is human biology. How much protein you need depends on your age and on whether you are for example pregnant.

Rich versus poor

Rich people’s diets can be a little too rich in proteins. It is a different story for poor people. Good protein sources tend to be more expensive foods.

The protein leverage hypothesis

It says that humans will keep eating, eating and eating to reach that minimum percentage of protein that they must have in their food. This theory was developed by David Raubenheimer and Stephen Simpson at the Charles Perkins Centre of the University of Sydney, Australia.

Corporate greed

If the human leverage hypothesis holds up — and as it makes sense, it likely does – this human requirement for sufficient protein and the urge to keep eating to obtain it creates great opportunities for greedy food manufacturers.

But Johnson did not mention the food industry. He wags his finger at the people and tells them that they are hurting the NHS. His government’s proposals to curb the food industry only appear to concern advertising and may well remain mere proposals.

UK government failing its people

When does Johnson start pointing the finger at the people who cause poverty and malnutrition instead? Obesity is often essentially a form of malnutrition and as Philip Alston has said, poverty is a political choice. Philip Alston was the UN Special Rapporteur on extreme poverty who found the UK government unresponsive and in denial in 2019 when he told it what it was doing to millions and millions of Brits. The UK government shut its ears for Alston’s words and diverted its eyes.

Pollution effects and other health disparities

Air pollution

COVID-19 also disproportionately affects people who live in areas with high levels of air pollution. That — living with pollution — also tends to go hand in hand with poverty. Has Boris Johnson ever said a word about that so far? Not to my knowledge.

Discrimination

Health disparities that seem to affect people of certain ethnicities and with tinted skins more are, to a large degree, the effect of their discrimination and marginalisation.

Discrimination causes stress. Prolonged negative stress can affect health, including lowering one’s immune response. The chronic stress of racism can lead to chronic inflammation.

Discrimination, marginalisation and poverty also affect access to health care. Did you know that physicians are less likely to refer black people for testing, for example?

You do not need to have hate or even dislike in a society before groups of people become disadvantaged and marginalised. All you need is to have separate groups of people and a power imbalance from the beginning.

The groups that hold most of the power will prosper more and more while the people in the other groups have the low-paying, front-facing jobs in which they are at the highest risk for diseases like COVID-19. They are the ones whose bosses tell them to come to work even when they are ill. They live in the areas with the highest pollution, the dusty and mouldy homes with sometimes a lot of noise disrupting their sleep, the food deserts with the expensive supermarkets. They are also the ones who face the longest waiting lists to get medical care.

And they are the ones whose landlords may change the locks on their doors because of the high-risk jobs they have and the fear that they may bring COVID-19 home with them.

Investing in women and learning to listen

Who prepares food and who shops?

Often, it is still the woman in the household. It’s also women who hold the lowest-paying jobs. Investing in women and in eradicating gender inequality — in addition to working to eradicate racial and other inequalities — therefore should also help diminish health disparities.

Cooperation needed

The fact alone that Britain expected to have to stockpile foods and medications in view of Brexit is a strong indication that the UK government needs to learn how to cooperate better with others as well as organise itself better. That requires listening to people, also to those with dissident opinions, instead of conveniently dismissing them as an excuse to carry on business as usual.

To sum it up

Boris Johnson appears to be unaware of the social determinants of health and the health disparities that existed before COVID-19 came along. Whether people are poor, disabled, elderly, migrants or non-whites affects the chance that they are in optimal health and obesity can be part of that. The extra weight of people like Boris Johnson is a different story.

Further reading

Bouie, Jamelle. 2020. Why Coronavirus Is Killing African-Americans More Than Others. Higher rates of infection and death among minorities demonstrate the racial character of inequality in America. New York Times.
https://www.nytimes.com/2020/04/14/opinion/sunday/coronavirus-racism-african-americans.html

Kumar S, Quinn SC, Kim KH, Daniel LH, Freimuth VS. 2012. The impact of workplace policies and other social factors on self-reported influenza-like illness incidence during the 2009 H1N1 pandemic. Am J Public Health 2012;102(1):134-140. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490553/

Quinn SC, Kumar S, Freimuth VS, Musa D, Casteneda-Angarita N, Kidwell K. 2011. Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic. Am J Public Health. 2011;101(2):285-293. doi:10.2105/AJPH.2009.188029. https://pubmed.ncbi.nlm.nih.gov/21164098/

Villarosa, Linda. 2020. ‘A terrible price’: The deadly racial disparities of Covid-19 in America. New York Times Magazine. https://www.nytimes.com/2020/04/29/magazine/racial-disparities-covid-19.html

There is also ample literature on the health effects of pollution, the association between poverty and health as well as between poverty and pollution and on the lack of attention for the good health of older adults. That race is a social construct and that racial disparities generally have more to do with discrimination and marginalisation than with genetics both appear much less well known. In itself, it tells the story of all disadvantaged groups of people, including for example the elderly, the poor and the disabled in the UK. The health disparities of these groups should not be seen as separate, just like pay differences for men and women and gender roles also have to be addressed if we want to make the world a healthier place for everyone.

You can watch the video by Boris Johnson here:
https://www.youtube.com/watch?v=EtwFoTzVdZs

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