Tuesday, 27 July 2010

Getting people healthy - the carrot or the stick?

Many years ago, a guy I'd been dating for a couple of weeks called me up feeling really down and after much cajoling eventually told me he felt he was getting fat and it was making him miserable. Ever the one to try and be helpful, I told him that as I had to get up every morning at about 7am to do an hour-long medical regime, why didn't I give him a daily wake-up call so he could go for an hour's run every morning and he'd soon lose the weight?

That was the last phone call we ever had together. It turns out tough love wasn't what he was looking for.

So this week the nation read with horror about the country's fattest woman eating herself to death. It was so vaudeville grotesque that it embedded itself in the nation's consciousness.  A woman so desperate for cake she died for it?

The woman in question had had a stomach staple operation but still couldn't quit eating fatty food, persuading relatives to smuggle in fish and chips to her hospital bed. So how should society persuade people to take charge of their own health?

A previous blog said that perhaps we're all relying too much on medicine as a quick fix, hoping it will get us better instead of investing in a time-consuming lifestyle change. This is more evident than most with diet habits. Stomach stapling, crash diets, slimming pills are vastly popular despite it being pretty well known across society that to lose weight you need to eat less and exercise more. But my phone call with my ex shows that people just don't want to hear that.

Despite loads of CF mothers complaining that their teenagers are rebelling against doing their meds, I never did. It never crossed my mind. So what made me do two hours of medicine a day without complaining? Well, my parents didn't set it out like it was something I could choose. I go to school, I do my meds, I hang out with my brother. Like everything else, it was just something I did.

Plus in exchange for taking responsibility for my medicine I got to go out and enjoy the fruits of my labour - I got to party (within reason) at house parties, pubs and clubs. So some carrot and some stick. And an understanding that if I wanted to feel healthy I had to put in some work to achieve it.

Some boroughs suggest paying people to lose weight but I'm totally against it. If someone can't envisage the improvement feeling healthier would do to their lives then I can't imagine that just paying someone £10 a week will persuade them to make a permanent life-change to keep the weight off.

But should society go further? Deny operations to those that haven't committed to losing weight, quitting smoking or stopping drinking? So that when money is spent, it makes a difference? The NHS is clearly strapped for cash so perhaps tough love is one way to solve the problem - but will the nation be prepared to listen?


  1. I think society is focused on the wrong issue -- if you actually dig through the research it isn't weight issues causing bad health. People can be "overweight" (by our random BMI standards) but still healthy, if they exercise and eat a variety of healthy food. People come in all shapes and sizes, and most of us have a natural "set point" weight that we can't deviate much from. And thin doesn't necessarily equate to healthy. This is a really controversial view, however, and I know people are always skeptical when I talk about it. But there are two great books out there that I highly recommend to anyone interested in the issue: Rethinking Thin by Gina Kolata and The Diet Myth by Paul Campos. They have really made me rethink the way that I view weight and body size.

  2. I think the crux of the matter is that to be healthy a person needs to take responsibility for their health... there isn't a pill that can cure a lack of motivation. I'll look those books up - they sound really interesting!