Monday 13 March 2023

Obesity and personal responsibility

Last week the weight loss drug semaglutide was authorised for prescription from the NHS. It can reduce body weight by around 15 per cent and has been used successfully by various celebrities in the USA. It's not cheap, costly perhaps £1,000 a month but eventually it will be off-patent and could play a significant role in tackling obesity. There is a detailed article about it on Works in Progress.

Meanwhile, in the Observer, Martha Gill makes a good point...

Nesta, the UK’s “innovation agency for social good”, spends a third of its considerable budget on tackling obesity, but treats the jab with suspicion, even though it can cause weight loss of 15%. The risks of “effective weight loss drugs” such as semaglutide, it wrote, was that it “might well deepen the emphasis in the public discourse on a ‘personal responsibility narrative’”, distracting from “the root cause – the food environment”.

This, again, is strange. Let us remember that obesity kills and semaglutide will save lives. Imagine greeting a new treatment for lung cancer with the concern that fewer people coughing their last in hospital might take the pressure off tobacco companies.

That is very easy to imagine. Look at how 'public health' activist groups have tried to shut down vaping in many parts of the world (though not so much in Britain). Look at how neo-temperance groups have responded to the rise of alcohol-free beer. Look at how many food cranks want to get rid not only of sugar but of artificial sweeteners.

The dominant puritanical element in 'public health' doesn't want science to solve problems. They want people to change their behaviour which, in their view, requires changing 'the food environment'.

How much success has Nesta had in 'tackling obesity', despite the millions of taxpayer pounds it has got through over the years? None whatsoever. 
Does Nesta have any policies which would reduce body weight by 15%? No, not even if they were all introduced at the same time. The sugar tax didn't work, the reformulation scheme didn't work (and yet Nesta still supports it) and the food advertising ban won't work either

It is essential for these tax-sponging authoritarians to portray personal responsibility as ineffective. It seems to be like Kryptonite to Nesta...
The arrival of effective weight loss drugs and increasingly personalised nutrition services to the market might well deepen the emphasis in the popular discourse on a ‘personal responsibility’ narrative.
And yet personal responsibility has prevented far more cases of obesity than Nesta or semaglutide have ever done. The reason why the 'personal responsibility narrative' remains popular with the public is that most people are not obese, despite living in a supposedly obesogenic environment, and those who are not obese do not attribute this to sheer luck.
Like nearly everybody, I like chocolate and I could eat it every day if I wanted. The reason I don't is that I don't want to be obese. I like eating cheese and crackers in the evening but I don't do it most days for the same reason. What is that if not taking 'personal responsibility'? And while I don't expect everybody to have the same utility function as me, it's still a choice.

The argument against personal responsibility is sometimes made with reference to the rise in obesity since the 1950s. "Are we to believe that there has been a loss in willpower since 1950?", they ask rhetorically. 

To which the answer is YES! Of course there has! Haven't you seen the state of people these days?! And you're not helping by telling people that they're not responsible for what they eat and that physical activity won't help the lose weight.

Sure, there are genetic factors to take into account and people have different appetites, but the fact that 28% of the adult population is obese does not prove that personal responsibility doesn't work. Personal responsibility is pretty much the only thing that has ever worked.

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