Should the NHS fund Weight Watchers schemes?

The National Institute for Health and Care Excellence (NICE) recently recommended that the NHS should learn from commercial weight loss programmes such as Weight Watchers, Rosemary Conley and Slimming World. The NICE guidelines suggested that doctors should take a “respectful” and “non-judgemental” tone when helping patients to lose weight. As well as this, GPs were encouraged to continue to identify overweight patients for referral to state-funded commercial weight loss schemes, run by companies such as Weight Watchers, with obese adults being given priority.

The plan is estimated to cost hundreds of millions of pounds, but is also likely to save the NHS vast amounts in the long run, if successful in reducing obesity. Approximately 1 in 4 adults in the UK are obese, a condition that is linked with other ailments such as diabetes, heart disease and some cancers. The costs to the NHS attributable to people being overweight and obese are projected to reach £9.7 billion by 2050. Figures show that Weight Watchers and similar schemes manage to reduce participant’s body weight by 3 per cent, and NICE believe that even this small amount will help in the long term. Is it right, therefore, that the NHS subsidise the cost of these commercially run weight loss schemes?

One argument against such schemes is that the NHS is already in a perilous position with regards to resources – hospitals are dangerously underfunded, so why are we spending money on what is essentially a self-inflicted “life style choice,” avoidable if people just had better self-control? One particularly vitriolic Mirror column argued:

“All fat people have to do is stop shoving (the wrong kind of) food into their mouths and get off their backsides and do some exercise. And I can say this because I am one of those fat people. I’ve spent 30 years yo-yoing from a Size 12 to a Size 22. And I’m not sick. I’m greedy, I’m lazy, I love doughnuts and I don’t have much willpower.”

This is a particularly heightened version of a style of argument that views the individual as the primary target of intervention to combat such public health problems. Leaving aside the problematic argumentation technique of universalising from the author’s own experience, this argument is self-defeating in another way. The author writes that one technique to achieve weight loss is to stop eating the wrong kind of food. This is a valid point and cuts to the heart of the obesity epidemic, but the author might be mistaken to claim that the individual is ultimately the source of, and solution to the problem. We’ve recently been warned about our dangerous levels of sugar consumption, and there are links between junk food and obesity. So, it seems, the author is right that controlling what we eat is key. But perhaps they are mistaken to lay the blame entirely at the feet of the individual.

Public Health England (PHE) cites 7 causes of obesity:

• Biology: an individuals starting point – the influence of genetics and ill health;
• Activity environment: the influence of the environment on an individual’s activity behaviour, for example a decision to cycle to work may be influenced by road safety, air pollution or provision of a cycle shelter and showers;
• Physical Activity: the type, frequency and intensity of activities an individual carries out, such as cycling vigorously to work every day;
• Societal influences: the impact of society, for example the influence of the media, education, peer pressure or culture;
• Individual psychology: for example a person’s individual psychological drive for particular foods and consumption patterns, or physical activity patterns or preferences;
• Food environment: the influence of the food environment on an individual’s food choices, for example a decision to eat more fruit and vegetables may be influenced by the availability and quality of fruit and vegetables near home;
• Food consumption: the quality, quantity (portion sizes) and frequency (snacking patterns) of an individual’s diet.

For 3 of these 7 causes (“activity environment”, “societal influences”, “food environment”) social/environmental factors are explicitly listed as affecting obesity: the public provision of cycle shelters/road maintenance, the influence of the media, the availability and quality of fruit and vegetables near home. It is also possible to imagine that the final cause, “food consumption,” has social determinants as well, if we consider that parents may not have the time and availability to produce home cooked meals every day using fresh ingredients, or be able to afford fresh ingredients at all. Just from this fairly shallow analysis we can see that obesity is influenced by far more than just individual choice, and is down to a number of factors, some of which are beyond an individual’s own control. Of course it is necessary to balance social determinants with individual choice, and many cases of over-eating are likely to be unassociated with wider environmental factors. Even then, however, the widespread and ready availability of junk foods could be seen as influencing an individual, constructing her choice to over-consume, making it more of a possibility.

The above points from PHE suggest that there is far more to the obesity epidemic than an individual’s own self-control, or lack thereof. No amount of individual willpower or self-mastery will be able to affect the public provision of green spaces and cycle lanes, or reduce the existence of aggressive marketing campaigns for fast and processed foods. It is important to remember, therefore, that people’s choices are made within this social context. Although courses such as Weight Watchers do aim at a holistic approach that seeks to help individuals “make sustainable changes to their lifestyle behaviours,” through promoting healthy eating and physical activity, this alone may not be sufficient to combat our obesity crisis. Teaching people the value of a healthy lifestyle is key, but this needs to be undertaken in conjunction with a concerted public policy effort that would seek to shape and constrain the various other forces listed by PHE as contributing to obesity. Such a social constructivist view of obesity helps us to understand why, despite ‘free and autonomous individual choice,’ we still see group differences, and group health inequalities. There is, for example, thought to be a link between poverty and obesity, and according to Department of Health figures, the poorest children are almost twice as likely to be obese than the richest. This could be due to to the time and monetary costs associated with a good diet. A paper on children in England from 2007 to 2010 used the indices of multiple deprivation, an official government measure that looks at income, employment deprivation, health, education, housing and other factors, and found a strong correlation between obesity and deprivation scores. Further, one report by Heart of Merseyside, a cardiovascular health charity working across Merseyside and Cheshire, claims that the rise in the consumption of fast foods occurs as individuals downgrade from more expensive restaurant meals due to the economic downturn. Research by the Institute for Fiscal Studies shows that families are spending less by buying more junk food in the recession. Falling incomes and rising prices meant customers were buying more processed foods with increased saturated fat and sugar content. The reports, titled ‘Food Expenditure and Nutritional Quality over the Great Recession’ and ‘Gluttony in England? Long-term Change in Diet,’ studied 15,850 households’ purchases from 2005 to 2012. Another important study published open access in the British Medical Journal looked at associations between schoolchildren’s weights and their consumption of fast food and takeaway outlets, in the deprived inner London Borough of Tower Hamlets. More than 50% of the children in the survey purchased food or drinks from fast food or takeaway outlets twice or more a week, with about 10% consuming fast food or drinks from these outlets daily. About 70% of these children from Black ethnic groups and 54% of Asians purchased fast food more than twice a week. The study concluded:

“This study revealed a very high frequency of fast food consumption among the schoolchildren. Taste, quick access and peer influence were major contributing factors. These schoolchildren are exposed to an obesogenic environment, and it is not surprising that in this situation, many of these children are already overweight and will likely become obese as adults.”

Such research would suggest that environment has a notable part to play in food consumption. All things being equal, Weight Watchers schemes may be beneficial and have a chance of working. But as long as these outside forces persist unbridled, such schemes may only be a surface-skimming solution to the wider problem of the grip corporations and fast foods have on our eating habits.

This notion of corporate control relates to a further reason we have to be wary of the state funding such commercial weight loss schemes. It is important to remember that ultimately, Weight Watchers and other such companies, are profit-driven commercial enterprises. Their main motive is arguably to deliver high returns to their shareholders. One writer notes:

“As former finance director of Weight Watchers, Richard Samber, put it to me – “It’s successful because the 84% [who can’t keep the weight off] keep coming back. That’s where your business comes from.”)”

Speaking at a college event in Oxford on Friday 13^th June, Susie Orbach, the renowned social critic and author of “Fat is a Feminist Issue,” made the salient point that if diets really worked, you would only need to do them once. It is in these weight loss companies’ commercial interests for people to remain in a perpetual state of dieting, and it is worth noting that the UK dieting industry is estimated to be worth around £2 billion a year. Dieting is big business. It may be objected that there isn’t necessarily anything in the fact that weight loss companies benefit from people being overweight to show that they do anything to sustain this pool of customers. However, it would also appear that the dieting industry and the processed foods industry are two sides of the same coin, with Weight Watchers having been owned by Heinz up until 1999. It is now owned by the investment firm, Artal Group, which also owns the following companies in Europe:

• Poult/Dryon: Private label biscuit manufacturer based in France and Belgium.
• Pizza Hut Finance: A 50/50 joint venture with Pepsico, operating over 100 outlets.
• Dan Cake: Europe’s market leader in cakes, pastries, and swiss roles.
• Neuhaus: Belgian premium chocolates manufacturer with distribution entities in the USA, France, Spain, UK, Germany and Japan.

As well as the second and third biggest cookie companies in the US.

Although some might want to say this simply represents a diverse investment portfolio, there does seem to be a prima facie conflict of interest here. It should trouble us that the same super-corporation that markets weight loss to us, also essentially markets the ingredients for weight gain. Similarly, Unilever owns both Slim Fast and companies such as Ben and Jerry’s, Magnum, Hellmann’s and Cornetto.

By funding companies such as Weight Watchers, therefore, the government may be inadvertently perpetuating the cycle of obesity, and serving the sectional interests of various corporations that produce food that contributes to the nation’s unhealthy eating habits. What may in fact be required is an overhaul of our current policy approach. If there are links between deprivation and obesity, the coalition’s austerity approach may need re-examining, if the ubiquitous availability of junk food is contributing to an obesogenic environment, perhaps we ought to re-think the way companies are allowed to market themselves, and if commercial weight loss schemes also have harmful vested interests, perhaps NHS funds would be better directed elsewhere.