- guardian.co.uk, Thursday 20 January 2011 11.00 GMT
- Article history
Obese adults are being encouraged to believe 'that surgery is the only pragmatic answer' to weight loss Photograph: Catherine ShawSince November 2010, a cosmetic surgery provider has broadcast a series of commercials on Channel 5 celebrating the physical and beautifying benefits of bariatric surgery. Over 49 seconds two slim, ordinary-looking women (not models) champion the procedures, which can allegedly precipitate 50-65% weight loss. Sounds good, no? The prospect of a quick way to remedy a weight problem is obviously going to seduce a lot of people into surgical gowns, and I comment with a certain degree of authority: I have always been fat. Of course, like a lot of fat women I hope to stumble across some magic instant slimming beans (more runner than jelly) but I'm not holding my breath. I can't. But as much as I wish I had the willpower to stop munching, I am amazed people are taking such drastic and costly measures instead of exercising self-control.
The advert is shocking, not because of its content but because such invasive and potentially dangerous surgery is being marketed as a legitimate alternative to dieting. Over the last decade the NHS alone has recorded a tenfold rise in anti-obesity procedures, a figure which is not wholly representative since additionally patients pay privately (costs range from £3,500 for an intra-gastric balloon, £5-8,000 for a gastric band, up to £15,000 for a gastric bypass).
This is not surprising. Magazines are saturated with stories in which former fatties showcase the aesthetically pleasing results of their medically precipitated weight-losses. And, in most cases, they look good. However, what was traditionally a last resort in the most extreme cases is not only being normalised, but also celebrated. Gastric band surgery is becoming as accessible and accepted a practice as teeth whitening. Those of us who would have formerly tried eating healthily and exercising quickly admit defeat and covet the surgical option. There is no longer a reason to test the limits of our self-discipline.
That is not to say bariatric surgery is always unnecessary. Anyone who watched Britain's Fattest Man would probably agree that telling 70-stone Paul Mason to simply take up running and eat more greens was going to be ineffective. But his was a desperate situation. Lauding surgery as the only realistic choice does not just absolve us of all responsibility for our weight, but also ignores the psychological nuances that cause us to be greedy in the first place. Jamie Oliver stalks the land claiming potatoes aren't chip-shaped when dug out of the ground but educating children to eat healthily is a redundant enterprise when simultaneously, the idea that over-indulgence can be easily rectified at the right price is entrenched in the national consciousness .
It is a scientific fact that if you eat fewer calories than you expend then you lose weight. Anyone who claims otherwise is subconsciously failing to recognise the extent of their daily food intake, as demonstrated by Debbie Chazen in the BBC's 10 Things You Need to Know About Losing Weight. While Chazen believed she was only consuming around 1,500 calories per day – less than the recommended 2,000 – she was in fact eating 3,000 and under-reporting in her written diary by 43%. This was not intentional and it is apparently common. The excess can be attributed to forgotten snacks and poor portion control, but it indicates the ease with which we claim a diet has failed us rather than acknowledging we have failed to diet.
As someone who lost over four stone at the beginning of 2009 only to steadily regain it through gluttonous binges, I know it is easy to fall off the fruit wagon. But I also know that diets definitely do work. The suggestion that young people should be widely offered the procedure is nothing but symptomatic of our impatience and laziness as a nation. The irony is that even after surgery patients are supposed to amend their eating patterns and exercise: if this is the case, why go under the knife?
It is OK for celebrities to disseminate the benefits because they can afford to pay privately for a decision that mostly has its roots in vanity. While the NHS only offers surgery in the most severe cases (BMI 40+), with childhood obesity rising the threshold for what constitutes "severe" will naturally have to rise for it to be possible to satisfy demand. This means there will eventually be a surplus of considerably overweight adults unable to qualify for surgery on the NHS, unable to pay privately, and unwilling try diet and exercise because they have been conditioned to believe it is futile; that surgery is the only pragmatic answer.
This undoubtedly reflects the status quo to a certain extent, but the situation is likely to worsen as the World Health Organisation (WHO) predicts that by 2015, obesity will afflict more than 700 million adults across the globe. There is a simple solution. Despite celebrity endorsement and glittery advertising, bariatric surgery should be regarded as a taboo subject in all but the most hopeless circumstances.
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