Tamworth in Staffordshire, a pleasant former market town 14 miles from Birmingham, has had its moments in the national limelight. It boasts a statue of Sir Robert Peel, whose constituency it was and who bred the Tamworth pig, and it is the home of the Reliant Robin, the three-wheel car invented in a back garden in 1935.
But, as of 2011, it has been trying to shake off the less welcome title (shared with Gateshead) of fattest town in Britain.
Just over 30% of people in Tamworth are obese, according to the National Obesity Observatory, Britain’s official collector of such data. Gateshead and Tamworth have 30.7% adult obesity, while two other districts, Swale and Medway in Kent, have also for the first time nudged over the 30% line. By 2050, warned the seminal Foresight report of 2007, the UK could hit 60% adult obesity if nothing is done. Tamworth is halfway there.
To the visitor, the girth of Tamworth’s inhabitants is noticeably large. The nearly one in three who are technically obese are not hard to spot. While some council members protest loudly at the tarring of their town as fattest in the land, contesting the accuracy of the data and pointing to all that they are doing to encourage the local population to get more active, Jeremy Oates, who sits in the council cabinet and has health as part of his remit, acknowledges there is a problem. “We can run around saying the figures are out of date, but the bottom line is there is still an obesity issue,” he says.
Local GP John James, chair of the clinical commissioning group that will decide what NHS services the area needs, says people do not notice that others are overweight any more, because almost everybody is.
“I have been a GP for 30 years,” says James. “We don’t need the statistics. We have all seen it happen. But we normalise visually. We look around the room at other people and say, I’m fairly tall or I’m not very tall. So in a room full of overweight people, nobody thinks they are fat.”
Oates, who is not overweight, is surprised at how far it has gone. “It’s not just elderly but overweight people using mobility scooters,” he says. He recently saw four men in early middle age with walking sticks. “I thought, when did walking sticks become fashionable?” And then he realised these were overweight people who needed sticks to be able to get around.
“We’re almost on the verge of a lost generation – obese parents who aren’t recognising that their children are obese. Getting parents to recognise that is quite tricky,” he says.
Tamworth is not out of step with the rest of the West Midlands, which has an average adult obesity rate of 26.4%, just as Gateshead is within the general range of the north-east, where adult obesity averages 27.8%. The figures are a bit out of date, because they are based on 2006-08 data from the Health Survey for England, but that is the most up-to-date information there is. The names at the top of the league table will no doubt have changed by the time new National Obesity Observatory data is published, but it is a safe bet that there will be even more towns with more than 30% adult obesity – not fewer. This is not just Tamworth’s problem – it is everybody’s problem.
Tamworth’s civic leaders have been doing what they can – which is mostly to encourage and enable people to take up sport and become more active. The zumba dance-fitness classes the council organised took off. In the grounds of the town’s Norman castle, it installed free outdoor gym equipment. There are now about 15 council-run exercise and fitness classes a week, including Nordic walking. It invested £17,000 in free swimming lessons at a local pool and subsidised the SnowDome, the first indoor ski slope with real snow.
The council has got results. In 2009 just over 9,000 adults in Tamworth were taking part in sport, but by 2011 this had risen to 11,000. With a population of 76,000, however, there is still a way to go. It is, says Rob Barnes, director of housing and health, “a really good community leisure offer” but people’s thinking needs to change if more are to use it. “They have a perception that it is normal to be overweight, it is normal not to exercise and normal to smoke.”
It would take something else to get the local people really moving, mused Oates. “What we’re lacking in Tamworth is high-achieving sporting heroes. We haven’t got a Jessica Ennis. It is a shame we haven’t got a local connection with a role model.”
Local people do not believe Tamworth is fatter than anywhere else. Anne Devenney, a consultant for Slimming World in Tamworth, says: “I do see people struggle with their weight, but I wouldn’t say it was massively noticeable or that every person you see is obese or overweight. I can’t understand that we have been labelled as the worst. There’s nothing different in Tamworth. The zumba craze has gone mad in Tamworth and we have got cycle paths galore.”
She says there are many reasons why people put on weight. “A lot of factors cause people to overeat. It could be depression, it could be not enough money to do exercise – slimming groups cost money and healthy food costs money. There are lots of other factors beyond overeating on fast food. There is lack of employment – it all has a knock-on effect for people nowadays. You get in the car much more easily. Everything is much more convenient. You don’t necessarily walk to the shops any more. There is a big picture.”
In her case, it was emotional distress. Her fourth child, Cameron, was diagnosed with a very rare blood disorder when he was 15 months old, after four months of tests. He needed a bone marrow transplant and luckily all three of his siblings were a match, but he suffered complications after the operation and eventually died.
“He was in Birmingham children’s hospital for virtually six months,” she says. “It became ready meals and hospital meals and never leaving the room because he was in isolation. [We parents] called it the mum’s shuffle – wandering down the corridor in your slippers.”
Devenney’s weight went up to 103kg (16st 4lb) and she had to wear size 20 clothes. She used to order two big breakfasts at the McDonald’s drive-through and eat both. “I can’t face even one now. You get a little bit embarrassed because you feel disgusted that you did that.
“People don’t necessarily understand how difficult it can be. Even now I can still have bad days. I’m still in danger of reaching for the chocolate. I don’t think that will ever leave me.”
There came a point when she knew she had to do something. She was ashamed of having to struggle up the six flights of stairs to the hospital car park. And she had her other children to think of.
“It was a good few weeks after we’d lost him. I was eating a lot and down with everything. Then it was a sudden realisation that I didn’t want a tragedy for the others. I looked at myself and felt awful.”
With the support she got from her Slimming World group, she ate better food, took up running and is now size 10 and weighs 67kg (10st 8lb).
Michelle Wright went to see her GP last year with pains in her feet and joints. She was 1.67 metres (5ft 6 in) tall and weighed more than 108kg (17st). “My doctor didn’t even say to me I was overweight,” she says. “He just started me on steroid injections. He didn’t advise me to lose weight or anything.”
She knew herself that she was too heavy. “At Christmas last year I was in size 22s. My Christmas present under the tree was the biggest parcel there and when I opened it, it was a coat,” she says. It was huge. She did not feel good about herself.
Wright started trying to cut the calories in the food she ate on her own, but then saw adverts for Weight Watchers in the new year and joined up. “When I lost about three stones, the pain stopped in my feet,” she says.
She thinks the epidemic of overweight is down to the pressures on consumers. “You only have to sit down and watch TV. There are the special offers, buy one get one free, boxes of Maltesers in the supermarket for £1. But also people are making the wrong choices. It is down to willpower as well. You choose what you put in your mouth.”
Obesity rates rise with deprivation, most research shows, but there are studies that suggest the area in which you live may be more important than the amount of money you earn. So those less likely to be obese include people who do not use cars, because they cannot afford them or live in a town with a cycling culture, those who have fresh fruit and vegetable shops nearby and not just an abundance of takeaways and corner stores selling processed food, and those in places where the norm is not to be fat.
It is very complex, says Jonathan Topham, district public health lead, but searching for reasons for obesity in Tamworth, he points to lower levels of activity than average for England – three in five men and women say they are completely inactive – and low consumption of fruit and vegetables (22% eating five a day compared with 29% on average in England), which is a marker for a healthy diet.
“We do have issues around lifestyle and behaviours,” he says. “We have lower levels of physical activity than you would expect. It looks like the levels of healthy eating are not as good as they should be. There is probably a correlation with obesity.”
The town also has low educational attainment at GCSE – fewer than half its students get A*-C GCSE grades (including English and maths) – and there are high levels of teenage pregnancy compared with the rest of Staffordshire.
It is just as complex in Gateshead, where director of public health Carole Wood talks of activities and school initiatives, including encouragement to the older generation to pass on recipes and cooking skills to the younger ones.
But they are stumped for answers to one of the biggest local problems – how to stop more fish and chip shops opening. There is such a density that in some areas people can buy fish and chips for £1. It’s a meal heavy in saturated fat.
“I don’t think we have one fish and chip shop or hot takeaway shop that would cook in vegetable oil rather than beef dripping,” she says. But it’s a planning nightmare, pitching health against jobs in the local economy.
It is, as the Foresight report said in 2007, the “obesogenic environment” that is to blame, and that has to be tackled on many fronts at the same time – food, transport, activity levels, planning and, importantly, education.
Both Tamworth and Gateshead say they are doing what they can, but they can’t do it alone. Tackling social and cultural issues, as well as practical matters like food labelling and advertising, requires a lead from central government.
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Dr Philip Lee, Conservative MP for Bracknell and a practising GP, today suggested that people whose lifestyle choices lead to medical problems should have to contribute towards their healthcare costs. He apparently highlighted type 2 diabetes – which can be brought on by an unhealthy diet, being overweight, and lack of exercise, although some people are genetically disposed to it – and is quoted in the Huffington Post as saying, ‘If you want to have doughnuts for breakfast, lunch and dinner, fine, but there’s a cost’.
At first glance, the idea that those who lead unhealthy lifestyles should bear the burden of their own resulting health problems seems fair. But there are serious problems with this idea. Let us consider two of them.
First, it seems likely that this sort of policy is not merely about penalising people for unhealthy lifestyle choices. Dr Lee’s comment about doughnuts and diabetes suggests that he is targeting fat, lazy people with a cavalier attitude towards their own health. Discussions of this sort of policy also often highlight (as the Huffington Post article does) the cost of treating the health problems of smokers and heavy drinkers. But it is not only fat people, smokers, and heavy drinkers whose lifestyles end up costing the NHS money. People often suffer health problems as a result of leading lifestyles that we do not normally think of as being unhealthy: sporty people are at an increased risk of suffering joint problems, computer users of eye strain, outdoorsy people of skin cancer, drivers of injuries in car accidents, and so on. If a policy of making people pay for healthcare necessitated by their lifestyle choices is to be fair, we must ensure that we target Olympic gold medallists with knee injuries just as heavily as we target doughnut-guzzling smokers with diabetes. If we do not, such a policy could end up as a surreptitious tax on people with the sort of lifestyles that society frowns upon. This would be a sinister and worrying outcome. We might celebrate those who win Olympic gold medals over those who sit at home with a fag and a doughnut, but financially penalising people for doing the latter amounts to a curtailment of freedom that is unacceptable in a society that aspires to liberal values.
Second, whilst Dr Lee’s suggestion is intended to save the NHS money, it could end up doing the reverse. How is it to be determined to what extent a patient’s lifestyle is responsible for her health problems? Whatever the method, it is likely to involve a significant amount of time and effort – and therefore expense – spent information-gathering, consulting, discussing, and evaluating. Perhaps it might require even more sophisticated and expensive processes: some people, after all, may be genetically disposed to diabetes, lung cancer, or liver disease. It would be unfair to penalise such people for their health problems, even if they are fat, smoking, alcoholics. So it might become necessary to screen people for such genetic predispositions before concluding that their health problems are caused by their lifestyles. This burden on the NHS is likely to grow as medical understanding of various diseases advances: every new factor that is identified as contributing to a disease is another factor that must be taken into account when evaluating the extent to which a patient is responsible for the fact that she suffers from that disease.
The idea that those who cost the NHS the most should be made to contribute the most is intuitively appealing. But a policy that attempts to enforce it risks being unacceptably paternalistic and counter-productive. This does not entail that such a policy could never be made to work. If such a policy was transparent about what it aimed to achieve, perhaps it could be workable, cost-effective, and even an incentive for people to lead healthier lifestyles. For example, the government might introduce a policy that all smokers who suffer respiratory problems will be made to contribute towards the cost of their treatment, regardless of whether or not they are genetically disposed to such problems. It could do so without representing the policy as part of a general campaign against those whose lifestyles cost the NHS money – a campaign which, in fairness, should also target athletes and the like. Such a policy may be controversial, but it is not obviously any more unfair than the taxes already levied on tobacco. Even so, it would perhaps be difficult to avoid such a policy being represented by the media as part of a general ‘make the unhealthy pay’ campaign.
Article source: http://blog.practicalethics.ox.ac.uk/2012/11/tax-the-fat/
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MEDICS have joined forces in a nationwide battle against obesity.
A campaign by the Academy of Royal Medical Colleges was launched yesterday with a broadside against an unlikely target – the London 2012 Olympics.
The body, which represents 200,000 doctors, says sponsorship of the Games by fast food and soft drink firms including McDonald’s and Coca-Cola sends out the wrong health message. Spokesman Professor Terence Stephenson said: “They clearly wouldn’t be spending the money if they didn’t benefit from being associated with successful athletes.”
Almost a quarter of adults in Britain are thought to be obese and half of children may be overweight by 2020.
Prof Stephenson added: “It’s a much bigger problem for the UK than HIV was, and much bigger than swine flu.”
The campaign will start by reviewing diets, exercise, minimum pricing, changing advertising and food labelling.
Prof Stephenson said it was likely the solution lay in changing the way people were exposed to advertising. “Another aspect is the taxation of cigarettes to deter people from buying them – that seems something to look at in relation to food.”
He added that exercise was not the answer. “I would have to run on a treadmill at top speed for an hour to counter-effect the calories from one or two Mars bars.”
The Department of Health said it welcomed the initiative.
Let’s tackle real causes – Dr Ian Campbell. GP and founder of Obesity Forum
OUR obesity crisis has developed over the past 50 years. The society we have created discourages physical activity with our dependence on the car and encourages eating too much thanks to our liking for high-fat, high-sugar foods and alcohol.
It leads to high blood pressure, type 2 diabetes, raised cholesterol, and a higher risk of heart disease, strokes and some cancers. On average, obese adults die nine years prematurely.
Changing the environment we live in is vital. I can help my patients lose weight, but we will only see real progress if we limit the promotion of unhealthy foods, make our streets safe for children to play outside, ensure schools and workplaces offer healthy options, and make public transport cheaper and more attractive.
We need government action.
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19:48 EST, 26 March 2012
19:48 EST, 26 March 2012
For a man who used his mental arithmetic skills as a tool of his trade for years, it was a perplexing moment.
Tom Mitchell and his wife Liz, from Bootle, Merseyside, were at the checkout in their local supermarket and, as she’d done hundreds of times before, Liz handed Tom the money to pay for the groceries.
‘Tom looked at the money then at me,’ recalls Liz.
‘Then he shook his head and I could see the confusion in his eyes. “What do I do with this?” he asked me. “What are these things for?” ’
Changing your lifestyle can greatly reduce your risk of vascular dementia, this includes losing weight, reducing alcohol intake and stopping smoking
This was more than out of character for Tom: until his retirement four years earlier, he’d made his living as a scrap metal merchant.
‘His ability to calculate weights and prices in his head was amazing,’ says Liz.
‘Yet there he was by the checkout, seemingly unable to even work out what the coins in his hand were for.’
Back at home, a concerned Liz tried to discuss the matter with her husband.
‘The strangest thing of all was that he didn’t seem at all bothered by what had just happened,’ she explains.
‘He just seemed to be quietly confused.’
Worried, Liz took Tom, then 62, to their GP. He carried out a basic memory test and pronounced there was nothing wrong.
‘I was relieved and more than happy to believe the GP, although deep down I knew something wasn’t right,’ says Liz.
‘A month or so after that visit I found him eating grapes off the floor, because he had mistaken the carpet for the table.
‘We’d lived in our house for 20 years, but suddenly Tom couldn’t remember where the toilet was and I’d find him wandering from room to room looking for it.
‘Again, he wasn’t distressed by this. In fact, he used to look puzzled if I mentioned it.’
Vascular dementia is the second most common cause of dementia after Alzheimer’s disease
Tom’s personality was also changing: ‘He had always been a very kind family man, but he was now regularly bad tempered and often unreasonable, and he seemed to be having trouble sleeping.’
After a few months of this, Liz decided to take Tom back to the GP.
This time he was referred to a memory clinic at their local hospital, where he was also given brain scans. The diagnosis: vascular dementia.
‘To say I was devastated was an understatement,’ recalls Liz, now 60.
‘Tom was my first and only boyfriend; we were the perfect match and for our entire married life we had been content just being together, raising our boys, Thomas (now 38) and Mark (35), and enjoying our home life.
‘And now Tom was being taken away from me in the cruellest possible way.
‘But Tom either didn’t or couldn’t seem to understand what I was telling him. All he said was: “We’ll just have to get on with it then.” ’
Vascular dementia is the second most common cause of dementia after Alzheimer’s disease.
It affects around 200,000 people in the UK and, unlike Alzheimer’s, where experts have yet to pinpoint the cause, the origins of vascular dementia are very well understood.
‘Vascular disease is caused when the blood supply — the vascular system — to and within the brain is disrupted or damaged,’ explains Dr Karen Horsburgh, a neuroscientist at Edinburgh University who specialises in the causes of vascular dementia and Alzheimer’s disease.
‘If blood cannot reach the brain cells, the cells will eventually die. This can lead to the onset of vascular dementia.
‘It can happen suddenly — for example, with a significant stroke, or over a long period of time due to an ageing process which is not yet fully understood.’
Vascular dementia is also often triggered when people suffer from mini strokes.
‘This can cause imperceptible damage, but over a series of months of years, this can build up to a significant disruption of brain function,’ says Dr Horsburgh.
There are, however, several key differences between Alzheimer’s disease and vascular dementia, she adds.
‘The brain of someone with vascular dementia will show evidence of blocked blood vessels and general damage to the vascular system, and you can actually test the reduced blood flow using a special angiograph in the same way you can test the blood supply to the heart.’
This involves injecting a dye into the bloodstream that shows up on an X-ray to reveal how well the blood is flowing into certain areas.
‘With Alzheimer’s disease, a brain scan will show more general brain cell death and a build-up of amyloid plaque — a protein associated with Alzheimer’s disease.
‘This tends to affect the neurons first, the grey matter in the brain — the part of the brain associated with, among other things, memory.
‘However, vascular disease can damage any part of the brain — wherever the blood flow blockage occurs.
‘So depending on which part of the brain is damaged, you may lose cognitive function such as perceptions, physical functions or memory.’
Yet there is another, more crucial difference between the two types of dementia, a difference experts are desperate for people to understand and be made aware of.
While there is not yet any known cause of Alzheimer’s disease, the causes of vascular dementia are not only known, but in many cases preventable.
‘Vascular dementia is caused by broadly the same things that will cause cardiac disease,’ explains Dr Horsburgh.
This means anything that clogs up or damages the arteries and stops the blood supply from flowing adequately.
‘So if you smoke, have high cholesterol, suffer from hypertension or fail to take regular exercise, then you are increasing your risk not just of a heart attack, but also of suffering from dementia as well,’ she says.
Indeed, someone who smokes doubles their risk of getting vascular dementia, according to the Alzheimer’s Society.
If you have high blood pressure, your risk is up to three times higher than the average person, and someone who has survived a stroke (which suggests they have existing blocked arteries) has a one in three chance of succumbing to dementia.
Being a diabetic also increases your risk, though experts are unsure why.
However, perhaps rarely for dementia, there is some good news.
According to experts, lifestyle changes may reduce your risk, postpone and maybe even prevent altogether the onset of vascular dementia.
‘For too long people have thought getting dementia was just bad luck — in fact, you can actively reduce your risks,’ says Jessica Smith, of the Alzheimer’s Society.
‘We say that what is good for the heart is good for the head.
‘Certainly some people may have genetic predisposition towards vascular dementia. But changing your lifestyle can greatly reduce your risk.’
This includes losing weight, reducing alcohol intake, taking exercise and stopping smoking.
It is a message Liz wishes she’d known about earlier.
‘Tom was very overweight and he was diagnosed with type 2 diabetes in his 40s,’ she explains.
‘He also chain smoked, though he gave up after he developed blocked arteries in his legs.
‘Doctors were always telling him he was at risk of heart disease, but if he’d known he was at risk of dementia because of his lifestyle, I’m sure he would have taken more notice.’
At the moment, the best hope of treatment for the condition lies in working out how the disease occurs — this is something that Dr Horsburgh and her colleagues are working on in a project funded by Alzheimer’s Society.
Another project paid for by the charity is trying to work out a way of standardising the diagnosis and care of vascular dementia.
‘Lack of awareness of vascular dementia, both within the public and, to a certain extent, the health care professions, is a real problem,’ says Jessica Smith.
‘Some patients will get good care; others will be left to cope as best they can.’
That has certainly been Liz’s experience. Since her husband’s diagnosis she’s not heard back from the hospital, nor is he receiving treatment for his dementia from his GP.
Five years since Tom was diagnosed, Liz is now his full-time carer.
At the age of 67, the once-independent businessman is frightened if Liz leaves him for a even a few minutes and during his bad times he can shout at his wife for up to ten hours at a time.
Their friends have melted away and, save for visits from their sons and journeys to a support group, Liz lives a lonely and isolated life.
‘It is only my deep love for my husband that keeps me going,’ she says.
‘Living with dementia is hell, and I wouldn’t wish it on anyone else.
‘I know that if either Tom or I had known that his smoking and being overweight could be the cause of dementia, then we would have changed his lifestyle in an instant.’
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My Mother died after suffering from Vascular Dementia for 13 years. She was very healthy, slim, walked miles every day and had long- living parents who were the same. Vascular dementia can attack anyone …..
They never forget where the fridge is though; do they?
Put an ASBO on her banning her from the food cupboard.Then give her a card which will be stamped at a Gym,then she can take it to the benefit office to say she has tried to do something about her illness??.
The ASBO was only a thought.
Alzheimers and dementia are so sad. It is heartbreaking to see the personality of the person you love disappear, and to watch them so lost and frightened, especially as you know there is only one end for it eventually in death.
My deepest sympathy to Liz and Tom, and all the people with this, and their families. Anything that may help is worth knowing.
I think that all the fat people who read the DM must feel pretty depressed right now. They already know they’re likely to get diabetes, heart disease and cancer. Add to that Alzheimer’s and dementia and it covers most bases. Isn’t it time someone at the DM did some real research. There’s lots out there now.
If this is the case, then there’s going to be a huge rise in dementia patients in a few years!!!
My father lost his life to dementia. Not an ounce of fat on his body. Work every day of his life and past retirement age. He ate a healthy diet. We were privileged to have fresh fish straight from Brixham harbour. So NO Dementia can affect anyone and I live in dread that it may be hereditary as it was very very painful watching dad disappear into his own world
My father had vascular dementia. He didn’t smoke, hardly drank and was slim and active. He also had low blood pressure all his life. So it can strike anyone without warning, believe me.
Being fat doesn’t seem to affect ones ability to claim benefits though.
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Even the most sentimental champions of the NHS recognise its dark side. Given that its Chief Executive Sir David Nicholson has demanded a £20 billion efficiency saving if the NHS is to survive, and that demographic changes mean millions more elderly people will rely on its services (and space), the NHS can only do one thing: ration.
If rationing is acceptable, though, scapegoating is not. And too much evidence points to the elderly being the scapegoats in the battle to save the NHS. As the Telegraph reports today, elderly patients are being denied the best cancer care. The figures are alarming: lack of treatment is contributing to 14,000 deaths a year among the over-75s. Men and women are dying prematurely each year because their diseases are diagnosed later and less likely to be operated on.
Already the elderly are short-changed when it comes to nurses’ time. Nurses in hospitals plead to being too busy to look after their charges decently, and so elderly patients frequently suffer dehydration, malnutrition and a lack of hygiene.
This treatment is cruel and unfair: age comes to us all, and is not the result of lifestyle choices. There are plenty of conditions, though, that are the direct result of bad habits, poor diet, and the wrong choices. These conditions range from obesity and diabetes to smoking-related diseases like emphesema. If a 20-stone, 30-something woman comes into hospital with a bad diabetic attack, does she deserve to be at the front of the queue or the back? She has chosen to stuff her face with Mars bars and Coke, and is now suffering the consequences of her choice. She cannot claim ignorance of the dangers of her diet: the Government has carpet-bombed us with health advice, from schools to GP practices. Class no longer regulates access to healthy living: everyone who can watch the telly, let alone read the magazines, knows that a high-fat diet will make you look bad and feel worse.
Does the obese 30-something lay claim to NHS services and a hospital bed when this means thousands of others will have to do without?
The septuagenarian who develops breast cancer has done nothing wrong – except grow old. The NHS has to consider that there are deserving cases and undeserving ones. Age should not be a barrier to optimum care; but bad habits should be.