- Tony Delamothe, deputy editor, BMJ
Sex and death obsessed our immediate forebears, yet now we hardly turn a hair at their mention. Food, however, is another matter. So much about the subject is controversial.
Even one of the simplest questions—what makes us fat—is hotly contested. This week we provide space for two critics of the theory that obesity is an energy balance disorder: Gary Taubes (doi:10.1136/bmj.f1050) and Robert Lustig (doi:10.1136/bmj.f2287). Thankfully, neither wants to rewrite the laws of thermodynamics. What they do want to establish is that the insulin releasing properties of sugars such as sucrose and high fructose corn syrup are to blame for obesity. The Atkins diet—low carbohydrate, relatively high fat and protein—may have been along the right lines, after all.
Step outside the hallowed halls of biochemistry and things really heat up. Since the UN summit 18 months ago, we know that almost two thirds of global deaths result from non-communicable diseases and that unhealthy diet has an important role in these. But what to do about it: cajole individuals to change their diets or get governments to use legislation, regulation, and taxation to propel their populations towards the healthy option?
In a Head to Head this week we ask whether we can leave industry to lead efforts to improve population health, the option currently being pursued in the UK with its responsibility deals (or “irresponsibility deals,” as the Scottish Health Action on Alcohol Problems (SHAAP) labels them (doi:10.1136/bmj.f2415). Derek Yach, late of Pepsi, believes that “market led solutions, when combined with public policies, will make healthy choices the default option” (doi:10.1136/bmj.f2279). Epidemiologist Klim McPherson counters with the food industry’s (successful) one billion euro campaign “to dissuade the European parliament from legislating proper labelling of food.” Rather than being part of the solution, markets and their exploitation are “the dominant cause of most long term health problems such as obesity,” he writes (doi:10.1136/bmj.f2426). Make what you will of global food giants’ participation in Mexico’s National Crusade Against Hunger (doi:10.1136/bmj.f2458).
In its report, SHAAP argues that the health of millions is being endangered by unregulated free markets, with industry’s resistance to the introduction of a minimum price for alcohol its particular bugbear. Recently, UK Prime Minister David Cameron has had second thoughts over his initial firm commitment to a minimum price, while the health secretary apparently doesn’t share his predecessor’s enthusiasm for plain cigarette packaging. Are we headed for a world where the individual is left free to choose his or her poison?
If so, it’s a world where one would not be surprised to encounter the ghost of Baroness Thatcher. In his Observations column, previous BMJ editor Richard Smith, who joined the BMJ a month before she became prime minister in 1979, reflects on the “Thatcher years” in Britain. “Suppressed in those early days was a government report on alcohol that showed clearly that increasing its price was the most effective way to reduce the harm it caused … Thatcher didn’t seem to want to hear any evidence that didn’t fit with her view of the world and, like a dictator, tried to suppress evidence and language that she didn’t like … With her ideological commitment to individualism and disbelief in society [Thatcher] never liked public health” (doi:10.1136/bmj.f2434).
So it’s cheering that Public Health England, one of the slew of new bodies set up by the UK government earlier this month, has already come out in favour of a minimum price for alcohol and plain packaging of cigarettes (doi:10.1136/bmj.f2018). Things can only get better.
Cite this as: BMJ 2013;346:f2472