I don’t know what caused Amazon’s recommendation algorithm to suggest Tom Watson’s new book, Downsizing: How I lost 8 stone, reversed my diabetes and regained my health. To the best of my knowledge I wasn’t searching for any of those topics, but I admit I was intrigued enough to download a free sample. The sample was good enough to encourage me to purchase the book itself … which I then proceeded to devour in a single sitting.
On one level, Downsizing is an open and honest story about one man’s battle with his weight and his desire to improve his health. He freely admits that the plan he followed—the ketogenic diet—is what he found worked best for him after doing a lot of research on the topic; the book is most definitely not a how-to guide to weight loss or managing diabetes, but rather a starting point for those who are interested in any of the points mentioned in the sub-title.
While it was inspiring to read about Tom’s journey from becoming someone who weighed 22 stone (140 kilos / 308 pounds) and couldn’t walk the half mile to his workplace to someone who lost 8 stone (50 kilos / 112 pounds) and climbed Snowden, it is what he learned along the way that really caught my attention. Because Tom Watson’s workplace was the Houses of Parliament: as an MP, he was privileged to see the inner workings of what was being done—or not—in the battle against obesity.
A naturally curious “nerd” (his word, not mine), once he got serious about reducing his weight and turning his health around, the research he did and the people he spoke with helped him make the necessary changes while exposing him to what was happening behind the scenes. His anger and outrage at what he calls the Global Sugar Industrial Complex (GSIC) are palpable: food and beverage producers aim to make their products as addictive as possible by using an ingredient we don’t need in our diets—sugar. Rather than cater to our nutritional needs, they seek to tickle our taste buds and stimulate the addiction centre of our brain … all while their fingers are in our wallets.
The knock-on effects of this are enormous: the financial drain on the NHS from dealing with type 2 diabetes alone is approximately £10 billion a year. This is a number that will only continue to grow as it’s estimated that type 2 diabetics will number over 4 million by 2025. Beyond financial terms, how many lives aren’t being lived to their fullest due to ill health? How many people are sitting on the side lines while their children grow up, or suffering from diabetes-related complications?
Tom’s love of research and his desire to get to the heart of the issue comes across loud and clear in Downsizing. In particular, he used the most up-to-date research to design his new lifestyle, from what to eat (in his case, a low carb, high fat diet) and how to make his behaviour change stick (make it into a habit). It was just as clear, however, that many health recommendations are no longer fit for purpose, such as the NHS Eatwell Guide and its one-size-fits-all-approach to the ideal diet. The “average” fails to take into account individual responses to food, and some of the latest research indicates that each person’s body responds to the same foods in very different ways.
Why am I discussing this on a blog about litter? Because the exact same tactics are being used in the battle against rubbish. Instead of the ineffective Eatwell Guide that doesn’t seem to be stemming the tide of obesity, the primary solution touted to tackle litter in the UK is the community clean up … which doesn’t seem to have any effect on the people who drop rubbish in the first place.
Likewise, the idea of one-size-fits-all is long gone. In advertising, audience segmentation helps target groups and individuals in ways that they are more likely to respond to. When it comes to health, more and more research is showing the advantages of personalisation, from catering to the individual microbiome in our guts to hyper-specific diets that factor in our personal biochemistry.
Yet anti-litter interventions in the UK seem to be stuck on treating everyone as being motivated by the same things, and advertising to them in the same way that has been done for decades. There is no attempt to target those who are more likely to litter where they are spending their time, using methods that are more likely to be effective.
One of the biggest similarities I noticed was how the big sugar brands (e.g. Coca-Cola) would donate money to charities promoting exercise and an active lifestyle. The effect of this was two-fold. It associates the brand with health and wellbeing, while also implying that all one needs to do to stay healthy is be active … ignoring the fact that you would need to walk five miles to burn off the calories in just one 20-ounce bottle of soda (which also contains the equivalent of 16 tablespoons of sugar). The result of this is that it helps insulate the brand from attack and manipulate reality.*
Because this isn’t a solution to obesity. It’s a distraction. The actual cause of the problem is ignored. The solution—reducing or eliminating the consumption of sugar and processed foods from one’s diet—gets passed over for the option that benefits the big brand. In a similar way, I suggest checking out who sponsors the Great British Spring Clean. This annual event points to the increasing number of volunteers taking part as a success, while conveniently overlooking the numbers that matter in the battle against litter: is the amount of rubbish collected going down year on year?
I would argue that this type of corporate support amounts to a ginormous conflict of interest. Anyone who regularly picks up litter will notice that the names on the sponsorship list often top the tally of brands being found, which raises a slew of questions: Who benefits from litter picking being advocated as the only solution to litter? Where are the ads in which fast food companies and takeaways tell their customers to get their act together and not litter? Where is the support from the beverage industry for a robust deposit return scheme? Where is the willingness to do things that make a genuine effort to stop those who litter?
Finally, there is the avoidance of long-term, proactive actions to prevent a problem in favour of short-term, “easy” answers. With type 2 diabetes, patients are prescribed a pill. This doesn’t cure their diabetes nor does it mean that they are unlikely to have further complications: it manages the condition without stopping it.
Tom Watson makes the argument that it is better to encourage people to make the necessary changes to their diet before they even ring their GP’s alarm bells as being pre-diabetic, i.e. when the scales continue to creep up in obese territory.** This can help stop health issues before they even begin. Yet the financial cost and time necessary to do this for an already overstretched resource like the NHS is pointed to as prohibitive … while overlooking the cost of inaction in terms of lost productivity and quality of life, as well as future medical interventions.
Focusing solely on cleaning up the litter others leave behind fits the same template. It mitigates the problem without actually attempting to solve it. Without any coherent, joined-up approach to changing behaviour and UK culture, the environmental degradation, the danger to wildlife, and the public expense will continue year after year.
Tom Watson is currently advocating for Remission for All: helping those with type 2 diabetes take the steps necessary to control their health. He finishes the book by outlining the entire arsenal that can be used to tackle the problem, from the technological (continuous glucose monitors) to the political (sugar tax) and various tools in between. I likewise argue that zero litter by 2030 is achievable if we actually focus on those things that are likely to bring it about. While cleaning has a role to play, it is necessary to look at the entire toolkit, from education and enforcement to targeted campaigns and joined-up thinking. Otherwise, relying on community clean ups to stop litter is a bit like celebrating weight loss with a slice of cake: great for a moment … but unlikely to lead to long-term progress.
I recognise that a high BMI is not a guaranteed indicator of poor health, and I would assume biomarkers would also be used to help in diagnosis and measurement. I also recognise that sometimes people need a health scare to make the necessary changes to their lifestyle, but that’s a blog post for a different day!