Dr Phil Hammond, broadcaster and sessional GP in Bristol

Have you ever wondered why models are pencil thin? Men, at least all the ones I’ve ever met, prefer women to have curves and many delight at the sight of an ample rear. None find women with forearms thicker than their waist attractive. I have never been to a proper fashion show but every time I see a televised clip I find myself shouting ‘Please eat something!’ at the screen.

So who decides that anorexia is chic? Fashion designers, apparently, who seem to be the only people who lust after curve-free, androgynous models. I gleaned this piece of information from a researcher while queuing up to be interviewed by Ann Widdecombe. The formidable Miss W is turning her fire against the fashion and diet industries for a new programme, and joked (yes she does have a sense of humour) that her book on how to lose weight would be a one liner: ‘Eat less and move more.’

Ann is a survivor of ITV’s Celebrity Fit Club where she refused to indulge in gimmicky stunts and just got on with losing a pound a week by walking everywhere and eating smaller helpings of a balanced diet. As a believer in personal responsibility, she cannot see why everyone else does not follow suit. It’s not rocket science: energy in versus energy out. Who needs drugs and NICE guidelines and faddy diets and surgery? The NICE guideline on obesity1 is certainly not easy to digest. Dozens of pages repeating roughly the same message. If only we could reduce them to one line.

Ann is off to meet those at the extremes of the scales—a woman who exercises for 30 hours a week and is all muscle, and another who weighs 30 stone and isn’t. The former is obsessed with the treadmill, the latter can hardly get out of the house. She managed to lose four stone on orlistat before putting it on again. Now she’s pinning her hopes on gastric banding, which Ann is predictably sniffy about.

I have to say I’m a fan of the gastric band. I have a friend who carries out bariatric surgery and who has seen amazing results, not just for long-term weight loss but for reversal of type 2 diabetes. Of course, there are those who will liquidise their chocolate bars to get past the band but for really overweight patients (body mass index of 40 or 35 plus comorbidities) it can be a life saver. And it is much less risky than a gastric bypass. According to my friend ‘It’s all done by laporoscope and to music. My favourite track is the Spice Girls "When two become one” ’.

There are plenty of obesity conundrums. Many doctors think of it as social or psychological and that it should not be treated as a medical problem, but for some patients extreme medical treatment (i.e. surgery) saves their lives. And all parents have the dilemma of not wanting their daughters to scoff too many chocolate eggs, but then not being so critical of their eating as to send them off on the road to anorexia.

Ann’s message is simple, which is why it will not work. Eating is as much for emotional gratification as to satisfy hunger, and those who are overweight often have worse psychological profiles than those with cancer. Changing eating and exercise behaviour for a lifetime is a huge nut to crack, and there is no single, simple answer. People need to be emotionally and financially secure to take their health seriously but our society is so unequal that a quick hit of cheap stodge is sometimes the greatest pleasure many people get. As Garfield once observed: ‘I can resist everything except temptation’.

  1. National Institute for Health and Care Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. Clinical Guideline 43. London: NICE, 2006