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Independents' Day

The poverty of excess

Dr Shaba Nabi

One of my early memories is being really distressed about the front cover of my sister’s teacher training book – ironically called ‘Children in Distress’. It featured a scrawny-looking child with a greying white dress and a dirty face, holding her head and crying. Poverty was synonymous with emaciation and malnourishment, and this image epitomised this.

Years later, my brother, while at medical school, completed a project on the association between poverty and failure to thrive. As a young teenager, I became one of his subjects, coming in under the second centile for both height and weight. It wasn’t until after I left home to go to university that I grew another five centimetres because my vegetarian diet wasn’t being restricted by a diet of chapattis and curry sauce.

But when I see poverty now, I no longer see these images. I see morbidly obese children being diagnosed with type 2 diabetes and vitamin deficiencies, because despite their appearances of excess, they are likely to be malnourished in essential micro-nutrients.

What society and the medical profession fails to embody is that obesity is far more complex than the simple mantra of eating less and moving more. It is likely to be associated with poverty and low socio-economic status; a reversal of the previous trend of poverty being linked with being underweight.

Next time you think or say anything about obesity, ask yourself, would you use the same phrases for someone who was being treated for anorexia nervosa?

One reason is that junk food is significantly cheaper than healthy food. When I take my three kids to the mall, I can feed them all for under £10 at McDonalds, whereas stocking up on a healthy salad and fresh fruit from the M&S café would cost me twice that. Rather than adopting an authoritarian junk food tax, we should be subsiding healthy food for all – an ideal I fear will remain a distant pipe dream with the advent of Brexit and restricted European food trade.

Apart from the economic reasons for eating junk food, there are also psychological ones. It is a continual mystery to me why obesity is not viewed as an eating disorder, when anorexia and morbid obesity are two ends of the same spectrum. Many people who are obese are addicted to food, and like any other addiction, the drug of choice is being used as a band-aid for any number of painful and traumatic events, as well as compensating for feelings of low mood and anxiety.

And let’s not forget the biology of this. We are all genetically programmed to have a certain body shape as well as an appetite ‘off switch’, and genes are kinder to some than others. This genetic variation combined with an obesogenic environment amplifies the risk factors for obesity.

Despite most healthcare professionals being aware of the multi-factorial causes for obesity, I still hear lots of dismissive and judgmental comments about this patient group. So next time you think or say anything about obesity, ask yourself, would you use the same phrases for someone who was being treated for anorexia nervosa?

Because that emaciated child on the front cover of ‘Children in Distress’ should now be replaced by a morbidly obese child, eating for comfort, for a multitude of biological, social and psychological reasons.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at

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Readers' comments (10)

  • The cheapest diet is vegetarian bought at the market. People do not eat junk food because it is cheap they eat it because it is convenient.

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  • David Banner

    It’s mind boggling...........after many hundreds of millennia in which poverty equalled starvation, it flipped 180 degrees in 1 generation (in first world countries at least). The McDonaldisation of drive-through Britain has transformed the poor from cachectic to obese. But surely corpulence is preferable to malnutrition?
    I’ve always favoured traffic light taxation of food...
    Red - add 20%
    Amber - nil
    Green - deduct 20%
    All the waffling leaflets and lectures on healthy diet are no substitute for cold, hard cash, especially for those where every penny counts.

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  • |Mark Howson | Locum GP|02 Aug 2019 4:18pm

    I couldn't have put it any more succinctly

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  • I saw an article about “the worst food desert in the UK” where the nearest fresh food “was a 30 minute walk away”. The fact that a 30 minute walk is seen as an obstacle is astonishing. Don’t get me wrong, I’m lucky to have a farm shop 10 minute cycle away but sometimes we need to say that too much of it is diminished personal responsibility.

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  • Just been to the upper middle class Waitrose shoppers ‘wilderness festival’ this weekend. Didn’t see anyone obese. All meals £8-10 and didn’t fill up the blokes in our group. Tasty and vegetarian ( mostly) though.
    It’s complicated

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  • Dont think theres a cheap market in Bournemouth. Defo cheaper to get frozen chickennneggw5s n chips from Iceland. I guess chips are vegetarian food tho

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  • 1st generation immigrant. Vegetarian. Mother cooked everything from scratch and we were made to eat our beans to 'get our protein'. We did go to Mcdonalds about twice a year for a treat but this was 40 years ago ! The nearest one for us was in Croydon. The liberals won't like it but I think child benefit should be paid on an electronic card which can only be accepted for healthy fresh food , meat or veg. Not takeout food and fizzy drinks. It would be good for the health of children and good for british farming.Free cooking classes included. ie the home economics of before. How many times do you see a young mum bringing a young child to morning surgery, both drinking a fizzy drink for breakfast.

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  • It is both the convenience and cheapness, they are not mutually exclusive.

    If no need to cook more time at home to watch X factor and dream of little Jayden, kayden or Wayden having his 15 seconds of fame. Or hit the pub.

    This is the poverty of western liberal secularism.

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  • Brilliant article. Totally agree that these issues are incredibly complex. I don't agree that morbid obesity and anorexia are two ends of the same spectrum. The patients' with anorexia nervosa usually have a distorted body image and think that they are morbidly obese. I suppose the morbidly obese are similar as they also believe that they are morbidly obese.

    I think that individuals have a responsibility to take responsibility for their own lifestyle choices. I also believe that governments can have massive impacts on these choices. Smoking is a good example of positive state intervention. Huge amounts of money is spent by the junk food industry advertising their products. Tax the hell out of them.

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  • Dear all,
    Really gets my goat all this "don't ostracise obesity". We treat Anorexia as an illness, why not obesity then?
    Paul C

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