Capitalism, fat and our failed food system

Weight loss drugs treat the issue individually, and miss the structural dynamics (Photo: flickr/Chemist4U)

The government wants to inject people claiming unemployment benefits with drugs to help them lose weight and get into work.  

Labour health secretary Wes Streeting penned an article in the Telegraph newspaper last week titled, “Widening waistbands are a burden on Britain.”

Obesity is “holding back our ­economy” and costs the NHS £11 billion per year, he complained.

Currently, 26 percent of the population of Britain are estimated to be “obese” and another 38 percent are considered “overweight”. The overall “obesity rate” is predicted to rise to 40 percent by 2035.

Streeting argues that as citizens we have a personal responsibility to help reduce this “burden”. He mentions healthier diets and exercise, but he sees a major role for the pharmaceutical industry.

The strategy’s centrepiece is a collaboration with pharmaceutical giant Eli Lilly, which has agreed to invest £279 million.

A five year trial is set to start in Greater Manchester. It will measure whether Eli Lilly’s weight loss drugs have an effect on unemployment and the sick days people take off work.

Big pharma hopes to make mega profits from this. Eli Lilly boss David Ricks recently complained that the NHS is keeping the price of drugs too low.

Streeting said, “The long-term benefits of these drugs could be monumental in our approach to tackling obesity.

“For many people, these weight-loss jabs will be life-changing, help them get back to work, and ease demands on our NHS.”

But health workers are critical of the plan. Lynne, who has been a dietitian for nearly 40 years, told Socialist Worker, “It’s not getting to the root of the problem.”

The highest rates of obesity are in the poorest areas. Ignoring the effects that class and poverty have on diets and weight, and simply trying to inject people with drugs, doesn’t address the underlying issue.

“The idea that we are going to solve deep fundamental problems in society using a medication is great for the pharma industry. But it is of very little value for ordinary people,” Lynne said.

Obesity is often treated as a personal failing. If someone is judged to be overweight, it is because they aren’t making the right food choices or doing enough exercise.

But capitalist society has distorted our relationship with food. As capitalism alienates us, we can look to find comfort in food. People lack control over their lives, so food can be a way of reasserting that control.

People can use food as a reward for a dealing with the difficulties of life in capitalism, like struggling with work.  Sometimes people just want a hot, tasty prepared meal at the end of the day.

Eating disorders—which can mean eating too much or too little—can stem from a variety of causes.

According to the NHS, eating disorders can be a way of using control over food to cope with stressful situations.

And, because food is commodified for profit, marketing distorts our understanding of it.

Unhealthy food can be marketed as healthy food. Unhealthy cereals target children with appealing advertising such as cartoon animals.

Our food choices are also a way of socialising with others, whether that means going for a beer in the evening after work or meeting our friends in a chicken shop. 

Within capitalism’s food system, all this can create unhealthy eating habits.  Lynne also explained that capitalism has changed our relationship to hunger.

And the system creates that hunger—17 percent of children in Britain face food insecurity. When people do not have access to food, they tend to want to eat as much as they can when possible.

Last year a government report found that lack of access to food can—paradoxically—lead to higher levels of “obesity”.

The report found that food banks were seeing record levels of demand due to the cost of living crisis. Food banks are a vital emergency measure but not a sustainable solution.

The Independent Food Aid Network said that it relies on surplus food and therefore couldn’t guarantee the food they provide is “adequate, healthy or nutritious”. 

Poorer people have to make a choice between the quantity of food they can buy and the quality.

Foods that are high in salts, sugars and carbohydrates tend to be cheaper per calorie than fresh foods. It makes sense to buy a bag of chips if it provides you with enough energy to meet your needs for the money it costs. 

Some poorer places have also become “food deserts”. Food outlets available are dominated by takeaways and small corner shops offering a limited range of sweets and snacks rather than fresh fruit and vegetables.

Katherine, who’s also a dietitian, told Socialist Worker that long and unsociable working hours also leave people with less time to shop or to cook. Night shift workers find it hard to access fresh food and lack of sleep “plays havoc with your regulation”.

Politicians have lamented that working class people don’t cook their own food. Political commentator Isabel Oakeshott asked in 2017 why parents who can’t afford to feed their kids breakfast don’t just buy a big bag of porridge.  Working class people are shamed for not cooking from scratch, but there is a systemic problem with education about nutrition. Cooking lessons in schools have been slashed.

The government could use subsidies to make fresh foods cheaper and provide more training on nutrition for NHS staff.

Exercise in schools could be more focused on people doing healthy activities they like, rather than finding the next top footballer or Olympic athlete.

Provision of weight loss services is also patchy. Real investment is needed to give dietitians the time to discuss people’s food choices with them.

Lynne explained how shaming people for their lifestyle choices would be counterproductive.

“We are told that we are making a free choice,” she said. “But it’s very hard to make a free choice. There are people who have gained weight and want to be supported.

“It is not that they are bad, weak or a burden on society. That will only make people unhappy and less likely to feel that they can join in some activity they might want to do. People might really want to go swimming but feel ashamed of the way they look in a swimming costume.” 

“Keir Starmer’s whole approach is to treat people like a burden. It’s a cruel and disgraceful approach to a human being’s health.”

Are weight-loss drugs the claimed ‘miracle cure’?

The government is about to start a trial into using Terzepatide to aid weight loss and reduce time off work.

Ozempic and Wegovy have also been mentioned as drugs that could play a role in the Labour’s plan to cut obesity.

Ozempic (semaglutide) is an injectable drug that works by mimicking the hormone GLP1 which the body naturally produces after eating. It can create a feeling of being full and can also slow down the digestion system making you stay full for longer.

The drug also triggers the body to start producing insulin which helps manage blood sugar levels. For this reason, it is used for people with type 2 diabetes.

Ozempic is currently prescribed in Britain only for diabetes and not as a weight loss drug. Wegovy works by a similar method and is available on the NHS for weight loss.

Terzepatide—branded as Mounjaro or Zepbound—mimics a different hormone called gastric inhibitory polypeptide (GIP). But it works in a similar way, by slowing down digestion and encouraging insulin production.

Ozempic has become notorious over the past year as rumours circulated about celebrities taking the drug.

An online black market in this and similar drugs has fed supply shortages for people with diabetes.  Lynne said that these drugs could have value for some people but they don’t address the underlying relationship people have with food. If people still eat after using drugs that makes the body think it is full, this can worsen side effects such as vomiting and constipation.

Losing weight requires dietary changes and exercise. Otherwise, when people come off the medication, they risk regaining weight again.

Katherine agreed. “Weight loss needs to be sustainable and needs to be done slowly,” she said. “If you lose weight too quickly your body reacts by gaining weight again. There is no quick fix.”

Does it matter if people are ‘fat’?

Fat acceptance advocates want to end stigma against larger bodies. Its advocates are critical of the assumption that people gain weight because they are personally irresponsible. 

Some prefer to use the term “fat”. The National Association to Advance Fat Acceptance advocates terms like “fat”, as opposed to “obese” or “overweight” as those can imply that there is an ideal weight.

Others prefer to use relative terms like “higher” or “lower” weight, and terminology remains contested. But those who support fat acceptance draw attention to the way marginalised people, including the working class, are stigmatised.

There is broad acceptance that larger people may be at risk of health complications such as cancer or diabetes.

But some larger people have complained about being lectured about weight loss by doctors when it may not be the main cause of their particular health problem.

Fat people face stigma, including when looking for work. A 2021 study found that 58 percent of people in weight management programmes had experienced stigma from their work colleagues.

In recent years, larger people have become more widely accepted in the media.

Comedian Sofie Hagen and actor Aidy Bryant have provided role models of people who accept the shape of their bodies. There are more “plus sized” models in the fashion industry, but the pressures on people—especially women—to be thinner haven’t gone away.

There are certainly people who want to lose weight.

But, Katherine explains, it is important that health workers aren’t perceived as the “food police” and that there is a non-judgmental culture.

People come to dietitians saying, “I’ve been naughty,” because they ate something like a cake or a biscuit that they perceive as bad.

But there shouldn’t be moral values attached to different types of food.

People should be allowed to enjoy food. “There is no good food and bad food,” she said. “It’s a cliché to say ‘everything in moderation’ but it’s true.”