Book review

Review by ursula arens writer; nutrition & dietetics

Ursula has spent most of her career in industry as a company nutritionist for a food retailer and a pharmaceutical company. She was also a nutrition scientist at the british Nutrition Foundation for seven years. Ursula helps guide the NHD features agenda as well as contributing features and reviews.

the ShAPe we’re iN: how junk food and diets are shortening our lives

by saRah boseLey GuaRdian FabeR pubLishinG (26 Jun. 2014) isbn-13: 978-1783350384 amazon: papeRbacK; £10.55; KindLe £4.79

‘Being fat is your own fault. You eat too much. You’re clogging our Nhs waiting lists. You should go on a diet, get some exercise, learn self-control.’

This is the push-against position that gin women hits 38 percent (compared is the starting point for the book by to African men at 17 percent), whereas Sarah Boseley; health editor of The Chinese-origin adults only show obeGuardian newspaper. There are truths sity in seven percent. What are African to all of the above statements (if you women doing wrong? What are Chiare fat), but the author’s concerns are nese adults doing right? that the demonisation There is much disof overweight people cussion about the pos(by media, and poli- . . . when it comes to sible particular contriticians [and dieti- bution of free sugars tians?]) is unrelenting prevention and treatment in relation to the risk and seems to do little of overweight. Sugto prevent or treat the of obesity, there is much ary and fruity drinks condition. Who is to are now consumed in blame and what can finger pointing, but no greater amounts and be done (in the view with greater frequency of Sarah Boseley)? fights for ‘ownership’. than previously, and

There are no easy the author comments answers and Sarah that this may be one observes that when it consequence of previcomes to prevention and treatment of ous, and still current, public health adobesity, there is much finger pointing, vice to limit intakes of fats in the diet. but no fights for ‘ownership’. Increas- The multi-national soft drink manufacingly, media portraits of über-obese turers have all extended their ranges to individuals show voyeuristic non- include fruit juices and smoothies and sympathy and may in fact give com- the nearly cheapest natural sweetener fort to many of the viewing popula- now available to the food industry is tion who are themselves overweight, apple-juice concentrate produced in but not to the point of the fat-handicap bulk in China. The consumer is like a portrayed in the TV exposés. There are ping-pong ball of confusion between lots of statistics to confirm population concepts of natural versus artificial fattening, but of particular interest are and juice-good versus juice-bad. Pragthe peaks and dips of these figures: in matic dietetic advice on public health UK residents, obesity in African-ori- nutrition is needed more than ever,

Sarah Boseley has written a fact-filled but readable book about many of the food and health issues being discussed in the UK . . .

despite or because-of, the explosion of nutrition information sources (my view; not stated directly by Sarah Boseley).

Obesity is increasingly a ‘radicalising’ issue and there is an urgent need to better translate the various grades of fatness and fitness into health risks and outcomes, rather than the lump-diagnosis by BMI. Research published by Professor Flegel in 2013 suggested no increased risk in mortality in the US population, in those who were overweight compared to those who were healthy-weight. Fat acceptance advocates challenge some of the traditional concepts asserted by health professionals and criticisms of media hectoring of the obese. There is also dismal cynicism of the overall ineffectiveness of dieting in longer-term time periods (see the seminal paper by Traci Mann in American Psychologist, April 2007). Ms Boseley states that fresh debates over treatments for obesity are needed. A significant step in recent discussions was the stance by the American Medical Association to define obesity as a disease (rather than just an outcome of lifestyle). A decision of great consequence for medics and dietitians, but also for lawyers, administrators and American health insurance funders.

The chapter with the title ‘Mexicoke’ is about the dramatic increase of obesity in the population of Mexico (who, at 33 percent obesity, exceed US population figures of 32 percent). And the decision in 2013 to tax all sugarsweetened drinks. Perhaps as an outcome of various trade agreements between the US and Mexico, there has been a massive increase in the consumption of sweet bottled drinks; these products are cheap and attractive status symbols for a poor population, but also solve the real problems of hydration in many rural areas where the water supply is unsafe. Sarah Boseley spent some time in Mexico and gives many anecdotes of the constant messaging supporting sweet drinks; in one small market she went to, every menu board, every fridge, every chair, every waiter’s T-shirt and every chef’s apron in every single café, bore a soft drinks logo. Additionally, soft drinks are often included for ‘free’ in the all-in price of meals. Sarah Boseley interviewed many of the medical experts and health educators who supported campaigns to reduce intakes of liquid-sugars in the Mexican population, and this chapter in particular will be of interest to dietitians looking for policy details on discussions that are also happening in the UK. In any case, the entire world will be observing the experiment-Mexico, in relation to the effectiveness of fiscal measures to reduce intakes of particular foods.

Great questions about diet and health-ofthe-population are one thing. Great answers are another. The final chapter concludes with thoughts of what to do, and Sarah supports, of course, family meals, more sports and activity facilities, less talk of calories and more of eating well and quality improvement of foods that are available in schools and hospitals. Changes in social and built environments are the answer on paper, but the ‘how’ is just the start of the next open question that Sarah Boseley has left open.

Dietitians, this is an excellent book that is a zippy read, full of up-to-date and interesting information. The book does not provide detailed and structured answers to the issues raised, but then, that is the baton that is passed to our profession. Sarah Boseley has written a fact-filled but readable book about many of the food and health issues being discussed in the UK, and The Shape We’re In deserves a place on the dietetic bookshelf.