Drink Tank

Your fault you’re fat? I don’t buy it

By Alessandro R Demaio, Harvard University.

This article was originally published on The Conversation.

This last week, my working week started in London and ended in Mexico City. Beginning on one side of the ocean in the Queen’s Capital and 6 days later, finishing up in a very different megacity, this transition was one of contrasts. From fish and chips, to tortillas and tostadas. Flat white to cafe con leche. The food, the culture, the weather – it seemed like two different worlds.

Yet as I explored the Mexican capital, one shared element stood out. Walking the streets, parks and public spaces, a commonality surprised me about both these incredible urban meccas.

Throughout both Mexico City and London, I couldn’t help but notice the amount of alcohol and junkfood advertising. Almost ubiquitous, it was largely impossible in either city to take in a view of the urban environment, without noticing the billboards, bus-boards, or moving advertisements dotted throughout the visual field. In London, the sheer amount of alcohol advertising – bus shelter after bus shelter – and on the other side of the Atlantic, the endless red and white soda billboards.

Now in countries where binge drinking and obesity are a huge strain on the healthcare system and wider society, this got me thinking. What of the continued and passionate debate (see last week’s column article) on the paradox between personal responsibility and structural determinants of these health issues. Far from a consensus, this discussion is often driven by conflicting ideology and political viewpoints. In short the question is: does our fatness and our love of alcohol come down to stupidity or poor self-control on the part of individuals? Or is something bigger at play here?

Are people making poor but informed choices on what they eat and drink, or are we all being duped by industry?

As I enjoyed my cafe con leche, in the nation with one of the highest rates of obesity in the world, I thought back to medical school. In particular, to our ethics classes and the concept of informed consent. To be able to put someone to sleep or even give them a vaccination (assuming they are not unconscious and their life is not in direct danger), then a doctor must be very careful to ensure that consent for any procedure meets three strict criteria.

So how do these stack up when we apply them to our health choices?

1. Full and open disclosure.

First, to agree to any medical procedure, the patient must be given all the facts. Not just the benefits of the procedure, but also the chances of something going wrong – however small or unlikely. They must be told in a way that they can easily understand and the onus is on the doctor to make sure they do.

Compare this to soda or alcohol companies and their interactions with consumers. Sure there might be a small warning on the label or a nutrition panel that no-one can easily understand without a nutrition degree, but it is hardly a drop in the proverbial ocean when compared to the endless ‘information’ that is provided on the benefits of consumption. Does the company have to provide all the facts and risks? No. Does the company have to make sure that the person understands soda is linked with obesity, and alcohol with cancer? No.

2. Free from coercion.

The second criteria is to be free of coercion. The doctor cannot force, mislead or talk the patient into having the procedure – or manipulate them in any way.

Now I don’t claim that companies force anyone to do anything, but the advertisements I keep seeing are certainly misleading and sometimes manipulative. Sexy scenes of fun nights out; themes of health, wealth and happiness in a poverty-stricken nation; using children’s characters and even our own names on the label to get us to try the products.

3. Be in a sound state of mind.

Finally, to have legal, informed consent even for the most minor of medical procedures, the person must be of sound state of mind at the time. They cannot be in terrible pain, or under the influence of drugs or alcohol, and they cannot be a minor.

Yet… When it comes to products like soda and alcohol – linked with serious disease outcomes – we allow advertising in bars and clubs where people are under the influence. We most certainly allow junk food and soda advertising directed at children or in the view of children. Sure, in many nations we don’t allow the sale of alcohol to seriously intoxicated customers, but are there many measures to help people make better choices before they get to this point?

I don’t buy it.

Now I am not saying that we have all been brainwashed and that we can take no responsibility over what we eat or drink. I know many of you will respond with angry calls that I am paternalistic, socialist or in favour of Big Government.

But take just a moment and actually reflect on things.

When we have almost no health education or worse, rely on industry for this; when we are ill-equipped to critically navigate the advert-laden, urban landscape; when we are bombarded with predatory advertising and the risks are written in tiny letters with almost comical brevity; and when we are hooked as children on these products or indoctrinated into a culture of wanting them long before we have the insight and critical thinking ability to question it… Is this really about personal choice? Is this really about just choosing to eat healthier, be thinner, or drink less?

At a time when two-thirds of Australians, Americans and Mexicans (and many other nations) are overweight or obese, does this rapid and unprecedented rise come down to a sudden lack of insight, intelligence or personal control on the part of individuals?

Is it simply your fault?… I don’t buy it.


Alessandro R Demaio does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation. Read the original article. Follow Dr Alessandro Demaio on Twitter via @SandroDemaio.

Alessandro Demaio

Dr Alessandro Demaio, or Sandro, trained and worked as a medical doctor at The Alfred Hospital in Australia. While practicing as a doctor he completed a Master in Public Health including fieldwork to prevent diabetes through Buddhist Wats in Cambodia. In 2010, he relocated to Denmark where he completed a PhD with the University of Copenhagen, focusing on non-communicable diseases. His doctoral research was based in Mongolia, working with the Ministry of Health. He designed, led and reported a national epidemiological survey, sampling more than 3500 households. Sandro held a Postdoctoral Fellowship at Harvard Medical School from 2013 to 2015, and was assistant professor and course director in global health at the Copenhagen School of Global Health, in Denmark. He established and led the PLOS blog Global Health, and served on the founding Advisory Board of the EAT Foundation: the global, multi-stakeholder platform for food, health and environmental sustainability. To date, he has authored over 23 scientific publications and more than 85 articles and blogs. In his pro bono work, Dr Demaio co-founded NCDFREE, a global social movement against noncommunicable diseases using social media, short film and leadership events – crowdfunded, it reached more than 2.5 million people in its first 18 months. Then, in 2015, he founded festival21, assembling and leading a team of knowledge leaders in staging a massive and unprecedented, free celebration of community, food, culture and future in his hometown Melbourne. In November 2015, Sandro joined the Department of Nutrition for Health and Development at the World Health Organization’s global headquarters, as Medical Officer for noncommunicable conditions and nutrition. From 2017, he is also co-host of the ABC television show Ask the Doctor – an innovative and exploratory factual medical series broadcasting weekly across Australia. Sandro is currently fascinated by systems-innovation and leadership; impact in a post-democracy; and the commercial determinants of disease. He also loves to cook.

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