Is obesity really just as big a threat to humanity as terrorism?

Which of these should keep you awake at night counting the minutes till Doomsday? Terrorism? Climate change? Asteroid collisions? SARS? AIDS? None of the above, according to US professor of health law Lawrence Gostin. In a burst of impassioned rhetoric, he told the Oxford Health Alliance Summit in Sydney this week that although global terrorism is "a real threat", it’s just a teddy bear next to the 800-pound gorilla of obesity. "Ever since September 11, we’ve been lurching from one crisis to the next, which has really frightened the public," Gostin said. "While we’ve been focusing so much attention on that, we’ve had this silent epidemic of obesity that’s killing millions of people around the world, and we’re devoting very little attention to it and a negligible amount of money." Purblind politicians, it seems, are averting their gaze from the horrors to come. "In the current US Presidential campaign, prevention of obesity and the effect it is having on the poor has so far registered barely a blip on the Democratic side of politics and zero on the Republican side," says Gostin.

The obesitarians are making an audacious tilt at knocking the global warming industry from pole position. "It is true that new and re-emerging health threats such as SARS, avian flu, HIV/AIDS, terrorism, bioterrorism and climate change are dramatic and emotive," said Stig Pramming, the Oxford group’s executive director. "However, it is preventable chronic disease that will send health systems and economies to the wall."

But obesity is just one of many threats to national finances in the year 2030, to say nothing of the perils of budgetary known unknowns and unknown unknowns. What about oil shortages, depression, ageing populations, Ebola, mass migration, internet meltdown and nuclear warfare? Although the prospect of millions of avoidable deaths through heart disease, diabetes and cancer is dismaying, why should the Oscar for moral panic (and the lion’s share of research funding) go to global obesity rather than to global terrorism or global warming?

At work here are both a cynical public relations campaign and a profound moral confusion. They need to be exposed lest the next generation of panic-mongers uses the same tactics.

First of all, check the facts. Gostin got his wrong. Obesity is an issue in the US presidential campaign. Republic hopeful Mike Huckabee is the most famous ex-obese man in America. His triumphant loss of 110 pounds and his book "Quit Digging Your Grave with a Knife and Fork" help explain an electoral appeal which baffles foreigners. Since he clearly has the upper hand in the obesity stakes, it’s little wonder the other candidates have ignored it.

Second, and more seriously, is the moral equivalence of death by terrorism and death by gobbling. Even where the threat of terrorism has been exaggerated, it rends the fabric of political life. Terrorism strikes at the law and order which guarantee a workable democratic society. A suicide bomber killing himself and dozens of others in a Baghdad food market is simply not the same as sloooowly killing yourself in a supermarket with a supersize Coke and a roast chicken. The former, if unchecked, will destroy a democratic state and human rights. But a democracy of obese voters is still a democracy. It is absurd to equate the two.

But public health boffins are sometimes less sensitive to human rights. Unsurprisingly, Gostin was the author of the Model State Emergency Health Powers Act in the United States, a post-9/11 proposal to revise public health laws to cope with bioterrorism and epidemics. This was sharply criticised as a authoritarian law which would have allowed governments to quarantine people against their will and given state public health officials immunity from prosecution even for death or permanent injury.

Third, in any case, Gostin’s foreboding calculations may be completely wrong. They do not appear to account for the savings that public health systems will achieve through a decline in life expectancy. In fact, a study in the New England Journal of Medicine has even forecast that obesity will rescue the American social security system from bankruptcy. The idea that for the first time since 1900 the average lifespan of a generation will be shorter than its parents is dismaying. But the impact on the bottom line should not be ignored — if OxHA is interested in the truth.

The problem with obesity is that its victims would have died anyway – and not too many years later. The real issue is how by how many years their life expectancy is reduced. The authors of the NEJM study estimate that it is only "one third to three fourths of a year". This not negligible when spread over millions of Americans. But lethal childhood diseases in the Developing World deprive millions of victims of decades of life. Pro-life supporters could even trump this by multiplying the 40 million annual abortions by the world average life expectancy.

Finally, pooh-poohing the danger of terrorism is bound to be a public relations disaster. OxHA wants to enlist youth, activists and environmentalists in a "coalition of the committed" who will build a world of weight-watchers. Sorry, guys, but it’s impossible to get passionate about calorie-counting and regular exercise. Fighting terror, and even fighting global warming, have a social justice dimension which obesity lacks. Ultimately death by obesity is a lifestyle choice. Death by terror isn’t.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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