In this new segment - Bad Public Health Takes - Jane and Chris dissect Prof Susan Jebb's suggestion that bringing cake to work is like passive smoking, and whether taking weight-loss drugs is cheating.
Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com
In this new segment - Bad Public Health Takes - Jane and Chris dissect Prof Susan Jebb's suggestion that bringing cake to work is like passive smoking, and whether taking weight-loss drugs is cheating.
Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com
cake passive smoking
SUMMARY KEYWORDS
people, cake, drug, passive smoking, eating, public health, bodies, workplace, obese, doctors, article, full body shots, appetites, argument, office, thought, freewill, smoking, idea, Australian
[Intro]
Chris: Okay, so welcome to a new segment of disciplinary. It's called bad public health takes, I think we're gonna call it shit public health. But we want to keep it family friendly. And I think the idea, if we can contain ourselves, is that they're going to be shorter and punchy, little episodes on things that perhaps have appeared in the media or public discourse around public health. Usually, I think some kind of public health body or public health professional coming out with a hot take as to what they think could solve what usually is a very complex problem. So Jane, what are we talking about today?
Jane: Well, what triggered today's bad take was the recommendation that there should be no cake in the workplace. I was shocked. Hurt. I like cake. So yeah, background is the UK Food Standards Agency chair, who is Professor Susan Gibb in the UK has put forward an argument that people should not bring cake into the workplace. Now, she said that that should not happen, we shouldn't do it for the sake of our colleagues health.
So apparently, she's speaking in a in a personal capacity here, not as a representative of the Food Standards Agency. So you know, cutting her a little bit of slack, might have been an off the cuff sort of comment, but probably not because she backed it up with a few, I believe poorly thought out ethics arguments, which is kind of what piqued my interest apart from sadness about cake. Well, I mean, so the idea I believe she said is it's like passive smoking, bringing in cake is like passive smoking. It may have been an off the cuff mark, but that is such thought, or meme within public health, that anything that can be associated with smoking or passive smoking, then can be you know, garner a whole bunch of interventions.
You know, another funny one that I remember not so long ago, bacon, eating bacon is like smoking cigarettes, etc. So it is part of the genre of something is like smoking.
Alright, so what does she say? It's because essentially, I didn't read this article, I just read the headline.
I read it several times. Well, you know, the point about smoking is interesting because she makes the explicit connection and says we've done this with smoking already. It has worked now we need to do with food with this very specific thing about cake, which again, feels like a personal attack, but I'll let it slide. I'm not quite sure why cake is the demon here?
I know because we could round up all of the cheese toastie makers in offices because yeah, that that would be my weakness. It's not usually no one usually brings in toasted cheese sandwiches to share, which they should we should bring in to share with our colleagues like jaffles.
Okay, quick aside, is it an Australian thing or a New Zealand thing to have tinned spaghetti in a jaffle?
I've done yeah, I've done it, but it can be very hot. Very hot, very messy.
All right. So in addition to saying that we need to be treating cake like cigarettes. Professor Jebb made three kind of spurious ethics claims about why we should keep cake out of the out of the workplace. The first was that she said that cake in the office undermines freewill which is kind of interesting, that freewill thing. I don't want to call it an argument exactly, because it's just a, maybe a bit of a thought bubble. It seems to come up a lot when we talk about bodies and food, and specifically diets, you know, what people eat.
I would have thought that undermining somebody's free will, when it comes to cake would involve sort of holding them down and putting it in their mouths.
Oh, you could have eating cake is a condition of your employment.
There you go. Okay, that is a much better take.
So, one, cake in the office undermines free will. The second is seems to be a sort of harm principle argument, right, saying that you have an obligation not to bring cake into the office for the sake of your colleagues health. Right. So the idea that you need to be mindful of how you're harming other people by bringing cake into the office. That seems to me to be quite a leap. Yeah.
But, but you can do lots of like the harm principle can be so loosely and flexibly applied. It's sort of I remember there was that BBC, BBC documentary a few years ago about the power of nightmares, which was more about politics at the time, Tony Blair and George W. Bush around, you know, the invasion of Iraq, but essentially, like, if you can imagine, so just the link being the sort of power of nightmares the power of creating and suggesting a harm relationship, then it can require some kind of intervention, because it was a similar thing used around people who weigh more, should have to pay more for their airline tickets, because not only are they taking up more space, but they're using more fuel to move the I mean, I just can't help but always laugh at that suggestion. But anyway, there you go.
So did I see this just last week? [Oh, it's back again] No, slightly different is that people who weigh less should have a bigger baggage allowance.
Same thing differently put, shocking to read, don’t know what else to say, but still current?
Yeah. Oh, and my final thing about Professor Jebb’s thing is that we have in addition to this kind of harm principle thing, that we have a moral obligation to provide supportive environments.
And that that somehow in the workplace, and extends to food. And that, to me, is kind of an interesting one, right? Because a supportive environment can mean a whole lot of different things. And I would like to give a big shout out here to my own workplace, which has a morning tea that happens from time to time, where people volunteer to bring cake. And the point of that morning tea is to get people a) into the office, because we're all still a little bit stuck in that, you know, COVID era working at home, and b), to get people from different offices in different sections of the school to get together and have a chat and have a cup of tea. And obviously, they don't need to eat cake. But it's a thing that brings people in. There is not an obligation, not a cake condition of employment.
Well, that's right. I mean, it could be you could use a social isolation argument to counter the no cake argument to, you know, the importance of bringing people together. But why can't people be brought together around celery sticks, carrot sticks, and hummus?
They may not choose to come downstairs, if that's on offer, I don't know. Oh, they might. I mean, you know, maybe. So another sort of supportive work environment thing is, do you want to sit together and have lunch and just meet at this place at 12 o'clock, and just bring whatever you're having? You know, so that doesn't involve any sort of food obligation. But it is a meeting that centers around food, you know, this is what we do. And this is a real problem with equating food and cigarettes and I know that the cigarette break was previously a way for people to get together and talk shit outside the office.
And, you know, maybe food has taken the place of that, but food does have a different or more perhaps wide ranging, I think cultural sense set of meanings and understandings. Yeah. Cigarettes.
Yeah, well, I think you know, like the age old solution is always like, hey, do both you can have a bowl of fruit and some cake. But I think the underlying thing as well, and the podcasts that I quite enjoyed the Maintenance Phase had a thing on work wellness and how, you know, I think to quote, they're mildly bullshit. A lot of that is, is that you know, how much of our workplaces need to become spaces or policing bodies and food choices. Like we've talked about this before. But I find it very frustrating when people comment on what you're eating at work, if it's anything other than those chicken nuggets look nice.
You know, I just think any sort of commentary on what other people are eating in the workplace is just, yeah, sort of one of those things that should become more seen as not a social norm, perhaps, but there's a lot of commentary on that I find. And Professor Jebb then equating it to passive smoking seems to be another bit of a stretch. Yeah. So another thing that she does is that she she talks quite a lot about people's health. But really what she has to be talking about here, I think, is the size of someone's body. Because we have no idea what people's health status is. And we, you know, we have a tacit agreement that we don't delve into people's personal health situations, right. So when she's talking about providing a healthy environment, she's she's saying, let's have an environment where people don't have big bodies, presumably, if they don't want them? I don't know. But I think she probably doesn't think about that bit.
Yeah, yeah. Well, yeah. Then the people with the bigger bodies, either are on a diet or should be on a diet according to this logic. And so that's where the providing of cake is undermining their, quote unquote, free will.
Yeah. But to me, it just seems a reach with predictable reach with the smoking analogy. And just a continuation of policing people's choices and bodies in a work environment.
Yeah, bad take bad take.
Maybe moving on, though, a little bit from the saying no to cake in the workplace. We could talk a wee bit about the cover story in this past weekend’s, Australian. So when would that have been?
It was the fourth of February and for the international listeners, the Weekend Australian is I guess, Australia's only national newspaper. But it is a Murdoch publication, if no doubt if you're in the UK or US.
But that's not to say that, therefore this is a bad story satisfied? No, the boo was for Murdoch, for sure. Yep.
Yeah, so that was kind of interesting. It was, it was on my mind because of the cake thing. And so and I was quite struck when I walked into my local IGA to get some milk by the picture of a person with a bigger body on the front page saying, I don't remember exactly what it says now, but the story says disease or lifestyle, should it basically be managed through diet and exercise alone, or with the help of new weight loss drugs, the medical community is divided. So the story was about the medical community being divided.
With that said, there were people with bigger bodies in the article talking about their experiences. I don't know if you notice, Chris, that but those people all had full body shots, whereas the experts the presumably, I don't know who knows what their bodies were like, didn’t have full body shots. So there's the headshot and the full body shot. And it's kind of interesting. I was thinking about the work that you were doing previously about the headless fatty, right?
Yes, yes. Well, that's fine. It's at least this way. They've still got their head. They've got their heads.
But it's kind of like we don't need to know what people look like to understand their experiences. And in this in this article, some of the struggles that they've had around weight and weight loss and interactions with the medical community around us. So full body shots do seem gratuitous.
Yes, I guess that said the arguments were. I guess, just just before moving on, I would say that the the full body shots are majority of them are tasteful shots in and of themselves. They're not like in the past, Australia had a public health campaign where they had people basically in their undies. So it wasn't.
Yeah, they were sort of wearing regular street wear, just sort of on that.
But yeah, the point still remains, and probably feel really good about the way that they look in these photos, which they should, because they're nice photos. It's more, that there seems to be a need for the photos to be to kind of illustrate the point or something.
But I guess going back to the sort of bad public health take the divide that is talked about, and here on the one hand, there are doctors who say there are drugs available for people that can help curb their appetites. It seems to be so Diabetes drugs, for example. Ozempic, which I believe is the only one that is available in Australia, although it's currently unavailable in Australia, though it's approved and has previously been available. And other doctors who say no, because a shortcut or an easy fix is not an appropriate thing.
There are different reasons given some other if there's an easy fix, then we won't do the systemic work that needs to be done to reduce obesogenic environments. The second is that if you give someone drugs, they'll just keep eating cake. And that's clearly bad. And the third, what was the third?
Well, the third is related to the second I thought, which was the highly moralize people should the reason why people that is that they're eating and not exercising. And they shouldn't have an easy out for that they should have to do the work do the work. That's exactly it. Yeah.
Yeah. So the moralizing part obviously is depressing. Because all of the people who were interviewed talk about how hard they have worked. They've done the work, you know, they've severely restricted their calorie intake and so on.
And we know that that doesn't work. So doing the work isn't interesting sort of moral take?
Yeah, because it doesn't work. Yeah. But then then the thing that I thought was good with this article, when they say the author of the article is Natasha Robinson. So I did like the way that they interviewed some people who have, who are obese and don't want to be and have been trying all of these different approaches for many years. And really talking about, you know, to quote, their the psychologically devastating aspect is that despite all of their will, and discipline and organization, whenever they go into sort of doctor's offices, they're told calorie and calorie out. And then when they say that they've done all of that, that basically, it's not believed and called to be liars. And I think that that also ties into the long, longer history of seeing fat people as somehow deviant, both in embodied form, but also
Yeah, they're clearly not telling the truth. If they say, yeah, and people will sit there their work thing, just pulling it back to the work, right.
The idea that one of the one of the people interviewed said something about not going for a job or not wanting or not feeling like they could really advance the career. Because if they can’t manage their own bodies appropriately, how are they supposed to manage other people? So this idea that what you just said basically, that people as well as having, I guess, unruly bodies, that they're not able to exercise the freewill that is somehow is supposed to fix everything.
Exactly that idea, though, of having control over the self to have control over other people and to have a managing position that is like an ancient idea going back to the Greeks as well in relation to, if a man can't control his sexual and dietary appetites, then he can't control his family, and he can't then control the city and be a Senator.
So, yeah, I think that these are ideas that over the years have had just different medical glosses to them to sort of provide these justifications.
But so what with this, what's the what's new? Because for me, some of it was I just felt like reading, you know, I have my PhD work on this in 2008 to 2010 was sort of this same kind of stuff. But the one of the differences is this introduction of a drug. I mean, what did you make of that, as you know, I think it was referred to as a paradigm shift, and seems to be the one that has picked up this, you know, quote, unquote, divide between some doctors who think it's good, and others who think that it undermines either the environment or the need to do the work.
And so that's interesting, because I was like, oh, what's new here, and I didn't see the drug as a paradigm, paradigm shift. I should say here that I know nothing about the drug. But I was, in my head I was like, isn't this what they did with speed in the 70s? You know, like, with all the women on, I don't remember what the drugs called. Right. But is this new? Or is it a new drug that is being promoted?
Yes. Well, certainly the idea of using a drug to, you know, to address body weight is not new. Like and you could even throw in the old tapeworm. I guess, using some kind of agent to accelerate weight loss is not new. But I think these, these particular types of drugs are seen as a new breakthrough. They, I think they they sort of are like a blocker in your mind, one of the users of them describes saying that they blocked the sort of appetite and desire to eat.
Yeah, but I mean, I found it was, there was some things, say, on the doctors who are opposing the introduction of this, some things I agreed with, like, for instance, the idea that, you know, in labeling something, a disease and seen as a pharmaceutical fixed for it does open up, you know, it does serve the interests of the pharmaceutical industry significantly and open up a big market for them.
But that doesn't necessarily mean that it's, you know, inappropriate to use it under certain circumstances. It's like, I guess, Prozac and other sort of anti anxiety and antidepressant.
And that seems to me be the real confusion in all of this discourse, at least from when I've been paying attention to it from the mid 2000s, which is this lumping together of overweight and obese. So there's and there's lumping together at the statistical category that you can bump it up to, like 66% of Australians are overweight and obese, and then bring in this drug discourse. And then so someone then is one of these doctors who are opposing it says are well, you'll be having the whole Are you going to be giving this drug to you know, the whole of society, there's a whole of society option. Whereas then other doctors in the article talking about that there is a very small percentage of people who are morbidly obese who have metabolic syndrome, who, no matter what they do, they will not be sort of reducing weight, and its impact on health and movement and all of those sorts of things. And these people this drug is helpful. So similar from what I understand with things like anti anxiety medication, that for people, it provides a sort of blocker to that to them, for them to be able to sort of re stabilize their lives and what they're doing.
But yeah, yes, and I thought that as well. Until I was reading about, Wegovy which is not available here yet. Which is indicated and adults with a BMI of over 30.
And this is where the pharmaceutical? That's right. And this is where the pharmaceutical industry argument, I think becomes really important because the if we're going to say 66% of the population is at some significant health risk to themselves and society because they have a BMI over 25. Then it does open up an enormous market. Whereas if we're focusing on the 5% of people who have, for a variety of reasons, morbidly obese to, you know, one of a better description and desiring weight loss, then it's a much smaller area of intervention. Yeah, yeah. And so my big bugbear is always this. And it sort of comes out in sort of these different contradicting moments throughout this article of this is a public health national issue.
Because we're going to lump together overweight and obese. But then we're also talking about this very small portion of people.
So there's no there is a section said yet broad societal level prevention strategies do little to assist those with living the severe obesity who frequently live in isolation and racked with the feelings of shame and failure around them to just slip straight into it around two thirds of Australians are overweight or obese, with roughly 1/3 overweight and 1/3 obese. So yeah, just it's sort of slipping. You know, it's basically a sort of that book, How to Lie with Statistics.
You know, I thought that that could have used a really lovely edit, or at least a paragraph break, or not included those stats at all.
Yeah. Agree. My only other comment really, is that freewill features fairly prominently in this in this Australian article as well, from doctor's comments.
And and to be fair, they're saying this isn't about this isn't an issue of freewill. They're saying that that people are unable to control feelings of hunger and yeah, feelings of hunger, I believe.
Yeah, I mean, my only concluding point would just be how, firstly, listen to people and believe them, if they tell you what they eat, that's what they eat. But also, just the underlying assumption, you know, to quote, one of the doctors saying that a potential quick fix, you know, people can just keep on eating all their junk food and ultra processed foods and just take a tablet, this idea that is so prevalent in public health that people like, it's the same as when that study comes out and says that, you know, glass of red wine is good for your health or chocolate, you know, someone from, you know, I could name names, but I don't want to get into trouble will come out in the media and say, this is, you know, irresponsible reporting. This is giving a green light to people to just drink red wine or eat chocolate, or in this case, it's like, people are mindlessly just, you know, shoving their faces with cake, even though as a lot of the qualitative research has shown and also even in this article, that people who are trying to lose weight, the opposite of mindless they are sort of, you know, worryingly obsessive over everything that's going in. Yeah. Yeah.
And if I can just put in one final comment that is that on the very front page, and you're going to have to listen to me rustle now. It's personal problem or society's fault rewrite of obesity treatment rules to banish stigma. And stigma is in scare quotes. I guess I would like to tell whoever does the headlines at the Australian. That stigma is real. Yeah. Yeah. It's not a made up thing.
Yeah. Well, that's right comes back to believing people.
Well, thanks a lot for listening to this first episode of our first segment, I should say public health takes Okay, bad public health.