The men who made us thin. Part 3.

Jacques Peretti investigates the rise of the diet industry. In the third of four programmes, Peretti discovers how the World Health Organisation’s recognition of obesity as an epidemic generated huge profits and explores some of the latest developments in bariatric surgery. The BMI is one of the simplest methods of establishing whether a person is overweight, and is relied upon by doctors worldwide. Over a third of the UK population falls into the ‘overweight’ category, making up the largest market for the slimming industry. Although surgery has previously been available to the obese, a new operation is being targeted at moderately overweight individuals. Tom Lavin, one of the first to offer the minimally invasive procedure, predicts that it will soon become routine. A BMI of 25-27 was considered normal until a shift in US policy in the mid-90s instantly reclassified 29 million Americans as overweight. Key to the change was a report written by leading British nutritionist, Philip James. In 1995 James established the International Obesity Task Force. Informed by pre-WWII MetLife insurance data (mentioned in episode one), the IOTF report recommended lowering the boundary of the BMI overweight category from 27 to 25. Although adopted by the World Health Organisation, the new standards have their opponents. Judith Stern, former VP of the American Obesity Association, claims that the move was not supported by science – she suggests that it was politically motivated. The IOTF received substantial funding from the pharmaceutical industry. James denies that the drug companies influenced his report, although he admits their backing allowed him to bring the topic to the world’s attention. Stern does not consider those with a BMI of 25-27 to have a medical problem, and believes that the label causes unnecessary psychological distress. Legal expert Paul Campos describes how the issue inflated into a global panic, paving the way for profiteering. One of the main beneficiaries was the food industry, which responded by developing slimming products. Bruce Bradley, former marketeer for General Mills, is upfront about the industry’s desire to cash in. One example is Special K; Kevin Brennan, former marketing director at Kellogg’s UK, explains how the product was targeted at women. The ‘two week challenge’, which encouraged dieters to replace two of their daily meals with the cereal, was a particularly successful marketing ploy. Artificial sweetener was crucial to the development of these products. Peretti explores the history of sweeteners, beginning with Tillie Lewis, one of the first to manufacture artificially sweetened diet foods in the US. Carolyn de la Pena explains the ‘guiltless pleasure’ mentality that allowed dieters to eat sweet foods, as long as they chose diet products. But recent studies have shown that rats given sweeteners actually put on weight. Professor Dana Small at Yale set out to discover if the same was true for humans; she discovered that the brains of those who used sweeteners demonstrated a weaker response to sugar. By the early 2000s our increasing obsession with slimness was boosted by celebrity culture. Emma Rich from the University of Bath describes how ‘fat’ became politicised and moralised, increasing body anxieties. Moving on to the role of women’s magazines, Peretti talks to photographers agent Danny Hayward who describes a staged campaign with Jade Goody featuring her yo-yoing weight over a six month period. Peretti then travels to Malmo, Sweden to learn about a new device, AspireAssist, which makes it possible to lose weight whilst eating as much as you want. The procedure passes a tube from the stomach to a skin port which, when opened, evacuates up to 30% of its contents. Michael, one of the first to undergo the surgery, demonstrates how the device works. He believes AspireAssist will best serve obese adults who have made a permanent commitment to maintaining a healthy weight; Peretti remains concerned that it will be marketed to a wider market. In Los Angeles, bariatric surgery is big bucks. Peretti meets Mal Fobi, pioneer of gastric band surgery. By performing the procedure on celebrities, including Roseanne Barr, Fobi boosted the profile of bariatric surgery. Surgeons in the US now want insurers to cover surgery for those with a BMI of 30. Fobi admits that as a doctor he goes after the private market and has even operated on female models with a BMI of 27. Recent research suggests that those in the overweight category actually have slightly lower mortality rates than those in the normal category. Katherine Flegal, US government scientist, discusses her findings. James declares Flegal’s papers an embarrassment to the discipline – a position refuted by Stern, who claims that Flegal’s work was only dismissed because it threatened existing government policy. A small number of academics are now calling for a change of focus to fitness rather than fat. Grassroots activist Angela Meadows believes that weight is equated with health because it is comparatively easy to measure. Peretti joins a female boot camp to find out if it is possible to be both fat and fit, concluding that in our ever more extreme attempts to be thin we have lost sight of what matters; being healthy.