There were things at the carefree turn of the century that feminists rarely argued about in public (though pioneers must have been debating at home): trans rights, sex workers, the meaning of rape – call it the Germaine Greer trinity. Yet there was a culture war waged on middle-brow front pages that I always found nebulously misogynistic, focused as it was on women’s bodies: obesity.
“Six out of 10 women overweight,” the papers would proclaim. Excess weight occurs in men as well as women (in fact 9% more men are overweight) but it was always framed as a women’s issue. It tapped into ancient perceptions of the weaker sex – vanity, lack of self-control and a deep pool of self-loathing.
That’s why it was almost a relief to see lorcaserin across the front pages – a slimming pill that’s three times more effective than dieting alone. It was like diving back into welcoming waters, when prejudices were subtle and had to be teased out.
So yes, I want to talk about middle-aged spread, which is the technical term for “fat but maybe you should just learn to live with it, huh?” I want to talk about the muffin top, which is the insider’s phrase for “fat, and also jeans too small”. I want to pick a fight with those elements of the medical profession so besotted with the human quality of self-control that they would prefer to deal with widespread diabetes than innovate. It’s the perfect proxy for the schism at the heart of all politics: do you site your hopes for progress in the individual, or do you look to collective ingenuity?
But I also want to pick a fight with a corporate culture that creates obesity by shovelling sugar into unexpected foodstuffs, then riding to the rescue with a pill that part-solves the problem. I don’t care that this leaves me pro-lorcaserin one minute, and anti it the next. This is what debate used to be about: tolerant of complexity, accepting of contradiction, playing out the abstract in terms that were practical. Those were the naturally occurring defences against absolutism and self-righteousness. It didn’t make us any thinner, mind.
Obesity is dramatic because it generates anxiety, an emotion if not hot then at least compulsive. There’s a secondary emotional hit, which you’ll only know if you’re thin: schadenfreude, also tepid, also quite magnetic. Diet pills, as a conversation point, are the Merchant of Venice of the oeuvre, the punishment looming so large that you almost forget what the fault was. Orlistat, the only anti-obesity drug currently available on the NHS, was famous for its appalling side-effect: it works by preventing the body from being able to absorb fat, with the result that the fat simply leaks out uncontrollably. When countries were debating its licensing in the early noughties, there was a spate of apocryphal horrors, people who knew a person who’d had to wear a nappy or rendered themselves unconscious with their own flatulence.
Before that, the pharmaceutical options were basically amphetamines, which delinquents would get over the counter in the US and, sure enough, become very thin, but also unable to finish a sentence.
The stories were grimly satisfying, one in the net for the preachers of self-control: how fitting that a person, unable to control their appetite, should embark down a path that ended with them unable to control anything, be it their bowels or what comes out of their mouths.
The great hope of the 90s was the discovery that overeating was only a proximal cause of obesity: the root problem was appetite, governed by a system in which the brain flipped between two binary states, anorexigenesis (“I’m not hungry and I can burn fat”) and orexigenesis (“I’m hungry and I need to store energy”). These drives were so strong, one US medic and anti-sugar campaigner, Robert Lustig, told me, that simply telling people to resist them “is physically impossible and clinically dangerous”; also, implicitly, very cruel. But the discovery of leptin, the hormone that governed the switch, didn’t deliver the magic bullet.
Instead, lorcaserin – trademarked Belviq in the US – goes at the brain from a different angle: if food gives you a nice, warm, serotonin-ey feeling, triggering the hormone will obviate the eating (or some of it). It warns, in its list of side-effects, of “hallucinations, a feeling of being high or in a very good mood, or feelings of standing outside your body”, continuing that if you get an erection that lasts for more than four hours, you should go to the nearest emergency room.
This – if I know anything at all about obesity and public health in this country – will send Nice into a moral conniption. The idea that the overweight should be rewarded with joy, and a side of Viagra that they didn’t even order, offends everything that is decent. Won’t someone think of the taxpayers? But then, it does appear to work. So there’s that.
• Zoe Williams is a Guardian columnist
