Liquid diets: Iain Duncan Smith targets obese benefit claimants
Revealing Iain Duncan Smith's enthusiasm for putting obese benefit claimants on a liquid diet says a lot about the motivation of the man running the Department for Work and Pensions (DWP).
To your average Tory, giving benefit scroungers a shove in the right direction is never the wrong thing to do. IDS thinks obese benefit claimants could do with a very big shove indeed.
Suggesting they might want to consider a liquid diet is an idea which is as uncompromising as it is divisive. Some voters I've spoken to about it think it's exactly what obese 'scroungers' need (none of them were obese themselves). Others have reacted with horror that Duncan Smith could even contemplate such a course of action. Either way, his motives are revealing.
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— Frances Ryan (@frances__ryan) September 14, 2014
Tory diet plan for those 'too fat to work' http://t.co/hRJJj72Ti1 even DWP try to distance from IDS's latest barmy 'back to work' plan
— BendyGirl (@BendyGirl) September 14, 2014
At the end of the summer the work and pensions secretary met with two representatives of Cambridge Weight Plan (CWP), a private company whose celebrity-endorsed liquid diets promise rapid, permanent weight loss for those ready to commit themselves.
Duncan Smith listened to what they had to say. He nodded in all the right places, those present reported. He said he would go away and think about it all for a bit.
A fortnight or so later one of those who attended the meeting – his constituent Ruth Barber, a CWP consultant – received a promising letter.
"I have written to the health secretary to make him aware of the Cambridge Weight Plan," IDS wrote.
"I have also asked my department to investigate the possibility of introducing this as an option for those who are too obese to work."
What Duncan Smith did not do is dismiss this out of hand. He did not say 'liquid diets are completely inappropriate for benefit claimants'. He did not say 'I utterly rule out even suggesting to claimants that they should consider foregoing food in order to guarantee their benefits'. Instead he chose to entertain the possibility that giving claimants the "option" of surviving on a diet of nothing but soups, shakes and bars might be a reasonable course of action to take.
When this is put to officials working for IDS at his department, they shrug it off as a 'constituency matter'. The implicit assumption behind this thinking is that anything a politician says to placate an actual voter should be automatically discounted as irrelevant to the serious business of actually running the country.
You might, just about, apply this thinking to the first of IDS' points. Writing to the health secretary is very much the sort of thing any local MP does when a constituent bugs them with a specific issue. But you can't fob voters off when the issue at hand pertains to your own department. This approach just doesn't wash when you are, er, yourself, the secretary of state.
Government figures obtained by a freedom of information request reveal the motive behind IDS' thinking. That these have been released at all is a minor miracle, for the government wasn't actually supposed to be telling us this information. The DWP revealed, in response to a question about the cost of claimants with obesity-related issues, that obesity had added £28 million to the total benefits bill in 2012. When an attempt was made for comparable figures in 2013, officials initially resisted on the grounds that they were never supposed to be published as annual data. Eventually, though, they backed down.
The data were striking. In just 12 months the total cost had jumped up to £40 million – three-quarters of which came from 5,890 disability living allowance claimants. The total number of people who are 'too obese to work' had risen from 7,080 to 7,750.
This is part of a much bigger national trend. There are one million more diabetics now than there were seven years ago. 'Morbid obesity' – that is, those with a threshold body mass index of 40 or more – is the UK's fasted growing weight category. A quarter of those aged 16 or over are now obese.
IDS – who for all his faults is one of the longer-term thinkers in the Cabinet – knows this can only be bad news for the overall benefits bill. The Conservatives' welfare cap, which when it comes into effect will brutally squeeze the welfare state, is a big enough challenge for this country's most vulnerable. Obesity is just another emerging obstacle which is making it harder to keep this huge contributor to the nation's public finances in check. No wonder IDS, presented with a possible solution, pricked his ears up and expressed interest.
Professor Anthony Leeds of the Central Middlesex Hospital, the University of Surrey, and CWP, was at the meeting. He wrote to IDS afterwards calling for an interdepartmental working group to examine the options.
"A block grant could be allocated to DWP to enable job centres to steer suitable overweight and obese people towards providers (NHS obesity units or private providers who would bid for contracts)," he said.
"The important endpoint would be a return to employment for more than six months, with the body weight changes and medical outcomes being secondary measures for the purposes of the economic review done at the end of, say, two years. Providers would be well advised to include a range of options including diet with exercise and psychological counselling as well as surgery for some cases."
This particular idea has numerous benefits for a cash-strapped government. For a start, it is economically sound: at £45 a week, the cost of the Cambridge Weight Plan diet is less than a typical weekly food bill. Then there is the speed with which it works. Five out of six dieters, it is claimed, can get back to work in under three months. Finally, there's the possibility that these liquid diets could even be funded by the NHS. Apart from unsubstantiated rumours of a Scottish NHS Trust trying this option out, this hasn't happened yet. If it has happened, it really would attract headlines. If it could be defended as effective, though, who knows what this government might not try?
Right now the Department of Health is being distinctly off-ish. It sounds like its officials resent being bugged by the problem by another Cabinet minister. A spokesperson pointed out the National Institute for Clinical Excellence (Nice), which is the main judge of this sort of thing, is currently looking at the guidelines on how to manage obesity and the overweight. Right now they're not recommending that anyone looks at low calorie diets.
CWP says this is grossly unfair. It is frustrated by Nice's work, complaining it ought to have examined the evidence for using formula diets before surgery. Swedish research, it says, shows that two-and-a-half stone of weight loss can be lost using low-calorie meal replacements, and that the weight stays off for four years. Anecdotally, this is being questioned.
These before-and-after photos show Steve Hancock, a 50-year-old former binman from Wolverhampton. He used to suffer from sleep apnoea, the 'silent killer' which afflicts many obese people. At his worst, he stopped breathing 82 times a night. But following the CWP diet helped him. "My dad was diagnosed with bowel cancer. Every week I would go straight from my weigh-in and he'd be so pleased for me when I'd tell him my loss for that week. He used to say: 'I don't want you to end up like me.' He passed away in August 2011 and I vowed to reach my goal for him." Happily, Steve did. He now works as a lorry driver and feels young again. He has put on a very small amount of weight from his low point, but feels healthy and has succeeded in keeping the weight off for three years now. It's a tremendous achievement.
Still, Steve has doubts about whether his approach will work for everyone. His comments put CWP's claim that liquid diets are a panacea for Britain's obesity problem in some perspective. "Liquid diets are fine for the short-term," Steve says, "but as soon as you start eating normal food again you tend to put weight back on."
CWP fears Nice will reject the Swedish research it pins its hopes on. If that happens, IDS' offhand gesture of interest looks likely to get stuck. Ultimately obesity is not within the purview of his own department. He just has to pay the bill.
What this sorry episode does reveal – if we didn't know it before – is that IDS is a man who wants to make benefit claimants do something to earn their money. If they're too fat, that means losing weight. He looks for opportunities to cut the benefits bill wherever he can. If that means drastically shaking up the lives of those who need the state's help, he is prepared to do it.
To some, this willingness to act makes him a minister to be admired. To others, it makes him a monster.