Don’t treat obesity as physiology or physics

I have a whole bunch of draft and outline blog posts from winter and spring that I was never able to find the time to finish off. To clear them out of the way, I’ve bashed out some half-hearted conclusions, and will post them this month.

Flicking through the pile of Natures that never got read properly, ready to be rid of them, I alighted on Gary Taubes’s opinion piece: Treat obesity as physiology, not physics. Bear with me while I appear to be completely off-topic talking science for a while.

Taubes argues that:

…obesity is a hormonal, regulatory defect… it is not excess calories that cause obesity, but the quantity and quality of carbohydrates consumed. The carbohydrate content of the diet must be rectified to restore health.

Taubes set out his case that it is not useful to think of obesity as a straightforward energy in/out imbalance that causes weight gain, but that it’s in understanding that specific forms of that energy — carbohydrates, and sugars doubly so — activate our body’s own fat accumulation systems (through the well understood insulin process) where solutions lie. You’ll be familiar with it from all that “Atkins diet” and “glycaemic index” stuff: energy in the form of carbs bad; energy from dietary fat not so much.

Taubes thinks this is important stuff because:

…the overeating hypothesis has failed. In the United States, and elsewhere, obesity and diabetes rates have climbed to crisis levels… despite the ubiquity of the advice that if we want to lose fat, we have to eat less and/or move more.

There is an obvious response to this, but Taubes pre-empts it:

Yet rather than blame the advice, we have taken to blaming the individuals for not following it ‘properly’.

Suggesting that Taubes thinks that if only we change the advice from “eat less and exercise more” to his “don’t eat high glycaemic index foods”, the advice will be followed and we will then succeed in defeating obesity.

I imagine any “advice” we give will be useless, whether it’s based on physics or physiology.

Because while obesity is about physics and physiology — and psychology and genetics and half a dozen other fields of science — none of those things explain what is important: why there is more obesity now than in the past, and how to make there be less of it in the future.

The laws of physics haven’t changed in fifty years. Physiology, and the genes that underlie it, can change — but only by evolution over the course of hundreds of generations, not a few decades. Sure, our bodies have a mechanism for turning carbohydrates into fat stores. But they always have.

The focus is on the quantity of energy in and the quantity out because that is what has changed during the rise of the obesity crisis. By all means refine that to a specific focus on an excess of high-glycaemic index foodstuffs and a deficit of burning off specific sugars, but the problem that really matters remains fundamentally not one of physics or physiology but of our environment.

Taubes is right to treat those who “blame individuals for not following the advice properly” with contempt. But not because the advice is wrong. Because any “advice” — right or wrong — is going to be useless. This is not a problem that individuals have created for themselves, and it’s not a problem that individuals can be “advised” to solve for themselves. This is a problem of the environment that we live in: the types of food that are available to us, and the opportunities for an active healthy lifestyle that have been taken away from us.

Taubes later uses an analogy with smoking and lung cancer, and the analogy perfectly describes what’s wrong with the idea that obesity should be treated as a physiology problem. We know a great deal about the physiology of smoking-related lung cancer. We know how all of the many different carcinogenic chemicals within cigarette smoke flow through the lungs and pass through membranes into the cells. We know the chemical reactions that they participate in and how those reactions cause damage to the cells’ DNA. We know exactly which pieces of DNA damage result in the harmful mutations that transform them into cancer cells, driven to grow and divide. We know exactly how those mutations — to genes with names like RAS and RAF, and EGFR and a dozen others — change the shape of the proteins that those genes encode, and why that change of shape causes those proteins to misbehave. We know how these things result in the tumour evading the body’s inbuilt defences, how they hijack the blood supply to allow their expansion, and how they go on to invade and destroy neighbouring tissue and eventually escape and metastasise.

And knowing these things about physiology makes not the slightest difference to solving the smoking problem. Smoking-related lung cancer, like obesity, is a process of physiology. But it’s a problem of environment. And the most important lesson from smoking for obesity is that you can’t solve a problem environment with advice alone. Bad lifestyle choices are not an individual failing. Good lifestyle choices need an infrastructure to support them.

Bristol: this is an embarrassment, sort it out

Bristol is, I think — and have mentioned here many times — one of the top three least worst cities for cycling in the UK. They understand there that it is the danger and discomfort posed by motor traffic that prevents people from cycling, and it is their steady expansion and improvement to traffic-free routes that enabled a near doubling of cycle modal share for commuting since the 2001 census, to what is, by Britain’s risible standards, a relatively respectable 8%.

And this last week the city invoked jealous looks from the rest of the country on twitter when it opened the consultation on the latest in its long backlog of cycle network infrastructure projects: a proposal for what it describes as a “Dutch-style” bidirectional cycle track alongside a main road and the New Cut of the River Avon a little way south of the city centre. Not because the few hundred metres of cycle track are in themselves all that revolutionary, but because they saw a city quietly getting on with it, happy to replace car parking spaces with cycling infrastructure, and with little of the “Crossrail for bikes”-style hype.

So it should be a subject of great embarrassment for Bristol that at the same time as designing “Dutch-style” cycle tracks that take space from motoring on Clarence Road, it is finalising planning permission for the next Facility Of The Month alongside a big new ringway road — dressed up as a Bus Route — a couple of kilometres to the south.

The latest visuals of the South Bristol Link Road are strong contenders for the most ridiculous artist’s impression of a new road yet — and gosh does that prize have some competition.

_68808465_13.07.16reservedcorridorartisticimpressionfromnewsletter

And amongst the wildflower meadows and sylvan glades of this new paradise, where morning motorists will no doubt be serenaded by songbirds as they speed uninterrupted through the city like they were promised in the car commercials, pedestrians and cyclists will be treated with utterly contemptuous shared pavements.

brt

A nineties throwback, a footway with a white line down it, interrupted by every driveway and sprawling side-road. Straight out of the government’s Manual for Crap Facilities.

Elsewhere Bristol is learning the lesson that much of its first generation cycle infrastructure — the Railway Path, the quaysides, and many dozens of “fiddly little bits” documented in detail by Sam Saunders — is proving inadequate, victim of the city’s small success, as their insufficient capacity and lack of clarity creates conflict between users. Which is why the city is learning to build “Dutch-style” clear cycle tracks — Clarence Road being the latest of a series.

And it’s why it’s so galling to see a proposal for something not even up to standards of that first generation of infrastructure. A facility that is, at best, worthy of Birmingham or South Gloucestershire.

What do we want? Marginal gains!

When do we want them? After a statutory period of public consultation

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Oh, wait, no. The chant that greeted commuters on the Aldgate gyratory from the couple of thousand who turned out at short notice for the LCC “flashride” protest was:

Blue paint: not enough.

We always knew that Boris Johnson’s splashes of blue paint on big main roads were woefully inadequate and as we pause to mark the latest inevitable fatality to occur on the most lethal of the lot, CS2, the last thing we need is friends who tell us to be less ambitious in what we ask for.

The people who came to protest at Aldgate on Friday did so because they knew it was worth their time to do so: they know that what they are asking for is worth asking for. Worth fighting for. They came to ask for things that will make a real difference. A phase change.

Not marginal gains. Not splashes at the margins that “dance and dodge around motor traffic”. Nobody ever came out on a march with pickets asking for marginal gains.

Marginal gains are not enough.

But, despite decades of failing to motivate anybody with the prospect of marginal gains, marginal gains are what some would still have us campaigning for. Why? Because the cycling lobby is too weak. There aren’t enough cyclists to hold any sway.

It’s always good every now and again to have somebody new butt in, who hasn’t been paying attention, to run through and remind us of all the canards and zombie arguments. Welcome, Guy Chapman:

We can formalise the argument with a formula. The extent to which a cause is worth fighting is dependent on the magnitude of the payoff multiplied by the probability of actually getting your way. And the assumption is that there’s an inverse relationship between the magnitude of what’s being asked for and the chances of actually getting it. So we get fans of small payoff campaigns telling proponents of high payoff campaigns to “be realistic”.

Problem is, I reckon they’ve got their probabilities wrong. And they’ve got them wrong precisely because of the fact that you’ll never get people out on the street chanting for marginal gains. All except a small hardcore of campaigners will look at the payoff, shrug, and ask themselves what’s the point. Seeing nothing in it for ordinary people, the media will ignore it and politicians will dismiss it as a single issue minority pressure group asking for favours.

Whereas, if you get your strategy right, if you ask for something that is ambitious enough to motivate people to fight for it, you will have a much better chance of achieving your goal. If it’s attractive enough and inclusive enough to appeal to more than just the usual few suspects. If it has something to offer them.

The reason why we so often don’t get our strategy right all comes back to that pernicious way of thinking that is at the root of so much that is rotten in this field, and is so excellently demonstrated in the first of those tweets:

That is, the tendency towards the assumption of monomodality. In this case it causes us to think about cyclists’ issues, and ask ourselves what cycling campaigns can do for cyclists. Even when discussing the issue of what it takes to enable more people to make more of their journeys by bicycle — what we can do for people currently excluded from cycling — too many contributors to the discussion are encumbered by this idea that this must be a job for cyclists.

And there aren’t enough cyclists, therefore cyclists can’t achieve much.

Therefore there’s no point in trying.

When actually, the correct conclusion to all this is that if we are ever to achieve anything worthwhile, what we ask for has to appeal beyond cyclists: beyond those few who are happy to put that cringe-inducing cliché “keen cyclist” beside their name; beyond the hardcore who turn up to campaign meetings. Beyond the sort of weirdoes who tell to their bewildered friends that it’s fine if you “take the lane”. It has to actually have something obvious to offer to people.

Parliament Square

If you want to motivate and mobilise, your vision needs to make an obvious offer of something worth fighting for. (via Pedestrianise London)

At its finest, Go Dutch does that. It motivates and mobilises people who would just shake their heads in wonderment at the campaigns for marginal gains. It at least brings on board what are usually dismissively filed away under “occasional cyclists” — the third of the population who use their bikes on the very rare occasions when they can do so in a safe environment, but who otherwise leave them languishing in sheds, longing for the opportunity to use them more. It even brings on board a few people who aren’t even occasional cyclists, but who can see the possibilities when they are presented clearly in visualisations like those drawn up for Blackfriars and Parliament Square. Go Dutch motives and mobilises people because it has something to offer them. It gets in the Evening Standard because it’s of interest to ordinary Londoners. And it gets the attention of politicians because it’s for their electorate, not for a minority special interest group.

Marginal gains have nothing to offer to people like m’colleague opposite, who has taken Bikeability and lives on a 20mph street, but who still won’t use her bike for anything other than recreation because to do so in London is far from fun. Marginal gains have nothing to offer to people like my friend Shiv, who, if you even humorously suggest might “take the lane”, will explain that this is a “fucking terrifying” idea. Since they are not cyclists, they are at best going to ignore any campaign to make life marginally easier for cyclists as having nothing to offer them.

Go Dutch does offer something. They can see it making a difference to their lives. That could be for them. They can sign up to that.

Your country needs you

On Friday:

Join the London Cycling Campaign protest ride this Friday calling for clear space for cycling on our streets

Meet 6pm for 6.15pm start at Tower Hill (where it meets Minories) http://goo.gl/maps/8CzmeThe protest ride will last approximately 20-30 minutes, including a brief stop at the junction of A11 Whitechapel Road and A1202 Commercial Street to pay respects at the place where last week’s victim died
The ride will be marshalled by LCC staff and volunteers, and will finish at Altab Ali Park around 6.30pm

And read more about why at ibikelondon.

On Saturday:

National rally against road-building

Saturday 13 July 2013 at Crowhurst, East Sussex

Come to the Combe Haven valley to raise the alarm about Government plans for a massive programme of new roads. Join campaigners from across the UK for a rally and walk along the route of the most destructive and fiercely opposed new road being built in England – the £100 million Bexhill-Hastings Link Road.

That is all.

Stevenage is not Britain

So a dull grey 1950s new town of 85,000 people situated 25km beyond the London boundary on the far side of the Hertfordshire green belt seems to have become the unlikely topic that has dominated cycle campaigning discussion all spring. Driving this agenda is Carlton Reid, starting with his Roads Were Not Built For Cars blog describing the dense network of separated cycle paths that were built alongside the town’s big dual carriageway roads, and under the roundabout intersections, when the new town was laid out five decades ago.

Despite its network of “Dutch-style” cycle paths, Stevenage now has a modal share for cycling in the low single figures, just like its cycle track-free neighbours: it’s a typical British town, Reid points out.

The reason the cycle tracks didn’t work in Stevenage, he goes on to explain, is that car use was not restrained. The dense network of cycle paths parallels a dense network of high-speed dual carriageway motor roads linked with high-capacity roundabouts.

Others have already pointed out that the Stevenage cycle path network is ossified in its 1960s state, detached from the parts of the town that have grown since then. And others have already pointed out that the quality of the infrastructure is frequently far below modern Dutch standards, and doesn’t come close to the density of modern Dutch networks — accompanying only the biggest dual carriageway roads, with cycle users still expected to mix on through distributor roads that are much busier and faster than they would be expected to use in the Netherlands. And others have pointed out that the 14% mode share for cycling that Stevenage achieved in the 1970s — before the infrastructure had fallen so far behind the town’s expansion — is actually quite impressive for a town built for driving at a time when cycling in Britain was hitting rock bottom.

So I have no intention of discussing those things, or whether Reid is right to shrug them off. Because on the main point — that the primary reason people don’t cycle in Stevenage is because it’s a town built for easy motoring — everybody is agreed.

I’m more interested in whether Britain really has anything important to learn from Stevenage. Because Reid goes on to draw general conclusions about the UK from this town’s experience. Dutch-style infrastructure and street design, he says, would not be enough to get us on our bikes. At least as important is making it harder to use cars. Indeed, in a particularly bizarre episode that it’s probably kinder not to dwell on, he mocks the “build it and they will come” position with a weird sports analogy. It’s too easy to drive in Britain, he says, so using the car is too culturally ingrained for cycle tracks alone to get people cycling.

The problem with obsessing over the Stevenage story, then, is not that Stevenage is not the Netherlands. It’s that Stevenage is not Britain.

The Stevenage story tells us about mid-20th century new towns, which were built with dense networks of dual carriageways to keep high volumes of motor traffic flowing freely to all destinations. Traffic really is unrestrained in Stevenage. And Stevenage really does have a deeply ingrained car culture: populated by a self-selected pack of people who were attracted out of the overcrowded capital in the 1960s and up the motorway to the semi-detached countryside with the promise of a double garage and everything else that the white heat of technology could provide.

But most places are not Stevenage. It’s ironic that those who seem most fond of the Stevenage story are so often also those who like to point out that many of the streets in the City of London are medieval and so too narrow for cycle paths.

Most of us live in towns and cities that are not like Stevenage, physically or even culturally. Not to anywhere near such an extreme extent, at least. We live in cities which are, no doubt about it, car sick. Cities which have been scarred and divided by some big roads, and cities which have been disfigured by sprawling suburbias with double garage semis, certainly. They are cities where the car has done much damage, and where built-in dependence on the car still does great damage, and you wouldn’t catch me opposing car restraining policies if you were proposing them.

But though there may be little in the way of political policies to actively restrain car use in these places, the car is not, as in Stevenage, the free and fast and utterly unrestrained thing that it is in the new towns. In normal towns and cities, which don’t have the same dense network of dual carriageways joined by roundabouts, serving multistory car parks and double-garaged homes, the car must crawl down old streets narrowed by on-street parking; sit in the congestion that it inevitably creates; and on reaching a destination get waylaid by the task of finding suitable storage. Stevenage’s lesson about the need for policies of car restraint don’t matter for most of us, because in our towns and cities, there are already massive factors pushing against car use.

The problem for us is the lack of any alternatives to go to. In Stevenage the pull of the cycle path network has to compete with the much stronger pull of the road network. Supply of transport infrastructure far exceeds demand, so people opt for whatever’s most attractive. Everywhere else, the push of congested streets and insufficient public transport is met with the much stronger push of hostile cycling conditions. Here supply of transport infrastructure doesn’t meet demand, so people make do with whatever’s least painful.

So yes, of course the formula for building cycling is multifactoral. But there’s a very good reason why there is such a strong focus on campaigning for better infrastructure, and why we might even say: build it and they will come. This is the factor that has so far been missing. In London, in Bristol, in Manchester, Belfast and Glasgow, we have the push of congested roads and too many stored cars for the space available. We have the cycle training in schools and the glossy promotional campaigns. What we’re missing is the infrastructure.

If you care about growing cycling in Stevenage, by all means, go and campaign for the factor that is missing in that town: car use restraint. Good luck to you. Make it difficult to drive and I’m sure They Will Come, to coin a slogan.

I don’t really care about Stevenage. I care about enabling cycling it where it’s needed most, and I’ll carry on campaigning for the factor that is missing in those places: the infrastructure for it. In those places, when you build it, they do come — a phenomenon I’ll explore in more detail later in the week.

The choreography of a British intersection

Copenhagenize recently analysed in detail how Danes behave at an urban intersection. I wonder what they would make of the terrifying mess that is the British urban road junction?

You might recognise the junction from the Tour du Danger series.

In case you missed it…

…I made a little video with the incoming chair of the Cycling Embassy of Great Britain, who you might also know as the author of As Easy As Riding A Bike

Full story here.