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“Are your friends making you fat?” asks the headline of a newspaper profile of Nicholas Christakis.

Are your friends making you fat?” asks the headline of a newspaper profile of Nicholas Christakis.

Christakis argues that obesity spreads from person to person, like cholera.

John Snow's map of the 1854 Broad Street cholera outbreak

People who have lots of social connections are more at risk of obesity just as they are more at risk of cholera. Those in the periphery of the network are less likely to become obese.

This might seem strange to viewers of Channel 4s Britain's Fattest Man, which followed Paul Mason, a man who is noteworthy for being both obese and having very few friends.

I think Paul's story tells us a lot about the types of problems we face as a society and give us a glimpse of how reformed public services could better solve these problems.

As the candid consultant observed in the documentary, most of the people he sees who are very overweight have some underlying problems with relationships. In Paul's case, his main problem was that he did not have any relationships.

Paul's weight was average as a teenager but then, in quick succession, he broke up with his girlfriend, lost his job and his father died. His mother then became unwell and he moved in with her to be her sole carer.

Faced with this strain he started to eat. You can easily imagine other people in similar circumstances turning to drink or drugs, but Paul turned to food.

He ate so much that he needed to re-mortgage the family home. His sisters promptly disowned him for squandering their inheritance. His mother then died. He was acutely isolated and ill-equipped to deal with this.

He continued to eat. He was eating 20,000 calories a day, 10 times the recommended amount.

Eventually, the public purse started to support him in more and more dramatic ways. He was provided with a carer who supported him for 12 hours a day. He was given money in the form of benefits. He was given special equipment. Eventually, he was brought into hospital for a series of operations to reduce the size of his stomach. He is now of a size where it is possible for him to move around on a specially designed wheelchair, and he receives fewer hours of support.

We might be tempted to argue that the huge cost to the taxpayer (over 100,000 a year in care costs alone, the Daily Mail estimates) do not represent good value for money, we might even be tempted to agree with Paul himself, who is suing the NHS for allowing him to get so overweight.

These are both interesting points. I am reminded of Cacioppos work on loneliness and Smalls work on the role of institutions in building our social networks. I think it would be fair to sum up their arguments by saying that loneliness has a very negative effect on people and that institutions can build peoples social networks through placing obligations on people.

How might this apply to Paul Masons case?

As things currently stand Paul's isolation was partly remedied by paying a care worker to visit him for 12 hours a day. The medical consultant obviously did not consider it anything to do with him that Paul was isolated. Neither, presumably, did the Job Centre when they assessed him for his benefits.

However, the relationship Paul had with his care worker was not of the type that exists between friends and family. There was nothing reciprocal about it. He was in receipt of her presence as long as the Local Authority deemed him entitled. This type of relationship infantilizes and breeds dependency.

A different approach might have been to require and support Paul, when he first appeared to the authorities as being severely overweight, to undertake activities which might grow his social connections. He could have been moved in the direction of the local timebank or a local sports club that needed volunteers.

At present the rights and responsibilities approach to benefits emphasises the need for applicants to look for work or to attend courses to help them find work. Perhaps it is time to consider other types of responsibility being placed on benefit recipients. This would have the dual advantage of growing individuals social networks and saving the public purse since people will be less likely to need the very expensive downstream treatments such as stomach staples and liposuction.


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