Picture of Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

Fat people eat more ice cream. That’s not an evidence based, statistically validated or methodologically robust observation. It just looks that way to me.

Yet it fits with the Global Burden of Disease Study published this week. “British girls become the fattest in Europe” shouted the Times of London headline on Friday, and this was echoed in almost every other UK newspaper. Canadians will be relieved to know their figures are better, but those for the USA are much worse.

Overall, the world wide prevalence of obesity has increased although, interestingly, it appears that the rate of increase has slowed in developed countries.

Now back to the anecdotal evidence. Just when I fancy an ice cream, and far away from international obesity data, it’s almost certain that I will meet some obese teen ambling along, slurping a giant ice cream cone. It puts me off. It is not politically correct, however, to imply that obesity is someone’s fault. You might think that, as a doctor, you could reasonably suggest in a consultation that someone lose a little weight. But, beware! To imply, even obliquely, that someone might be fat because they eat too many chocolate donuts, candies, or biscuits is to risk a major argument. Like almost everything in health, someone else must be to blame.

Muffin tops are the norm. Jeans bursting at the button. Great wobbly bellies, man boobs, and enormous reinforced bras. Clinicians see the fat mountain daily. We already know about inflated clothes sizes and airplanes with larger seats. But, as a population, we seem blind to the need to re-calibrate portion size and challenge the nature of fast food.

The wrong food is cheap, convenient and there are too may vested interests. We live in a world of giant sized soft drinks and buckets of popcorn where even children going to the cinema consume enough calories to feed a family in Africa. Yet, we cannot accept that we are creating generation O-for-Obesity.
Controversial? I can feel the rage of overweight people saying that I do not understand; they have big bones, eat very little, must have something wrong with their glands, or it’s genetic (it’s not). But, I do concede that we are all a little to blame. We tolerate a fast food society, allow governments to capitulate to the food lobby and make it so difficult for people to be physically active.

Fat is a complicated issue.