If you're fat - unhealthily overweight - is it a matter of personal responsibility or because you're a victim of a toxic food culture?

Judith Collins was speaking to Chris Lynch in Christchurch yesterday and pooh poohed the idea of an obesity epidemic saying it was time for people to take personal responsibility if they were fat.  I tend to be of that school of thought myself - but speaking purely for myself.  If I pile on the lard, it's because I'm making too many poor choices about what I put in my mouth - mainly alcohol - and not doing enough exercise.  And I think most of us feel that way don't we?  If we look in the mirror or see fatties on the street, we don't see them as prisoners of their DNA or collateral damage in the junk food wars - we see lazy ill-disciplined greedy people.

But bariatric surgeon Dr Richard Barbour says obesity is not a moral failing. He is adamant that the science says it comes down to our genetic makeup and the food environment in which we live.

If you want to lose weight and you want to lose it permanently the most effective way to do that is surgery.

According to specialists, bariatric surgery leads to lasting weight lost, improved quality of life, remission of type 2 diabetes and reduced heart disease and cancer risk.  But whether or not you get that surgery depends very much on where you live.

Compare these two DHBs – Canterbury DHB to Waitematā DHB. Both regions have a similar population and morbid obesity rate, but the number of surgeries being done at Waitematā is far higher.  In 2017, 478 people had publicly funded gastric bypass surgery. Since the launch of the Ministry of Health's bariatric initiative in 2010, public funding for procedures reached $18 million.

But the surgeries are not keeping pace with demand. I don't know – I can gain and lose fifteen kilos over a year to eighteen months. I have friends, mostly male, who have stayed exactly the same weight for twenty odd years, give or take half a kilo.  I have no idea how they do it. But what I do know is that if I reduce my alcohol intake, and regularly exercise, the kilos start to drop off.  And that says that for me, I'm not a victim of anyone or anything.  In my case Judith Collins is right, it’s all about personal responsibility.