Jane McCredie: Active neglect

IN the ongoing global war on obesity, New York City’s Board of Health this month voted to ban the sale of super-sized sugary drinks in restaurants and cinemas.

It’s a move in the right direction and one Australian regulators might do well to consider, along with more stringent food labelling requirements and perhaps taxes on unhealthy foods.

But a session at the recent Australasian Medical Writers’ Association conference made me wonder if the obesity epidemic might have grabbed an undue share of public and media attention, leading us to neglect another — possibly even more devastating — health crisis.

Several speakers at the conference raised concerns that media reports and public health campaigns tend to shine the spotlight on our bulging waistlines rather than the related, but not identical, issue of our increasingly sedentary lives. We need, they said, to start talking about the inactivity epidemic.

When it comes to the seven deadly sins, gluttony gets a lot more press than sloth, partly perhaps because it offers better visuals — think of all those television reports showing headless fat people walking down the street. As one speaker at the conference put it, “we love a freak show”.

For clinicians and public health researchers too, obesity is perhaps a clearer target than inactivity. Apart from anything else, there are objective measures for it, and ones that don’t rely on notoriously unreliable self-reporting.

But the fact that inactivity doesn’t lend itself to compelling TV footage or easy quantification doesn’t make its health impacts any less devastating.

A recent series in The Lancet called for a rethink on the issue, with one paper suggesting the global death toll from inactivity — an estimated 9% of all premature deaths — might outrank that of obesity and rival that of tobacco.

The authors estimated that in Australia physical inactivity was responsible for 10% of all-cause mortality after adjusting for confounding factors, compared with a global median of 9.4%.

We also scored above the global median in the proportion of non-communicable diseases estimated to be caused by inactivity: 6.3% of coronary heart disease, 7.8% of type 2 diabetes, 10.4% of breast cancer and 11.2% of colon cancer after adjustment.

In comparison with other wealthy nations, we did slightly better than the Americans, and hugely better than the British, but had more inactivity-related illness than either the French or Germans.

That was roughly in line with our ranking in WHO data on rates of physical activity in different countries, which show that 38% of Australian males and 42.5% of females aged 15 years and over don’t meet activity guidelines.

An accompanying comment in The Lancet series lamented that we had been slow to recognise the importance of physical inactivity in comparison with other risk factors such as tobacco, diet and alcohol. The motivation “to tackle it at a population level has not been forthcoming”, the editorial said.

One of the problems, as these commentators suggest, is that we tend to see physical activity as a means to tackling overweight and obesity rather than as an end in itself.

That can lead people to give up on exercise, seeing it as a failure if it doesn’t lead to immediate weight loss, despite all the other benefits it might bring.

Perhaps one of the keys to solving the obesity crisis might be to reduce our obsession with weight.

In the words of the Lancet comment, maybe it’s time to focus more on “using the body that we have in the way it was designed, which is to walk often, run sometimes, and move in ways where we physically exert ourselves regularly whether that is at work, at home, in transport to and from places, or during leisure time in our daily lives”.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 24 September 2012