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A COUPLE of weeks ago while driving to Shepparton I stopped for petrol. I went into the convenience store to pay and, unusually, decided to have a good look around.
All that I saw was wall-to-wall sugar packed in gleaming wrappers ready to bring me joy; or sugar bottled or canned, full of bursting happiness.
One store does not make an obesity epidemic but this one was symbolic of the commercial reality that does.
Our lives have become so saturated by energy-dense nutrient-poor (AKA junk) products and their relentless advertising and sponsorship that we now consume them at toxic levels, resulting in widespread and highly resistant health, productivity and financial problems.
Recent evidence from the US (whose obesity patterns we strongly mimic) shows that obesity is likely to be causing more death and sickness than we had previously calculated. Data from AusDiab show that type 2 diabetes, one of the major consequences of obesity, is out of control.
Obesity has become one of the industrial epidemics of the 21st century. The Australian National Preventive Health Agency reports that obesity has dramatically worsened in the past two decades for children and adults, and those in remote Australia and with poor levels of income and education are more severely affected.
In 2009, the National Preventative Task Force and the AMA released wideranging and comprehensive approaches to tackling obesity. Yet when we look at the assessment sheet to date we deserve a “fail”.
Our workplaces are no leaner nor more active; our schools are yet to have physical activity and nutrition mandated as part their curricula; there is no ban on marketing energy-dense, nutrient-poor foods to our children; no taxation measures to stimulate healthy food and decrease junk food consumption; and no reduction in the relentless production, promotion and sale of junk food and drinks.
On the positive side, there are plans for a star system to indicate energy, saturated fat, sodium, sugars and one optional positive nutrient on front-of-pack food labelling, and the federal government has funded the states for prevention programs across communities, schools and workplaces.
One state government — WA — has had the guts (excuse the pun) to run a campaign (LiveLighter) to show the brutal truth of what toxic levels of sugar and fat do to us. It is the only bright light on the Australian landscape that provides us with compelling and actionable information.
The campaign encourages community discussion to force us, along with our governments, to take on two of the vectors of obesity and two of the most effective blockers to reduce obesity — Big Food and Big Soda.
When doctors counsel their patients to give up smoking, they can be sure that their patients will go out to an environment free of tobacco. They won’t be confronted, as they would have 40 years ago, by a barrage of up to 14 tobacco ads per hour on TV, billboards, and prominent sportsmen encouraging them to continue the habit. The result is we have seen smoking rates drop from 75% in men in the 1950s to 16% now.
Unfortunately, the same can’t be said for doctors counselling their patients and their families about dietary behaviour or physical activity. Every bit of encouragement and advice, and every attempt to reinforce the personal responsibility of their patients, is constantly undone and undermined by the obesity-generating environment that is contemporary Australia.
Our children constantly look up to the kings of Australian sport who have become emissaries for junk foods and sugary drinks that have no nutritional value.
When new Prime Minister Tony Abbott was the health minister he advised us to get our kids off the couch and away from the TV — he isn’t wrong, but he is only half-right.
Our obesity epidemic will only be solved — or at least managed more effectively — by a combination of personal responsibility and societal responsibility.
We need a whole of society approach, and it must be led by physician advocacy, focused as much on prevention as treatment — as has been done with other major health successes in Australia such as tobacco, road trauma and skin cancer.
Doctors can and must do more.
Professor Rob Moodie is professor of public health at the Melbourne School of Population and Global Health, University of Melbourne.
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As a young GP I cannot help but notice how poor dietary & lifestyle habits (and therefore arthritis & diabetes) are passed on within families from one generation to the next. How then do my more mature colleagues reconcile their experience and wisdom with SO much inertia? It’s an uncommon privilege to care for multiple generations of a family, with that comes a certain responsibility that needs to be played out during individual consults and in advocating more broadly for our patients. Both genes & lifestyles are inherited- encouraging proud grandpa towards healthier habits impacts on what his grandchildren see, remember & emulate in their lives- it’s their health at stake too!
Could people please stop implying that dietary guidelines have ever advocated eating sugar. Since the very first Australian Dietary Guidelines, the advice has always been to avoid, control or limit added sugars (the words have changed slightly with various revisions).
The Dietary Guidelines have also advised people to eat less saturated fat. Sadly, that has not happened. Nor have people eaten anything like the fruit and vegetables that were recommended.
Did we really expect that government guidelines would be effective when they are contradicted by foods and drinks marketed extensively? There are no ads for carrots or green beans and very few for unsugared wholegrains. Compare that with the ads for alcoholic beverages, sweetened drinks, fast foods and snack foods (sweet or salted). Are you so surprised that so few people actually follow the guidelines?
If doctors followed the guidelines for healthy food, drinks and exercise and promoted such habits to their patients, it just might help.
Not sure how useful this editorial is to a challenging problem. I’ve struggled with obesity all my life. I do the daily exercise but eat more than I need. The exercise keeps the weight a little less than it would otherwise be and keeps the biochemistry in check. The fat but fit phenomenon is an interesting subplot to what for me is a drama. The only techniques that work long term are variations on gastric surgery or lap bands as illustrated by many prominent people in the community and in the short term isolation in a healthy environment of the Golden Door style or diets which mostly last less than two years. The isolation from food required is in the house. Drugs have been disappointing counselling of various forms has failed. Food becomes a medication, soothing,mood lifting, a source of interest a point of social focus. Unlike the addictive nature of cigarettes we don’t really know why our size continues to grow. I suggest much more research and stratification of research and comments. The vilification of the obese and the assumptions about the person based on their shape already provide strong personal incentives.Now what’s needed is a feasible evidence based long term plan.
Albeit tongue in cheek since the smoking campaign worked so well, i suggest the following measures
All high sugar and high fat foods to be kept covered from view and, to be served in bags printed with pictures of organs surrounded in toxic fat. To have exorbitant taxes placed on items that fall in the unhealthy category. And for staples like bread and milk to be placed at the front of the shops
All health professionals should be engaged in this issue. I believe part of the problem lies in GPs and allied healths inability to directly address it with patients whom it clearly needs to be discussed. And yes I agree with Rosemary that these health professionals need to be seen to ” walk the talk” as it were. It is a far more convincing for a fit and healthy looking person to be explaining the benefits of a healthy weight to someone who is overweight. I think nutritionists in general have had it wrong for too long as well. It is emerging that sugar is the main problem here and not fats. All health professionals need to be up with this and not promoting low-fat (= high sugar) as has been done for many many years now. The other major issue issue here that is a primary cause of obesity is people’s lack of physical activity and has been shown to be the most important thing in terms of decreasing NCDs. All health professionals, especially GPs should be screening every patient (and themselves) for the amount of physical activity they do each day. Just 30 minutes a day of moderate physical activity is what the evidence calls for we should all be promoting this as well. Btw, nice article Rob.
Of course members of the medical profession should lead the way as a group. We know diets don’t work and GPs need to have an understanding of the problem from a more wholistic perspective. This isn’t a problem that can be addressed at an individual level. The normalisation of poor eating habits and behaviours must be questioned. GPs have a responsibility to read broadly.
The problem with grand centralized schemes to “fight obesity” is that to this day nobody is 100% sure what is causing it. A generation ago our nutritional experts came up with the classic food pyramid which advised big intake of grains and other carbohydrates and small intake of animal products. Look how well that worked out!
At this stage, it is probably fairly safe to say that sugar and high-fructose corn syrup are major contributors to obesity. However, the role of saturated fat is much less clear. It is probably too simplistic, if not outrightly false, to claim that saturated fat is bad but vegetable oil is good.
We can argue these questions all day, as the evidence is simply not that good. However, the broader point is that we as doctors should be wary of laying down the law on dietary advice when there is so much uncertainty about the dietary factors behind obesity.
Yes, doctors have an important role in public health advocacy — and that includes addressing obesity, as they did with advocating for smoke-free public places. Notwithstanding the crucial role of public policy, however, there are basic things that need to be done better with one-on-one communication in clinical settings. When a GP hands a patient a pathology form for an oral glucose tolerance test but doesn’t explain what the relevance of blood glucose levels are to the patient’s health, then it is no surprise that the patient thinks, ‘B!oody hell — 2hrs of sitting around? For what? Forget it.’ And when a GP says that there are aspects of a patient’s ‘lifestyle’ that need to be changed, it is no wonder that the patient feels defensive. Men, especially, would benefit from information and communication tailored specifically to them: research has shown that ‘health’ and ‘healthy’ foods are substantially feminised concepts, whereas the more functional concept of ‘feeling fit and well so that you can do everything that you want to do’ is not. Prevention can be a very hard sell if it is to rely for its success on conscious, deliberate decisions — the main pay-offs in terms of health are long-term and uncertain, whereas the foregone gratifications are immediate and obvious. Lack of personal motivation and the powerful influences of the obesogenic environment mean that governments will have to stop shying away from food reformulation and making changes to the ‘choice architecture’ so that the healthy choices will become the default options.
There is a real opportunity now to connect with the new Government, which is led by someone who believes in personal and health and fitness. What he doesn’t understand are the various barriers which work against other people thinking and acting as he does. We need informed and articulate ‘champions’ who can lobby effectively, and this includes demolishing the obviously effective lobbying job that the perpetrators and beneficiaries of the obesogenic environment have done to date. And if there is an ideological blind spot which makes it too hard for the Government to move to regulation as a first option, then get Richard Thaler or other ‘nudge’ experts to start seriously applying the lessons of behavioural economics so that we can start using the same tools to promote health as the marketing industry uses to damage it. But the first and biggest ‘must do’ is to get the message to the Government, delivered by those to whom the PM will have a hard time saying ‘no’, that simply expecting 20 million people to make ‘healthy choices’ in the current environment is something that just ain’t gonna happen. It would also help if social marketing were better designed and targetted to take account of the different attitudes, beliefs and health literacy levels of different population groups.
Well said, Rob.
When doctors smoked, they were ineffective advocates for change. When they stopped (and the overwhelming majority did), they were most effective change agents.
Doctors also need to take a strong role in combating obesity. I see many people who say that their weight must be OK because their doctor has never said anything about it.
We need doctors to not only have healthy eating and exercise habits, but be seen to do so. Could we start with no jelly beans for kids please? If little ones need a “present”, give them a balloon.
If you need evidence of how GPs have failed to address the obesity problem, the data around osteoarthritis management provides it: Obesity is major risk factor for OA in the knee and hip yet less than 10% of GPs have asked their OA patients to lose weight as part of the disease management. Furthermore, if GPs got their obese patients to lose just 10% of their body weight, they would help lessen their pain by up to 50% without dependence on pain medication.
Clearly GPs need to do more on an individual and collective basis.