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14 June 2012, 6.36am EST

Knowledge is power… but it won’t help you lose weight

Researchers have been telling us for decades that being overweight is not good for our health. Medical journals are full of articles that link overweight and obesity to just about every disease and illness in existence, including mental health problems. Not only that, but in my field of the developmental…

Vc64kj63-1339550359 — Psychological influences on weight problems are extremely important, but are often overlooked. vistavision

Not only that, but in my field of the developmental origins of health and disease, we’ve linked obesity in one generation to multiple problems in the next.

Excess weight and obesity place huge cost pressures on Australia’s health system. In 2005 this cost was estimated at A$21bn … annually. And there are plenty of other social and economic costs involved with being overweight, especially given the marginalisation of obese people in our society.

As scientists, we believe that knowledge is power. So surely, the knowledge of how bad being overweight and obese is for our health, and the knowledge of the enormous social and economic costs, is all we need to start reducing our waistlines, right?

Wrong. Rates of overweight and obesity in Australia are increasing and the trend is predicted to continue. By 2025 an estimated one in three children will be overweight or obese. Overweight could in fact be the “new normal” for future generations.

So while researchers are busy trying to disseminate knowledge and education about why it’s bad to be overweight, we’re getting heavier. Is it possible that the solution isn’t based on knowledge and education?

Let’s consider the barriers to this knowledge actually leading to change.

Psychological influences on weight problems are extremely important, but are often overlooked in favour of dietary changes. But negative self-perception and attitudes towards eating play an important role in the development and maintenance of obesity.

For many people, food is a source of comfort. Paul Goyette

For people who are overweight and obese, being told in so many different ways that big is bad doesn’t encourage a healthy self perception. And society tends to have negative views of being overweight, associating it with laziness or unattractiveness.

Psychologists know that when an individual has a low sense of self-worth or feels disempowered, they are not only vulnerable to mental health problems, but their self-efficacy, which is their belief in their ability to change, is challenged. So the information not only makes people feel bad, it also limits their ability to make changes towards achieving a healthy weight.

Plus there are a myriad of attitudinal influences on weight maintenance that knowledge alone can’t always shift. If, like me, you grew up in 1980s when Bob Geldof and Band Aid were crooning about famine in Africa, you probably heard the phrase “Don’t you know there are starving children in Ethiopia?” whenever you attempted to leave the dinner table without finishing everything on your plate. This is one simple example of how early lessons about food can play into later weight problems: wasting food is associated with guilt, so food must be eaten.

Another example is viewing food as a source of comfort. If you tell someone who uses food to soothe their emotions that they can’t eat that comfort food anymore, it leaves an emotional void that needs to be replaced by something else if weight loss is to be successful.

So if knowledge doesn’t work, what does?

Psychological weight-loss strategies that address the thinking and behaviour behind overweight and obesity tend to be far more successful than trying to target diet alone. But each weight management group might comprise eight to ten people, and there are around 300 million people worldwide who are obese. What we need is a population approach.

Recently, New York Mayor Michael Bloomberg announced plans to ban the Big Gulp (jumbo size soft drink cups) in his city. This move would actually ban all sugary soft drinks more than around 470ml, not just the Big Gulp.

In the same week Disney detailed plans to restrict advertising on its children’s television channels for food products that don’t conform to strict nutritional guidelines.

I don’t like the idea of bans per se, but these initiatives have the potential to change the culture around our consumption of foods that contribute to weight problems from an early age. They challenge the “normality” of eating unhealthy foods by limiting their availability and promotion.

But perhaps the most effective solution would be to prevent obesity from conception. Ensuring the optimal pregnancy environment to encourage a birth weight within the normal range is thought to reduce the risk of obesity later in life, when compared with low and high birth-weight babies. Support for mothers, particularly those living in social disadvantage, can help introduce positive nutrition practices right from the very start of life.

Focusing our attention on early life is resource effective in the long term, and prevents the establishment of food choices and behaviours that lead to life-long obesity. Prevention is the pathway from knowledge to change.

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52 Comments sorted by

James Jenkin

EFL Teacher Trainer

Monique, thank you for a very interesting article.

I'm curious when you say 'I don't like the idea of bans per se'. Why not? If you believe state intervention is important for public health outcomes, how do you decide what is acceptable and what is not?

For example, if banning large serves of soft drink has the 'potential to change the culture' for the better, why hold back? Why not ban fast food altogether?

11 months ago report
1. rory robertson
  
  rory robertson is a Friend of The Conversation.
  
  former fattie
  
  In reply to James Jenkin
  
  Before we start banning anything, let's start by educating everyday people on the fact that sugary food is much more of a problem that fast food in general. On this, try http://www.guardian.co.uk/business/2012/jun/11/why-our-food-is-making-us-fat
  
  Why not take my $40,000 challenge? To be clear, I will reward the first successful researcher with $20,000 (cash), if anyone is able show beyond dispute that the available (valid) information really "…indicates a consistent and substantial decline in total refined or added sugar consumption by Australians over the past 30 years". (Check it out at #10 and #11 in http://www.australianparadox.com/ ).
  
  11 months ago report
2. Monique Robinson
  
  Associate Principal Investigator, Telethon Institute for Child Health Research at University of Western Australia
  
  In reply to James Jenkin
  
  Thanks James for your interest in the piece. I suppose what I mean is I'm not an advocate of banning things that have accompanying risks as a first course of action. Legislating against fast food is too simplistic and implies the weight problem is only based on fast food where so many factors (eg portion size of healthy food) influence weight.
  
  11 months ago report
3. James Jenkin
  
  EFL Teacher Trainer
  
  In reply to Monique Robinson
  
  Thanks very much for your reply Monique. What's your opinion on the libertarian argument that state intervention can have unintended consequences - in particular, when people feel governments should make decisions for them, they stop exercising responsibility?
  
  (I'm undecided, incidentally, not trying to be contrarian!)
  
  11 months ago report
George Fink

Professorial Research Fellow

Not so fast....while thermodynamics is paramount it is important not to ignore between subject differences in metabolic rate. There is considerable evidence that some people may be more prone than others to develop obesity on the same level of calory intake. Many studies are in progress on metabolic and hormonal factors that determine metabolic rate and thermogenesis. The mitochondria, the sub cellular energy generators are one of several major targets of this research as are a consortium of hormones, central (I.e. in brain) and peripheral that determine calory intake, satiety and metabolism. Much of this research is ongoing at Melbourne and Monash unis and the Baker IDI and Garvan institutes.

11 months ago report
1. Christine Harris
  
  student
  
  In reply to George Fink
  
  I'm a living example of differences in metabolic rate - I can eat anything and won't put on weight. However I still choose to eat a very healthy diet - in fact I have made a big effort to cut out cane sugar from my diet totally (partly as an ELISA test showed a food intolerance and partly I just don't think it's good for me), however I eat quite a bit of fat as I don't believe it is bad for ME - it's my opinion that different people require slightly different diets and it's important to be aware of your body. Obviously this takes a fair bit of research, self awareness and motivation. Which is where psychological aspects certainly do come into the equation. I do think it's wrong to look at diet as just a problem for being overweight - I will never get overweight - but I know if I'm eating a bad diet it has big impacts on me including psychological impacts - in my opinion it works in both directions, creating a harmful feedback loop.
  
  11 months ago report
2. Jennifer Lee
  
  Lecturer in Creative Writing, Gender Studies and Literary Studies at Victoria University
  
  In reply to Christine Harris
  
  This is a great point. The idea that we should all naturally fit within a certain size that has been pulled out of the air is ludicrous (note that, historically, the weight that is considered 'normal' has, several times, been changed overnight so that millions of people suddenly fit in the 'overweight' category - hence, an 'increase' in obesity). Some people are naturally slim and some people are naturally fatter. But, there is evidence that dieting messes with our 'set point weight' and makes us…
  Read more
  
  This is a great point. The idea that we should all naturally fit within a certain size that has been pulled out of the air is ludicrous (note that, historically, the weight that is considered 'normal' has, several times, been changed overnight so that millions of people suddenly fit in the 'overweight' category - hence, an 'increase' in obesity). Some people are naturally slim and some people are naturally fatter. But, there is evidence that dieting messes with our 'set point weight' and makes us fatter than we might otherwise have been. In other words, a focus on health without focusing on weight, is much more beneficial and less stigmatising.
  
  While this article attempts to be kinder to fat people, it is somewhat patronising. There are many fat people who don't have a psychological problem with food. They may or may not eat more than a thin person.
  
  If you're interested in reading more, have a look at Linda Bacon's article on Health at Every Size: http://www.nutritionj.com/content/10/1/9/ and look out for my piece in the Conversation, 'A big fat fight', this afternoon.
  
  11 months ago report
3. Deborah Lupton
  
  Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney
  
  In reply to Jennifer Lee
  
  I will be interested to read your piece, Jennifer. There has also been rather a debate raging on my blog site in relation to a post I wrote on the obesity sceptics' views on obesity, with medical and public health people, a HEAS advocate and an obesity sceptic putting forward their views: http://simplysociology.wordpress.com/2012/06/13/is-being-fat-bad-for-your-health-obesity-sceptics-disagree/ It seems that there is nothing like debates over obesity/fatness to arouse strong feelings in people!
  
  11 months ago report
4. Jennifer Lee
  
  Lecturer in Creative Writing, Gender Studies and Literary Studies at Victoria University
  
  In reply to Deborah Lupton
  
  Thanks for including that link, Deborah. I went and read most of that blog - it's great that you summarised that research. It seems to me that, those of us that are obesity sceptics have read a lot of the research that claims there is an obesity epidemic, but those who claim that overweight and obesity equal bad health haven't really engaged with the research that contradicts their views. And, medical professionals who claim that they know obesity is always bad for your health because they see those patients everyday are not seeing the millions of healthy fat people who aren't at the hospital!
  
  My article is here: https://theconversation.edu.au/a-big-fat-fight-the-case-for-fat-activism-7743
  
  11 months ago report
rory robertson

rory robertson is a Friend of The Conversation.

former fattie

Thanks for a thoughtful piece, Monique, on one of the most important topics in the world. Yes, the obesity epidemic is a global scourge, increasingly starting at a young age. The solution may be complicated. Or not.

My experience is that simply not eating (added) sugar - 50% of which is once-hard-to-secure "fructose" - drove a sudden reversal of my trend to obesity. Thousands of others have had the same experience. For many thousands more in coming years, I predict, simply removing added…
Read more

Thanks for a thoughtful piece, Monique, on one of the most important topics in the world. Yes, the obesity epidemic is a global scourge, increasingly starting at a young age. The solution may be complicated. Or not.

My experience is that simply not eating (added) sugar - 50% of which is once-hard-to-secure "fructose" - drove a sudden reversal of my trend to obesity. Thousands of others have had the same experience. For many thousands more in coming years, I predict, simply removing added sugar/fructose - anything sweet - will turn out to be a “silver bullet” for significant weightloss and better health.

And then – as the suddenly sugar-free experience the unexpected joys of trending towards slimness again and away from diabetes - sceptical food scientists watching from the sidelines can ponder all the second-order issues that make a complete understanding of obesity so complicated. As you note, public-health authorities in the US and elsewhere increasingly are focused on the damaging effects of "sweet poison".

An important part of the anti-obesity story is that SUGAR/FRUCTOSE DOES SOMETHING BAD TO APPETITE CONTROL, KILLING “SELF DISCIPLINE“. So scientists need to put more energy into explaining exactly how/why sugar tends to promote food cravings, why a calorie clearly is not a calorie when it comes to satiety. The following study is a neat start in that direction: http://www.nutritionj.com/content/9/1/51 . Meanwhile, the opinions of “scientists” working on the clearly wrong assumption that “a calorie is a calorie” should be ignored or ridiculed.

My confident forecast is that within a decade or two, across the scientific, medical and nutritionist communities, added sugar/fructose will be linked to obesity and diabetes in the same way that today the sun is linked to sun cancer, and tobacco is linked to lung cancer. It probably is that simple. Set up a Google “Alert” for “fructose“ and watch the evidence - linking the sweet stuff to bad health outcomes – roll in each week, month after month.

My bottom line is that removing added sugar from our food supply is the obvious low-hanging fruit in any serious anti-obesity and anti-diabetes campaign. If we have "too many" fat babies, toddlers and school children, let's somehow stop them eating added sugar for a year and then talk about what ELSE should be done.

In the meantime, it would be helpful if high-profile University of Sydney nutritionists who published a spectacularly flawed paper - claiming (falsely) that sugar consumption and obesity/diabetes are unrelated - should acknowledge their obvious mistakes and correct the pubic record.

Why not take up my $40,000 challenge? To be clear, I will reward the first successful researcher with $20,000 (cash), if anyone is able show beyond dispute that the available (valid) information really "…indicates a consistent and substantial decline in total refined or added sugar consumption by Australians over the past 30 years”, as concluded in Australian Paradox.

Moreover, I will pay a further $20,000 to the charity of choice at the University of Sydney's low-GI school, and publish a genuine public apology in The Sydney Morning Herald, The Australian and The Australian Financial Review. What could be fairer to the University of Sydney? Check it out at #10 and #11 at http://www.australianparadox.com/

If society over time can gain a better understanding of – and then reduce – the damaging health effects of excess sugar/fructose, then tens of billions of health-care and aged-care dollars could be saved or redirected, every year. Not to mention the much happier, healthier and longer lives that would be lived by a slimmer population with greater control over its appetite.

Best wishes,
Rory

11 months ago report
1. Eric Glare
  
  HIV public speaker and volunteer
  
  In reply to rory robertson
  
  Seeking to buy the result you want has long corrupted science and shows your lack of ethics, lack of objectiveness and not enough interest in the nuances of the truth - like directly buying votes in elections, it should be illegal. If you are so confident as you write, you should give the money directly to researchers who are trying to prove you are wrong.
  
  11 months ago report
2. rory robertson
  
  rory robertson is a Friend of The Conversation.
  
  former fattie
  
  In reply to Eric Glare
  
  Cool your jets, Eric. I'm not "Seeking to buy the result I want". I have already demonstrated the facts at #10 and #11 on http://www.australianparadox.com/ . But neither the authors, the "journal" nor the University are prepared to admit their errors. The whole episode is a disgrace. The point of the $40,000 challenge it to get outside observers to consider the evidence. For example, if you are as competent as you are "outraged" (and missing the point), perhaps you can provide your assessment…
  Read more
  
  Cool your jets, Eric. I'm not "Seeking to buy the result I want". I have already demonstrated the facts at #10 and #11 on http://www.australianparadox.com/ . But neither the authors, the "journal" nor the University are prepared to admit their errors. The whole episode is a disgrace. The point of the $40,000 challenge it to get outside observers to consider the evidence. For example, if you are as competent as you are "outraged" (and missing the point), perhaps you can provide your assessment of whether Australian sugar consumption and obesity have moved in completely different directions over the past 30 years. If you can prove they have, then you'll be in the money. If you look at the evidence (see charts in #10) and quickly (and correctly) conclude that the high-profile University of Sydney scientists are hopelessly wrong - both in their spectacularly false conclusion and in not correcting the public record - then perhaps you'll channel your heart-felt criticism towards those who have earned it.
  
  11 months ago report
3. Eric Glare
  
  HIV public speaker and volunteer
  
  In reply to rory robertson
  
  Do you understand that researchers and even patient support groups are not ethically allowed to take your money as it is proposed here and on your web site? It is called 'dollarship' as in a conditional scholarship.
  
  Sorry but your page isn't readable as it wanders all over the place with every method of shouting available - legitimate constructive rebuttal doesn't need shouting, it needs structure. Until it looks like their response to you complete with supporting references and restrained language, you cannot expect people to wade through it. And you need stats software for trends (no pencils).
  
  11 months ago report
4. rory robertson
  
  rory robertson is a Friend of The Conversation.
  
  former fattie
  
  In reply to Eric Glare
  
  Don't fret too much over the formatting, Eric. Or that my "trend" is drawn in. Imagine your own perfectly straight trend through the 1980-2010 period in Figure 1. I'm confident it's up not down. The point is that all four of the authors' own valid "big picture" sugar charts trend up not down (in #10 at http://www.australianparadox.com/ ). Wouldn't you think that if the authors' main claim - the available information "indicates a consistent and substantial decline in total refined or added sugar…
  Read more
  
  Don't fret too much over the formatting, Eric. Or that my "trend" is drawn in. Imagine your own perfectly straight trend through the 1980-2010 period in Figure 1. I'm confident it's up not down. The point is that all four of the authors' own valid "big picture" sugar charts trend up not down (in #10 at http://www.australianparadox.com/ ). Wouldn't you think that if the authors' main claim - the available information "indicates a consistent and substantial decline in total refined or added sugar consumption by Australians over the past 30 years" - were correct, the sugar trends would be down not up? Eric, it's not rocket science. I'm just suggesting it's a bit unreasonable for high-profile scientists to poison the public debate with a paper dominated by errors including an obviously false conclusion - sugar consumption and obesity are unrelated - and then pretend everything is fine. Sure, it takes courage to admit one's mistakes, but most of us do it anyway. In any case, the "Australian Paradox" paper remains a menace to public health (see #6) and the University of Sydney scientists should do the right thing and correct the public record without further delay.
  
  11 months ago report
Kath Read

IT Librarian

"But perhaps the most effective solution would be to prevent obesity from conception."

Am I reading this right... are you advocating eugenics??

11 months ago report
1. Seamus Gardiner
  
  Citizen
  
  In reply to Kath Read
  
  The answer, Kath, is that you're not reading it right. I inferred, and I believe it's reasonably clear, that the author is talking about maximising the health of the mother during pregnancy in order to limit obesogenic factors affecting the foetus.
  
  11 months ago report
2. Chris Booker
  
  Research scientist
  
  In reply to Seamus Gardiner
  
  That was certainly my reading of it (as in the health of the mother during pregnancy, not eugenics). There is also evidence that the metabolic health of the father at conception can influence the metabolic health of offspring.
  
  The problem is that many (if not most) pregnancies are accidental, so that in order to reduce trans-generational effects there needs to be a population-wide improvement in obesity.
  
  11 months ago report
3. Kath Read
  
  IT Librarian
  
  In reply to Kath Read
  
  So what happens when the "optimal environment" during pregnancy is provided, but a baby is born fat? What happens when one or both of the parents are fat people? Are they not permitted to have children? Are their children removed from them?
  
  Or what about when two thin people, have a "normal" weight baby... that becomes fat when puberty hits? What happens, as did in the case of my own parents, if they have one baby that becomes fat at puberty, and one baby who stays thin all his life? Where…
  Read more
  
  So what happens when the "optimal environment" during pregnancy is provided, but a baby is born fat? What happens when one or both of the parents are fat people? Are they not permitted to have children? Are their children removed from them?
  
  Or what about when two thin people, have a "normal" weight baby... that becomes fat when puberty hits? What happens, as did in the case of my own parents, if they have one baby that becomes fat at puberty, and one baby who stays thin all his life? Where was the "optimal environment" - if fat is a product of environment during pregnancy? If their environment or lack of parenting skills caused me to be fat, why is my brother thin?
  
  Fat happens. For all sorts of reasons. So what's the "solution" when it happens? To sterilise fat people so they can't have any more fat children? To euthenase fat children or anyone who becomes fat? To take fat children away from their parents. Do you take the fat ones and leave the thin ones in the same family?
  
  Again, I read it pretty clearly - it smacks of eugenics. It's a slippery slope people, and it makes me sick that options for "preventing" fat people are even being considered.
  
  11 months ago report
4. Seamus Gardiner
  
  Citizen
  
  In reply to Kath Read
  
  Oh, please....
  
  You have just committed a heinous crime on 'theconversation' by resorting to the 'slippery slope' fallacy. My advice: take off your paranoia tinted glasses and read the article again.
  
  If you think that maximising the health of a pregnant mother in order to prevent obesity in the child is some sort of eugenics you have no concept of public health at all. That's fine, not everyone does - but don't resort to some over the top hysteria just because you don't understand it…
  Read more
  
  Oh, please....
  
  You have just committed a heinous crime on 'theconversation' by resorting to the 'slippery slope' fallacy. My advice: take off your paranoia tinted glasses and read the article again.
  
  If you think that maximising the health of a pregnant mother in order to prevent obesity in the child is some sort of eugenics you have no concept of public health at all. That's fine, not everyone does - but don't resort to some over the top hysteria just because you don't understand it.
  
  Let me break it down for you: people who are obese are more prone to life limiting disease. This is a bad thing for the individual and society. We can prevent the obesity. Therefore, we can prevent the deleterious health effects. This can be accomplished by maximising the health of the mother. This too is a good thing. No-one gets killed, no foetuses are aborted, no obese persons are discriminated against and everyone is healthier and lives a long and happy life.
  
  How you can read eugenics into this is totally and utterly beyond me.
  
  11 months ago report
5. Paul Richards
  
  strategic foresight
  
  In reply to Kath Read
  
  Kath - all your points are valid.
  We are on the cusp of understanding "The Gut Microbiota".
  
  Most of the issues regarding weight will probably be found to be centred around understanding this complex environment unique to every individual. We humans have abused our internal flora as we have the wider environment, something we are only coming to terms with even now. Major events can take the ideal birth, breast fed child and reverse the micro flora balance of human homeostasis, these events have only recently been identified as contributing to the intake of nutrition and storage of fat.
  
  If you wish to understand more about this, the June issue of "Science" covers the subject extensively. Take heart most of the so called experts on diet and nutrition are going to change their stance soon enough.
  
  The article "My Microbiome and Me"
  by Mara Hvistendahl covers the weight issue as well as can be expected for the present.
  
  http://www.sciencemag.org/content/336/6086/1245
  
  11 months ago report
6. Seamus Gardiner
  
  Citizen
  
  In reply to Paul Richards
  
  Yeah, Paul...just looked at it. It seems to me that either you're planted here to sell subscriptions or you have some other vested interest. Either way the journal you cite does not mention obesity and i think I'll just wait for the alleged revolution in diet and nutritiion in due time.
  
  11 months ago report
7. Paul Richards
  
  strategic foresight
  
  In reply to Seamus Gardiner
  
  What the .... selling. Who do you associate with to be so cynical?
  
  One hardly needs to promo the worlds premiere science publication.
  It makes more profits than most leading Universities turn over.
  
  Here is another article for you, it could actually be short enough to read.
  http://goo.gl/INV9D
  
  Here is the tittle to the single article I referred to, and there have been numerous over the last five years.
  By the way I was referring to Zhao Liping and the direction his research is going in China.
  
  Written about in the article;
  "My Microbiome and Me"
  by Mara Hvistendahl
  
  I suggest you keep your cognitive biases in check and stop projecting
  your value system onto others.
  
  I wish people here well, my value system is centred in a far different area
  than you assume.
  
  11 months ago report
8. Kath Read
  
  IT Librarian
  
  In reply to Seamus Gardiner
  
  Wow, you're a patronising piece of work, aren't you? I've committed a "crime" now by asking some valid questions as to what people's expectations are with "curing obesity"? Questions that rather than answering, you just spewed a lot of patronising rubbish at.
  
  I don't need you to "break it down" for me. If you can't respond without being patronising, it shows me your arguments are pretty damn weak. But anyone who really looks into the topic of fatness and health can see that.
  
  "We can prevent…
  Read more
  
  Wow, you're a patronising piece of work, aren't you? I've committed a "crime" now by asking some valid questions as to what people's expectations are with "curing obesity"? Questions that rather than answering, you just spewed a lot of patronising rubbish at.
  
  I don't need you to "break it down" for me. If you can't respond without being patronising, it shows me your arguments are pretty damn weak. But anyone who really looks into the topic of fatness and health can see that.
  
  "We can prevent the obesity." Really? Really? Why are there still fat people then? Why do diets have a 95% failure rate (with a 5% margin of error on that statistic)? Why are their fat children born to thin parents, or siblings in a family that are fat while others are thin?
  
  If you know how to prevent obesity, why aren't you writing pieces for The Conversation, or at raking in the big bucks solving one "problem" that not a single other person on this planet has permanently solved. Do you honestly think there would be a $60 billion dollar weight loss industry if we "knew how to prevent obesity"?
  
  Until you live a life in a fat body, you have no right to decide whether or not "obesity" should be prevented/eradicated/cured or what should be done to that body. You don't get to decide what other people do with their bodies. You might think you do, but you'd be very, very wrong about that.
  
  No matter how much you scold me, all you do is make yourself look like the ignorant bigot you are.
  
  11 months ago report
9. Seamus Gardiner
  
  Citizen
  
  In reply to Kath Read
  
  Oh dear... Where do I start?
  1. The article mentions research into how epigenetic factors and the uterine environment predisposes the fetus to obesity post natally. It does not suggest that we can 'prevent obesity', but perhaps limit it which is a positive public health move ( not mentioning the health benefits for the individual).
  2. If you think that we shouldn't maximize the health of individuals and populations than you are either misguided or cruel.
  3. You work in a library, get a dictionary…
  Read more
  
  Oh dear... Where do I start?
  1. The article mentions research into how epigenetic factors and the uterine environment predisposes the fetus to obesity post natally. It does not suggest that we can 'prevent obesity', but perhaps limit it which is a positive public health move ( not mentioning the health benefits for the individual).
  2. If you think that we shouldn't maximize the health of individuals and populations than you are either misguided or cruel.
  3. You work in a library, get a dictionary and look up eugenics. Whilst you're there get any basic text on public health and read about the negative health effects of obesity. If you still don't believe me I invite you to the hospital where I work and I'll show you some of the effects of obesity.
  4. This is a public health argument not an aesthetic argument. Aesthetics are a matter of opinion. Public health is a matter of evidence and how to effectively apply it to ethically maximize health. If you are outraged because you think this is about how people look you are wrong. Let me say it again so it is very clear, this is not about how people look it is about maximizing health. It in no way is about infringing people's right to be fat if they want.
  
  And as to your ad hom attack, I really wish that I was an ignorant bigot, I really do, it would make life a lot easier for me.
  
  11 months ago report
10. Seamus Gardiner
  
  Citizen
  
  In reply to Paul Richards
  
  Sorry Paul you are right... Obviously we are on the cusp of a revolution blah, blah, blah.....
  
  11 months ago report
11. Paul Richards
  
  strategic foresight
  
  In reply to Paul Richards
  
  Sean - a little more reading backing our gut microbiota and import roll it plays.
  This article in the url below shows a clear link to the human immune system, gut flora and disease. Breast feeding is something we have industrialised out of most of the worlds food chain, demonstrating how little we understand about foods relationship critical natural bacteria. The fact that an unknown component of breast milk kills HIV particles and virus-infected cells, as well as blocking HIV-transmission, lifts…
  Read more
  
  Sean - a little more reading backing our gut microbiota and import roll it plays.
  This article in the url below shows a clear link to the human immune system, gut flora and disease. Breast feeding is something we have industrialised out of most of the worlds food chain, demonstrating how little we understand about foods relationship critical natural bacteria. The fact that an unknown component of breast milk kills HIV particles and virus-infected cells, as well as blocking HIV-transmission, lifts the vail on current 'nutritional truisms'.
  
  Directions in nutrition like 'slow food', 'palio' diet and many others have one thing in common. They take our diet away from industrial processing to an era without the influence of logistics affected foods. Unfortunately the best pre industrialised foods are not readily available here in Australia, having legislated them out with generations of 'nutritionalists' help. But raw food does allow us to circumnavigate the centre isles in the 'supermarket', and on a personal level that is the best most can do.
  
  At this point we still understand next to nothing about the micro-environment internally, the effect it has on homeostasis and this calls into question all so called experts on nutrition and diet. I wish you well in developing or heightening your awareness on this unpopular set of evidence.
  
  Breast milk seems to kill HIV - the paper below.
  http://goo.gl/CimBY
  
  11 months ago report
Deborah Lupton

Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney

Not everyone agrees that there is an 'obesity epidemic' or that being fat is necessarily bad for people's health. See my blog post on this: http://simplysociology.wordpress.com/2012/06/13/is-being-fat-bad-for-your-health-obesity-sceptics-disagree/

11 months ago report
1. Seamus Gardiner
  
  Citizen
  
  In reply to Deborah Lupton
  
  Deborah,
  You must live in a parallel world to me. In my world obesity is not an arbitrary sociological construct but a health risk with reams upon reams of evidence describing its potential negative health effects.
  I would suggest a visit to a coronary care unit if you need to see with your own eyes how lifestyle factors can affect health.
  
  11 months ago report
2. Anthony Nolan
  
  Ruminant
  
  In reply to Deborah Lupton
  
  Deborah, with all due respect, it's one thing to link to your blog containing contrary argument about perceptions of obesity but it is another to engage in dialogue with those with whom you disagree. Your blog doesn't allow for dialogue. The Conversation does. What about actually entering into a discussion about this topic here on The Conversation. Otherwise your contribution looks pretty much like a drive by.
  
  11 months ago report
3. Deborah Lupton
  
  Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney
  
  In reply to Anthony Nolan
  
  Hi Anthony. I didn't see the point of replicating the same arguments that are in the blog. Just wanted to point people to an alternative perspective. My blog is also open for comments by anyone, just as The Conversation is.
  
  11 months ago report
4. Deborah Lupton
  
  Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney
  
  In reply to Seamus Gardiner
  
  Hi Sean. Have you read the books I referred to in my blog posts? They are full of very detailed analysis of the ways statistics are collected and used in medical and public health accounts of obesity. They are not arguing that extreme overweight may have negative health effects, but rather that this is then used to contend that anyone who designated as overweight or obese using the BMI (which itself is a highly arbitrary and contentious way of defining fatness) is at risk of serious health problems. Campos and colleagues published a shortened version of their contentions in the prestigious and peer-reviewed International Journal of Epidemiology.
  
  11 months ago report
5. Deborah Lupton
  
  Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney
  
  In reply to Deborah Lupton
  
  Sorry, that should read: 'They are not arguing that extreme overweight may NOT have negative health effects ...'
  
  11 months ago report
6. Seamus Gardiner
  
  Citizen
  
  In reply to Deborah Lupton
  
  Deborah,
  Thanks for the clarification. I see there are a couple of issues here.
  1. Is BMI predicictive of a high fat/lean mass ratio.
  2. Is a high fat/lean mass ratio predicitive of higher risk of disease.
  
  In my judgement 1=no, 2= yes, but only to a point.
  
  BMI values are easily confounded by body morphology away from the norm. High fat/lean mass ratio is predicitve of disease: in general there is a relationship but the smaller the ratio the less the correlation. There are, of course…
  Read more
  
  Deborah,
  Thanks for the clarification. I see there are a couple of issues here.
  1. Is BMI predicictive of a high fat/lean mass ratio.
  2. Is a high fat/lean mass ratio predicitive of higher risk of disease.
  
  In my judgement 1=no, 2= yes, but only to a point.
  
  BMI values are easily confounded by body morphology away from the norm. High fat/lean mass ratio is predicitve of disease: in general there is a relationship but the smaller the ratio the less the correlation. There are, of course, many variables such as type of diet, exercise, socioeconomic status, genetic factors etc. of which I'm sure you're familiar.
  
  I take it thatyour comment relates to labelling overweight people in general as risktakers (in terms of disease risk) when mildly overweight people may be of a low or negligible risk. Fine, no issue there... but it's a mistake to extend this to the morbidly obese, which is a result of harmful lifestyle factors (in part) and a strong and predictable contributor to preventable disease.
  
  11 months ago report
7. Deborah Lupton
  
  Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney
  
  In reply to Seamus Gardiner
  
  Hi Sean
  
  Not many would argue against the contention that the 'morbidly' obese (at the very end of the fatness spectrum) are at higher risk for health problems (except for some fat activists perhaps). But they represent only a small minority of those labelled as 'overweight' or 'obese' and this is the problem of over-generalising about the dangers of fatness.
  
  11 months ago report
8. Anthony Nolan
  
  Ruminant
  
  In reply to Deborah Lupton
  
  Thanks for your reply. So are you agreeing that there isn't an obesity epidemic or that "being fat", I'm guessing you mean obese, isn't bad for people's health? Or are you only reporting what others are saying?
  
  11 months ago report
9. Deborah Lupton
  
  Senior Principal Research Fellow, Department of Sociology and Social Policy at University of Sydney
  
  In reply to Anthony Nolan
  
  I have not myself gone through the huge mass of studies that people like Paul Campos, Michael Gard and Jan Wright have. But they put up a convincing argument, using lots of examples, about the ways that generalisations and exaggerations have constantly been made in the medical and epidemiological literature about the health risks of overweight and obesity.
  
  I use the term 'fat' because many fat activists and sociologists writing in this area prefer this term to what they consider the medical terms of overweight and obesity.
  
  I have been researching this area because of a book I have written on the ways in which fatness is portrayed and understood in contemporary culture (just checking the proofs and doing the index for it now).
  
  11 months ago report
10. Seamus Gardiner
  
  Citizen
  
  In reply to Deborah Lupton
  
  Deborah,
  i see your point but i disagree that it is only a small subset of the overweight that are at a reasonable risk of disease.
  
  11 months ago report
11. Seamus Gardiner
  
  Citizen
  
  In reply to Deborah Lupton
  
  Deborah,
  i see your point but i disagree that it is only a small subset of the overweight that are at a reasonable risk of disease.
  
  11 months ago report
Bernie Masters

environmental consultant at FIA Technology Pty Ltd, B K Masters and Associates

I'd be grateful for some clarity on the issue of weight versus fitness. My understanding of what the research is showing is that (1) overweight people with a BMI between 25 and 30 have a longer life expectancy that people who are obese (BMI >30) or normal weight (BMI 20 - 25) and (2) fit people of almost any weight range live longer than unfit people.

If my understandings are correct, then aren't we sending out the partially wrong messages? Shouldn't our loudest message be: it's better to be fit and overweight than unfit and overweight? If yes, then the primary emphasis on losing weight by eating less fat and sugar, etc, is inappropriate (not wrong, just not the best message).

11 months ago report
1. rory robertson
  
  rory robertson is a Friend of The Conversation.
  
  former fattie
  
  In reply to Bernie Masters
  
  In practice, Bernie, it's much easier to lose weight - by avoiding added sugar for (say) a year - and THEN get fit. It's amazing how much more fun everyday exercise is when you are not dragging round that extra 10-30kg. Ask Peter FitzSimons (http://au.news.yahoo.com/sunday-night/features/article/-/13058226/fitzys-sugar-coating/ )
  
  11 months ago report
2. Seamus Gardiner
  
  Citizen
  
  In reply to Bernie Masters
  
  Bernie,
  That's a really interesting point... Physical fit people who exercise regularly derive cardioprotective benefits and cancer protective benefits despite being overweight. If their cholesterol and triglyceride levels remain within normal limits you'd have to wonder how much risk they are at.
  
  11 months ago report
John Wright

Director

Hi Monique
A very interesting article and one that raises many more questions than it answers.
What if the knowledge has been wrong? . At least for the large and growing cohort that are motivated to change. Given the rather one size fits all nutritional advice and the industrialisation of our food supply (carefully designed to support the nutritional advice), consider the impact on the average person when they do as the experts ask and still put the kilos on.

A number of researchers have spoken…
Read more

Hi Monique
A very interesting article and one that raises many more questions than it answers.
What if the knowledge has been wrong? . At least for the large and growing cohort that are motivated to change. Given the rather one size fits all nutritional advice and the industrialisation of our food supply (carefully designed to support the nutritional advice), consider the impact on the average person when they do as the experts ask and still put the kilos on.

A number of researchers have spoken of nutrition research as psuedoscience, and there have been many calls for more rigorous public advice Marrantz, 2008, http://www.zoeharcombe.com/2012/05/diabetes-uk-low-carb-diets-%E2%80%93-what-is-the-official-advice-for-diabetics/ are but two examples from opposite ends of the research tree. And yet we are taught encouraged, scolded even if we do not take the knowledge as gospel. What would your psychologists make of this.

Secondly I am curious as to why you and others do not favour a ban. In medical research, relative risk, NNT, QALYS, all provide 'statistical justification' to treat many to benefit the few. Banning sugary drinks, or trans fat strikes me as equally justifiable given the cost benefit to the public health system even if the item banned is not the causative agent (parallels with statin therapy here). Why is it considered 'interfering with freedom of choice in nutrition, but a public health necessity in medicine? Perhaps this is a question for the philosophers, unsullied by commercial interests.

George individualising metabolic management is key here. Substrate composition is as important as calorie load and this needs to be individualised based on amongst other things mitochondrial function.
Feinman and Fine, 2004

11 months ago report
Margo Saunders

Public Health Policy Researcher

There are two important things about knowledge and the adoption of personal health-promoting behaviours. First, knowledge alone is not enough. There are simply too many other factors, both conscious and sub-conscious, that drive behaviour. These tend to overwhelm or cause us to discount what we ‘know’.

Second, knowledge, in a conscious sense, may not even be necessary for behaviour change. Many individual behaviours, including those with direct impacts on health, occur in response to deliberate…
Read more

There are two important things about knowledge and the adoption of personal health-promoting behaviours. First, knowledge alone is not enough. There are simply too many other factors, both conscious and sub-conscious, that drive behaviour. These tend to overwhelm or cause us to discount what we ‘know’.

Second, knowledge, in a conscious sense, may not even be necessary for behaviour change. Many individual behaviours, including those with direct impacts on health, occur in response to deliberate cues which have been put into place to increase the likelihood of our making certain choices. Our behaviour does not involve conscious ‘knowledge’ of the choices – it’s just that there are very effective default options which undermine health, and these may not even the things that we would choose if we were completely aware of what was going on and could stop and think about it. Redressing this balance by changing the ‘choice architecture’ so that the default options are the healthy options works in the same way.

Badged as ‘nudge’ theory, the argument is that we can steer people into making ‘good’ choices (ie, those which are actually in their best interest, had they been given a chance to make a rational decision) by presenting information and choices in different ways.

It is also interesting to note that the ‘nudge’ approach has been challenged on the grounds that it constitutes a weak substitute for more effective regulatory approaches, such as the ‘bans’ about which Monique admits some squeamishness.

The Nuffield Council on Bioethics’ Intervention Ladder (http://www.nuffieldbioethics.org/public-health/public-health-policy-process-and-practice) provides a handy guide to public health interventions and the circumstances which warrant specific types of interventions. However, it has also been recently argued that starting at a higher rung on the intervention ladder (ie, regulation) may be justified: ‘Depending on the evidence, stronger measures might be required from the start. … Non-intervention is not always to be preferred over intervention, as ‘doing nothing’ will often have adverse consequences for many people.” (http://www.nuffieldbioethics.org/news/intervention-ladder-informs-lords-behaviour-change-report)

11 months ago report
Paul Richards

strategic foresight

Thank you Monique.
"Rates of overweight and obesity in Australia are increasing and the trend is predicted to continue."

Gut Microbiota and the ongoing research recently started will change everything.

In the current magazine Science one of the preeminent sources of science on the planet they have chosen to focus on "The Gut Microbiota" fro June 2012.

Having read every article on offer at this subscription only magazine on the subject, the conclusion about obesity is correct. Obesity…
Read more

Thank you Monique.
"Rates of overweight and obesity in Australia are increasing and the trend is predicted to continue."

Gut Microbiota and the ongoing research recently started will change everything.

In the current magazine Science one of the preeminent sources of science on the planet they have chosen to focus on "The Gut Microbiota" fro June 2012.

Having read every article on offer at this subscription only magazine on the subject, the conclusion about obesity is correct. Obesity is increasing and not just for the reasons of "super sizing" food intake. The issue is far more complex and indeed involves birth. Specifically a natural birth and normal breast feeding of an infant. As all of the balance in the natural gut flora / microbiota we acquire from this process and bolster it via breastfeeding and reinforce naturally crawling on the ground, even to the importance of eating dirt as infant.

Given we are at the very beginning of understanding of this crucial area of balance any dietary recommendations need to be looked at carefully. As even drug uptake varies depending on the make up of an individual microbiota. It is fairly certain at this point that the industrialisation of foods for transport efficiency has exposed humans to less naturally fermented foods and has a part in the obesity epidemic. In Australia's case we have even banded the use of milk products which are now known as a reach source of microbiota promoting probiotics.

I recommend anyone in the nutritional field look very carefully at the new data and the implications on intestinal tract disease, obesity and their resulting diseases before coming out with concrete diet statements.

We are at the beginning of a paradigm shift in thinking on food and finally making sense of some dietary regimes that indeed include meat among other demonised foods. If I was entering nutritional studies currently it would be smart to pause take this in and see the opportunity study of microbiota and their application could have.

Source; http://www.sciencemag.org/content/336/6086/1245

11 months ago report
Jack Arnold

Director

Thank you Monique for a thoughtful article containing an achievable positive solution.

My friend Blind Freddie reminded me that if men got pregnant then pregnancy health would be a major government expense with time off for a good pregnancy term.

However, like the post partum problem of neglected early childhood education the reality is that until women dominate politics & business there is unlikely to be any real but necessary change to these unhelpful present social attitudes.

11 months ago report
rory robertson

rory robertson is a Friend of The Conversation.

former fattie

Here's a question for the group. So, high-profile scientists write a high-profile but hopelessly flawed obesity paper, concluding (falsely) that sugar consumption and obesity are unrelated. (It's all documented at http://www.australianparadox.com/pdf/NutrientsLETTER2405122.pdf )

In more than a year, only one academic - one honourable exception - has said anything bad about the paper (as far as I can tell): http://www.smh.com.au/national/health/research-causes-stir-over-sugars-role-in-obesity…
Read more

Here's a question for the group. So, high-profile scientists write a high-profile but hopelessly flawed obesity paper, concluding (falsely) that sugar consumption and obesity are unrelated. (It's all documented at http://www.australianparadox.com/pdf/NutrientsLETTER2405122.pdf )

In more than a year, only one academic - one honourable exception - has said anything bad about the paper (as far as I can tell): http://www.smh.com.au/national/health/research-causes-stir-over-sugars-role-in-obesity-20120330-1w3e5.html

The authors are perhaps Australia's high-profile defenders of added sugar in food, and have a serious undisclosed conflict of interest in the process (see #11 in earlier link). Consider the following newspaper articles:

· http://www.theaustralian.com.au/news/health-science/a-spoonful-of-sugar-is-not-so-bad/story-e6frg8y6-1226090126776
· http://www.theaustralian.com.au/news/health-science/war-over-sweet-nothings/story-e6frg8y6-1226261140744
· http://www.theaustralian.com.au/national-affairs/weight-a-minute-dont-blame-sugar/story-fn59niix-1226080214264
· http://www.theaustralian.com.au/news/health-science/disgust-at-claims-sugar-as-dangerous-as-alcohol/story-e6frg8y6-1226260002393

My questions include: How is it that such as woeful-quality paper as Australian Paradox can be published and become a menace to Australian public health (see #6), and yet hundreds - thousands? - of full-time academics in the obesity/diabetes space have nothing to say? I'm wondering: clueless, disinterested or just anxious about causing a fuss for very good reasons?

As an outsider, I'm keen to understand what is going on. Any thoughts? My email is strathburnstation@gmail.com if you'd like to keep this part of the conversation in the vault (forever).

Regards,
Rory

11 months ago report
Anthony Muscio

Systems Analysist and Designer

Thanks for this article and I must agree that the lack of due regard to the causes of obesity is an important area of focus. Simply put I think we are focusing on the wrong thing, consider the following;
Somethings (A) leads to obesity (B), obesity leads to some negative things (C). This does not rule out the possibility that A is causing C and B is simply another symptom of A. Talking about people with obesity as a cause of health problems completely ignores the fact that the "root" cause is a whole lot of Somethings (A).

Naming a person - rather than a symptom as Obese, just calls on the individual concerned to to define themselves as their symptom. Although tempted sometimes, we don't call people who have headaches "headaches". This approach simply puts too much responsibility on people to address a symptom not a cause, so no wonder they rarely find the underlying reason for the problem and struggle to maintain self esteem and empowerment at a time when it is needed the most,

11 months ago report
1. Paul Richards
  
  strategic foresight
  
  In reply to Anthony Muscio
  
  Anthony - "we don't call people who have headaches "headaches" Priceless, that works for me and will use it.
  
  In 10 years we will see I am certain just how the corporatisation of food has ruined human health. But for now we endure the nutritional experts and their language.
  
  11 months ago report
2. Paul Richards
  
  strategic foresight
  
  In reply to Paul Richards
  
  More on the industrialisation of foods by corporations.
  "Where Supersizing Began - The Men Who Made Us Fat - Episode 2 - BBC Two"
  
  http://youtu.be/Jh-W2DCXfq4
  
  11 months ago report
Eric Glare

HIV public speaker and volunteer

I really like the conclusion: "Prevention is the pathway from knowledge to change." However at times, when the writing isn't so carefully worded, the central premise of this article tends towards being academically corrupt; particularly the question "So if knowledge doesn’t work, what does?". In a research response this should raise the question: can obesity rates decline without knowledge? I doubt you would suggest that this latter question could ever be true and that mostly prevention extends from…
Read more

I really like the conclusion: "Prevention is the pathway from knowledge to change." However at times, when the writing isn't so carefully worded, the central premise of this article tends towards being academically corrupt; particularly the question "So if knowledge doesn’t work, what does?". In a research response this should raise the question: can obesity rates decline without knowledge? I doubt you would suggest that this latter question could ever be true and that mostly prevention extends from knowledge. I can envisage mainstream media sensationalising your article by taking the 'information is bad' line.

Understanding the psychological influences and that psychological support is helpful are important pieces of information but they require people to get over a giant hurdle of stigma that says counselling is only for the severely mentally ill, is shameful, etc. The issues seem very similar to what I see in behavioural change in the sexual health sector where stigma is a major block to prevention. I particularly dislike challenges on so-called political correct language - it is as if we only need to be kind to people when we are playing politics (some of it is selfishness emanating from conservative politics). I was surprised Lupton claimed 'fat' was a preferable term for some - we may need to use different language for different people and peer education could help this. As a long-term survivor living with HIV, I am much more susceptible to the consequences of cardiovascular disease risk factors due to HIV and its treatments. My peers and I require a different approach to other groups -currently these issues are collectively called premature aging. It is assumed we are all ok with the idea of confronting death but I think that is wrong.

What we really need is evidence-based knowledge on both prevention and the health consequences of being overweight. Perhaps we should say the pathway of prevention from information to sustainable change needs to be paved with prevention information, genuine support and destigmatising initiatives.

11 months ago report
1. Margo Saunders
  
  Public Health Policy Researcher
  
  In reply to Eric Glare
  
  Eric, see my earlier comment on 'nudges' and the need to acknowledge that much of our behaviour is not based on conscious, rational decision-making but is 'nudged' or steered by various influences. This is how much of marketing works (and see Brian Wansink's 'Mindless Eating'). So I would say that the evidence does suggest that 'knowledge' (ie, as a basis for individual decision-making) is not necessarily a prerequisite for a decline in obesity and that it may in fact be much more effective to create less obesogenic environments so that, instead of relying on millions of people all making the 'right' decisions, the default options are those which are less likely to promote obesity.
  
  11 months ago report
2. Eric Glare
  
  HIV public speaker and volunteer
  
  In reply to Margo Saunders
  
  Unless it is ad hoc stumbling, there has to be knowledge somewhere in prevention. But I agree, most people are not fully engaged whatever the issue we are trying to prevent. Nudges are fine and I guess what we use in sexual health except those that are stigmatising, dictatorial or limiting choice don't work very well. Obviously some people are nudged by key messages while others need more knowledge like an essay and some will rebel. But can you get prevention happening in an ethos that isn't positive for that change? Too many people have thought they could do that with HIV and whole countries missed their opportunity to not have an epidemic.
  
  11 months ago report

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