National action needed to stop obesity becoming the norm

If we’re to confront obesity and with any real impact, we need to examine the way modern lifestyles have dramatically altered our food intake and energy expenditure. Darwin Bell

By 2025, it’s predicted that ⅔ of the Australian population aged over 25 will be overweight or obese if current trends continue. To paint the picture more crudely, it means that a person of normal weight will soon be the exception rather than the rule.

These numbers are based on data from the Baker IDI-led AusDiab surveys of more than 11,000 Australians who were tracked over five years.

Obesity leads to a range of conditions that compromise health and shorten life. Most notably, it’s a precursor to type 2 diabetes as well as hypertension, sleep apnoea, cardiovascular and musculoskeletal disease and a number of cancers. The cost to the community is huge, and the consequences include rising health-care costs, lost productivity and untold human suffering.

A 2008 Access Economics report put the cost of obesity to Australia and its impact from chronic disease at A$58 billion a year. The impact of sleep disturbances resulting from obesity, type 2 diabetes, hypertension and heart failure alone will have a highly detrimental effect on workplaces. As sleep and concentration decrease, road accidents increase, affecting people who work in areas such as truck driving and public transport while office-based employees are likely to find it difficult to stay alert and productive.

In the face of this rising tide of human disease, the Victorian government’s obesity program announced on Friday is a very welcome initiative that ticks nearly all the boxes for one of the most comprehensive anti-obesity programs worldwide. The strategy covers nearly all of the key recommendations of the federal government’s National Preventative Health Taskforce, of which I was a member, and should be implemented across the country.

rae brune/Flickr

Comprehensive approach

In tackling obesity, it’s critical that we move away from the parochial and narrow approach of single-issue groups who advocate for strategies that focus on individual interventions, such as television advertising and food labelling. If we’re to confront obesity and with any real impact, we need to examine the way modern lifestyles have dramatically altered our food intake and energy expenditure and created an “obesogenic” and toxic environment.

We need to ensure that preventative programs, such as the one outlined by the Victorian government, cut across all community groups – schools, workplace and local communities. And it’s equally critical that health professionals work closely with policy makers to acknowledge the biological basis of obesity.

Researchers are beginning to understand the extent to which genes and the way they interact with environmental factors pre-dispose some people to gaining weight. A major part of obesity is hereditary. Other contributors are the lifelong consequences of poor or excessive maternal nutrition, which could pre-dispose people not just to obesity but type 2 diabetes, heart disease and mental health disorders in adult life.

Nature or nurture

There’s compelling evidence that our early-life experiences can heighten the risk of becoming an obese adolescent or adult and of developing obesity-associated diseases in adulthood.

The rapidly rising incidence of childhood obesity is testimony to the contributions of early life experiences on future health outcomes. Experiments have shown that maternal over-feeding can distort a person’s feeling of fullness and affect food preference, muscle mass and insulin resistance.

Research also shows that some of these early life responses to genetics and the environment are reversible, suggesting the exciting possibility that focussing on the nutrition and health of mothers and young children could be effective points of intervention.

enric archivell

For specific groups like Indigenous Australians, appalling environmental circumstances make for greater susceptibility to diseases such as type 2 diabetes. We need to acknowledge and address this in order to develop strategic programs which will “close the gap” in health outcomes.

And, in the face of increasing scientific evidence, we can no longer charge sloth and individual sedentary behaviours with sole responsibility for obesity.

Time for action

It’s encouraging to see the Victorian government embracing such an ambitious and wide-sweeping program. There’s still room for improvement though, with more emphasis needed to address vulnerable groups such as indigenous and culturally and linguistically diverse groups.

With increasing scientific evidence around the relationship between maternal health and the development of chronic disease in adult life, targeted programs addressing pre-pregnancy planning and nutrition during pregnancy should be cornerstones of any approach.

Broadly speaking, the multi-pronged anti-obesity measures outlined by the Victorian government are a step in the right direction, reflecting many of the key messages from the National Preventative Health Task Force. This is a bold initiative worthy of congratulations. But with developed countries such as Australia now struggling to control epidemics of obesity and type 2 diabetes it’s critical that we implement this strategy or one like it across the country without a moment’s delay.