Like politics, football and global warming, obesity is a topic that attracts huge attention in the media as well as talk on the street and in coffee lounges. This is not surprising since it is the most serious health issue facing the global community today.
Australia is in the top ten fattest nations globally and, like many other countries, we are struggling to control the epidemic of obesity and related chronic diseases, such as type 2 diabetes.
The renowned Israeli scientist, Eleazar Shafrir at the Hebrew University, coined the term “diabesity” to characterise the close link between obesity and diabetes. Today, diabesity is shaping as the biggest chronic disease epidemic in human history. It also leads to the onset of other debilitating and costly illnesses such as heart disease, certain cancers, musculoskeletal disorders and obstructive sleep apnoea, to name a few.

In Australia, the national diabesity epidemic continues unabated. The Federal Government’s response to the recommendations of the recent Preventative Health Taskforce Report on obesity has been very disappointing. We must question its commitment to the recommendations, as well as the effectiveness of the limited interventions that have been put in place.
Many in our community, including our politicians, have a simplistic view of the causes of obesity. They blame two major factors: laziness and ready access to attractive, energy-dense foods. This fallacy is fuelled by the media, which reinforces the idea that the obesity crisis is primarily caused by sloth and gluttony.
Such views invite a passive response and allow government to retreat to the message of individual responsibility. Yet, in reality, as stated by the UK obesity expert Professor Peter Kopelman, “the causes of obesity are embedded in an extremely complex biological system, set within an equally complex societal framework”.
Obesity is a highly complex disease and nearly every drug developed for it so far hasn’t proved safe enough. We have to find the silver bullet, and only continued scientific research will get us there.
Based on this view, the strategy to tackle obesity needs to be based around an understanding of its complexity and not on a half-hearted collection of disparate and unconnected measures that are unlikely to address a burgeoning epidemic of this magnitude. Seven years after we conducted the last Australian Diabetes and Lifestyle Study (AusDiab) survey, there are still no reliable national monitoring data on diabesity and a distinct lack of evidence to suggest that we are winning the war.

Despite the important recommendations of the Preventative Health Taskforce, initiatives to address the obesity crisis have been fragmented, with more than $35 million dollars being spent on social marketing initiatives such as the balloon man, Eric, and his “Swap It, Don’t Stop It!” campaign. It’s not clear how this campaign is being evaluated and whether it will have any impact on the obesity epidemic without other major, well-funded initiatives.
Fundamental to both the treatment of obesity and its prevention is a strong research framework. So where do we start?
Before 1994, obesity research was stagnant. It received a huge boost after the discovery of leptin – a key hormone involved in appetite regulation – by Jeff Friedman at the Rockefeller Institute in New York. This landmark discovery set the field alight: it triggered major new collaborative initiatives around the world, and provided a focus for researchers on the role of the brain and pathways that regulate appetite.

For our government and public health bureaucrats, there is a compelling need to change the myth that sloth and sedentary behaviours are largely responsible for obesity. Let’s get beyond the blame game, which inevitably seems to end with responsibility for controlling obesity being laid at the feet of individuals.
Politicians and bureaucrats need to recognise the fundamental change in thinking of scientists and public health researchers about the underlying drivers of the obesity epidemic. There’s a significant biological component driving the very behaviours we tend to focus on and blame people for.
A 2008 Access Economics report put the cost of obesity in Australia at $58 billion per year. The potential cost of strengthening research into the cause of obesity and its prevention, and implementing the broad range of interventions recommended by the Preventative Health Taskforce would seem to be an absolute bargain against such a figure. But is anyone in Canberra listening?
Dale Bloom
Analyst
There seems to be a number of studies linking general stress, with an increase in obesity. Such as this study
http://psychcentral.com/news/2010/09/05/chronic-social-stress-linked-to-obesity/17685.html
This seems plausible, particularly if the overweight person becomes stressed because they are overweight, which then makes them eat even more.
I think this is an area worth more research, and an aid to reducing weight might be learning relaxation exercises.
Kate Rowan-Robinson
Kate Rowan-Robinson is a Friend of The Conversation.
Registered Nurse/Sexology Student
It's a worthwhile thought, Dale. There is going to be no simple solution to the issue and it is certainly something that needs a more "holistic" approach. It is well documented that stress hormones can slow the loss of weight, particularly in cases of long term stress. Holistically speaking, learning relaxation exercises could also have benefits that extend into aiding conditions that can be related to obesity, such as high blood pressure.
We can't blame obesity upon sloth and gluttony, it is…
Read moreGavin Moodie
Principal Policy Adviser
I didn't find this piece as informative as I'd hoped. It told me, twice, that obesity is a big (!) problem; that obesity isn't due to sloth and gluttony, twice; and again twice, that it is due to a complex interaction of biological and social factors.
I looked for some indication of those biological and social factors which would inform a policy.
Rosemary Stanton
Nutritionist & Visiting Fellow at University of New South Wales
No one doubts that Australia has a serious problem with obesity. Nor do most people doubt that the solutions are complex.
However, it is not correct to claim that Australia is one of the 10 fattest nations in the world. According to WHO, the fattest nations are Nauru, Micronesia (Federated States of), Cook Islands, Tonga, Niue, Samoa, Palau, Kuwait, United States, Kiribati, Dominica, Barbados, Argentina, Egypt, Malta, Greece, New Zealand, United Arab Emirates, Mexico, Trinidad and Tobago, Australia......
The only way Australia gets into the top 10 is if you go only for OECD countries. However, if we're seeking answers, I think we probably need to look at the whole world, not just the OECD.
While I'm on the topic, even though we need to acknowldge the complexity of obesity, we can't dismiss major factors such as what people consume and their levels of physical activity.
Stephen Riden
Research and Information Manager, DSICA
Looking at that list of fattest nations, you can't easily conclude that obesity is related to GDP levels or characteristics of a nation's diet.
Conversations around obesity focuses too much on food and its availability or price, and in comparison we overlook physical activity levels. In turn, people too often think just about exercise as physical activitiy and we should acknowledge the role of labour-saving devices in the household and the workplace as contributors to national obesity levels.
Carol Chenco
Carol Chenco is a Friend of The Conversation.
Research Officer
I do agree that there is more in the obesity issue than just sloth and gluttony but as Rosemary Stanton puts it, we can go a long way by increasing our physical activity and thinking more carefully about our eating patterns. Relaxation therapy and all these others means of getting at the problem, simply put, do not override cutting down on food portions and increasing physical activity - it is the complexity of why we are not motivated to do this that is the problem. If relaxation can increase our motivation to eat less and exercise more, that maybe one approach.
Julie O'Toole
eating disorder pediatrician
I am afraid that the paradigm of calories in and calories out as the answer to the obesity or diabesity epidemic will die a very hard death. As "what we eat and how much" does not explain the whole experience of increasing human size neither does "not enough exercise". And this will be very hard for some people to accept.
We don't really know what has happened, much less why.
John Holmes
Agronomist - semi retired consultant
Is there any thing in the claims that excessive fructose levels in our diet is interfering in the feed back re satiety? Eg by damping out the messages which say "You are full, stop eating."
Other claims are made re damage from fructose metabolism in the liver as well.
Emily Cooper M.D.
logged in via Twitter
There is an overwhelming body of research and evidence dating back to the 80's that Obesity is caused by complex biologic factors. As a physician In America I am having great success at longterm weight normalization in the vast majority of my overweight / obese patients by treating leptin resistance and insulin resistance with existing medications and supplements. Continuing to limit the conversation to food and exercise will prevent us from really solving this problem. The lack of 'discipline' theory does not add up. Many of our overweight and obese patients are serious athletes and very disciplined however even extreme discipline has not resolved their problem.
Jennifer Lee
Lecturer in Creative Writing, Gender Studies and Literary Studies at Victoria University
Stated above: 'A 2008 Access Economics report put the cost of obesity in Australia at $58 billion per year. The potential cost of strengthening research into the cause of obesity and its prevention, and implementing the broad range of interventions recommended by the Preventative Health Taskforce would seem to be an absolute bargain against such a figure. But is anyone in Canberra listening?'
This article talks about not blaming and shaming 'obese' people, so why do medical professionals, academics…
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