LET US INITIATE A HEALTHIER DIALOGUE

I felt compelled to write a response to an opinion column last week in The West Australian titled “Fat chance it’s not your fault” about people with obesity (see link below). I generally find Gemma Tognini’s articles both interesting and engaging but I believe that she is sending the wrong message in this case. I am, however, grateful to her for starting a much needed dialogue about a significant public health issue in our society. Obesity is a complex condition but the research is now showing that up to 70% of causation is from genetics. There are many misconceptions about obesity and her tongue-in-cheek proposal that we should send a message like “stop eating yourselves to death and go for a jog” is both simplistic and unhelpful. Obese people have a metabolic profile that predisposes them to store more fat due to their body’s inbuilt ‘set point.’ Many of them do not overeat and many of them have robust exercise routines. The current data shows that diets do not work for them in the long term as their body fights to put the weight back on. This usually causes rebound weight gain and we now know from the research that, in the general population, dieting is a significant precursor to long term weight gain. But vulnerable people, faced with our culture that promotes the “thin ideal,” continue to be seduced by false promises from the multi-million dollar diet industry.

I strongly advocate for lifestyles that are healthy and active, as studies have proven that this can reduce the incidence of many illnesses. However, obesity occurs within a different biochemical context and this relates to many hormones – such as insulin and leptin. For many, obesity is not a lifestyle choice and we need to reduce the blame, shame and stigma towards our obese family members, friends and fellow members of society. If you have a genetic profile that predisposes you to weight gain then the odds are stacked against you in our current ‘obesogenic’ environment. As Dr Robert Lustig, demonstrates in the documentary entitled “The skinny on obesity,” it goes way beyond personal responsibility and there are clearly societal and environmental forces at work. He points out that fast food outlets are prolific, over 24000 different ‘foods’ enter the market each year and 80% of food in our stores are laced with sugar. He maintains that consumer choice is limited when processed, highly palatable food is accessible on every street corner. Personal responsibility is not ultimately going to solve the problem and we are not going to effectively change behaviour when our food environment is so detrimental.

Gemma calls on us to stop “lowering the bar” and to demand “equality of effort.” Her message is to make people accountable for their choices and equates this to – “if I don’t exercise… my rear end expands.” We do need to raise the bar, Gemma, but this lies in regard to public policy. To date Australia does not have a national co-ordinated plan to tackle obesity and the transnational food industry has unequivocally impeded progress on prevention policies and regulations. Companies are not concerned about the health of consumers and will continue to flood the market with processed food and sweetened beverages if it will continue to earn them huge profits. But our policy makers need to effectively address this and we need a cohesive public health community to move the agenda forward to provide an environment that is less obesogenic and more health promoting.

Let us also try to be more understanding of how obesity occurs and what could really help, not hinder, the situation. Let us stop the harsh judgements, often based on misinformation, that are dished out so readily. It is important to educate our children to make healthy choices and to be more active, by modelling this behaviour and creating healthy home environments with limited processed food. But we can also teach our children that it is wrong to tease and bully others who may be carrying extra weight as this can cause a lifetime of psychological issues and can also lead to a reliance on food for emotional coping.

We can increase accountability by demanding a better food environment for our families. We do have a major public health issue but let us deal with it in a helpful way, dispense with false assumptions and advocate for societal measures that will, in fact, improve our health and wellbeing.

To see Gemma’s article, CLICK HERE