Issue 45 / 28 November 2011

MOST humans on this planet — past and present — would count themselves lucky to face the health problems we confront today.

“What?” the world’s subsistence farmers might ask. “You’re worried about being too fat?”

Well, yes, we are, though perhaps we’re not worried enough.

The World Health Organization says overweight and obesity are now linked to more deaths worldwide than is underweight, and you only have to look around you to see that the lean, athletic Aussie is an endangered species.

It’s not that we haven’t been told about the risk posed by our spreading waistlines; hardly a day goes by without a media article on the obesity epidemic or the rising tide of chronic disease that accompanies it.

But we just keep on getting fatter and, if anything, we seem to be becoming less worried about it.

The latest data from the University of Sydney’s Family Medicine Research Centre’s BEACH study show that 62% of adults presenting in general practice in 2010‒11 were overweight or obese, up from 55% a decade earlier.

Perhaps even more disturbing was that the extra kilos were accompanied by a decrease in GP counselling about nutrition and weight over the same period (from four to three per 100 problems managed).

It’s not clear from the study, which was based on 100 consecutive consults from a random sample of 1000 GPs, whether this decline was the result of GPs being less likely to broach the issue or patients becoming less likely to seek help.

Either way, it seems we as a society are starting to accept overweight as the new norm, a trend to be lamented perhaps but not something we can really do much about.

After all, when everybody around us is also overweight, it’s easy to convince ourselves we’re looking good. (Men are better at this than women, as Canadian researchers found.)

And the fashion labels don’t help. They may use anorexic models to promote their brands, but they also surreptitiously redefine the standard sizes to make us feel good about ourselves and thus their products.

In the ABC comedy series, Kath and Kim, Kim protests, “I’m not a size 16, Mum, I’m a size 10”.

“Country Road size 10”, Kath replies disparagingly.

Country Road may no longer be into “vanity sizing” but there are plenty of other brands that would have me believe I am a smaller size now than I was as a teenager — clever marketing perhaps, but hardly designed to promote good health.

Overweight is a notoriously intractable problem: health professionals have few proven interventions in their armoury and patients are not exactly known for their compliance with recommended lifestyle changes.

But it does seem that we need to try to hang on to an image of what a healthy human body looks like: not the stick-figure celebrities that populate the glossy magazines, but not a “Country Road size 10” either.

American researchers reported earlier this year that overweight and obese people in that country are now more likely to consider their weight normal than they would have been 20 years ago.

But doctors could make a difference, they found. Overweight patients were more than eight times as likely to have a realistic view of their weight — and more than twice as likely to have tried to do something about it — if a doctor had told them they were overweight.

However, more than half of the overweight patients, and more than a third of the obese ones, had never had this conversation with a doctor.

Of course, trying to do something about it doesn’t necessarily equate to success, but maybe we need to be more honest with each other — and ourselves — on this weighty question.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 28 November 2011

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3 thoughts on “Jane McCredie: Sizing up reality

  1. Anonymous says:

    But aren’t GPs more likely to be obese too? Would that make them less likely to give this advice?

  2. Dr Robert Peers says:

    I have something new to treat fatness: I have been using inositol powder supplement, 5 gm/day [costs 50 cents], to treat anxiety, since I borrowed the idea in 1999 from Israeli researcher Prof Joseph Levine (1997). He saw good results using 12 gm/day in depression, panic, OCD and binge-eating. I use less than that, but still get good results. Many overweight anxious folks report loss of food cravings, especially for chocolate, within days of starting the supplement. There is also a large increase in physical and mental energy, about the same time (this may be due to anxiety reversal, plus a special anti-ageing effect of inositol: mitochondrial biogenesis). As the weeks roll by, patients report 4-10 kg weight loss (but muscles often enlarge); sometimes losing 20 kg; and one big guy has lost 99 kg (from 196 kg) in 18 months. Obesity researchers are now waking up to the fact that what drives chronic over-eating is not a physiological need to eat, but an illicit stress-driven desire to do so! [The anxiety itself, affecting 1 in 4 Westerners, is caused by fatty maternal diet during gestation–E Sullivan, 2010). Cortisol seems to be the hormone responsible for both prenatal anxiety programming, and for over-eating in anxious subjects, and its level is likely reduced by inositol, since this treatment reverses HPA stress axis activation (J Levine, 2001, dexamethasone suppression test). I have also seen good fat loss — along with a burst of energy — in podgy anxious children, simply by putting them on a diet high in inositol (grains, nuts, legumes, citrus). Fabulous!

  3. drjohn says:

    One of the disheartening things about obesity is the level of self-deception about it. I would love a dollar for every time I have heard ” But I don’t eat that much, doctor “
    I would hazard a guess that it is not just me whose eyes glaze over after hearing that.
    I am tempted to retort ” No, perhaps not now or today , but you obviously have in the past. “
    Of course, chronic weight-gain is multifactorial and I suppose we as drs, given that the weight level is contributing to any ill- health in such patients, need to calmly and persistently pursue successful treatment of this basic, root of many evils condition. It probably should be addressed EVERY time a patient presents with diabetes, hypertension, OA of hips, knees and backs but it’s at least as hard as getting the message across as the ” viral lecture ” and ignored just as much.
    Apart from the above-mentioned inositol, anyone have any new ideas?

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