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Obesity – a major national health problem


Few things are as confronting or anxiety-provoking as winding up in a hospital emergency department cubicle.

As an emergency physician, I manage medical conditions which cover the entire spectrum – babies with a fever, through to the frail elderly who have had a fall or become confused. A cricketer with a soft tissue injury may be followed by a middle aged man with severe chest pain and a heart attack. It’s never boring, and it’s always challenging.

An essential part of emergency medicine – and indeed most medical practice – is understanding the factors which led to the presentation. Some are obscure, but many are apparent on a regular basis. I assess risk, and know that some of them are unavoidable, such as getting older or inheriting genetically determined risk factors.

However, there are many risk factors which are environmental. It is a matter of regret that they could have been minimised or avoided altogether – and lead to longer, healthier lives.

Most Australians know that these factors include smoking, alcohol misuse, overweight and obesity, and overexposure to the sun. It is no coincidence that these are recurring themes in the AMA’s public health agenda.

Earlier this month, I spoke at a forum on the need for a national strategy to deal with obesity.

More and more, we are seeing people who, for a range of complex reasons, have become dangerously overweight or obese. As a result, they are at a greatly increased risk of major health problems such as diabetes, cardiovascular disease, arthritis, and even a number of cancers.

The statistics are well known, but bear repeating: two-thirds of Australian adults, and a quarter of children, are overweight or obese.

It has become the exception for Australians to be of healthy weight.

The greatest thing about my work is, quite simply, the opportunity to care for people when they are at their most fragile and vulnerable. I get to relieve pain, make challenging diagnoses, and save life. But my strong preference, whenever possible, is to prevent or mitigate the impact of disease in the first place.

The advice given to patients by their GP can often be a difficult pill to swallow. Advice regarding healthy lifestyles is received in many different ways, and the reasons for success or failure are often elusive. I try to play my part in the emergency department by being objective, empathetic, and practical in what I advise.

At a national level, it is clear that if we continue with increasing rates of obesity, the harms will inevitably follow. We face the very real prospect of life expectancy declining for the first time in centuries.

So what is to be done?

Education and improved health literacy are an obvious part of the equation. But, although people should pay heed to what they do and what they eat, it is all too easy to dismiss the nation’s expanding waistline as simply a matter of individual responsibility.

We need programs that educate parents about healthy eating for toddlers and young children. Children need to be taught about healthy food and eating patterns. We need to think about what we can do to help people avoid excessive weight gain during pregnancy. In this era of celebrity chefs, we encounter many who have never learned the basics about food preparation.

Ads for food that is full of sugar and fat, and not much else, saturate the television shows watched by millions of Australian adults and children. This happens because marketing works. But the problem goes well beyond television.

Food production companies, like their alcohol counterparts, are skilled at promoting their products through social media in ways that might astound those of us who are a little older.

We need to target the nexus between sport – particularly professional sport – and junk food. Fast food chains are major sponsors of sport at all levels, building brand loyalty and helping to normalise the overconsumption of their products.

In addition to issues surrounding our relationship with food, Australians have become far too sedentary, and for this we are also paying a price. We should make it easier for people to be active by thinking more carefully about how we plan and build our cities, suburbs and towns.

We need to make physical activity a healthy, life-long habit, and that means encouraging people to walk to the shops, cycle to work, take the kids to the park, to play team sports, and to move around more during their workday by building better workplaces and transport.

It is a sad reality that on weekends, I often see empty playgrounds and overcrowded shopping centre car parks.

So, better marketing regulation, improved health literacy and more effective town planning are just a few important and practical steps we could take right now, to improve health and reduce future health costs.

This year, the AMA has been working hard at ensuring obesity and other major public health issues such as alcohol and tobacco remain high on the national agenda.

Only a month ago, we convened the National Alcohol Summit to focus attention on the country’s drinking problem, to highlight the damage being done, and to demand the implementation of a series of solutions.

There will be no let up next year.

The AMA is developing an ambitious public health agenda for 2015 covering all of these areas, as well as extending into road safety and head injury prevention, to do what we must to help build a healthier Australia.