Obesity Epidemic: Time for a rethink. Time for action. Time for leadership.
BY AMA VICE PRESIDENT DR TONY BARTONE
There is no shortage of axioms we associate with this topic. “Obesity is a life style disease.” “It is a matter of choice.” “It’s a disease of modern society.” “It’s a matter of too much in and not enough out.” Right? If only it was that simple. The only thing we can hand-on-heart truly say is that it is a multifactorial problem that requires a multi-pronged approach.
Recently at the AMA National Conference in Melbourne, I had the pleasure of being part of a panel (https://natcon.ama.com.au/session/tackling-obesity) discussing the multiple facets of what is the obesity epidemic and what needs to happen if we are to curb this rapidly progressing threat to our lifestyle and our health outcomes.
The panel facilitated by Professor Brad Frankum included Professor Stephen Duckett, Professor Steve Allender, Jane Fleming OAM; Mr Ahmad Aly, Dr Geoffrey Annison.
What was clear from the discussion was that the problem is immense. With two-thirds of Australians either overweight and or obese we are under no illusion. Recent Australian Institute of Health and Welfare data shows that it is even greater among men where there appears to be a social acceptance around their significant excess weight.
However, what is clear from the discussion is that we need to start looking at obesity as more than just an individual condition. We need to look at it at various levels, with many different strategic approaches focusing at individual, community and public health levels, as well as at government and regulatory perspectives, if we are going to achieve changes.
We need to seriously consider the evidence emerging that it is a biological disease; one that has its underlying components in genetic predisposition and one that has its expression in an obesogenic environment that is modern society.
Furthermore, this emerging body of opinion makes the point of the existence of a primitive response mechanism of our bodies to maintain and resist attempts at dieting, defending our weight through a raft of physiological and hormonal changes in response to the weight loss and defending the set predetermined weight. Hence, we can understand the resultant yo-yo weight loss/gain our patients report in response to many attempts at losing weight.
Clearly, prevention is extremely crucial but is not the sole solution. However its role cannot be diminished. It is cheaper to prevent a problem than to solve it. Being a GP, this is firmly underpinning all our efforts in lifestyle advice and behaviour modification that we discuss with our patients. GPs are ideally positioned to initiate the conversation with our patients and assists our patients with their journey in dealing with their situation. Furthermore, GPs, I believe, have a unique place in the communities they are part of and need to lead and be a part of the community solution.
The issue of a sugar tax came under the spotlight. Even though evidence was presented by Professors Allender and Duckett that a sugar tax cut directly led to modifying or a change in consumption behaviour and to a lesser extent to a reduction in weight (particularly in the Mexico example), such evidence was ignored by Dr Annison of the Food & Grocery Council who still, along with others, believes that moderation of intake and appropriate lifestyle choice is the sole solution to the problem.
Prof Duckett beautifully made the point that he felt a sugar tax was inevitable. Political overtones from the sugar production electorates would be a significant obstacle in the short term. He did make the point that if the politicians representing these electorates, which also have some of the highest levels of obesity, did not recognise the impacts on the health of their constituents, and did not make the hard decisions, why on earth are we paying them. The importance of top-line government/ industry measures was further emphasised, as was more robust food labelling requirements.
Effort in this space must be proportional to the size of the problem. Prof Allender illustrated the comparison with a viral global epidemic led to two-thirds infection rate with a resulting 20year life expectancy outcome. The border response at our airports in the face of a possible virus would be absolutely enormous and immediate.
Communities need to be empowered to develop solutions to lead the change. Studies are showing that a local community level reduction of 5 per cent in obesity in children, over a two-year timeframe, can lead to immediate health improvements and a reduction in the burden of mental health issues.
The appropriateness of bariatric surgery as an intervention in obesity needs to be well understood and supported by public health and government interventions, especially when it comes to public hospital funding. It is clear that bariatric surgery is not an isolated intervention but part of a suite a measures that is a lifelong contract by the patient.
Physical activity is equally important but the role of gyms as being the sole solution is being beautifully challenged by the work of people like Jane Fleming. Participants aged between 18 and 87 frequenting her community-led physical activity programs, reveal the success of a program deserving closer attention and more support.
Fearless, strong leadership from the very top is required in this space. National governments and authorities can provide the coordination. But there needs to be leadership to facilitate a multi-pronged suite of policy and other interventions focusing at every level in the discussion – from Government right down to the individual choices and response. Our position statement outlines a suite of measures and initiatives at every level and no one, single measure is more important or acceptable in isolation. It does provide a pathway or a roadmap to guide advocacy and the basis for further engagement. Ultimately, every part of the medical profession has a role to play in leading their community and their profession in the future solution to this epidemic of the 21st century.