Whose responsibility is ‘obesity’?

I am sure that I heard Treasurer Joe Hockey say somewhere, perhaps in his Treasurer’s speech on the budget, that he — perhaps all Australians — expected that we would look after ourselves with respect to health. It is a view that I hold myself, and maybe I was projecting it on to him. But my reason for raising it now is that ethical discussions of the Government’s position have been hard to find in the subsequent clamour over the Budget. It is all about lies, broken promises and heartlessness.

I’ll be a boring Grumpy Old Man for a moment and say that I cannot remember more than one or two obese people in the towns I lived in when I was growing up. I’m sure there were more, and one of my my grandmothers was rather plump, but my memory is that we kids ate everything put in front of us, raced around outside, drank lots of milk, and had little money to spend on sweets. We walked or ride our bicycles to school, we played a lot of sport, and only a few families had cars.

We were all slim to skinny, the kids of my youth and adolescence. A few boys were bigger and taller, but they weren’t fat. Only one kid in my whole school experience had the nickname ‘Fatty’, and he wasn’t in any sense obese, just a bit plumper than the rest of us. By and large, my generation of high school students remain lean rather than overweight, and that is more than fifty years after we left school.

More recent generations seem to be rather heavier. The reasons are clear, and we all know most of them: Australia is a lot richer, food is cheap, we eat out a lot, we eat food for comfort, we eat a lot more sweet things, we don’t exercise much, we drive cars and watch the telly, and so on. Officialdom is out there warning us. We are the second most obese nation after the USA. There’s trouble ahead, with adult-onset diabetes, high blood-pressure, strokes, heart disease and so on facing the fat as they get older.

So far as I can see, the governments, state, territory and Federal, are the principal worriers, because obesity leads to ill-health, which leads to health care and hospitals, which leads to higher health costs. Again, as far as I can see, the general population takes little notice, though some individuals do try to sort themselves out. We are buying more bicycles, walking and exercising more, and all that is good, but still the obesity ‘epidemic’ is out there,  infecting children now; it’s not hard to see a lot of overweight children.

Why is there resistance? Well, we like to do what we like, and eating, drinking and watching television are enjoyable. Giving them up can cause pain. ‘I’ll do what I want to do!’ is the current mantra, not just about food, but in general. We have ‘lifestyles’ and they are addictive.

In health-cost terms, the whole community bears the cost of obesity through taxation. Is that fair? If obesity is something we bring on ourselves, or on our children, and is preventable for the great majority through living a healthier life, shouldn’t we all go down the healthy path? Now I don’t think that Joe Hockey said anything about obesity, perhaps because he didn’t want to be termed a ‘fattist’. But it does seem to me to be an obvious example.

Obesity is generally measured through the use of the Body Mass Index (BMI), which relates your weight to your height, with three grades: Normal, Overweight and Obese. Some measurers simply run a tape measure around your waist, and tell you that 94 cm plus is a no-no. Either way, there is both commonsense and simplicity in the measurements, and they do tell you something.

Now smokers know that they are paying a hefty tax in order to enjoy cigarettes, and the tax is there in part because of the likely high medical costs that face smokers at the end of their (usually shorter) lives — and in part to discourage the practice itself. I can’t see a real equivalent in the case of the obese. You could have a varied Medicare rebate related to your BMI, so that the lean and hungry get a full rebate and the obese very little. But in practice that won’t work, I should think.

In my view the health system, like social welfare itself, is there to save us all from catastrophe. It is not a convenience. We should feel fortunate in going through life without needing it, and happy to pay our taxes so that it is there for the others who do suffer catastrophes. I am glad it is there, but I do feel that we should construct our lives so that we are both self-reliant and altruistic. Why should the lean support the overweight?

A friend to whom I was setting out all this remarked that he remembered a slogan pasted to the bottom of a mirror in a hospital bathroom that said: ‘The person you are looking at is the one who is responsible for your health and well-being’. I agree. I would also be interested in what readers think about this issue and other like it. Governments are trying to educate us, but is that enough?

On re-reading I perhaps  should have remembered that Mr Hockey might have avoided using the example of obesity because while not obese himself, he is not really in the ‘lean and hungry’ category. I also thought his Treasurer’s speech was, as a speech, rather a good one.

 

 

 

Join the discussion 28 Comments

  • dlb says:

    Joe Hockey has undergone gastric band surgery to reduce his weight. Must say something about our lifestyle that a motivated man such as Hockey can’t bring his weight down by “natural” means.

    I wonder if the the $10000 for surgery may one day be covered by Medicare to avert a perceived health crisis?

  • DaveW says:

    Hi Don,

    I enjoy your essays because they are often well researched and thoughtful, but you seem to be under par today. Possibly it is your lean bias. My impression of the medical literature is that being lean is not necessarily a good sign, especially as one gets older, and that people who are mesomorphic to moderately ‘overweight’ (but not grossly obese) tend to be healthier, better able to survive things like heart attacks, and live longer than those who are skinny. Should I, in my rotund splendour, have to pay to support your failure to set aside enough fatty reserves to overcome an illness?

    A second disagreement I have is your assumption that people are primarily responsible for their being fat. The obesity epidemic started in the 1950’s along with the medical-establishment and government war against fat. Obesity was rare then, but fat was blamed for heart disease. The promotion of low-fat/high carbohydrate diets appears to be directly responsible for the obesity (diabetes, heart disease) epidemic in Western societies and has matching patterns wherever meats and fats have been displaced by carbohydrates from American indian reservations to American Samoa to the poverty belt of the Appalachians: the so-called ‘Diseases of Civilization’ closely follow the shift to processed carbohydrates. You can’t really blame people for following government nutritional advice or for having to rely on the carbohydrate-saturated foods available in grocery stores. Most ‘heath’ foods are loaded with carbos. There is a fair amount of literature about this now and Gary Taubes has several accessible books that go into detail and publishes regular editorials, e.g.

    http://www.nytimes.com/2012/07/01/opinion/sunday/what-really-makes-us-fat.html?_r=0

    and this one that seems to show a parallel with climate research:

    http://www.nytimes.com/2014/02/09/opinion/sunday/why-nutrition-is-so-confusing.html

    Also, I believe that the current consensus is that preventative medicine is far preferable economically to waiting for a catastrophe. So, regular yearly check-ups, tests and the like are encouraged. This could be self-serving, but I assume this recommendation is in good faith (although I never go to a doctor unless I have to).

    I think you are correct about exercise and health, but not exercise and weight loss. Exercising makes you hungry and if you then indulge in carbohydrate-rich health foods you aren’t going to loose any weight. Also, if I remember correctly, you would have to walk 35 miles at a moderate pace to burn off 1 lb of fat: our bodies are pretty good at conserving energy.

    • Narelle says:

      Excellent Dave. I think this post of Don’s is disappointingly simplistic and uninformed. It reminds me of the attitudes to AGW expressed by people who have not bothered to investigate ALL the science.
      Using ‘overweight’ and ‘obese’ interchangeably is just inaccurate. One is normal and healthy, the other is generally a problem but not necessarily one the individual has a lot of control over. This combining of those terms is partly something used by the weight loss and fitness industries to brainwash the population and increase business.
      Metabolism varies hugely between individuals and surely is related to age.

      Narelle

      • Peter Kemmis says:

        Hi Narelle

        Reflecting over these various comments including DaveW’s and yours in particular about the complexity of the issue, reminds me of how cholesterol was demonised from the 1950s, I think, and that fear of fats spawned margarine and all kinds of “low-fat” products. The parallel between that process and the AGW story is strikingly similar – simplistic assumptions about carbon dioxide levels, and whole new “renewables” industries and $$s.

        But there you have a whole swag of orthodox opinion – I’ve just done a simple search on the web, and there they are – all the “no-no” web references, from government to heart foundations to margarine makers.

        I know Pete Seegar’s song “Where have all the flowers gone” is about the futility and carnage of war, but the refrain springs to mind: “when will they ever learn?”

        • BoyfromTottenham says:

          Hi Peter,
          some good points as usual, but i beg to differ about fear of fats spawing margarine – AFAIK it was invented by the Germans prior or during WW2 because they couldn’t get enough real butter due to war restrictions. Then after the war the canny manufacturers took it global…woe to us. I always hated the stuff, even in the UK in the 1950s. Fortunately I have always eaten sensibly and have only gained 3 or 4 kilos since I was 20 – over 40 years ago. Lucky me, or good genes?

          • Peter Kemmis says:

            Hi BFT
            Well, thank you; I didn’t know it was invented back then. And I agree, I never liked it, have always eaten what I like, lots of fruit, eggs, milk, butter, can’t stand white bread, love wholegrain etc, meat, and sugar (the missus gives me a bit of gentle stick about the latter – I tell her I burn it off, but it’s a bit like climate change, the evidence is not quite there yet) – I blame it all on Mum, bless her soul. And now the doctors bitch because they don’t see much of me! Well, probably genes helped, both sides of the family reasonably trim. I do agree with the sentiments of these comments; it’s high time we stopped moralising, as if carrying a bit of weight is indicative of some degree of moral laxity.

            I do think we need some really good science about fat cells, how they form, and if and how they can be reduced in size and/or quantity (other than by surgery – gastric binding is drastic binding). My Dad had some pastoral work with Australian aboriginals in the first half of the 1930s; none of those folk in a glass slide photo I have show any sign of carrying a bit of weight. Nor do any other photos of seen elsewhere of those times. In 1959 I spent a couple of weeks with a mate on a mission station in our Northern Territory. Again, can’t remember any such case.

            I suspect that genes follow diet and lifestyle, and then as a child today if mum and dad are carrying too much, you can get a double whammy. Not only will you have their genes, but then the diet they enjoy may become your diet also.

            Incidentally, I don’t take the good fortune of my health for granted. But I think you all know that by now. All the best to you, BFT!

      • Don Aitkin says:

        Narelle,

        Where did I use ‘overweight’ and ‘obese’ interchangeably? I distinguished between them, without giving the BMI boundaries, but anyone can look them up. Tell me what I have overlooked, and where I am uninformed. I agree that controlling one’s size in our era is difficult, and my wife keeps saying so, and it is true that there is some kind of preference for apparently anorexic models, but my question remains — whose responsibility is it, and the question is relevant because of the Budget.

        And yes, metabolism does vary between individuals, and is related to age, and we live longer than earlier generations, but why weren’t there lots of obese people in the 1940s and 1950s?

    • Don Aitkin says:

      DaveW,

      I didn’t say anything about exercise and weight loss.
      Much of what you say is correct, but my question remains — who is responsible? I have read a great deal in this area over a number of years, and ultimately all the advice comes down to ensuring that one’s input and output are more or less balanced. That is to say, if you eat a lot, you’ll put on mass unless you exercise sufficiently to burn off the excess.

      Yes, an obese person can live a long life if he or she avoids the usual accompaniments to obesity, just as smokers can live a long life if they avoid lung cancer and emphysema. But the probabilities aren’t good.

      But thank you for providing the information you did. I have read Gary Taubes’s stuff in the past, but didn’t refer to it, as I might have done.

      • DaveW says:

        Hi Don,
        I’ll answer your question below, but first I’d like to make some points:
        You are correct that you didn’t make a statement about exercise and weight loss, but you did make several statements that implied a direct relationship between exercise and weight gain, and this from your reply “That is to say, if you eat a lot, you’ll put on mass unless you exercise sufficiently to burn off the excess.”

        I don’t think this is a general rule, because other factors may be more important, e.g. genetics, source of calories (all calories are not equal), and factors other than amount of exercise that affect metabolic rate and digestive efficiency. Even childhood diet may be one of the complicating factors. We store fat in fat cells, apparently fat cell number is fixed in adolescence, and if you are fat as an adolescent then as an adult you tend to have more fat cells crying out to be filled. Once the number is fixed (there is a turnover, but apparently no increase irrespective of diet), you can only store so much fat: http://www.nature.com/nature/journal/v453/n7196/abs/nature06902.html.

        So your construction ‘mass = calories consumed – calories burned’ has some value at the extremes (if you don’t eat you will loose weight and if you constantly stuff yourself with carbohydrates you will get very fat) but it seems a gross oversimplification if applied as a general rule. Or another way of putting it: Are you lean because the number of calories you consume and the amount of exercise you get is in balance or do your genetics, childhood history and choice of foods also conspire to influence your BMI?

        I didn’t say anything about people who are classified as being obese or very obese living longer – the data seem indicate that people who are moderately fat live longer than those who are obese or skinny. Also, I would posit that being somewhat fat is more of a healthy human norm, than a perpetually lean and hungry look.

        To answer your question ‘who is to blame for the obesity epidemic?’, I would place most blame on a dysfunctional nutritional health establishment, a food industry that removes fats and replaces them with highly processed carbohydrates, and the addictive nature of those highly processed foods. Call that 80% of the problem. The other 20% can be blamed on the individual if you chose, but has to include their genetics, access to a healthy diet, and opportunity for exercise.

        • Mike O'Ceirin says:

          As one FatB to another mass = calories consumed – calories burned is in fact absolutely wrong. There have been many attempts to prove that by long term studies none of which have proved it watch this http://www.youtube.com/watch?v=YpllomiDMX0 Have a look at diet foods they contain very large amounts of sugar. Weight for weight sugar has less Kj than fats but they drive insulin levels up. If I eat an egg at 400Kj I will not drive insulin levels up and I will not be hungry for 12 hours. If I instead have a serving of corn flakes it is 400Kj also but it has a glycemic load of 73. Mars bars are much less than that and for such I am going to be still hungry.

      • Mike O'Ceirin says:

        I do not agree with DaveW when he writes about overweight is okay. There
        is much evidence the way to prolong life is to bring weight well down.
        To read about it look here http://www.crsociety.org/ That being said though who is responsible for me being overweight? I have tried lots calorie restriction diets. For me they work for a period then fail. I have been advised by nutritionists and medical experts that all I have to do is stop being a slacker and get with it. So I dropped to 6000Kj a day for months on end. Initial success then back to the same story. The 5:2 diet, eat normally 5 days then for me 1100Kj for each of 2 days. Same old same old. These days I am losing weight being now 19% over (10% loss in 4 months) and using the advice of http://kidneylifescience.ca/category/dr-jason-fung/obesity/ I have taken the advice of the experts and failed so who is responsible them or me. I now think all diet advice is wrong because they are not telling us what makes us fat. Have a look at this image fattening carbohydrates increase insulin levels which causes gluttony and lack of excise! This flow chart confirms my life experience.
        http://kidneylifescience.ca/wp-content/uploads/2014/01/Hormonal-Obesity-theory-step-2.jpg

        • DaveW says:

          Hi Mike,
          I’m not saying overweight is ok, I’m saying that is what the literature is currently claiming. As we know, this is subject to change without notice. However, I don’t think lean/skinny/anorexic bodies are necessarily signs of good health and much of what we call overweight is actually not.

          I’d say our image of what a human body should look like is very recent and doesn’t match most of the healthy people that I know (also look at some Rubens paintings or movies with chorus girls from the 1930s). Also, I’d agree that once you are obese not only is exercise difficult, but it won’t help you take off weight.

          Have you ever tried a low-carb (Aitkins type) diet? Works wonders for me. I lose weight even if I consume more total calories (but it comes off faster if I also reduce total calories). Tough getting by with no bread, potatoes or pasta, though.

          • Mike O'Ceirin says:

            Aitkins failed for me because of the boring nature of it and if one strays correcting is difficult. That said of normal diets it was the best. I am going with a very low glycemic load and fasting. This means socially I can eat normally. Aiming for 20 Kg loss before 2015.

  • margaret says:

    The 3 part documentary The Men Who Made us Fat is currently on ABC TV. In the US it all began with overproduction of corn which was then used to make corn syrup high in fructose. This product became used in processed foods and soft drinks. Advertising then played its role. It’s an oversimplified precis of the first episode but fairly horrifying and while I agree that personal responsibility is important, so many new factors have made it more difficult to be slim, stay slim, and ensure our children are slim.

  • PeterE says:

    Yes. I think that ‘diet experts’ have had a role to play – ‘it is important to have plenty of bread, cereals; a glass of red wine a day is very healthy, drink milk, heaps of vegetables, three square meals a day’ and so on. People are eating more than they need in the belief that they are doing ‘the right thing’. Then there is yet another recent theory of ‘the caveman diet’ which seems to contradict these earlier dietary advices; ‘eat heaps of red meat, steak and eggs for breakfast …’ The best advice I came across years ago was a government pamphlet with kilojoules listed for most foods and an indication of the total Kj needed each day.

  • Fay Thomson says:

    Interesting discussion . There is a lot more to know for example how those born in 1930s and 1940s were fed as babies- was that the beginning of mothers being encouraged to use formula?
    I have just been diagnosed as having lactose intolerance so have a new road to travel down- smoothie drinks made with fruit and cows milk has always been one of my cravings- easy of course just substitute a different milk
    Yes , a lot to learn and documentaries such as “The Men Who Made Us Fat” and others a good start.
    I’d hope that soon our cafes and restaurants lift their game. Have you ever stopped off to eat eg at Central Station- all the food total rubbish and cooked without an ounce of love.

    • Don Aitkin says:

      Yes, Central needs a huge makeover. Leipzig’s similar building, and built around the same time, has three floors of shops, including several excellent food shops and eateries.

  • Don.A says:

    There is an Australian lawyer turned author called David Gilespie who addresses the onset of weight gain in “Sweet Poison” and his three following books. Well worth a read. Very like you Don in his agnostic approach to the establishment.

  • Mike O'Ceirin says:

    I have noticed Joe Hockey’s weight loss but I doubt his BMI
    is fewer than 30 which means he is still obese. Mine is 31 and I think his
    would be higher than mine. I too grew up near a small country town but my
    father and mother were very overweight. I suspect that was the start of my
    continual problems with weight. These days I consider myself an expert since I
    probably have tried all diets and weight loss drugs. All work dramatically for
    a while and then stop as you continue the same regime. An example of the
    extreme disappointment is one in which a drug is taken to stop the absorption
    of fat. As usual it worked well for a while and then without a change in
    caloric intake the loss stopped, and then I started to gain weight.

    Always what puzzled
    me was people around me would eat more and be thin. My wife and I used to eat
    much the same and yet there was a 60Kg weight difference how could that be? I
    have though I think found the answer. It turns what I thought about obesity on its
    head. I tried the Aitkin’s Diet some years ago and it was the most effective I
    had tried up to that time. It failed after some like all the others.

    Last January this http://joannenova.com.au/2014/01/there-goes-another-consensus-crash-diets-solve-diabetes-in-3-weeks/
    appeared on the JoNova site. In the comments there was link to this http://www.youtube.com/watch?v=YpllomiDMX0
    the speaker has a blog http://kidneylifescience.ca/drjasonfung/
    at the same time the BBC got into the act with this http://thefastdiet.co.uk/ the overall
    message from this can be summed up with this image.

    What one eats and how one eats is important. Since January I
    have stopped most carbohydrates eat more protein and natural fats. This is
    accompanied by fasting. I have dropped 13 Kg with a long way to go but I have
    methods now that work and a realisation that just about all advice from
    the diet industry is wrong.

    • DaveW says:

      Hi Mike,
      Sorry, your comment must have been coming while I was typing. For me, Aitkins is hard to keep to for two reasons (1) carbohydrates are everywhere and it is almost impossible to eat out in restaurants or at friends without imbibing and (2) carbohydrates do taste good – and set up the metabolic feedback you cite which makes you crave more.
      My wife is naturally slender, eats processed carbohydrates all day, and packs away most of the potatoes, bread or pasta that I serve her at dinner (but not myself). It’s really not fair, but it is consistent with body mass being more than just calories in and calories out.

      • Mike O'Ceirin says:

        Absolutely agree Atkins failed for me as well and my wife is the same. You need to look closely at what her habits are in regard to sugars etc. Past history is important with us all if you very the body as a thermostat. I urge you to look at the links I have been leaving particularly Dr Fung. I was 125Kg Feb 2013 conventional dieting brought me do 118 in Jan 2014 when I started what I do now. Today I am 104. Hypertension and diabetes are a deadly argument for weight loss.

  • Mike O'Ceirin says:

    The image failed to display I will try again

  • margaret says:

    I apologise for being pedantic but the diet that has been mentioned is I think the Atkins diet, not Aitkins.

  • margaret says:

    I read that in rich countries, unlike poor countries, the wealthy people are likely to be slimmer and the poor people are more likely to be obese- although Clive Palmer and Gina Reinhart give lie to that theory.

  • DaveW says:

    Here’s a Canadian alternative hypothesis for obesity that may have a kernel of truth:

    http://www.theglobeandmail.com/globe-debate/the-real-reason-the-french-dont-get-fat/article18924862/

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