The Fat of the Land: Obesity and health embedded in a complex matrix

The recently released Social Development Report 2004 in New Zealand, highlights a critical problem, not only for New Zealanders, but also for Australians. Waistlines are expanding, belts are being let out, physical activity has become a thing of the past, arm and workchair activities now predominate, and diets are on the decline. We are losing the battle against flab.

Today, probably 25 per cent of all Australians are obese and possibly 67 per cent of all adult males and 52 per cent of adult females are overweight. More importantly perhaps, at least 8 per cent of all young children are obese, and possibly 28 per cent overweight.

Twenty years ago only about 8 per cent of Australians would have been classified as obese with barely 20 per cent overweight. We are not alone. The prevalence of overweight and obesity is increasing at an alarming rate worldwide. In the USA, the obesity rate increased from 15 per cent to 39 per cent in the 20 years after 1980. In New Zealand, at least 20 per cent of the population are obese, and possibly 60 per cent overweight. By 2020 there will be at least 5 million obese Australians - enough for several rugby front rows for many years to come.

Like most developed countries, low educational attainment and social disadvantage would seem to be the best predictors of obesity. In Australia, obesity and overweight status have become diseases of the poor and disadvantaged. As The Economist once remarked, it is the poor who regularly eat chips and hamburgers, who have high sugar intakes and who smoke more and exercise less, while the wealthier eat up on tofu, fish, fruit and vegetables and hit the gym afterwards.

Ten years ago approximately 53 per cent of all women in the lowest socio-economic group in Australia were overweight with 24 per cent obese compared with 44 per cent and 14 per cent respectively in the highest socio-economic group Today, these figures would be substantially higher. There would also seem to be a strong correlation between the amount of TV we watch and the level of obesity. The average Australian child probably now watches about three hours of TV a day.

Ethnic minorities like Aboriginies and Torres Strait Islanders in Australia, and Pacific Islanders and Maoris in New Zealand would seem to be particularly at risk. The last figures available for New Zealand (and now well out of date) indicated that just under half of all Pacific Island women were obese, as were 26 per cent of all males. Today possibly 80 per cent of all Pacific Island adults in New Zealand are probably overweight or obese.

The situation is even more disturbing with respect to the young children of Pacific Islanders and Maoris. Today, it is more than possible that 40 per cent of all Pacific Island children aged between 5 and 14 years are either overweight or obese, as well as 25 per cent of all Maori children. In Australia, disturbingly high levels of obesity and overweight status have been reported among a variety of Aboriginal and Torres Strait Island communities. Possibly today, between 65 and 70 per cent of all Aboriginal and Torres Strait Island women are overweight and 35 per cent obese.

The knock-on health effects of this weight gain are significant. Alarming increases in the level of diabetes, as well as potential increases in heart disease, arthritis and a cluster of diet-related conditions are all part of it, not to mention shortened life expectancy. The increase in Type 2 diabetes is of particular concern. Once thought of as a condition of older obese adults, now more cases are being seen among younger adults and adolescents.

Fifty years ago, people who worked in manual jobs had very low levels of obesity. The technological revolution has changed all that. Jobs have become increasingly mechanised and desk bound, and computers and TV have greatly increased our sedentary life-style.

This together with the perceived (and real) higher costs of healthy food and the perceived costs and problems preventing discretionary physical exercise, have produced a dramatic transformation. The challenge for Australia is to recognise that over the last half century we have created an environment where social, cultural, economic and physical conditions actually promote excess weight and obesity.

Such an environment determines what food we eat; where and how frequently we eat it; what physical exercise we do; how much TV we watch; how much time we spend playing with our children; how much we rely on our car, how we prepare food; how much we indulge in high energy convenience foods as well as the nature of physical activity in the work environment.

How should we as a society react ? The prospect of doing something about this battle of the bulge is bleak unless we address the root cause - poverty and social disadvantage. It is not cheap to eat healthy foods. Convenience foods, cigarettes, alcohol and inactivity become “support” mechanisms for people forced to lead demeaning or impoverished lives.

It would also seem that we have got things the wrong way round. For every $1 our health system spends per person per year on preventing obesity, it probably spends $60 per person per year treating its consequences. Health education programmes targeting children or a particular group will not suffice. We need complex strategies that involve families, consumers and communities, schools, the food industry, transport and urban design, sport and recreation, the media, marketing, the health sector and local and central government.

To this end the recently announced food, advertising and media industry accord against obesity in New Zealand, is a step in the right direction. But we also need to recognise that there are many vested interests in maintaining the status quo, including elements of the food, advertising and pharmaceutical industries. In the long run we need to advocate prevention not treatment, and like so much of our society we need to recognise that not all our citizens possess the necessary personal resources to be able to make healthy life-style choices.