A tide of fat

Ask the average Aussie what he or she considers to be a challenge facing the globe and no doubt the following would feature frequently – the economy, the environment, affordable housing, the Eurozone crisis, Indigenous health, job security, public education, Congress and the debt ceiling…

Perhaps far far down the list, a lone pollster would cite the unsustainable strain created by increasing rates of obesity around the world. Perhaps someone had read The Economist's Special Report on Obesity published in December last year.

Let me throw you some of The Report's frightening facts and figures - obesity is currently the fastest growing cause of disease. By 2030, 3.3 billion people will be overweight or obese and one in ten of us will be baring our buttocks daily for an insulin injection.

At home, the Australian Bureau Statistics projects that by 2020, 75% of the nation will be overweight and 65% obese.

It's time we all started jumping up and down (preferably literally) about obesity.

If losing weight was easy there would be no epidemic - but, as The Economist special report notes, unlike other vices such as tobacco, drugs and alcohol, keeping the kilos in check requires changing a multitude of behavioural patterns.

Indeed the path to health and leanness is an all-consuming odyssey - we must not only eat the right foods but the right amount of the right foods – this requires knowing what are the right foods and being able to afford the right foods. On top of this, is learning how to negotiate situations where we have no control over what food is available to us.

As if the task wasn't onerous enough, an increasing number of studies are indicating that once you start dieting, the hormone leptin starts falling. When leptin levels fall, not only does your appetite increase, but your metabolism slows down too. Please excuse the food related idiom – but this is a recipe for failure – we're destined to be doughy.

Another part of the problem is the way we view the problem – we think of weight as an individually based phenomenon – my weight problem. However, as the negative externalities generated by obesity continue to mount, your weight problem is in fact increasingly my problem too.

Jessica Irvine, one of Australia's leading economists reveals in her book Bananas, Zombies and Why There Are No Economists In Heaven that her own weight loss was partially motivated by her knowledge of the economic cost of carrying unnecessary kilos – appreciating, that her weight was serving to weigh down others.

How often though, does a colleague in the tea-room cite reducing the strain on the healthcare system or increasing their productivity at work as a motivating factor behind their current diet or exercise regimen?

In 2010, an Australian Medical Report found that annual direct healthcare costs for a normal weight, overweight and obese person were $1710, $2110 and $2540 respectively – in the aggregate these differences could soon have people pleading their pudgier pals to forgo dessert for the sake of their own hip pocket.

On the work front, an American study published in the Journal of Occupational and Environmental Medicine in 2010 estimated the reduction in productivity directly attributable to obesity was costing the US economy $73bn annually – going so far as to scrutinize the output lost when one tries to type and eat simultaneously.

In her book, Jessica Irvine quotes a mind-blowing stat from a 2009 Access Economics report – if just 3% of the Australian adult population started using fitness centres it could reduce healthcare costs by around $200m and boost GDP by $82m.

Scared yet?

Obesity, an increasingly communal problem requires a communal response, but it is unclear what is or will be the most effective measure.

Is banning junk food necessary? - like Mayor Bloomberg outlawing the Big Gulp Soda in New York.

Instead of an outright ban, do we (with regressive consequences) tax high calorie processed foods? In Denmark, a tax on the fat content of foods was abandoned after a year – studies showing that it failed to change consumption habits, generating nothing but a saturated fat shopping spree on the eve of the tax.

Should people with gym memberships get discounts on their private health insurance (despite the fact a gym membership doesn't necessarily translate to frequent gym use)?

Or do we offer free health screenings like they have in Abu Dhabi?

Perhaps we should be enacting calorie education programs in schools to prevent the next generation from being as fat as us.

Or can this generation still be saved? Should we be subsidizing gastric bands for the morbidly obese? This was the topic of debate on 702 ABC Radio the Thursday before last when the news that the Shadow treasurer, Joe Hockey, had had his stomach stapled.

The government flat-out financing gastric banding for obese people would have any person who has taken ECON101 asking questions.

The majority of economic strategies which seek to effect change or manipulate behaviour boil down to creating incentives – how does a morbidly obese person's incentive to keep the weight off change when they haven't footed the $15k bill for the operation?

Melanie Tait, the ABC Broadcaster who had a gastric band in 2008 (paying for it herself) conceded that the virtues required for traditional weight loss – self-restraint and increased physical activity - remain essential ingredients for long-term success, even with the artificial kick-start created by stapling one's stomach.

Long-term studies do indicate that the majority of gastric band recipients shed some serious kilos - some of them losing up to 50% of their body weight. However, even with these extraordinary weight loss numbers, many gastric band recipients still report BMIs over 30 – although a far cry from their pre-operative BMIs of 45+ these 'success story' patients are still, technically, obese.

Additionally, a recent Monash University study revealed that up to half of the candidates required follow up surgery – will these costs also be covered by the publicly funded package?

If the government is going to intervene, a reverse HECS arrangement may prove the most effective way to preserve private incentives - the individual bears the upfront costs of the gastric band and weighs in annually for a decade – for every year their weight loss is deemed adequate to alleviate medical pressures and this weight loss is maintained they are awarded a partial rebate.

There is no stand out solution and there is still so much to be tried and tested, but for now we need to start thinking of obesity as the ominous threat that it really is – it must sit in our psyches alongside its fear-breeding equals.

However, what may stand to separate the obesity epidemic from its catastrophic cohort, as The Economist poignantly notes - is that it is an entirely preventable problem.

Be it folklore or fact, it is still widely quoted that 95% of people who diet fail to lose the intended weight, or, if they do, they're back to square one before they've even had time to enjoy their slender self.

Perhaps a psychological shake up of what is motivating us to spend more than $800m this year on weight loss measures could go some way in securing greater long-term success – in these desperate times it's at least worth canvassing.

So I implore you, think not of those jeans you so desperately want to get back into, or of being trim and taut for your cousin's wedding, but - cue drum roll for the syrupy, emotionally charged warning - the burden your weight places on your generation, your children's generation and your children's children's generation.