Lifestyle is the key

More and more people are using “corrective or cosmetic” surgery to overcome symptoms of an over-indulgent lifestyle. This demonstrates the immediacy of our thinking and actions. If a person can’t work out in a gym, backyard, or even regularly walk, or they simply can’t be bothered then there are implants available for greater looking pectoral or gluteal muscles. Throw in a breast augmentation and a tummy tuck for good measure.

Ever wondered why diet books and weight loss products are a multi-billion dollar industry in Australia alone? Excess fatness is the most important risk factor for diabetes yet people can’t seem to help themselves or the public purse. When there is either a faster option or an expectation that the system will eventually take care of me - “I can have my cake and eat it, or two”.

The trouble with all of these treatments, pharmaceutical, surgical or otherwise, is that the benefits are typically one-dimensional. If you take statins then, sure, it helps to reduce blood lipids and fatty plaques but this is also a benefit of regular physical activity. However, with an active lifestyle you also get the return of a larger and stronger heart, more capillaries to carry oxygen in the heart and skeletal muscles, more elastic blood vessels that are less likely to rupture to cause strokes and heart attacks, better control of body weight and blood pressure, stronger bones and muscles to reduce the chance of osteoporosis and falls as we age, and the list goes on and on.

Where to from here?

Almost nothing changes in terms of behaviours unless there are inducements or penalties, or both, in place. Take smoking for example. Three decades ago when the prevalence rate in Australia was around 40 per cent who would have predicted this to fall to less than 20 per cent today? No one, and it wouldn’t have happened if it wasn’t for legislation to add taxes; to prevent advertising through most avenues; to restrict the sale to minors and in how it is sold on site; the illustrations on packaging the damage that is done to health, and so on. Educational campaigns may have been useful, although it is difficult to tell, but clearly the big-stick approach changed behaviour.

Educational campaigns have been run in Australia promoting more physical activity and how good it is for one’s health. Follow up surveys reveal more than 90 per cent of the population know it is good for them and what they need to do. Repeat state and national physical activity surveys also show the rate of sufficiently active adults has flat-lined at about 50 per cent of the adult population. People report a “lack of time” as the single most important reason for not achieving adequate levels of physical activity. Dig a little deeper and you find that (despite what they say) those who are most likely to reach a sufficient level of activity are those with the least amount of leisure time. Those least likely to be active are those with the most leisure time. We also know that for each additional hour of leisure time we get, about 50 minutes is spent on screen-based entertainment.

The answer is not a simple one. For some people there are more important day-to-day struggles with mortgages, children, work commitments and on and on. Should anything be more important than your own health or the health of the broader community?

Let’s make a greater effort to both reconstruct the health care system to more adequately “front-load” the spending model and address the inequalities of health and disability. This will only work if, as part of the model, there is also a greater emphasis on rewarding lifestyle choices that reduce the national burden of disease and disability.