If I might plagiarise myself for a minute, obesity is a difficult topic to write about, so some quick preliminaries. First, people have a lot of natural variation in healthy body shapes and types, it is perfectly possible to be “fat” and healthy. Second, obesity is in part a socioeconomic issue and a function of the way that poverty limits options. Third, “fat shaming” is nasty, unhelpful, and far too prevalent.
Having said that, one doesn’t need to pick on individuals to acknowledge that collectively the incidence of obesity in rich countries is increasing, that it represents a significant public (and in many cases personal) health issue with multiple consequences, and that NZ is doing particularly poorly in these respects. As a society we have a problem. A growing problem:
Obesity and problem drinking are on the rise in New Zealand
An annual snapshot of the nation’s health shows 31 percent of adults are obese and problem drinking is increasing.
Children living in the poorest neighbourhoods were five times more likely to be obese than those living in the most affluent and, for adults, the equivalent rate ratio was 1.7 times, after adjusting for age, sex and ethnic differences.
More than 5.3 percent of the adult population was morbidly obese, up from 3.4 percent five years ago.
The hazardous drinking rate has risen again, returning to levels seen in 2006/2007
It’s no surprise that obesity is more prevalent amongst the poor: Obesity linked to cycle of poverty. And no surprise that obesity, drinking, and the use of other substances are all on the rise. I believe that these are in large part reactions to increasing poverty and stress. An interesting piece in The Guardian yesterday argues that eating problems are structural:
Obesity isn’t the half of it: fat or thin, our eating is disordered
It’s wrong to focus on obesity as a ‘national risk’ like terrorism. The truth is far more complex, and solutions shouldn’t be couched in warlike rhetoric
Is obesity a result of overeating? Yes, maybe, and no. There’s science and then there is the agenda of the various health, fitness and diet businesses mixed up in this. Sometimes fatness is the result of inadvertent repetitive dieting which can upset our metabolism. Sometimes it’s a result of eating the non-food foods that industry peddles. These drench our tastebuds with fat, salt and sugar combinations that overstimulate without giving a sense of satisfaction – other than reaching the end of the packet. Sometimes it is because these same non-food foods take a too-quick journey through our body without being properly digested.
Sometimes, as epigeneticists are discovering, it is to do with changes that occurred two generations ago, when food was very scarce. Sometimes, as Tim Spector of King’s College London, proposes, it is to do with changes caused by early and frequent antibiotic use which alter the flora in our gut.
Today, troubled eating is ubiquitous and grows with each generation. The women and men whose bodies sit comfortably within the proscribed “normal” may have equally unruly and chaotic appetites and eating difficulties. This is what needs recognising. We have disordered eating across the board. That is the true public health emergency. …
Similar conclusions are drawn by a NZ obesity campaigner Robyn Toomath in this piece at Briefing Papers:
Why I Don’t Ask People To Lose Weight
At the core of the free market ideology with respect to food is the belief that it is our choices that determine the nutritional environment and we are fat because we choose to be.
Maintaining this myth is dangerous from a public health perspective as it deflects attention away from strategies likely to be effective in reducing obesity rates. Strategies which maintain choice but ensure that the default favours the eating of healthy food and maintenance of regular exercise. I am talking about fiscal measures which make healthy food affordable and accessible, and efficient public transport in the place of cars. But making weight an issue of personal responsibility is also powerfully stigmatising. Doctors contribute to this by asking people to do something most are incapable of.
We know that obesity is genetic; we know that our environment is stacked against thinness; and there is no evidence for people becoming lazier or more self-indulgent. Very few people want to be fat. The societal pressure to be thin eclipses the medical imperative for most individuals. But diets don’t work. Only 15% of people who embark on a weight loss diet have maintained weight loss at the 5 year mark. I stopped asking patients to lose weight decades ago.
That piece was written in October. Since then, Robyn Toomath has given up:
I quit. After 14 years fighting New Zealand’s obesity crisis, nothing’s changed
I’ve been campaigning for an environment that favours slimness over obesity for 14 years and nothing’s changed. It’s time to call it quits.
The Labour government at the time  identified childhood obesity as a major issue and determined to fix it. The ministers of health and education recognised this as a cross-sectoral problem and for several years New Zealand led the way with a health select committee inquiry in to obesity and type 2 diabetes, a comprehensive healthy eating, healthy action program funded largely through district health boards and a school nutrition program to ensure healthy food was sold in school cafeterias and tuckshops.
Just before the election, the Public Health Act was revised to include a clause that would allow the deputy director general of health to regulate if industry failed to keep promises designed to improve public health.
Labour lost the election to a conservative party that campaigned against the “nanny state”.
The principle that was lost in all of this is that, of course, we are sentient beings capable of choice, and that this is highly valued, but choices are made in context.
If the context is a community with no fruit and vegetable shops, but a string of fast-food outlets along the high street, then people choose between one form of unhealthy food and another.
If junk food advertising on television and the internet is associated with cartoons and games and hardly any healthy food is advertised, then children choose (demand) this food. If brown bread is three times the cost of white, poorer people will buy the white. The default needs to change so the healthier option is the easier one and only governments can achieve this, through regulation.
I’ve been saying these things for years and our government remains resolute in its support for an approach which is a proven failure. Not only have numbers kept rising but a personal responsibility approach is stigmatising.
Citizens, not advocates, need to demand that healthy food is affordable and accessible, that traditional ways of eating are preserved and that our cities favour exercise.
Structural problems need structural solutions. Progress on this major public health issue has been set back by a decade because we elected a useless National government. Add it to the list along with many other issues, notably planning for our aging population (superannuation) and action on climate change (e.g. the ETS). The Brighter Future is a disaster.