Pub: Sydney Morning Herald
Subsection: The Essay
The fat of the land
Obesity is big business but all the inquiries, conferences and multimillion-dollar campaigns miss the obvious point: we must exercise self-discipline and eat less, writes Elizabeth Farrelly.
"I ADORE eating and drinking," confides the lean, muscular woman at pool's edge. She bends her knees and reaches forward, curling her toes. "So I just do shitloads of exercise." Splash! and she's gone, stroking purposefully down the pool. Her friend on the starting block smiles ruefully at the departing figure, no doubt calculating whether she, too, could squeeze enough exercise into her bulging schedule to facilitate some serious gluttony.
But now the Rudd Government proffers an answer to this conundrum. And it follows a strangely familiar pattern. Just as if we manage our clean coal and our emissions trading with care we can eat our climate-change cake without losing a crumb (as the subtext goes), so with obesity. Guzzle away, then get thin. Which is why the only concrete recommendation to emerge from the Federal Government's latest obesity report, Weighing It Up, is public funding for bariatric surgery. Of course, bariatric surgery (aka laparascopic gastric banding, or lap-banding) can transform lives that otherwise seem doomed to misery. It's expensive most of the 12,000 such operations performed in Australia last year cost upwards of $9000. It may even reduce the risk of cancer.
The three most moving submissions to the inquiry were from "Name Withheld". Each was from an obese person and detailed the causes and effects from their viewpoint. One blamed "brainwashing" of children. Another ("I eat when I'm hungry, angry, lonely, tired, even happy") blamed advertising and food labelling. And the third ("we are broke") argued that $100 a month to cover gym and weight-loss program expenses would sort the problem. In a wonderful non sequitur, Brian and Linda ("my wife and I are overweight") argued that "we find that bread also spoils quickly".
It's touching. But to state-fund? Is this an admission of defeat? What does it say about us? We scorn Iran's publicly funded gender surgery for its risible insistence that homosexuality doesn't exist but what about our own truth-shirking policies?
In many ways, it seems an example of the indomitable human urge to cheat. No sooner do we understand that the body needs exercise than someone invents a machine to do it for us in three painless minutes a day. No sooner do we see the benefits of meditation than someone is flogging "meditation on the go; techniques you can use on the train, in the gym, in the office". The contraceptive pill and diet pill are similar examples of our urge to have the fun without the effort, nipping out from under the consequences.
But another implication of publicly funded lap-banding is that we no longer regard ourselves as discipline-capable. Obesity is no longer a simple personal trait but an official chronic disease, a public health issue. Prevention would be preferable, sure. But not to worry. If you can't help pigging out, nanny will reach in through a little keyhole and strangle your stomach for you. All for your own good, natch. And, as it happens, ours.
The reasoning is clear. Despite a decade of healthy-food-and-lifestyle propaganda in schools and on television, things are still getting worse. Obesity is now a majority interest, affecting 68 per cent of Australian men and 55 per cent of women. In children, the fat figures have doubled in 20 years, to 24 per cent of boys and 26 per cent of girls.
And, at an official cost of $58.2 billion yes, that's billion last year alone, it's cheaper to cut it out than fund it. Fat may not be a feminist issue but it sure as hell is a political one.
Now it's likely to get worse even faster. In these recessionary times, fast food is on the increase. McDonald's has announced plans for 55 new restaurants while KFC and Pizza Hut are also, like our waistlines, expanding.
At this rate, we'll all be obese by 2050. Well before that, though within the decade, according to Gary Egger, adjunct professor of health sciences at Deakin University and founder of Gutbusters the costs will have bankrupted our medical benefits system. Something has to change.
But bariatric surgery on Medicare? Are we saying the fat fatwa, like the wars on drugs and on terrorism, is a war we've already lost? Is self-control no longer even on the agenda?
At an individual level, fat has no particular political dimension. It may be regarded as misfortune, disease, weakness or just likeable personal quirk. Traditionally (except in scarcity situations where a fat priest or king clearly signified tyrannical greed), fat implied jollity, as in the aptly named Friar Tuck.
But as fat becomes general it takes on moral and political connotations and not only because of the familiar but nonetheless obscene asymmetry that makes a billion people in the world overweight or obese while 24,000 people mostly children die daily of starvation.
Perhaps, rather than knitting peggy squares, we could find a way of squeezing the lipids from our bodies into theirs? Maybe we could give fat just as we give blood (only without the chocolate biscuits)? Maybe there's a tasty health-cracker to be made by mixing our lipo-suck with America's corn mountain ... or do we draw the line at cannibalism?
But I digress. The politics of fat has several complicating factors. First is that, while the epidemic nature of Western obesity is now generally recognised to the point where we could rename the First World the Fat World there's no agreement as to cause.
Weighing it Up, from the House of Representatives Standing Committee on Health and Aging, runs to 223 pages. Its 12 members and six secretaries traversed the "length and breadth of the country", visiting schools, hospitals, clinics, planning bodies, academics, governments, food bodies and remote communities. They held 17 public hearings and received 158 written submissions. And yet there is still no consensus on cause.
Apart from the usual gluttony-and-indolence suspects, submissions blamed food marketing, food science, failure to sleep, failure to breastfeed, failure of the government to fund gym classes, genetics, unhappiness, helicopter parenting, stress, obesogenic environments, cultural change, poverty, education and, of course, mothers.
If that's not enough, there's also the documented effect of television in lowering the metabolic rate in children to the tune of three hours' exercise (or 1.3 cans of soft-drink) a day, as reported in the journal Paediatrics and elsewhere. Or the possible role of Bisphenol-A (or BPA), a plastic polymer widely used in food packaging, dental polymers and babies' bottles. Increasingly banned because of links to birth defects and other toxicities, BPA has been detected throughout the food chain in canned foods, soft drinks and groundwater. It also has known estrogenic activity, including promotion of breast-tumour growth. Bearing in mind the evident feminisation of men from man-boobs to metrosexuality and estrogen's fattening effects, maybe that's another thing to worry about.
Another complication is the socio-economics of fat. Neatly inverting the wealth-fat link of traditional scarcity environments, fat is now an indicator of low income, low education and low (or no) employment. And yet it is clearly not solved by just adding education or money. As Professor Boyd Swinburn, director of the WHO Collaborating Centre for Obesity Prevention at Deakin University, says, "obesity is not a knowledge deficit problem".
A further fat-complication is the play of corporate and otherwise vested interests in the scene. For make no mistake, fat is a scene. Fat is huge.
It's not just the usual food and marketing culprits, many of whom made defensive submissions to the inquiry. McDonald's says it's not its fault it has introduced voluntary food labelling and reduced fat, especially trans fat. Woolworths said it's not its fault after all, it has had the "fresh food people" slogan for 20 years. The Confectionery Manufacturers Association says relax, chocolate makes you happy (and happy people lose weight). And the Nut Industry Council says nuts, if eaten sensibly, are part of the solution, not the problem.
The Parents Jury blames advertising. The National Centre for Epidemiology blames parenting, inter alia. The Foundation for Advertising Research and Free TV Australia both insist there's "no link" between advertising and childhood obesity. Surprise.
Merck Sharp & Dohme opportunistically pushes its new weight-loss drug. Weightwatchers says the Government should subsidise weight-loss programs. Tai Chi Productions wants $600,000 for tai chi; the hypnotists want more hypnosis; the Australian Sports Commission wants its activities funded across all schools; and Covidien, which trains bariatric surgeons, advocates more bariatric surgery.
And this is another aspect of corporate complications: the vast and growing conga line of consultants now servicing the obesity industry. Medics, dietitians, policy nerds, psychologists, epidemiologists, oncologists, pharmacologists, futurologists, economists, neuroscientists, geneticists, epigneticists, physiotherapists, statisticians, marketing types, educators and lawyers all trying to help, yes, but all squeezing a living from fat.
Quite a lot of them will attend at least four big conferences this year alone: the European obesity conference in Amsterdam in May, the Childhood Obesity Conference in Los Angeles in June; Obesity 2009, the Obesity Society conference in Washington in October; and the relatively sylph-like, one-day Australasian fat-frat in Auckland in December.
What is to be done?
The parliamentary obesity committee made 20 recommendations, almost all of them what Swinburn calls "soft policies". "Develop and implement long-term, effective ... marketing and education campaigns"; "explore ways that GPs collate data on height and weight"; "consider adopting a tiered model of health care ..."; "create a set of standard guidelines" for food labelling; and "work with all levels of government and the private sector to develop nationally consistent guidelines which focus on creating environments that encourage Australians to be healthy and active." Talk about fat.
Not only are these measures universally vague and discretionary. Without a goal or yardstick between them (again, like the emissions trading scheme) there's no way of knowing, ever, whether anything has been achieved. It's hard to avoid the suspicion that this is exactly how everyone likes it.
Or almost everyone. A rare dissenting voice has been Swinburn's. He describes the Commonwealth's $124 million Active After School Communities program's self-recommended ongoing funding as "a classic case of large amounts of funding going to a program which was not recommended by the Government's own National Obesity taskforce, nor will it be evaluated to see if it makes any difference to childhood obesity".
The best answer, he says, is rules. Personal rules ("eat less") and societal ones, as in regulation. Laws, even. It's the same with urban design. "Obesogenic" car-based environments are often blamed for fat and contrasted against "healthy environments". But no one will name the single critical variable that must shift from one to the other, for it's that unmentionable the d-word, density.
Even the Planning Institute of Australia submission drivels on about "the provision of walking and cycling facilities" but refuses to talk of ending sprawl, increasing density, living more leanly and compactly, which is the sine qua non of walkable cities and can only be achieved through clear, inelastic regulation. But nah, forget it. Let's expand into our cars and fund bariatric surgery.
In the end, as Swinburn told the Amsterdam conference in May, obesity is about eating too much. Exactly what you do or you eat matters less than simply reducing calorie intake.
It's a consumption issue, with a direct analogy to stuff. The apparently endless proliferation of personal storage where people cling grimly and pay exorbitantly to keep three and four times as much stuff as they can house is society's adipose tissue. And the answer is not to chuck it out or even recycle. The answer is to consume less in the first place.
We know this is also true of fat. Dozens of studies show that lifespan increases and cancer decreases not with body mass but with reduced calorie intake. It's a rule you can't cheat. Except by lap-banding.
Perhaps, then, we'd argue not only to fund lap-banding but (as with Iran's sex changes) to force it, except for one thing; that our belts may soon be tightened for us. If you think the financial bubble-burst is bad, just wait until the consumption bubble does likewise. Consider the combined effects of peak oil, massive topsoil erosion, climate-induced drought and 8 billion people by 2030. It has to mean food loss, quite likely ours.
Of course, sustainability comes under quite another committee. But it may make our calorie intake self-limiting, allowing nanny to keep her hands in her pockets (and out of ours) after all.
DRAWING: By Simon Letch