04:49am Thursday 24 August 2017

Sloth and gluttony: sinfully simplistic answers to the obesity epidemic

Many people blame laziness and ready access to attractive, energy-dense foods for the obesity epidemic.

By Professor Paul Zimmet

Like politics, football and global warming, obesity is a topic that attracts huge attention in the media as well as talk on the street and in coffee lounges. And it is the most serious health issue facing the global community today.

Australia is in the top 10 fattest nations globally and we, like many countries, are struggling to control the epidemic of obesity and related chronic diseases (such as type 2 diabetes).

The renowned Israeli scientist, Eleazar Shafrir at the Hebrew University, coined the term “diabesity” to characterise the close linkage between obesity and diabetes. Today, diabesity is shaping as the biggest chronic disease epidemic in human history. It leads to the onset of other debilitating and costly illnesses such as heart disease, certain cancers, musculoskeletal disorders and obstructive sleep apnoea, to name a few.

In Australia, the national diabesity epidemic continues unabated. The Federal Government’s response to the recommendations of the recent National Preventative Health Taskforce Report on obesity has been very disappointing and we must ask questions about their commitment to the recommendations, as well as the effectiveness of the limited interventions they have put in place.

Many in our community, including our politicians, have a simplistic view of the causes of obesity. They blame two major factors: laziness and ready access to attractive, energy-dense foods. This fallacy is fueled by the media, who reinforce to us that the obesity crisis is primarily caused by sloth and gluttony.

These views invite a passive response and allow government to retreat to the message of individual responsibility. Yet, in reality, as stated by the UK obesity expert Professor Peter Kopelman, “the causes of obesity are embedded in an extremely complex biological system, set within an equally complex societal framework”. Obesity is a highly complex disease and nearly every drug so far developed for obesity hasn’t proved safe enough. We have to find the silver bullet, and only continued scientific research will get us there.

Based on this view, the strategy to tackle obesity needs to be based around an understanding of its complexity and not on a half-hearted collection of disparate and unconnected measures that are unlikely to address a burgeoning epidemic of this magnitude. Seven years after we conducted the last Australian Diabetes and Lifestyle Study (AusDiab) survey in 2005, there are still no reliable national monitoring data on diabesity and a distinct lack of evidence to suggest that we are winning the war.

Despite the important recommendations of the Preventative Health Taskforce, initiatives to address the obesity crisis have been fragmented, with in excess of $35 million of dollar being spent on social marketing initiatives such as the balloon man, Eric, and his “Swap It, Don’t Stop It!” campaign. It is not clear how this campaign is being evaluated and how it will have any impact on the obesity epidemic without other major, well-funded initiatives.

Fundamental to both the treatment of obesity and its prevention is a strong research framework. So where do we start?

Before 1994, obesity research was in a stagnation phase. It received a huge boost after the discovery of Leptin – a key hormone involved in appetite regulation – by Jeff Friedman at the Rockefeller Institute in New York. This landmark discovery set the field alight; it triggered major new collaborative initiatives around the world, and provided a focus for researchers on the role of the brain and its pathways that play a role in appetite regulation. The recent symposium between scientists from Monash University and the world-renowned Weizmann Institute (in Israel) highlights the potential of these collaborations.

For our government and public health bureaucrats there is an impelling need to change the myth that sloth and sedentary behaviors are largely responsible for obesity. Let’s get beyond the blame game, which inevitably seems to end with responsibility for controlling obesity being laid at the feet of parents and the individual.

Politicians and bureaucrats need to recognise the fundamental change in thinking of scientists and public health researchers as to the underlying drivers of the obesity epidemic. There is a  significant biological component driving the very behaviours we tend to focus upon and blame people for.

A 2008 Access Economics report put the cost of obesity in Australia at $58 billion per year. The potential cost of strengthening research into the cause of obesity and its prevention, and implementing the broad range of interventions recommended by the Preventative Health Taskforce, would seem to be an absolute bargain against such a figure. But is anyone in Canberra listening?

Monash University’s Professor Paul Zimmet, is  Director Emeritus of the Baker IDI Heart and Diabetes Institute and is a member of the Scientific Advisory Committee  of Weizmann Australia.


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