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  Globesity - your future on the fat planet TRANSCRIPT PROFESSOR PHILIP JAMES: It's been described by the World Health Organization as the biggest unrecognized public health problem in the world. TONY ABBOTT: Two thirds of Australian males are now overweight, one half of Australian females are now overweight and a quarter of our school children are now overweight, a third of those are technically obese. PROFESSOR PAUL ZIMMET: Today when people are living longer lives as a result of improvements in science and medicine, we face the horrifying scenario that many parents will outlive their children because of this affluenza epidemic. KIRSTINE LUMB: The world's waistline is bulging. Over one billion adults worldwide, and 10 percent of children are now overweight and obese. Obesity is contributing to decreased life expectancies; from type 2 diabetes, cardiovascular disease, and various cancers. It's reached pandemic proportions and yet our government has decided not to pull rank, putting the onus back onto individuals. TONY ABBOT: We can't have a government canteen at which everyone eats; we can't have a bureaucrat supervising every family's meal time. We can't have compulsory exercise programs every morning in every neighbourhood park. What we need to do is to give people more opportunities to do the right thing by themselves. KIRSTINE LUMB: Recent government refusals to ban food advertising to children is bewildering given they do recognise this as a very serious condition. TONY ABBOTT: Obesity is one of the principal factors in diabetes and that can reduce life expectancies by up to 15 years. Seven thousand Australians a year die from the cardiovascular complications of obesity. That's 20 people a day are dying in this country from being overweight. KIRSTINE LUMB: At the recent International Congress on Obesity in Sydney, scientists and experts from around the world called for immediate action to address this very international problem. PROFESSOR PHILIP JAMES: The evidence from Asia is that it's escalating faster than we could ever have dreamt of, therefore most of our predictions are probably substantial underestimates. I'm told that I'm an alarmist, I'm not an alarmist, I'm trying to get the message across that the more we look at it, the more we've got it wrong because we've been underestimating the problem. KIRSTINE LUMB: According to many academics, the obesity epidemic in Australia and around the world is largely a result of our industrialised environment and our inability to adapt quickly enough to it. PROFESSOR EMMA WHITELAW: We have evolved over thousands and thousands of years to be able to store energy when we kill an animal or pick a great big juicy piece of fruit or berry, but we no longer need the ability to store that energy because we are being provided food on a plate continually. So I think we now are getting obese — food is too easy to get unfortunately. PROFESSOR PAUL ZIMMET: Our whole environment has changed, we now live in the most obesegenic environment in human history and, for example, exercise is being engineered out of our lives just by the way we live, by our modern society, and that's a very important factor. PROFESSOR PHILIP JAMES: At the same time, the food industry has been built to make sure that people don't have a shortage of food, and now the companies are doing everything to sell their products which means I'm being bombarded because everyone wants me to buy their particular brand, so my brain is trying to shut down on my intake and the food industry is trying to get me to eat more. KIRSTINE LUMB: So much of the once undernourished world is now over nourished; and the multinational food companies are so powerful in international trade that we will continue to be force fed their products. This is not a matter of weight being attractive or acceptable, it's the fact that obesity is leading to extremely serious health problems. PROFESSOR PHILIP JAMES: Many of my colleagues now talk of diabesity, not obesity and diabetes, but diabesity as a single continuum, and what we've got is an unprecedented epidemic of diabetes. KIRSTINE LUMB: Diabetes is no longer just a scourge of the developed and wealthy nations. In the bid to feed the famines we have oversupplied people who genetically are not prepared for a plethora of food, nor a sedentary lifestyle. PROFESSOR PHILIP JAMES: The centre of diabetes is not as we imagine in the wealthy countries of Europe, it's in Asia and the Indian problem of diabetes is catastrophic. We are talking about perhaps a third of adults walking in the slums of the big cities of India and Asia who are either already diabetic or they're showing that they're on the verge of becoming diabetic. UMA SWAMY: The trend to put on weight, yes you can see, when you walk past the streets of India you will definitely see a lot more people are looking fat these days. KIRSTINE LUMB: Uma Swamy and her mother, Valli, who now live in Sydney, are from southern India, they grew up in a world where food was sparse and physical activity was part of everyday living. UMA SWAMY: I think the basics have really changed these days, that's what I really think is happening, from what my mother used to do when she was a child, all the comforts that have come through due to the technological advancement that has happened, and what she as a child has known, she had to go and fetch water from the well. The amount of milk that my parents could afford or buy and what we do now, there is a huge difference. KIRSTINE LUMB: This change in lifestyle has had dramatic effects on Uma's mother. Valli is now technically obese, she is also diabetic, blind and has suffered a recent heart attack. UMA SWAMY: She suffered because of that, because she hasn't taken care of her weight when she was in her 50s and so when she came to her 70s I think it's just blown out and her heart just couldn't take it, there were lots of problems in her heart because of her cholesterol and because of her diabetic condition. KIRSTINE LUMB: What Uma and her family are concerned about is whether or not their genetic background is influencing their current health situation. UMA SWAMY: I think we do tend to put on weight, even though I make sure that I don't eat too many fried stuff, I take less carbohydrate, I do everything, but in spite of that, I put on weight. So we don't know why, and I do a bit of treadmill, not that I don't. I try my best to sort of squeeze in at least half an hour of treadmill, but all that put together doesn't really bring down your weight. I just feel that I don't know, I just put on weight and I'm a bit concerned, it could be genetic, it could be environmental, it could be anything, so we don't know why, so yes it is a concern. PROFESSOR EMMA WHITELAW: I think, ultimately, people should be reminded of the fact that they have control over their body weight despite all the genetics. We know that if you stop eating you get thinner and ultimately the power is in their hands. KIRSTINE LUMB: There is another intriguing finding, it's looking as though it's not just genetic shuffling of genes over the centuries that effects our predisposition to obesity, but we can actually alter the way in which genes function, merely on the basis of a mother's diet during pregnancy. PROFESSOR PHILIP JAMES: It's become very clear that there's so-called epigenetic changes, not genetic changes, epigenetic changes which are effecting the way the genes work, such that you're programming the way those genes develop and behave, and that development phase looks as though it's in pregnancy and probably for the first 18 months or two years of life, and after that we're then either resistant or super sensitive to developing diabetes. PROFESSOR EMMA WHITELAW: Epigenetics is the study of molecular changes that can alter the way in which our genes are expressed, so you can see it as an extension of genetics. The field is a very young field and probably the best experimental evidence for the importance of epigenetics in obesity has come through studies in mice. KIRSTINE LUMB: What this research suggests is that if women are overweight when they become pregnant, not only are they more likely to get diabetes during pregnancy, but their children will be extremely sensitive to developing diabetes, and possibly, their children's children as well. PROFESSOR PHILIP JAMES: Now there is dramatic new evidence suggesting that when the genes are switched on or off in the uterus you're switching on and off the genes of the foetus's own reproductive tissues, so you may actually be effecting two or even three generations. KIRSTINE LUMB: Some children already suffering the effects of obesity, to the extent that they are diagnosed as morbidly obese by the ages of 12, 13 or 14, are being treated by Sydney doctor Robert Parker, at the Children's Hospital in Westmead. His statistics of overweight and obese children in Australia suggest we are already facing a public health catastrophe. DR. ROBERT PARKER: The figures would suggest it's somewhere between 20 and 25 percent, so it's almost one in four, in some populations we believe that overweight and obesity is now one in three. KIRSTINE LUMB: Dr Parker's work is a first for Australia, bringing together a team of clinicians, physiotherapists, dietitians and exercise physiologists to provide exercise interventions for severely obese children. DR. ROBERT PARKER: What is of grave concern and greatest concern for us is the doubling rate. From 1965 to '85 there was a doubling rate, so that was a 20-year period, the doubling rate was then halved from 1985 to '95 from 20 years to 10 years, and we suspect that the rate is doubling faster yet again. We're putting our little toe in the water to try to find ways to motivate children who otherwise hate exercise, hate themselves, do not like the way they see themselves, are bullied at school, are bullied at home and just for all intents and purposes are living in environments that basically, that preclude them from going out and being active like most other children. KIRSTINE LUMB: But it would be irresponsible for society to be purely focused on the obese. It is those who are gaining weight, even slightly, who need to address their ballooning weight, before it's too late. MATT O'NEIL: There is a downside by focusing on the O word, obesity, because what it will create is a group of people that might feel victimised, that we're targeting them only, and it also creates another group that are just creeping from being normal weight to a bit overweight to feeling their pants getting tighter, which is the exact time you should be looking to get more active and reduce your calories, but because of the focus on obesity you might think, well it's not me, I'll wait till I get bigger later, and by that time, all the research now is showing it's incredibly hard to reverse. So the key thing is if your pants are starting to get tight, do something a bit now. KIRSTINE LUMB: Recognising the signs of weight gain and understanding how to manage weight is essential in maintaining health. MATT O'NEIL: It's a simple thing, energy in, energy out. Whatever diet you're on, whatever exercise program, whatever pill, potion, lotion, gadget or gismo, it all comes down to does it cause you to do less exercise, does it cause you to eat more, if that's the case that energy balance scale tips and you put on more weight around the middle. So it is energy in, energy out, as simple as that. PROFESSOR PAUL ZIMMET: To prevent this pandemic we need fundamental changes in our societies. Urban planning to ensure that people exercise more. Physical activity introduced into school curricula again. Nutrition education starting in schools. Production and availability of cheap, healthy foods and responsible food labelling and advertising. KIRSTINE LUMB: The Australian government has been actively highlighting the need for individuals to address their health and fitness through public health campaigns and through very public role models. The Prime Minister and Health Minister are both extremely strict with their personal fitness regimes. But they stress this is an issue of personal responsibility — not something that can be enforced on a population. TONY ABBOTT: It is a very serious health problem, we do need to tackle it, but it's got to be tackled at the level of the individual, of the family, and the social organisation as well as at the level of government. MATT O'NEIL: We hear this time and time again from the government, it's our own responsibility, there is personal responsibility, but this problem is so big that we actually need a combination of both solutions, both individuals putting up their hands and saying I will try and eat less and perhaps the government saying I'm going to help you by reducing your exposure to high fat and high sugar foods. TONY ABBOTT: If something is harmful under all circumstances, we are prepared to look at bans, but something is only harmful in ill disciplined doses so to speak, well then public education is much more important than bans. Philosophically I'm a reluctant regulator. On the other hand, I'm very keen to see a better informed people making more sensible choices. PROFESSOR PHILIP JAMES: It's been shown in a whole series of systematic analysis that if you go in for the usual business of telling people that they should exercise more and eat less and this type of health education, it's been tried, the evidence, systematically refused by independent scientists shows a pretty useless way of doing things. KIRSTINE LUMB: Last year the federal government announced it would not be banning television food advertising to children. TONY ABBOTT: They have not been shown to work. In Japan, in Sweden, in Quebec we have had long standing bans on advertising of so-called junk food to kids and their obesity rates are increasing just as much as everyone else's. PROFESSOR PAUL ZIMMET: It's quite clear in Australia we're not going to have TV advertising banned at this stage. The government has made that quite clear. It's very much in favour of better food labelling, which I agree to. KIRSTINE LUMB: This move by the government flies in the face of calls from experts on obesity who claim we should throw every tool we have at solving this problem. NEVILLE RIGBY: First of all there isn't good evidence to suggest that these bans don't work PROFESSOR PHILIP JAMES: It's been essentially shown in pretty convincing terms, by the most world experts you could imagine, that this process distorts and harms the pattern of eating for children. So I'm not quite sure how somebody can argue with that evidence, and if you're asking for proof that if you stop damaging children they'll get better, well isn't it time that you tried that experiment? KIRSTINE LUMB: Perhaps what will resolve this debate in Australia, and the health issue of obesity around the world, is the economic impact of future health bills as our society gets sicker. PROFESSOR PHILIP JAMES: The economic costs of obesity are going into billions of dollars for countries and the projections are that no health service on earth, including the United States, can afford the consequences of what's happening. MATT O'NEIL: Based on expert predictions, within the next 20 to 30 years we're looking at 100 percent of the population being overweight or obese. The real problem is that if we don't get a handle on it now, that even before the end of our generation we're going to be paying higher fees for health funds, there's going to be longer waiting lists for government in terms of getting into the hospitals and people are going to find their quality of life disappears at an earlier age. KIRSTINE LUMB: In New Zealand there have already been some changes to private health insurance, with discounted premium costs for those who lead a healthy lifestyle. But despite the international attention obesity is attracting … what if we are not able to curb this rising epidemic? TONY ABBOTT: For hundreds of years, ever since the beginning of the industrial revolution, each generation has been living significantly longer and healthier lives than its predecessor, and if this obesity epidemic continues, that process will reverse. And our kids will live shorter, less healthier lives than we do. That would be a tragic development for a country like Australia, it would be a tragic development for the entire, for the entire world. Click here for a printer-friendly version. |
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