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Building healthier bodies can start with healthier towns

Prof Simon Stewart

by Prof Simon Stewart

26 May 05:40am

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Filed under: Fast Food, Health, Obesity, Preventative Health, Society

27 comments

With the majority of middle-aged Australians either obese or overweight the direct contribution of their excess fat to poor health outcomes is potentially staggering.

Are we all getting our marching orders? A file artwork by The Australian's Jon Kudelka.

Over the next 20 years it is likely that overweight and obese Australians will experience 700,000 more hospitalisations and 120,000 more deaths related to weight-related diabetes and cardiovascular disease (including heart attacks and strokes) compared to the same population who remain healthy and slim.

The calculated cost to society in terms of health care alone is $6 billion. The cost of losing loved ones and productive members of our society is probably incalculable.

At a national level, our disputed claim as the fattest developed nation on earth has at least put some perspective on our collective weight gain and fall from grace as a truly active nation of budding athletes.

Even if we are not the fattest in the world, would we really be happy to win a bronze medal at the fictional Fat Olympics?

Those who visit our shores (particularly those from European countries where cycling and walking are the norm) are struck by how big we have become.
The options being considered by the Federal Government and their recently formed Preventative Health Task Force are many and varied. We have already seen a campaign to “measure up” and consider the impact of increasing weight on our individual health with increasing awareness of the same.

However, this is unlikely to be successful when “fat” has become the norm and our collective eyes have been recalibrated to accept and embrace greater girths. More radical policies and health initiatives may be required. Some experts have advocated increased availability to radical surgical options once considered the option of last resort for the morbidly obese - for example, gastric banding.

At the same time, there have been suggestions that more draconian policies in respect to the cost of health insurance will need to be implemented in the not-too-distant future, such as the obese paying higher premiums, or denying access to certain surgeries until reaching an agreed weight.

These are drastic. More palatable options will focus on community interventions to both encourage and reward healthier lifestyles; remembering that healthier eating and increased exercise not only increases the likelihood of weight loss but tackles the other two modern drivers of preventable cardiovascular disease - high blood pressure and high cholesterol.

Similar to “Tidy Towns”, there is merit in the idea of promoting “Healthy Towns” with the provision of sporting facilities and other recreational services to those communities prepared to tackle issues of local food supply - like getting rid of some fast-food shops, or access to healthy lifestyles by means of programs like free fitness coaching.

These would be best supported by initiatives that can monitor a communities’ health overall and reward them for achieving key milestones like, for example, a collective loss of weight.

Baker IDI has engaged more than 2500 adults in regional communities in Victoria to monitor their heart health. This includes a number of basic parameters including their overall weight and waist circumference. A six month trial of intervention in Colac, Victoria has shown that the associated Protecting Healthy Hearts Program (funded by the Department of Health and Ageing) can not only engage and retain a large number of adults in one community, but promote positive life-style changes, including sustainable weight loss, that will prevent future cardiovascular events.

The challenge will be balancing a carrot and stick approach to weight loss that doesn’t disadvantage the most vulnerable individuals and communities.

It is a paradox that the poorest people in our society are most at risk of being obese. As a result, the politics of food advertising and consumption will need to be carefully managed.

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27 comments

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    • acker says:

      07:42am | 26/05/10

      How about encouraging Australian farmers to grow more local produce by busting up the supermarket duopoly and introducing a growing location to city distribution centre cartage tax (including overseas produce) and add a fa, sugar and salt tax that will hit all those cheap generic processed foods.

      Encourage more local fresh produce and local fresh produce markets, and help remote aboriginal communities get fresher and more affordable fresh food.

      Reply

    • missnoir says:

      08:53am | 26/05/10

      I agree, and we should have more farmer’s markets with local produce in the city. I know there are some in Eveleigh and Pyrmont, but not sure where else, and I think they are only on Saturdays.

    • Budz says:

      09:57am | 26/05/10

      I don’t want to have to pay more for the unhealthy good I eat just because other people can’t control themselves.

    • acker says:

      11:13am | 26/05/10

      @Budz… Why should someone in a remote indigenous community pay 12 times more for a lettuce that was probably grown 500km closer to their community than some city slicker in central Melbourne ? where is the social justice in that ?

    • Budz says:

      03:08pm | 26/05/10

      @acker…...I am happy to subsidise their vegetables as long as they subsidise my housing, transport and other costs that are higher in the city. See, I do believe in social justice and equality smile

    • zoe says:

      03:25pm | 26/05/10

      @Budz I would rather pay more for the occasional unhealthy food and less for the healthy food I eat most of the time.

    • Tracey says:

      08:07am | 26/05/10

      I think that our town planning regulations play an unrecognised but significant part, too. Shops are now allowed only in very limited, highly concentrated zones, with the subsequent demise of the “corner shop”. I’d love to see the return of more “corner shops”; where one could walk for the newspaper or some milk instead of getting in the car. These shops also provide a sense of community which would be wonderful to see restored to suburbia. : )

      Reply

    • missnoir says:

      08:33am | 26/05/10

      I think gyms should be more affordable and flexible, then a lot more people would join up. People should be rewarded for going regularly. In my current gym I get free personal training if I show up to the gym at least once a week for 12 weeks. If I miss even one week, I have to pay for it. This should be taken further - at least 3 times a week and you get ongoing rewards.

      Also, our serving sizes in cafes and restaurants are ridiculously large, especially compared to places like Asia. They could easily be halved. It is what we are used to eating, therefore we eat far too much all the time. This is why I always lose weight when I travel in Asia, because the serving sizes are much more suitable.

      Reply

    • Budz says:

      11:28am | 26/05/10

      A gym is generally a private comany that is there to make profits. I very much doubt if they can that you actually go to the gym after you pay your membership fees.

      If you know you are going to a restaurant where the portions are large, then you can always share a dish, no one forces you to eat it all.

    • Hermano says:

      01:08pm | 26/05/10

      Here’s an idea Miss Noir: get a bike.  I can’t believe so many people go to gyms to compensate for their sedentary lifestyles.  Make your lifestyle more active and you’ll be fitter, thinner, happier and won’t spend all that money being yelled at by a personal trainer and putting up with all those horrible gym junkies.

    • Anna says:

      03:28pm | 26/05/10

      Are you kidding?
      My gym is the world, it is subsidised 100% by the government. Somehow being fit and healthy is enough of a reward for me.

    • Liz says:

      08:58am | 26/05/10

      ‘our collective eyes have been recalibrated to accept and embrace greater girths’ and what about the excessively thin models so many are worried are giving bad messages to the young?

      Reply

    • Martin G says:

      11:42am | 26/05/10

      Both sides are at fault, the middle-ground on this issue is far too small.

      The promotion of ‘plus-size’ models as ‘real women’ is as irresponsible as promoting the stick-figure models.

    • centurion48 says:

      09:16am | 26/05/10

      Set aside land in every suburb in the major cities for community gardens. Actively assist people to grow vegetables locally - either in their own backyard or the community garden - and set up growers markets. Allow, encourage even, people to have a few chooks and/or ducks at home for eggs and meat.
      Many suburbs have lovely grassy parks with trees and shrubs but this is under-utilised space that could be used productively. It might also engender some community spirit.

      Reply

    • SalC says:

      03:23pm | 26/05/10

      Local community gardens are an awesome idea!  You can grow a few different things and swap with your neighbour!  It’s great if you’re renting and you can’t dig up your backyard.  So many other countries have community garden areas (some are sprouting up in suburbia here) but it needs state government support to provide the space, and council support to maintain.  It’s an investment in the future health and wellbeing of our communities.

    • Dino says:

      09:36am | 26/05/10

      Many country towns are very focused on the use of cars for people to get anywhere. In my Home town, Horsham, this has resulted in big problems with car parking in the CBD. My solution would be to make the town more pedestrian and cyclist friendly with walkways where cars must give way. However, getting this sort of thing on the agenda with the powers that be is very difficult. Perhaps the state government could lead the way with some guidelines and financial support.

      Reply

    • acker says:

      09:48am | 26/05/10

      Shutting off streets and making them into pedestrian mall’s were a good idea, unfortunately local and state government planning departments then approved gigantic shopping centres which took all the customers who shopped in the pedestrian mall.

    • missnoir says:

      09:55am | 26/05/10

      Another good idea is to make it safer for bike riding in places like Sydney. I would love to use a bike to get around the city but it is far too dangerous, too much road rage and not enough bike lanes.

      Reply

    • Martin G says:

      11:45am | 26/05/10

      Your real name wouldn’t be Clover Moore would it?

    • Hermano says:

      01:14pm | 26/05/10

      Forgive me Missnoir, I just told you in another comment to get a bike.
      I agree to an extent about riding being dangerous.  The thing is, there are almost always safe alternatives to the main roads.  I’ve been riding from Parramatta to the CBD recently (weather permitting) and there are quiet backstreets most of the way that are wide enough to take bikes.  There’s even some marked bike lanes here and there.  Haven’t had any trouble with road rage yet, although I’ve had a few people on the M4 laugh and take my picture as I’ve cruised past them at 40kmh…

    • centurion48 says:

      05:12pm | 26/05/10

      You would be surprised about how safe it is on a bike. I live in Sydney’s Eastern suburbs and used to commute to Mosman and later to South Coogee. I do all my errands and shopping (including groceries) on the bike. I happily cycle up and down Oxford St and in the city. I am couteous to car and bus drivers and they respond. I have cycled for many years and am confident but get a bike and start cycling to work along backstreets. You will love it.

    • Trevil Knieval says:

      05:47pm | 27/05/10

      When I lived in Cronulla, I used to ride my bike to Port Botany 2 or 3 times a week. It was great. Then they put in the m5 tunnel on\off ramps at the airport tunnel and made the tunnel impossibly dangerous to use (I did it twice and almost got hit both times). I had to stop riding as the alternative route was no better.

      Its road planning like my example above that creates an environment where safe bike travel is decreasing, not increasing. Its a total shame.

    • Mr Pastry says:

      09:57am | 26/05/10

      Play Pickleball and burn up the excess calories - sorted

      Reply

    • DocBud says:

      10:19am | 26/05/10

      Do the facts support Professor Stewart:

      http://jama.ama-assn.org/cgi/content/full/293/15/1861

      “Using relative risks from the combined survey data, we estimated that 111 909 excess deaths in 2000 were associated with obesity (BMI ?30). Of the excess deaths associated with obesity, the majority (82 066 deaths) occurred in individuals with BMI 35 or greater. Overweight was associated with a slight reduction in mortality (–86 094 deaths) relative to the normal weight category. Thus, for overweight and obesity combined (BMI ?25), our estimate was 25 814 excess deaths in 2000, arrived at by adding the estimate for obesity to the estimate for overweight. Underweight was associated with 33 746 excess deaths.”

      Note the dishonest trick of hiding the indicated positive benefits of having a BMI between 25 and 30 by adding them to the excess deaths caused by obesity (mainly morbid obesity). Thus a “slight reduction” of 86094 excess deaths is hidden to produce a presumably significant 25814 excess deaths.

      The excess deaths for a BMI of 30 to 35 (29843) is less than the excess deaths for underweight. What are we going to do about all those skinny people who are dying early, introduce government run force feeding farms?

      I know your whole existence relies upon it, Professor, but please stop proposing the spending of large somes of taxpayers’ money and the infringing of people’s freedomg (e.g. closing down private businesses) to save us from ourselves.

      I think the real challenge is for politicians and people like yourself to suppress the urge to let people live their lives how they chose and leave them enough money in their pockets to do so.

      You may be well-meaning but I do not want your help, please leave me alone and only offer help to those who seek it.

      Reply

    • DocBud says:

      11:22am | 26/05/10

      Sorry, I meant:

      I think the real challenge is for politicians and people like yourself to suppress the urge to interfere in people’s lives and to let them live their lives how they chose and leave them enough money in their pockets to do so.

    • null says:

      01:34pm | 26/05/10

      the decline in numbers actively participating in sport is a big contributor.  Much of this comes from the “at fault” view to incidents and injuries.  This leads to blame whena kids breaks their leg/arm, which leads to lawsuits, which leads to higher insurance, which leads to increased safety requirements such as new quipment and greater personal protective gear, which all adds up to make organised sport a luxury.  Net result - peopple exit their teens with no experience of the joy part of exercise - only the penitence/negative experience

      Reply

    • Ducks says:

      07:08pm | 26/05/10

      Sport, one of the great Aussie past-times, should be subsidised. To play team sports in the cities is often prohibitively expensive. To play hockey in Perth for example is approximately $30 per game, assuming you play every game. A number of people in our club, predominantly students were forced to drop out due to lack of funds. Yet you shouldn’t have tobe working full-time to be able to afford to play sport.

      Reply
 
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