Hal Swerissen

About 65% of Australian adults and a quarter of children are overweight or obese and about 60% of Australians are trying to lose weight at any one time. And yet policies to reduce obesity have been startlingly unsuccessful. Instead obesity is increasingly accepted, normalised and celebrated. Have we given up?

Does it matter?

You are obese if the ratio of your weight in kilos divided by your height in metres squared is 30 or more. An easy check is your waste circumference. If it is 88 cm or more and you’re female or 102 cm and you’re male, you’re probably obese. If so, you are at least 20 percent overweight and those of about average height are carrying around 12-15 kilos of extra weight every minute of every day – about equivalent to the suitcase you drag to the plane when you go on holidays. Ideally, your height weight ratio (Body Mass Index) should be between 20 and 25.

Overwhelmingly, the evidence indicates that being obese increases your risk of premature death. At age 40 your life expectancy is likely to be around 4 years less if you’re obese. Around 4-5% of all deaths may be attributable to being overweight or obese – around 8000 deaths a year in Australia.

In particular, you are 10 times more likely to get type 2 diabetes and diabetes increases your risk of heart disease, stroke and cancer and a range of other diseases. An estimated 1.3 million Australians now have diabetes, an almost three fold increase over the past 20 years.

This mirrors the world wide increase in obesity but particularly in the United States, New Zealand, Australia and Canada (the ‘Angloshere’). We are easily the fattest countries of the advanced economies. For us, the news is not good – obesity has reached pandemic proportions.

Why is this happening?

The main cause of the obesity epidemic is our changed food environment. Obesity has increased dramatically in Australia over the past two decades. In 2000 about 19% of the Australian population was obese. Today it is over 30%. World wide there has been a nearly three fold increase since 1970. The human genome hasn’t changed over that time. Evolution takes much longer. The increase is due to changes in the environment, in particular what we eat and how much we move. In simple terms, we eat too much and don’t move enough.

There has been a huge change in the food we eat. Industrialised food production, distribution and marketing are making us fat. Australia now has an ‘obesogenic‘ environment characterised by high levels of processed food, heavy on added fat and sugar, animal products and refined carbohydrates, preprepared and delivered to your door or car window, or packaged for your super market trolley. Add to that the substantial reduction in physical activity associated with changes in work, transportation and leisure activities over the past 50 years and it is easy to see why on average we consume significantly more calories than we need each day.

Other countries have done better. Japan, South Korea and Singapore are all advanced economies with low levels of obesity. All have obesity rates of less than 10 percent. All have very different approaches to food and physical activity than is typically the case in the Anglosphere – much more incidental physical activity and much greater emphasis on fresh plant and fish based food and avoidance of dairy, wheat, red meat and added sugar.

And these differences can’t be explained away by genetic variation. Japanese Americans in Hawaii and Los Angeles, exposed to typical western diet and physical activity, are much more likely to be obese and have metabolic diseases like type 2 diabetes and cardiovascular disease compared to native Japanese. Clearly, the environment matters.

Why haven’t we fixed the problem?

None of this will come as much of a surprise. But why has public policy to address obesity been such a monumental failure? Obesity has now been a public health priority in Australia for at least a quarter of a century with little success.

Part of the problem is that we lost sight of the forest for the trees. We have been bogged down in marginal nutritional debates about genetics, micro nutrients, energy balance and individual behaviour. There has been much too much emphasis on individuals managing their own weight and not enough focus on the environment that led to weight gain in the first place.

The focus on genetics, metabolism and individual behaviour rather than the social and economic environment causing obesity has been exacerbated by the increasing medicalisation of obesity. Obesity is more and more seen as a disease rather than the effect of an obesogenic environment. While making obesity a disease avoids blaming individuals for being obese, it also takes pressure off the social, cultural and economic factors that have produced the obesogenic environment.

The focus on individuals rather than the environment has seen an explosion in bariatric surgery, weight reduction medication and weight reduction programs. At any one time nearly two thirds of the Australian population is trying to lose weight with only about 20 percent long term success. Getting to, and staying a healthy weight in today’s food world is not impossible, but it’s a hard task.

Not surprisingly, being overweight and obese is becoming normalised.The body weight explosion has led to social and political movements objecting to body shaming, denigration and discrimination. Around a third of people who are overweight or obese underestimate the extent to which they are overweight, increasingly there are criticisms of ideal body types, and there is a growing fat pride movement promoting obesity.

These arguments quickly become toxic and exploited by commercial interests. Worse, they distract from the underlying social, economic and cultural forces that drive the obesity epidemic. While denigrating people for being obese is not acceptable, nor is it ok to accept obesity as a widespread, normal state of affairs.

Paradoxically, as food industrialisation has dominated the landscape, we have seen cooking and eating become performance art and fodder for ideology. Television chefs, celebrity recipe books and art cuisine abound. Movements around slow food, systematic fasting and paleo dieting have emerged. At the same time, the ordinary, everyday culture of communal cooking and meals has fragmented and declined in favour of convenience.

Public health advocates have understood that social, economic and environmental influences are the main causes of population obesity, but they have had little success in doing much about it. Their focus has been too narrow. Much of the effort has gone into information campaigns (including food labelling), and localised community strategies focused on individuals, school, family and community behaviour, with little impact on the obesity epidemic.

There have been strategies to influence the production and supply of food. But they have been narrowly focused on taxation and regulation of fat, sugar and salt. There is evidence that taxation can reduce consumption of sugary drinks. Similarly, there are increasing arguments to use regulation to set standards for food production and distribution. But, despite the emerging interest in taxation and regulation to reduce obesity, there is little evidence that they have had much impact on population obesity levels to date.

Rethinking the problem

Doing more of the same is tantamount to accepting that we have given up on obesity. We need a policy reboot.

Focusing on individual behaviour, small scale community change and narrow tax and regulation measures isn’t working. No amount of TV cooking shows, slow food, fad diets, fasting and gym memberships is going to reverse the obesity trend. Nor will labelling, health literacy, school lunch programs and sugary drinks taxes. Instead we need to think about obesity as a symptom of an unsustainable model of food production and distribution that has emerged over the past century.

We are a victim of our own success. With industrialisation food production and distribution has been scaled up to ensure an adequate, predictable and safe supply of food to support an increasingly industrialised labour force living mainly in cities. Broad acre farming, industrialised food processing, large scale distribution logistics and scaled up retail outlets saw a dramatic increase in productivity and a much more secure and adequate population food supply over the past 100 years or so.

The globalised food industry now accounts for about 10 percent of global GDP . It is a profit driven and depends on ongoing investment, productivity improvement and most importantly growth in consumption. As a result there is a significant global food surplus with an estimated capability of feeding 10 billion people.

But the surplus is unbalanced leading to regionalised food insecurity, hunger and mal nutrition, particularly in poorer countries where it is unprofitable to provide sufficient food. Affluent societies consume significantly more calories per person leading to greater profits for the food industry.

The underlying economic model for the food industry is now unsustainable. Production techniques, storage, processing, distribution and consumption patterns result in about a third of food being wasted. Additionally, the food industry is responsible for significant environmental degradation and over 25 percent of carbon emissions. Increasing industrialisation and expansion in less developed countries also disrupts local communities and exploits and displaces workers thereby increasing poverty and inequity.

Today’s global food industry is vast, concentrated and powerful. Huge conglomerates like Bayer shape agriculture. A limited set of large companies like Cargill, Archer Daniels and Nestle dominate food production. Major retail chains control food distribution. The food industry shapes and creates consumer demand for convenient, energy dense food high in salt, sugar and fat.

Unsurprisingly, with dramatically increased food supply and much greater affluence particularly in post industrial societies, the food industry has shifted its emphasis to increasing consumer demand to maintain growth and profitability. Super markets, drive through pick ups, online ordering, home delivery, convenient packaging, taste and product reformulation are all innovations to drive greater demand, particularly for high preference easy to eat high fat, high salt and high sugar food.

The food industry is driven by commercial concerns. If ethically produced sustainable, healthy, nutritious foods are profitable, industry will produce and distribute them. But it will resist regulation that threatens current profitability, particularly during periods of major transition.

Nevertheless, there are now broader concerns, largely driven by the existential threat of climate change, that unrestrained, profit driven, economic growth in consumption is unsustainable. A broad social and environmental coalition focused on environmental and social sustainability has emerged. Industry is increasingly being pressured to take account of ethical, social and governance concerns. Institutions like the United Nations and the World Bank are turning their attention to the need for sustainable development, including agriculture, food production and distribution.

Whether the dominant underlying economic model will be forced to shift far enough and fast enough to avoid widespread catastrophe remains to be seen. But reigning in over production, waste, mal distribution and over consumption of food is part of the overall campaign for sustainable development.

Where to from here?

If we want to address obesity, we need to reduce over consumption by better managing our food supply. A sustainable food policy will need to have a much greater focus on the improving the production and supply of food for populations, particularly in relation to energy dense, processed food with high levels of sugar, fat and salt.

The food industry will be highly resistant to reducing overall consumption and the dietary mix of the population because of the impact on growth and profitability. In part this will see the valorisation of individual choice, competition and markets and the terrible dangers of the regulation and the ‘nanny state’. Industry will argue that individual choice leading to obesity should not be restricted by industry incentives and regulations.

In reality, choice is shaped by our social, cultural and economic environment and communities always regulate the those to help individuals make better choices to reduce harm. When two thirds of the Australian population, including a quarter of children are overweight, there is clearly a case for better managing the food industry.