7:23am, 18 Feb 2010 neil peace

We suffer from “portion distortion”. Since 1960 standard serving sizes have increased significantly. In 1960 a Cheeseburger was 333 calories and is now 590. A French Fries serve was 210 calories, and is now 610. A Muffin was 210 calories, and now 500 (From NHLBI, USA Dept of Health). We tend to eat what is in front of us. This is human nature; it is in our “hard drive”. The bigger the portion the more energy we consume.

However, this rise in portion size is not obvious to the consumer.

Our federal government can help the consumer overcome “portion distortion”.

To some extent this has already happened. Food nutrition tables show the “number of servings”. But this is in the small print. It is not obvious to most consumers.

Various Nutrition Authorities could set the meaning of a standard serve – perhaps at 1960 standards. Anything larger must have meaningful bold labels. For example, if a “standard” muffin portion was set at 1960 standards (210 calories) and the vendor wanted to sell a larger muffin then it should be labeled accordingly. The present day 500 calorie muffin would be labeled 2.5 normal serves. After all, how many consumers know that a 500 calorie muffin for morning tea is in fact greater energy consumption than an evening meal? How many consumers know that the extra 300 calories in the modern muffin adds up to a body fat gain of 15 Kg in a year if consumed each day?

Governments could legislate for labeling of portions so that the consumer is not duped by portion “creep”.

This is but one of many steps the government could take to help fight obesity.

Next time you buy a muffin it could say in bold print BLUEBERRY MUFFIN 2.5 SERVES. Neil Peace

7:28pm, 31 Jan 2010 neil peace

In my suburb there are no footpaths. Rarely do mothers push prams. In my suburb school kids don’t walk to school (less than one Km). I’m not sure why. Never do you see shoppers carrying groceries home (less than one Km). I’m not sure why. In my suburb kids don’t play on the streets even though it’s a crescent with no through traffic. Why? There are reasons but they are not clear to me. In this typical Sydney suburb in which I live, activity is limited by something, possibly a multiplicity of factors. The end result is inactivity. Nothing happens to bring change.

Meanwhile, hospitals are full, health costs are out of control, and a young girl I know is profoundly sad. She is very overweight and never smiles. At an age when looking good is a prime aim she doesn’t. No wonder she looks sad. Is her life wasted? No; but she feels it is.

This is not an unusual story; I live in a middle class suburb in Sydney and there are many such suburbs in Sydney. And in Melbourne and in Adelaide and in Brisbane and Hobart and Darwin and Perth and a thousand other places.

What is my council doing? Nothing. What is my state government doing? Nothing. What is the federal government doing? Nothing. There is no work on footpaths and it seems unlikely that mothers will be able to push prams in my suburb. It appears unlikely that children in my neighbourhood will walk to school. It looks like carrying groceries home will not happen.

Hospitals are full, health costs are out of control and the people in my community are sad.

What should I do?

4:50pm, 17 Jan 2010 john sadeik

I am an Accredited Exercise Physiologist (AEP) and I would like to see a much simpler, more efficient referral process for individuals accessing enhanced primary health care services through their GP.

This would include an increase in the number of sessions eligible to the individual to 10 (separate to services provided to other Allied Health Professionals) to allow AEP's to make a significant diference to the individual and their lifestyle modifications.

I would like to see the ability for GP's to refer patients who are obese or at risk of becoming obese to be referred to AEP's under EPHC to allow for us to make a difference by preventing the of onset chronic conditions as a result of obesity and assit individuals with their weight loss.

This would decrease the cost on the Australian Government through decreasing onset of chronic conditions and expensive surgeries such as lap band surgery through preventative measures.

12:33pm, 17 Jan 2010 advok8

The Government would do well to look at the final report of the WHO Commission on the Social Determinants of Health. They clearly define how obesity - and many other health issues should be addressed.

The WHO World Health Report 2008 Primary Health Care Now More than Ever also defines the way forward.

Increased investment in health promotion, including increased recognition of the health promotion workforce and the need for this workforce to be utilised at all levels of the health care system is essential.

The Ottawa Charter and the Declaration of Alma Ata provide key frameworks for action. Using them to build comprehensive primary health care (not the selective primary care being spoken about and funded in Australia) would be a positive more in the right direction. The time for reports, talking and rhetoric needs to end. It is time for action!

7:32am, 14 Jan 2010 neil peace

What could happen if Australians entered into a contest to create an active neighborhood, called the PHYSIES Prime Ministers Award?

Imagine the following annual contest, in three divisions.

Division one

Each shire council throughout Australia enters a contest to provide the MOST USED new facility for increasing activity for residents of the shire (for under $200,000).

The objectives are two fold. Firstly, the contest increases the discussion on the need for increased activity as a mechanism to reduce chronic diseases. Hopefully the media will report progress on various projects through the year. Secondly, ideas and improvements appear in the public arena and councils, industry and governments can take on the winning ideas from others.

Division two

This is for industry. Companies enter the contest to see which employer can provide the MOST USED facility for increasing activity for their employees (for under $200,000).

Division three

The third category could be the education departments throughout Australia doing the same thing. The contest is to find which school can come up with an idea and implement a new facility for activity which is MOST USED by teachers and students (for under $200,000).

Each division winner receives A PHYSIE - the Prime Ministers Award for Physical Activity.

The following are examples for the three divisions.

Division one – the council’s award – might go to a council which added, to street signs, the walking distance between various points in the shire

Division two – the industry award – might go to a company which created a computer program to record pedometer steps by employees – entered daily – for those choosing to register for a pedometer supplied by the company.

Division three – the schools award – might go to a school which installed a set of physical activity stations (sit ups, push ups etc) on the school grounds and established an annual endurance event. Each month students who wish to and teachers wanting to, go through the stations and the student and the teacher showing the most improvement over 6 months wins the prize.

11:21am, 22 Dec 2009 neil peace

In my opinion the federal government should control advertising when it comes to health issues. Indeed, pharmaceutical advertising is controlled. Treatments for high blood pressure do not appear in the popular press.

“Treatments” for obesity DO appear in the popular press but without proof of efficacy. This, I believe, is counterproductive for the obese individual.

Being obese is not pleasant. Quality of life is significantly reduced. Obese people have usually tried a multitude of “treatments” without success. Like the patient with untreatable cancer, the obese person is desperate for a “cure”. Along comes a full page ad in the local paper claiming to have the answer for obesity and it is no wonder the obese person grasps at the “opportunity”. The research shows that these “treatments” do not work. Where does this leave the obese person – having tried the advertised “treatment”? Again, research shows that they regain lost weight and usually more! Was this a service to the person? Clearly not.

My argument is that the popular press advertising for a health treatment should not be permitted without quality medical research – the same type of research that the government demands for a pharmaceutical.

In my opinion, when it comes to health, the government should protect vulnerable individuals from false “promises” in the form of advertising.

Nobody chooses to be obese. Neil Peace

4:12pm, 21 Dec 2009 supertooth

Obesity, heart disease, diabetes and tooth decay are all food related .

Supermarkets have some 10 million visitors a day and could be induced to promote heathy diets particularly fresh foods like veg and fruit and store managers can help schools organise and publicise DVD assisted community forums with local health provessionals and demonsrtationd of the products from the supermarket and links to health websites. Mental health could be included but a team needs to plan this out to be meaningfull and not boring

3:37pm, 02 Dec 2009 neil peace

Giving up food is not the same as quitting smoking or stopping booze – you HAVE to eat.

Diets appear to be equal when it comes to weight loss. In 2009, Bray [NEJM 2009], from Harvard published a study comparing diets and concluded, “Reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize”. Earlier studies report the same findings. In short, what counts is the ability to stick to a diet, not the make-up of the diet.

This information is available in reputable medical journals. Medical practitioners of various skills, including GP’s read these journals.

Most of our chronic diseases are weight related. High BP, high cholesterol, heart disease, kidney disease, joint diseases, sleep problems, diabetes etc.

What patients do GP’s see in their office? Patients with high BP, high cholesterol, heart disease, kidney disease, joint disease, sleep problems, diabetes etc. - most of them overweight or obese.

And so, what if GP’s were enticed to become expert at treatment of overweight and obesity? Their successes would translate into fewer patients with high BP, high cholesterol, heart disease, kidney disease, joint disease, sleep problems, diabetes etc. The burden of chronic disease would diminish.

The return on the investment would be remarkable. Investors would scramble to be involved.

The government has the power to make the treatment of obesity attractive to GP’s.

But here’s the rub. Treatment of obesity is not like treatment of high BP. For hypertension, it can be as simple as check the BP and adjust tablets. Not so for obesity. Treatment of obesity is complex. Most GP’s have given up on treating obesity. It is difficult. It is VERY difficult to treat obesity in the 15 minute consultation system.

There appears to be no short cuts. You have to deal with the individual barriers preventing weight loss. This takes more time than applying a BP cuff to the arm.

Hence, we need an intelligent government. We need a government interested in a high return on their investment. We need a government able to see the long term benefits of getting GP’s to take the time to properly treat obesity. This would be a rare government indeed.

8:47am, 17 Nov 2009 neil peace

Being obese or overweight affects productivity (Nicholas Pronk 2004, MT Halpern 2006), in the form of absenteeism and presenteeism. [Presenteeism = being at work but not productive due to reduced health]

A USA researcher calculated that, “Paying 67 cents to super size an order — 73 percent more calories for 17 percent more money — adds an average of 36 grams of adipose tissue. The future medical costs for that bargain would be $6.64 for an obese man and $3.46 for an obese woman.” [Jay Zagorsky, Ohio State University 2006]

Australia has a different system of health care. These dollar values don’t apply to employers, but do apply some where in the chain of health costs.

In 2005, Joel Dimsdale of U. of California showed that, “Obesity accounted for a significant portion of physical fatigue after controlling for depressive symptoms …” This cannot be good for employee efficiency at work.

Research shows that improving health by reducing obesity benefits the employer. What are the dollar values for reducing employee obesity? Kristin M. Baker of University of Georgia has shown, “A program to reduce weight and improve health risk factors in obese employees produces a short-term return on investment (ROI) of $1.17 per dollar spent …”

Once again, American numbers do not translate directly to the Australian scene.

The CDC in USA [http://www.cdc.gov/leanworks/] lists specific ideas for employers wishing to help employees lose weight and improve fitness.

In Australia employers could offer flexible work hours to accommodate exercise routines, form teams for community events such as the City2Surf, install change rooms and showers, encourage management to be involved in weight control measures, provide healthy snacks, and provide quality information on the company intranet.

If you doubt the effect of obesity on work performance, wear a 15 kg back pack or weighted vest for the 8 hour working day. That is the fatigue that the obese person feels every day.

Nobody chooses to be obese. Neil Peace

8:01pm, 07 Nov 2009 neil peace

Wt loss is difficult. We know what to do – eat less, walk more – but only 5 % succeed long term. Why such poor figures?

Our genes formed thousands of yrs ago when food was scarce. Ideal genes: 1) able to lower metabolic rate (use less fuel, greater chance of survival) 2) used less fuel in activity, 3) gain fat when foods available. In famine, those with high metabolic rates perished. Their genes were not passed on. Those who fidgeted or moved too much used up fuel and did not survive. People unable to gain body fat did not survive.

In 1994 Friedman described a hormone – Leptin. Now, numerous hormones are known to act on the brain to regulate metabolic rate AND dictate food seeking behaviour. A complex of hormones drive us to “seek food, eat food and eat extra”. We now know that the only requirement for eating is the presence of food. One does not need to be hungry, bored, stressed or depressed in order to eat. Most people, when they bump into appetizing food, will eat – whatever the state of their hunger. Our forebears ate as much as possible, when food was available, in case there was no food tomorrow.

We now live with food abundance. We frequently meet appetizing food.

Genetic makeup changes about 1 % per 100,000 yrs. We come from thrifty genes of thousands of yrs ago. We come from forebears who could lower metabolic rate when food was scarce. Hence 60 % of Australians are overwt or obese, and rising.

We have genetics for food scarcity but live with abundance. This is difficult for an individual to change. Eventually, governments have to change the environment we live in (they cannot change our genes). We need to reduce contact with appetizing food. It is hard to imagine governments controlling food outlets without committing political suicide.

We need to increase energy output. Here governments have more hope. We need more footpaths, more cycle paths, safer ways for kids to get to school, longer lunch breaks, better change facilities at work and school, compulsory activity in school, tax breaks for fitness products, taxes on fatty/sugary foods, cycle paths beside rail lines, floodlit parks for safer play in the evening, a cycle path around Australia and ……

In Emergency Depart in public hospitals staff describe the increasing chaos of too many patients (the effect of obesity on health takes about 20 yrs – the obesity epidemic began in earnest about 1980).

Nobody chooses to be obese. Only governments can change our environment.

12:32pm, 31 Oct 2009 neil peace

Exercise is not fun, it just has to be done! In the National Weight Control Registry study in the USA (author Rena Wing), four features separated those who had lost weight and kept it off (maintainers) versus those who lost weight and regained (regainers). One of those four characteristics of successful long term weight loss was regular aerobic exercise (like walking, cycling etc). That study and others indicate that long term weight loss is almost impossible without adequate exercise. Sure, people lose weight on a diet but regain over the next two years.

If exercise is not fun then what can governments and employers do to help exercise happen? Some employers have a philosophy of encouraging exercise. This understanding that exercise is of value usually comes from the top management - in my experience. If the CEO goes for a lunch time walk then the employees are more likely to do the same.

Employers could make showers available for employees, they could offer flexible work hours to allow exercise before work or at lunch time. Employers could enter teams in community events such as the Sydney to Gong Bike ride or City2Surf etc.

Research shows that being overweight or obese increases the amount of time taken for sick leave.

Research shows that being overweight or obese increases the "presenteeism" rate. This means that the employee is at work but is feeling unwell and work performance is reduced.

Governments will be forced to do something about the ability to exercise.

There are many options for governments, but they require the will to change. If not the government will be changed.

At a recent diabetes conference, the following figures were given. In 1985 there were 30 million diabetes in the world. In 2000 there were 150 million diabetics. In 2009 there are 300 million diabetics.

In the near future, the Australian health system will have no chance of handling the health consequences of obesity and diabetes.

11:25pm, 25 Oct 2009 sleepydumpling

The most effective way to help Australians have healthy bodies? Let go of the perception that fat bodies cannot be healthy. A fat body that is active and eats well is just as healthy as a thin body that does so. However a thin body that is sedentry and eats poorly is far more unhealthy than a fat body that is active and eats well.

Shaming people to lose weight does not work. If it did, the obesity rate would be declining, as we've had a good 30+ years of fat shaming.

Encourage people to have positive body images regardless of size, promote activity for fun and remove morality from food. When emotion is removed from food, humans no longer feel the need to hold bad eating habits, such as bingeing and purging, starvation and overeating.

Educate doctors in basic human rights, which means that a fat person has as much right to health care as a thin one. Doctors who turn patients away from health care "until you lose weight" need to be recognised as negligent and discriminatory. Patients who are fat shamed then hold off on health care out of embarrassment, which makes health issues that could be dealt with early escalate until they are major problems.

Positive body image is the most important thing that can be taught to young people. If they are positive in their bodies and self esteem, they are more likely to be active than those are humiliated for not being able to keep up, or having a body shape that is considered "wrong".

Encourage people of all ages, shapes, sizes and types to find activities that they love doing, and have fun. If someone feels happy, fun and postitive, they're going to be more inclined to continue those activities than those who have been humiliated, or worse, forced to do the activity.

Offer equal health care to EVERY Australian, and do not punish fat people simply for being fat. You want them to get good health care and live a healthy life? Make a doctor's office a safe, positive experience, rather than an exercise in shame and guilt.

Do some research into Health at Any Size. This is the way we should be approaching health in this country, not by "combatting obesity".

8:46pm, 25 Oct 2009 fatlotofgood

There are several points I would like to make:

* It is misleading to say that nearly 25% of Australian children are overweight or obese. A relatively small number fall into the obese category (despite what media sensationalism makes out) and often children in the overweight category have bodies preparing for a growth spurt and so have gained weight to go along with an increase in height. The weight tends to come first though. So the 25% is misleading to say the least.

Similarly with the number of adults being lumped into the overweight/obese category. There are many more in the slightly overweight category that in the obese category. Not to mention, fat people are people too and should be treated with respect and dignity. Something that rarely seems to happen especially in this type of debate. You will never prevent obesity. Some people will always be bigger than the 'norm', that is the way it works. There are always going to be some on the higher end of the scale and some on the lower end.

Demonising fat people is not going to encourage them to lose weight. It hasnt worked thus far and we (yes I am fat) have been demonised plenty over the years. One commenter seems to be labouring under the misapprehension that obesity is seen as being acceptable. Obviously this person isnt fat or they would know that fat is not seen as acceptable and that fat people are ostracised every single day in so many ways. If it was possible to lose weight and stay thin dont you think people would do it? Why would be expose ourselves to the fat-hatred of this society if we could actually lose the weight and stay thin? Do you think we enjoy being treated like lepers and having 'war' declared against us?

The truth is that diets do not work (and don't use lifestyle changes when you really mean diet) and that over 90% of people who lose weight on a diet put it all (and usually more) back on within 5 years. The stress of weight cycling (yo yo dieting) puts more pressure on the body than being overweight does. And before you start on about the 'super obese' please look at some reliable stats and realise that the people over 150kg are a VERY small percentage of the community. The epidemic/pandemic that we are led to believe is taking over our world is doing no such thing. It is a manipulation of population statistics designed to make money for big pharma (who do you think sponsors half the studies? Do you have any idea how many 'researchers' doing these studies into obesity are actually sitting on the board or some other paid position within big pharmaceutical companies?). Not to mention that so many studies have proven that extra weight actually improves health outcomes in many illnesses.

Being fat is not all bad health wise. It should also not be assumed that fat people are fat simply because of overeating and lack of exercise. Some people are genetically bigger. Some people are on medications that make them gain weight (antidepressants anyone?). Some people are working their butts off to provide for their family and dont have time to exercise. Some people can't access affordable fresh food and so have to make do with what they can get that they are able to afford. Some people simply aren't educated about nutrition. This is why a Health at Every Size approach needs to be adopted. This encourages people to eat mindfully and to engage in physical movement that they ENJOY.

Exercise needs to not be considered as a means to weight loss. Exercise to have fun and for the pleasure of movement rather than making weight loss the focus and you will get many more people taking part. Een when fat people try to get out and move, they are laughed at and ostracised. Do you think that encourages them to participate? No, it encourages them to stay at home and hate themselves. Self loathing causes a lot more health problems that fat ever has.

Anyway, health is not a moral imperative. If someone wants to eat junk and not exercise, that is their choice. We dont penalise car accident victims for choosing to get in a car. We don't penaise people for getting pregnant and having premie babies that cost a fortune to keep alive. We don't mention sporting injuries that clog up our emergency rooms every weekend. If you think fat is a choice, then so are all those activities yet none of those people are demonised.

The point is that society hates fat and that health is an excuse to demonise fat people. Plenty of thin people eat poorly and don't exercise but they get away with that with no social sanctions simply because they are thin. I am fat and I have a very productive life. I am a professional with a fulfilling career, a great family life and a happy active existence. I have no health issues whatsoever and my doctor is more than happy with my health. A number on the scale or a category on the (flawed) BMI does not define who I am and I am sick of people assumming it does. We need to look at the systemic issues before condemining individuals.

11:51pm, 23 Oct 2009 adenosyne

I think the government needs to recognise that not all fat people are fat because they have poor nutrition and don't exercise. There are so many reasons why a person might be fat: weight is about 60-80% heritable/genetic - some people will always be obese no matter what they do, it's how the bell curve of human biodiversity works, just as there will always be some people who are naturally very thin; there are many health conditions that cause you to gain weight easily and not be able to lose it, such as polycystic ovary syndrome, insulin resistance, hypothyroidism, food allergies, etc, not to mention chronic illness, injury and disability that can leave a person unable to exercise or eat well. Many medications are known to cause weight gain, such as the widely-prescribed anti-depressants and contraceptive pill, steroids, and even some anti-cancer and anti-diabetes medication.

Health campaigns really need to take the focus off BMI/weight/waist measurement. There are plenty of people who eat lots of junk food and never exercise, yet because they have a fast metabolism they don't gain weight, yet their lifestyle puts them far more at risk of chronic illness than a fat person who eats well and gets their daily exercise - but the "Measure Up" campaign only features people who have gained weight. Surely there could be a campaign that highlights that everyone, no matter their size, should follow a healthy lifestyle. Perhaps show people of various sizes, ages and abilities enjoying lots of different physical activities and shopping for and cooking good food and talking about how great they feel (not look, or talk about how much weight they've lost), rather than the "scare you healthy" style of campaign that threatens people with the spectre of chronic disease. Focus on the positive.

This style of campaign would also be helpful in reducing eating disorders and dieting. There is scientific evidence that encouraging people to enjoy physical activity they actually like, learning to eat a balanced diet that includes occasional treats, and encouraging good self-esteem improves health measures such as cholesterol, blood pressure and blood glucose and long-term lifestyle change, as opposed to traditional programs of weight loss - "Size acceptance and intuitive eating improve health for obese, female chronic dieters." Journal of the American Dietetic Association. 2005 Jun;105(6):929-36.

3:12pm, 23 Oct 2009 Belle

Big Red 's lack of empathy and understanding is very sad. I see obese people at work . But I do not see them as unworthy like big red. Metabolism has to play a part and genetics. So we tell a labrador it is a failure because it does not look like a greyhound? No. We accept that some people cannot put on weight no matter what they do. And others seem to fight a battle all their lives.

People like big red have a discrimination issue where the demonise those they think are easy targets. Hitler tried it. Mugabe is trying it now. Support people in a non-judgemental manner and please get off your high horse BigRed

6:40am, 22 Oct 2009 neil peace

Governments can help us with weight control. Imagine if children could walk or ride the bike to school safely. Radical as it sounds, put a lollipop man or woman on each street corner to make it safe for kids to walk to school. Could every rail line have a bike path down the side (with a safety fence) giving an enormous increase in cycle options. What if there was a tax break for everything to do with fitness. What if all foods with over 20 % of calories from fat or sugar had a 20 % extra tax. What if all local parks had flood lights so that kids could play outside after dinner. What if new food outlets had to be licenced and must offer low fat and low sugar options next to existing fare. What if all parliamentarians had to undergo fitness testing and weight loss regimes as part of their obligation of representing their constituents. What if all new buildings had to have shower facilities to allow staff to change after an exercise session. The possibilities are many. Should a parliamentary group go overseas and gather all the ideas from around the world on what governments have done to help fight the obesity pandemic. These ideas are radical - but it is going to take a radical thought process to reverse the obesity problem. It appears to me that we have no chance of providing health care to the Australian population as the effects of obesity hit the population generally.

5:24pm, 19 Oct 2009 poetspicnic

Kitchen Garden programmes in schools are a terrific way to example healthy living choices of both what foods to eat and getting active in the garden to grow great food. Collingwood College in Melbourne was a pilot for this now expanding project, initiated by Stephanie Alexander. Students are surprised at how good vegetables taste when they are picked fresh with no deterioration through packing and transport (usually requiring expensive refrigeration as well). They better understand nature and want to know more, they teach their families through their food experiences at school, and demand for improved food effects the businesses they then choose to frequent. Family members can also volunteer regularly or enjoy open days and activities (such as working bees or even community choirs) around such gardens.

By contrast most of the problems with dealing with "obesity" arise from the misconception that it is from overeating, when it has more to do with nutritional lack, and therefore is a form of starving. Too many foods lack balance, and provide something filling rather than something substantial. Fast burn foods quickly require replacement but still have no sustaining value, so we tend to eat more often. We now have charts available of low GI foods, but they only consider one element at a time, not the overall dietary balance. Energy exchange spirals into all sorts of health problems which may look good because they increase activity in the short term, but meanwhile they are doing great internal damage to young bodies. Even many of the vitamins and dietary supplements on the market do not contain usable quality or forms of nutrients for growing bodies, so the commercialism involved in the health market becomes one that feeds the need for more doctors and hospitals who still don't have the appropriate knowledge or application in their own lives to be considered experts in the lives of others. Often untrained people who have had to deal with chronic fatigue or irritable bowel syndrome or similar issues in their own lives or families know more than the so-called experts, because they have to experience it on the ground instead of through abstract theories and institutionalized outcome-based studies which partly rely on the sustainability of the institution.

These are some of the issues which need to be looked at together to start addressing the health of our nation's children, and apply to all age groups. Some good programmes are already appearing but their viability is limited by financing structures which time-limit their support. Promotional campaigns are not needed when the people involved are so happy with programmes they are involved in that their word-of-mouth increases interest and involvement. Put dollars where they count, let people experience healthy choices, and save the environment as well as the money being wasted on promotional materials that have no sustainable use.

9:13pm, 17 Oct 2009 Christine

Do our shops really have to sell so many different brands of biscuits? Maybe we were better off when we just had a few different types and people mainly knew how to bake their own and could use wholesome ingredients, if they wished to. I wonder how many of the overweight problems are partly connected with companies wanting to make money, even if they affect customers' health. A lot of the food that we see in shops and supermarkets is packaged really attractively, sometimes the 'bad' stuff even more so. Things like rice and potatoes and carrots are often in pretty plain packages, on the other hand. But if supermarkets want to hold onto their customers for a while, and not have them die early from heart attacks and other conditions influenced by buying 'bad' dietary choices, they could think about the percentages of things in their aisles, and overall shops, which can be considered healthy, poor health choices, or neutral. And how about we compare the returns that farmers are getting for their fruit and vegetables, vs what the companies are making on their heart damaging meat pies, sweet biscuits and soft drink.

10:46am, 17 Oct 2009 neil peace

I believe the willpower debate is important. If our government believes a lack of willpower causes obesity then it follows that the solution is within the power of each individual. If the government accepts that willpower is not relevent, then they will work towards changing the obesogenic society we live in. This explains my enthusiasm to debate the issue of willpower.

It is clear from research that the only requirement for eating is the presence of food. One does not need to be hungry or tired or stressed or bored or depressed - in order to eat. I have had (and I believe most people have) the experience of coming into contact with food shortly after completing a meal. If the food is tempting it will be eaten. Something drives this desire to eat - even in the absence of hunger.

Wansink (Obesity Research. 13(1):93-100, 2005 Jan.) demonstrated our tendency to eat whatever is available with the elegant soup bowl experiment. Those whose bowls kept filling with soup kept eating.

The obesity pandemic has followed a trajectory in parrellel with food availability. In short, the more food is available the more we will eat. Deborah Cohen (Diabetes 57:1768–1773, 2008), in a brilliant article, shows that we buy and eat in response to availability and salience of food and a host of subtle marketing techniques. She says that our eating is "beyond awareness and beyond individual control".

These and many other articles point to the need to change our relentless contact with food in order to stem the obesity pandemic. This is almost impossible at an individual level. This can only occur with government intervention. Neil Peace

4:32pm, 14 Oct 2009 Judy Stone

I agree with Neil and RachM, but feel 'bigred's' attitude is unhelpful to say the least. I fail to understand how will power and eating habits can be blamed solely for people becoming increasingly overweight. I believe infrastructure is at least partly to blame. If there are inconsistent cycle and walking tracks to get to work, or if these tracks add considerable distance to the journey, people are more likely to use their cars. If there are not enough pools (which there are not in Canberra) people are discouraged from swimming. If gyms are all expensive and privately run, people will not use them. If workplaces do not encourage lunchtime exercise, people won't do it. I could go on but won't. Exercise must be made easy for people or it won't be an option.

Similarly making healthy food choices needs to be made easier. At the weekend my husband and I wandered around a shopping mall for an hour looking for a healthy food choice without success. We wanted something quick to eat which wasn't saturated with fat and sugar. Needless to say our options were very limited. We ended up shopping in the supermarket and going home to prepare something ourselves. This is not making healthy food choices easy.

8:14pm, 13 Oct 2009 RachM

Obesity is such a complex issue, and it's a huge misnomer that it comes down to lack of willpower. Misinformation runs rampant, and people dilligently do what they think is "the right thing" with no results. From there they lose hope and give up. I think it is important to remember that the suggestion of a "lack of willpower" places additional pressure on children and adolescents who have little or no control over the foods they are exposed to anyway. Dietary changes long term, not diets, and exercise regimes that are sustainable, not biggest loser style flog sessions, are the cornerstone of prevention. Addressing obesity once an individual has reached that state requires a more complex intervention, physically, psychologically and nutritionally.

I also think that any discussion of interventions to prevent obesity need to be tempered by a consideration of the pressure to be "skinny". I was horrified to hear a 10 year old girl state that she couldn't eat too much and needed to watch her weight and stay skinny because they had discussed it at school. The message of healthy eating had been distorted by the cultural picture of skinniness as desirable. Her parents said that it wasn't only their child, and that several other parents were having trouble with their 'tween" girls. This needs to be monitored very carefully, as anecdotal evidence is never considered enough - except to the parents involved. The encouragement of anorexia or sarcopenic obesity (skinny with no muscle) is not a positive health outcome.

I agree with Neil, the environment and culture need to be addressed in order to create a new paradigm where health is the target, not a mandatory figure on a set of scales.

4:38pm, 13 Oct 2009 bigred

The problem with obesity is that it's so widely accepted. If fat people felt ashamed to go out in public, they'd be more inclined to do something about their lifestyle. If XXXL t-shirts weren't available, ordering three meat patties on your cheeseburger wasn't an option, and bike racks weren't on the front of busses (on a tangent: using the rack qualifies the passenger for FREE bus travel - what's going on there? Bikes are meant to be ridden...), there'd be no choice but to take positive steps to improve your life.

Look around you at work. I work in an office, and out of the nearest 20 people, I would say that at least 15 of them are obese or drastically overweight. Maybe employers should stop employing overweight staff? Ugly people don't get jobs as models - perhaps adopting a similar employment policy towards obese people in the wider workforce will force change. I'm not talking about discrimination, either. I'm talking about being fit for work. I know I don't want to get stuck behind a 160kg bloke who has to have a breather on every second stair while the building's burning down.

12:22pm, 10 Oct 2009 Neil Peace

Jen Li wonders what brings weight control if not willpower. In my view it is necessary to change the environment we live in rather than expect each person to apply willpower in a relentless fashion. If one postulates that willpower is part of the obesity pandemic then why do the majority of our population (60 % of Austrlians are overwt or obese) lack the willpower? Why do most of these people achieve well in other aspects of their lives (have the willpower to complete difficult tasks) and yet fail when it comes to obesity? The rate of obesity has risen dramatically and does this imply that the people in the 1950's had excellent willpower but in 2009 they do not? This seems improbable. Why do 95 % of people embarking on a weight loss program fail over the course of two years (not lose at all or lose and regain)? If you place an overweight person in a controlled environment such as an army camp and use XYZ weight loss program they lose wt. On return to their normal environment and trying to continue the regime from the army camp - they regain the weight. In one situation - the army camp - the food and exercise is controlled. In their own environment they are expected to continue on the basis of willpower and self-discipline, but invariably fail. Hence the conclusion that willpower is not the way to weight control. Neil Peace

2:33pm, 07 Oct 2009 Jen Li

Neil Peace, if willpower has no role to play in obesity, what does? I know that there are some thyroid issues that result in weight loss either extremely difficult or impossible, and if you have Cushing's Disease, you can forget about losing weight, because it's not going to happen. However, thyroid problems aren't to blame for every case, and Cushing's is actually extremely rare (unless my endocrinologist has been lying to me all this time).

It seems that for many cases of obesity, it can and needs to be addressed, whether it's by doing more exercise, eating less, or seeing a doctor about potential endocrine problems. And if obesity is a result of diet and exrecise, then actually, it is a result of willpower.

As for what governments, industry and community groups should do... I'm yet to figure out the silver bullet - I'll get back to you.

9:31am, 07 Oct 2009 Neil Peace

Weight control is difficult at an individual level. I am certain that to reduce the obesity pandemic will require federal government intervention. I am surprised at the slow response by governments to the obesity problem. This sluggish response suggests to me that the government still views obesity as an individual, personal problem of lack of willpower. This is not correct. I will happily send references from the medical literature to demonstrate that willpower has no part to play in the obesity pandemic. Until governments understand this concept they are unlikely to muster the policies needed to reverse the obesity problem. Millions of Australians are suffering due to obesity, thousands are dying and yet we have almost nothing happening to counter the rising tide of obesity. Why? Neil Peace

2:12pm, 30 Sep 2009 rotraut123

Obesity in children is I suggest a combination of diet, exercise and other factors including the absence of both parents from the home for longer periods.

Two suggestions that spring to mind is creating safe environments for children to be children and play and relate like children once did. The second is to realize the issues and ensure quality parenting in what ever timeframe is available. This may require some support or educational roles at least initially.

The one thing I am not in favour of is creating an environment where children feel guilty, lost or unloved. I also do not support surgery or drugs unless other alternatives have been explored. I suggest the kind of sleep a child has and our they relate both to other children and adults is significant.