There is a global epidemic of weight gain. In the United States 74% of the population are significantly overweight, in Europe 60% and in Australia and New Zealand nearly 78%.
Worldwide it is estimated there are 442 million adults developing weight-related diabetes. In the last twelve years there has been a 400% increase in those with a BMI over 45. The chief medical officer in the United Kingdom has described weight gain as a national threat to the health system equating to a tsunami ‘flooding’ health systems to the disadvantage of other desperately needed areas.
Obesity is not a disease
The medical profession has responded by identifying the problem as obesity. Then – with the negativity and fat shaming of the term obesity firmly, if inadvertently, established – we added another derogatory term by calling it a disease, which it is not.
Tuberculosis is a disease, leprosy is a disease but being overweight is a reversible condition.
Weight loss can, if not cure, can at least remediate or improve conditions associated with weight gain such as obstructive sleep apnoea, type II diabetes, liver disease, heart failure, infertility, dementia and depression. Telling patients they have a reversible condition related to weight gain rather than a disease, gives them hope and positivity.
What is now needed from the medical profession is an approach which is not negative or fat shaming, but gives patients hope and utilises strategies, such as positive reinforcement and cognitive behaviour therapy, to assist in successful outcomes. With that strategy in place the next consideration is how to present dietary and nutritional information. This needs to be simplified and presented in a way that is sustainable and doesn’t contain negativity or fat shaming terms.
Central to weight gain and weight-related conditions is the wrong type of food, the large volumes of food and the speed with which food is eaten. As a result it has been fashionable to describe those who overeat as lacking in willpower. This partly absolves the medical profession from intervention, since if there is no willpower any interventional strategy will fail. Again the negativity implicit in such a belief not only shames but doesn’t represent the truth.
Fast food companies have done research to establish a ‘bliss point’, the amount of sweetness that generates an addictive, repetitive response. This has overwhelmed willpower creating a near addictive response. That’s where our focus should be as part of the strategy. A similar situation existed with using salt to produce a ‘moreish’ response when eating salty foods.
A more positive approach, rather than blaming the patient for willpower, would be to help people understand that their health is being corrupted by a third force interested only in the financial bottom line. Excess calories and the type of calories is where the focus should be. Rather than confusing the patient with multiple diets, the emphasis should be on volume reduction, which I believe is a more natural approach leading to healthy eating.
Diets are not only confusing for patients, at any time in the United Kingdom more than 17 million people are on a weight reduction diet. The startling statistic however, is that 80 per cent of both men and women give up their diet four months after starting.
Counting calories is difficult and often an unpleasant experience and clearly for many obviously unsustainable. Therefore there needs to be a new approach which can motivate, educate and potentially be more successful/sustainable with weight loss. In my book, Fat Off – The Right Way: A clever and sustainable eating guide for weight loss and healthy living, the focus in the first part is about education and motivation, using a cognitive behaviour therapy approach and subliminal suggestion, to help generate desire with positive reinforcement to take charge individually of health.
The book uses a variation of the KISS principle – ‘Keep it simple slim’ – which starts even before eating with education about food and how to avoid unhealthy purchases when supermarket shopping. In the second part the focus is on healthy eating with the central concept built on volume reduction/calorie reduction, sugar denial and moving towards food which is as healthy as affordable and as organic as possible.
Volume and therefore calorie reduction as well as the avoidance of junk food, is aimed at reducing the dopamine stimulus which produces cravings, in addition to allowing the stomach to re-adjust to a decreased volume. This return of normal stretch receptor feedback mechanisms and Grehlin (the ‘hunger’ hormone) levels further adds to and returns eating control towards a more normal state.
Helping patients understand the food addiction pathway, as well as providing practical advice on breaking the dependency cycle on junk food and countering the advertising which, like smoking, has evolved to suggest that there is a healthy aspect to high-carbohydrate, high sugar foods.
A new medical strategy also needs to focus on wider issues which may help with weight loss. For example the problem with soft drinks is not only the sugar but bisphenol A (BPA) which lines many, if not all, plastic bottles. BPA – if it leaches into the soft drink or even water – is a potential carcinogenic agent. Perfluoroalkyl substances (PFAS) used in oil and water resistant textile coatings (such as nonstick food pots, pans and food containers) may also leach out and impair glucose balance, and therefore increase body weight and alter fat cell growth. The Guardian reported in 2015 that one study estimates that endocrine-disrupting chemicals in food and food containers are costing Europe more than €157 billion annually in associated health costs.
Heart attack pics on chocolate?
Responsibility within this new strategy includes educating patients about weight gain factors which can be controlled. The second tier of that strategy is to address the cause.
Can you imagine, as we have done with cigarette advertising, if we could put pictures on chocolates or sweets of rotting teeth or a heart attack graphic. Would it be effective? Certainly research indicates that it is with smoking.
Medical intent is one thing but the fast food and sugar industry contribute billions of dollars to economies and regulating them requires political courage. Such a move, as with the sugar tax, would be greeted with loud voices saying it is not effective when there is now research showing it is. Not only that but the unmeasured factor is the focus it places on sugar and its harmful impact, which creates increased awareness amongst our population.
Much more can be done with a collective medical willpower, to combat a condition which with the right support and understanding is reversible.
Paul Anderson, MBChB FRACS/FRCS (Edin) MA, PhD Dip Tch MBChB FRACS JLA MBBS is an Upper Gastrointestinal Hepatobiliary and Bariatric surgeon. He is also a lecturer at Te Whare Wānanga o Awanuiārangi’s nursing school, offers the free Specialist Review Clinic to the Eastern Bay of Plenty and is the founding Chairman of Specialists without Borders.