OBESITY IS THE BIGGEST PUBLIC HEALTH HURDLE OF THE CENTURY - PAUL ZIMMET

Like many nations, Australia is in the throes of an unprecedented epidemic of obesity and type 2 diabetes an epidemic in acceleration mode. Over the last week, more than 2500 scientists have been in Sydney for the 10th International Congress of Obesity. The theme of the congress was From Science to Action. Its aim has been to produce workable strategies to counter the obesity pandemic and to deliver to communities and governments the leadership that only a meeting of this significance and magnitude can offer. Obesity is the single most important challenge for public health in the 21st century. More than 1.5 billion adults worldwide and 10 per cent of children are now overweight or obese. Yes the worlds waistline in bulging some cynics call the phenomenon Globesity. Professor Phillip James, chairman of the International Obesity Task Force, warned the congress that it is sweeping the world with terrifying rapidity. Obesity is the driving force behind type 2 diabetes, which causes significant cardiovascular complications, kidney failure, blindness and amputations. This is leading to decreased life expectancy from type 2 diabetes, cardiovascular disease and some forms of cancer. The selection of Sydney as the host city for the conference was made eight years ago, but in the meantime Australia has assumed the not-so-welcome honour as the nation with one of the fastest-growing rates of obesity in the world. The 2000 AusDiab study, undertaken by the International Diabetes Institute, showed that more than 60 per cent of our adult population is overweight or obese, along with 20 per cent of our children. It is a tripling in numbers over the last 20 years. The Pharmaceutical Benefits Scheme subsidised the obesity-related conditions diabetes and heart disease by more than $2 billion last year, and the costs are still rising. This is replicated in many nations and this diabesity pandemic is now set to bankrupt health budgets all over the world. Emerging from the conference was some important new scientific research. In the last decade, fat has moved from being viewed as inert blubber to probably the most active endocrine (hormonal) organ in the human body. It makes a vast range of chemical substances vital to body function from control of appetite, energy balance, our immunity and blood clotting, to regulation of insulin and other hormonal actions. Fat in the abdominal cavity, the Aussie beer gut makes chemicals that cause type 2 diabetes and heart disease. On the public health side, VicHealth CEO Robert Moodie, noted that there was a role for government regulation and, without it, we will not be able to curb the epidemic. He said that the contemporary environment promotes obesity. The obesity diabetes

epidemic will continue unless we accept that many years of health promotion aimed at individuals seem to have had virtually no effect. Our own state and local governments may have inadvertently contributed to this epidemic by allowing developers to create urban social problems. New developments lack proper attention to sidewalks, bike paths, public transport corridors, playing fields and friendly exercise areas that are essential to maintain a healthy lifestyle. We can rejoice that obesity has implanted itself firmly on government radars. Tackling obesity and its consequences has been taken to a new political level. Our federal and state governments have recognised the need for action to tackle obesity and diabetes through the Better Health Initiative. Federal Health Minister Tony Abbot and John Howard have been powerful advocates of action with certain reservations such as in the area of banning TV advertising. We dont have the luxury of time to deal with the epidemic its as big a threat as global warming and bird flu. Solutions are urgently needed, and involve more basic issues than more exercise and correcting diet. The way ahead for us to address this globesity crisis is not for obesity researchers, scientists, health professionals and politicians to live in their silos with pet beliefs on issues of taxing junk foods and banning TV advertising. What is needed is a bigpicture approach, and to acknowledge our lives and the environment have changed in the last 20 or 30 years. Just three weeks ago, Professor Phillip James and I wrote an editorial for the Medical Journal of Australia (2006;185:187-8) which outlined some key legislative and regulatory measures that are required to turn the epidemic around, particularly in relation to childhood obesity. We need urban planning to help people exercise more, physical activity reintroduced into curricula, nutrition education in schools, production and availability of cheap healthy foods, and responsible labelling and advertising. At the congress, a major topic was the call by many for bans on marketing and TV advertising to children. While this seems sensible, the evidence that it translates into reduced obesity rates is not yet available. Certainly stronger guidelines are needed, and we may need to implement guidelines for food labelling. Currently, labels cannot be understood by consumers and health claims are often misleading. Looking at the big picture, the prevention of obesity and type 2 diabetes requires co-ordinated policy and legislative changes, with greater attention on our urban environment, transportation infrastructure, and workplace opportunities for education and exercise. Governments local, state and federal should commit to optimising opportunities for exercise in a safe environment. A multidisciplinary, politically driven, co-ordinated approach in health, finance, education, sports and agriculture can contribute to reversing the underlying causes of the obesity epidemic.

This may well be the single and most important challenge for public health in the 21st century. It is a battle than we can and must win. Professor Paul Zimmet AO is director of the International Diabetes Institute and chairman of the 10th International Congress of Obesity held in Sydney this week.

OET reading style questions

1. According to the article, in Australia a) There are more overweight children than adults b) Australia has the fastest growth rate of obesity c) In the past 2 decades Australias rate of obesity has increased 3 fold. d) None of the above According to Robert Moodie a) Government regulation will not help lessen the epidemic b) Modern lifestyle encourages obesity c) Health promotion is a good way to reduce obesity d) Obesity is a bigger problem than diabetes Which of the following statements are true a) New suburbs do not encourage people to develop a healthy routine b) Australians have too much time to enjoy luxury foods c) John Howard and Tony Abbot support prohibiting TV advertisements d) obesity is a greater danger than bird flu & global warming Professor Philip James believes a) Advertisements must be labelled b) Make healthy food more affordable c) Physical education reduces academic levels d) Education is necessary to encourage people to exercise

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According to the article it can be concluded that a) Lack of exercise is the number one cause of obesity b) Modern lifestyle is not as healthy as a traditional lifestyle c) Obesity and type 2 diabetes can only be reduced if governments are involved in the process d) None of the above Match the word and definition 1. cynic 2. subsidy 3. inert 4. to curb something 5. inadvertently 6. underlying causes a) a grant or gift of money from a government to a private company, organization, or charity to help it to function b) somebody who is critical and sarcastic c) to control or limit something d) without intending to or without realizing e) not readily changed by chemical or biological f) present and important but not immediately obvious

Answer Sheet
Question 1 a) Incorrect b) Incorrect c) Correct: It is a tripling in numbers over the last 20 years. d) Incorrect Question 2 a) Incorrect b) Correct: He said that the contemporary environment promotes obesity. c) Incorrect d) Incorrect Question 3 a) Correct: New developments lack proper attention to sidewalks, bike paths, public transport corridors, playing fields and friendly exercise areas that are essential to maintain a healthy lifestyle. b) Incorrect c) Incorrect d) Incorrect Question 4 a) Incorrect b) Correct: availability of cheap healthy foods c) Incorrect d) Incorrect Question 5 a) Incorrect b) Incorrect: c) Correct: Looking at the big picture, the prevention of obesity and type 2 diabetes requiresco-ordinated policy and legislative changes, with greater attention on our urban environment, transportation infrastructure, and workplace opportunities for education and exercise. d) Incorrect:

Vocabulary Answers 1. b 2. a 3. e 4. c 5. d 6. f