Junk food: opiate of the masses

Australians are getting fatter. Obesity rates have more than doubled in the last couple of decades. This is bad news despite the misconceptions, if not big fat lies, about obesity. For instance, not everyone knows that carrying a little pudge is probably healthier than being skeletal.

Fat is expensive. A 2008 report for Diabetes Australia "guesstimated" that the current cost of obesity in Australia is $58 billion, comprising $8 billion in direct financial costs and $50 billion in lost quality life-years. Gross obesity does increase the risk of assorted diseases and injuries. On average, being extremely fat will take a few years off your life and cause a degree of personal misery. It even reduces fertility and harms fetuses.

Like many common “chronic conditions”, obesity is getting reframed as a “chronic disease”. Diseases need medicines or surgery. This might explain the eyebrow-raising at recent promising research into paying people to lose weight. Fixing fatness is now a big health care issue.

Obesity medications have proved, for the most part, largely ineffective if not downright dangerous. Several have been withdrawn due to life-threatening side-effects. Nonetheless, the manufacturers of fat-busting pills remain an unseen hand behind many public health obesity messages.

Fatness also supports a major surgical industry. The benefits of fat removal by liposuction are often short term and skin deep. Even extensive liposuction does not seem to reduce the risk of obesity-related conditions like diabetes or heart disease. The potential to create cosmetic disasters is ever present.

Bariatric surgery, an assortment of gastrointestinal modifications to reduce food intake and absorption, is becoming increasingly popular. Several studies suggest that it can extend lives when performed on the fattest people by the most experienced clinics. Nonetheless, this is major surgery and serious complications are common.

The Inverse Care Law operates with most medical treatments. In other words, availability is inversely proportional to need. Wealthy people who are somewhat obese can readily receive private bariatric surgery but this surgery is practically unobtainable, even for the incredibly obese, in most public hospitals.

This is not surprising. Surgeons make more money for less work operating on less obese private patients - the surgery is easier, the anaesthetic safer, the recovery better and you don’t even need as much help moving patients on and off the theatre trolley.

I vaguely recall ex-ironman Grant Kenny saying years ago that if he wrote a weight-loss book it would be no more than a couple of pages long and called something like “Eat less crap and get off your arse”. His advice was good although a lack of exercise is widely overrated as the cause of obesity. Many fat people do plenty of physical work. If you disagree, try getting off your own arse to drag a 30kg bag of fat around all day.

Fat is stored more easily in some people than others but there were no fat inmates in Nazi concentration camps. Eat very little, and you will be skinny. Eat too much, and you will be fat - especially if you are eating crap.

I might be a doctor but Supersize Me - the Big Mac binge movie - was an eye-opener. I had not thought a few weeks of dining exclusively at the Golden Arches would lay on ten kilograms, derange your liver function tests, raise your blood pressure, precipitate depression and make you impotent.

But, that said, few people are totally clueless about what is healthy food and what is not. These days, smokers know cigarettes are toxic but have them anyway. And, despite the often-deceptive advertising, people do not usually eat mountains of junk food thinking it is particularly good for them.