How to wage war against obesity
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In the fight against obesity, some are pushing for public polices, such as higher taxes on soft drinks. Studies suggest sugar-sweetened beverages — the single greatest source of added sugar in our diets — may also be the single biggest driver of the obesity epidemic, especially among children.
“There seems to be something special about calories when they get delivered in liquids,” says Kelly Brownell, co-founder and director of the Rudd Center for Food Policy and Obesity at Yale University. “The body doesn’t recognize them well, and there’s less compensation when people consume too much. Third is, they’re so heavily promoted, it’s ridiculous. And fourth, you’ve got this possibility of the sugar, especially coupled with caffeine, being addictive enough to be a problem.”
In a report published last year by the New England Journal of Medicine, Brownell and half a dozen other experts in nutrition, public health and economics, called for a penny-per-ounce tax on soft drinks and other sugared beverages.
Brownell says his group’s research shows that a penny-per-ounce tax on sugary drinks, with part or all of the revenues designated for obesity prevention programs, would raise $150 billion over 10 years in the U.S. “That’s how high the consumption is.” A penny-per-ounce tax — which would add, roughly, 34 cents to the cost of a one litre bottle of pop in Canada — would lead to about a 23 per cent reduction in consumption of those beverages, Brownell says, “which, in the United States, would mean the average person would go from drinking 50 gallons (per year), to 38.5,” Brownell says. “It’s not as if you’re forbidding people from having them. They’re still drinking 38.5 gallons.”
Others want to require restaurants to include calorie counts on their menus. Brownell and his colleagues published a study in December that showed such labels inspire people to eat 14 per cent fewer calories.
Calorie labels, along with information on the recommended daily caloric intake for an average adult, led people to consume, on average, 250 fewer calories in after-dinner snacking than people who saw menus with zero calorie information. Another study, this one published in January in the journal Pediatrics, showed that parents presented with hypothetical meals at McDonald’s restaurants choose meals for their children containing 102 fewer calories on average when the menus listed calories for each item.
In 2006, the House of Commons voted down a private member’s bill that would have required fast food chains to post the number of calories in menu items beside prices on menu boards. Former Liberal MP Tom Wappel, who introduced the bill, blamed in a Vancouver Sun story a “huge and powerful lobby” from the food industry for the bill’s defeat.
But government regulation of the food industry isn’t the only thing people are calling for. Taylor and others want tougher controls on the commercial diet industry. “People are desperate,” she says, “and they’ll do things like spend huge amounts of money on these quick fix diets that promise losing 40 pounds in eight weeks through very unhealthy ways.
“We know that when people do that, most will rebound, and probably gain back more weight than they had lost,” she says. “Even trying to lose weight is contributing to obesity. We have a generation of people that are dieting themselves into obesity.”
But many turn to commercial diets when they can’t get the help from doctors. Taylor says her colleagues are good at treating the problems that occur as a consequence of obesity — diabetes, high cholesterol, hypertension — but, “we’re not as good at treating obesity . . . So, it just gets ignored.
“To tell somebody who has a weight problem to eat less and exercise more is not helpful.”
What’s more, we live in a thin-obsessed culture still steeped in the idea that if people just try hard enough, they’ll get the body they want, that fat people, somehow, “do it to themselves.”
Doctors aren’t immune to those attitudes. “Health-care professionals are human beings, and human beings, we have this aversion to the big fat slob. Do you know why? Because we’re afraid we may end up like that if we lose control,” says Dr. Nicholas Christou, a professor of surgery at McGill University and director of the bariatric surgery program at the McGill University Health Centre.
“Almost all of us are fighting, one way or another, unless we’re anorexic, to maintain a weight down to a level we’re comfortable with. These people, when you see them, remind us of that failure.”
Christou sees the extreme end of the obesity crisis, the “morbidly” obese, people “who have absolutely failed miserably at any attempt whatsoever to get them to permanently lose their weight and keep it off.” For the severely obese, weight loss surgery can be life-saving, but wait times for bariatric surgery are the longest of any surgically treated condition in the country. Christou has patients who have been waiting for surgery since 2002.
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