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Revised draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Children and Adolescents

ID: 
17
Personal Details
First Name: 
Tony
Last Name: 
Kierath
Additional Information
In regard to your comments, do you have a Conflict of Interest to disclose?: 
No
Specific questions
Question 2: What would help you implement these recommendations into practice?: 

Change them completely to try and solve the real issues rather than just more of the same banter that was

Specific comments
Comments: 
General comments
Comments: 

Draft Obesity Guidelines for Adolescents and Children

Thank you for inviting me to respond to the new guidelines. It is obvious that we need new guidelines as the problem has only gotten worse since the last set were published. What has been attempted obviously has not worked and Australia still remains in the top ten of the world league tables of obesity. I have no need to reiterate the cost of this both in social and economic terms but as with the previous publication, undue emphasis is placed on this nexus of intake versus expenditure and that by increasing calorie expenditure, weight loss will be achieved. Tragically nothing is further from the truth. We get fat because we eat too much not because we do not exercise enough. The human body is far too efficient with food digestion and exercise such that there are not enough hours in the day to meaningfully exercise enough to lose weight. The problem is not that we watch too much television, or indeed that we eat too much fast food. The problem is that we just eat too much food altogether and this publication again fails to really address the question of why we eat too much. I might point the committee to a publication by the OECD called “The Obesity and Economics of Prevention”. This states quite clearly that the obvious truths that the cost of calories has diminished fifty per cent in the last thirty years and incomes have increased several times. The result of this is that the proportion of our disposable income spent on food is diminished and we can afford the more calorific intensive foods. Similarly we are burdened with this legacy of three meals a day plus morning and afternoon tea and a snack in the evening. Because we can afford to eat – we do.

Not only that, we have now intertwined and enmeshed all forms of socializing with the consumption of calories. No longer do we meet people apart from at a coffee shop and consume an overburden of calories at the time. When was the last time that you were offered celery and water when meeting any acquaintance or business colleague. I would even go so far as to suggest that meetings of this committee are accompanied by lashings of unnecessary calories. What the committee needs to say is that we now, as a nation, must eat less. The committee must be prepared to say that it is OK to go without meals. Breakfast is not important. Any suggestion that breakfast is required to promote some form of metabolism is complete scientific nonsense. The implications of stoking this obvious fact are enormous in that this will mean amending enormous swathes of legislation related to the workplace and change in social norms. On average obesity correlates extremely well in my practice with post code and the expenditure on lotto by post code. Correlation co-efficient on 0.93 is extremely powerful. The problem of obesity in this country now is greater than the burden of cigarette smoking in numbers and the only person who has spoken without a forked tongue on this matter has been Tony Abbott in the distant past who said “Don’t eat it”. Therefore to achieve the outcomes that are required we must borrow from the practices of countries who have been able to achieve low levels of obesity with high incomes and the glaring example of this would have to be Japan. This is technologically one of the most advanced countries on the planet yet it has the lowest rates of overweight and obesity in both men and women in the OECD. Seeing what they eat it is not hard to explain why, I might also add.

For too long we have sat around skirting the issue of the fact that to lose weight we need to eat less. That is not just less of fast food or readily available food. it is less of all sorts of food. The number of calories we eat needs to be diminished and I suspect the only politically savoury manner to achieve that would be as we did with cigarettes and that is to raise the price ie add GST and remove the ability and options to eat.

As with the previous edition of the guidelines, surgery is the only form of therapy the provides meaningful weight loss, but again we just don’t have the ability to operate on sixty per cent of the population. The only means of solving this problem is with prevention. Weight loss is difficult to achieve and consequently with the current population that we have, our interventions are likely to be limited. However, future generations will need to be inoculated with the idea that eating less is better and putting systems in place that will prevent future generations from suffering the same obesity related issues that we currently do would indeed be far-sighted. However I feel that these recommendations will be unacceptable politically, despite the fact that we now have some good evidence that a little bit of starvation every now and then has some health benefits. As a nation we will continue to patter around the edges of this problem until a cataclysm which, I suspect, will be a major economic/financial issue or a war or perhaps even some biologically devastating event causing crop failures.

Kind regards

TONY KIERATH

Page reviewed: 6 September, 2012