Getting Tough on Obesity

The idea of a fat police is abominable. Yet there are some lessons from policing of tobacco could be used to fight the fat epidemic. This would help considerably in terms of cancer prevention.

The association between larger BMI and cancer was first brought to light in 2003 as a result of American Cancer Society. In this study, some cancers in particular were shown to have a strong association with particular cancers.

Recent studies have shown that when obese individuals undergo gastric bypass surgery it reduces their cancer incidence.

Factors that have been identified as potential drivers of this increased risk include specific things about people’s diet or level of physical activity, certain metabolic factors, hormones and associated processes, and perhaps something about the fat tissue itself.

There is evidence that elements of a person’s diet a role that is equally important to tobacco in terms of contribution to the overall risk of cancer.

Obesity is likely to contribute to this risk and this contribution is likely to increase with the continued rise in global obesity. It is not known if the rise in overweight young people will further add to the associated cancer risk.

So weight control is now recognised as a priority in cancer prevention.

Some of the modern lifestyle changes that have resulted in the dramatic increased prevalence of obesity since the 1980s include:

  • Increased availability and reduced cost of food.
  • More high density foods.
  • Greater variety of foods available.
  • Increased portion sizes.
  • Increased frequency of eating and more snacking.
  • Large servings.
  • High energy drinks.
  • More sedentary lifestyles.
  • Expensive to be physically active.

Similar strategies used in tackling smoking might work with obesity.

Both smoking and overeating are behaviours with short term rewards that are difficult to change.

In both the risks are difficult to assess, occur over long-term and on an individual basis. In both the global scale of the problem and vested interests make prevention a more difficult task.

Risk factors seem to cluster in the more deprived groups in society.

In the case of smoking prevention, the drivers of policy and restricting tobacco availability are the strong association with cancer, the lobbying of those who don’t smoke and protection of children.

Prevention campaigns include advertising bans, mass health education, warnings at point of purchase, warnings in terms of alarming images, restrictions of the opportunity to carry out the behaviour, increasing taxation, provision of treatment services so health professionals who want to engage can refer patients, tackling the commercial sector to offset their desires to sell more and the support from cancer organisations.

The strong medical case is well acknowledged and universally recognised.

There is no anti-obesity lobby despite some noises about climate change, and it is not really a contender as a legitimate driver for weight reduction.

The introduction of nutritional guidelines for school meals in some schools goes a way towards the protection of children but Ireland lags behind in this regard.

Ensuring junk food is no longer sold in vending machines in schools is one policy and has been adopted in the UK. Also in the UK there is also a ban on junk food advertising during children’s programming on TV.

The British Government has invested £75m in the first year in the Change for Life campaign, which is a mixture of mass marketing and mass mailing in an attempt to engage families with children in the issues of weight control.

Awareness is a big problem as many people are not even aware they are obese. In an English study, most parents did not identify their children as obese and only 17% of them with obese children thought their child was overweight. Doctors were even found to have difficulty in identifying obesity even in themselves.

Mass education for obesity prevention could include warnings at point of purchase, calorie labelling, restriction of opportunities for eating and increased taxation on unhealthy foods.

The problem is that these measures would be punitive on the healthy weight population too. Few people would not be willing to pay extra for food to prevent an obese person from overeating.

One of the advantages of offering obese people treatment, despite the fact it may not improve their individual health significantly, does emphasise the illness aspect and the fact that something is being done and that it is being taken seriously.

The food industry is a very powerful political lobby and restrictions will not be easy to implement.

By labelling food as low fat people may perceive they can thus eat as much as they like just as in the case of light cigarettes.

Support from cancer organisations for obesity prevention is less vigorous than smoking prevention.

For them, the issue is whether to invest into research into how obesity impacts on the development of cancer, response to treatment or survival or invest in obesity reduction through health promotion in the same way they invested in tobacco control.


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