EDUCATION HAS FAILED AS A PUBLIC HEALTH POLICY

Airplanes are an interesting microcosm of human existence. I love air travel. I love being cocooned by airports offering every convenience at 180% of it’s standard market value. This is a place I catch up on work as I literally have nothing else to do. Many of my blogs are written in airports as being trapped in a metal can without the distraction of Wi-Fi encourages reflection. I sincerely hope Wi-Fi never approaches a reasonable price during flight.

Today I am seated beside an elderly couple. The woman struggles for several minutes to reach the seat belt around herself before the buckle makes the familiar click. I pull the arm rest down to prevent her partner from spilling out into my seat. This will be a long, uncomfortable two and a half hours where my spine is curved towards the aisle to allow me enough room to type.

“They must be getting shorter” she remarks. 

Yes, I’m sure that’s it. The ability of people to deceive themselves never ceases to amaze me. I am not in the habit of fat-shaming. But I do call a spade a shovel and it is clear this couple is obese. In our society they’re more common than someone of my build is, so perhaps they’re looking at me with the same bewilderment that I am observing them. I confess I was primed before boarding by reading several articles on the lack of physical activity by Australians, various theories on diets which could be more effective in controlling weight and an article encouraging women to put themselves first and some general recommendations on healthy lifestyles. I read them with growing cynicism. None of this is new. None of this is different to any of the messages which have been repeated ad nauseum over the past decade or more. The first article confirmed what is very clear: none of the messages are having any effect on physical activity or obesity.  As a public health policy, education has failed miserably.

One of the more interesting articles was a study on mice who were given either free access to food 24 hours a day, or access restricted to a 10-hour window during the night, which is when mice naturally feed. They did some cool things with gene alterations in one group but that’s not the interesting part. As a diet strategy, intermittent fasting isn’t new. And I have been trialling the 10-hour window myself during some training down time. I have noticed (warning: n=1 experiment) that forced to delay breakfast until 10am and denied any snacking after 8pm has resulted in eating one to two less snacks per day. This would equate to around 600 calories a day which is the recommended reduction required to lose half a kilogram per week.  So I assumed that the protocol achieved weight loss or maintenance by simply reducing the amount of food people eat. The study did show slightly lower calorie intake by the time-restricted mice but not enough to account for the differences in weight gain. In summary, the time restricted mice stayed lean and metabolically healthy while the mice with 24 food access became obese and developed metabolic risk factors similar to cardiovascular disease in humans.

The study concludes there may be something magical about eating all your daily calories in a 10-hour window versus spread out during the day. I am skeptical as I come from the ‘calorie is a calorie’ school. Also, there may be some failure to account for increased physical activity during the eating period in the 10-hour mice which resulted in more energy expenditure. Either way, it does seem that, however it works, cutting down the window of food consumption during the day may be a good strategy. Given their tendency to subvert good ideas though, I do anticipate people gorging on fast food during the 10-hour window and then being surprised at the failure to lose weight.

During a month’s stay in regional France, I did make an observation related to this idea. The restriction of food outlet opening times to meal times. I recall trying to get a meal at 11.15am and being almost faint with hunger only to be told that the restaurant opens at 12pm and not a moment before. I could have coffee though and the French do such poor work with milk it would undoubtably be black. The restaurant then closed at 2pm and would not trade again until 6.30pm. There was only one fast food restaurant located on the outskirts of town. I wondered if it was the lack of availability of food that corresponded to the lower rates of obesity in these areas? Would McDonalds be so bad if it was only opened for a couple of hours at breakfast, lunch and dinner? Did this change in trading times for convenience foods predate the sharp rise in obesity?

There is a lot of evidence for the metabolic value of fasting. As an athlete we are often conditioned to think of hunger as a bad thing. That the slight pangs of hunger indicated our hard-fought muscle gains were being catabolised by starvation. The 10-hour strategy is most certainly useless for athletes. For those training at 5.30am they would need to have dinner at 3.30pm to follow the program. And it has been repeatedly shown by studies that poor fuelling before sessions results in low quality training and sometimes failure to complete the set workout. However, on days off or recovery days, it is conceivable we might have a black coffee, do an hour of easy riding and make morning tea our first meal of the day. Emphasising our calorie consumption around exercise and then sticking to standard meals for the remainder of the day could be effective for those in the “but I’m doing all this exercise, why aren’t I losing weight” category. And repeat after me – there is no meal after dinner.

Another article on the failure of Australians to get the recommended amount of physical activity each week. How is this even possible? We have the best climate for getting outdoors and access to some of most stunning areas to recreate. One article blames the computerisation of the workplace for a lack of incidental exercise during the day. Another study shows that those with the most physical occupations have the poorest health. Confused yet? In general, physical jobs are the domain of lower skilled, less educated and lower paid workers. And there IS a correlation between income and poor health and obesity. So, if obesity is an income problem, isn’t it logical to use monetary measures to address it? I have considered that food should be sold on a cents per calorie scale. Although for someone with a high calorie consumption due to high level training, that does negatively impact me. Should 100 calories of broccoli cost the same as 100 calories of sugar? I know which would lead someone to feeling more full and also provide additional nutrients while that amount of sugar would hardly be noticed. 

The sugar tax is the closest thing which tackles the obesity issue on this angle. And it fails to account for the alternatives which aren’t taxed (fruit juices) but are not that much healthier. It also does nothing to address the myriad of other foods, like potato chips, which are linked to increases in body weight. But I do believe that if you want to ‘nudge’ the population to making better choices, you have to price the undesirable choices out of the market. See how effective cigarette taxes have been in conjunction with sales and consumption restriction. Surely food could be treated the same. It is not a mystery which foods are linked to obesity (processed) and which foods are not. No one ever got fat on broccoli. Increase the taxes on processed foods until the obesity levels drop. Restrict trading hours for food outlets. No one needs an ice-cream sundae at 2am. It is the responsibility of government to intervene in this problem as clearly society is unable to help itself. The obesogenic environment is a real thing – 24-hour access to cheap, processed and nutrient-free food is costing society billions of dollars and lives.

Why do I even care about people being obese? Let them kill themselves. It’s free choice. Firstly, I do care. I care about those who genuinely want to improve their health and aren’t succeeding, either through lack of resources or failure to follow advice which can be complicated, conflicting or impractical. I have all the time in the world for people who have the will, but not the way. I do not wish to watch one more television show which shows how easy it is to lose weight with your own personal dietitian and trainer. This is not a realistic option. Secondly, it enrages me to see the burden on the public health system which is so unnecessary and prevents those with serious problems, not brought about by their lifestyle, from receiving treatment in appropriate time frames. Obese people don’t kill themselves. They suck up medical resources to manage their multitude of conditions and extend their life far beyond what it would be without these interventions. I don’t advocate for a system which refuses treatment to those who are deemed to have brought it on themselves. The complexities of apportioning percentages of blame to factors is far beyond administrators and not close to being moral.  Which leaves us with the current system where people are being refused timely treatment for a range of illnesses due to lack of capacity of hospitals.

So back to our couple on the plane. I look at what they're ordering. They have the same unusually healthy plane snack that I do of some lavosh crackers, capsicum dip and celery sticks. They don't even finish the dip. Tea - no sugar. Going well so far. Then the man pulls out a ziploc bag of lollies and they proceed to munch away during the flight. And suddenly it all becomes crystal clear. Face - meet palm.