Weight Gain and the Food Industry in Australia

The problems of widespread overweight and obesity also exist in Australia. While all ages are affected, interest in finding solutions for children is growing.

The following is an extract from a transcript of interview conducted on October 17, 2005 by ABC Television for the Four Corners investigative journalism program. Here Ticky Fullerton is posing questions to Professor Boyd Swinburn, President of the Australasian Society for the Study of Obesity.

Q. How many children in Australia are overweight or obese do you think?

A. We haven’t had a national survey for 10 years but … it’s probably between 25 and 30 per cent are overweight and obese.

Q. That’s a staggering amount.

A. I know, it is, and it’s huge compared with other countries. If you stack Australia up against European countries we’d be in the top 20 per cent of all European countries in terms of obesity.

Q. And what do you put that down to?

A. I think it’s the environment; it’s the food; it’s the physical activity levels; it’s a whole range of things. And we also don’t have a strong tradition,  at the school level on healthy eating. The physical activity is much better within the school level but the healthy eating, particularly at secondary schools, is shocking.

Q. Australia is famous for being outdoor and being sport obsessed.

A. Well we think we are but we end up with 50,000 people in a stadium who need exercise watching 36 people on the playing field who desperately need a rest. You know we’ve got it the wrong way around. We watch the sport, we don’t do it. I think we need to take what happens at school in the early years when kids are involved in sport and get that going, and keep the activity going, perhaps not in a competitive sport area, but at least in being active and and involved and organised, or unorganised sport and activity.

Q. Why is there so much dispute about the causes of childhood obesity?

A. Well, it’s because there are so many of them and it, and it applies differently in different contexts and with different people. And in many ways I’ve gone away from that and if you ask me what’s the cause, is it physical activity or is it eating, or is it the parents, or is it the schools, I say that’s a silly question.

Q. It plays into the hands of the food industry, doesn’t it?

A. Well, it does but I’m interested in the solutions. You know who’s going to contribute to the solutions, how can we get out of this? It’s multi-factorial, lots of things up there, they play out differently in different settings and different people, but the question is how are we going to turn it around, that’s the more important question.

Q. Nevertheless it’s because there are people on the health side of things who are arguing about whether the driver is food and diet, and whether the driver is lack of physical activity, it has allowed the food industry to say, well you know it’s all about balance, and we don’t have to do very much there, it’s about choice.

A. Yeah, I know, the choice and the balance thing always comes out from the food industry because that plays to, that plays to their strength and of course they’re now promoting physical activity programs and emphasizing the role of physical activity, which is what you’d expect, that would be an expected corporate response from organisations that actually have been part of the problem and now need to be part of the solution.

Q. The food industry, I know for instance Coca Cola would say there’s no such thing as a bad food.

A. Well, there’s no such thing as a bad food, that’s what the food industry always say, but of course there is. You talk to any person on the street and say, can you tell me some junk foods? And they’ll reel them off and they’re all the same ones. They are foods that are high in energy and have no other, or few other micro-nutrients or any other goodness. So they’re stacked full of energy but nothing else. It’s junk food. People know it, the only people who deny it are the food industry.

Q. So what has the overall strategy of the food industry been?

A. Well the food industry, I think responded initially like big corporations would, like we saw tobacco, like the alcohol industry do. When there’s a perceived external threat around products that we’re producing, then they go into denial phase and they go into obstruction phase and they go into ah diversion phase; it’s physical activity, it’s nothing to do with eating, or, and they go into, we don’t know the answers, the scientists can’t agree. There’s a whole lot of responses that the food industry are doing that we saw in tobacco. Now I hope, I’m hoping that they’re getting beyond that and really seriously looking at at solutions.

Professor Swinburn appears to have some critical insight into the ways in which industries that have major responsibilities for causing illness and disease, manoeuver in their own defence. It is frankly quite a disturbing comment on societies to observe the continued ability of tobacco and alcohol industries to cause so much disease and death every year.

Now it is the turn of the food industry. The overweight and obesity problems are still not receiving the attention they deserve based on their associated morbidity and massive costs. This will gradually change and in the course of pressure being applied we will no doubt see the approaches being taken that Professor Swinburn refers to, much like we have witnessed in the tobacco and alcohol industries.

It is a fascinating observation that advertisers often take the greatest weakness of a product and deal with it by blatant denial in the form of stating the exact opposite as a great strength. We are seeing this classic tactic at present in the food industry from the confectioners.

For example, lollies, candy bars and chocolates are being marketed as health foods, claiming wonderous abilities, usually based on claims of the questionable addition of dubious vitamins. Be warned, this junk food does not suddenly become health food by the addition of a few vitamins.

Weight loss is a truely pressing issue for Americans and most western nations. This is certainly not the time to be promoting consumption of chocolate or any form of candy or confectionary, especially not as health food! It is important to take weight loss seriously.

Overweight and obesity pose a major public health challenge. Not only is the prevalence of this serious medical condition soaring among adults (between 1960 and 1994, overweight increased from 30.5 to 32 percent among adults ages 20 to 74 and obesity increased from 12.8 percent to 22.5 percent), but it is also affecting ever greater numbers of American youth and exacting a particularly harsh toll from low-income women and minorities.

The Third National Health and Nutrition Examination Survey (NHANES III) estimated that 13.7 percent of children and 11.5 percent of adolescents are overweight, while a number of smaller, ethnic-specific studies suggest that overweight and obesity may afflict up to 30 to 40 percent of children and youth from minority populations.

According to NHANES III, the trend in the prevalence of overweight and obesity is upward. From 1960 to 1994, the prevalence of obesity in adults (BMI >30) increased from nearly 13 percent to 22.5 percent of the U.S. population, with most of the increase occurring in the 1990s.

"There are several possible reasons for the increase," asserted Karen Donato, coordinator of the Obesity Education Initiative. "When people read labels, they’re more likely to notice what’s lowfat and healthy’ but may not be looking at calories. Also, more people are eating out and portion sizes have increased. Another issue is decreased physical activity. So people are consuming more calories and are less active. It doesn’t take much to tip the energy balance," she said.

In 1999, almost 108 million adults in the United States were overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality.

The total costs attributable to obesity-related disease approaches $100 billion annually. Wouldn’t you rather see that money spent on better things? This relates to avoidable disease, avoidable expense and avoidable suffering and deaths.

"Overweight and obesity pose a major public health challenge." said NHLBI Director Dr. Claude Lenfant. Yes indeed, and it one that must be dealt with.

Assessment of overweight involves evaluation of three key measures–body mass index (BMI), waist circumference, and a patient’s risk factors for diseases and conditions associated with obesity.

The definition of overweight is based on research which relates body mass index to risk of death and illness. Overweight is defined as a BMI of 25 to 29.9 and obesity as a BMI of 30 and above, which is consistent with the definitions used in many other countries.

BMI describes body weight relative to height and is strongly correlated with total body fat content in adults. According to the guidelines, a BMI of 30 is about 30 pounds overweight and is equivalent to 221 pounds in a 6′ person and to 186 pounds in someone who is 5’6". The BMI numbers apply to both men and women. Some very muscular people may have a high BMI without health risks.

BMI should be determined in all adults. People of normal weight should have their BMI reassessed in 2 years.

"The evidence is solid that the risk for various cardiovascular and other diseases rises significantly when someone’s BMI is over 25 and that risk of death increases as the body mass index reaches and surpasses 30," said Dr. F. Xavier Pi Sunyer, director of the Obesity Research Center, St. Luke’s/Roosevelt Hospital Center in New York City.

According to an analysis of the National Health and Nutrition Examination Survey (NHANES III), as BMI levels rise, average blood pressure and total cholesterol levels increase and average HDL or good cholesterol levels decrease. Men in the highest obesity category have more than twice the risk of hypertension, high blood cholesterol, or both compared to men of normal weight. Women in the highest obesity category have four times the risk of either or both of these risk factors.

In addition to measuring BMI, health care professionals should evaluate a patient’s risk factors, such as elevations in blood pressure or blood cholesterol, or family history of obesity-related disease. At a given level of overweight or obesity, patients with additional risk factors are considered to be at higher risk for health problems, requiring more intensive therapy and modification of any risk factors.

Health professionals are also advised to determine waist circumference, which is strongly associated with abdominal fat. Excess abdominal fat is an independent predictor of disease risk. A waist circumference of over 40 inches in men and over 35 inches in women signifies increased risk in those who have a BMI of 25 to 34.9.

The most successful strategies for weight loss include calorie reduction, increased physical activity, and behavior therapy designed to improve eating and physical activity habits. People should engage in moderate physical activity, progressing to 30 minutes or more on most or preferably all days of the week.
Reducing dietary fat alone, without reducing total calories, may be helpful for the heart but will not produce weight loss.
 
Note that the upward trend in adult obesity has also been observed in children. Treatment issues surrounding overweight children and adolescents are quite different from the treatment of adults. However, a healthy eating plan and increased physical activity is an important goal for all family members. There is really no room for chocolate, no matter how healthy irresponsible marketers try to make it sound.

Here we are, talking about chocolate for your heart, and it’s not even close to Valentine’s day!

I have already dismissed as dangerous to health any suggestion that eating confectionary is beneficial to your heart. I also indicated that greed and competitive market forces in a multibillion dollar industry will virtually guarantee that you will be increasingly subjected to a contrary message.

So I thought it might be helpful to spell out a few facts and to provide a short list of sugnificant research reports that you can quickly evaluate yourself.

Eating dark chocolate daily seems to lower blood pressure, reduce LDL (bad) cholesterol and improve insulin sensitivity. These are all desirable outcomes but it is important to understand the details and not be tricked into thinking this can be translated into eating more sweets.

Chocolate is made from cocoa which is rich in flavanols. These are the same beneficial antioxidants found in green or black tea and red wines. As far as heart benefits go, cocoa increases nitric oxide, reduces platelet aggregation, making blood less sticky and inhibits oxidation of LDL cholesterol. Again, these are quite desirable outcomes.

However, these are not likely benefits from most store bought chocolate goodies. Even the so-called "health enhancing" new varieties are, firstly, unlikely to achieve these outcomes and secondly, going to contain plenty of quite undesirable qualities along with any possible benefits.

The benefits are only seen with pure cocoa and dark chocolate, which taste very bitter due to their high content of flavanols. Most of the chocolate people consume is made with "dutched" cocoa. This means the cocoa beans are treated with alkaline solution to make them darker in color, and milder in flavor. As much as 90% of the flavanols can be lost during this dutching process, taking the benefits with them.

Milk chocolate is diluted with milk so has fewer flavanols than dark chocolate. White chocolate has none at all, being made only with cocoa butter. Keep in mind that the amount of chocolate consumed to create the benefits also adds up to an extra 500 calories per day which simply cannot be justified, especially in the face of an obesity epidemic.

Below is a short list of articles you may like to read to further explore this issue. They have mostly been published this year. It would be interesting to know who funded each piece of research. I haven’t explored that data but you could always let me know.

References:

Vlachopoulos C, Aznaouridis K, Alexopoulos N, et al. Effect of dark chocolate on arterial function in healthy individuals. Am J Hypertens 2005;18:785-91.

Fisher ND, Hollenberg NK. Flavanols for cardiovascular health: the science behind the sweetness. J Hypertens 2005;23:1453-59.

Keen CL, Holt RR, Oteiza PI, et al. Cocoa antioxidants and cardiovascular health. Am J Clin Nutr 2005;81(1 suppl):298S-303S.

Sies H, Schewe T, Heiss C, Kelm M. Cocoa polyphenols and inflammatory mediators. Am J Clin Nutr 2005;81(1 suppl):304S-12S.

Engler MB, Engler MM, Chen CY, et al. Flavonoid-rich dark chocolate improves endothelial function and increases plasma epicatechin concentrations in healthy adults. J Am Coll Nutr 2004;23:197-204.

Fraga CG. Cocoa, diabetes, and hypertension: should we eat more chocolate? Am J Clin Nutr 2005;81:541-2.

The health benefits associtaed with dietary intake of antioxidants are many. Everyone concerned with inflammatory polyarthritis specifically, should pay attention to which antioxidants are included in their diets.

As a part of the European Prospective Investigation of Cancer Incidence, Norfolk study, the diets of 88 people with inflammatory polyarthritis were compared with those of 176 healthy individuals of similar age and gender (as controls) to determine the effect of carotenoids in the diet on the incidence of inflammatory polyarthritis.

At the outset of the study, the participants recorded the type and amount of all foods and beverages consumed over a seven-day period. During the eight-year study, the participants were screened for inflammatory polyarthritis development. Analyses were performed to estimate the daily intake of the antioxidants beta-cryptoxanthin, zeaxanthin, lutein, lycopene, and beta-carotene. Carotenoid intake levels were divided into thirds for purposes of comparison.

Zeaxanthin intake was 20% lower and beta-cryptoxanthin intake was almost 40% lower among the participants who developed inflammatory polyarthritis than among the controls. Compared with the lowest third of beta-cryptoxanthin intake, participants in the highest third of intake were about 58% less likely to develop inflammatory polyarthritis. Zeaxanthin intake also appeared to decrease risk, but the association was not as strong as it was for beta-cryptoxanthin. There were no differences between the groups with respect to dietary intake of beta-carotene, lutein, or lycopene.

So, is it difficult to obtain this polyarthritis protecting anti-oxidant? No, not really. Drinking an 8 ounce glass of orange juice per day provides enough beta-cryptoxanthin to help reduce the risk of developing inflammatory polyarthritis.