The big fat truth

1 March 2010

JENNY CARRYER reports back from a recent conference on physical activity, health and obesity

Recently the School of Physical Education at Otago University hosted a conference entitled “The Big fat Truth’’: What are we weighting for? It’s time to move” (Feb 1-3, Dunedin). Six leading experts presented their research providing multi-disciplinary perspectives on the relationship between physical activity, health and obesity. The disciplines of epidemiology, exercise physiology, medicine, psychology and sociology combined to critically evaluate the relationship between obesity and health and to consider the almost heretical question of whether or not the obesity epidemic really exists.

First up was Professor Stephen Blair, the author of over 400 papers in the scientific literature reporting the essential role of exercise in supporting optimal health. As a speaker he was highly critical of many of the obesity myths, which remain unchallenged in the medical literature, and he had some interesting key messages.

These included:

  1. No grants should be awarded nor papers published on fitness or obesity, and a health outcome unless both body size AND the level of physical activity are accurately measured and taken into account in analyses.
  2. Physical inactivity and low fitness are highly prevalent in modern societies.
  3. Inactivity and low fitness are strong determinants of morbidity and mortality due to chronic disease.
  4. Comprehensive programmes to increase activity are crucial to the public’s health.
  5. There are health benefits of activity/fitness for all subgroups of the population, including people who are thin and overweight and obese individuals.
  6. We need to promote the consensus public health recommendation for physical activity for all, in clinical settings, public health programmes, and elsewhere.
  7. Although people think they know, no-one actually knows how much physical activity is required to manage body size but without doubt physical activity is the most significant predictor of good health outcomes.

For nurses, the take-home message here is that regardless of the BMI of any client, we should be considering ways to support all people to make physical activity a routine part of their lives.

Professor Nanette Mutrie (Scotland) made a case for walking as the most likely mode of activity to appeal to the most sedentary. She also noted the importance of actually reducing sitting time in a day as well as increasing activity time.

Another speaker, Associate Professor Michael Gard, is about to publish a book entitled ‘The end of the obesity epidemic.’ In his presentation he shared data from multiple countries showing that there are clear signs that obesity rates are leveling off around the world and most interestingly that this leveling, off began happening 10 years ago, just at the point that the idea of, an obesity epidemic was emerging. His key message was the significant mismatch between the actual data and the current rhetoric about the epidemic. Anyone who is interested to follow this in more depth might like to read Olds, T et al (2009) in the International Journal of Obesity. Michael Gard’s presentation presented a huge amount of international data and asked delegates to consider why so many people from so many scientific backgrounds (and especially medicine) have got so caught up in the seeming hysteria.

Paul Campos (law professor and long-time writer and thinker about the issue of obesity) asked why such moral panic has arisen around obesity. He proposed three reasons for this:

That the current panic advances economic interests such as those of the pharmaceutical industries.

  1. Our culture (especially for women) is fundamentally eating-disordered.
  2. We have structural concerns related to the over-consumption of some parts of the world in stark contrast to the starvation of many other parts of the world.
  3. In particular Professor Campos noted the very low levels of BMI currently treated with concern and he suggested that the epidemiological evidence alone suggests we raise our level of concern to a BMI of 35 or over.

Many of the conference themes could be considered supportive of Professor Rod Jackson’s proposed moratorium on the terms “overweight” and “obesity’’ (The Listener, Jan 23-29; 2010). My own view is that the associated negativity, blaming, endless media barrage and daily predictions of early death from well-meaning health experts have created a culture of hopelessness and obscured a number of important aspects. It is a myth that thinness is easily achievable by all with discipline and will-power but it is well founded that healthful nutrition and regular activity confer significant benefits regardless of size.

The Guidelines for Weight Management in New Zealand Adults released for consultation at the end of last year unfortunately ask health professionals to counsel anyone whose BMI falls outside the template of presumed normality towards beginning to eat healthily and take up exercise. This ignores the many thin people who eat badly and do not exercise and presumes that larger people need such advice. For the many (women in particular) whose adult lives have been a long and lonely battle with diets and rigorous exercise programs this will be totally unsupportive.

As nurses we could more constructively focus on how all people in New Zealand can have sufficient knowledge and resources to eat as healthily as possible and let’s also focus on making exercise available, safe and not undertaken with the sole and often futile goal of losing weight. And perhaps we will stop adding to the considerable misery of large people, some of whom may well eat unwisely and many of whom do not.

Jenny Carryer is executive director of the College of Nurses.