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Dr Aseem Malhotra Headshot

To Combat Obesity We Must Alter Our Environment

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Today's study published in the Lancet claims that if populations as a whole exercised more we could potentially save millions of lives worldwide. I would certainly advocate the multitude of health benefits of regular physical activity such as reducing the risk of heart disease, reducing blood pressure, improving muscle tone etc. One thing I don't believe physical activity alone has much effect on is obesity. Although these findings don't specifically measure yearly trends in exercise levels the message seems slightly at odds with other studies that suggest that our physical activity levels have actually increased slightly in the past 30 years as obesity has rocketed. However the research certainly raises questions of our lifestyles as a whole.

Last week I returned from a two week holiday to San Francisco where I was horrified to witness the striking level obesity which was made most apparent to me at a baseball game.

As a Cardiologist who treats the impact of diet related illness on a daily basis, it appeared bizarre to observe the paradox of thousands of overweight people appreciating and cheering on a group of elite athletes playing one of America's most loved sports, while gorging on junk food.

There is nothing wrong with eating the occasional treat but clearly highly processed foods loaded with excess sugar and carbohydrates, the most important culprits of weight gain, have insinuated themselves within our daily diets. Robert Lustig, the paediatric endocrinologist, at the University of San Francisco, whom I met on my visit, suggested in his recent paper published in Nature that sugar fulfills four criteria that justify its regulation like alcohol. It is toxic, addictive, has potential for abuse and has a negative impact on society. In addition to the economic costs with $150 billion dollars spent by US health careon morbidities associated with the metabolic syndrome (consisting of type 2 diabetes, hypertension and fatty liver disease), the chairman of the US joint Chiefs of Staff has declared obesity a "threat to national security" as a quarter of applicants for are being rejected for obesity related reasons.

Last September the United Nations declared that for the first time in human history diet related diseases such as heart disease, cancer and diabetes pose the greatest threat to our
health worldwide contributing to 35 million deaths per year. With The USA topping the world league of obesity and Britain not far behind health experts from both sides of the Atlantic are asking serious questions to determine how did we allow the situation to get this bad and what is likely to be the most effective strategy to combat it?

It boils down to one simple word that has the most profound impact on all of us: environment.

I don't believe anyone chooses to be fat. Most individuals value their health and appearance yet continue to behave in ways which undermine it.

As Theresa Marteau, director of Behaviour and Health research unit at the University of Cambridge points out "we are heavily influenced by automatic behaviours which require little cognition where the desire for instant-gratification far outweighs greater less assured and more distant rewards to make us more likely to act in unhealthy ways." Despite wishing to lose weight for example we still buy the beautifully packaged chocolate bar at the check out till. The food industry, well aware of the influence of environment on behaviour, have taken advantage by not only mastering the promotion of cheap junk food, but have spent billions specifically targeting the most vulnerable members of society; our children.

Consequently there are now well over 20 million children who are overweight by the age of 5, and we are now seeing cases of 7 year olds being diagnosed with type 2 diabetes.

When I asked my six year old nephew why he likes to go to McDonalds he very astutely replied "It's because of the toys. Kids like toys and that's what attracts them!"

Last week I questioned why the likes of McDonalds and Coca Cola, as main sponsors of the Olympics, were allowed to make use of the most effective international marketing platform in the world reaching out to billions of people across over 200 countries in a special report for BBC's Newsnight.

1980 Moscow Olympic gold medalist Duncan Goodhew told me that he would not eat sugary or
processed foods while training because it would impair his performance and make him gain weight.

In the studio debate that ensued a former marketing director of the International Olympic Committee spoke came across as the worst apologist for the food and drink industry. He referenced McDonalds now having salads on their menu and that people just need to be more active. Adding salads to go alongside a burger as well as the association with sport creates a "Halo"effect, making us perceive such "food like substances" as healthier than they actually are.

Also with the oversupply of cheap processed food almost everywhere we go our choice is now limited. We should learn from history and realise the most effective intervention to alter the statistics on obesity needs to be government regulation to curtail the availability these unhealthy products. Legislation restricting the advertising of tobacco and the banning of smoking in public places were extremely effective but took place decades after the link between tobacco and lung cancer was made. The same tactics adopted by Big Tobacco to stall government action are now being taken up by an extremely powerful food and drink lobby who, according to a special report by Reuters, spent $175 million lobbying against tougher food standards since President Obama took office in 2009.

It's clearly having the desired effect with many claiming that Washington has now gone "soft" on tackling child obesity and Michelle Obama herself turning her emphasis to physical activity.

In Britain the health secretary Andrew Lansley has cosied up to the food industry by agreeing to include them in discussions over food policy, a tactic that leading public health expert Professor Simon Capewell describes as akin to allowing " Dracula to take over the blood bank".

Getting many food companies to sign up to a "voluntary agreement" deal to cut the nations calories by five billion by 2015 in reality translates to each of us cutting down on the equivalent of sixteen peanuts a day from our diets, which is clearly an ineffective strategy in tackling obesity. It certainly appears that so far political ideology that favours the corporations is trumping scientific evidence. We cannot stand back and allow a government policy that favours the protection of the huge profits of a minority at the cost of the health of the health of the population. We could have saved millions of lives with earlier intervention with Big Tobacco.

For the sake of our children we must not allow the same to happen with Big Food.

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