KEY POINTS:
Here's something I hope the parliamentary health select committee inquiring into obesity will clear up for me: How can you tell if you're obese?
No, really, I'm serious. I ask because, recently, it was pointed out to me by someone I'm seriously considering divorcing that I might have one of the symptoms of this epidemic, namely fatness.
I prefer to call it "a little extra winter weight", and, no, I don't think I'm in denial, though I understand this to be another of the symptoms of those in the grip of the Obesity Epidemic. (I've lost count of the number of times I've seen fat people declare that they eat hardly anything at all. Not to mention the number who insist their lifelong affair with meat-pies hasn't made any difference to their corpulent figures. On TV3's Downsize Me, the professional downsizers simply spread out their subject's food intake for the week and let the mountains of pizza, potato chips, chocolate biscuits and fizzy drinks do the talking.)
But obese? Me? Had all those mirrors been lying? (Never mind, don't answer that.) Yes, yes, I know about the Body Mass Index (BMI), which defines obesity as having a BMI of 30 or more (32 for Maori and Pacific Islanders, on account of our having proportionately less fat). The BMI is weight in kilograms divided by height in metres squared. But frankly, any definition that requires a calculator has its work cut out.
BMIs were being bandied about with reckless abandon recently, when the Madrid City Council took a stand against unhealthy skinniness by banning models with a BMI of less than 18 from its September fashion week, after an emaciated Uruguayan model died of a heart attack moments after stepping off a catwalk. Organisers of the Milan Fashion Week followed suit by insisting that models look "healthy" rather than starved and sickly. Kate Moss, by the way, is reported to have a BMI of 15.
What does a BMI of 30 (i.e. obese) look like? I've no idea - and neither did most of those tested recently by the Counties Manukau District Health Board. Apparently, most people's definition of obesity differs wildly from the clinicians' definition. In fact, many of those who'd be considered clinically obese don't regard their weight as at all problematic. Sure, they could stand to lose a stone or two, but "very or abnormally fat"? Nah, mate.
Which is an attitude I'm totally in tune with, although I can see why this would be a problem for a health board serious about tackling the frightening growth of diabetes on its turf. Obesity is a high risk factor in preventable Type 2 diabetes, which afflicts some 12,000 in South Auckland. The DHB estimates another 12,000 cases have yet to be diagnosed, and expects that to double by 2025. But there's just no point going on about an obesity epidemic when most people think it has nothing to do with them.
A friend of mine who is battling to reduce her daughter's burgeoning size has found it helps to define the problem more precisely, and honestly. Euphemisms about "putting on weight" and being "big-boned" masked the problem and undermined her efforts to downsize her pre-teen daughter, who resented being deprived of favourite foods just to lose "weight". Being "fat", though, and the reality of associated health problems - that was something else altogether.
But who can blame the pussy-footers? Most of us have been conditioned not to talk about weight and girls in the same breath, lest we turn our daughters into anorexics. Now, thanks to the so-called obesity epidemic, we have permission to be insensitive.
According to the Eating Difficulties Education Network, which made submissions to the health select committee conducting the inquiry into obesity and Type 2 diabetes, the anti-obesity message has just aided and abetted those with eating disorders. The group says the "obesity epidemic" had made "obesity phobia" and "fat prejudice" a problem in schools, with children being bullied for being overweight. And I think they're probably right. Has our worship of thinness gone too far?
You'd have to say yes, given the plan by some American designers to bring out a new woman's clothing size that I haven't seen since my babies were newborns: size 00 - as if size 0, the equivalent to a NZ 4, isn't emaciated enough.
But of course that isn't the problem the Counties Manukau DHB and public health professionals around the country worry about. It's obesity, as they define it, and its very costly consequences. What, though, is a reasonable response by government and health agencies?
Those who see obesity as a problem driven solely by individual choices are naturally allergic to any kind of government intervention. But those who work in the field see the environment as critical in shaping the way people behave.
The answer, I suspect, is a mix of regulation and education. Going through children's lunchboxes, as some schools have been doing, and banning parents from driving their kids to school is going too far.
But banning harmful trans fats from our foods, as in the US, introducing a more simplified "traffic light" food labelling system here (for people like me who simply can't see the small print in food labels), and banning fizzy drinks and other junk foods from school cafeterias (though government would need to find ways to help poor schools replace the money lost from soft drink sales), seems eminently sensible.
People who grow up in healthy environments take it for granted. But in places like South Auckland, creating healthy environments takes work. This can mean persuading McDonalds and Coca Cola to offer low sugar alternatives as the default drink in McDonald's Manukau stores, a trial that cut sugar consumption by 17 per cent without anyone ever noticing.
It also means providing more parks, ensuring footpaths are wider and more user-friendly, that dogs are kept under control, that footpaths and parks are better lit so they feel safer, and that verges are kept clear of prickles so that more people are encouraged to walk and run round their neighbourhoods.
Forget obesity, it's meaningless to most of us. It's about healthy people and places.
