Interesting article, and a good point.

I might point out, as Dr. Gunn hinted, that there are also a lot of myths about obesity. For one thing, the goals have definitely shifted downwards, making the problem look worse than it might be. The BMI scale is a notoriously misleading indicator; I work with a fitness instructor who flatly refuses to use it. I think the famous example is that, on the BMI scale, George Clooney is considered obese.

A case in point is the "Australia is the fattest nation on earth" survey. When this was first trumpeted in the media, my first reaction was immediate skepticism, and sure enough, it was soon shown that the survey was indeed questionable. Nevertheless, the idea had taken root, unquestioned, in the national conscience.

I myself am on the large side, but I don't live on crap, and I'm not entirely sedentary: I train in martial arts, and I bushwalk fairly regularly. That said, my main problem is definitely lifestyle - my work traps me in front of a computer 8 hours a day. I know that exercise helps: On an extended bushwalk, I can easily lose several kilos over a couple of days despite a solid diet of high-energy foods.

But I digress; to address the theme of the article, I think that Dr. Gunn is only mostly right. People (in rich nations) often do eat to make themselves feel better. That most of them eat crap is due to the successful marketing of crap as desirable. For myself, if I go more than a few days without a "fix" of fresh vegies or fruit, I start to feel horribly unwell.

Perhaps we need more Jamie Olivers in the media, marketing fresh food as feel good food?

My kids love watching Jamie Oliver, after all.

"To tackle obesity, let us first consider what causes it."

O.K. so where is the next paragraph. I might suggest that the good doctor is suffering from the main cause of obesity, sloth. We need his answer to the question.

David

Good work, Andrew. The message - eat less and exercise more - has been around for ages and tangled in a web of consumerism that's threatening to strangle it.

Women's magazines pay lip service to healthy eating while fawning over un-fat celebrities - to sell convenience foods, cosmetics, fashion, you name it. Remember the appalling treatment of a famous former Olympic swimmer when he was perceived to have put on a couple of kilograms? Young men are being sucked into the debacle too.

Sex sells and sexy isn't fat. So if you create an obesity epidemic that says most people aren't sexy, you have a platform on which to sell more crap. Enter the 'healthy food' spin, 'celebrity' chefs and the treatment of food as a consumer icon rather than a cultural activity around interpersonal interaction.

It's a sad treadmill.

Interest disclosure - www.collaborativecooking.com.au might help.

By the time a person is able to take care of herself the eating tradition is already well embedded and she is showing the results of twenty or more years of being raised on pre-cooked and fast-food trash.

The root of the problem is the lack of effective leadership and modelling in the home. This is not surprising where caring for a family and performing household tasks are held in low esteem, to be avoided wherever possible and 'outsourced' to Maccas or to the supermarkets for pre-packaged mush in plastic.

After all, the 'quality of life' of the parent/s is far more important than being with and taking care of the children they brought into the world.

So it is 7.00am to 7.00pm child care and a quick pop into Maccas on the way home for the kids. No, mum or dad doesn't need a burger, just coffee and a whimsical sweet treat from the coffee shop because she or he has already enjoyed the tapas and wine bar after work with workmates. Then there was that restaurant during the day (networking and mentoring). Gym is Wednesdays - no kids yay! It is the quality of contact with the child that counts more than the time spent with them (or taking care of their nutritional needs). That is right, isn't it folks?

Fortunately for weekends there is the children's program on TV or DVDs to amuse the children while they enjoy their TV snacks and Coke. What about some Guvvy funded child minding during the weekend so that mum or dad (single parent households are the go) can enjoy some bar and restaurant (a BYO will do) recreation after a hard working week?

It is the firstly the selfishness of parents and secondly the lack of household skills of parents that lead to child child obesity and then on to adult weight problems. There is no magic in it, just a consequence of the crappy 'family' traditions which are only to be expected given the selfish, self-centered 'me, me, me' individualism that is in vogue in the West.

The cause is lack of proper education in the early years of schooling, this is reinforced by psychological advertising controlled by vested interests. Take one example, milk. Dairies are promoted as being essential for our bodies and great for your health. Yet if you look at the results of studies world wide and the viewable evidence, you find dairies are the cause of most life style diseases. Everything you buy which has had some form of processing, contains diaries, salts and sugars, all fattening, all contribute to the onset of type 2 diabetes, heart disease, organ failures, colds, flu and many cancers.

This is where the cause lays, within the marketing and regulation industries. It can be fixed by altering our education system to teach what real nutrition is about and not that espoused by companies who control by donations etc, the political system which allows such false and dangerous promotions aimed at the gullible and weak of society. If your fat, it's because you eat the wrong foods and are lazy. You should eat to live, not live to eat. You wouldn't put petrol in your radiator or water in your engine sump, so why do it to the machine which gets you around the earth and allows you to live. To me it's just not logical or even rational, only stupid.

Obesity, like every other health or social problem boils down to one thing alone, attitude, and attitude alone.

There is so much information available out there, and by now well and truly common knowledge, and everyone knows about what is healthy and what is not, there is really no excuse.

Social inequities boil down to exactly the same cause, attitude!
So the gist of your argument that this IS a “cause” is irrelevant.

I have small children and I get truly infuriated at the fact that all and sundry of people come up to my kids and proffer chunk food into their mouths, a truly gross social misconduct if there ever was one.

Feeding my kids is something extremely private and sacrosanct, yet all and sundry of the blithely obtuse populace take the extreme impertinence of virtually forcing chunk food into the kids mouths.

And that’s where it all starts!

Once such a bad habit has gotten hold of a little mind, sweets become the most desired food, and the healthy food on the table remains untouched.

Granted, changing a such entrenched attitude might be a tad challenging for some, but it is just a matter of CHANGING ONE’S ATTITUDE!

So please don’t commiserate with your patients and tell them straight out that it is their POOR ATTITUDE that led them into their predicament in the first place, and prevents them now from freeing themselves of their perceived “addiction”.
The addiction here is only in the mind, so it is just their attitude that stands between their current chronic behaviour, and one more constructive to their health.
Straight talking might just lead to some self examination of their current state of mind, or actually attitude, and there is no catalyst more potent than the sudden realisation that has sprung out of one’s own contemplation.

continued

And let them know that proffering their preferred chunk food into children’s mouth is a gross violation of all socially acceptable standards, as it is equivalent to offering kids, alcohol, cigarettes or drugs.

And don’t think a change if social milieu will be of any use, the American multinationals have penetrated every nook and cranny of our planet with their nauseating marketing of chunk food, and where I’m staying at the moment, Thailand, there are just as many obese people and kids as in any developed country with such a problem, e.g. Australia and the US.

“Coke adds life” would have make any right thinking person spewing gall, considering the health damage this brew alone has caused all over the planet.

It is not only the American tobacco multinational companies which cogently can be accused of mass murder, but consider the following all in the same league: McDonalds, KFC, Coca Cola, Pepsi, Monsanto, Dow, and the list goes on, and the crime enormous.

You might argue that they are not breaking any laws, but the laws of common sense and decency…………

Are we really living in “enlightened” times, or is this the epoch of maximising profits at all costs?

While I'm sure a lot of people do it, I find the idea of eating junk food to make me feel better absurd. I can't think of a single time when I have eaten rubbish and felt better afterwards - even while I'm eating, it's hardly a pleasant experience. Yes, I enjoy the occasional McFeast or something like that, but everything in its place.

I think previous posters have hit the nail on the head when they identify education and conditioning as children as the cause of the problem. I work in a high school with an ostensibly healthy tuckshop. Great idea - promoting healthy eating - but the reality is that the food on offer isn't as healthy as you might expect. Toasted sandwiches wrapped in paper that has turned transparent as a result of the grease dripping out of them; 'healthy' meat pies; flavoured milk . . . the list goes on. Yeah, it's healthier than the old gristly meat pie and 600ml Coke with a dessert of donuts and lollies, but what message are we sending to kids? They leave school believing that what they have eaten is not only not bad for them, but actually good. We need to tell the truth about what we are feeding to people. We don't need to do it politely - we need to be able to openly condemn people who shove cheeseburgers down their kids' throats. We need to charge airline passengers whose body fat rolls over the armrests for two seats. We need to stigmatise obesity the same way we stigmatise alcohol abuse and smoking. It's all substance abuse, isn't it?

I know several people with obesity issues that never touch junk food, but have food available at home.

A relative of mine, has had gastic banding (a less invasive version of bariatric surgery) and it has changed her life.
The cost of this through the private health system after medicare refunds was $6000, and is available (with a long wait) through the public health system. So is affordable to most. But I agree that it should be better supported.

Obesity is due to several factors, availability of food, genetic disposition, etc. The wealthier the country the fatter they are, and there is an almost 100% correlation. The countries with the greatest social inequalities are generally the poorest, and so I fail to see the national correlation.

However, the poorest in rich society are generally the fattest, as fast food is cheap and readily available. Combine this with shorter working hours / free time, and you have recipe for obesity.

Thank God no one is suggesting a "War on obesity". I'm sure the holier than thou brigade would like another excuse to throw their weight around.
Interesting fact that obesity is worst in countries with large rich/poor gap. I'd really like to see an analysis on why this is true.

Just my 2 cents here:

Evolution has hardwired us to eat to survive. Those with the most voracious appetites were more likely to survive during the 'famine and feast' times of our hunter gatherer days. Some extra fat would help you survive until the next feast.

2. Modelling: A pig farmer once said that if you had a piglet that didn't eat, you would put it in a pen with a piglet that would eat. Now apply that modelling or "I want what they've got" to the contemporary western world of advertising, and cheapest junk food (relative to GDP) availability we've ever had.

3. Eating rituals. There is probably less emphasis on the notion of a sit down meal with family and friends at home without the TV on. The French are good at this, and it could be argued that this is the reason why the French have somewhat lower obesity rates than the rest of us, despite their emphasis on butter, their portion sizes are smaller.

4. The pacific islanders have the highest rates of overweight people in the world. Interestingly, the french colonies amongst this group have somewhat lower rates of obesity.

5. There are wide disparities within nations of obesity rates. Within the US, Missisipi residents have the highest rates of obesity, whilst those in Colorado have the lowest.

6. There is this big emphasis on avoiding "junk", but we also need to focus on 'portion control'.

7. Bill Clinton was recently interviewed about a program to tackle child obesity. He stated that if current rates continue, that life expectancies will fall for the first time

8. We're lazy and expect modern medicine to be able to manage the consequences of obesity, such as hypertension, diabetes. In the 1940s, if you were obese and diabetic and hypertensive, you were probably going to be dead before 50.

9. There was a lot more "incidental physical activity" prior to the 1950s, especially "incidental" walking rates of at least 10km per day.

Just my 2 cents.

Plenty more reading at:

http://en.wikipedia.org/wiki/Social_determinants_of_obesity

http://en.wikipedia.org/wiki/Obesity

http://en.wikipedia.org/wiki/Epidemiology_of_obesity

http://www.scribd.com/doc/2415430/Countries-with-the-highest-obesity-rates

http://www.webmd.com/diet/news/20080717/7-slimming-tips-from-the-skinniest-state