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Speaker: Talking past each other: Ideological silos and research

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  • Russell Brown, in reply to Deborah,

    Please, stop using the word “obesity”.

    The word is used in Rebecca’s original post and in both of the contrasting works she describes, and it’s universally used in public health. Using it in terms of a value judgement is clearly wrong and harmful. Is there an alternative word to use?

    I’m in favour of a bit of regulation here, rather than the more diffuse mechanism of taxes and price signals. And a bit of regulation / public provision of walkable suburbs, playing spaces, reasonable employment with a livable wage, all the things that make it possible for people to be fit and healthy, rather than worrying about policing their size.

    I think, in line with the original post, the discussion has revolved around policing food and drink manufacturers rather than people, but staying with that post’s overall theme, perhaps we should establish what our common ground is. It seems that the effectiveness of a sugar tax isn’t established and there is the obvious risk of further penalising people who already face disadvantage, so yes, perhaps regulation is the better option.

    Although it wouldn’t be easy: perhaps a more serious attempt to signal nutritional information is one more immediate path. Even Nutrigrain’s rinky-dink “health rating” provided some motivation for Kellogg to improve its product. I’d endorse everything else you propose, although I don’t think seeking long-term social equity precludes focusing on the content of staple food and drink. Can we agree on that?

    This isn’t simply academic for me. My mother has Type 2 diabetes and it would appear I’m predisposed to it. I’ve looked enough it its impact to not wish its effects on anyone.

    Auckland • Since Nov 2006 • 22743 posts Report Reply

  • steven crawford, in reply to Sacha,

    If a substance is harmful, why not ban it rather than taxing it? Sugary drinks have zero nutritional benefit and many proven harms.

    Would short term energy rate as nutrients like a shot of morphine offers temporary emotional resilience – as a glass of wine helps people to be socially fluid?

    Atlantis • Since Nov 2006 • 4163 posts Report Reply

  • Jackie Clark,

    Why are we worried about policing food?
    Is it because we are genuinely worried about "the children"?
    Is it because we just don't like fat people?
    Or is it because we all want to be healthy and live long lives? A matter which is greatly influenced less, in reality, by what you eat and more by genetics and in some cases, environmental factors - accidents, smoking, murder etc
    Because at the moment, there is a conflation.
    I would posit, if you're worried about "the children" that their families pose more of a risk to them.

    See this article

    If it's because you just don't like fat people, well, never mind. There, there.

    However, if you want to extend life and live a healthy one, that one is something we can talk about. At length. As long as you don't proselytise, or judge other people, and as long as you accept that for the common good of all of us, reducing sugar in our diets is a biggie but not bigger than the violence in our homes, or the poverty in our communities, or the social inequities that exist all around us.

    These conversations become entirely moot unless we start to talk about the other things I have just mentioned.
    If you're well off and middle class, you police your own intake of food, not other people's.
    You don't get to do that.

    Mt Eden, Auckland • Since Nov 2006 • 3136 posts Report Reply

  • Deborah, in reply to Russell Brown,

    Please, stop using the word “obesity”.

    I have an on-going, low level campaign in my party to stop using this word. I didn't mean to direct that remark at just the people writing and commenting here.

    It's a finger wagger word, and people feel targetted by it. It has the rhetorical structure of, "Oh, we don't me you, dear. It's your fat we don't like." As if a person can somehow be separated from their body.

    I'm hopeful that if we stop talking about the war on obesity, and start talking about the war on fat people (I'm feeling a little ill just typing those words), then we cut down on the horrible language stigmatising fat people and telling them that they're the ones at fault, and start focusing on health and healthy ways of living, and healthy ways of designing our communities and patterns of work and the like.

    Regarding diabetes, and weight, skinny people get diabetes too, and there's on-going research into the obesity paradox. I don't know enough to do anything more than google "obesity paradox and take a look at what seem to be the more reliable sources there.

    Point is: this stuff around fatness and fat people and health is incredibly complex, and any public policy solutions may need to be similarly complex. And in the meantime, it would be good to stop stigmatising fat people.

    New Lynn • Since Nov 2006 • 1445 posts Report Reply

  • steven crawford, in reply to Jackie Clark,

    Why are we worried about policing food?

    I'm no more interested in policing food as recreational drugs. My interest is regulating the ways people market these things.

    Atlantis • Since Nov 2006 • 4163 posts Report Reply

  • giovanni tiso, in reply to Russell Brown,

    Although it wouldn’t be easy

    That's just about my biggest problem with the sugar tax. That it's so easy. There's nothing so easy as taxing consumption, especially the consumption of things that poor people consume. A British journalist even went as far as touting the regressiveness of the tax as one of its chief virtues, given that type 2 diabetes is also regressive (in that it disproportionately affects poor people). In the same article, he noted without a hint of irony that other things could be tried as well and maybe further cutting benefits wouldn't help.

    But that's precisely the political environment in which the sugar tax thrives, one in which tut-tutting paternalism is the only viable response - in the name of the fact that we have to do something - to an epidemic caused by corporate greed. The sugar tax was introduced in the UK at the same time as sweeping benefit cuts which, given what we know about incomes and nutrition, are guaranteed to lead to poorer diets and more health problems. And this is why we can't look at the measure in isolation. It's not just the sugar tax. It's the sugar tax and the far more obvious and workable things we won't do to alleviate poverty and improve health outcomes in a vast and growing sector of the population. Such as (in New Zealand) extending the in work tax credit to beneficiaries. Or, yes, regulating the industry: there is no reason why saying you can't put more than X amount of sugar in a bottle of flavoured water should be controversial or difficult, if we have the evidence to back that up. Do we really think people are going to buy corn syrup on the black market and spike their drinks with it?

    A sugar tax could achieve some of its stated aims, I'm really not in a position to say otherwise. But it will almost certainly achieve another aim which I personally consider more harmful: reinforce the idea that poor health is a result of bad habits and choice. Which in turn leads down the road of refusing care to people who - in spite of us helping them by making bad drinks more expensive - insist on making those choices.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Bart Janssen, in reply to giovanni tiso,

    fat hate

    WTF. Seriously what fate hate? Nobody was deriding people for being obese. For some reason (and I know offense is always in the eye of the beholder) someone felt offended by others saying obesity is a major health problem that will harm the lives of those suffering the disease (and yeah I know those are hard words).

    But frankly some of the comments about being obese are akin to "my father smoked till he was 87".

    Obesity is a huge health problem. That is NOT saying obese people are somehow less than human but it is saying that sitting on your hands for fear of causing offense is just not acceptable either.

    Auckland • Since Nov 2006 • 4449 posts Report Reply

  • Bart Janssen, in reply to Jackie Clark,

    Or is it because we all want to be healthy and live long lives? A matter which is greatly influenced less, in reality, by what you eat and more by genetics

    All the data says there is a genetic component to tendency towards increased fat production and storage. Simply put some people gain fat faster than others.

    But the data also show that increasing calorie availability, especially in the form of easily digested and absorbed calories is the major environmental factor in the increase average weight in societies.

    I appreciate your experiences but the data collected in New Zealand and worldwide contradict your conclusions.

    Auckland • Since Nov 2006 • 4449 posts Report Reply

  • giovanni tiso, in reply to Bart Janssen,

    Obesity is a huge health problem.

    It is?

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Bart Janssen, in reply to giovanni tiso,

    It is?

    Troll

    Auckland • Since Nov 2006 • 4449 posts Report Reply

  • giovanni tiso,

    Obesity is not a health problem. You can argue it can lead to health problems - and it's far from uncontroversial - but not that it's a health problem in itself. Nobody has ever died of obese.

    And guess what: calling it a health problem is precisely the kind of language myself and a few others are saying we really ought to avoid, lest we tell people their bodies are wrong. Which has lots of consequences of its own.

    So, you know: troll yourself.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Bart Janssen, in reply to giovanni tiso,

    Nobody has ever died of obese.

    Nobody ever died of smoking.

    Auckland • Since Nov 2006 • 4449 posts Report Reply

  • Carol Stewart, in reply to giovanni tiso,

    That’s just about my biggest problem with the sugar tax.

    It doesn't give you pause for thought that a large number of public health researchers think otherwise?

    Wellington • Since Jul 2008 • 821 posts Report Reply

  • giovanni tiso, in reply to Bart Janssen,

    Nobody ever died of smoking.

    You are descending into actual idiocy.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Russell Brown, in reply to giovanni tiso,

    Obesity is a huge health problem.

    It is?

    Two years ago the New Zealand Medical Association described New Zealand’s rapidly increasing obesity rate as “a public health crisis".

    The World Health Organisation describes childhood obesity as “one of the most serious public health challenges of the 21st century.”

    So yes, there would seem to be something to worry about.

    Auckland • Since Nov 2006 • 22743 posts Report Reply

  • giovanni tiso, in reply to Carol Stewart,

    It doesn't give you pause for thought that a large number of public health researchers think otherwise?

    Of course it gives me pause. They have their arguments, I have mine. There are very solid reasons, as Russell noted above, why we don't let medical researchers write social policy, although they should certainly help inform it. And frankly I would have far less of a problem with the sugar tax if we were also doing all the other things that researchers and public health advocates have been suggesting for years, chief of which is giving poor people more money.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Bart Janssen, in reply to giovanni tiso,

    You are descending into actual idiocy.

    You decided to enter a discussion of trying to figure out how to change a problem that exists in our society with distracting nonsense. You made what was a complex discussion about possible solutions into a discussion about name calling. Not terribly worthwhile.

    Like it or not every public health professional describes obesity as a health problem in the same way as describing smoking as a health problem and they're right.

    It is a nonsense and derailing to pretend we are hating on fat people because we are trying to figure out a decent way to reduce the exposure to high sugar foods.

    Auckland • Since Nov 2006 • 4449 posts Report Reply

  • giovanni tiso, in reply to Russell Brown,

    So yes, there would seem to be something to worry about.

    It's still not a condition, which is what saying it's a health problem means. Words being words and such. Didn't we agree as late as one page ago that this kind of distinction is sort of important? It either is or it isn't.

    Do I think the rise in the rates of such lifestyle and nutrition-linked diseases as type 2 diabetes is a problem? Yes, I totally do. Should we do something about it? Absolutely. With all due haste. I just disagree on the thing we are doing and the social messages it sends.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • giovanni tiso, in reply to Bart Janssen,

    You made what was a complex discussion about possible solutions into a discussion about name calling. Not terribly worthwhile.

    I get that you don't care about those implications, that is coming through pretty clearly believe me. Some of us do.

    Wellington • Since Jun 2007 • 7473 posts Report Reply

  • Rebecca Gray,

    Kia ora tatou,
    Thanks for your comments - I hadn't decided til now whether to weigh in.

    I think a lot of the discussion here is from people who are way more "on the same side" than the two groups I described in my post, AND YET it's still really hard to agree about the most appropriate response to the issues raised. I've seen some people disagreeing and thought they both made perfectly valid points, which probably illustrates how complex, and also how emotive, some of these issues are.

    Perhaps we can agree that:

    * the amount of sugar in our diet currently causes nasty, somewhat preventable health issues on a population level.

    * genetic predisposition + environment + other social factors such as poverty mean some people are more at risk of these problems. The first factor here is not modifiable but the other two are. Both the environment AND poverty need to be addressed. Doing one does not exclude doing the other. It's the extent to which they should be addressed which people can't agree on. Prioritisation issue, I guess, which we will get with any policy-related discussion.

    * shaming people for being overweight is awful, not just missing the point but actually creating more harm. I totally agree that a health framing rather than a weight framing is more helpful, but we can surely still acknowledge that there's a link. From what I can tell, obesity (sorry, I am using a clinical term and I recognise it may not transfer well in all contexts) is to diabetes what smoking is to lung cancer: no, not all smokers get lung cancer and some non-smokers get it too, but smoking is the one most clearly proven modifiable risk factor. Being defined as clinically obese does not mean being unhealthy, it's just a risk factor for some health problems. Some of the issues that lead to diabetes etc also contribute to weight gain. So it's somewhat understandable (if unfortunate) that these get lumped in together when discussing policy measures. It is a real challenge, from what I can tell, for any sort of health promotion targeting diet to avoid implicitly saying "we think you're living your life wrong if you are overweight". It is really important not to make individual people and their bodies the target here.

    * the processed food industry is unlikely to make changes of their own accord, if the status quo is working for them. So as Russell noted, regulatory changes may be needed before the industry starts modifying products.

    * a lot of the anti-intervention arguments about freedom and choice etc echo the ones the tobacco industry and its like have used. These arguments are ideology-based and it seems reasonable to be wary of them. What does freedom even mean?
    Freedom to choose soft drink whenever?
    Freedom for kids to not grow up around implicit messages that these products are everyday items?
    Freedom to not have your body shamed?
    Freedom to make sustainable changes to your lifestyle to be healthier?

    Wellington • Since May 2016 • 23 posts Report Reply

  • Russell Brown, in reply to Rebecca Gray,

    Kia ora tatou,
    Thanks for your comments – I hadn’t decided til now whether to weigh in.

    Kia ora Rebecca. Thanks for joining it – I can imagine it has looked a little daunting at times!

    Auckland • Since Nov 2006 • 22743 posts Report Reply

  • David Hood,

    People do die of diabetes, but the effects of it as a chronic condition are also pretty hard on the living too.

    To summarise a bit of the Ministry of Health research I linked to earlier. Back in 1996, when people were first really modelling the likely growth, the 1996 figures were 81491 cases of Diabetes.

    The "worst case" of the models published in 1996 was that in 2011 there would be around 145000 cases. I don't have the actual 2011 figures, but there were 257776 cases in 2014, which is about 3 times as bad as the worst case estimate.

    In one sentence: Since 1996 the population has gone up by 1.2 times, diabetes has gone up by 3 times.

    Dunedin • Since May 2007 • 1443 posts Report Reply

  • linger, in reply to Rebecca Gray,

    Very helpful summary, Rebecca.

    (Ironic that "obesity = name-calling" is a reductionist position.)

    Tokyo • Since Apr 2007 • 1885 posts Report Reply

  • Rebecca Gray, in reply to Rebecca Gray,

    Oh I should just note before anyone points it out to me - the comparison with weight and diabetes/ smoking and lung cancer is obviously not a perfect fit. Smoking is a modifiable risk factor (you can stop smoking though it is often difficult). In some cases weight is not so modifiable, as those links posted earlier about The Biggest Loser etc indicate. So saying "just lose weight" to someone whose body is determinedly remaining large is probably not helpful. Dealing with any health risks posed by the weight, so the person can be as healthy as possible regardless, may be the better way to go. Robyn Toomath actually states this in her book.

    Wellington • Since May 2016 • 23 posts Report Reply

  • Rosemary McDonald, in reply to Rebecca Gray,

    Freedom for kids to not grow up around implicit messages that these products are everyday items?
    Freedom to not have your body shamed?
    Freedom to make sustainable changes to your lifestyle to be healthier?

    I conducted an unscientific survey last night. Asked Female Offspring in early twenties..."Do you feel guilty when you eat junk food?" FO launched into a rant (can't think where she gets that from) and said how she was never going to be skinny, she was comfortable with the way she looks and anyone who doesn't like can just go....well you get the picture. Mum very happy that beautiful daughter is comfortable in her skin.

    BUT...you didn't answer my question...."Do you feel guilty when you eat junk food?"

    "Hell yes...(Mum happy that early conditioning effective), and if a packet of sandwiches at the lunchbar was not twice the price of a sausage roll and a can of fizzy I'd buy the sammies..."

    So there...it comes down to education and cost.

    Waikato, or on the road • Since Apr 2014 • 1337 posts Report Reply

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