Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Agree
- Andrew Montgomery (11 May 2007)
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Re: Agree
- M Justin S Zaman (14 May 2007)
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Re: Re: Agree
- Andrew Montgomery (17 May 2007)
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Andrew Montgomery, locum Auckland
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Dr Zaman is absolutely on the button. I have been attempting get the message through to our health administrators with regard to sugar. Currently the human race is abused by the food industry. Child abuse by the fast food ,confectionery, and other sweet food purveyors is out of control. Children weighing ten times their weight in kilograms are routinely seen in the practices where I work. Our duplicitous government is more concerned about the effect of smacking children than the effect of obesity - and indeed passive smoking in children. There has been legislation passed in NZ addressing smacking and passive smoking in adults. It is not illegal to smoke in an enclosed room with your child. Obesity in children is a crime of ommission in the absence of government regulation and commission (or ignorance) by the parents of the children. There is, of course, a snowballing genetic/in utero contribution as well. I have made these points to the Commissioner for children and to the minister of health - but they appear unconcerned and seem to believe that the food that children consume is no concern of the State. Despite repeated requests for information as to how the obesity epidemic is to be funded and as to who should assume responsibility for the abuse of children by food I have received no coherent responses. An aggressive legislative response is required. Competing interests: None declared |
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M Justin S Zaman, Clinical research fellow in epidemiology/Specialist registrar in cardiology University College London
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Dr Montgomery Thanks for your comments. A nutrition transition has occurred amongst populations in high- income nations in which not only is energy intake per person higher but also a higher proportion of that energy is derived from added sugars and fat, a relationship first shown in 1962. (1) To create an environment in which individual behavioural initiatives can succeed, major shifts in population behaviour through public health policy are necessary. Population-level health promotion through government or non-governmental organisations such as disease-specific charities aim to increase awareness of good health and improve access to it. The North Karelia project in Finland began in 1972 at a time when the country had one of the highest rates of cardiovascular disease in the world. The project targeted principally dietary behaviour to reduce cholesterol levels and led to a decrease in cardiovascular incidence in the region. (2) The project influenced dietary behaviour throughout the country with time, and also led to changes in the food industry with increased production of healthier cooking oils and salt reduction in food products. Taking advantage of local factors has implications for global strategic planning of population prevention. South Korea’s government have encouraged continuing adherence to the relatively healthy traditional Korean diet that, despite a large intake in the consumption of animal products over the last 30 years, has contributed to limiting fat intake and slowed the rise in obesity. (3) The lesson is similar to that learnt in Japan and implies that economic development can occur without adoption of atherogenic developed world behavioural patterns. It has been argued that the US environment that causes obesity is now being exported around the world and producing obesity everywhere it has been tried. (4) In the United States alone the food industry spends over $30bn (£16.5bn, 25bn) on marketing, more than any other industry and with food advertising having tripled in South East Asia, (5) the transition towards a high fat diet that took more than five decades in Japan has occurred in less than two in China. (6) The World Trade Organisation (WTO) applies rules of trade between countries in order to facilitate increased global trade and hence market penetration and global advertising in developing countries. Increased liberalisation of trade has spurned the growth of the transnational food industry resulting in three out of every ten pesos that Mexicans spend on food being spent in Wal-Mart whilst higher profit margins are being experienced in developing country settings. (7) The WTO stipulates that imported goods, services, and intellectual property be allowed the same competitive advantages as domestic versions in the markets of importing countries despite the overwhelming superior marketing budgets of developed world multinational organisations. Meanwhile, fast food companies simultaneously sponsor preventive health programs for adolescents (8) and aggressively market to the same age range in developing countries. (5;9) The obesity epidemic is comparable to the tobacco epidemic. (6) Evidence that increased tobacco consumption results from trade liberalisation (10) and global marketing (11) are potentially applicable to the obesity epidemic. The Framework Convention on Tobacco Control is a potential template for a global public health policy on obesity. Potential international standards might restrict marketing for unhealthy food products and the advertising and availability of unhealthy products in schools, standardise food packaging and labelling or introduce or tax measures to reduce the demand for unhealthy products. (12) Thus health behaviours are not “lifestyle” variables, governed largely by individual choice and therefore a matter of individual responsibility, but are socially patterned and reinforced in groups. http://www.hsph.harvard.edu/review/review_2000/specialfoph.html Reference List (1) Drewnowski A. Fat and Sugar: An Economic Analysis. J Nutr 2003; 133(3):838S-8840. (2) Puska P. Nutrition and mortality: the Finnish experience. Acta Cardiol 2000; 55(4):213-220. (3) Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr 2000; 71(1):44-53. (4) Hill JO, Wyatt HR, Melanson EL. Genetic and environmental contributions to obesity. Med Clin North Am 2000; 84(2):333-346. (5) Lang T. Trade, public health and food. In: McKee M GPSR, editor. International co-operation in health. Oxford: Oxford University Press, 2001: 81-108. (6) Chopra M, Darnton-Hill I. Tobacco and obesity epidemics: not so different after all? BMJ 2004; 328(7455):1558-1560. (7) Reardon T, Berdegue JA. The Rapid Rise of Supermarkets in Latin America: Challenges and Opportunities for Development. Development Policy Review 2002; 20(4):371-388. (8) http://www.scripps.edu/news/press/091306 . 2006. Ref Type: Electronic Citation (9) Jacobsen MF. Liquid candy: how soft drinks are harming Americans' health. Washington, DC: Center for Science in the Public Interest, 2000. (10) Bettcher D SCGE. Confronting the tobacco epidemic in an era of trade liberalization. Commission on Macroeconomics and Health, editor. WG4:8. 2001. Geneva, World Health Organization. Ref Type: Report (11) Collin J. Think global, smoke local: transnational tobacco companies and cognitive globalisation. In: Kelley L, editor. Health impacts of globalisation: towards global governance. New York: Palgrave, Macmillan, 2006: 61-86. (12) Taylor AL. An international regulatory strategy for global tobacco control. Yale J Int Law 21, 257-327. 1996. Ref Type: Journal (Full) Competing interests: None declared |
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Andrew Montgomery, locum Auckland
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All doctors and politicians should read and comprehend Dr Zaman's concise summary. I have battled for 5 years to convey this message to New Zealand politicians, media and patients. I have failed as have other doctors in New Zealand who share our concerns. I despair for the future of health in New Zealand. Competing interests: None declared |
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