Monday, March 4, 2013

The Obesity Paradox

The published copy of this article can be found on Independent Australia -

The rapid rise of the Australian ‘obesity epidemic’ has been a well documented subject. From healthy eating campaigns to reality TV shows, extensive national discourse and concern continues to surround the ever-ignominious ‘O word’. 

Albeit, despite exhaustive government funding, Australia is losing the battle of the bulge. The prevalence of obesity in Australia has more than doubled in the past 20 years, and is currently listed as “the single biggest threat to public health in Australia.”

With the war on weight failing, an almost paradoxic corollary effect has reared it’s head. As rates of obesity rise, so too, have eating disorders.

According to the Deloitte Access Economic report on eating disorders, almost 1 million Australians are currently suffering from an eating disorder, resulting in an estimated 1,829 deaths last year alone. The annual carry on socio-economic costs of this are estimated at $69.7 billion. 

Yet despite their unequivocal impact, eating disorders remain somewhat of an enigma in Australia. Fragmented, under- funded, and under-researched, a glaring lack of parity underscores the national dialogue - or rather, lack of - surrounding these issues. 

In order to address the rising prevalence of such lifestyle related chronic diseases, the National Partnership Agreement on Preventative Health was formed, providing $932.7 million over nine years to “lay the foundations for healthy behaviours.” 

Of this funding, a mere $3 million has been pledged towards the National Eating Disorders Collaboration to provide resources directed at prevention, early intervention and treatment. 

In juxtaposition, over $700 million has been delegated to health initiatives aimed at “decreasing rates of obesity,” including healthy children, workers and communities schemes, and the Measure Up! campaign. 

The result is a health system that fails to provide effective treatment to ED patients, in comparison to other diseases resulting in similarly high mortality rates and burdens on sufferers and the health system.

Not only does the current system fall through on the provision of necessary health resources, but the burgeoning focus on shedding the kilos has seen an increase in unhealthy behaviours in those it seeks to target.

Lydia Jane Turner, a psychologist for Body Matters Australasia said that “recent studies have shown that not only are eating disorders on the rise, but that 1 in 5 'obese' Australians are now showing eating disorder symptoms.” 

People start off wanting to make 'healthy' changes, but find themselves resorting to increasingly rigid and drastic practices in order to lose or maintain weight loss,” she said.

With fourteen million Australians currently classed as 'overweight' or 'obese', concern about the ‘obesity epidemic’ has taken the form of public health campaigns. However, present, multi-million dollar prevention schemes have shown limited success at best

Ms Turner hailed such campaigns as a ‘band-aid’ solution to a much larger issue. 

 “There is no doubt that Australians are putting in the efforts to lose weight: population data shows a 200% increase in dieting over the past 50 years. Yet the solutions prescribed don't work,” she said.

“To date none [obesity campaigns] have been successful... The more we shame fat people into dieting, the more of an increase we expect to see in fat people with eating disorders.”

It is a subject ‘Fat Activist’ and former ED patient, Kath Read, knows all too well.

For 23 years, Kath engaged in a range of destructive behaviours, including ‘exercise mania’, purging and abusing prescribed amphetamines in order to lose weight.

Physically - my teeth are ruined, my metabolism is shot, I was constantly anaemic and no doubt deficient in other vitamins and minerals,” she said.

Most of the behaviours were tacitly encouraged or at least a blind eye turned to them by doctors, mental health professionals, family, friends, teachers, colleagues and anyone else in my life.”  

Despite presenting with evidently disordered symptoms, the stark lack of resources and understanding surrounding ED’s impeded the possibility of effective treatment.

It is still believed that fat people can not have most eating disorders simply because they are fat... I was 38 before I was finally diagnosed with an eating disorder.”

The Deloitte Access Economic report concluded that cases like Kath’s were a common occurrence, with participants reporting long struggles with EDs, which were often lengthened by initial misdiagnosis. 

A lack of general knowledge pertaining to eating disorders throughout the health profession was a common lament. In many cases, treatment was able to manage physical weight issues, but not the underlying mental causes. 

Psychiatrist Chia Huang, director of the Melbourne Clinic Eating Disorders Unit, has seen patients exhibiting similar behaviours first hand, and believes it is difficult to seek help. 

Most people who are overweight or obese don’t receive psychiatric treatment, and tend to present more so to programs such as Weight Watchers or Jenny Craig,” he said.

The interesting thing is, you can be overweight and have Anorexia Nervosa. They experience a lot of the starvation symptoms.”

While it is erroneous to suggest that eating disorders are experienced solely by those classified as ‘overweight’ or ‘obese’, or that government-funded health campaigns have no place in Australian society, it is high time we reevaluate our priorities and the potential repercussions of a health funding scheme rooted in disparity and stigma. 

Kath noted the importance of non-stigmatising public health campaigns in providing awareness about the larger mental and physical issues at hand; campaigns which, had they been available, could have prevented years of suffering. 

"[They] must be accessible to all, not just thin, white, able-bodied, affluent people.  Public health campaigns that acknowledge the factors of low income people, people of size, people of colour, people with disabilities, and so on," she said.

"Campaigns to ensure the availability of affordable, good quality, fresh food for all.  Campaigns to ensure that safe, enjoyable physical activity is available to everyone in whatever form is suitable for that individual."

In conjunction with effectual health schemes, providing treatment options is an imperative factor in ensuring the minimisation of harm.

Georgina Roberts, a psychologist at the Southern Health Wellness and Recovery Centre said while government-funded treatment programs offer high-quality, specialised ED treatment, they are far and few between.

There are private treatment options available, however individuals with Eating Disorders generally require long-term treatment. Many will stay engaged in treatment for years,” she said.

Unfortunately, most families are unable to fund private treatment for an extended period of time. This is why Government-funded Eating Disorder programs are so critical.”

With statistics showing 1 in 20 Australians diagnosed with Anorexia will die, and that an estimated 1 in 10 Australians will suffer from an eating disorder at some time in their lives, the presence of ED’s is incontrovertibly a pressing issue. 

An issue that, lest appropriately funded, will continue to claim the lives of Australians. 

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