Wednesday, 3 July 2013

Obesity. It seems Philip Larkin was right...


I hope this is true - it may be a false dawn - but there is evidence of some more sensible thinking around public health, thinking that is moving away from the kneejerk New Puritan and prohibitionist rhetoric. Rather than talk of all-population solutions, we get work looking at targeting. It seems that the lessons of AIDS and HIV - blanket advertising doesn't work nearly as well as a focus on the high risk groups - is beginning to creep into thinking around other public health topics.

Here, for example, is Nick Pearce, Director of left-wing think tank IPPR talking about Early Bird a study looking at the precursors of diabetes in children:

All children gain weight during growth, but EarlyBird is interested in the excess gained. It finds that over 90% of the excess weight in girls, and over 70% in boys, is gained before the child ever gets to school age. These findings support a need to re-direct public health initiatives towards an earlier period in childhood.

And the report goes on to show that:

Daughters of obese mothers are 10 times more likely to be obese than the daughters of normal weight mothers, and the sons of obese fathers six times

So rather than use nannying, all-population bans, taxes and controls, we should begin to target the main at risk group - the children of the obese. And there's more - it seems that exercise isn't the answer either:

Using time-lagged correlation to imply direction of causality, weight gain appears to precede inactivity, rather than inactivity to weight gain.

People don't exercise because they're fat, they're not fat because they don't exercise.

Pearce's piece still talks about 'obesogenic' environments (despite the evidence from the study he cites where the critical environment is the home environment prior to school) and suggests population-wide interventions, so we're not out of the woods yet. But the findings throw up some different - perhaps more effective than the environmental interventions preferred at the moment - possibilities. These could include:

  • Better pre- and post-natal information and support especially for obese mothers. We have existing engagement from health authorities through pregnancy and the first year of a child's life - this present an opportunity to target public health interventions
  • Understanding of diet and it's relationship to weight is poor (not least among public health professionals) - there is the chance to improve information, again targeted at the parents of young children

What isn't needed is policies that target the pleasures of those who are not overweight and not at risk because some people enjoying those pleasures are obese and at risk. Yet this is still the preferred approach - that and gimmicks like daft awards schemes for takeaways serving smaller portions!

In the end, it seems that Philip Larkin was right after all!


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