Monday, September 24, 2012

Eating habits - can they be changed?

Few Australians are good at maths

Smoking rates have dropped considerably over the last 40 years. That’s partly because, as smokers die, fewer smokers take their place, and partly because others have quit by changing a habit. Can we change another habit – eating better and eating less to lose weight? That, I think, is far too difficult for adults.

Democracy is not good for body weight
Why are we unlikely to see weight loss in the near future? Because we live in an affluent democracy where food is relatively cheap, available 24 hours a day, 365 days of the year and you have the freedom choose what you eat. The default position of humans is to take the short-term gains (taste, convenience) rather than look to the future.

This is why we have compulsory superannuation (in Australia). No-one can see, or wants to see, the future. When it arrives, they realise they have fewer than 10 years to save for retirement, or desperately search the internet for a “natural” cure for their ailment. We prefer the hope of a solution to the proven benefits of investment or prevention.

I’m not capable
One major barrier to educating the population is that 46% of adult Australians do not have the “minimum literary skills required for individuals to meet the complex demands of everyday life and work in the emerging knowledge-based economy.” (Adult Literacy and Life Skills Survey 2006). For numeracy skills, 53% of adult Australians do not meet the minimum level. Even of all those people who claimed they were good at maths, 44% did not meet the minimum numeracy skills! (Can you work out 10% of 120? Yes? Well done; only half of us can do that calculation.)

We love to roll out public weight loss campaigns with advertising suggesting that a paunch signals your downfall (cut to image of man wondering if he will live long enough to see his children graduate from high school) followed by a direction to a website, which means that half the population have already dropped out from seeking information. If you don’t have literacy skills then you are unlikely to be reading a well-meant on-linesolution.

I’m not even fat, anyway
Another barrier for weight loss campaigns is that as we getter fatter, we are more accepting of overweight and misclassify ourselves from a weight perspective. This may reduce our interest in losing weight. In a US survey 21% of overweight women and 46% of overweight men felt that their weight was “about right” (Burke 2010).

It seems that many obese people do not enjoy weight loss campaigns and prefer non-stigmatising interventions that are designed to improve lifestyles, rather than promotion of weight loss. In an Australian study, only one third of obese adults thought that media campaigns were effective in addressing obesity (Thomas 2010). They particularly dislike the negative presentation of overweight and the scare tactics used to get them to change.

Is there a solution?
It is easy to see fault in the repetitive weight loss campaigns that appear directionless. Even those that do their best to deliver useful health and weight information acknowledge the limitations and difficulties faced (Maitland). There may be some helpful changes that could change people’s behaviour:

1. Work with the food industry to improve the nutritional quality of food. That is already happening with Food and Health Dialogue, which has already made big steps in lowering the salt level of food. OK, less salt won’t influence weight but it is a good start in improving health.

2. Create exercise-friendly areas in the urban areas. Hats off to those municipalities that have extensive bike paths, parks and dog walking beaches.

3. Run advertising campaigns that demonstrate simple visual tips on increasing activity and eating better. These campaigns will be run by people who have been able to change their habits and are paid to be ambassadors for healthy habits.

One common touted solution is to tax certain foods. I have written before why I don’t think that will help. A more radical solution is to ban fast foods or limit their opening hours. A bit of idealism that won’t work in a free society.

For me, Yoda summed it all up in his advice to Luke Skywalker: “Try not. Do. Or do not. There is no try.” Don’t try to change a habit. You just change it. It’s hard, I know, that’s why almost no-one succeeds. Then, as another another famous person said: “Life wasn’t meant to be easy.”

What does it all mean?
In an affluent democracy with easy access to affordable food you will always have overweight folk. Long ago I predicted that overweight and obesity will stabilise at 75-80% of the population and the relatively lean will become a forgotten minority group who create weight loss campaigns. I was reminded of being in a minority when a large department store didn’t have a belt small enough for my 88 cm waist (34.5 in, and that ain’t skinny), and couldn’t sir just cut a few cms off the belt in the back shed? I’ll still continue to spread the message, yet resign myself to spreading it to an ever larger population.

Burke MA, Heiland FW, Nadler CM. From “overweight” to “about right”: evidence of a generational shift in body weight norms. Obesity 2010; 18: 1226-1234
Thomas SL, Lewis S, Hyde J, Castle D, Komesaroff P. “The solution needs to be complex”. Obese adults’ attitudes about the effectiveness of individual and population based interventions for obesity. BMC Public Health 2010; 10: 420
Maitland C, James N, Shilton T. Regional considerations for state-wide social marketing campaigns – some lessons learned. 11th National Rural Health Conference