By Alessandro R Demaio, Harvard University
There’s been a lot of discussion about obesity this week. Whether or not it’s a disease (as it is in the USA now) and how this label would positively or negatively influence action taken by society and governments in addressing this large and growing burden.
This conversation is important, but I have noticed very often it ends with confusion. Questions around why we begin talking about obesity - and end discussing mental health, cancer, heart disease or diabetes. To make things even more confusing, the term ‘Non-Communicable Diseases’ might even be mentioned.
Flickr / Matti Mattila So what is the link between all of these diseases, and why can we not have a discussion about obesity, without talking about a range of seemingly unrelated ailments?
Well the reality is that all these diseases are actually highly interrelated. Obesity, diabetes, heart disease, cancers, lung diseases and mental illness (all combined are called Non-Communicable Diseases, or NCDs) largely share the same drivers or “risk factors.” Things like an unhealthy diet, using tobacco, drinking alcohol and not getting enough exercise are all related to, or direct drivers of obesity and diseases like diabetes and some cancers. What’s more confusing though, is that obesity itself puts us at higher risk for diabetes and certain cancers too, as does diabetes for heart diseases - for example.
Taking a step back though, the overlap becomes even more apparent. Because at a time when two-thirds of Australians, Mexicans, Americans and more are overweight or obese (and obesity is rapidly rising in even the poorest nations), this is not an issue that comes down to ‘stupid individuals making poor choices’. The reason we have a poor diet, or smoke, or don’t get enough exercise - is largely due to the built environment around us, the ubiquitous nature of junk-food and alcohol advertising, the way our cities are designed, the structuring of our food system, the subsidies that make unhealthy foods cheap, the over-focus of treatment at the expense of prevention in our health systems, the lack of integrated health education in schools and so on…
These are the structural and social determinants of health, and disease.
Let’s just look at food - which is a leading risk factor for disease worldwide with poor diet driving obesity, diabetes, heart disease, some cancers and more. We can say that people eat poor diets because of poor choices, but I don’t really buy this. Do we really make informed, un-coerced decisions on what we eat? We buy the chocolate bar because it’s delicious, but also because we are bombarded with advertising which makes us want it. They use behavioural studies to develop the right flavour, size and packaging. They place it at the check-out because they know we will impulse buy it - that is, we never really wanted it. The sugar in that bar is cheap because our governments (more so in the USA and Europe) subsidise the cost of sugar production and having eaten the bars as a child due to clever marketing specifically pointed at young people, we associate chocolate with happy memories.
My point is that in a nation where 2 in 3 of us are overweight or obese, something much bigger is going on that simply ‘stupid people making poor choices’.
My other point is that whilst we might think of these diseases as separated outcomes, they actually have common root causes, risk factors and social determminants. Many of them far beyond the health sector.
Some biting food for thought.
Alessandro R Demaio, Australian Medical Doctor; Postdoctoral Fellow in Global Health&NCDs at Harvard University, does not work for, consult to, own shares in or receive funding from any company or organization that would benefit from this article, and has no relevant affiliations.