Thursday, October 16, 2008

Fat & Healthy

Fat & Healthy

OK, be honest, if you see a chubby person do you think “hey, you look sensational” or “don’t collapse near me please, I ain’t done CPR training in years”? It is difficult not to think that a person with a greater width than you dines on pastries and wouldn’t be wise to plan past the weekend.

There are two (unexpected) types of people
A US report on 5440 adults found there are two types of people we do not normally acknowledge. One group of adults (or phenotype) were healthy, overweight people who did not have the cluster of expected risk factors for early demise, such as high blood pressure, blood glucose and blood cholesterol. Another phenotype is the physically lean person who did have a cluster of risk factors for heart disease and early death.

The study revealed that one in four lean adults were just around the corner from their first heart attack, while a half of overweight adults (yes, half) were healthy on the inside, or “metabolically healthy” in their words. That is, all things being equal, they would live a long and healthy life. Even one in three obese adults were metabolically healthy.

Are thin health professionals too smug?
We are frequently told of the prevalence of overweight and obesity (67% men; 52% women), with the implied assumption that all of these people are going to die young unless they see the error of their habits and start taking better care of themselves. That some people classed as overweight could be healthy will not suit the socially-sanctioned and health professional-endorsed view that all overweight people are, or likely to be, a health burden. And it is easier to make every fat person feel guilty rather than admit that some of them are pretty fit and healthy.

Why is it that we assume that a lean person is a healthy person? It seems that plenty of trim folk have high cholesterol and blood pressure, although they are not publicly admonished as they look healthy. Go to the gym and see the people aiming to get the right look, the “approved look”. Is this self-obsession healthy? When a solid looking guy tells you that he hates Good Friday and Christmas Day because the gyms are closed, you wonder if we haven’t missed something in our list of risk factors for health. I recall a conversation with one 25 year old lady who had decided not to have children. Why? Because she would look fat for five months or so!

Is health just based on measurements?
I wonder whether health is measured solely by what is measurable? We can measure your blood pressure, but there isn’t a simple test for happiness. You won’t find it in the textbooks, but I think that health includes an appreciation of a normal body; for example, pregnancy is normal, being able to bench press 150kg (330lb) is not. Healthy habits also include volunteering, mentoring, giving to charity, hugging your kids, and buying Girl Guide biscuits even if they go to the dog.

The salient point
That point is that you cannot assume that every fat person is a walking heart attack and that every lean person should plan for a long life. A better measure of your health will come from a knowledge of what is happening on the inside, such as blood cholesterol, blood pressure, fitness levels and Prostate Specific Antigen in men. On a different level, it would be wise to meet with your friends each time assuming it could be the last, independent of their size. Morbid, I know, but that thought could get you to appreciate them more each time you do see them.

Reference: Archives of Internal Medicine 2008; 168 (15): 1617-1624

Tuesday, October 14, 2008

Nutrition Impact #1

Can you believe it? Only 3% of people follow a healthy lifestyle. If there was you, me and your mother then the next 97 people would be unhealthy. And where did we get the word vitamin from? All this in five minutes.

Wednesday, October 1, 2008

Junk Food Tax

Junk Food Tax

It is socially sanctioned, media attractive, and loved by just about every health authority (and self-proclaimed health authority) in the land. The “junk food” tax is seen as a means of generating revenue and a way to get people to stop eating their favourite treat.

Community support
Many people for a long time have requested a food/fat tax of sorts. A survey in the US last year found that three quarters supported a tax, yet two out of five said that a tax wouldn’t change their eating habits. A report from the Economic Research Service of the United States Department of Agriculture in 2004 concluded that a small tax “is unlikely to have much influence on consumer diet quality or health”. Of all the groups suggesting a fat tax in the US, the report found that none had specified how they would use the extra funds to improve eating habits or food choice.

Here in Australia, Access Economics produced a 2006 report that estimated the direct cost of obesity to be $3.8 billion, with nearly half of this due to lost productivity. In the report, they claim that the idea of a “fat tax” is flawed. A broad tax on certain foods doesn’t target obese people and assumes that obese people overeat only taxed foods. The tax also assumes that a higher cost will shift consumption away from certain foods towards healthier foods. Access Economics use the example that having virtually free tap water has not shifted consumption away from soft drinks and fruit juices.

What to tax?
Even if you did tax certain foods, on what would you base the tax? Fat? Saturated fat? Salt? Sugar? Or combinations of these components? If it was a fat tax, then it may include oils (100% fat) and nuts (50-80% fat). But hang on, you say, they aren’t junk foods. So how do define a junk food? One that is high in saturated fat and salt may be your answer. If so, then cheese is a junk food. OK, you didn’t mean cheese, you meant potato chips. What about high sugar drinks like soft drinks? Well, they have the same sugar content as pure fruit juice. Should we tax juice? You will notice that anyone proposing a food tax never, ever defines what to tax, most likely because their thinking is based on an emotional argument and not a practical argument.

What level of tax?
If you wanted to enforce an additional tax on a food, what level should it be at? On this next comment, I am speculating. What if a $3 serve of fries attracted a 50% tax to take it to $4.50? If that did change sales, and I doubt it, the fast food outlet might just decide to use a poorer quality cooking oil and take a revenue-neutral or small-loss stance and sell them for $2.00 instead. Add the 50% tax and you have a $3.00 serve, the same price as before, only now with more cholesterol-raising potential. Who is the winner here? As I said, I am only speculating, but it is a definite possibility. McDonalds has twice changed its cooking oil in the last four years to reduce saturated fat levels. Love them or hate them, it is the right direction to head.

Another option
Rather than taxing foods, in may be more productive to offer tax incentives to food companies to encourage changes to their recipe formulations. Food companies in Australia and New Zealand have made concerted efforts to reduce sodium, saturated fat and trans fats in the food supply. The Heart Foundation tick program each year has removed 235 tonnes of salt from the Australian food chain and over 35 tonnes from the NZ food supply, compared to pre-2002. Margarine manufacturers virtually deleted trans fatty acids from table margarine around a decade ago. Maybe food companies are a lot like children – they respond better to encouragement than regular beltings.