Let’s focus on obesity New Zealand!

As recently as 2017 New Zealand was the third most obese country in the Organisation for Economic Cooperation and Development (OECD) and New Zealand children had the second-highest obesity rate in the OECD, with one in three children overweight or obese.^1–3 Humankind has not always had an issue with obesity.⁴ This crisis has coincided with the dietary advice of the last 50 years. Obesity has exploded in New Zealand over this time, resulting in a sicker population and increasingly economically unsustainable health expenditure.¹

Obesity is associated with prediabetes, diabetes and its multiple complications (ischaemic heart disease, stroke, renal failure, blindness, peripheral neuropathy), hypertension, non-alcoholic fatty liver disease and polycystic ovarian syndrome.

As a general practitioner, I see obesity and its consequences on a daily basis and spend a good deal of time managing it. I have the tools to do this. But as a society, how well are our guidelines being followed and how well are we doing? Guidelines are only of any value if they result in positive change. We clearly need to assess how well we are managing obesity. A recent review found a paucity of New Zealand based research on obesity and weight loss interventions and identified some areas for potential study.⁵ It also highlighted the fact that weight loss tools are available but more holistic management is needed in this area.

Now would be an opportune time to target obesity in the context of our new health reforms.⁶ Obesity management cannot just involve catching people at the ‘bottom of the cliff’. There must be an imperative to prevent obesity through preventive medicine. I believe we should now more actively promote obesity management as an integral part of day-to-day healthcare practice and focus on the actual cause(s). We also need to affect further change at Government level. Consideration should be given, for example, to regulation of sales through Government-led deterrents against highly processed food with little nutritional value. The United Kingdom and Mexico have demonstrated significant reductions in sugary drinks consumption by way of a ‘Sugar Tax’.⁷

The last 50 years have seen the ‘fattening of New Zealand’ with a consequent mushroom-cloud of morbidity and mortality arising from insulin resistance. The nutritional advice we have been given has evidently not worked. Obesity is particularly relevant to COVID-19 where risk of serious complications or death are significantly increased with obesity and diabetes.⁸ Thirty-five years ago, the World Health Organisation asserted prevention is better than cure.⁹ Let us now aspire to that philosophy in order to see a society with improving health outcomes and less misery or death arising from obesity.