Posted by: ezzakazhall | January 15, 2013

Smoking vs Obesity! Who’ll take out the championship?!

smoking

“Oh well. At least I’m not fat.

Happy New Year, good readers. My apologies for a severe dearth of posts of late – last term at school was nothing if not frantically busy. Hoping to post a bit more regularly over the next few weeks.

For my first post of 2013, I will be discussing this piece I found on Stuff Nation the other day. Stuff Nation is a recent phenomenon – basically, it gives Joe and Jane Public the chance to publish articles and editorials about local and national issues they consider important. No journalistic training required. Kind of like blogging with a byline, you could say. Or citizen journalism, as my tutor likes to call it. And I, for one, have no issue with this kind of citizen journalism. However, I am slightly bothered that it allows the kind of article linked above to see the light of day.

Basically, the author believes (and he is entitled to his beliefs, of course) that the New Zealand Government, specifically Associate Health Minister Tariana Turia, is focussing too much on cultivating a “Smoke-Free New Zealand”, when it should be directing its energies towards preventing obesity. Because, according to his sources, more New Zealanders die from obesity-related illness than die as a result of tobacco consumption or the effects of second-hand smoke. Says the author, “the Health Minister never mentions the 8500 New Zealanders who die every year from a poor diet – over double the amount killed from tobacco consumption, and 21 times the amount killed from environmental tobacco smoke. She does not mention the 3250 New Zealanders who die every year from being fat, or the 1500 who perish from a lack of vegetables, nor the 2500 couch potatoes who die from insufficient physical activity.” 

(I am slightly suspicious as to where this gentleman got his statistics. He says he obtained them from Ministry of Health reports. If he’d provided the links to said reports and studies, I might be inclined to take him a bit more seriously.)

If we take the side of the author, there is evidence to suggest that the New Zealand Government does not appear overly concerned about the supposed obesity “epidemic”. For example, in October 2012, our Government was granted the Couch Potato Award by the Australia and New Zealand Obesity Society, for its “weak leadership” in reducing obesity in New Zealanders. In the linked article in the NZ Herald, the Society claimed that the New Zealand Government’s health promotion is poor, that it has provided concessions to the processed food industry, and that is has defunded obesity-awareness programmes such as Healthy Eating, Healthy Action and moved away from enforcing healthy eating programmes in schools. Health Minister Tony Ryall dismissed the Couch Potato Award as a publicity stunt and, despite claiming that the New Government has, in fact, made an effort to improve Kiwis’ health, doesn’t seem to be taking any further action on improving our health outcomes following been “given” the award.

This Voxy article highlights the extreme inequalities in health outcomes between wealthy and deprived communities in New Zealand – for example 19% of children in lower-socioeconomic areas are obese, compared with only 3% of children in wealthier areas. One suggestion made in the article was improving accessibility of healthful food options to all New Zealanders, either through Government subsidies or by removing GST from fruit and vegetables. However, as far as I am aware, the current Government does not seem in a rush to help Kiwis access healthy choices.  Nor does it seem in any rush to solve New Zealand’s child poverty problem. 

So, there’s that to consider. However, my quibbles with the Stuff Nation piece are as follows:

1) I feel very uneasy about the type of argument used here – what is often referred to in social justice communities as a “derailment”. Ie “why are we trying to fix this major problem, when we should be focusing on a supposed even bigger problem? Reminds me very much of arguments I’ve seen, where people have asked why we’re worrying about women’s issues when there’s starving children in Africa, and why is the Government spending all this time trying to encourage marriage equality when unemployment is so high? The writer claims that more people die from “obesity-related illnesses” than from those caused by tobacco – but 5000 deaths from smoking is reasonably significant, when you consider we’ve only a population of 4.8 million.

2) The author mentions the thousands of people who die from “being fat”, die from poor diet and die from not getting enough exercise. However, some studies have shown that slim and “normal weight” people are also at risk from the same illnesses as those who are overweight. This New York Times piece talks about the “obesity paradox” – in which overweight and obese patients with chronic conditions fare better than thinner people with the same conditions. The article notes that A) diabetes patients of normal weight are twice as likely to die as those who are overweight or obese, B) overweight dialysis patients had a higher chance of survival than smaller patients and C) larger people with heart problems fared better than thin people with the same heart problems. So, if we look at this article – we can see that not only do thin people get the same diseases as fat people, but that fat people seem less likely to die from said diseases. This Huff Post article also talks about the high rates of pre-diabetes and coronary risk factors in “normal weight” children in the US.

3) The title of article is problematic – “ban obesity”. Essentially what he’s saying is that the New Zealand Government should ban what is pretty much just a body size – based on a fundamentally flawed system of calculations. As I pointed out on this post, several of our top athletes, including Valerie Adams and most of the All Blacks’ front row, are technically obese on the BMI chart. Should tall, muscular people with large frames (the BMI system takes into account neither bone density nor muscle mass) also make the author’s blacklist, if he’s using the BMI to measure obesity?

As the author fails to suggest exactly how New Zealand can “ban” this body size, I would assume he is referring to state-sanctioned restrictions on those products that supposedly contribute to obesity and placing a tax on high-calorie foods. Problem is, the Danish Government attempted to impose a tax on “unhealthy foods” not long ago -which saw the prices of some items (including specialty cheeses) rise by 25%. This Economist article tells us more. The same fat tax was scrapped by the Danish Government last year, after it was found that Danes were crossing the border into neighbouring countries to buy their favourite treats at lower prices. So, we can see from this example that people can get around high taxes if they want particular items badly enough. Plus, as the Economist piece mentioned, the tax ended up being cumbersome for retailers and played havoc with the local economy. While I am all for the New Zealand Government making healthy food options more accessible, I’m not entirely sure if prohibition or higher taxes are to way to go.

4) As I have pointed out on several occasions on this blog, obesity can also be the result of health conditions or medications. For example, according to WebMD, 25% percent of people who take SSRI antidepressants will gain weight. Rapid weight gain can also be the side effect of antipsychotic medications. Would the author suggest banning these potentially living saving medicines? In addition, research has shown that particular eating patterns and tendency towards weight gain is heavily influenced by genetic makeup. So what next – DNA policing?

5) Finally, something that really bothers me about the article is this bit:

“According to a study by the Erasmus University Department of Public Health, smokers save society money because they die younger, and a smoking ban would increase costs as the healthier population eventually moved in to nursing homes and the relatively expensive diseases of old age.”

Obviously, he is saying that, in the long run it would cost the New Zealand health system more if smoking was banned, and tobacco-related diseases decreased in number. Because apparently it’s more expensive if we just let New Zealanders live long, full and healthy lives, so they eventually die of plain and simple old age.

Well, as I have seen from other articles, there is a long-held belief that obesity is linked with diseases such as diabetes, heart problems, strokes and sleep apnoea (there is, in fact, a correlation between obesity and these illnesses, but correlation does not imply causation), all of which have an impact of life expectancy. And, the author states that 3250 Kiwis die from “being fat”, 1500 die from lack of veges, and 2500 who die from being couch potatoes. So, if obesity *does* contribute to life threatening health conditions, and if thousands of Kiwis die from an unhealthy and sedentary lifestyle… then is it not also cheaper to let these people die from their illnesses, and avoid letting them grow old and end up in rest homes, which cost the state more? If we’re applying the same logic as he applies to smoking, then…that’s 7250 people who will die early, and who won’t end up in expensive rest homes. So…why exactly is so he keen to rescue the obese and let the smokers all die out?

Obviously, from reading I have done while researching this blog, I have found that a high body weight and poor health are not necessary the same thing. Several posts ago, I posted a link to this study, which shows that healthy habits are a better indicator of overall health and wellbeing than body size. Conversely, it is possible to be slimmer and in poor health. And, as I said above, studies have shown that larger people with the same chronic conditions as thin people have a better chance of survival than their smaller counterparts. My problem is that the author has quoted numbers of people who supposedly die of obesity…and that it’s a terrible thing that they die every year, but not so terrible that smokers die, because it’s cheaper? Circular logic.

That’s about all I have on this topic. Feel free to leave me a comment if you wish to discuss this more. Will try and update again shortly.

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