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The fat of the land
  1. I D Wacogne
  1. Dr Wacogne was on secondment at the Royal Children’s Hospital, Brisbane for two years and is now a locum consultant in general paediatrics at Birmingham Children’s Hospital, UK.

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They say that you are what you eat. By current trends it’s looking like, by the year 2050, we’ll all be 150 kg by our thirtieth birthday and the only exercise we’ll get is activating the direct computer access to McKFC for our next order of a pork fat thick shake.

Obesity is no laughing matter for those living with it, particularly for children. The jolly image of the subtly named Fatty from Enid Blyton’s Famous Five rarely corresponds with the miserable, unfit, teased child that you and I meet in clinic. And we’re living in the middle of an epidemic of it, or so we’re told. Our children are getting fatter, doing less exercise and eating worse and worse foods. On the other hand, the other epidemic we’re living with is the one of obsessive thinness, of which the worst extreme is anorexia nervosa and associated illnesses. It is very confusing to try and figure out why society has these two apparently paradoxical morbidities.

But then again, perhaps it isn’t so paradoxical. We live in a society obsessed by weight and appearance. After all, what is the second question, after gender, asked by every parent of a newborn baby? The weight of course—a number almost as irrelevant in the vast majority of cases as the Apgar score (itself now the third question asked by many parents). We weigh and plot and encourage and scold throughout childhood. And then we wonder why most ten year old girls have been on a diet and why those of us who store energy more efficiently than others decide to opt out and close their ears to everything further that health professionals have to say on the subject.

What can we do? It has taken decades of persistence to get our profession to take the issue of surveillance of weight and growth seriously, and it would be disastrous to go back to a situation where nobody cared. But it does seem odd that we bemoan a society obsessed by weight at the same time as fuelling that obsession, and being aghast each time we meet an overweight person who has effectively opted out.

Perhaps we need to look more closely at why people opt out. Australia might offer some clues. Australia has the second highest levels of childhood obesity in the world, but at the same time is one of the most active sporting nations in the world. For example, in successive Olympic games Australians have won more gold medals per head of population than any other country. So, where do all the overweight folk come from? Are they simply sitting at home watching it on TV? Well, yes they are, for the most part. There is no place in highly competitive sport for someone who is less than excellent. It takes great strength of character to keep on trying if everyone else is better than you, is beating you, and adverts on TV remind you—as in a recent Australian banking advertising campaign—that “No one remembers who came second.”

Another lesser factor must be the sponsorship. The fast food giants effectively run the Australian school football code leagues, with voucher prizes for winners and runners-up. Non-prize winners would tag along for commiseration fatty meals. It wouldn’t take long for the message “Feeling low? Eat something!” to establish itself in a young mind. It is worth remembering that a fast-food chain has never yet done something for entirely altruistic reasons, no matter how much they might protest that they do.

We need to maintain our vigilance, our disapproval if you like, regarding serious obesity. At the same time, we need to insist that taking part—getting out there and having some fun and some exercise—is every bit as important as winning. This may sound like wishy-washy leftie thinking, but it is vitally important for our future health. If winning is the only thing, then what incentive is there to go on if you can’t win? It took me years to understand why I liked to cycle so much (one of the major reasons is that I’m never going to lose—or for that matter win—anything). I don’t need to anxiously await selection onto a team, or fear letting down team members with an appalling own goal. I’m a wimp, I know, but for many of us, this is our memory of sport.

In a tennis tournament involving 100 players, 99 must lose. In a soccer match, unless there is a draw, 11 players lose. Often the draw is seen as all 22 people losing. For those of us who are more jaded and cynical this might be a metaphor for life, but we shouldn’t burden our children with it early in life. There must be a way where there can be more winners, or where we can be less obsessed by winning, and by weight, and a little more inclusive. The alternative is that we all lose, and that we all become the fat of the land.

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