Transcript - Dr Gannon - 4BC - Obesity in Australia

BEN DAVIS:   Look, we are a nation of fatty boombahs, we know that. I've been telling you that for some time. You just have to look around. Go to your nearest shopping centre. Look at the street. How many are overweight? Thirty per cent of Australians are obese. That's the official figures. Two in three adults are overweight. One in four of our kids, our grandkids, are either overweight or obese. Those stats are staggering.

They are based on BMI though - body mass index. You know I've got a problem with this. It's an antiquated and a flawed system deciding who is overweight and who is obese. I know they've got to stick a number on it but how they work this out, it's calculated by dividing your weight in kilos by the square of your height in metres. Now I'm not going to lose you with the maths here but the number they get to, well there's a healthy range: 18.5 to 25. Anything over that and you're supposedly overweight.

Now here's my issue with BMI, something that the World Health Organisation uses to calculate obesity as well: this system doesn't allow for the fact that muscle weighs more than fat. We know that. Scientifically proven. So we have the example which I have shared the example before. When I was in Grade 12, my final year at school, I was exactly the same dimensions - height and weight - as Glenn Lazarus. One of us was playing front row for Australia, the other was a fat school kid who was bullied and teased. But we both had a BMI of 31-plus. Lazo wasn't obese though, he was an elite athlete. So why are we still relying on a method like this? I think I've even used the example of Ben Roberts-Smith. His BMI puts him into the overweight to near-obese category. Please. Please.

Still, we know we're a nation of fatty boombahs regardless of how it is measured. Obesity is draining the health system that you pay for. Heart problems, Type 2 Diabetes, eye issues, knee and back complaints, blood pressure, the list is endless and it's prompted another call from the Royal Australasian College of Physicians to classify obesity as a chronic disease. A disease. So it's not your fault if you're fat, it's a disease. Really? What about just doing some exercise? Going for a walk, going for a run? Well, stop putting crap in your mouth, bad food.

Look, I'm not convinced that it's a disease and it's something the AMA aren't buying either. The Australian Medical Association President is Dr Michael Gannon. Doc, good to talk again. Is obesity a disease?

MICHAEL GANNON:   Look, we don't- we haven't called for it to be labelled as a disease. We've heard the latest from our colleagues at the College of Physicians going down this road. We certainly think it's a public health issue that needs attention and if defining it as a disease gets the changes we need to see in society then we'll look at it, but it also might not be particularly helpful. There is a lot more to this story than personal responsibility, and there is more to it than calories in and calories out, but it's complicated. And it's an issue that deserves complex analysis.

BEN DAVIS:   Alright well, let's talk about some of those complications. What's the problems with classifying obesity as a disease?

MICHAEL GANNON:   Well, I think, again, if that's where we need to get to, to actually be able to deliver bariatric surgery to more people in the public hospital system, if that's where we need to get to enable- to get governments, whether we're talking about local governments, State governments or Commonwealth Government acting on making sport and recreational opportunities more available to people, especially those of limited means, if we need to classify it as a disease to get action on taxation of sugar sweetened beverages well then I'd be less concerned about the definition, but defining a disease process purely on the basis, for example, of body mass index might not necessarily be helpful.

BEN DAVIS:   I'll get into body mass index in a moment but then what would change if it was classified as a disease? So, you've just pointed to government's recognition of it. So if something is categorised as a disease, it's a whole new approach, is it?

MICHAEL GANNON:   Well, I think that's right, yeah, and it might not necessarily be helpful and it's why in our most recent Position Statement on Nutrition, looking at the issue of obesity, we decided not to make this call. It is an area that needs attention. It is no exaggeration at all to rank obesity alongside tobacco as the greatest public health challenge of our age. We now have a majority of Australian adults who are either overweight or obese. It contributes to health problems that are seen by doctors of basically every speciality every day through the relationship with cardiovascular disease, with stroke, with osteoarthritis, with worse pregnancy outcomes, with mental health implications. It is a real emergency.

We need to turn the ship around. Disease classification, would that help? I'm not necessarily convinced but we do need to look at the food we put in our mouths, but we need to look at those Australians on limited incomes and see what their food opportunities are because the reality is that if you're of limited means, often the food stuffs that you're more likely to eat are relatively nutrient-poor, calorie-rich, very high in trans fats, other fats, sugar, salt, and those heavily-processed foods are more likely to contribute to obesity. We will maintain our calls for a sugar tax. [Indistinct]…

BEN DAVIS:   [Interrupts] And see, Doctor, that's where you and I don't see eye to eye on that. Taxing the nutrient-poor foods and the sugary drinks: that's personal responsibility. That's about what you put into your body. So that's where personal responsibility does come into it rather than something that you might not be able to control because of the genetic make-up that you have. I know the US classify obesity as a disease, has that worked for them?

MICHAEL GANNON:   Well, it certainly hasn't fixed their problem, but whether it will help turn things around in that area where America leads the world remains to be seen. But Australia does have a problem with obesity. We're right up there in terms of the worst countries in the world, in terms of prevalence within the population. It's going to take a generation and we will look back at some of these conversations and marvel at the fact that it took so long.

BEN DAVIS:   What about coming up with a different way of measuring it? Like BMI, that's not an accurate measure of someone's health.

MICHAEL GANNON:   Well you're correct on that. You've got heavily-muscled people who by the definition of BMI alone are obese, and we're talking super-fit people who are at the top of elite sports et cetera. Waist-hip ratio is probably more effective in terms of capturing that central abdominal obesity, that fat inside our bellies that contributes to diabetes, contributes to high cholesterol, contributes to other health problems. But that's not to say that someone with a- the majority of people with a BMI more than 30 will have health problems and it is a slow burn. Over time, it will reduce their quality of life, it will reduce their life expectancy for the majority of them.

BEN DAVIS:   Anyone working on changing that and getting rid of BMI, maybe working on WHR, waist-hip ratio?

MICHAEL GANNON:   Yeah, certainly in some settings it is used and it's certainly a more effective ratio. We've become familiar with BMI in the last 10, 15 years and it has its use. But it is a blunt instrument. Maybe defining disease or not defining disease is an equally blunt instrument. What we need is a whole of society approach to a major public health problem and we need to nip away at it issue by issue. So I'm speaking to the Council of Medical Colleges tomorrow. So that's one of the conversations that we will have with them. We're all working to the same end to try and address this major prevention public health issue.

BEN DAVIS:   It is an ongoing conversation. We'll be talking again no doubt. Doc, appreciate your time.

MICHAEL GANNON:   Pleasure, Ben.

BEN DAVIS:   AMA President, Dr Michael Gannon.

16 May 2018

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