The war on waist

“I used to always wear long sleeves and leggings because I didn’t want to show my arms and my legs … I’ve only recently just cut my hair for example because before that I thought you have to have long hair to hide your chubby face.”

For Louise McVicar, the decisions she used to make about what to wear and how she should look were all influenced by her belief she was overweight and that was something she should be ashamed of.

Recently, she has begun to feel differently about her body. She says focusing on what she can do and how she feels and not on how much she weighs has given her more confidence.

McVicar, from Perth, has started a body positivity group for people on the social networking site Meetup. She’s been overwhelmed by the initial response. She wanted to share the knowledge she had gained from an online support group which helped change her opinion about her own body.

She is fat and she’s okay with it. Well, she’s starting to be anyway.

Louise McVicar Photo: Jackson Worthington.

Obesity is a problem. We know that. Rates are going up with new figures showing two thirds of Australian adults classify as overweight or obese. This means they have a BMI of over 25. The World Health Organisation says obesity is linked to 66 diseases and it accounts for 8.4 per cent of the burden of disease in Australia. In comparison, the burden for alcohol and illicit drugs is only 7.2 per cent combined.

Statistics from the Australian Institute of Health and Wellness

It’s not just a problem for adults either. Childhood obesity is on the rise. Latest figures show a quarter of Australian children are overweight or obese. A new study suggests childhood might be where the answers lie. The study published in ScienceAdvances found genetic markers active in childhood obesity are also active in adult obesity. The study took data from different cohorts around the globe and in total looked at 22,000 people including 1,500 from Western Australia from the ages of two weeks to 13 years old.

Senior author of the study Professor Marjo-Riitta Jarvelin from Imperial College London’s School of Public Health says the findings show the origins of adult obesity lie in childhood obesity, which means preventing childhood obesity could be the key. But we need to be careful because how we go about preventing childhood obesity may have unwanted side effects.

Last year, three out of every 10 respondents to the Mission Australia Youth survey said body image was one of their top concerns. More than 28,000 people between the ages of 15 and 19 took part in the survey. One 15-year-old female said: “We need to accept that body image problems are more present than we want to believe. The amount of girls and boys in high school struggling with eating disorders is scary.”

Body image and eating disorders may be a bigger problem for the youth of today than obesity. So, the question becomes how to prevent childhood obesity in order to curb the increasing rates of adult obesity without creating a bigger problem for ourselves. This is where the experts disagree.

Statistics from Mission Australia.

Monica Macoun is a practising psychologist in Perth, Western Australia. She argues a focus on overall health is the best way to treat childhood obesity. “You don’t want anyone to feel bad for who they are, but to work towards healthy goals, good living, healthy relationships, whatever it is.” She says people generally underestimate the impact poor body image can have. “I do believe we’re slowly getting better, slowly. But there is a lot of ignorance around.”

For Louise McVicar the answer seems simple. She wants people to focus less on weight and more on health because childhood pressure to lose weight has had a lasting impact. “From a very young age I definitely heard a lot of negative opinions about body like, you should cover up your arms if your arms are too fat.”

It’s not just about the emotional impact of poor body image either. People who suffer eating disorders are more likely to have a high BMI. Which means there is an overlap between people who are considered obese and people who have eating disorders. The National Eating Disorders Collaboration, an Australian organisation based in New South Wales, says around 1 in 5 people who are obese have disordered eating. It also says the rates of obesity and eating disorders occurring together are higher than either occurring on their own.

This isn’t a small or niche issue. The Butterfly Foundation already estimates the socio-economic cost of eating disorders to be $69.7 billion and says around 1 million people in Australia are living with an eating disorder.

Statistics from the Australian Institute of Health and Wellness and the Butterfly Foundation
Louise McVicar Photo: Jackson Worthington

For Louise McVicar an obsession with diets began with her mother. “My mother is also very conscious of her weight, she has been on constant diets and I joined in when I was a young teenager.” Now in her 30’s McViar worries her cousin is going through the same thing she did as a kid. “I’ve got a cousin who’s quite young and I can see she’s very healthy but she’s in a slightly bigger body. Even though she does sport and eats really well, I can hear all the negative talk around her like it was around me at that age.”

For Dr Carolynne White the issue with dieting is around sustainability. White is a lecturer at Swinburne University in Melbourne and the President of Health At Every Size Australia. She says a focus on overall health instead of weight will be more effective in the long run. The HAES program is a weight neutral approach revolving around five core principles; weight inclusivity, health enhancement, respectful care, eating for well-being and life-enhancing movement.

White says she decided to adopt the program after community consultation at a health service where she used to work. “People’s concerns were much more than just their body weight. People were concerned about things like anxiety, depression, the affordability of food, disordered eating and poor body image.” She wants the Federal Government to change the way it approaches health. She wants them to move away from weight and nutrition and focus on overall health.

But not everyone agrees.

Dr Hendrik Rensburg. Photo: Jackson Worthington

Dr Hendrik Rensburg has been working in the field of bariatric medicine for nearly 40 years. His medical practice in Perth is the longest running medical practice in Australia. He doesn’t believe in the weight neutral movement. “I’m looking at health and if you want to make fat people more acceptable as normal,” he says. “I can’t agree with that.”

He says weight loss is the best medical treatment modern medicine has to offer. “There is a fallacy, the healthy fat person, it does not exist. If you’re slightly fit and you’re fat, you can be slightly healthier but you’re never healthy with a lot of fat.”

The problem is weight loss is often ineffective. People are more likely to have put the weight back on five years later than have kept it off. Rensburg himself says that globally the success rate for patients keeping weight off after five years is around one per cent. Although he does say his success rates are higher.

For Rensburg the problem is a lack of understanding about what causes obesity. In fact, he doesn’t even like the term obesity, which comes from the Latin for over eating, because people who are obese aren’t necessarily gluttons. “There is no guilt for a person because they’re fat, they can’t help it. The food is there to eat all the time.”

For him the answer to Australia’s obesity problem is simple. “The food supply. The government could sort this thing out overnight by legislating the food supply, but you think they will? They’ll be out at the next election.” The Australian Medical Association has also called on the Government to regulate food in the form of a sugar tax.

Lawrence Beilin co-authored the study linking childhood obesity with adult obesity published in ScienceAdvances. He is an Emeritus Professor of medicine at the University of Western Australia and is a consulting physician at Royal Perth Hospital. Which in his words means he’s working but retired from the paperwork. He doesn’t believe legislating the food supply will work on its own.

Emeritus Professor Lawrence Beilin Photo: Jackson Worthington

He says our environment is the key factor pushing weight up. “People have become more sedentary, less physically active and have greater access to fast food,” he says. He believes food regulation needs to play a role in a multi-pronged approach. “It’ll have a small effect, but multiple small effects can end up having a big effect. Just as with the efforts to get tobacco use down.”

Beilin believes education should be a key focus in trying to prevent childhood obesity. He wants parents and would be parents to be educated about the impacts of obesity. He says education around food is a must because losing weight is three  times harder than putting it on and once people get into the habit of eating poorly it is hard to break.

But Dr White from HAES Australia says equating nutrition and obesity could have unforeseen consequences. “Eating disorders are one of the leading contributors to disease among young women and have a higher mortality rate [than obesity]. So, you don’t want to be focusing in on nutrition with the idea of making people smaller.”

For McVicar it’s important to set a good example for the next generation. She wants people to focus on how they feel and not how much they weigh. Her message is simple. “Appreciate your body. You don’t even have to love it immediately but at least don’t hate it.”