My fascination with the environmental and social roots of obesity can be traced back more than 20 years, to a Native American reservation outside Phoenix, Arizona. There, as a young medical researcher, I worked at the US National Institutes of Health studying the Pima Indians, a formerly successful civilisation suffering the consequences of being displaced and marginalised by European colonists, such as alcoholism, violence, and poor mental health.
The Pima Indians also famously suffer from a high prevalence of diabetes, and for this reason they have been the subject of intense study by NIH for more than 40 years. When I arrived in the late 1980s, I saw that biology was not the real problem. Driving down to the reservation from Phoenix, I realised that it was not things within the body that were determining the health problems of this population. I came to the conclusion that obviously the driver of diabetes was obesity, and that obesity was just a normal physiological response to an abnormal environment. I now call this the ‘obesogenic environment’.
Growing up in Auckland, New Zealand, I chose to study medicine because of the breadth of career options it offered, and specialised in endocrinology. But on my return to New Zealand after working in Phoenix, I found my interest moving towards research and public health, and took a part-time role as medical director of the National Heart Foundation of New Zealand, where a successful campaign to raise cigarette taxes opened my eyes to the impact we could have when working at the population level.
By 2000 I was looking for a full-time research post, and found one in Australia as professor of population health, and subsequently Alfred Deakin professor, at Deakin University in Melbourne. Here I have focused on effective solutions for reducing obesity, taking a multidimensional approach that includes policy, research, and pragmatic demonstrations of how interventions can work at the community level.
Those demonstrations have included projects around the Australian town of Geelong in Victoria, where three community intervention programmes in children have led to significant reductions in overweight and obesity. Those demonstrations prove that in this population of children, building up the community’s capacity to find its own solutions can produce reductions in overweight and obesity. We also know that these approaches can be translated to a whole-of-country scale. However, from other research in the Pacific, I believe that additional approaches will be needed to achieve the same level of success for obesity prevention in some ethnic groups.
To accelerate the process of policy change, I have actively sought partners outside academia and government, helping establish such groups as the Obesity Policy Coalition, the Parent’s Jury, which provides a platform to advocate for healthy food and environments for children, and the Food Alliance, which focuses on food sustainability, security, and equity. I have tried to catalyse the establishment of these coalitions so that there are multiple platforms for public health advocacy out there.
Despite the growing obesity epidemic, I see some reasons for optimism. We’ve seen from the demonstration projects in Victoria that communities can turn things around for their kids. I also believe we are starting to get a bit of ‘prevention infection’ happening, where other communities are picking up on what has happened and are implementing it themselves. So I think we are probably going to see the plateauing and early reversal of this epidemic within kids in countries like Australia. I’m not so optimistic for adults but for kids we’re going to see that happening in the next several years.
At the policy level I am less hopeful. In that area we have made very little progress in the past ten years. In our research and the research of others, we’ve been able to specify and model several policy interventions which are highly cost effective and feasible, but they are not being implemented due to the counter lobby power of the food industry and other private sector interests.
As I have dug more deeply I have come to see that the core problem is a set of economic, political, and policy structures that are driving consumption-based growth. To me, the underlying drivers that are promoting overconsumption of food, and its resulting obesity, have the same roots as those that drive our overconsumption of fossil fuels and the resulting greenhouse gas emissions and climate change.
There is a need for the fight against obesogenic environments to be more tightly linked to the wider political debate about strengthening democracy and recapturing public policy for public benefits rather than being dominated by corporate interests. Health is right now a relatively weak force in the totality of lobby pressures on politicians. We need to learn that what is good for climate change and reducing car use, will also be good for obesity.
I am Alfred Deakin professor of population health and director of the WHO collaborating centre for obesity prevention at Deakin University in Melbourne, Australia. I trained as an endocrinologist in Auckland, Research career began with metabolic and clinical studies at the National Institutes of Health in Phoenix, Arizona and at the University of Auckland. Medical director of the National Heart Foundation in New Zealand from 1993 to 2000. I have developed and supported a number of community-based demonstration projects in the Barwon-South West region of Victoria, linked with similar projects in Melbourne, Auckland, Fiji, and Tonga.