Diet and exercise alone will not stem obesity - Sydney Morning Herald

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Diet and exercise alone will not stem obesity

October 02, 2011

THEY'VE tried the diets, they've tried the protein shakes, they've tried the pills, but for many of Australia's obese nothing seems to be working.

The number of obese Australians has more than doubled in the past 20 years and 60 per cent of the population is now classified as overweight or obese.

The disease cost the economy $8.3 billion in 2008, Access Economics says. But taxpayers could save billions of dollars by sending the obese to dietitians, fitness coaches or even surgeons to lose weight, rather than waiting until they end up in hospital.

Researchers at the University of Queensland and Deakin University have estimated it would cost $140 million to provide diet and exercise programs to every overweight adult and would avert 3000 years of sickness. Spending $120 million on gastric bands for a quarter of very obese adults would avert 140,000 years of sickness, as they tend to result in bigger and longer lasting weight loss.

There is a growing consensus that diet and exercise alone won't achieve a permanent reduction in our alarming obesity levels. Some health experts argue obesity is a biological disease that can only be fixed by surgery, while others say there needs to be complete societal change including junk food taxes and better urban design.

''The public believe that fat people have only themselves to blame and we shouldn't spend money on them,'' Joseph Proietto, an obesity specialist at the University of Melbourne, said. ''The main reason [for obesity] is genetic; the environment also contributes.''

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The federal government is now under growing pressure to find cost-effective ways to prevent people from becoming obese and developing chronic illnesses, instead of just treating them when they get sick.

''We need to have an overarching strategy for obesity in our country,'' Australian Medical Association president Steve Hambleton said.

''We have to intervene earlier. We can't wait for people to turn up at hospitals. It's much more expensive to fund a heart attack patient or someone with diabetes.''

Obese people have a higher risk of developing type 2 diabetes, heart disease, osteoarthritis, certain forms of cancer, and are likely to die younger.

To stop people getting fat, health experts want the government to tax junk food and drink, put traffic light nutritional information on food and cut junk food advertising to children. All of which would save money.

For those already tipping the scales, their options are to diet and exercise, take drugs, or undergo surgery. But what really works?

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''Whatever you do, whether it's a band or a pill, a healthy diet and exercise are extremely important,'' Dr Tania Markovic, director of metabolism and obesity services at Royal Prince Alfred Hospital, said. ''Nothing will work without healthy eating and regular physical activity.''

Overseas studies have shown people at risk of type 2 diabetes who lose 5 per cent of their weight by seeing a dietitian and doing supervised exercise cut their chances of developing the disease by 60 per cent.

GPs lobbying the Health Minister, Nicola Roxon, to fund personal training sessions have been rebuffed with the reminder there is already a Medicare rebate for GP-referred visits to exercise physiologists.

Some health experts believe there should be a taxpayer-funded co-ordinated weight loss program for all obese Australians. UNSW and the University of Sydney are trialling programs incorporating sessions with dietitians, exercise physiologists and counsellors, with success.

''All indicators point to the recruitment of allied health professionals [to help treat obesity],'' Chris Tzar, the director of the Lifestyle Clinic at UNSW said.

''I think there will be some standard treatment guidelines issued, based on the evidence of the program.''

But Dr Hambleton warns the public purse can't afford tailored programs for everyone. ''We know if you had a personal trainer and a personal chef you'd lose weight - there's a TV show that proves it. But it's not cost effective,'' he said.

And it might not result in significant permanent weight loss. Studies suggest obese adults who modified their diet and exercise lost less than five kilograms within two to seven years, while those who took obesity drugs as well had lost 5-10 kilograms within one or two years of treatment.