Kirsten Patrick is Deputy Editor at CMAJ
There’s a quote from the film ‘When Harry Met Sally‘, (Meg Ryan, Billy Crystal) that I always thought was rather profound. One of the supporting characters, a writer, says,
Restaurants are to people in the eighties what theatre was to people in the sixties.
That dates the movie, and me, but how much more true it is now, I think. In the past three or four decades food has come to define us socially and has evolved into entertainment more and more.
Earlier this week Dr John Fletcher and I published an editorial in CMAJ called ‘A political prescription is needed to treat obesity‘, which garnered some criticism from two high profile Canadian bloggers. Dr Brian Goldman of CBC’s “White Coat Black Art”, only mildly critical, suggested that the idea of a donut tax was impractical given the ease of cross border shopping for Canadians. Dr Arya Sharma, who writes the daily blog “Dr Sharma’s Obesity Notes“, was far more derisive . Dr Sharma misinterprets our editorial and suggests that we are naively arguing that taxation and regulation of high-calorie and nutrient-poor food products is the ONLY viable approach to the obesity epidemic. Which, clearly, it is not. We are in no way in denial about the need for a multi-pronged, multi-generational approach in response to rising obesity. In fact, perhaps Dr Sharma did not read the whole editorial before pronouncing judgement as we clearly state: “Strategies that include individual interventions, school-based nutrition and activity interventions, incentives for active commuting and changes to thebuilt environment should continue; however, we also need robust ways to restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products.”
The problem of population level obesity is multifactorial and has been decades in evolution. Political solutions that involve laws and taxation will take years to show benefits – and obviously effective treatment and lifestyle-choice solutions will continue to be necessary. But that does not mean that we shouldn’t back political solutions as part of a more comprehensive strategy for treating obesity and NCDs in the longer term.
It’s taken years of poor regulation of Big Food and Big Beverage to get us to the current state where high fat and high sugar convenience foods are ubiquitous and abundant in the lives of many; it’s taken decades for humans to develop the comfortable and arguably addictive relationships with said foods that drive the high rates of NCDs that we are now seeing.
The organization of world trade has developed in the last century to make trade between countries and movement of goods between international locations as easy as possible. This has improved the economic well-being of the populations of many countries and we shouldn’t dismiss that. But it is worth acknowledging a stark difference between the global organization of trade and global organization of health. Organization of trade is slick, supported by international laws and treaties, and has the buy-in of the majority of the world’s countries. Conversely, the organization of health on a global scale is poorly organized in so far as it is not supported by global level legislation or by international treaties, but merely by sets of ‘recommendations’. At present, Big Food and Big Beverage are empowered to market their wares at us pretty-much unrestricted while very little joined-up policy exists to curb the negative health effects of this.
The Canadian government is not the only government to have largely ignored food regulation policy. Dr Sharma dismisses our argument by saying that that ‘actual data from government intervention on reducing the consumption of the said foods is so far lacking’, which would seem disingenuous. Of course not many data exist. Very few governments have enacted any laws. [In fact, there is evidence – which Dr Brian Goldman mentions in his blog on our editorial, but for us to get a real idea of the effect of policies like these we need time, and we need to be able to deal with the confounding of certain elements – cross-border shopping being one.]
I would personally argue that what we need to bump this issue up the political agenda internationally is international agreements targeted at curbing the excesses of the industries that manipulate and aggressively market the foods that damage our health. As part of a well-rounded and multilevel approach, of course.
Unfortunately when the obesity ‘experts’ pooh-pooh the political prescription for obesity they just empower governments to feel no remorse at all about being spineless and shifting all responsibility for preventing obesity to the ‘consumer’.
Arya M. Sharma, MD
I am not pooh-poohing or arguing against the need for political strategies to promote better health. I am just objecting to the notion that efforts at prevention will, in the foreseeable future, present a viable alternative to getting serious about finding better treatments and making these widely accessible to the people already living with this disease. (I did see the passing nod to continuing these efforts at individual interventions but, given that these individual efforts are unavailable to the vast majority of Canadians living with this problem, a call for dramatically increasing (rather than just continuing) these efforts would have been more appropriate)
As much as I would love to see societal and policy measures ultimately reduce the global burden of obesity, not even the greatest optimists believe that we will achieve a notable reduction in obesity rates in the coming decades – as I pointed out, even a 30% reduction in the prevalence of obesity still leaves us with millions of overweight and obese Canadians in desperate need of treatment.
Thanks for your comment, Dr Sharma. And for continuing to bring the problem and the need for solutions to our attention.