Commentary about a dental device aimed at facilitating rapid weight loss has recently been aired in the national and international media and on social media. While public views of health issues are important, we cannot afford to deflect attention from the global obesity pandemic and the science-based approach to its management.
Obesity has caused a greater degree of ill-health and premature death in most countries than Covid-19, the other global pandemic. It needs to be treated with similar respect. Obesity is driving escalating rates of type 2 diabetes estimated to be costing New Zealand $2.1billion annually, a large proportion of GDP (0.67%) for a single disease. It is an important risk factor for heart disease, several types of cancer and disabling conditions such as hypertension, gout, polycystic ovarian syndrome, osteoarthritis and bone fractures in children. People with obesity who develop Covid-19 are at higher risk than others of a poor outcome. One third of the adult population of New Zealand is obese.
The causes of obesity are sometimes said to be complex. However, the principles for losing excess weight are simple although not easy to implement.
The pandemic is driven by the availability of foods that are highly processed and high in fats and sugars, and which are consumed by people who don’t have enough regular physical activity. This leads to the accumulation of excess body fat in people who are susceptible to it. There is no equivalent of a vaccination for obesity so, at a population-wide level, the only approach to stemming the tide of the pandemic is to alter the “obesogenic” environment.
Unlike New Zealand’s world-leading approach to the management of the Covid-19 pandemic, our current Government has done little if anything to seriously alter an environment which promotes an intake of calories in excess of the body’s requirement. Health Eating Healthy Action (HEHA), an initiative of the Clark government nearly 20 years ago, was a comprehensive, world-leading approach to the prevention of obesity, aimed at young people and their families. Ironically, this was disbanded by the Key government and has not been resurrected by either the previous Labour-led government or the present Labour Government.
A range of public health measures, such as reintroducing HEHA (or something similar), restricting junk food advertising and introducing a sugar levy, are absolutely pivotal to the management of the obesity pandemic. The suggestion that these are nanny state initiatives is no more tenable than arguments that wearing masks on public transport to protect against possible outbreaks of Covid-19 or helmets when cycling to prevent head injuries are infringements of personal liberties.
While we need to prevent people from becoming obese by creating an environment that encourages healthy eating and regular physical activity, we also need to support people who are trying to lose weight in order to reduce their health risks. Many people would benefit from the support of dietitians and other health professionals who are able to both provide scientifically sound nutrition and exercise advice as well as the support required to make lifestyle changes. New Zealand does not have enough trained professionals able to offer this support, creating opportunities for self-styled experts to provide alternative, unproven and sometimes even potentially harmful advice to those anxious to lose weight.
A small proportion of people need additional help. Drug treatments have mostly been disappointing. Several promising treatments either have major side effects or haven’t proved to be effective in the long term. Semaglutide, a drug used in the treatment of diabetes, may prove to be useful but is prohibitively expensive and not yet generally recommended for people who do not have diabetes. The use of very low-calorie liquid formula diets and bariatric surgery were often associated with unacceptable side effects when first introduced. However, treatment regimes and surgical techniques have been refined to the extent that they are now producing impressive benefits, including remission of type 2 diabetes. They should be available as standard treatments for people who choose them and are considered suitable. The dental device may also eventually prove to have a role for people who need to lose a substantial amount of weight prior to surgery to reduce anaesthetic and surgical risks. There may even be other situations in which it could be useful but further research is required to determine that.
It is unfortunate that most of the commentary on the device focused largely or exclusively on negative aspects which might have applied equally to other invasive interventions such as bariatric surgery when they were first introduced. What is needed is acknowledgement from the media, public, healthcare providers and Government that we are facing a pandemic that needs to be managed using the same principles as those required for controlling a global infectious disease outbreak. Government should be introducing appropriate public health measures aimed at reducing the obesogenic environment.
Healthcare providers need to ensure that appropriately qualified health professionals are available to support individuals who wish to lose weight. A recent report identified a national shortage of dietitians, so universities should increase the number being trained. Funding should be available for specialist services such as bariatric surgery and intensive weight-loss programmes. Research into novel treatments, including the dental device, should continue.
Fat-shaming has no place in this discussion and should never occur, but we must keep talking about how to address the obesity pandemic and we urgently need action.
- Jim Mann is a professor of medicine at the University of Otago and director of the Healthier Lives National Science Challenge.
