How do we solve a problem like obesity?

Last month Niki Bezzant spent an intensive five days in a castle in Austria – a place used as a backdrop for The Sound of Music – thinking, talking and debating about why our kids are getting fat. Here are her, somewhat frustrated, thoughts after attending the Salzburg Global Seminar.

The Salzburg Global Seminar was titled: Halting the Childhood Obesity Epidemic: Identifying Decisive Interventions in Complex Systems. I was invited to be there, at the organisation’s home, Schloss Leopoldskron, as part of a group of 60 people: academics; health researchers; public health workers; former politicians; government representatives; doctors (medical and Ph.D.); and leaders of grass-roots movements. It was a huge gathering of big brains (as well as a few journalists like me) and  a hugely inspiring experience. At the same time what I learned was overwhelming, frustrating, heartbreaking and infuriating.

The Salzburg Seminar was founded in 1947 as a kind of think tank to solve the world’s big problems. And there’s no denying this one – obesity – is a biggie; a ‘wicked’ problem as people in research circles say. That doesn’t mean evil. It just means really, really hard to solve. The clue is in the name of the seminar: complex systems. That’s what we have to understand and deal with if we really want to figure out how to help our kids with obesity; to nourish them and give them the best possible chance of growing into healthy adults.

The overriding fact I was left with, is that childhood obesity – like obesity at any age – is not a problem of personal failing. It’s not an issue of poor parenting. It’s not a failure of willpower. That’s never been a rational explanation, when you think about it even for a moment. Humans haven’t suddenly lost their ability to parent, or had a mass loss of willpower in the past 50 years. Obesity is far, far more complex than that.

Another thing I needed to be reminded, is that obesity is a disease and it needs to be thought and talked about that way. People are not obese. People suffer from obesity. It’s an epidemic because it’s transmissible among families; communities and countries. If a child has a parent with obesity – mother or father – they are highly likely to have obesity, too. And there is huge stigma and bias aimed at people with obesity. Research has found prejudice towards people with obesity is equivalent to racial prejudice, with equivalent negative outcomes.

So what’s driving obesity? And what can we do about it? Again: wicked problem. One I really want to tackle in long-form form in the coming months. But here’s a very brief overview:

The world around us
Our immediate environment has a huge impact on our behaviour and that of our children. We live now – all of us – in environments experts describe as ‘obesogenic’. That means we’re surrounded by an overwhelming amount of ultra-processed, unhealthy food and marketing for unhealthy food. It’s almost impossible to escape. This has been demonstrated by local research, showing kids are exposed to alarming levels of ultra-processed food marketing on a daily basis; even when they’re in ‘safe’ places like home, sports venues or school. The way cities and towns are designed also impacts kids’ ability to move and get outside.

Growing inequality
It might be easy for us to say “Well, how hard is it to feed our kids healthy food, or start a garden?” But we may not realise how a statement like that comes from a place of privilege. Because the answer to that question, for a lot of people, is “it’s really hard”. One in five Kiwi kids lives in food poverty; that means their parents struggle to provide enough nourishing food. That’s heartbreaking; not only to think of children being hungry, but also because poverty has far-reaching effects, well beyond childhood, on almost every aspect of life. Obesity and food poverty are linked. Obesity is a disease of undernutrition, just as stunting from malnutrition is. Kids here in the most deprived areas are three times as likely to suffer from obesity as kids in the least deprived areas.

The bigger picture
Going even broader for a minute, there are big things in the wider world driving the childhood obesity epidemic. They include the global food system: the way we produce and distribute food; the increasing globalisation of the food supply and the dominance of a very few manufacturers of ultra-processed foods; the increasing influence of the food industry on food policy around the world; the corruption of governments.

Another driver is trauma, including the intergenerational trauma caused by colonisation. We’re getting really big picture here, but it needs to be considered. It’s consistent around the world that populations affected by colonisation are at far higher risk of obesity than others. And we’re fast learning that what happened to our ancestors can affect our health, too, in sometimes devastating ways.

Yet another driver is climate change. This is an adjacent wicked problem with which we are all familiar. Experts now speak of the Global Syndemic: the intertwined issues of obesity, undernutrition and climate change; the first two being forms of malnutrition which all over the world are the leading cause of poor health. In the near future, the health effects of climate change will seriously compound these problems too.

What can we do? 
If you’ve read this far you might be feeling a bit depressed by now. It’s easy to be overwhelmed. But I reckon there are some things we can do.

  • We can change our own mindsets towards all people – adults or children – with obesity. When we catch ourselves judging, we need to stop and remember all of the above.
  • We can remember it is the right of every child to have good health. Obesity is, in fact, an issue of basic human rights. It’s worth noting New Zealand is a signatory to the United Nations Convention on the Rights of the Child, one of which is the right to good health.
  • We can use our voices, as people with influence in various spheres, to talk about this. We’re falling down as a country in addressing this, and it should be something we feel angry about. It should be something we’re demanding of our politicians: what are you doing about this? Where is your strategy? What is your plan? How are you going to help us with this wicked problem?
  • No-one has to look far for strategies – health experts have been recommending them for at least a decade. They include small basic things like laws on the advertising of unhealthy food to kids; healthy food in schools; sugary drinks taxes. And it extends to broader actions in the areas of housing, employment, welfare, education and agriculture. It would be amazing to have the platform of meaningful legislation to work from and support communities, whanau and individuals to make healthy changes.

I don’t know about you, but I don’t want that old thing about this generation of kids being destined to shorter lives than their parents to be on my conscience.

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