The prevalence of people who are overweight and obese has increased markedly over the past three decades in both developed and developing countries.
In Ireland about 60 per cent of adults and 25 per cent of children are overweight or obese. We conservatively put the costs of overweight and obesity on the island in 2009 at €1.6 billion. This includes both direct healthcare costs and indirect societal costs from disability, lost productivity and premature death. It does not include the effects on psychological wellbeing, social stigma and quality of life.
Governments around the world, including our own, are struggling to devise strategies that will stem and ultimately reverse this epidemic. These are the issues addressed in the latest book by Prof Mike Gibney, one of Ireland’s most prominent nutritional scientists. Gibney is eminently qualified to reflect on the myriad forces – biological, behavioural, environmental, economic and cultural – that drive the obesity epidemic and to propose potential solutions at both the individual and policy level.
For a book aimed at both general readers and policymakers, this is an ambitious undertaking. And while Ever Seen a Fat Fox? is excellent in many respects, it does not succeed at this level.
The book is written in a direct, engaging and combative style. Unlike many academics, Gibney is not one to sit on the fence in relation to key scientific issues or to conceal his disdain for researchers and policy advocates who approach the problem of obesity from a different perspective to his own.
Appetite regulation
The approach of those working in this area is influenced by disciplinary perspectives. For Gibney, the regulation of appetite at the individual level is the most important question about obesity, whereas for those of us in public health the core issue is the societal factors producing a threefold increase in the prevalence of obesity since the 1980s.
Gibney’s interests draw him towards the genetics of appetite control and the neural responses to images of high-calorie foods on brain scans. In his policy prescription, he medicalises the problem with a suggested programme of mass monitoring of blood pressure and blood glucose. By contrast, I am concerned with the marketing strategies of the food sector, particularly the targeting of children and adolescents with advertisements promoting foods high in sugar, saturated fat and salt, and I would prioritise public policies that support, as far as possible, healthy choices in relation to diet and physical activity.
Clearly, no discipline has a monopoly of insight on the problem of obesity, and we need to sustain research endeavour at both the individual and population levels in a spirit of mutual respect and collaboration.
The complexity of obesity and the related point that no single policy measure at either the individual or policy level will be dramatically effective in the short or medium terms are recurring themes in the book. This is generally accepted.
Indeed, a well-regarded 2014 report from the McKinsey Global Institute, Overcoming Obesity: An Initial Economic Analysis, argues that if we are to halt and reverse current trends, we will need an ambitious, comprehensive and sustained portfolio of initiatives by national and local governments, retailers, the food industry, restaurants, employers, media organisations, educators, healthcare providers and individuals.
In this context, however, I do not accept Gibney’s suggestion that those in public health (myself included) and other disciplines who advocate for specific measures to combat obesity, such as the proposed tax on sugar-sweetened drinks, are mostly self-serving, misguided populists, oblivious to the complexity of the problem.
I share his enthusiasm for greater emphasis on the promotion of physical activity (especially walking for at least 30 minutes a day for adults) as a key determinant of healthy weight, wellbeing and longevity. The short section on saturated fat and heart disease is one of the highlights of the book, and I would especially recommend it to health journalists, celebrity chefs and policymakers.
Gibney effectively demolishes recent nonsensical suggestions that “fat is back” and reiterates longstanding advice to reduce saturated fat from meat and dairy sources in favour of healthier fats from fish and plants. It is highly likely that this advice has contributed to the 60-plus per cent decline in death rates from heart disease experienced in Ireland since the mid-1980s.
Industry views
I am less sanguine about Gibney’s views on the food industry. For example, he dismisses the role of processed food in obesity on the basis that it accounts for no more than 10 per cent of our daily intake. This is a somewhat baffling argument, given that an intake of as little as 100 calories per day in excess of physiological requirements will produce weight gain of up to 2.2kg/5lb over a year. It is equally difficult to accept the argument that the role and influence of multinationals are overstated and largely benign.
Although he cites the work of the social psychologist Jonathan Haidt on the perils of ensnarement within an in-group with a narrow worldview, Gibney seems unwilling to consider that his own views on obesity may have been influenced by his alliances with the food industry, including research collaborations and paid consultancy work (all properly acknowledged from the outset).
In short, Ever Seen a Fat Fox? is curiously uneven. Excellent chapters on the history of the food chain and the regulation of intake sit alongside chapters that should have been omitted, notably one on "A miscellany of matters".
For the next edition Gibney needs an editor who will play to his strengths and persuade him to tone down the rhetoric. A section on obesity, environmental sustainability and climate change might also be in order.
Ivan Perry is professor of public health at University College Cork and principal investigator at the HRB Centre for Health and Diet Research at the university
