Issue 3 • 2021
RACP Fellow tackling obesity crisis at home and abroad
This edition we spoke with an inspiring RACP Fellow who is paving the way forward in obesity management in Australia and around the world.
Professor Louise Baur AM FAHMS FRACP is just months away from stepping into the role of President at the World Obesity Federation and will be the first paediatrician to take the helm. Starting her career in general paediatrics and then clinical nutrition and being one of the first ever paediatricians to be involved with the World Obesity Foundation, Professor Baur has been instrumental in raising the profile of childhood obesity as an issue of clinical and public health importance.
Professor Baur’s research has also helped improve management of childhood obesity and improve our understanding of the factors that help prevent obesity in the first few years of life.
Establishing a more sophisticated understanding of obesity
In the last 40 years since Professor Baur began working as a doctor, obesity management and our clinical understandings of it have evolved. Professor Baur says that over time we’ve developed a much more nuanced view of obesity as a disease – and that there are various interrelated systems that contribute to obesity.
Where previously obesity may have been understood as a problem that was simply caused by a bad diet, our approach to obesity has now evolved to see it as a disease that has various contributing factors like food distribution systems, stress, poverty, built environment structures, a community’s health status, childhood experiences, mental health and genetics.
Professor Baur says that she plans to continue this legacy of improving understandings of obesity prevention and treatment in her role as President of the World Obesity Federation.
“One thing I really want to address in my time as President will be reducing the stigma around obesity. People with obesity face so much stigma from their community. And I know from my paediatric experience, that children with obesity face stigma from their teachers, their peers, their parents, and even from the health profession.”
Professor Baur says that this stigma doesn’t help – it just makes the problem worse. “The stigma linked to obesity often prevents people from engaging with treatment options and can reinforce the problems they are facing with the disease. People with obesity often feel embarrassed, they buy the lie that this is simply a matter of eating less, and nobody can help them. The impact of stigma is cruel, and it has to change.”
Preventing obesity using a wider lens
There are many factors to address when it comes to preventing obesity. Professor Baur says we need to take a life-course approach, “What might work best for preventing obesity in an adult may be different from that in a young child.” “Unless we take a complex systems approach – going beyond an individual or family, and starting to think about the broader inter-related factors, such as food systems, physical activity infrastructure, transport systems, the built environment – then we will really be missing important opportunities to reduce this disease.”
“The reality is that most of the time, we physicians are often treating people living in a pathological environment. When you think about exposure to food marketing, lack of physical or financial access to healthy food and nutritional education, a lack of social and mental support structures, the list goes on, you can really begin to see how our modern environment is often working against us. And it’s different for every individual, and for every community.
“Most of the time, instead of being able to transform a patient’s environment – we are instead simply helping them to cope within it.
“I hope that the work we’re doing at an international level by getting these issues prioritised with the World Health Organization (WHO) can help us begin to shift the environment to work for us, not against us.”
“The longer we continue to stigmatise obesity and overlook the complexities of treatment and prevention, the longer we will continue to let down people suffering from this disease.
“There are many ways governments and healthcare systems can do better for patients with obesity. This includes, but is not limited to, better funding and resourcing for local primary health networks, improved specialist support options, and better access to appropriate treatments like bariatric surgery – which we know is extremely effective.”
Professor Baur also stresses the need to recognise the higher risk of obesity in Indigenous populations and find appropriate ways for prevention and treatment that will be supportive and healing. “We must do better to hear, include and be led by Indigenous voices in this process.”
Lastly, Professor Baur wants to make sure that the voices of people with obesity are heard and used to continue to improve treatment and support.
“We need more mechanisms for all people affected by obesity to be heard, particularly for those in low and middle-income countries. Over time these voices have been building, and I hope to provide a greater platform for these people in my leadership at the World Obesity Federation.”
Sugar tax: A tool to reduce obesity and save lives
Did you know that more than 2.4 billion litres of sugary drinks are consumed every year in Australia?
Excessive sugar consumption has a significant impact on chronic disease in Australia and Aotearoa New Zealand, including contributing to obesity, diabetes and heart conditions. Sugar taxes can incentivise people to choose healthier substitutes while also encouraging manufacturers to alter their products to reduce the sugar, and therefore reduce the tax rate.
The Australian Medical Association cites Australian modelling that estimates that a sugar beverage tax that increases the retail price by 20 per cent would lead to a reduction in the prevalence of obesity of around two per cent and healthcare expenditure savings of $609 million to $1.73 billion.
There is already a sugar tax in place in over 47 jurisdictions around the world, and this model has proven to be effective in improving health outcomes in the community. This all begs the question, what’s stopping us?
© 2021 The Royal Australasian College of Physicians