Dr Paul Hutchison: We can arrest obesity at birth

Some libertarians in New York are beside themselves that Mayor Bloomberg is requiring a range of high calorie soft drinks to be sold only in small containers. In fact, he is pushing a spectrum of diet, exercise, and non-smoking programmes.How could this happen in the land of the free?

The good mayor has been advised by public health experts that in parts of New York, especially lower socio-economic areas, obesity rates are topping 70 percent of the population. He's worried about the huge costs associated with the epidemic of non-communicable diseases such as type 2 diabetes, hypertension, atherosclerosis, and heart and lung disease.

In 2009 New Zealand was said to have the third highest obesity prevalence in the OECD, with 37 percent of adults overweight and 21.4 percent of children (27 percent of adults obese and 8.7 percent of children).

Alarmingly, the obesity rates of adult NZ Pacific Islanders are greater than 55 percent. Almost certainly the transition over the last few decades of dietary, exercise, work, and transportation habits has had a major impact. In a Hawkes Bay study between 1989 and 2000 a 300 percent increase in childhood obesity was observed.

As a former specialist in obstetrics and gynaecology for over a decade I have stressed to my parliamentary colleagues the profound importance of an optimal environment around conception, antenatally, and postnatally as to how the child will end up - whether it be from a health, education, justice, or social viewpoint.

Sir Peter Gluckman says there is now compelling biological and clinical evidence that those who have a poor start in life have greater risks of developing obesity and non-communicable diseases. He believes the most important political and scientific question is 'Whose fault is it?' - to what extent are these diseses a matter of voluntary behaviour and to what extent are they hardwired?

In their book 'Fat, Fate and Disease' Gluckman and Hansen stress 'unless we focus on efforts on the education and health of parents-to-be, and healthy human development in the first few years of life, we may fail to prevent risk of ill health and shorter lives in the next generation'.

Current methods for dealing with non-communicable diseases - optimal diet, exercise, and stopping smoking -are not enough. As obesity rates increase, surgeons and pharmaceutical companies are kept busy. But attention has to be paid to what Gluckman describes as developmental hardwiring of appetite control, developmental hardwiring of willingness to exercise, developmental set points for body weight and exercise.

In June I presented a 'New Zealand perspective' at a 'Global Obesity Forum' which is calling for a worldwide prevention campaign and where the main focus is to prevent childhood obesity at the local level. One such New Zealand programme is 'Project Energize' developed by Professor Elaine Rush and others which includes 44,000 children in 241 schools in the Waikato.

Expertly trained 'energizers' work in the schools to improve nutrition, physical activity, childhood obesity rates and the like. The outcome after eight years looks promising across all socio-economic groups and ethnicities at the cost of 20 cents per child per day.

From Gluckman's work we must recognise that prevention in adulthood will have limited success in isolation. We must also work with the food and beverage industry for win-win solutions.

It did not go unnoticed that Nestlé and Coca-Cola were major sponsors of the 'Global Obesity Conference'. Profits are vital for business success, but as Adam Smith once noted 'it is not from the benevolence of the butcher, the brewer, or the baker that we can expect our dinner, but from their regard to their own interest'.

If we want less obesity and diabetes we have to hardwire into our nation's psyche, through education of the scientific evidence, that our individual and collective interest will be best served when we demand to purchase healthy food and beverages. To get the food companies responding may require a combination of cooperation, coercion, and incentives,

What is evident is that a whole of life approach starting preconception needs to be taken. In my view this includes a strong reproductive health programme, prepregnancy nutritional literacy for both young men and women (as in 'Project Energize'), worlds best practice antenatal, natal, and postnatal care, and well-child checks extending through preschool to school.

For both children and adults it is important to have balanced nutrition, daily exercise, and not smoke (see Ministry of Health website).

It is a good thing the New Zealand government is setting the agenda of taking a whole of life approach; by not doing so there will be significant extra health costs, poor productivity, as well as premature morbidity and mortality.

* Dr Paul Hutchison is MP for Hunua and chair of parliament's health select committee, on combating obesity.