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Tuesday, 2 October 2012

Fighting fat. The politics of obesity interventions

In the fall of 2010 the pan-Canadian Ministers of Health released a report on Curbing Childhood Obesity in Canada.  This was followed in June 2011 with a descriptive monograph of Obesity in Canada.  This site has addressed the issue of weight control on numerous occasions October 2011 , March 2012, June 2012.

In the short time since the formal national dialogue has begun on curbing youth obesity, there is lots beginning to happen.  One would expect a shotgun approach to finding out what works, and what doesn’t.  Lining up are the academic community on one side, looking for the research dollars from the trickle of beginning to flow from places like CIHR.  On another side are entrepreneurs looking for a share of a burgeoning market, whether in specialized camps, training facilities, weight loss programs or snake oil supplements to curb appetites.  On a third side are a group of funders who have historically funded children’s health care and looking to enter into the market and new issue specific groups like the Childhood Obesity Foundation .  On a final side are the traditional program structures of health and education  who are being expected to retool their operations to accommodate new weight control initiatives, and where such retooling is often an impediment dragged by inertia and the inability to stop doing other important work.

Speak to those in the know, and the solution lies in prevention.   Solid family and school healthy eating, supported by a community that encourages healthy foods.  Reduction of fast food marketing and access to youth, reduced screen time and increased daily physical activity.  The problem is that prevention isn’t sexy.  There is nothing to fix, and the costs to existing programs and products that might lose are enormous.  Industry interests from Apple to Burger King, from Game Boys to X-Box have investments that are dependent on recruiting new converts to their products. 

There are however developing school based and after hours interventions for youth identified as at risk for weight problems.  While listed as “prevention”, these early intervention programs are an integral part of addressing weight concerns amongst populations that have yet to habituate lifestyles.   The Canadian Obesity Network provides a list of combined prevention and early intervention programming that is a good reference Canadian Obesity Network  although the site is a bit dated in its postings and appears inactive since summer 2011.  

The third component is in intervention based programs.  Whether hospital based bariatric services like offered in Winnipeg, Shape Down in BC, Pediatric Obesity Clinics that are sprouting up associated with children’s hospitals.   These will be necessary intervention based treatment programs until effective prevention and early intervention are in place.  Such treatment programs however should be short lived if other prevention and early interventions are effective and supported.   It would be a shame to see major funding shifts that focus on treatment without matching such dollars with prevention. 

A late addition comes out of Wellesley Institute blog http://www.wellesleyinstitute.com/news/childhood-obesity-in-ontario-why-we-must-act-now/#.UGuHb0ea0UA.twitter . Another corporate style program forwarded via Twitter, and a community based demonstration project information on SCOPE. 

So the last question is probably the toughest and comes from the Wall street journal as New York City has waded further into government’s role in addressing obesity, who’s responsibility is it to prevent obesity, society or the individual?   Obesity prevention responsibility .  A more fundamental philosophical question is whether obesity  and weight problems are even a disease?  While they are a risk for illnesses, do they meant the criteria for being an illness themselves?   Your opinions are welcomed as a comment.   

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