Leading surgeons are lobbying to get weight loss surgery made available through the public health system. In the Medical Journal of Australia yesterday, surgeons Michael Edye and Michael Talbot claim it's the best treatment option for some.
Which may well be the case – but there are some things we could do first before we start assuming that surgery will cure everything. My own experience of extreme weight loss (well over 50kg) benefitted from a medical experience less invasive. But I'd argue that it worked well for a number of reasons.
And the main one is education around what we eat and how we move – in an environment which is non-toxic and non-punitive.
Watching the social media footprint of the AMA's Alcohol Summit last week gave one clear indication – if we are thinking obesity and its social harms, don't blame the fat person. Make sure the world we live in makes it possible to eat less, move more, know where calories come from.
Occasionally, I'll have a glass of full cream milk with a shot of the meanest espresso I can find. It serves to remind me of what a decent iced coffee tastes like, away from the baby flavour which passes for that drink in the local supermarket. And I know when I drink milk that there are quite a few kilojoules in my own private vice.
Milk won't kill me. And I drink it rarely. But there is one thing I drink two or three days a week and I don't know what's in it.
Yes. My favourite pinot. Reisling. Shiraz. Arneis. I'm pouring myself a glass of wine right now and when I look on the label there is nothing. No kilojoules. No carbs. No recommended dose. No warning that pregnant women shouldn't drink. Nothing. I'd be lucky to find a bottle which says there are 8.03 drinks in each 750 ml bottle (differs for each bottle too).
Alcohol makes us fat. It has other dangers. Yet its nutritional labelling is entirely voluntary.
Kate Conigrave, senior addiction medicine staff specialist at the Royal Prince Alfred in Sydney and a director of the Foundation for Alcohol Research and Education, says research says that less than half of alcoholic drinks have appropriate labelling. From the point of view of nutritional labelling, she says: "Let's bring it up to the standard of other food and drink products in our society . . . [alcohol labelling] is totally out of keeping with everything else we do."
But she is also appalled from a safety point of view – how is it, she asks, that every single alcoholic beverage is not labelled with a warning for pregnant women.
"The current guidelines are that it is safest to drink nothing . . . why should women not have the right to know that [alcohol] may harm their unborn child."
We know that today alcohol will kill 15 Australians and cause 430 hospitalisations. And we also know that labelling on cigarettes had a direct and near-immediate impact. Why aren't we doing the right think on alcohol?
Conigrave is furious – why, she asks, is alcohol exempted from all the normal controls and regulations. She can only assume that the alcohol industry has done too good a job of conning politicians.
Elizabeth Elliott, professor of pediatric medicine at Westmead Children's Hospital, sees the effects of those who don't know or understand the impact that alcohol has on foetuses. While it is not possible to conduct randomised clinical trials because of the ethical dilemma of possible harm, there is other research which shows the damage. Elliott says: "We know that if you don't drink, you won't harm your baby."
And she says that the decline in smoking rates is a model for what she hopes will happen with alcohol in Australia.
"We have done it with smoking, we can do it with alcohol."
Let me say this. Every single medical person I spoke to cheerfully admitted they enjoyed a glass of wine. And me too. What I didn't know was that a standard glass of wine is 130 calories. The kind of glass which gets poured for me at fancy restaurants or which I might pour myself is more likely to be 200 calories.
So it's a matter of health. But it's also a matter of safety. Why don't bottles have warnings about pregnancy? Why don't they mention the safe number of drinks to have each week? Or the fact that your decision-making might be impaired if you drink and drive?
Paul Haber, clinical director for drug health services and a professor at the University of Sydney, says the labelling would have to be consistent and mandatory if it is to have any impact. There is also, he says, a limit to how much information you can stick on a bottle of wine. That said, if you plan to have labelling on bottles, you will need to know how much of that dose is your recommended amount.
And folks, let me explain, four or five drinks a night, every night, is not recommended.
Haber says any measure would also need to be in concert with other measures – good to have labelling but Haber says there also needs to be price increases.
Here's the real challenge. Haber explains that popular measures are ineffective alone and effective measures are often unpopular. He knows price hikes work but even small ones make consumers unhappy.
For Australia, maybe a little unhappiness is a good thing.
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