Saturday, January 17, 2015

Solving The Fat Dilemna

I listen to a lot of podcasts, some climbing podcasts (go to The Dirtbag Diaries for an upscale climbing podcast, or The Enormocast - way more fun - for a grassroots climbing podcast), but mostly health and fitness podcasts, and, mostly (if not all) with an ancestral slant. After a while, you do hear the same thing over and over, but, sometimes there are some interesting nuggets. Listening to one such podcast recently I was struck by how humans are almost inevitably drawn to finding technical solutions to every problem that has ever arisen, despite the fact that some problems require non-technical solutions. Take the ever increasing levels of fatness in the Western world (and increasingly the developing world as more and more people take on a Western type diet) the solutions for which always seem to focus on various technologies. 

The first thing I noticed when we stepped off the air-plane in Mascot was how fat the average Australian is. Now I know that in these politically correct times we are not supposed to think of people as fat, overweight, or obese. Instead they are, I guess, "differently bodied", but, the truth is almost 70% or Australians are fat, and 25% of Australian children are fat. This is on par with Americans, frequently thought of as the fattest folk in the world, and only slightly ahead of Canadians (60%). Now you can argue that these overall figures are based on BMI which does not account well for muscularity, but, you've only got to walk down any suburban (or city) street, go to any shopping area, or, in fact, simply put your head out the door of your cave to see that the 66% of Australians who are overweight, are, in fact fat, not jacked. The classic Australian has a big protruding insulin resistant belly and a red face from chronic inflammation. Among women of child-bearing age it is, in fact, difficult to determine which are pregnant and which just insulin resistant ("just" is perhaps poorly applied when talking of insulin resistance). 

Many experts think being fat is a complex issue, not simply the calories in/calories out equation presented by conventional science. There is likely a complex interplay of hormones (insulin, ghrelin, leptin, cortisone, and others), the gut biome is implicated, reward centres in the brain are involved as are neurotransmitters such as dopamine, there are social pressures and individual psychology. Other experts (see Tim Noakes) think that being fat is relatively simple - eat more carbohydrates than your individual tolerance allows and you get a run-away appetite that leads you to eat too much (carbohydrate generally) and you get fat (note that people on Tim Noakes eating plan "Banting" are easily dropping substantial amounts of body fat). 

Standard nutritional and exercise advice generally makes people fatter rather than leaner, but, in the end, there must be some personal responsibility and there must be some personal impetus to be all that you can and not settle for being fat and ill. Traveling around Australia, I have been shocked by how much poor health Australians will tolerate. The average Australian is in such poor physical condition that simply walking is difficult (or impossible) and their ruby red faces glowing beacons of systemic inflammation could light up an entire city.

As Mulder famously said on the X Files, "the truth is out there!" Information is now readily and freely available on how to get lean and stay lean. Information availability alone, however, has never been a good motivator for behavioural change. Disseminating information is relatively easy, getting people to change their behaviours is notoriously hard. Perhaps that's why humans are always looking for a technological solution, like the "chemical gastric bypass" that is currently under research. 

I don't think any of these technological solutions will offer the answer. Somehow you have to get people to care more about their health, longevity and functional capacity and less about how good something tastes for the few seconds it is in their mouths. Because, from my observations, people don't really give a damn. Entire lives are ruled by instant gratification. In the end, getting and staying lean and healthy is all about delaying immediate short-term pleasure to gain longer term satisfaction. The day modern medicine can develop a pill for that, the fat problem will be solved. 

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