Will We Ever Solve The Diabesity Problem?

Unless your head is firmly stuck up your you know what, you can't help but notice that Australians are getting fatter) and sicker.

There is lots of hand-wringing about the state of the nation's health. Yearly, it seems, federal and state governments launch some kind of initiative to improve population health. Some of these are downright stupid, and none of them work. Even the multi-factorial interventions never actually address the issues that contribute to the problem, some of which are not amenable to intervention - such as our evolutionary biology - while others are woven into the fabric of our lives so tightly that changing them is inconceivable.

Here is my take, in no particular order, on why the situation is only going to get worse:

• Evolution. We are biologically wired to seek out as many calories as possible while doing as little as possible. There are a few odd evolutionary throwbacks, people who do lots of exercise and don't over feed, but for the most part, biology rules and unless we are really conscious of monitoring and modifying our behavior constantly - which is pretty bloody hard - we will all follow optimal foraging strategy.

• The protein leverage hypothesis. Notwithstanding the propaganda pumped out by dieticians and Big Food, humans don't actually need carbohydrate, we need protein and fat. Fat, we currently have in abundance, however protein consumption, particularly quality protein from animal sources, is low in the general population and much of the protein consumed comes from poor sources like various grain products or fortified franken-foods. Turns out we are driven to keep eating until we meet our protein requirements. If the protein quotient in the food is low a lot of food must be consumed to meet protein requirements. This is why when people start eating quality protein as the centre point of their diet, their food intake decreases.

• Big Food. Although I think the term food is a misnomer. I would rather say Big Toxin Masquerading As Food but that is quite a mouthful. Optimal foraging strategy is behind all of Big Food's products. Get people to consume highly palatable but nutrient poor food and they will eat more and more and more both because of optimal foraging strategy and because of the protein leverage hypothesis. In the modern world, we are literally seeing people eat themselves to disability and death. Big Food is everywhere. Most of the grocery store is taken up with Big Food products, then there are the cafes, the bakeries, the milk-bars, the corner stores.

• A is for addictions. This is the one no-one ever wants to admit. Not people suffering from an addiction nor the public health institutions responsible for population health. Eat hyper-palatable foods and you get a surge of brain chemicals whose message is "that is fantastic, do that again." This works great for motivating people to have sex so that the species can proliferate, but it is bad news in a world where we are surrounded by Big Food. And, it's not simply Tim Tams and taco chips which are addictive. There is evidence that gluten in wheat triggers a similar response. In fact, when people go on a real food diet, one of hardest things to give up is bread. Addiction is not a sign of moral weakness. It is a normal response to an environment which is in direct conflict with our evolutionary origins.

• Moderation. We are told over and over by public health authorities, such as dietitians, that we should not give anything up because "moderation." Moderation, as the saying goes, is a myth. Turns out, we define moderation as anything that is a bit more than what we are doing right now. So, if I eat Kentucky Fried Chicken daily, I will define moderation as eating Kentucky Fried Chicken twice daily.

• A is also for advertising, and we are daily bombarded not only by Big Food advertisements but by the message that trying in any way to rein in our appetites is silly. You know what I mean. Advertisements that feature such slogans as "you deserve it," "you're worth it," "reward yourself," etc. Yeah, I know, we all like to say that we are uninfluenced by advertising, but the simple matter that advertising exists proves that concept wrong.

• Public health information and nutritional advice is just so bad. Dietitians are some of the worst. Somehow dietitians have come to view "food groups" - a construct of modern day humans - as written indelibly in stone like the mythical ten commandments. Moderation, intuitive eating, all foods can fit, these are the slogans of failed public health advice.

• We are getting progressively weaker, not just physically, but mentally. We are losing the ability to do things that are difficult for us because we have engineered life to be as easy as possible. Having an easy life has even become a status symbol. Given that the only way to be healthy in the modern world is to fight against Big Food, public health messages, advertising, and your own biology almost on a minutely basis, it is little wonder that so few of us are actually healthy.

• Reward. The reward for eating franken foods is immediate. A surge of dopamine and other neuro-transmitters that make us feel good. Going to a cafe, having a piece of cake with your coffee, it's easy, it's social, and it is the ultimate iterative feed back loop. Whereas the reward for opting out of the franken food is a long way off and difficult to visualize. Delayed gratification is not a good evolutionary strategy. 

• We are really good at adding things in but not taking things away. So we can be convinced to spoon dollops of butter or coconut oil into our coffee but giving up bread is like asking Charleton Heston to put down the gun. That slice of toast spread with industrial seed oil and jam, has to pried from "our cold dead hands."

The fundamental problem is that we have an evolutionary mismatch. Maintaining any semblance of health in the modern world requires us to fight not only our own biology but society at large. We must swim upstream like a spawning salmon. And we all know how that ends.