The David Gillespie Blog

Nicola Roxon thinks were too fat, smoke too much and drink too much. And all of this overindulgence is costing the country a motza. But don’t worry she’s got a solution. She’s going to nag us to death instead. This week she announced she’s creating the National Preventative Health Agency (NPHA).

This brand spanking new, taxpayer funded thingo will ”push, cajole and lead” families, schools, workplaces, industries, clubs and community organisations to encourage healthier living.

You don’t have to exercise too much imagination to understand what that’s going to look like. Get ready to be told you need to exercise more, eat less fat, stop smoking and stop drinking. Nicola’s health taskforce has observed that the stuff we’ve been told to do for 30 years isn’t working, and their solution is, ah, to do more of it?

Its timely then, that just last week, the Royal Children’s Hospital in Melbourne published the results of a study into exactly how effective that kind of nagging is. The research team asked 66 general practitioners to administer advice “targeting change in nutrition, physical activity, and sedentary behaviour.” The advice was in accordance with the national healthy living guidelines, exactly the same guidelines that Nicola plans to ‘cajole’ us with.

In the study, 258 obese Melbourne children were randomly assigned to either an intervention or a control group. The children in the intervention group saw their GP four times over a 12 week period and received all the recommended advice about nutrition and exercise. The kids in the control group lived life as normal without any nagging from their doctor.

Twelve months later, the researchers checked in with the kids to see what difference it made. The result was that the counselling “did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds.” The researchers went on to note that “and it would be very costly if universally implemented.”

Details are a bit light on at the moment, but I don’t think Nicola is planning to have our doctors nag us once a month. Even if she did, this study suggests the outcome would be exactly the same as doing nothing. And doing nothing sounds like it might be quite a bit cheaper.

Our standard health advice might be firing blanks but elsewhere in the world, similar studies with slightly different advice have achieved significantly more impressive outcomes. In the UK, 644 schoolchildren were divided into two groups. One group was told they would be healthier if they stopped drinking sugar (in the form of soft drinks) and the control group was not told that. The message was delivered in four one hour lessons (one per term) during a school year.

The group of kids who weren’t told about sugar got fatter. By the end of the school year, there were 7.5 percent more overweight and obese kids in that group than there were at the start. But in the other group there were slightly less (.2 percent) fat kids. No one was forcing the children to stop drinking sugar and they didn’t entirely stop. They just slightly reduced the amount they drank on average.

The UK study was done in 2001 and adds to the pile of over 80 studies which say that if we drink less sugar we lose weight. This kind of evidence seems to have escaped the mighty deductive powers of our health hierarchy. Because even in the face of unequivocal proof that the advice we give our children doesn’t work, we’re lining up for more of the same.

Nicola, the definition of insanity is doing the same thing over and over and expecting a different outcome. It doesn’t matter how often you nag us about exercising more and eating less fat or how many Quango’s you create to do it. The advice is wrong and it won’t get more right by saying it more often. It’s time to start paying attention to what the science really says rather than what Big Sugar would like us to believe it says.

Also published in Crikey

There are many good reasons not to be a lawyer. The conversation stopping, effect at parties. The requirement to undergo body cavity searches are every airport where you fill in a customs declaration. And the most pressing of all, the constant need to be up to date.

If you give advice which is based on out-dated information, there is no shortage of your colleagues happy to assist your former client in lodging his claim for damages. They will happily point out that of course you should have been aware of the High Court’s ruling in Muffy v The Crown handed down last Tuesday. And Courts will have little difficulty agreeing that you have been sadly remiss in your continuing education requirement, and strike you from the rolls.

We expect lawyers to be up to the minute because if they stuff things up, the consequences can be very dramatic indeed. Ok, bad advice won’t kill you but it might as well after they’ve carted off you last possession in the back of the repo truck. We have similar expectations of doctors, nurses and even paramedics for very similar reasons (except, when they stuff up it very well may kill you).

But for some reason when it comes to dietary advice all the standards of professional conduct appear to go out the window. Until now, that is. The word on the street today is that one of Kevin’s multitude of taskforce commission thingys wants to regulate the weightloss industry.

According to the Telegraph, the Preventative Health Taskforce wants a ‘wide-ranging review of diet products and a common code of practice drawn up covering the cost, the training of counsellors and the promotion of the diets’. The idea being that if they can’t prove the diet works (after say, two years), then it will not be approved for sale or the promoter’s license will be withdrawn or something like that (the details are a bit vague).

If this were to actually happen then it would be a giant step forward, but I’m not holding my breath. The little evidence there is on the effectiveness of diets (which hasn’t been paid for by the promoters) is damning.

One recent example is a study out of the University of Missouri. The researchers looked at two popular weightloss options and directly compared them over a 12 week period. What makes the study unique is that they didn’t just focus on the amount of weight lost. They dug a little deeper to determine exactly what kind of weight was lost. Was it muscle mass or fat? The news was not good for either option.

Fifty Eight overweight, sedentary (less than 60 minutes exercise per week) women were randomly assigned to either a group completing a Weight Watchers program (the largest and oldest diet program in the world) or enrolled in Golds Gym’s weightloss program.

The average participant was 32 years old, had a BMI of 30 (just on the border of obese) and a body fat percentage of 40% at the start of the 12 week program.

The average gym member lost about one kilogram after 12 weeks and the average weight watcher lost four kilos (about 5% of their body weight). More importantly, neither group reduced their percentage of body fat. Whatever they lost it wasn’t fat (which means it was either muscle or water).

Neither group improved their cholesterol or triacylglyceride profile. If they were heart attack or diabetes candidates before they started they still were when they finished. So after 12 weeks of sweating at the gym or attending weight watchers meetings and eating special (and expensive) meals, the end result was exactly … nothing. Oh, except the weight watchers lost some of their muscle mass.

I can’t see the diet industry just standing there and taking the imposition of a regulator and professional standards without a fight. There is a whole lot of lobbying between a story in the Tele and actual legislation. But it’s a fight we need to have. Sure, bad advice from a doctor might kill you a lot quicker than bad advice from a nutritionist, but that doesn’t make the advice any less dangerous, the profession any less in need of regulation, or the ‘professional’ any less legally (and morally) liable for their actions. Bring it on, and the sooner the better.

Also published in Crikey.

Apparently sugar doesn’t make you fat. It doesn’t give you tooth decay. And it also doesn’t make children hyperactive.

Now, stop giggling. There’s really true research to ‘prove’ all of this and you can get your own free copy of it from the Sugar Research Advisory Service (SRAS). I know this because Donnell Alexander was good enough to write in to the Waikato Times last week (Letters, August 5) and spill the beans. And Donnell ought to know. After all, she describes herself as being from the ‘secretariat’ of the SRAS and she’s a ‘NZ Registered Dietician’ to boot.

The SRAS ‘aims to encourage appropriate use and enjoyment of sugar as part of a healthy and balanced diet’. It does this by highlighting research that shows that far from being bad for you, sugar is really quite a good thing to have in the diet. The SRAS is wholly funded by the New Zealand Sugar Company, but I’m sure that doesn’t influence them in any way whatsoever.

Donnell must have only just scored her job with the SRAS because try as I might, I couldn’t find her profile on their website. I did however find quite a fulsome profile of her at Network PR, a public relations firm that helps ‘clients to convey complex information in ways that will help change attitudes and effect behaviour change around serious health problems such as obesity, diabetes and osteoporosis’.

Network PR describes Donnell as a ‘key member’ of the ‘food group’. And it seems Donnell is ‘expert at interpreting complex information for use with different audiences’. They go on to froth, ‘she recently assisted organisations such as New Zealand Sugar and Coca Cola Oceania prepare submissions to the Parliamentary Select Committee into Obesity and Type 2 Diabetes’. There are no prizes for guessing what those submissions said.

Let’s just put aside the possibility (remote, I know) that Donnell was trying to influence attitudes and change behaviour on behalf of an entity that makes a living from selling sugar. I sure she was just trying share genuine ground-breaking research that dispels all those awful myths about sugar.

It seems the core study is a summary of a workshop which took place in 2002. The workshop came up with the astounding recommendation that up to 25% of your diet could be sugar. The only reason they stopped at 25% was that they concluded if you ate any more than that you wouldn’t have room for stuff in your diet that you actually need to stay alive.

The workshop was sponsored by the International Life Sciences Institute (ILSI), ‘ a nonprofit, worldwide foundation that seeks to improve the well-being of the general public through the advancement of science.’ ISLI gets its money from folks such as The American Beverage Association, Cadbury, Nestle … well, you get the picture. But once again, I’m sure the financial interests had absolutely nothing to do with the ‘scientific’ outcome.

Strangely though, when you look at research that hasn’t been paid for by Big Sugar, you get entirely different results. I don’t want my research paid for by Big Sugar and then ‘communicated’ by people, expert at ‘changing behaviour and attitudes’. The (independent) science is done, the evidence is in and it’s unequivocal. Sugar consumption is the most significant factor in the accelerating incidence of heart disease, diabetes, obesity and a raft of associated illnesses. In that context it’s outrageous for the New Zealand Sugar Company to be propagating dangerous nonsense about sugar being good for you.

If you’ve been eating a bit too much sugar lately you might have forgotten to keep up with your reading on the dangers of fructose. So to help you out, here’s an interesting tidbit.

Back when Kevin was an MP rather than a PM, he made an inconvenient election promise that might be interpreted to mean he would fix the health system. So (being keen to be seen to be a man of his word), after he got the gig, he formed a Commission. The Commission was to gather submissions from anyone who cares and come up with recommendations on how to fix the health system.

The Commission duly performed as expected and (a year and half later) came up with sleep inducing statement of stuff-we-already-knew (in 123 parts). Unfortunately (and rather inconveniently) the Commission also suggested an actual structural change. They wanted to add basic dentistry to Medicare. Even more unfortunately, the Commission (clearly getting carried away with its own importance) suggested raising taxes to pay for the actual structural change.

Kev knew the media would eventually read the report and discover the tax-bomb. So he cut them off at the pass by announcing plans to have a ‘conversation’ (yep, another one) with the Australian people before anyone did anything. The plan was to punt the issue well beyond the next election. The nit-picky media (you know who you are) chose to focus on the tax rise rather than all the excellent stuff-we-already-knew (obviously being manipulated by the opposition’s friends in high places), causing a bit of a pickle for our hero …

No, this isn’t the plot for an episode of The Hollowmen. It’s very (and, all too sadly) real. But stepping aside from the political reality (that gradual change will most likely occur in due season), its worth looking at some of the concentrated wisdom of the health hierarchy so painstakingly collected throughout the report.

An overwhelming theme is that prevention is better than cure. So it’s a bit odd that the single biggest cost in the whole thing (and the only item with a specific funding proposal) is actually 100% cure and 0% prevention. The National Health and Hospitals Reform Commission want to spend $3.6 billion per year on basic dental services. The money will come from a 50% increase in the Medicare levy paid by every ‘working family’.

Dental services are primarily consumed fixing damage done by tooth decay. And the cause of tooth decay is established beyond any shadow of a doubt. There aren’t many occasions when Nestle, Coca-Cola and the World Health Organisation find themselves in complete agreement on a health issue, but this is one of them. Tooth decay is caused by the consumption of sugar.

Preventing a disease is rarely as easy or as obvious as halting the consumption of a single consumer substance. It’s even rarer to have everybody (even the people who make a fortune from selling it) agree that it does in fact cause the disease. The only other example I can think of is tobacco (yes, Big Tobacco did eventually agree). All of which makes me wonder why the medical and political responses to lung cancer and tooth decay are so very different.

We actively try to prevent people commencing consumption of tobacco. If they are foolish enough to do it anyway, we tax them into submission instead. The taxes raised vastly exceed the health costs of treatment and go to benefiting the whole community. Imagine our response to tobacco if it was the same as the proposed response to sugar. We’d be handing our kids a ciggy, resigning ourselves to the inevitability of them eventually needing extensive treatment for lung diseases and jacking the medicare levy up to cover the costs.

Since everyone is in wild agreement that the cause of tooth decay is sugar, why are we not acting to restrict its consumption? Why are we not doing anything to convince people to think twice before shoving it in their gob? Why are we prepared to mutely accept the damage it does and raise taxes to pay for it?

There are many reasons to be worried about sugar consumption. It causes heart disease, stroke, diabetes, obesity and helps cancer grow. But none of these are as black and white as tooth decay. We can’t even muster the political will to do something about preventing a disease that everybody knows is caused by sugar. We’d rather just jack up taxes than attempt any kind of prevention. So we have no hope of doing something about short circuiting the real drivers of the health cost explosion (obesity, heart disease and diabetes).

We’ve got our faces so firmly pressed against his large grey buttocks, that we no longer have any chance of seeing the giant sugary elephant sitting in the room. Before we race to slap a tax band-aid on the most obvious sugar disease, let’s really do something about prevention rather than simply making agreeable noises and having more ‘conversations’ with the Australian people.

Also published in Crikey.

Boy, am I glad my free thepunch.com.au subscription is up to date. I had barely pulled the digital cling wrap off yesterday’s copy before I noticed sugar was being hotly debated by none other than the big kahuna of News Limited’s foray into online journalism, David Penberthy.

Dave was taking the big stick to that icon of the Australian nutrition, Rosemary Stanton, for taking the big stick to that icon of, well, ah, crocodile stuff, Bindi Irwin. Rosemary was upset by an ad that Bindi had done which promoted a packet chocolate cake for Green’s. She didn’t think it was appropriate for a child to push unhealthy food to other kids.

Penbo came out flailing in defence of Big Sugar. Slamming Rosemary for delivering a ‘pretty out there tirade’, he went on to accuse her of being in ‘cloud cuckoo land’ and suffering from ‘bad taste’ while she was about it.

Rosemary, you have a point. High profile kids shouldn’t advertise high sugar (the cake mix is 37% sugar) foods to kids. They will want to buy it (otherwise, Green’s ‘significant’ contribution towards wildlife conservation will have been a waste of money). But it is cake mix. No-one is suggesting it is healthy, no-one is giving it a heart tick and no nutritionist is advertising it as a replacement for fruit or anything else. It’s a treat, we know it’s a treat and no-one is being duped.

David, you have a point – it’s just cake – but get a grip. Rosemary just said she was saddened by an inappropriate use of a child in advertising. No nuclear devices were detonated. Australia didn’t lose the Ashes. And no advertisers were harmed.

Don’t get me wrong, I am loving seeing the glitterati of the food debate (a little artistic license with that, I know) slugging it out in the broadsheets of the nation. But seriously people, there are bigger gummi bears to fry.

Streets want every child to get their ‘afternoon calcium’ from their new Paddle Pop Moos. They proudly proclaim every single ice-block has the calcium of ‘1 Glass of Milk’ but leave the fact that it is 20% sugar to the small print. Nestle would rather the kids get their daily calcium from Milo Duo ‘nutritious energy cereal’ (30% sugar) or a nice (Australian Heart Foundation approved) chocolate Billabong (19% sugar). Really health conscious kids are encouraged to go for some Uncle Toby’s Oats, So Tasty for Kids (30% sugar).

For that after breakfast snack, Kellogg’s wants you to feed your young iron-men Nutrigrain Bars and perhaps give the other kids some nice (heart foundation ticked) K-Time Twists (both 37% sugar – the same as the cake mix). And don’t even get me started on LCM’s (30% sugar) and their schoolyard commercials.

The problem is not that Bindi (or anyone else) is advertising cake mix. No-one is in danger of being fooled into believing chocolate cake is health food. The real problem is that food that should be clearly labelled as ‘high sugar confectionary – use extreme discretion when feeding to children’ is being marketed as the equivalent of broccoli ‘but fun’.

Why aren’t the hard questions being asked by the people who have the kind of firepower that gets column inches about chocolate cake? Why are nutritionists silent or complicit? These are the questions that need answering. Let’s leave spats about whether Bindi should have plaits or a pony tail to the school yard where it belongs.

Also published in Crikey

One of the real benefits of writing is that you often get to hear from new and interesting people. My piece about the Australian Heart Foundation last week inspired quite a few folks to plunge electronic quill into digital inkwell and dispatch missives in my general direction.

Leigh Sturgiss, executive director of the New Zealand Obesity Action Coalition tipped me off about another heart foundation having a bit of form in this area. She told me about the biffo involving Nestle across the ditch. Apparently in the Land of the Long White Cloud, even Nestle Milo is considered tick-worthy. The New Zealand Heart Foundation bestowed one of its ticks (identical in design, purpose and use to its Australian equivalent) on a ‘food’ which is 47.6% sugar.

The tick was featured as part of a national TV ad campaign in August last year telling people they could now say ‘Yes to Milo’. All sorts of people managed to get hot and bothered about that. Nutritionists stomped their feet and (not unreasonably) asked how on earth a product which is half sugar could get a heart foundation tick. The heart foundation leapt to Nestle’s defence and pointed out that if the product was consumed in small amounts and with low fat milk then it was ok. Strangely relying on children to consume chocolate in small amounts and seek out low fat milk as a strategy didn’t seem to placate the malevolent protesters.

But it’s all ok now, you see Nestle decided to drop the tick from Milo packaging at the end of April this year. “We just decided to pursue a different strategy”, said Nestle’s Maurice Gunnell and added (somewhat enigmatically) “… it served its purpose.” The ‘different strategy’ appears to have something to do with affixing Australian Heart Foundation ticks to the likes of Fruit Fix (72% Sugar), Milo B-Smart (with ‘only’ three quarters of the sugar of full strength Milo) and Billabong Ice-Blocks (to name a few).

Another correspondent who I shall call Warren was deeply troubled by my ignorance of the facts about sugar and saddened by my suggestions concerning the Australian Heart Foundation. Wozza is unusually shy for a member of his profession. You see he is a card carrying practitioner of the dark arts of public persuasion (PR and Corporate Communications). He marked his email ‘eyes only’ for me. Nevertheless he made some points (I’m sure entirely on his own behalf) which I feel should be discussed more publicly, so I’ll refer to them in a general sort of a way.

Oh, I almost forgot, a quick glance at Warren’s web CV (you know the one you didn’t know you had until you googled your own name) suggests a company he founded was once employed by none other than the Australian Heart Foundation to assist with, ah, communication advice. But I’m sure that had nothing to do with his need to express his anger at last week’s piece.

After affectionately describing the article as a load of nonsense, Woz went on to tell me a thing or two about sugar consumption. He concluded that there is ‘LESS sugar available in prepared food than ever before’. Really Woz? Ever?

At the start of the Second World War the average Australian consumed less than a third of their sugar from processed food (the rest they added themselves). By 1993, almost three quarters of their sugar was put in their food before they bought it. Even if our ‘two lumps in the cuppa’ habits had not changed in that time, food manufacturers made sure that our total sugar consumption grew significantly. The average Aussie now gulps down almost a kilo of sugar a week, but much like an industrial game of ‘Where’s Wally?’, I challenge you to find it.

Remember, of course, that even if you could track the sugar (from processed foods) down, you wouldn’t be able to add Fruit Fix to the list. The sugar in those little fellas is ‘all natural fruit sugar’ and is not included in the 50 kilo (per person per year) total for cane sugar consumption.

Warren then let me into a little secret. You see as well as being a master of the fifth estate, he’s right up on all the science on sugar metabolism (well at least until 2000, he concedes). He says the science doesn’t back me up and he ‘defies’ me to present substantiation. I know it’ll come as a bit of a surprise to Warren, but science didn’t stop in 2000. The boffin’s have managed to add quite a bit to the pile of human knowledge in this area in the last nine years.

Since many of my dear readers have probably got some interesting grass to watch growing or some newly moist paint to observe drying, I won’t enumerate the (over 3,000) studies on which I rely. I can however recommend a very tidy summary of some of the more pithy ones in an excellent round-up paid for by the University of California, the American Diabetes Association and the US Department of Agriculture. Woz, you’ll find that in your November 2002 copy of the American Journal of Clinical Nutrition. Oh, sorry, too recent for you isn’t it? Well here’s a link for your edification.

For the medically inclined, there’s an even nicer (but more estoric) summary in the January 2006 edition of Nature’s Journal of Clinical Practice: Nephrology.

All of this begs the obvious questions. Why is it left to a flak (that’s the technical term for Wozza’s profession) and lawyer (that’s the technical term for my profession) to debate the science? Why is the heart foundation missing in action? Why are they (and their NZ Confederates) handing out ticks to high sugar children killers? Why can’t Warren afford the cover price of a (truly excellent) book which summarises all the recent science?

Now this probably isn’t the reply that Woz had in mind when he sent his little ‘eyes only’ note. But I take particular exception to folks (who have a reasonable chance of being a mouthpiece for someone else) wanting to have secret discussions with me about the science. Warren, if you’ve got something to say, there’s a comment section at the end of the article. If you are saying it on behalf of someone else then direct them to the same section. Let’s have no more little private notes handed round the class behind the teacher’s back.

Also published in Crikey