Lifestyle is Medicine

By Garry Egger

From every reach of every corner of cyberspace I’ve been getting the same question, how does personal carbon trading work? It’s simple really, so lets do the obvious and start from the start!

Carbon emissions from the oxidation of organic fuel sources make up around 70% of the world’s greenhouse gases. These can now be accurately measured and attributed to the specific quantity of energy usage (ie, per unit of fuel, electricity, heating, cooling, etc) on a per capita basis.

Individual carbon emissions, and henceenergy use, are thus able to be given a value that can then betraded on an open market, like any other commodity.

The proposal for individual carbon trading, first mooted by Aubrey Meyer of the Global Commons Institute in the United Kingdom in 1996 and expanded upon by others, stimulatedinterest in the development of a workable financial incentive system that provides equity and efficiency in reducing nonrenewableenergy use and greenhouse gas emissions.

It proposes this through a system of “Contraction and Convergence”, with annual contraction of global carbon emissions over a number of years to an agreed sustainable, safe level, and convergence towards equal per capita emissions globally through trade of emission rights between frugal energy users (usually the poor) and profligate emitters (usually the rich).

An individual carbon trading system overcomes the huge deficiencies of current carbon offset systems, where trees are planted in the hope that they will “soak up” atmospheric carbon. Known by a number of names, perhaps the most current of which is TEQs (tradeable energy quotas), the scheme is based on the premise that about 40% of all energy use occurs at the individual and household levels.

Hence, while a corporate “cap and trade” system for carbon emissions (now accepted by most governments) may help reduce greenhouse gases, if the demand for energy among consumers remains high, the marketplace will overcome price rises.

For a personal carbon trading scheme, the plan is to allocate every individual an equal number of tradeable energy units per year, based on about 40% of a total budget (that includes both personal and corporate quotas) set by a central budgetary council. Each unit is equivalent to 1 kg of carbon released through energy usage.

Trade of units is conducted either through existing credit cards, or through a carbon card system administered by banks. Individuals who are left with carbon credits (ie, those who are frugal with non-renewable energy use) are then able to sell these back into the marketplace, thereby gaining financial benefit.

Those who overuse their quota pay a premium price for extra energy use. (A complete summary of the proposed practical applications of the scheme is available elsewhere.)

This system has equity, in that convergence occurs within countries from rich, high-energy users to poor, frugal users, and between countries, also from rich to poor, serving as a more empowering alternative to aid. Unused units are retired, with a view to contraction of the total energy budget to a sustainable level.

A discussion of the environmental implications of this system in a health context has recently been provided. However, the potential implications for the more than one in two in the Australian population who are currently overweight or obese have not been considered.

Image courtesy of  Stefan

By Garry Egger

As an epidemiologist and long term lifestyle medicine advocate, I’m constantly being asked “What can be done about this obesity problem?” It’s a question that sees me spend considerable time pouring over the peer-reviewed evidence and in particular the different interventions run in communities across the globe.

As you may well be aware, in Lifestyle Medicine we can trace most chronic health issues back to the ’cause of the causes’. These being modernity, industrialization, and economic growth. One of the big markers of our “illth” are obesity (at a personal level) and climate  change (or better still climate disruption) at a global level.

So I want to get the dialogue going on a stealth intervention to stop the pervasive disruption to our planet and its people. And the intervention is Personal Carbon Trading. So over the next few weeks I will publish my ideas as seen in the Medical Journal of Australia recently.

And as always, I am interested in your thoughts, so please comment below.

Did you know that over 15% of the world’s population are now overweight or obese? One approach to address this modern epidemic involves paying greater attention to the environmental antecedents, with systems for diagnosing and modifying “obesogenic” environments. However, the prospect of doing this on a large scale is daunting.

Localised programs offer hope, but expansion of these requires significant dedicated resources. The rise of global warming on the political agenda offers a unique opportunity for a “stealth intervention” to change this.

According to Robinson and Sirard, a “stealth intervention” for obesity is one done for another purpose that has a side effect of more physical activity and/or less energy intake.

Recommendations to reduce greenhouse gas emissions provide the opportunity to not only affect climate change and non-renewable fuel usage, but also coincidentally to change food and activity environments in favour of a more healthy energy balance, to reduce population levels of obesity.

Obesity is the metaphorical canary that has alerted us to the epidemic of lifestyle-related diseases, which now account for about 70% of all visits to general practitioners. Although genetics play a part in this, the star player is undoubtedly the environment.

Ironically, it is growth — although not only of the waistline — that links obesity, fossil fuel energy use, and climate change: growth of the world’s population, from around one billion people 200 years ago to over six billion today, and a projected nine billion in the next 40 years; growth in use of energy “sources”, and a consequent outpacing of “sinks” to soak up the additional greenhouse gases emitted; and, underlying all this, economic growth, with its built-in requirement for increased consumption, irrespective of outcome.

Energy is an underlying factor linking obesity and climate change: too little personal energy expended and too much food energy consumed in the case of obesity; and too much fossil fuel energy burned and waste emissions given off in the case of climate change.

Numerous reports and recommendations have been developed to deal with both of these, most employing appeals to logic or social responsibility, with a change in public attitudes being an implicit goal. But attitudes are not necessarily a driver of behaviour — often it occurs the other way around. Random breath testing, seatbelt usage, and pool safety are just a few examples of attitudes following behaviour that is legislated or regulated.

The axiom “legislate and regulate where possible; educate and motivate where not” provides health promotion with a wide broom for making healthy choices the easy choice. Using the other great modern motivator — the hip-pocket nerve — can also serve to improve the outcome.

Next up we will look at how personal carbon trading works. but for now, what are your thoughts? Would you go for a scheme such as this, does it have merits, and how could we implement it?

Image courtesy of JohnLeGear

By Garry Egger

Living in a rich country but being poorer than your neighbour, could be the cause of that gut.

Obesity is now bigger than Eddie McGuire’s Christmas list. But do we know why? Whilst not (yet) a Nobel Laureate, I can tell you that it’s largely down to what we eat (not necessarily how much) and how we move (not necessarily how much we exercise), with a little bit of family background thrown in.

Still, this is like saying ‘life is a sexually transmitted disease.’ It doesn’t stop it from happening. For more years than I can care to remember, I’ve been pushing the notion of an ‘obesogenic environment’ as the driving force behind why people eat the wrong foods and move too little. Now it seems, a new and less obvious social cause may also play a part. Equality and health.

In a new book called The Spirit Level British Epidemiologists Dr Richard Wilkinson and Dr Kate Pickett have shown that just about all health problems in a country are associated with the size of the income differential within that country.

Countries such as the US, the UK, and even Australia, where there is a big gap between the incomes of those in the top 20% of income earners, compared to those of the bottom 20%, do worse on all aspects of health, including obesity. Where the income differential is small, such as in Norway, Sweden or Japan, health and social problems – including personal happiness, are much better.

This is unrelated to the total income level of the country. The US for example, has the highest per capita income in the world. Yet it is last on every index of health in the richest 20 countries. It’s the wealth distribution within, rather than between countries, that seems to shape the health, happiness and well-being of the individual.

This is verified when the differences are looked at between states within the US. New England and Vermont have the best health and least income diferentials. Arkansas and Alabama have the worst of both. Why should this be so?

According to Wilkinson and Pickett, countries where there is a big income gap have higher levels of anxiety, lack of trust, and break down of social structures than those where people have to try less to keep up. And it’s not just the bottom of the scale that suffer. Obesity and ill-health for example are higher at all levels of social status in the unequal countries.

Obesity at every level in the US for example is up to twice and sometimes three times that in Sweden or Japan. But whilst it’s easiest in theory for an individual to eat differently and move more, how can one change social inequality to make the country less fat?

Surprisingly, agitation to limit excessive executive wages, a policy that is agreed to by 80% of the population, could go part way to having such an effect. Limiting corporate power, played out through political donations, could also have a health benefit. In those countries with good health status, there are different ways to achieve equality.

The Japanese for example have much less disparity of income. Japanese executives earn nothing like the 500 times the basic worker level of income that is paid in the US or Australia.

In Sweden and Norway on the other hand, excessive incomes are allowed but these are taxed accordingly to balance the system.

So next time, you’re poked in the belly and chided by some no-all drunk for being a glutton or sloth, come back with the line that it’s ex-Qantas chief Jeff Dixon’s huge executive payout, or Sol Trejillo’s golden hand-shake or bankers payroll exuberance that’s causing your corpulence. Then set out to get the bastards!

By Dr. Garry Egger

Practicing Lifestyle Medicine identifies that the environment influences much of what we eat and do for exercise. And while we can’t do much about the bigger‘macro’ environment, there are things we can do about the more local ‘micro’ environment.

Checking around the home for example might be a good start. Try a ‘home audit’ to check your micro-environment.

Changing the home environment can reduce the prospects for fat gain. So here is a check list which can be used as an indicator for modifying this ‘micro-environment’.

Get you patients (and yourself) to check the household for:

High fat foods: Try to make sure foods with more than 10g of fat per 100g are not stored in the house – or at least kept in a prominent position.

Accessibility of fatty snack foods and other ‘treats’: Put them up high, or away from easy sight if you do have them at all.

Oversized meals presented at meal times: Having them means the family are more likely to eat them, so keep the portion sizes down to begin with.

Low fat alternative products : Keep products like low fat, instead of high fat milk.

Limited fats or oils used in cooking: Don’t keep them and you won’t use them Low fat cooking methods and machines available (i.e. microwave, grillers)

Easy access to fresh fruit: Where fatty foods should be hidden, these should be easy to see and easy to grab for a snack.

Too many effort-saving devices: The things that STOP you moving (e.g. remote control TV; cordless telephones, leaf blowers, electronic kitchenware etc.).

Bikes or exercise equipment: If these are handy, they’re more likely to be used.

Limited eating places: get the family used to eating at the one place on most occasions. Then other places (like bed), don’t become a stimulus for eating.

Don’t shop on an empty stomach: You’re bound to buy more of what you don’t need if you shop when you’re hungry. Then these things lie around the house begging to be eaten.

If you would like to add any suggestions, please comment below. Remember we are all in this fight against Obesity and many hands make light work.

By Dr Garry Egger

Following on from my last two blogs I though you might like my 9 ways to spot a weight loss scam.

You see the  weight control area is full of ‘quacks’, all designed to lighten your wallet more than yourself.  Every day I get contacted by someone who wants to know if the cabbage soup diet is the answer to all their problems, or should they stop eating carrots because a book they got from a friend  said that it can slow your metabolism.

So I have created a Weight Loss Scam Filter.

All, or some of the following should be taken as an indication that a weight loss product or program is a ‘rip-off’.

1. Use of the terms ‘magic’, ‘wonder’ or ‘miracle’.
2. Use of a ‘new’, ’secret’ or ‘unique’ ingredient.
3. Ingredients from inaccessible places (e.g. ocean floor, Tibetan mountains)
4. Promise of dramatic weight loss in a short period.
5. Promises of ‘no effort’, ‘no exercise’, ‘no dieting’
6. Use of white coated ‘doctor’ in promotions.
7. Use of unconditional money back if a certain weight loss is not achieved.
8. Use of testimonials from ‘cured’ patients using only their initials.
9. Complicated (and usually unsupported) technical explanations of how the product works.

So next time you are looking at the latest fad, put it through the filter above. If you answer yes to any of the above, there you have it , a weight loss scam.

Have I missed anything here? If so, comment below.

By Dr Garry Egger

As promised, here are the following six tips to help you in your quest for proper long term weight loss. Or as was commented in the last entry, weight maintenance.

3. Don’t give up the grog – but beware the post alcohol binge
Usually first on the list of New Year’s resolutions (and first on those broken) is going off the grog. The confusion of knowledge in this area is astounding. Contrary to popular opinion, alcohol is not converted to fat. As a toxin, the body needs to get rid of it quickly, so it’s one of the first nutrients ‘burned up’.

If alcohol is combined with a high fat diet on the other hand, the alcohol is metabolised quickly and the fat ’saved’ in the fat cells for a rainy day. So it’s not a ‘beer belly’ you may have added over the Yuletide, it’s a ”beer plus chips or a beer plus peanuts’ belly. Cut the fats and there’s no need to cut the alcohol.

Now before you get too carried away with this, there is a downside. For some reason, as yet unknown, alcohol can encourage post-alcohol binge behaviour. You may have noticed how you never wake after a heavy night feeling like a salad.  What you lose on the swings, you can pick up on the roundabout.

4. Don’t drink anything you can eat whole
Like alcohol, sugar is not, in general, fattening in humans. In fact, the capacity for humans (although not other animals) to turn sugar into fat is limited. So a recommendation to reduce fruit juice in favour of the real fruit would seem to be out of place. But like with alcohol, if there is any fat in the diet, a large amount of sugar-rich foods or drinks (such as fruit juice) will mean the sugars are used preferentially as energy, helping to ’save’ fat for those lumpy bits around your middle.

Going completely fat free is not possible (or recommended), so it’s easier to give up the fruit juices in favour of the whole fruit. You’ll also get more of the fibre in the fruit, which tends to be more filling and help you eat less. Forget the ‘no added sugar’ or ‘natural’ labels, most fruit juices are naturally high in sugars anyway (vegetable juices on the other hand are not).

5. Get into a good bit of (low fat) dead animal
If you want something to get your teeth into, rather than out of, and still do your body a favour this year, look to increasing some low fat forms of protein in the diet – seafood, beans, lentils, lean meat etc(vegetarian sources are actually better for the environment). While all the emphasis in recent years has been on reducing fat and increasing carbohydrate, most people have forgotten the third major nutrient.

Protein is muscle food. Muscle burns lots of energy (fat doesn’t), and so by maintaining muscle with a high protein intake and some regular exercise, more of the flab you don’t want is likely to be burned up as energy.

Research into the Palaeolithic diet has shown that while dietary fat has increased through evolution from around 15% to 35% (helping to explain why we’re getting fatter), and carbohydrate has stayed about the same (although the forms have changed), protein consumption has dropped from  around 25% to 12%. Weight control experts are now looking to this as a possible positive change in nutrition for weight loss.

6. Eat anything that comes from the sea – except chips!
For years we’ve known that seafood contains a type of long chain fatty acid that can break down cholesterol in the body and aid in the prevention of heart disease. Initially it was thought that this was just in fish. And because early biochemical techniques suggested that shellfish, like prawns, were high in cholesterol, they should be avoided.

Now it’s been established that most seafoods are low in unhealthy, and high in healthy fats. We also know now that fish oils are metabolised quickly and studies have shown that you can actually lose weight by substituting fish fats for other fats. (Of course the benefits are lost if the seafood is fried, or coated in batter).

7. Don’t worry about getting fit – do what comes naturally
For years we’ve thought that fitness and fatness were the opposite ends of the scale – to reduce one, you had to increase the other. But a re-evaluation of research carried out in the 70s and 80s has shown that we got it wrong.

The ‘no pain, no gain’ motto is still a given for top-level athletes. But the main reason for the increases in obesity in Australia today is the decrease in daily movement due to the introduction of machines. In times gone past you would at least pump a fly spray to kill a fly. Now, a simple press of the button is enough. And who can remember the days of changing the TV channel or opening the garage door by hand?

Work by my own students suggests that technology has slowed us down by the equivalent of walking 8-10km a day – just in the last 15 years! And while machines get slimmer, those who operate them are getting progressively fatter. The weight control industry is likely to be kept fat keeping the computer industry slim for years to come.

8. Don’t wait up for the magic pill
Scientific eyes in the 1990s focused on ‘leptin’, a hormone which regulates the hunger. Initially it was thought that simply duplicating this would lead to a foolproof appetite suppressant pill.

The mentality is similar to thinking that because opiates exist as neuro-transmitters in the brain, a non addictive form of heroin could be made to  solve all our drug problems. Early attempts at mimicking leptin have been a failure as it becomes clear that nothing in physiology is clear. In the meantime, several other prescribed ‘miracle’ drugs for obesity have now been withdrawn – they don’t work or they cause too many dangerous side effects.

An effective weight control pill where you can stuff yourself stupid with whatever you like while you lie around the house and still look like Elle McPherson may not be out of the question. But don’t wait up for it this decade.

By Dr Garry Egger

January is the key player of the resolution season. So beware the resolution pedlars.

The weight loss market is rife with them. And the removal of advertising restrictions, as well as the ongoing rise in obesity (there are now 66% of men and 54% of women classed as overweight or obese) has guaranteed them a comfortable living. It’s a living that’s now also unencumbered by simple notions of truth and honesty in advertising.

But let me not be too harsh. After all, I am one who lives off the fat of the land – albeit, I hope, in an ethical manner. But it’s precisely for this reason that I feel obliged to point out some of the deceptions in my chosen field which, by imputation, tar us all with the one brush.

I’ve done this in several of my books (GutBusters, Professor Trim’s; Trim for Life etc). But the fact that none of these have been titled ‘The stuff yourself stupid with whatever you like while you lie around the house and still look like Elle McPherson diet’ means they will probably all be relegated to the remainder shelves quicker than you can down a pan fried ‘Mars Bar’.

So over the next few weeks I will provide my summary of traps for the wary player to start the second decade of the new millennium – a digest of digestion for proper long term weight loss!

Here are the first two

1. Avoid diets like the plague
Several long-term studies in obesity have now shown convincingly that diets – restricting food intake, or counting calories – don’t work. They can’t be sustained and they cause physiological adjustments in the body (i.e. reductions in metabolism), which guarantee that weight will be regained at some point – with interest!

Any restriction of food intake below the level required for metabolism plus an allowance used for energy requirements during the day (usually about 1.2- 2.00 times metabolism) can cause these adjustments. Even for a very light woman this would rule out a food intake below about 1200kcals/day.

A de-emphasis on any form of ‘diet’ in favour of an altered ‘ad lib’ pattern of eating, particularly by reducing fat in the diet and increasing fibre (fruit, vegetables, breads and cereals) is now favoured by most experts in the field.

2. Don’t fast – there’s long enough to do this when you’re dead
The average over-indulged Christmas punter will of course be tempted to starve him or herself into submission to pay penance for the weeks prior. If you’re tempted this way, you’re doing yourself a big disservice. Fasting is an even quicker way to cause physiological adjustment as the body goes into survival mode. In doing so it makes sure that you’ll never again be so afflicted by denial by granting you an extra slab of flab in case it happens again.

Contrary to popular opinion, fasting also doesn’t ‘cleanse’ the system or ‘eliminate fat producing toxins’. According to the American College of Sports Medicine it results in ‘ a reduction of blood glucose concentrations, excretion of high levels of potassium, nitrogen, sodium, calcium, magnesium and phosphate; reduction in blood volume and body fluids and reduction of the iron binding capacity of blood serum’. It’s enough to turn you off it till death.

Check out this blog soon for the other 6 tips.

By Dr Garry Egger

Greed: Good or bad? Gordon Gecko or St Thomas Aquinas? It should be a simple question. But is it?

Times change. There’s little doubt G.Gecko was right for his time.  Greed was good. It’s the way we got to where we are – not just the house and car, but the best health of any humans throughout history. And after all, isn’t health what economics is all about?

The answer again is not so clear. We have to go back to find out how the growth system of economics on which all our aspirations are based, works. 19th C ‘economists’ like John Stuart Millsaw that an economy had to grow to provide benefits for all. And growth requires more people, more production, and more consumption. Individual greed was one way of getting this.

But this came with a warning: In the Principles of Political Economy (1848), Mill warned that once the work of growth was done, a stationary economy would be necessary. John Maynard Keynes in saving the world from the great depression in 1930, said we may need to grow for up to 100 years but after that we would have to look to a different system because “nothing can grow forever.”

However, as we learned in recent years, to discuss the economic system (in contrast to its bits), has been like discussing falatio to a nun. It has split economics schools, with anyone daring to mention the dreaded adjective ‘sustainable’ within a word of the noun ‘economics’, usually sent to the knackery.

Yet, those in the health industry know that obesity, diabetes and other modern health issues are not simply due to lack of individual restraint, but are a side effect of the system. Obesity is merely collateral damage in the battle for economic growth.

The fact that such growth has a ‘tipping point’, beyond which negative returns occur, would seem obvious. Nothing can grow forever, and ‘growth beyond maturity is either obesity or cancer’. Contrary to expectations, doctors will also tell you that bad times, such as heralded by the 2008 GFC, actually lead not to more cases of depression, but less.

So St. Thomas Aquinas and all his righteous buddies of the time were right. Greed is bad. They even made it one of the seven deadly sins. But in contrast to G. Gecko, this statement reflects the past, but also the future. It signals the start of a new era, which must now capitalise on the gains of growth to date.  This doesn’t mean human growth must stop. A truly sustainable economic system (if this is not an oxymoron) will no doubt develop in stages.

But ultimately for humanity to survive, and for us to win the battle against the rising tide of lifestyle-related chronic disease, we must begin to lookto a different system of economics. That will test our capacity for adaptability as nothing else since leaving the trees. It might also leave a few traditional economists still swinging through the branches.

By Dr Garry Egger

New findings show how big CEO payouts and runaway executive salaries can cause obesity – and other health problems – but not to those who get them.

At first glance, the opposition to mammoth payouts to the likes of Jeff Dixon and Sol Trujillo, and executive wage levels into the stratosphere, smacks of sour grapes. But a new look at health and income disparities in the wealthiest countries in the world now justifies more concern than that just generated by avarice.

Figures put together by English researchers show that just about all health and social problems in a country, from mental health to obesity, and from teen pregnancy to violence in the streets, are made worse by an increased gap between the top and bottom 20% of income earners. Those countries where the gap is widest (ie. the US, UK and even Australia) don’t fare nearly as well as those where the gap is narrower (Japan, Sweden, Norway).

Remarkably, this could also provide an answer to the question of what’s driving the modern obesity epidemic.

Dr Richard Wilkinson is an epidemiologist with an upper class Oxford accent. Like other epidemiologists he studies the causes of disease. But unlike most of his professional peers, Wilkinson is not from a medical background. Instead, he studied economic history – a unique background for considering the real causes of modern lifestyle-related chronic disease.

At a recent International Conference on Obesity in Amsterdam, Wilkinson quietly surprised the world’s best obesity researchers by humbly apologising for not being a doctor. He then went on to explain that the answer that he and his colleagues had found for what causes obesity is not just sloth and gluttony, but how we fare against our neighbour.

For over two decades, Wilkinson and his colleagues, who include the venerated Australian epidemiologist Dr Michael Marmot, who has been knighted for his contributions, have been collecting data on health and social class. Marmot made his reputation on the finding that the lower one is on the social totem pole, the worse one’s health – independently of income, education and other factors that define social class.

Wilkinson expanded this by showing that it’s not an individual’s absolute income that matters, or even the per capita income of a country, but the relative difference between income levels within that country. In the US, where the highest 20% of income earners average more than 9 times that of the lowest 20%, scores are worse on all indices of heath and social welfare studied than in countries like Sweden, Japan and Norway, where the income differential is only around three.

The indices collected in a new book entitled ‘The Spirit Level’, with health researcher Dr Kate Pickett, include: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage births, and child well-being outcomes. In Japan, Norway and Sweden, although average income is lower than the US, all health indices are significantly better. There’s also a clear gradient between the world’s 20 richest countries on all indices, correlating to the size of the income differential. Australia is towards the US end of this gradient.

The big question of course is why should this be so?

Wilkinson presents data from a complex of surveys going back to the 1950s to show that anxiety levels have been rising in countries like the US over that time. From 1952 to 1993 the average college student was more anxious than 85% of the population at the beginning of it. And this is not just confined to college students. Studies in children have found that by the late 1980s, the average American child was more anxious than child psychiatric patients in the 1950s. There has also been an increase in a range of related factors, from the general feeling of threat (from crime, war, disease etc), to breakdown of social connectedness, with increased anxiety levels. All this appears to be less in more equal societies.

Anyone born before 1960 would empathise with this; from a time when houses didn’t need to be locked; when kids played in the streets without fear of ‘stranger danger’; when a verbal disagreement with a stranger didn’t climax in a crime scene.

But how can lack of trust, and the increased anxiety coming from this account for obesity? Wider gaps in income lead to wider waists according to Wilkinson because of the competition to ‘keep up’ by working harder, leading to less time for physical activity and more need for fatty convenience foods. Eating for comfort in times of anxiety is also a known cause of weight gain.

And if you don’t believe the difference between countries, the same effect is shown when states within the US are graded on income differentials. Texas and Lousiana are fattest and have 2-3 times the income difference of New Hampshire and Utah, which are the leanest US states, with the lowest income differentials.

According to Wilkinson, these figures confirm what should now be obvious: economic growth has ‘done its job’ in developing wealth in advanced countries. Now the job is to distribute that wealth more equally – both within and between countries. Studies have shown over and over that human well-being doesn’t improve beyond a set level of wealth. The current findings show that things gets worse, not just amongst the poor, but in all levels of society, where income is more unequal. Obesity is up to three times higher at all levels of society in the US compared to Japan or Norway for example, and not just amongst the poor.

It’s also no coincidence that when a measure other than Gross Domestic Product (GDP), the purely monetary measure of economic throughput that we use as our measure of progress is used, countries re-align themselves on the world well-being table. The US, with the number 1 per capita income drops to number 148 on a ‘happiness index’ (HI) measuring longevity, income and a subjective measure of well-being. Honduras, in the Caribbean, and Vanuatu in the Pacific leap to numbers 1 and 2 on the happiest places to live, from relative obscurity on a wealth table.

Of course these findings put health scientists into the dangerous territory of political policy. Limiting executive salaries according to Wilkinson, is a health, not an economic priority. Reducing the influence of multi-national corporations by introducing public funding of political campaigns, thus eliminating corporate lobbying, is a relatively easy structural change to make. Different countries on the good health end of the income differential scale also have different ways of ensuring greater equity: Japan for example has less of an income gap at payment; Norway and Sweden tax higher income levels more. Putting a cap on the amount people can borrow would also slow down the runaway debt bubble and reduce the increasing status gap.

There’s no way of going back to the past. And we’ve no doubt overshot the glory days of economic growth, where the marginal benefits of increasing investment exceeded the marginal costs. Climate change and the GFC has taught us that. But who is going to tell Jeff and Sole that their greed has caused my weight problem? Try explaining that to your GP.

Dr Garry Egger is Professor of Lifestyle Medicine at Southern Cross University and an Advisor to the World Health Organisation and Governments in lifestyle and chronic disease.
Dr Garry Egger is Professor of Lifestyle Medicine at Southern Cross University and an Advisor to the World Health Organisation and Governments in lifestyle and chronic disease.