Opinion Piece: We can't let our kids die young

Urgent action is required to prolong the lives of a generation faced with 'diabesity'

24 January 2018

By Professor Bob Graham, Victor Chang Cardiac Research Institute and Professor Shaun Jackson, Heart Research Institute

In 2004, renowned American cardiologist Valentin Fuster and his colleagues made the startling prediction that “one in three children born in the year 2000 will develop diabetes, resulting in a 30 per cent reduction in life expectancy”. If true, this would cut short the lives of millions of Australian children by up to 25 years, making it the first time in human history that children would, on average, be leading shorter lives than their parents.

Is this possible and why isn’t this front-page news? No one knows exactly how bad the obesity and diabetes epidemic will become, but the voices of concern are growing louder as the statistics worsen, and in some communities it is far worse than many of us imagined a decade ago. Today, three times as many people in the world die from over-nutrition than from starvation or malnutrition.

The health implications of this “diabesity” epidemic are enormous. Obesity and diabetes are major risk factors for a broad range of cardiovascular diseases, including coronary artery disease, kidney disease, stroke and dementia. Diabetes also causes blindness and leads to limb amputations. Based on trends, this scenario will get worse, leading to a tsunami of cardiovascular diseases that could overwhelm a healthcare system already struggling to deal with an ageing population.

Much of the problem begins in childhood and the obesity epidemic worsens through our teens and early adulthood. Once considered a disease of middle and older-aged adults, we are now seeing type 2 diabetes far more commonly in children and young adults, leading to health complications at a far earlier age.

This is most dramatically demonstrated in our indigenous communities, where high rates of obesity and diabetes affect the health of those in their 30s and 40s. Sadly, it is our most vulnerable who are at greatest risk. But none of us is immune.

What can we do? Perhaps a good starting point is to learn the lessons of history.

This is not the first time we have faced a cardiovascular “epidemic”. In the first half of the 20th century, Australians experienced soaring rates of heart disease and stroke. Back then, the causes of the epidemic weren’t widely recognised, nor did we have insight into the necessary preventive measures.

Painstaking medical research during the 1950s and 60s helped identify the major risk factors, particularly smoking, high blood pressure and high cholesterol. Co-ordinated government actions including greater tobacco industry regulation and public health campaigns, plus advances in medical treatments and technologies, led to a dramatric drop in rates of heart disease and stroke.

This is one of the great success stories of the 20th century and has helped improve the life expectancy and overall wellbeing of millions.

However, the job is far from done. Heart disease remains our leading cause of death, and the gains made in recent decades are being reversed by obesity and diabetes. And this time the impending cardiovascular epidemic is different, with the effects of sugary drinks, unhealthy high-calorie foods and our sedentary lifestyle, rather than smoking and cholesterol, taking centre-stage.

Government-led initiatives are critical, as only they can directly regulate the food manufacturing and other industries that are contributing to the “diabesity” epidemic. Medical research is also vital, to understand how diet and physical activities influence the metabolic changes central to the development of cardiovascular disease. This new knowledge will be essential to help identify individuals who are at greatest risk and allow early intervention.

Expanding our public health campaigns is also essential in changing the “obesogenic” environment. Rigorous research can provide the necessary evidence to support specific interventions. Research will also help inform local councils, employers, schools, the media, medical practice, insurance companies and the agricultural industry on how best to work co-operatively to improve urban design, promote physical activity, improve the supply and affordability of nutritious food and encourage better eating.

Immense effort and resources are required to address these problems, but can we afford not to make this investment? In our view it would be immoral to not invest, because our children would die younger and inherit social, health and economic problems of a magnitude not seen before.

So, where will the resources come from? A significant burden must be borne by the food companies contributing to the problem in such a big way, earning vast profits from high-calorie, low nutritious-value foods. Perhaps, in addition to a “sugar tax” on sweetened foods and beverages, we should consider a much broader “health tax” on companies contributing to and profiting from our “obesogenic” environment, possibly including computer and internet-related firms.

Regardless of how funds are raised, substantial resources must be channelled into not-for-profit research organisations and government programs aimed at tackling the “diabesity” epidemic and preventing the looming second coming of cardiovascular disease. Medical research can help us understand why certain individuals are particularly susceptible to obesity. It is vital that effective interventions that can be used early in life are developed, while clinical trials will be essential in assisting patients at high risk of obesity or diabetes-related complications.

None of this will happen without overwhelming public support and recognition that we need to fundamentally change the unhealthy environment we have created for our children.

So, are we prepared to let our children die younger than us? This is perhaps one of the great moral challenges of the 21st century and a debate that our society must embrace.

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Shaun P. Jackson is director of cardiovascular research, Heart Research Institute & Charles Perkins Centre, the University of Sydney; Robert M. Graham is the former Executive Director, Victor Chang Cardiac Research Institute, and Professor of Medicine at UNSW.

Originally published in The Australian.