After NSW Health Minister Reba Meagher yesterday announced a $36 million strategy to tackle obesity, many people rang in to radio stations to express their concerns about taxpayers’ money being used to treat what they saw as the result of lifestyle choices.

Some callers were disparaging about the nanny state getting involved in obesity prevention measures. Funny about that because the persecution of smokers to protect them from the health consequences of their own folly will probably go down in history as taking nanny state-ism to art form status, and I’ll bet that many of these same callers were all for it.

While we’re on this subject, can anyone please tell me why Nanny thinks it’s OK to ban tobacco use just about everywhere yet she doesn’t seem to feel it’s her responsibility to stop her charges from self-destructing on lethally fatty fast foods? And why doesn’t she intervene to modify urban environments which actively promote inactivity?

The magnitude of the obesity problem is much described these days, both in the scientific and lay press, but its nature is not so often analysed deeply. Could this be because we can’t face its ‘dark side’ — the one that reminds us of lemmings’ suicidal scampering (maybe lumbering in this case) en masse into the sea? Or is it because we can’t explain the illogic of why the fast food chains seem to have inherited a special strategic gene for warding off legislation, regulation and taxation that the tobacco giants missed out on?

Why does Nanny play favourites? If she can act decisively and effectively to reduce smoking, why can’t she act to reduce obesity and associated chronic disease risks? What if Nanny came to her senses and wanted to rule the playground with an even hand? What could she do?

For starters, she might need to see that obesity is not purely the responsibility of the Health Minister, and that many other portfolios need to be involved.

Then she might ask Treasury to develop some strategies to help redress the health differential between those who live in affluent suburbs and those who live in disadvantaged areas. For example, we know there is a socio-economic gradient associated with obesity, diabetes, heart disease and poorer health outcomes generally. We also know that poorer socio-economic areas are home to around 2.5 times more fast food outlets than their more affluent counterparts. So, if Nanny really wanted to level the nursery floor, what else could she reasonably do?

Perhaps she could call on the law. No, I’m not talking about banning advertising – it’s much more subtle than that. It’s about strategies like applying zoning laws to thin out the over-abundance of fast food outlets in high-risk areas. So if the NSW Government really wants to get serious about tackling obesity, it should be examining how California is using zoning laws to make it easier for people to make healthy food choices.

And, Nanny could insist on warnings and information about calorie content on restaurant food. After all, if the nannies that guard our cousins in America, the land of personal responsibility for just about everything, can do it, why can’t our Nanny do it too? And, while she’s at it, maybe she could get some joined-up legislation going — the long-awaited uniform national food labeling system for instance.

Nanny, what exactly are you waiting for?

Associate Professor Ruth Colagiuri heads The Diabetes Unit at the University of Sydney’s Australian Health Policy Institute and co-directs the Oxford Health Alliance Asia-Pacific Centre.

Talk back! Join the discussion about this article on Croakey’s health forum here.

Peter Fray

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