Fighting a losing battle against obesity

TOM FITZSIMONS

For 10 years now, Robyn Toomath has been leading a campaign against our bulging national waistline.

She is a social gadfly, the Cassandra of the obesity epidemic.

She has given countless interviews, on everything from the sex lives of overweight people to school tuckshop guidelines, from sleep-deprived kids to KFC's Double Down burger, always making the case for regulating junk food.

Unfortunately for her, and for the public health system, she has very little to show for it. "I can't see anything appreciable, anything I can hang my hat on and say 'Gosh, look what we've achieved'," she says, laughing as she sits in a Wellington cafe.

"So either I decide it's all been a complete waste of time, which, you know, would be a completely credible stance to take, or I say that, who knows? Maybe my campaign is like water dripping on a stone, where little bits can change slowly."

There were good signs for a while, she says. New guidelines in school cafeterias were a start, but they were pulled by Education Minister Anne Tolley – "for no reason other than perverseness as far as I'm concerned: that was a terrible thing to do".

She initially criticised a big project called Healthy Eating Healthy Action as too "soppy" – but in retrospect, she says, at least it was a "cross-government approach to obesity, of which we've got nothing now, nothing at all".

A review of public health legislation that was moving towards regulating advertisers has been buried.

"So everybody in the public health sector feels a bit crushed. I think the response from government is appalling."

Dr Toomath, 56, has mostly grey hair, a black leather jacket. She has a stern look about her, but she turns out to be talkative and open.

As well as founding and speaking for the lobby group Fight the Obesity Epidemic (FOE), a job she does in her spare time, she is clinical director and a general physician at Wellington Hospital.

That means she divides her paid work between hospital management, with all its squabbles and challenges, and hands-on medicine. She trained as an endocrinologist – her diabetes work first got her worried about obesity – but she has mostly given that away for general medicine.

Now, after 30 years in Wellington, Dr Toomath and her husband, the poet and writer John Newton, are moving to Auckland.

They have a bach on Waiheke Island. They are going to pull it down and build a new eco-house, with solar panels on the roof and a big, self-sustaining vegetable garden on the northward slope.

"Somebody Facebooked me the other day when they heard I was leaving. And they said, `Oh my God, we think of you as the quintessential Wellingtonian – how can you be leaving?' It does feel very strange, I have to say. I adore Wellington."

Her new job is the same as her old one, except it is at Auckland Hospital. She applied after being asked up there to review a service. ("It had got into a sad state and there was low morale ... they lost their way a bit," she says.)

She has a long family connection to Waiheke Island, where she has always imagined herself retiring. Her two daughters have their first jobs in Auckland, too, so she is excited about going north. And what about the campaigning role? Will she keep talking about obesity? She sighs. She has been thinking for years about flagging it, wondering if things are too hopeless. And she hates doing live TV. But then again, she does not have to look for the work.

"And I haven't lost my determination as to what should happen. I haven't gone off the boil in terms of thinking it's not worth it or this has been the wrong approach or whatever. My desire to get things changed is still very strong."

DR TOOMATH'S thesis is simple, but great fodder for libertarians and the talkback radio crowd. It goes like this: it is not their fault. Obese people did not choose to be that way. No-one would. Instead, they are at the whim first of their genes – especially those that control appetite – and then of an environment that is saturated in energy-dense, crappy food options.

The combination means a population that is getting fatter with all the health problems that causes – exploding rates of diabetes chief among them.

You might have already noticed this, but this view violates a core belief of people everywhere, of the modern mind even: that we are free to make our own destinies. That we are free to go to the gym and run off that beer belly – or just stop drinking the beer.

Dr Toomath is honest about this. She is not a big believer in free will at the best of times, she says, and especially not in this case.

"The idea that we can describe the problem in terms of personal responsibility, you know, that it can be called a choice, a lifestyle choice, it's crap. There's no choice ... To think that people choose to be obese, and if you educated them better, or if they were more steely and determined, self-denying, that they could not be the shape they are, is just rubbish."

For evidence, she says, look at famous people who cannot control their weight – the Oprah Winfreys and Sarah Fergusons. They have every reason, every resource, to try to stay slim, and yet they cannot.

"And yet here we are expecting our entire population, just ordinary folks, who walk past McDonald's on their way home from school and what-have-you, we're expecting them to show resources that people like Oprah Winfrey can't amass. It's just crazy."

Or sit at a World Health Organisation conference, as she did, and watch country after country around the world present a picture of skyrocketing obesity rates. A massive decline in global willpower?

Or spend years telling people if they just lost three or four kilograms, they would not have to go on insulin – a powerful motivation – and then watching them fail.

"In the hospital clinics, you'd have records that go back years and years and years. And you'd see people – they'd lose weight and then they'd regain it. I was thinking `What am I doing here? This is crazy'."

IF YOU accept Dr Toomath's premise, the justification for intervention becomes more understandable. A fat tax, subsidised fruit and veges, school bans on tuckshops selling junk food, advertising regulations – she has backed them all.

There is opposition, of course. Columnist Kerre Woodham wrote that "if Toomath and her ilk had just shut up about this burger, I would never have known it existed", before chowing down on a Double Down.

Writer Joe Bennett invited her to play him in squash (something to do with a gripe about the Body Mass Index) – "just name the day and I'll thrash the medical pants off you". She regularly gets painted as "a fruitcake", or "the fat nazi".

"Which is hilarious, actually. I'm actually deeply, deeply conservative in my views with regard to this ... There are thousands of academics and public health specialists for whom this is absolutely boring, bread-and-butter, routine stuff."

She is not ideological about it, she says. She did not start out wanting to control the environment so much. "It was a purely practical response to a problem. And that's still my view. If somebody came up with a pill, if somebody came up with genetic modification – you know, if anything worked, I'd be all for it."

About 10 years ago, Dr Toomath stopped telling her obese patients to lose weight. There was no point, she says. It was just adding misery to a lot which is already very hard. Instead, she just tries to care for them however she can.

"I think obese people in hospital for a long time had a really rough time. I think the discrimination shown towards obese people is worse than any racism or any other kind of discrimination certainly that's been experienced in New Zealand."

DESPITE her lack of policy success, Dr Toomath is not gloomy. It does not seem to be her style. She's actually a little optimistic, she says, after some of her recent conversations with people. She is heartened, too, that the Labour Party has backed taking GST off fruit and vegetables.

"I'm a pollyanna maybe, but I kind of feel as though maybe the general community is starting to get it," she says.

Obligatory down note: "The terrifying thing, though, is that it's all going to be too late. It's all going to be too slow and too late."

Dr Toomath should be used to intractable problems, you would think. She is in management in the healthcare system, after all. She has been through junior doctor strikes and hospital revamps and the public release of information about serious medical blunders.

So how do you run a good hospital? She laughs. God knows, she says. It is about the most challenging work environment around – doors always open, insufficient resources, people in pain.

"You can't fix things in a hospital. To think that you can make it all all right is a nonsense. There'll always be challenges that exceed your ability to fix them."

But at the same time, she says, almost everyone who goes into health is highly dedicated. She thinks management is about trying to harness that energy.

"They whinge a bit, and they complain about this and that, but in actual fact, they're exactly the same now as when I was a medical student."

She could never give up working with patients, she says. That has always been part of the deal since she went up the chain. It is why she still thinks medicine is the best job.

"It's not just about fixing people, because you often don't. It's about providing comfort for people who are frightened and ill."

Her new Auckland life will see her catching the ferry from Waiheke Island each day, maintaining her 55-hour-a-week job, with obesity campaigning on top of that. She does not have time for passions outside of work, she says, though her dedication to her family is obvious.

The only sadness in her life at the moment is that her burmese cat, Woody, has gone missing. He has not been home in a couple of weeks. She is hoping he has been weathering the big chill in some stranger's warm house.

She finishes up her coffee. Maybe it is chance that she is leading the anti-obesity charge. It is almost like she has not had a whole lot of will in the matter.

"I know it's just been the circumstance in which I've found myself, that having been a diabetologist, and having been in a position where I can speak, that I kind of feel I have to, really."

FAST FACTS

A 2006-07 survey found 63 per cent of Kiwis were overweight or obese.

That number was expected to be even larger now.

More than a third of children were overweight.

Those figures put New Zealand in the same bracket of obesity as the United States – one of the fattest countries.

According to the Health Ministry, about 826,100 (26.5 per cent) of New Zealanders are obese. Another 50,000 are extremely obese.

The ministry's Nutrition and the Burden of Disease report showed being overweight was a risk factor in 11 per cent of all deaths.

Obesity is more common among Maori and Pacific people.

- © Fairfax NZ News