While Mediterranean regions are fighting it out for top healthy nation ranking, Australia is slipping.
Spain has overtaken Italy as the world’s healthiest country, according to Bloomberg’s 2019 Healthiest Country Index, while Australia has dropped two places to number seven.
Despite Australia’s escalating rates of obesity and heart disease, our nation is still well ahead of the US, which has slipped one place to rank 35.
For the Bloomberg index, countries are ranked on elements such as life expectancy and penalised for tobacco use, obesity and other health risks. Environmental considerations like hygiene and access to clean water are also factored in.
In the US, life expectancy has slipped as a result of premature death from drug overdoses and suicides, while the Mediterranean diet, with well-established health benefits, could help explain Spain’s and Italy’s superior rankings.
A different analysis by LetterOne, the Global Wellness Index, is also searching beyond economic data in their quest to identify a healthy society.
The latter index uses metrics including blood pressure, tobacco and alcohol use, obesity, government healthcare spending, rates of depression, happiness and exercise.
According to their breakdown, Canada ranks as number one out of 151 countries. The US doesn’t fare well on this one either, coming in at number 37, while Australia just scrapes into the top 25 healthiest countries at 23.
Overall, what stands out from both lists is that many smaller nations are outperforming countries considered financially well off, reflecting increased awareness that strong economies do not equate to better health.
Even though Australia is doing moderately well in the overall scheme of things, several facts can’t be ignored. For instance, we endure, on average, 11 years of poor health – topping other OECD countries.
Health equality has a long way to go, with a 10-year gap in life expectancy between indigenous and non-indigenous Australians.
More than half of Australia adults have poor health literacy and less than four percent of people consume recommended serves of vegetables and legumes while most Australians don’t follow guidelines for any of the five core food groups.
We are also the second highest meat consumers in the world, eating on average 95 kilograms per person each year (260 grams per day) compared to a world average of 35 kilograms annually.
This is a major concern, given that red meat is classified as a carcinogen by the World Health Organisation.
A recent Lancet report by 37 experts worldwide recommends a dramatic reduction in meat consumption – no more than 28 grams per day – and 100 percent increase in legume, nut, fruit and vegetable consumption globally.
The CSIRO recommends that Australians also need to invest resources to support aging, address increased rates of chronic disease and improve equity in health care access.
The link between type 2 diabetes and obesity is so strong that the condition, also known as obesity-dependent diabetes, is now referred to as “diabesity”.
Diabesity has reached epidemic proportions globally, prompting researchers to name this century “the unprecedented diabetogenic era in human history”.
Over time, diabetes causes serious health complications, including heart disease, kidney disease and stroke. It impacts peripheral blood vessels, eyes, gums, and even the brain, with Alzheimer’s disease now dubbed “type 3 diabetes”.
Obesity is also linked to heart disease and stroke, and other conditions including colon cancer, depression, liver diseases and gastroesophageal reflux disease. Both conditions result in poorer quality of life and premature death.
Various lines of evidence have revealed how obesity escalates diabetes risk.
When fat cells grow, particularly by 30 percent or more, they get “angry” and release inflammatory markers, causing chronic inflammation. These cytokines impact insulin receptors that prompt cells to let glucose in. The pancreas tries to release more insulin and eventually becomes exhausted.
Abdominal fat cells also produce hormones that further decrease the effectiveness of insulin receptors.
In the pancreas, fat cells directly reduce its ability to release insulin. All these factors lead to insulin resistance and high blood sugar levels – resulting in diabetes.
In turn, diabetes can reinforce weight gain. For instance, when it’s not controlled and glucose can’t enter cells for energy and important metabolic processes, the cells send out hunger signals.
Anti-diabetic medications including insulin can also increase weight gain.
Essentially, once set in, the condition can spiral out of control and has therefore been described as a slow poison.
Apart from a genetic vulnerability, most factors contributing to diabesity can be addressed before it becomes unmanageable.
The primary candidates are diet and physical activity, so warding off diabesity means taking charge of lifestyle habits.
A varied diet that decreases meat, processed foods and refined carbohydrates while increasing fresh plant foods such as fruit, vegetables, legumes, nuts, seeds and wholegrains is a primary defence.
Apart from reducing caloric intake and weight gain, this dietary approach avoids blood sugar spikes by reducing refined sugars and increasing fibre, putting less strain on the pancreas to release insulin.
Research suggests the antioxidant compounds and magnesium in plant foods help cells become more sensitive to insulin. Antioxidant polyphenols may also prevent diabetes in other ways, including their ability to stimulate insulin secretion and improve glucose uptake.
Plant fibre not only slows the release of glucose into the blood stream, it promotes intestinal bacteria that can improve the body’s glucose response, insulin signalling and insulin sensitivity.
Plant-based diets are also low in saturated fat, advanced glycation end-products (AGEs – oxidant compounds that are particularly high in cooked meat) and other dietary elements associated with insulin resistance.
Exercise can not only help deter weight gain; its numerous health benefits include improved insulin sensitivity. Experts recommend a combination of regular aerobic and resistance or strength training for optimal results.
Other lifestyle factors that can help maintain healthy weight and blood glucose levels include lowering stress and sleeping well.
Although health is core business for hospitals, junk food and soft drinks have long dominated kiosks and vending machines that line hospital foyers and corridors.
But now Queensland is leading the way with a long overdue move to ban these items, which are driving contributors to obesity, poor health and chronic disease.
The ban is motivated by a call to reduce junk food advertising and availability to children. But other hospital goers will also benefit from moves to promote healthy food.
Making these changes is not easy. The food and drink industry, which has long enjoyed binding contracts with hospitals, has complained that it was not consulted in the decision.
Australian Beverages Council spokesperson, Geoff Parker, called the move “an insult to people’s intelligence,” arguing that “People don’t want governments snooping around in vending machines or hospital cafeterias.”
But the world’s leading obesity researchers say making unhealthy foods less available is needed to address the global health crisis. The ubiquity of food that is energy dense and nutritionally poor is a clear contributor to its overconsumption.
The executive summary of The Lancet’s 2015 obesity series argues that “Today’s food environments exploit people’s biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods.
“This reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments.
“Regulatory actions from governments and increased efforts from industry and civil society will be necessary to break these vicious cycles.”
Targeting individual behaviours does not work, the researchers contend. They say a broad environmental focus on ‘denormalising’ unhealthy food consumption is needed – much like campaigns to reduce smoking.
That means changing social norms by creating an environment in which consuming unhealthy food and drinks becomes less attractive, less conventional and less accessible.
When trialled, healthier vending machine food and drink options have produced successful outcomes in schools, workplaces, hospitals and health services.
Evaluations of these initiatives not only reported that people bought healthier food items, but also that sales increased.
Behavioural economics tells us that people don’t necessarily make decisions based on careful weighing of risks and benefits. Behaviours are influenced by emotions, identity and environment – including the options available to us.
Based on this, contemporary research is considering how to ‘nudge’ people towards healthier behaviours and improve population health. When it comes to food, a grouped analysis of 42 trials in developed countries found that, on average, nudging strategies produced a 15.3% increase in healthier choices.
Healthier options in hospital vending machines and kiosks may not benefit the processed food and sugary drink industry, but people’s health and wellbeing could surely profit.
Posted by ProPortion Foods Blog on May 7, 2018 in Obesity
Sparse but increasing evidence points to a delicate balance between weight loss and weight gain in aging. While malnutrition afflicts a considerable segment of our aging population, the obesity epidemic has also hit Australia’s growing older cohort.
And the health effects are just as damaging. Overweight and obesity amplify risk of chronic diseases like heart disease, diabetes, cancer and even dementia. They increase declining health in aging and can trigger physical and cognitive disability, boosting hospital admissions, health care costs and mortality.
“Sarcopenic obesity” is a new term to describe age-related loss of muscle mass combined with increased body fat. Evidence suggests it may even have worse consequences for disability than sarcopenia without obesity.
Health professionals are wary of prescribing weight loss in older adults for fear of impacting muscles, bones and nutrition status. But evidence suggests that shedding excess weight at an older age, as in younger years, can improve physical function and reduce chronic diseases.
Excess calories and scant physical activity are primary risk factors for obesity at any age. These have also contributed to swelling obesity in advanced years.
“In an affluent country such as Australia,” the National Health and Medical Research Council says, “food is plentiful, easily accessible, often energy dense and heavily promoted, and daily tasks and recreation depend less and less on physical activity.”
Increased love of eating out, computer use, television viewing, labour saving technologies, restricted time, fear of crime, and greater use of cars are likely contributors.
Compounding these factors, age-related declines in hormone production can increase fat accumulation. Aging also reduces muscle mass. It compresses spines and makes people shorter. All this can unfavourably tilt the fat:muscle ratio, so simply stepping on the scales may not reveal increased fat.
Less than half of health professionals advise weight loss in overweight or obese older adults. Yet such advice is a good predictor of efforts to shed weight. In support, governing health bodies now advocate treating obesity in older adults.
In so doing, priority must be given to preservation of muscle mass, bone density and nutrient levels. Individualised care is critical to address any related conditions. The suggested target is a gradual 5% to 10% weight reduction over 6 months, followed by weight maintenance.
A nutritious, well balanced diet is always optimal for healthy weight and healthy body. Plenty of plant foods provide nutrients that support good health and can be eaten in bulk without consulting the calorie counter. Round this out with oily fish like salmon, tuna and mackerel, dairy products, whole grains and healthy fats. Bin highly processed foods and refined carbohydrates.
The golden years demand special attention to consuming adequate protein (1.0-1.2 grams per kg per day) to help maintain muscle mass and bone health. Vitamin D and vitamin B12, notoriously compromised with age, are recommended as supplements. Fibre—from plant foods—and plenty of fluids will help keep things purring along.
Regular exercise is the crowning jewel—it burns energy to help shed kilos, maintains healthy muscle mass and bone density, supports a healthy immunity, reduces chronic physical illness, and helps keep the brain sharp.
Minimum physical activity recommendations are individually, professionally tailored aerobic exercise (increasing heart rate and breathing) 30 minutes a day, 5 days a week, and strengthening exercises at least three days a week.