Name: Melvin Teo
Student Number: n7689594
Tutor: Abbey-Rose Hamilton




A few years ago, Jackie Gleason had a big heart transplant in Chicago, a five-hour operation. It took the doctors four hours to get him on the operating table.
- Bob Hope (Confessions of a Hooker)



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A Larger Cultural Artefact
An obese woman with her calf and feet submerged in water was unaware that she was about to sit on the floating ball. Her look of uncertainty if the “chair” would support her suggested she might not have thought of the repercussions, she as an obese person has on the society. The effect of obesity has already begun (feet underwater). In this essay, I will address the consequences of obesity on society.



Public health
Obesity is a multifaceted matter and has been under the limelight by the World Health Organisation. Obesity has been considered the ‘global epidemic’ (World Health Organisation, 2011a, para. 1). Australia has become one of the highest prevalence of overweight and obese persons in the world (National Preventive Health Strategy, 2009; International Association for the Study of Obesity, 2010). In Western Australia, obesity has overtaken smoking as the number one preventable cause of disease (Department of Health, Government of Western Australia, 2010, para. 1). It is predicted by 2025, there would be more than 7.2 million (28.9%) of the population would be obese (Access Economics, 2006)
A comparison between National Nutrition Survey 1995 and National Health Survey 2007-2008 in figure 1 represented a rise in ‘Overweight’ and ‘Obesity’ categories with a reduction in ‘Normal weight’ category (Australian Bureau of Statistics, 2011). This notable epidemic has negative effects on oneself, society and the economy. This essay will address the effect of obesity.


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Figure 1, a comparison of the different Basal Mass Index (BMI) categories between National Nutrition Survey 1995 and National Health Survey 2007-2008.



Literature review
Obesity in this sense is attributed by an over imbalance of food intake and less energy expenditure over time (Food and Agriculture Organization of the United Nations, 1998, para. 11). BMI is used to classify an obese person with a BMI of 30 kg/m2 and above (Access Economics, 2006). With three in five adults either overweight or obese (Australian Institute of Health and Welfare, 2010), it has an impact on an individual health, the society and the economy (Bhattacharya & Sood, 2011, p. 147; Reilly et al., 2003, p. 748-751; Robinson, 2011, p. 10).

Individual

Obesity and health has been widely researched in recent years and it is linked to several chronic diseases; cardiovascular disease, type II diabetes, hypertension, dyslipidemia and cancers (Björntorp, 1997, p. 173; Fontaine & Barofsky, 2001, p. 423; National Heart Foundation of Australia, 2004, ), as well as a reduction in life expectancy (Bhattacharya & Sood, 2011, p. 140), to cite a few.

An American study conducted by Fontaine et al. estimated the relationship between life expectancy and obesity across lifespan (Fontaine, Redden, Wang, Westfall & Allison, 2003, p. 187). In figure 2, it illustrated a trend that younger adults with increasing BMI would incur a lower life expectancy as compared to older adults, against the average life expectancy. Such observable facts were the increase in complications associated with an increase in BMI.

Picture1.png
Figure 2. The x-axis shows the BMI from 25 - 30 (considered overweight) and 30 and above (considered obese) and plotted against years of life lost on the y-axis. The graph also depicts the year of life lost in different age groups ranging from 20 years old (lightest colour bars) to 70 years old (darkest colour bars).

A Spanish cross-sectional study of 245 older children (13.22 ± 1.8) has concluded the increasing of weight has impact on their development of foot structure which contributes to a lower medial longitudinal arch (MLA) or flatfoot. An alteration in balance and gait is one of the complications which could produce abnormal lower extremity alignment – knees, ankles and hips – with pain in adulthood (Villarroya, Esquivel, Tomas, Buenafe & Moreno, 2008, p. 39, 43-44).

Another dimension to look at is the connection of obesity and functional capacity. People who were obese reported to have a poorer functional status (such as walking and climbing stairs). This could attribute a reduction in social activity which affects an individual from living a fuller and complete life. It could pose psychological and psychiatric problems (Fontaine & Barofsky, 2001, p. 173-175).
Obesity affects individual’s psychological dimensions (World Health Organisation, 2011b, para. 2). Several studies have concluded that obese children were more prone to suffer from psychiatric and psychological problems than non-obese children and a higher female than male ratio was seen. Behavioural problems and low self-esteem were more frequently seen in obese children (Reilly et al., 2003, p. 749). These could be contributed by discrimination (bullying and ostracize) towards obese people and consistent negative feedback would generate a more negative self-concept (Carr & Friedman, 2005, p. 247; Crosnoe, 2007, p. 243).

Society

Obese people tend to be stigmatized by society (Rössner, 2003, p. S42); receiving real, implied and imagined negative feedback which decreases their self-concepts (Crosnoe, 2007, p. 243). They would respond with a combination of the two forms; internalising or externalising social feedback. An obese individual often internalise social feedback; negative feedback contributing to a more negative self-concepts. This dramatically hinders their motivation and confidence needed to develop goals (Crosnoe, 2007, p. 243). Crosnoe (2007, p.243) further illustrated that they may externalise social feedback which includes disengagement from school or work, drug usage or alcoholism. Exploring obesity and status attainment concluded obese students have fewer achievements than their non-obese peers (Crosnoe, 2007, p. 242). Such occurrence was observed in schools where focus on athletic performance is higher or school which obesity is rather uncommon (Crosnoe & Muller, 2004). In addition, obese students were 12% more unlikely to enter college than non-obese students where in obese girls seem to suffer more than their male counterpart (Crosnoe, 2007, p. 242).

In adulthood within the employment sector, hiring, earning and promotion fair worst in obese people (Atella, Pace & Vuri, 2008, p. 31-32; Cawley, 2004, p. 468; Morris, 2007, p. 423-427; Rössner, 2003, p. S42). It was concluded by a study that hiring managers with anti-obesity bias would subconsciously filter obese people from being interviewed (Agerström & Rooth, 2011, p. 797-801). Atella et al. (2008, p. 24) and Cawley (2004, p. 31-32) confirmed obese people earned lower wages than their non-obese counterparts. In fact, women earned 1.4 percent lesser for every ten-pound (4.5 kg) increase in weight but such phenomenon was not seen in men. Atella et al. (2008, p.32) also mentioned that the reduction in promotion among obese individuals was due to the stereotype (lazy, less conscientiousness, lack of self-discipline) by non-obese individuals. In addition, obesity could be a debilitating health condition that has an independent factor which affects their productivity at work and ultimately, employment longevity (Morris, 2007, p. 427).

The rise of obesity also impacts on workplace and, the ergonomic functionality of equipment and time and motion efficiency; increased girth could affect the wearability of the protective armour in security services, aprons in healthcare, affect on the respiratory capacity and the ability to wear masks etcetera (Williams & Forde, 2009, p. 148) which may give rise to stereotyping and exclusion of obese persons. Specially tailored equipments would cost more and have a direct impact on the socio-economic environment (Buckle & Buckle, 2011, p. 173-175).

Economy and Commerce

The cost of obesity to Australia’s economy in 1989-1990 was around 2% of the total healthcare budget (Department of Health and Aging. 2009, para. 15). Particularly in 2005, $3.767 million was depleted, of which 23.2% was from the direct financial cost to the Australian health system and the rest was indirect cost such as the loss of productivity, carer costs, deadweight loss (DWL) from transfers and other indirect costs as seen in figure 3 (Access Economics, 2006). In 2008, the figures were revised to $8.3 billion (total cost of obesity) and $2.0 billion (direct cost) (Access Economics, 2008). Every year, it has been predicted to cost the healthcare system $5.6 billion (National Preventive Health Strategy, 2009).

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Figure 3. Direct financial cost on health systems include the costs of running hospitals and nursing homes, General Practitioner (GP) and specialist services, the cost of pharmaceuticals, allied health services, research and other direct costs (such as health administration); Non-direct financial cost includes productivity losses (short and long-term employment impacts and premature mortality), carer costs (the value of community care services provided primarily by informal carers), Deadweight Loss (DWL) from transfers (taxation revenue foregone, welfare and other government payments), other costs (aids, equipment and modifications, logistics and accommodation costs, respite and other government programs and the bring-forward component of mortality, e.g. funerals).

Of the financial cost in 2005, $1.1 billion expense was borne by obese individuals (Access Economics, 2006) who spent on average of $2540 per year. BMI of overweight and obese person paid 16.9% and 32.7% more respectively as compared to a non-obese person (Colagiuri et al., 2010, p. 261). This summarised an obese individual paid more healthcare cost for their obesity and co-morbidities conditions (Colagiuri et al., 2010, p. 263).

Four out of five of the bariatric surgeries (stomach stapling, sleeve gastrectomy) were carried out on women which is a 3300% increase between 1989-1990 and 2007-2008, with the estimated value for weight loss procedures being $108 million (Australian Institute of Health and Welfare, 2010, para. 9). Anti-obesity medications have increased to 1.45 million items (13% increases from 2010) in the United Kingdom. Orlistat and sibutramine were the most commonly prescribed medications and it accounts for $38.1 million in 2005, a two-fold increase since 2001 (Srishanmuganathan, Patel, Car & Majeed, 2007, p. 200). With the increase in pharmaceutical medications, the Australia government subsidise more for the obese population under the Pharmaceutical Benefits scheme (PBS).

Other indirect cost mentioned by Buckle and Buckle (2011, p. 173) includes sick leave, workplace injuries, reduction in performance; increase psychological demands lead to fatigue, discomfort, errors and accidents. All these would have an effect on their employment (Morris, 2007, p. 427).
Effectively, direct and indirect costs of obesity have various and extreme costs on the given economy.




Social Theory
Goffman’s theory of social stigma defined as the “deeply discrediting” characteristics, labelled a stigmatized person as unaccepted or dangerous beholds by others. Such characteristics could be classified in three accounts; “abomination of the body” (physical ailments or deformities), “blemishes of character” (unnatural character such as obesity and prostitution) and “tribal stigmata” (social groups an individual was born) (Carr & Friedman, 2005, p. 245-246; Philip Manning, n.d.). On the application of Goffman’s model of social stigma, behavioural data collected could be used to compare and distinguish the non-stigmatized population. (Hebl & Dovidio, 2005, p. 156-157). It was not limited to non-obese individuals despising their counterparts; the victims took in the discomfort and awkwardness of a social interaction into their own self-concept (Carr & Friedman, 2005, p. 247).

Stigmatizing includes bullying, isolation and ostracising obese people (Crosnoe, 2007, p. 243) happens in varying social settings such as school , home and work (Rössner, 2003, p. S42). Crosnoe (2007, p. 242) mentioned that students whom were discriminated in school due to their weight problem reported lower enrolment into college than their non-obese peers. Both internalize and externalize social feedback which led to lower self-esteem and poorer school attendance respectively (Crosnoe, 2007, p. 243). Social dynamics exacerbated adverse effects of obesity on physical and mental health (Carr & Friedman, 2005, p. 245; Crosnoe, 2007, p. 241; Ferraro & Schafer, 2008, p. 150).

Decrease in hiring and promotion opportunities and earnings are some of the outcomes associated with stigmatization in the workplace exhibited by stigmatising employers and human resource managers (Atella, Pace & Vuri, 2008, p. 32; Cawley, 2004, p. 468; Morris, 2007, p. 423-425). Atella et al. (2008, p. 32-33) mentioned that these findings could be attributed from stereotyping obese people as being “lazy” and “lacking of motivation” leading to discrimination. Not surprisingly, prejudices against obese people were seen among health personnel (Rössner, 2003, p. S42). In turn, these stigmatization traits affect ones opportunities in life (e.g. self-acceptance) (Carr & Friedman, 2005, p. 245).

One should not overlook the cyclical effects it has on obese people. After being socially discriminating and resulting in a low social network, low self-esteem, individuals stayed home and would likely to reach for “rewarding” or comfort (high-calorie) food (Mandel & Smeesters, 2008, p. 309; Polivy, Heatherton & Herman, 1988, p. 354). A low social network would increase sedentary lifestyle, leading to weight gain (Shields & Trembla, 2008, p. 24-26). This puts them at severe risk of poorer functional capacity and health-related complications (e.g. deterioration of mental and physical health) which leads to shorter life span (Fontaine, Redden, Wang, Westfall & Allison, 2003, p. 192-193). Subsequently, the increase in horizontal dimension put them vulnerable to an increase in social discrimination (such as the wearability of the uniform) (Buckle & Buckle, 2011, p.171-172 ; Ferraro & Schafer, 2008, p. 245-255). On the macro level, it resulted in a direct (e.g. absenteeism) and indirect cost (e.g. loss of productivity) to the economy (Access Economics, 2006; Bhattacharya & Sood, 2011, p. 141-147; Department of Health and Aging, 2009, para. 15).




Analysis and reflection
With regards to the opening pictorial, the planet floating above water and her look of uncertainty to sit on the planet, goes to depict the vast implications obesity has on a society. Most scholar researches have concluded the impact of obesity on an individual’s health. The effect can metamorphose to the society and the economy as demonstrated. In this essay, mental health and physical health of an obese individual, clearly has a disadvantage on the society and therefore, impacts the economy.

With obesity on the rise, several companies have seized the opportunity to charge more from these people. With insurance companies charging excessive premiums (Ebrahim, 2006, p. 1) and a United States airline charges one obese person for the price of two for the seats taken up due to size (Deitel, 2005, p. 1), we could see an obese population eventually paying more. Obesity problems would have to be addressed; it is not just the monetary aspect but a holistic view and approach to make Australia a more sustainable economy. I have summed up a simple illustrated map.

Picture4.png

On the personal note, I feel that the government could have invested more in treating the origin of the problem instead of the effect of the problem – prevention is better than cure. The media has been widely used to influence consumer’s purchasing power (Kalaitzandonakes, Marks & Vickner, 2004, p. 1245) and particularly, negative emotive advertisements were significantly more effective (Murphy-Hoefer, Hyland & Higbe, 2008, p. 725; Shimp & Stuart, 2004, p. 51-52) such as the anti-smoking campaign. Similarly, New York City, department of health has rolled out an anti-soda advertisement (Drinkingfat YouTube video, 2009). The government could take this similar initiative to the successful tobacco countermarketing advertisements. Other strategies include casting fresh food to wider suburbs or designating a day for “Healthy Eating” programmes.





With better education and preventative measures, this would reduce overall future impact on the three categories visited within this paper.



Reference
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Wiki Comments

Culture, health professionals and death
by MagsMS
It’s a very interesting article where you have explored youth’s risky behavior.
Especially for the Chinese, similar to Samoan, force-feeding is uncommon but parents in China wants bigger size children to bring the children will be in good luck and fortune. China’s one-child policy has triggered a whole new dimension of how “previous” that child is and what they want will be given by their parents. Eventually, obesity is on the rise.
What could have made it better in this essay is the relationship of obesity and increase risk of car accidents. In an US study, men with BMI of more than 35 kg/m2 (cushion effect from increased subcutaneous fat) and less than 22 kg/m2 (smaller momentum effects) has an increase risk of death than intermediate BMI. This was seen only in left-side and front-end collisions (do not forget that the driver is on the left side in US). Such phenomenon was not observed on women because it has been hypothesized to be the different body shape and injury patterns (Zhu et al., 2006, p. 736). The study also concluded other finding (BMI and change in velocity) which is worth to read. :)


Zhu, S., Layde, P. M., Guse, C. E., Laud, P. W., Pintar, F., Nirula, R., et al. (2006). Obesity and Risk for Death Due to Motor Vehicle Crashes. American Journai of Public i-leaith, 96(4), 734-739. Retrieved from: http://web.ebscohost.com.ezp01.library.qut.edu.au/ehost/pdfviewer/pdfviewer?sid=b46aaf14-27d9-4982-a16b-b3a1d2611622%40sessionmgr112&vid=2&hid=123


Obesity is a Capitalist Disease
by n8291438
It was a very good article indeed. I thoroughly enjoyed reading it. Especially, you have given an insight in the advertisement timeslot which I have not thought of.
As this article talks about children which falls under Generation Y or the Millennial generation, it is interesting to find that the decision-making model has changed from Builders to Generation Y and it shows that Generation Y purchase more on emotion than the rationality of it which is the opposite for Builders generation (Beard, M. & McCrindle, M, 2010). Back then, the Sprite tagline was so emotion provoking, “Image is nothing, thirst is everything. Obey your thirst.” Would you get a bottle of Sprite?
These technological natives (children in the Generation Y and millennial generation), the usage of technology would be a contributing factor behind obesity. A wiki post by Kate Lauren Annat mentioned that Generation Y spent 5 hours a day on the computer (I spent 8hrs for the past 4 days on this assignment) and others. It’s a good read: “Generation Y and the Impact of the Information Communication Technology and the resulting Public Health Issues.”
With countless “bad” advertisements around such as the recent Oporto Ripper $4.99 deal, could ‘SWAP IT’ survive?
Not forgetting that with people getting obese, companies have taken this chance to charge more on insurance premium and airline charge towards the overweight or obese population. :)


Beard, M., & McCrindle, M. (2010). Seriously cool: Marketing and communicating with diverse generations. Retrieved September 26, 2011 from http://www.mccrindle.com.au/resources/whitepapers/Marketing-Communicating-with-Diverse-Generations.pdf