QWeekend: When will Queensland wake up to obesity epidemic?

WALK into any Queensland shopping centre or workplace and you’ll see the problem. So why are we so helpless to do anything about it?

MARCH 20, 2013. Danial Beinke remembers the date as if it’s one of his children’s birthdays. He didn’t need a wake-up call that morning. He’d received it in his doctor’s office the day before.

The 126kg man in his 40s, who had been on a public hospital waiting list for a hip replacement for five years, hobbled into his general practitioner’s surgery at Goodna, an Ipswich suburb about 20km from the Brisbane CBD. He limped out a changed man. His doctor had flicked a switch inside of him, his words as powerful as medicine.

“Mate,” his GP said, “you’ve turned yourself into a human forklift.” The doctor was talking about 40kg in excess fat his patient was carrying, equivalent to lugging around an average-sized 12-year-old boy.

Danial Beinke, 47. Picture: Russell Shakespeare

The self-employed furniture maker had high cholesterol, sleep apnoea and the added kilos were putting huge pressure on his joints, leaving him in constant pain. He was buckling under his own weight. Beinke was only 44 years old. When his doctor suggested he use a mobility scooter to lighten the load, it was the trigger he needed. He walked out of the appointment telling himself: “No more”.

“It was my D-Day,” he says. He’d watched his grandmother having to use a wheelchair after both her legs were amputated because of diabetes. “I wasn’t doing it,” Beinke says. He’d been popping painkillers “like Tic Tacs” for years and collecting kilos for longer.

As a young man, he’d burned off excess fat by playing competitive roller hockey. “I was about 85kg, quite slim, very athletic,” he recalls. But he gave up sport when he moved from Melbourne to Queensland with his wife, Kerri, in 1999. Three daughters – Madisson, Dannielle and Jemma – followed in the next five years.

“I hit 30 and turned into a couch potato with work and stress and kids and everything else,” Beinke says. Bad habits became part of his daily routine. The talented craftsman of Chesterfield leather chairs and sofas worked with an Esky by his side, filled with his “kryptonite” – soft drink, flavoured milk and beer. He would drink up to 10 cans of soft drink or four 750ml bottles of coffee-flavoured milk a day – liquid sugar. In summer, he would often open his first light beer at 8am. On top of that, he was eating junk food meals several times a week. Except for the occasional ­gherkin on a hamburger or potato in fries, his diet was ­devoid of fruit and vegetables.

On March 20, 2013, Beinke went “cold turkey”. No more soft drink, no more junk food and no more “grog”. He ­started exercising again. At first, he struggled to make it to the corner of his street and back. But from there, he built up to being able to power walk 8km in an hour. The embarrassment of going to a public gym “as a fat person” proved too much, so he bought his own equipment and set it up in his shed, working out regularly on top of his daily walks.

As he became more active, he started learning about ­nutrition. In the past, he’d tried to diet and had ended up weighing more than when he’d started. This time, he made changes he could stick to. He introduced vegetables to his meals and started limiting the portion of lean meat or fish he was eating to no more than 150g. His daily hit of liquid carbohydrates has been replaced with water, iced tea and black coffee – no sugar. Once a day, he’ll make himself a blueberry and avocado smoothie. He has cut out bread, eats rice and pasta only occasionally and snacks on a handful of nuts or a small apple. Beinke’s lost more than 30kg and kept it off.

He admits the first six months were challenging. “It took me that long to detox from the sugar craving with constant migraines,” he says, talking as if sugar is a drug. “There were many times I wanted to give up. But I looked at why I started. There was no way known I was going into that ­mobility scooter.”

He’s sleeping better, is no longer in pain and has ­cancelled the hip replacement surgery.

Walk into any Queensland shopping centre or workplace and on average, two in three (64 per cent) of adults and one in four children (26 per cent) will be obese or overweight. About 2.5 million people in this state are carrying too many kilos. One in three adults is obese (defined as having a BMI of 30 or more), up from about one in 12 in 1990. Queensland has the second-highest adult obesity rate in the nation at 30 per cent, or 1.1 million ­people, behind Tasmania with 32 per cent.

One in every 14 children in a typical Queensland schoolyard is obese – equating to about 59,000 students. Three decades ago, the figure was one in 50. Adult obesity has ­plateaued since 2011-12, after climbing about three per cent a year between 2004 and 2010. Children’s rates have flatlined since 2007-08. But they are proving as difficult to shrink as the average Queenslander’s waistline.

Evidence shows the population’s perception of what a healthy weight looks like has become skewed. Alarming Queensland Health research has found significant numbers of people misjudge healthy body shapes as too skinny and overweight individuals as within the ideal range. The data suggests unhealthy weight is so common, it’s becoming normalised. An overweight and obese society is collectively looking in the mirror and seeing a distorted reflection of reality. “We need to reset the thermostat on what’s ­normal and what’s not normal,” says emergency physician Dr David Rosengren, who chairs the Queensland Clinical Senate, a group of health professionals set up to develop ­strategies for the state’s most pressing health dilemmas.

Rosengren says weight should be routinely measured as a “vital sign” in medicine. “Health professionals and consumers must promote and support monitoring weight as an expectation of healthcare delivery,” he says. Regularly weighing patients would promote frank conversations about diet, exercise and the dire ramifications of obesity which can include infertility, pregnancy complications, stillbirth, heart disease, stroke, type 2 diabetes, chronic pain and increased risk of some cancers. But Rosengren says educating patients is not enough. He says politicians from all levels of government, bureaucrats and hospital administrators need to start labelling obesity for what it is – a public health emergency. “We need to provide support structures in ­society that make it easier for people to lose weight,” he says.

A sugar tax, limits on the density of fast-food restaurants and bans on junk food advertising and sponsorship should all be under consideration, he says. “It seems diabolically crazy that we allow fast-food operators to sponsor and champion sporting initiatives,” adds Rosengren, who has just come from swimming 3.5km at his local pool.

File picture: iStock/Getty Images

The Clinical Senate is pushing for Queensland’s 16 hospital and health services to remove sugary drinks from their vending machines, cafes and convenience stores to start setting an example. “How can we justify spending huge resources on chronic disease and on interventions and advice about obesity only to allow patients to walk from the outpatients’ clinic into the hospital canteen to buy a 600ml bottle of Coke, a chocolate milk or a tub of hot chips?” Ros­engren asks, more than a hint of exasperation in his voice.

In what may be the start of soft drinks becoming the new tobacco, the Murrumbidgee Local Health District, based in Wagga Wagga, southwestern NSW, and Barwon Health, which services southwestern Victoria, have both announced bans on sugary beverages. But Queensland equivalents are yet to join them.

Fionnagh Dougan, chief executive of Brisbane’s Lady Cilento Children’s Hospital, walks into her office after an encounter with a mum and her three-year-old in the facility’s convenience store. The little girl had been clutching $3 throughout an unpleasant medical procedure and was about to buy a promised treat. It’s an important reminder for Dougan that accessing a chocolate or an iceblock can help ease a young patient’s angst. “There’s something about being a children’s hospital and having limited access to a reward when a child has been through a difficult ­experience,” she says. But the health executive is about to draw the line on soft drinks.

Dougan moved to Brisbane last year from New Zealand, where sales of sugar-­sweetened soft drinks are banned in public hospitals. She’s moving towards a similar prohibition at Queensland’s only public pediatric hospital. “We have to work with our ­vendors who have certain agreements with us,” she says, adding the contracts have about 18 months to run.

Vendors have cooperated, limiting the size of chocolate bars and sugary drinks they sell. The positioning of stock means customers are also more likely to see bottles of water before soft drinks inside the convenience store, cafes and food court. Vending machines dispensing fruit and other healthy options are placed more prominently than those selling soft drinks. The hospital has never sold hot chips or deep-fried foods.

A ministerial brief obtained by Qweekend suggests all hospital and health services are preparing for a moratorium on soft drink sales.

“In late 2015, the Hospital and Health Board chairs agreed to voluntarily cease the provision of sugar-sweetened drinks from cafes and vending machines,” it says.

The brief suggests Queensland Government buildings may also be moving towards phasing out soft drink sales. Chief Health Officer Jeannette Young held an interdepartmental meeting in March when in-principle support was given for “action on sugar-sweetened drinks”.

The stance has broad approval within the public health sector. “Sugary drinks have no nutritional value, therefore have no place in government workplaces,” says Diabetes Queensland chief executive Michelle Trute.

Cancer Council Queensland chief executive Professor Jeff Dunn says political courage is needed to pull soft drinks from vending machines, particularly those that can be ­accessed by children. He also wants state government ­action on sales of sugary drinks in schools, children’s sporting events and activity centres. “We need politicians brave enough to stand up to the food and drink lobby,” Dunn says.

Dr Robyn Littlewood. Picture: David Kelly

Dietitian Dr Robyn Littlewood, who regularly sees children weighing more than 100kg at the Lady Cilento Hospital’s obesity clinic, says soft drink is a key risk factor. “If they can switch to water you know you’re going to make a difference, they’re going to lose weight,” she says. “At the same time with kids, you’ve got to watch they’re still ­drinking milk.”

Many obese children attending the clinic have health problems that in past generations would have emerged in middle age – high blood pressure, elevated cholesterol and type 2 diabetes – and often have respiratory problems that disrupt sleep. Chronic pain is also common.

“Children say they find it very, very hard to run,” Littlewood says. “They can’t play sports. Their ankles and knees hurt because of their size. One hundred per cent of my kids are bullied to the point where they don’t want to go to school. They tend to get very, very disempowered.”

The number of Queensland children under 18 diagnosed with type 2 diabetes has jumped more than 72 per cent in four years, from 47 in 2012 to 81 this year. Diabetes Queensland says four of those registered with the National Diabetes Services Scheme in January were less than 10 years old.

To access the Lady Cilento Hospital’s obesity clinic – staffed with doctors, dietitians and psychologists – children need to be referred by a pediatrician. This is more than just a clinic that weighs children and hands out fact sheets on what they should, and shouldn’t, be eating. All aspects of their lives – from school to home environment, outdoor ­activities and screen time, as well as diet – are forensically reviewed without “blame or shame”. A prerequisite of a child being accepted is he or she must attend with their families.

“It’s very hard to see changes in weight when you’ve got a child without family involvement,” Littlewood says. The Brisbane clinic, and a similar one in Ipswich, see about 100 children a month combined.

Littlewood says the model is working. “We’re seeing kids who are losing weight,” she says. “These are kids who have found it hard for many years. You see them change psychologically. They are different children. They’re confident. Their health improves.” Littlewood’s only frustration is the knowledge that tens of thousands of obese children throughout Queensland cannot access similar help.

Failure to address obesity has huge implications for ­individuals as well as the health system. Surges in adult cancers, such as those of the oesophagus and endometrium, have been linked to obesity. Cancer specialists speculate poor diets are to blame for a jump in Queensland bowel cancer incidence rates in people aged under 35. (Rates rose about four per cent a year between 1982 and 2013.) Some surgeons are reluctant to operate on obese ­patients who ­require elective procedures, such as hip and knee replacements, until they lose weight. Obesity inc­reases the risk of fatal blood clots during and after surgery, as well as other complications, such as infections and heart failure.

Surgeon Dr Rob Franz says specialists who require ­patients to shed kilos before a procedure have their “best interests at heart”, given the risks can be life-threatening. Franz, the director of surgery at Prince Charles Hospital, in Brisbane’s north, says patients weighing more than 150kg are not uncommon. He’s operated on a 250kg patient who required emergency surgery.

“We couldn’t nurse her in a normal bed because they only take up to 200kg in weight,” he says. Engineers reinforced an existing bed until a ­specially designed one for super-obese patients could be rented. Franz says his patient has since almost halved her weight with help from health workers.

The logistics of having to cater for mega-obese patients are putting a strain on hospital resources. When Sunshine Coast University Hospital opens next year with 450 beds, 31 will have hoists capable of moving patients weighing up to 270kg. Two others will allow staff to care for patients up to 455kg. The Gold Coast University Hospital, which opened in 2013, has “super rooms” with $47,000 beds for the largest patients, toilet frames designed to withstand 325kg weights, and ceiling slings able to lift up to 500kg. Paradoxically, the Gold and Sunshine coasts have two of the lowest ­obesity rates in the state.

Alan Scanlon with his children Finn (bottom left), Leo (bottom right) and Tess (on his shoulders), before he lost more than 50kg.

Alan Scanlon, 38, has worked in healthcare most of his adult life, first as a nurse and for the past six years as a clinical systems analyst at Princess Alexandra Hospital, in Brisbane’s south. Part of his job involves keeping up-to-date with trends to ensure the hospital has enough supersized equipment to meet demand. For years, he would do the numbers while weighing almost 150kg.

“In the beginning I didn’t think about it,” he says. “But after a while I was like, ‘If I come into hospital, they’ll have to get special equipment for me’. I didn’t want to be the person who needed an oversized bed or oversized wheelchair.”

But with a 117cm waistline and taking medication for high cholesterol, Scanlon was headed that way. Although he had tried to lose weight in the past, it was enrolling in a University of Queensland study into exercise and heart disease risk factors in early 2014 that made the difference. The research required him to complete three 40-minute exercise sessions a week for four months. Without changing his diet, he lost 8kg in eight weeks.

“I don’t know what switched it on this time,” Scanlon says. “I didn’t realise until a fair way through the study that people were dropping out. But I don’t like to let people down. The research was part of someone’s PhD.”

From there, as his fitness improved, he added more ­exercise to his work day, walking the 1.5km to his local train station at Kuraby, in Brisbane’s southeast, rather than ­driving. When time allowed, he would disembark one or two stops early and walk the rest of the way to the hospital. This progressed to earlier stops and eventually he swapped walking for running.

In January last year, he began cycling the 36km round trip. Cycle paths take him all the way to the Princess Alexandra Hospital at Woolloongabba. “I look for any opportunity to exercise now,” he says. “I love it. The only disappointing thing is, why didn’t I do it earlier?”

Alan Scanlon, now more than 50kg lighter, jumps on the trampoline with his children Finn, 8, Leo, 6, and Tess, 4. Picture: Russell Shakespeare

He’s gone from finishing his high-school cross country last to becoming a fitness fanatic in middle age. As he ­became more active, the father of three – Finn, 8, Leo, 6 and Tess, 4 – changed his diet. Scanlon began cutting out sweet foods and watching portion sizes. He also stopped hoovering his children’s leftovers.

“I had no goal about how much I wanted to lose in the beginning,” he says. “But when I got to 42kg, I said: ‘It’d be cool to lose 50’.” He consulted a ­dietitian and, a year after the journey began, he had lost 53kg – more than a third of his weight. His waistline has shrunk to 86cm, he fits into medium-sized clothes rather than 5XL, and he no longer takes cholesterol-lowering drugs. He’s also setting an example for his children.

“I can hopefully set a model for them so they don’t get to where I was,” Scanlon says.

A conglomeration of fast food joints are in close proximity to each other at Logan. The streetscape is typical of many Queensland towns.

Griffith University transport researcher Associate Professor Matthew Burke says Australia could do more to tackle obesity by encouraging exercise. He says 50km/h speed limits in suburban streets are “unusually high” ­compared with many countries and has called for 30km/h limits. “There are systemic issues that take the obesity crisis well beyond just personal responsibility,” he says. “One of the reasons few people cycle in Australian suburbia is they feel threatened by fast-moving cars. When cycling speeds and car speeds are similar, people start using those streets. We need to make 30 the new 50.”

Town planning decisions during the second half of last century delivered “automobile-dominated ­suburbia”, he says. Cul-de-sac streets proliferated at the same time as fast-food restaurant drive-throughs, computers were tying more people to their desks, and suburban blocks were shrinking.

“You can’t easily make shortcuts in an estate full of ­cul-de-sacs; it’s very difficult to walk anywhere, so walking ­disappears,” Burke says. “The problems of that model are seen on the waistlines of Australians today. Everything was tied to the car commute. We didn’t understand that sitting for long periods of time fundamentally makes us sick.”

Burke says policies are needed to increase the incidental exercise people do by boosting public transport use. Aust­ralia is one of the few countries offering generous fringe benefit tax concessions for company cars. He says large numbers of salary packages, including access to taxpayer-funded cars, go to public servants working in areas with good public transport. “Hardly any economist in Australia thinks it’s a good spend,” he says.

With calls growing for taxation reform to tackle obesity, researchers are working on medical solutions beyond ­bariatric surgery, which restricts the amount of food the stomach can hold. Weight-loss procedures are limited in the public hospital sector because of cost.

Queensland University of Technology scientist Professor Selena Bartlett says animal studies have found sugar activates the brain’s reward ­system in a similar way to ­alcohol and nicotine. She says animal research suggests drugs prescribed for nicotine ­addiction may also assist ­patients in losing weight. But human trials are needed.

The addiction specialist is hopeful techniques can be ­developed to train obese patients to use healthy habits, rather than eating sugar-laden food, to balance stress.

“The brain is always in balance between stress and reward,” she says. “What people are doing is balancing stress with diff­erent things. For some people it’s sugar, for others it’s ­alcohol or nicotine. I believe you can train people to use healthy habits, such as going for a walk when they get home, instead of opening the fridge, to balance stress.”

Bartlett says obesity is much more complex than public health campaigns calling on people to eat less and exercise more have led people to believe. “Obesity is frequently built from childhood stress and trauma,” she says. “But no one talks about the brain and obesity.”

Evidence is also emerging that gut bacteria may be ­important. Case studies of lean patients who have received fecal transplants from obese donors to treat antibiotic-­resistant infections have found some have put on large amounts of weight. “We’re sequencing bacteria in the gut to try to understand how they help us metabolise food,” says Professor Matt Cooper of the University of Queensland’s Institute for Molecular Bioscience.

The observations have spawned studies into whether transplanting gut bacteria from healthy-weight donors – known as “transpoosions” – can help obese patients shed kilos. Townsville-based gastroenterologist Dr Stephen Fairley is awaiting ethics approval for a trial in 80 obese ­patients. He knows of a Queensland man who lost 30kg after a fecal transplant from a “skinny donor who was happy to donate to a good cause”. The experimental treatment worked for six months but the man then put 15kg back on. Fairley says it may be possible to treat obese ­patients with regular doses of freeze-dried fecal material in capsules to help them keep the weight off.

Some experts say preventing obesity needs to start with women of child-bearing age. Growing research is pointing to a baby’s environment in the womb as an ­important risk factor for obesity. “There’s quite a lot of data suggesting that your life course of obesity is set in the fetal period,” says Royal Brisbane and Women’s Hospital ­obstetric physician, Professor Leonie Callaway. “Being born too small or too big both increase your risk.”

UQ’s Professor of Life Course ­epidemiology, Gita ­Mishra, who runs the Australian Longitudinal Study of Women’s Health, says obesity rates in young women have doubled in less than two decades. In Queensland, the latest figures show that 14.7 per cent of 20- to 25-year-old women are obese. That’s more than double the national rates for the same age group 17 years ago (6.4 per cent).

“The thing that’s quite scary is most of these young women have not started their reproductive years,” Mishra says. “Obesity plays a role in a woman’s ability to conceive and increases the risk of complications if they do fall ­pregnant. Obese mothers are more likely to experience gestational diabetes and pre-eclampsia. Their children are also more at risk of being overweight and obese.”

Maya Patel was just about to turn 40 and trying to ­conceive through in-vitro fertilisation when she was diagnosed with type 2 diabetes almost two years ago. She weighed 86kg at the time – in the obese range for her height. Over the next 12 months, Patel lost 12kg while ­attending the RBWH diabetes clinic and became pregnant early this year. The vegetarian has carefully watched what she eats while pregnant, wanting the best possible outcomes for herself and her baby, due in October.

Mum-to-be Maya Patel. Picture: Annette Dew

“I’ve learnt to read the backs of packets and understand the portions,” says Patel, one of almost 193,000 Queenslanders diagnosed with type 2 diabetes.

“What I was eating was right. It was just the portion sizes were too big. I could easily eat my butt off now because I’m pregnant, but I don’t want to do that. I’d be endangering myself and, more ­importantly, my child. I don’t want to jeopardise anything. I’m the one that chooses what I put in my mouth. If it’s going to affect my baby, I’ve got to take responsibility.”

She’s joined an exercise class for pregnant women and says her weight is tracking “where it should be” for a healthy-sized baby.

RBWH dietitian Dr Susie de Jersey, who has studied weight gain in pregnancy, says many women gain more weight than recommended, setting their children up for weight issues later in life.

“We found clearly that women didn’t know how much weight gain was healthy, and health professionals weren’t speaking to them about what they should be gaining,” de Jersey says. “There’s a cycle of ­obesity that we could clearly be preventing.”

As the chorus gets louder for political solutions to the obesity epidemic, back in Goodna, Danial Beinke crafts his furniture wearing a pair of black tracksuit pants, size small. He vividly recalls the day he bought them and the tears that fell when he fitted into them. It was the moment he ­realised he had turned his life around.

• For information about healthier living:healthier.qld.gov.au

• Australian dietary guidelines are available at:nhmrc.gov.au