To the Editor: Australians are fatter than they have ever been before. The prevalence of overweight and obesity (body mass index ≥ 25.0 kg/m2, or waist circumference > 80 cm for women or > 94 cm for men) in Australian adults is approaching 60% for both sexes and has more than doubled in the past 25 years.1

A prudent public health policy to fight the growing obesity epidemic would undoubtedly be to target strategies that avert this condition in the first place. So we were perplexed by the Australian Medical Association’s recent proposal to the Victorian Government to fund five public hospitals to provide 3000 obesity-related operations (ie, bariatric surgery) over the next 3 years.2 It appears the blueprint for the new millennium is to invest taxpayers’ money in modern technologies in an attempt to arrest overt clinical disease states.

To attack the growing burden of obesity by investing in strategies that target secondary and tertiary treatment is an admission that we may win battles on a few fronts, but lose the war. We propose placing greater emphasis on implementing and enforcing primary prevention strategies to fight obesity. Primary defence mechanisms can decrease obesity prevalence by preventing the condition in the first place! Indeed, the health care industry is paradoxical in that its principal goal is to end health problems and human suffering, and by so doing put itself out of business.3

We need to attack the environmental roots of obesity, namely our sedentary lifestyles and caloric excess. Emphasis on secondary and tertiary prevention is too little, too late and will not reverse the growth of obesity — the funds to treat obese individuals are finite, while the number of Australians with the potential to become overweight or obese is not!

In a letter to President Roosevelt voicing concerns about the Manhattan Project (the project to develop the atomic bomb during World War II),4 Niels Bohr wrote:

Obesity-related disorders impact on daily living. While bariatric surgery may provide a “magic bullet” for a few individuals, the time has come to legislate for minimum health standards, and to provide support for people to effect lifestyle changes to meet these requirements. Otherwise, obesity will remain a permanent threat to Australian society.

Comment: Obesity is a complex public policy issue. There are no easy solutions, and the medical profession needs to work with communities, governments, researchers, teachers, parents, industry and others to help all Australians achieve and maintain a healthy weight.

The Australian Medical Association (AMA) Victoria has six priority action areas to promote healthy weight:

• Ban food advertising to children;

• Simplify food labels;

• Promote physical activity every day;

• Improve clinical tools;

• Improve treatment options; and

• Evaluate and educate.

Bariatric surgery is one of the treatment options that needs to be further explored. Among many other items, AMA Victoria’s state budget submission for the 2008–09 financial year1 calls for a trial of 3000 bariatric surgical procedures to be performed in public hospitals, as part of a comprehensive approach to weight loss.

The evidence before AMA Victoria indicates that bariatric surgery is a safe and cost-effective treatment for a proportion of morbidly obese Victorians.2-5 However, bariatric surgery is an extreme response that should only be explored in extreme circumstances. There are many morbidly obese people who find themselves in these extreme circumstances and may benefit from the surgery if other approaches have failed. Further, bariatric surgery is cost-effective, as the costs are lower than the ongoing costs of treating chronic conditions associated with obesity.

Bariatric surgery is not the only policy approach to obesity being pursued by AMA Victoria. We see it as a small part of the solution, although it has been a larger part of recent media attention on the issue. I am pleased that the AMA has been able to highlight obesity as an important public policy issue, and I look forward to working with a range of partners to explore possible solutions.