Triptych prevention – part I: Healthy food
Some doctors believe that professor of oncological surgery Marjolein Smidt is crossing the boundaries of her field when she is angry about unhealthy diet, overweight and obesity and the major health risks associated with them. “But when you know the numbers, you can’t help but talk about them.”
Marjolein Smith
‘Of the 16,000 new patients with breast cancer in the Netherlands, 4,000 people are diagnosed due to the impact of lifestyle. And in men over the age of 50, 60 percent of all colon cancer is caused by lifestyle,” outlines oncological surgeon Marjolein Smidt of Maastricht UMC+. ‘I do not want to blaming and shaming individual citizens: our society is obesogenic. To give just one example: 80 percent of the food in the supermarket is not healthy. And the entire environment – from packaging in the supermarket to the wide range of fast food – is designed for temptation.’
‘What the supermarket can do, the government can also do: encourage healthy choices’
Big win
Her interest in the influence of unhealthy food on health arose during – or rather thanks to – the Covid-19 crisis in 2020. ‘During the first lockdowns it was suddenly possible to visit major international conferences virtually. This made it much easier to follow and review more sessions. I quickly noticed how many presentations focused on the impact of obesity on cancer incidence, prevalence, treatment, and complications. Then I realized: with chemotherapy we can make a few percent gain in hormone-sensitive breast cancer, but with lifestyle interventions the gain is many times greater.’
Moral duty
In the consulting room she sees every day the suffering caused by an unhealthy lifestyle. ‘If doctors wonder whether it is their job to talk about this with patients, my answer is crystal clear: if you have this knowledge and society does not, I see an opportunity. You are failing if you do not share this knowledge. In fact, it is your moral duty. Scientific evidence has been accumulating, especially in recent years. For example, I explain to my patients that being overweight or obese is a risk factor for tumor recurrence. And that we would like to help do something about this after the oncological treatment.’
Concrete help
Many patients grab this help with both hands, Smidt notes. ‘There is a lot of ignorance about the risks of being overweight. In relation to cancer, but of course also to all kinds of other diseases, such as osteoarthritis and dementia. More than two hundred diseases are lifestyle-related. Many people would love to lose weight, but don’t know how or where to start. That is why we proactively offer concrete help. Consider looking for a combined lifestyle intervention, a GLI, in the neighborhood or exercise offered through Maastricht Sport. We also explain that after one year of participating in a GLI, people are eligible for medication to lose weight. We also look at what other factors play a role, for example stress due to financial worries. Then we will contact the municipality.’
Unfair
What strikes Smidt is that people with a low socio-economic position more often choose unhealthy food, because they have difficulty affording healthy food. ‘In the survey by the KNMG Doctors Panel on prevention (see also box, red.) it emerged that 56 percent of doctors see unhealthy diet and insufficient exercise as the greatest threat to public health, and another 38 percent mention obesity. In short, the most important topic. At the same time, more than half of the doctors in that poll believe that citizens themselves have a responsibility. I think that’s unfair. Healthy food – such as fresh fruit and vegetables, eggs or low-fat dairy – is more expensive than unhealthy food. At the same time, our society does not invite exercise. Even our bicycles are electric.’
Government’s move
She agrees much better with the statement that the national government is responsible for prevention, just like 79 percent of the doctors in the KNMG Doctors Survey. “It is too embarrassing for words that the government spends more than 110 billion euros on healthcare costs and only a fraction of that on prevention,” says Smidt. ‘That could really be better. The broad lines are clearly visible in all vision documents, estimates and calculations for 2030 and 2040. Without intervention, 60 percent of the Dutch population will soon have a BMI that is too high.’
Doomsday scenario ahead
The healthcare system can no longer cope with the expected wave of obesity-related diseases in the near future. ‘There is already a shortage of healthcare workers. This will increase due to the aging population,’ the Maastricht professor outlines. ‘Don’t forget that people who do work are more likely to drop out due to absenteeism related to being overweight. We made a mess of it. The government and employers must now come up with measures to keep people healthy for longer. We all have an interest in that.’
Push
Fortunately, Smidt already sees a change. ‘A supermarket like Lidl is taking the lead by including health in its annual plan, no longer selling cigarettes and focusing on affordable, local fruit and vegetables. They make healthy choices attractive with a little push in the right direction, also known as nudging. A good example of this was a restaurant that placed a vegetarian main course on the weekly menu, and stated that guests could also choose meat. 67 percent of the guests then chose the vegetarian dish. The government can also do this: consider reintroducing swimming education or setting up adventurous playgrounds so that children exercise more. Or offer a healthy breakfast at all schools, so that every child starts the day without being hungry.’
Eliminate diseases
Finally, are all these positive measures affordable? Marjolein Smidt has to laugh at that. ‘Do you know what all that medication costs for diabetes, for example, or care for people with dementia, or all that absenteeism due to illness? Those costs are many times higher. Moreover: a healthy weight makes people more vital and happier. Someone told me I wanted to go back in time. But sometimes taking a step back is actually a step forward.’
Preventiepeiling
In recent decades, life expectancy in the Netherlands has increased significantly. But health differences between groups with different socio-economic status have not decreased and in some areas have even increased. We would like more insight into how doctors view this problem. That is why we recently asked doctors what problems and solutions they see and who plays a role in them.
Top three most important health threats
1. Unhealthy diet (56%)
2. Mental problems (50%)
3. Poverty (40%)
Top three people responsible for prevention
1. National government (79%)
2. Citizens themselves (55%)
3. Doctors and other healthcare professionals (23%)
Top three most important spearheads of prevention
1. Encouraging measures for healthy nutrition (48%)
2. Improving health literacy (44%)
3. Poverty reduction (41%)
Participants could choose up to three answers.
Long-term investment in a fair chance at equal health
Together with Marjolein Smidt, the KNMG shares the concern about the constant temptations to unhealthy behavior that our society is confronted with. The government plays a crucial role in this. We therefore urge politicians to ensure the availability and accessibility of healthy food. To really have an impact, it is not enough just to advocate healthy food. A broad vision on health policy is needed that extends beyond nutrition. This means that there must be an approach across the various policy areas and integral cooperation between all ministries. In addition, new policies must be tested for their effect on health. Only in this way can we achieve sustainable change for the health of everyone.
2023-11-30 07:00:00
#government #measures #people #healthy #longer
