Fight the bulge? Or fight the discrimination?
Airdate: 
Tuesday, May 28, 2013 - 20:30
Channel: 
SBS

'The medical system is buckling under the sheer weight of the 60 per cent of people that are overweight and obese."

'We live in a fat phobic culture."

Australians are getting fatter. And experts say diets just don’t work in the long term.

But should we be looking at this debate differently? Can you be fat and healthy? And are people resorting to surgery too soon?

This week on Insight: people who hate their fat, people who flaunt it, and people who’ve had it cut out.

Presenter: Jenny Brockie  
Producer:
John MacFarlane 
Associate Producer:
Joel Tozer 


Web Extra

The plumbing

Want to know the difference between lap band surgery and gastric bypass surgery? And you only have a minute to spare? Our 25-second graphic animations are here to help.

For more information on bariatric surgery, check out this study by the Medical Journal of Australia.

How should we tackle Australia's rising obesity rates? Should we be looking at this debate differently? Tell us what you think in the comments below, on Facebook or Twitter.

Transcript

JENNY BROCKIE: Hi, I'm Jenny Brockie, welcome everybody. Dorothy, describe your body for me?

DOROTHY TUAGALU: Curvy, voluptuous, carefree and just big and beautiful.

JENNY BROCKIE: Have you always felt that way about it?

DOROTHY TUAGALU: Not really. Because I've always been quite thin but I've just accepted the fact that this is my body now and it's, thankfully I haven't had any really drastic, you know, medical issues. But I really love my body, yeah, it's me. I've had, I've got four beautiful kids but, yeah, I mean there's always, there's, you know, the media and everybody out there that thinks there's a certain way that we should be, but I, you know, being a Pacific Islander, I mean this is how we are all pretty much, well most of us, quite solid built. But I quite - I am comfortable with my own skin.

JENNY BROCKIE: How is your size viewed in Samoa where you come from?

DOROTHY TUAGALU: Very acceptable - small on top and quite large on the bottom. So I would say my body's quite an ideal body for a Pacific Islander, small chested and, yes.

JENNY BROCKIE: So how would you be viewed if you were skinny in Samoa?

DOROTHY TUAGALU: Sick, sickly body, not acceptable. It's not, yeah, you're sick, you're an outcast.

JENNY BROCKIE: And how do you think the size that you are is viewed in Australia compared to Samoa?

DOROTHY TUAGALU: Um, well, I think they'll probably think I'm brave to get up here and say that, you know, I love my body. You know?

JENNY BROCKIE: Jenny, what about you, how do you think your body is viewed here in Australia?

JENNIFER LEE, VICTORIA UNIVERSITY: Oh, well, I think that there tends to be a perception that fat is linked with, you know, illness, undesirability, perhaps laziness, gluttonous, those kinds of words.

JENNY BROCKIE: how do you feel in yourself about your size?

JENNIFER LEE: Well, it's, um, it's changed over the years and I mean one of my earliest memories is my mother going to a weight loss group and taking me along. I was just colouring in in the corner and she put on weight that week so she had to wear a big snout and sing a piggy song in that group. So I suppose an early memory"¦

JENNY BROCKIE: How old were you when you were"¦

JENNIFER LEE: About four or five and she was just trying to do the right thing in her eyes by dieting, going to a weight loss group, and I suppose the shame attached to that image carried through for me and"¦

JENNY BROCKIE: So were you actually really then aware of your own weight at that age?

JENNIFER LEE: I think, well eight was probably the first age I remember because I asked, I said to mum I'd like to be thinner and she said: "Well you can go on a diet."

JENNY BROCKIE: You're eight in this picture, is that right?

JENNIFER LEE: Yeah, that's right.

JENNY BROCKIE: Now this is when you're on a diet?

JENNIFER LEE: Yes.

JENNY BROCKIE: You don't look overweight, particularly overweight to me?

JENNIFER LEE: Well, thinking back to then, I was beginning to get those feelings that I was disgusting and ugly and I wrote in my journal when I was 16 that I feared that I had the most disgusting body in the world. So that's the level of that hatred of that phobia that can come out of weight critique and food restriction, I believe.

JENNY BROCKIE: Have you tried to lose weight?

JENNIFER LEE: Oh, I tried for twenty years. I started formal dieting at 16 with Herbal Life and then on to calorie counting, Lite and Easy, Weight Watchers, all of those and you know, I'm a writer and just observing the fact that diets didn't work, that they inevitably failed and I put the weight back on. So at 28 I started to question what I was doing, you know?

JENNY BROCKIE: Okay. Julius, you're a fitness trainer, what do you think of Jenny and Dorothy being a happy with their bodies?

JULIUS KIESER, FITNESS TRAINER: I think that's fantastic. Are you healthy? Have you been to the doctors and they've told you that you're healthy?

JENNIFER LEE: Well I think that's a loaded question because I don't think anyone here who is thin is going to be asked that so I guess that's what I would say to that answer, that we have to look as well to the assumptions that are made and I would say you can't actually tell someone's lifestyle or health by looking at them. I do think that there's such a health focus in our country that I call it "healthism". A kind of moral obligation for people to be healthy and I think that we have to watch that too.

JENNY BROCKIE: But isn't that because it costs taxpayers a lot of money if the population isn't healthy. People have to go to hospital, they have various - develop various kinds of diseases. Isn't that part of the reason why there's that focus?

JENNIFER LEE: Well perhaps, but I also think that there's very much a focus on fat and health in our culture, on obesity and health.

JENNY BROCKIE: Heather, what did you want to say?

HEATHER YEATMAN, PUBLIC HEALTH ASSOCIATION OF AUSTRALIA: Well from a public health perspective, we can talk about individuals being healthy or unhealthy, but on a population basis, people who carry a lot more weight do have more health problems on average. So there is that issue of a greater risk for heart disease and diabetes in particular that we need to be conscious of, so the higher your weight, the more the risk.

JENNY BROCKIE: Kelli - Jean, what did you want to say?

KELLI – JEAN DRINKWATER: I think that people have a blanket idea that all fat people are unhealthy and all fat people are unfit and all fat people are miserable, whereas we are not one person, we are a group of individuals and each individual has their own relationship to their health and their bodies. I have incredibly like engaged physical activity and I'm the size that I am.

SHARNY KIESER, FITNESS TRAINER: It's not just exercise though that creates a healthy body, it's food, and I think from a perspective, healthy is hugely important with life, with the way we think. Certain foods that I eat make me tired for my children, we have four children, three of them are under two and a half. So the foods that I eat every day and that I give to my children every day, we give to our children every day, are so important for their behaviour, for everything.

JENNY BROCKIE: We'll get on to what people eat a little bit later on. Australians are getting bigger.

BMI VIDEO:

REPORTER: Since 1980 the average Australians Body Mass Index has gone from 24.9 to 27.7 for men and 23.6 to 27 for women. So what do these increases mean? Let’s take Mr and Ms Australia from 1980 – he weighed just over 77 kilograms and she weighed 62.

In 2009 the equivalent couple are almost 9 kilos heavier, that extra weight is equivalent to an adult female koala or 180 donuts.

JENNY BROCKIE: Okay, so we've all acquired a koala in those intervening years. How many people here have tried dieting? Show of hands.

NATASHA: I've tried Jenny Craig, I've tried Lite and Easy and I've tried Weight Watchers as well as, oh, there was another one that I've tried but I can't remember so I've tried about four or five different weight loss programs.

JENNY BROCKIE: And how'd you go?

NATASHA: Well with Weight Watchers I really did like it but the thing that I found hard was the motivation aspect. So trying to feel motivated to count the points every single day, that's the thing that I struggled with but then I think the thing with Jenny Craig and Lite and Easy is that unfortunately what happens is you'll start the program, you'll get food delivered to you, but what happens when you stop those programs?

JENNY BROCKIE: So did you change how you ate yourself when you weren't getting given the food, or did you just slip straight back into what you were?

NATASHA: I tried to but I slipped right back.

JENNY BROCKIE: And what were you eating, what are you eating?

NATASHA: I will admit that my portion sizes are quite big and I'm trying to eat a smaller portion because they say, for example, you should have like a handful or one cup of rise, whereas I think I tend to eat a bit more - like two or three times more us, because my mum's food is really delicious so.

JENNY BROCKIE: I'm just wondering what's driving people to go on these diets. Yes?

WOMAN: I think it could be a cultural factor because like you mentioned about coming from an Indian background, it is, you know, we have a standard of, we have this criteria to judge and being obese or just chubby can make you automatically fat.

JENNY BROCKIE: So very different in India to Samoa?

WOMAN: Yes, yes.

JENNY BROCKIE: Why is it only the women speaking up about this when we know, we know that men are more inclined to be overweight and obese? Yes?

MAN: Yeah, well I was a lot bigger than I am now. I was I was 280 and I'm now"¦

JENNY BROCKIE: 280 kilos?

MAN: Yeah, I'm 110, and I did it, I did it by counting calories and doing as much exercise as I could. But that's journey so I don't judge other people at all.

JENNY BROCKIE: How did you feel inside yourself about yourself when you were that weight?

MALE: Body image, yeah, that kind of got me but what got me was there is, outright discrimination but not said out loud discrimination. The stares that you get every single day, when a complete stranger hands you a note on the bus telling you that you need to go on a diet and you need to go see Jenny Craig, that when you have families laugh at you, when you have kids giggle at you all the time and also that whole thing about laughter with it, that it's a joke, and the way I described it is it's the last thing of bigotry that you're allowed to get if you're a stand-up comedian. You can bag out fat people all you like and you get away it and no one has a problem with that because they go that's funny, isn't it, ha, ha, ha they're fat.

JENNY BROCKIE: Louise, you're a psychologist, you specialise in eating issues and body image, describe your clients for us, how do they see themselves when they get to the point where they come to you?

LOUISE ADAMS, CLINICAL PSYCHOLOGIST: Very distressed about their bodies and very upset and frustrated with this continuous cycle of dieting and then regaining the weight and basically, the evidence is just in that diets don't work. You know, dieting, within five years most people have regained the weight. The failure rate for dieting is so high that if a diet was an operation, no one would go and have it. You know?

JENNY BROCKIE: So why is it so pervasive? Why do most of the people in this room put their hand up when I ask them if they've been on a diet?

HEATHER YEATMAN: I think it's a distortion within our society, and a number of people have mentioned that, that size and body image is just so important. But healthy eating really isn't part of the agenda. Dieting is part of the agenda, there's a whole industry out there that supports dieting, that supports weight loss programs, and yet, as just mentioned the effectiveness, the long term effectiveness is very, very small. So we should be advocating much more health at any weight and real focusing on healthy food and activity and actually getting on with other people and social interaction because that's what's going to make our society healthier in the long run.

JENNY BROCKIE: See this is so interesting, I think, because we have so many public health campaigns that are driving the message home for people to lose weight. But you're saying that when they go off to do it they go off and diet and it doesn't work?

LOUISE ADAMS: That's right, that's right, and I think the message that's not getting out is that we actually don't need to lose weight to become healthy. You know, I think we need to be focusing much more or healthy behaviours and helping people to have self-care and movement for the joy of it as opposed to kind of getting calories in, calories out. We'll really need to shift the messages and I think at the same time we need to empower people to look after themselves rather than trying to lose weight based on shame and self-hatred because that doesn't to help people with anything.

JENNY BROCKIE: So can you be fat and healthy?

LOUISE ADAMS: Absolutely.

HEATHER YEATMAN: Absolutely.

LOUISE ADAMS: I mean there's very large studies coming out saying that around 30 percent of people in that kind of obese range are actually perfectly metabolically healthy.

JENNY BROCKIE: Julius, I wonder whether you think people shouldn't be big, as big as some of the people in this room are. Do you think that's the case?

JULIUS KIESER: No, I think it's up to everybody to be as big as they're want to be but if you're not happy with your size, don't make, try and make excuses and reasons as to why you are happy with your size when you're clearly, in your head you're definitely not happy. And if it's a reason, you know, people say that they eat for comfort, is it because you are obese that you eat for comfort? If that's the case then just face the fact that you're not happy with your size rather than making, you know, reasons around you as to why you're not.

MAN: Sorry Jenny.

JENNY BROCKIE: Yep?

MAN: There's too many emphasis placed on the discrimination of fat people. What we should be looking at is the health aspects for everybody. Being fat is not good for the individual, it's not good for society and it's certainly not good for the health dollar. I mean the medical system is buckling under the sheer weight of the 60 percent of people that are overweight and obese. And I'd like to see the documentation that says that an obese person, someone that's 150 to 160 kilos, can be healthy. Can someone be fit and fat? Yes, someone can be fit and fat. But to be an ideal weight and fit is better than to be fit and fat and fit and fat are a very small minority of that 60 percent.

JENNY BROCKIE: Is that right Heather? You're a public health expert?

HEATHER YEATMAN: Well, as you go up in size, the risk of chronic disease also goes up. So yes, there is the increased risk and it is costing our health system something, in total, something like $60 billion because our community as a whole has greater size. You're talking about the Samoan community and other Pacific Island communities, yes, they're larger as a population now but a couple of generations they weren't. But also, as a community now, you have much higher rates of diabetes in particular.

DOROTHY TUAGALU: And we're very conscious of that, my generation is conscious now because we've got aunts and uncles that are dying at such a young age.

HEATHER YEATMAN: And so that is a cost to your community. That's right.

DOROTHY TUAGALU: And for me, I certainly would not be wanting to die now and leaving my kids. I'm conscious that, because my mum has, has heart disease, my father's a diabetic so I'm aware of those health issues that I could one day get.

JENNY BROCKIE: Your GP is here and Paniani, you deal with a lot of Pacific Islanders in your practice, don't you?

DR PANIANI PATU: Yes.

JENNY BROCKIE: What sort of advice then do you give someone like Dorothy about her weight and about eating and health and exercise and so on?

DR PANIANI PATU: It's a bit difficult because Dorothy comes out of a cultural background where being fat is encouraged and attractive as well, versus the health issues that they are facing now. So I would tell Dorothy that I find 80 percent of my patients have some sort of chronic problem.

JENNY BROCKIE: And you associate that with their weight?

DR PANIANI PATU: And I associate that with their weight.

JENNY BROCKIE: Godefa, you came here from Ethiopia as a refugee almost 20 years ago. How much did you weigh when you arrived in Australia?

GODEFA G’HER: About 48.

JENNY BROCKIE: And what did you weigh after a couple of years here?

GODEFA G’HER: 94.

JENNY BROCKIE: So two years and you virtually doubled your size?

GODEFA G’HER: Yeah, once you come to Australia, you've got everything. You've got the food. You see McDonalds, it's new, you know, all the junk food that you get on the street. You know, pizza and all of that, so but it's not only the, I think, the food but also it's the quantity of the food itself because I have a habit, I don't really get up from the, you know, dinner table until either I'm full or also the food is finished on the plate. And also like Dorothy said, culturally what I know is thin people are sick and you know, those people who are fat are good body build they are healthy.

JENNY BROCKIE: So when you went back to Ethiopia to visit and you were that much bigger, what did the people who you say?

GODEFA G’HER: Well they were excited, they were celebrating because I look good, look fantastic and I believe that.

JENNY BROCKIE: And what about now, what about your weight now?

GODEFA G’HER: I'm just under 73, 74, so I really work hard.

JENNY BROCKIE: What made you work hard, what pulled it back for you?

GODEFA G’HER: The doctor's warning and I just went to hospital for some respiratory issues and the doctor said your weight is another factor and I found it hard to believe that I am sick because of my weight.

JENNY BROCKIE: Juliette, can you relate to this because you came from Zambia, yes?

JULIETTE KAPAMBWE: Yes, I came from Zambia and what he's saying is true because when I came here I think I was, I was twice or maybe, yeah, I was very, very small. I was a size 12 when I came to Australia in 1996. And when I went back home, someone, when someone tells you are big or you've put on weight, it's a compliment rather than"¦.

JENNY BROCKIE: A criticism?

JULIETTE KAPAMBWE: Yes, yes. My parents, my in-laws, they were so excited when I went back because I had put on weight.

JENNY BROCKIE: What happened to your health?

JULIETTE KAPAMBWE: Diabetic at the moment, I'm type 2 diabetic, I've got diabetes type 2 and after it was gestational, when I had my last child who is eight years old and I was on insulin when I was pregnant four times a day so I had put on a lot of weight so that changed my habits of eating because I put on a lot of weight in a very short time.

JENNY BROCKIE: Andre, you study the eating habits in migrant communities. How common are those stories?

ASSOC. PROFESSOR ANDRE RENZAHO, MONASH UNIVERSITY: Yeah, they are really very common but actually what's not coming out as they talk, that can relate to the people who spoke earlier, is societal pressure. Because once you come to Australia, if you don't put on weight, then you look ridiculous. So you have to put on weight to fulfil the societal pressure back home - that is the pride you get so when you go back there's a sense of satisfaction. But the food they eat, while you call it unhealthy, for them they call it food for white people, food for rich people. So it's food they could never afford back home but when they call it healthy, but for them it's actually the food everyone aspires to eat prior to migration.

JENNY BROCKIE: Leeann, you've lost 42 kilos, why did you want to get the weight down?

LEEANN COX: Health reasons, but you know, just on like these people talking, when people say things when you're overweight, I don't know that they're being discriminatory as such. You know I got asked one time when I booked in for horse riding are you over a hundred kilos because obviously the horse can't handle high weight. They weren't being -I thought it was disgusting at the time but they've got an obligation to their animal to do that.

JENNY BROCKIE: But you wanted to get your weight down?

LEEANN COX: Yeah, definitely.

JENNY BROCKIE: For health reasons?

LEEANN COX: And for my own self esteem.

JENNY BROCKIE: Okay, you had lap band surgery. Let's have a look at how it works.

GASTRIC BANDING SURGERY VIDEO:

REPORTER: Gastric Banding is the most common form of surgery to treat obesity in Australia, often called Lap Band Surgery, it is performed through keyhole like incision. The gastric band is like a collar wrapped around the top of the stomach, the band can be adjusted by injecting saline through a tube placed under the skin.

JENNY BROCKIE: Now Wendy, you've gone about a thousand of these operations in Melbourne. What are the risks associated with doing that?

DR WENDY BROWN, BARIATRIC SURGEON: There are risks with any surgery so there's a risk of bleeding, infection and blood clots, and even dying under anaesthesia for any operation we do and there's a risk that we can damage the area we're operating on around the stomach. But it's very safe surgery.

JENNY BROCKIE: Okay, now I should point out that your research centre gets funding from Allergan which is a manufacturer of lap bands. So how can your research into whether it's safe or not be independent?

DR WENDY BROWN: Yes, in the world that we live in now where the tertiary sector are having their funding cost, funding cuts all the time we're asked, actually, to make industry partnerships. And I guess one of the natural partnerships for us is the manufacturer of the gastric band, the same as for people who are investigating high blood pressure. It might be the companies that make the drugs that treat high blood pressure.

JENNY BROCKIE: I should point out it's quite common in universities for this to be the case?

DR WENDY BROWN: Yeah.

JENNY BROCKIE: But in terms of those people coming to you and more people coming to you for lap banding surgery now? I mean it's gone from what 500 to 17,000 in ten years?

DR WENDY BROWN: Oh, there's been a big increase through the 2000s but since about 2009 it's really plateaued out. There's about eight or 9,000 lap bands done around the country a year and then probably about 4,000 of the other bariatric procedures.

JENNY BROCKIE: Leanne, how big were you?

LEEANN COX: 116 kilos.

JENNY BROCKIE: Were you aware of the risks associated with the surgery?

LEEANN COX: Yes, but as I was told, it's you know, no more, Professor O'Brien said to me he can do it probably safer than he can do a hernia operation.

JENNY BROCKIE: So what can and can't you do now in terms of eating?

LEEANN COX: Nothing, apart from bread really. I can't eat bread because that's sort of clogs and steak - the steak doesn't go down.

JENNY BROCKIE: What happens if something doesn't go down?

LEEANN COX: It gets stuck.

JENNY BROCKIE: And what happens then?

LEEANN COX: You go to the toilet and it comes up.

JENNY BROCKIE: So you vomit?

LEEANN COX: Yeah, it comes up but it's not like vomit, it's just like, comes up like solid still.

JENNY BROCKIE: So what can you eat now, what do you eat now?

LEEANN COX: Fruit, vegetables, lettuce, certain lettuces don't go down very well but anything that everyone else eats.

JENNY BROCKIE: And much smaller amounts?

LEEANN COX: Smaller amounts. I don't have breakfast and I was told when I was first looking at it that it will become about quality not quantity and I never believed that for a minute. I thought who can forget to have lunch some lunch, you know, you don't think about it anymore.

JENNY BROCKIE: Breanna, you're Leeann's daughter, what would you eat?

BREANNA COX: Everything, like I used to eat all the time – everything – like I was hungry all the time and I was working night shift so I was eating at weird times of the day and I would crave food like hot chips and gravy and just anything, cake, ice cream, I used to eat like half a loaf of bread for breakfast.

JENNY BROCKIE: So you decided to have the surgery that your mum had had?

BREANNA COX: Yes.

JENNY BROCKIE: How old were you when you made that decision?

BREANNA COX: I was 20, it was six months ago.

JENNY BROCKIE: And why did you opt for surgery?

BREANNA COX: Multiple reasons, mainly because I absolutely hated the way I looked, everything about myself. Going through high school, from about 15, I was bullied a lot, called every name under the sun and I just hated everything about myself.

JENNY BROCKIE: Had you tried to change your diet?

BREANNA COX: Absolutely, yes, I tried to change everything. I, I didn't have, to be quite honest, the willpower to sit there and say I'm just going to eat a salad and I'm not going to eat till dinner - Like I couldn't do it because I was hungry all the time.

JENNY BROCKIE: Okay, how did you feel about that mum, about your daughter having that operation at 20?

LEEANN COX: Because I knew how it worked, I was actually probably the one that talked to her about it. Because I know how she felt about her body, my husband was sceptical about it. He was like I don't know, she should try everything else first, and like everyone else - they think it might be the easy option. It's definitely not the easy option but it's a tool for you to work with. It stopped her being hungry. Like you can get out, you can exercise and you definitely can't exercise. Anyone that says they're fit and overweight, I've been there - you are not fit.

JENNY BROCKIE: Were you doing exercise Breanna?

BREANNA COX: No, not really. I had tried but I just, I couldn't maintain exercise or the level that I needed to because I would try running and I would - it's not so much that I was being laughed at, it was more in my head. Like I would feel like running down the street I would be looked at and that sort of thing because I could feel every bit of me jiggling. Like it was, it sounds stupid but it's such a mental thing as well.

JENNY BROCKIE: Wendy, how do doctors decide who to give the surgery to? I mean are there guidelines, is there an age limit on this, how does it work?

DR WENDY BROWN: There are guidelines, there are guidelines, most states will have guidelines around age which is 18 to 65 in my state Victoria and around size. We wouldn't normally offer this surgery unless your BMI was greater than 35 and you had a co morbidity of your obesity because if you are - co morbidity meaning a disease that can be changed by losing weight.

JENNY BROCKIE: What was your BMI Breanna?

BREANNA COX: My BMI was 35 and on top of that I have polycystic ovaries and I have endometriosis and if I hadn't lost weight, if I kept going the way I was going, it was likely to end up that I wouldn't have been able to have kids.

JENNY BROCKIE: Louise, do you have a view on this?

LOUISE ADAMS: I'm more interested in what happens to people in the long term after these kinds of surgeries because I really don't think we know enough about what happens to people, you know, post operatively. Some of the studies that look long term sort of ten years do show, you know, that these kinds of operations don't tend to last in terms of that dramatic weight loss and often the health problems that get taken away initially come back.

JENNY BROCKIE: Suzette, what happened to you, you had surgery?

SUZETTE FOSTER: I did, I had a gastric band in 2007 and over the next two and a half years I lost around 50 kilos, probably 55 kilos. Then mine just basically stopped working and I think I'd figured it out as well. I'd worked it out.

JENNY BROCKIE: How had you figured it out, what do you mean?

SUZETTE FOSTER: Well I'd worked out how I could get food in that I wasn't meant to. You know, you drink a glass of water when you're eating something and it washes everything down. You know, you eat things that go down easier, you know, chips, chocolate, whatever, all that sort of thing that just slides on down really easily, you know.

Then after, three or four years, I gradually put back on about 25 kilos of the weight that I lost and then I just realised this is just ridiculous, I don't want to put the weight back on, I don't want to get back up to that weight I was. I loved feeling how I felt when I was at my lowest weight.

JENNY BROCKIE: So what did you do?

SUZETTE FOSTER: I had gastric bypass surgery after a long discussion with my surgeon and lots of information and lots of, you know, working things out.

JENNY BROCKIE: Okay, this is different to lab band surgery, let's have a look.

GASTRIC BYPASS SURGERY VIDEO:

REPORTER: Gastric bypass reduces the size of the stomach using staples, creating a small upper pouch. The lower part of the small intestine is then connected to this new pouch. To help digestion fluids from the bypass section of the stomach are released through a new connection.

JENNY BROCKIE: You had that operation fairly recently, yes?

SUZETTE FOSTER: Eleven weeks ago today.

JENNY BROCKIE: Eleven weeks, how are you going?

SUZETTE FOSTER: I've lost 20 kilos and I feel fantastic. It's different to the band, you don't have that constricting feeling like you spoke about that sort of thing getting stuck, you don't have that. Everything, my meal sizes are just so much smaller and with the bypass you have to steer clear from things that are really high in sugar so that just knocks out a whole range of things that you just can't eat any more.

JENNY BROCKIE: What drove all this for you? I mean you say that you wanted to be smaller but were there health issues that you were worried about, did you have"¦

SUZETTE FOSTER: There was. I've got family history, you know my father passed away of heart disease young. My mum had had cancer. My family we're all bigger, we're all big, I've been big since I was in primary school.

JENNY BROCKIE: Why did you have to go for the surgical option?

SUZETTE FOSTER: I think I was addicted to food. I've tried all those other things that everyone's spoken about, the Jenny Craig, the Weight Watchers, the Herbal Life, you name it, and I just think I had an addiction to food.

JENNY BROCKIE: Louise, can you be addicted to food?

LOUISE ADAMS: I think what you're talking about happens to a lot of people and I think when you diet off and on you develop a very unhealthy relationship with food. Food's not just food, food has all of this kind of association.

JENNY BROCKIE: Kate, run us through all the things that you've done to try to lose weight?

KATE FINLAY: Everything listed, Jenny Craig, Lite and Easy, tablets that Oprah recommended that I shipped out secretly. I took to my stomach with a scalpel. I used to throw up every meal.

JENNY BROCKIE: Wait a minute, you took to your stomach with a scalpel?

KATE FINLAY: Yeah, my stomach and my arms.

JENNY BROCKIE: How old were you when you did that?

KATE FINLAY: About 20, 20, yeah.

JENNY BROCKIE: So real self-loathing?

KATE FINLAY: Yeah, I hate myself.

JENNY BROCKIE: You hate yourself still?

KATE FINLAY: Yeah, yeah, I don't like my body at all. I find it disgusting.

JENNY BROCKIE: Where does that come from, that feeling, when did you first start feeling like that?

KATE FINLAY: As a young child, like I was told, oh, you're thick thighs, you know, things like that. I was probably, not taunted as such but it was, you know, lucky you've got a good personality because you know, you're so fat. Things like that. So, lucky you're outgoing, lucky you've got pretty eyes. I put up that you're fat so you've got a barrier so you've got no feelings. I let it happen, I taunted myself and then it became self loathing all the time.

JENNY BROCKIE: Okay, so you went through all of this?

KATE FINLAY: Yes.

JENNY BROCKIE: And then you had lap band surgery and you lost 90 kilos?

KATE FINLAY: Yes.

JENNY BROCKIE: Is that right?

KATE FINLAY: Yes.

JENNY BROCKIE: What was that like at first?

KATE FINLAY: The first 52 was awesome. I thought I was the king of the world. I felt great because I was finally wearing normal person clothes and people actually started to come to me and talk to me, you know, felt good.

JENNY BROCKIE: Did it last?

KATE FINLAY: No, not at all.

JENNY BROCKIE: So what happened?

KATE FINLAY: I had lap band erosion. My lap band eroded into my stomach - I had a hole in my stomach so all of my stomach acid was leaking through my abdominal wall, my abdomen was infected with my own acid.

JENNY BROCKIE: So what happened then?

KATE FINLAY: I was really sick, really sick, I Rouony surgery.

JENNY BROCKIE: What's that?

KATE FINLAY: Basically I have no stomach really. I have a small well of a stomach. They had to remove more of my stomach than what they anticipated because of the scar tissue and the damage done. So I now don't really have any stomach.

JENNY BROCKIE: And you also had skin removed?

KATE FINLAY: Yes, I had about 15 kilos of loose skin removed, another thing I wasn't really told a lot about when you have a rapid weight loss was that when you're that stretched and you're that big that snapping back into place doesn't always happen. So I had a the lot of skin removed and it was about that time that we figured out that something was infecting my body as well because I got a massive infection from circumstantial surgery.

JENNY BROCKIE: We've got those photos there. That looks incredibly painful?

KATE FINLAY: Yes. I had the surgery twelve months ago and now I actually have a massive incisional hernia that now I'm on the public health system waiting to have that removed as well.

JENNY BROCKIE: You sound angry about it?

KATE FINLAY: I'm really angry about it. I'm angry that people are misinformed, I'm angry that they're doing it on 20 year old girls. Really angry - the idea that you can be buried with this thing, that it can be increased and decreased and it's not, it's not a tool.

JENNY BROCKIE: Because it does have to be, it does have to be increased, doesn't it? It has to be adjusted Wendy, it's not something you have done and then that's it?

DR WENDY BROWN: It's not a set and forget procedure, it's part of a process and I feel for Kate, but unfortunately I guess it's a bit like saying that some people are overweight, don't have any health problems, some people who get these surgeries get complications.

KATE FINLAY: But the surgery, you need to be informed.

DR WENDY BROWN: Absolutely, you do.

KATE FINLAY: That's my big thing, you're so misinformed, you are sold a product.

JENNY BROCKIE: Why do you say you're misinformed?

KATE FINLAY: You're sold a product. You're willing to lay out $10,000 and you're sold a product. It's the same as going to Jenny Craig and being told for $10 a month you can lose 10 kilos; people buy that, we pay the money for the lap bands because we're buying it. And fat people are vulnerable people. Fat people that dislike themselves, not fat people that are happy with themselves, we're scared, we're lonely, we're depressed so we're vulnerable. You tell me I can lose 50 percent of my excess weight I'm going to do it and I'm going to pay for it and because I'm willing to outlay the cash for it, you're going to do it and you're sold a product, that's all you are.

JENNY BROCKIE: Suzette, what did you want to say?

SUZETTE FOSTER: Well I had my surgery in 2007 and I was completely informed about erosion, ports flipping, you know, anything, everything, and I was even given the choice of a bypass back then in 2007. And the gastric sleeve was even mentioned as well.

JENNY BROCKIE: Which is a more drastic surgery?

KATE FINLAY: I've been sicker since having lap band surgery than prior to. I've had more, I've had one to two surgeries over the last seven years every year and I had no, no diseases, I had no high blood pressure, no heart disease, no respiratory problems, no joint problems, I had no diabetes, I was just fat. I was the classic victim of the diet. I'd do the extreme dieting, I'd lose 5 kilos, I'd feel great, I'd lose seven and then it would plateau, that famous plateau that everyone gets to, and I'd get depressed and down about it and, you know, that whole comfort eating thing, I suppose. Then I'd try another diet, I'd detox and try another diet so I was that person.

AD PLAYS:

VOICE OVER: When you eat more than you need to and aren’t as active as you should be, fat does not just build up around your waist, a toxic fat also builds up around your vital organs, releasing dangerous levels of chemicals that bring heart disease, diabetes and cancer closer. Fat around your waist is bad – but toxic fat around your organs is worse.

JENNY BROCKIE: Dorothy, what do you think of that ad?

DOROTHY TUAGALU: Man dang, why don't they have something about people who are slim, that, you know, they get too skinny that they're going to get diseases. Like it's always concentrate on fat.

JENNY BROCKIE: Godefa, what about you, what do you think of that ad?

GODEFA G’HER: I think for me it's scary, it doesn't tell you anything, rather than scared, terror.

JENNY BROCKIE: Jenny, what do you think of the ad?

JENNIFER LEE: I would argue it's negative, I think even using terms like toxic fat, I mean there's really no such thing, that's just made up for the ad and I think a lot of these kinds of ads are most negative. Like the most recent one I saw on the tram which was, apparently Diabetes Australia, and it's what we call a headless fatty. So you see this portion of the person, which you often see in the media and it allows people to disconnect from fat people to not feel the empathy. It's a very disembodied image.

JENNY BROCKIE: Kate, what about you, what did you think?

KATE FINLAY: It’s scary, it’s scary when you know what is going on inside of you, it’s actually worse than what it looks like on the outside. But I have a favourite saying and it’s called 'Skinny fat" and there are people out there that are skinny and they still eat crap. I have got friends that have got cholesterol problems that are the ideal BMI and the ideal weight. They have got cholesterol problems, heart disease, diabetes and they are skinny.

JENNY BROCKIE: Wendy, would you consider that a success if somebody just lost the weight but had all the other problems?

DR WENDY BROWN: No, not at all?

JENNIFER LEE: But wouldn't it be reported as such in the literature as a success?

DR WENDY BROWN: We report weight but we also report comorbidity change and quality of life change, they're the three things we look at. And I've had patients that have only lost 5 percent of their extra weight or haven't lost weight at all, but their weight being stable for them is what they were looking for and they've seen an improvement in their health and sense of wellbeing and to me I'm just as happy with them as I am with the ones, the rare one who last lost the most.

JENNIFER LEE: I don't think you've answered my question.

DR WENDY BROWNY: I think the vast majority of weight only lose about half of their extra weight, so we're not - we're bringing people down from a BMI of 43 to a BMI of sort of 33. We're not making people into the normal healthy weight range, we're just making them healthier and we always report weight, health and quality of life, and it's the three things we look at.

JENNY BROCKIE: Heather, we know that Australians, I mean we saw earlier Australians are getting bigger. Despite all the anti obesity campaigns and ads like that., why, why are we getting bigger?

HEATHER YEATMAN: Well there's a number of social changes that have occurred and a lot of people have mentioned about fast food and high fat, high sugar food being readily available, it's cheap. It's promoted a lot to children and one of the things that was also raised is having the skills to know well, what is a normal size? And are we focused on teaching our children a healthy relationship with food.

JENNY BROCKIE: Are we teaching the right things though do you think?

HEATHER YEATMAN: Well there are only a few schools that run, you know, cooking classes in primary school. Now surely having the skills to prepare food in the way, whatever way one wants to, but actually having the skills and control oneself to be able to do that, surely that should be considered a basic skill for all young people in our society. But it's not valued in our education system.

JENNY BROCKIE: We also know that junk food can be a lot cheaper sometimes?

HEATHER YEATMAN: Absolutely.

JENNY BROCKIE: Than buying healthy food?

HEATHER YEATMAN: And with the economic downturn, junk food relative to healthy food has become cheaper.

JENNY BROCKIE: Louise, what do you think about the ads like the one we saw?

LOUISE ADAMS: I think if you want to look after yourself a bit better this is how to go about it. You know, and I think if we're going to spend money on advertising we should spent money on this is how to look after yourself and maybe not, you know, messages about have, you know, have a surgery option or go on a diet. But things like psychologists teach like get in contact with things like hunger and fullness, learn mindful eating, you know, get that relaxed attitude towards food that I think is the foundation of health.

KELLI – JEAN DRINKWATER: I think one of the prevailing things happening here is that - what I'm hearing is this intense discussion around self hatred when you're in a bigger body and I wanted to ask people like down the front you who's 20, is your life better, are you happier, is everything better now that you're slightly smaller than you were before? I think one of the things"¦

JENNY BROCKIE: Well let's get an answer to the question, are you?

BREANNA COX: Absolutely and not I'm not a little bit smaller, I'm a lot smaller. And I did do research into everything, I can still have kids and that may not have happened if I had stayed the size I was. Like my question to you can you honestly say that you are 100 percent happy and healthy? Like you have no medical conditions whatsoever, you have no problems at all with your health?

JENNY BROCKIE: Okay. No, no, no, the question's been asked, what's the answer?

KELLI – JEAN DRINKWATER: I think it's really interesting that I feel like I need to justify my existence in this room right now.

JENNY BROCKIE: But hang on a minute, you asked her to justify her position?

KELLI – JEAN DRINKWATER: I asked her if she was happy. I didn't ask her to justify her health issues now or if there is any.

SHARNY KIESER: But have you got any health issues?

KELLI – JEAN DRINKWATER: No, I'm perfectly happy.

SHARNY KIESER: And I've love to know what do you see as healthy eating?

KELLI – JEAN DRINKWATER: Yeah, it's interesting that you've just assumed that I eat bad food because of my size.

SHARNY KIESER: No, I'd love to know because if you're really healthy, if you have any joint issues or so you're completely"¦

KELLI – JEAN DRINKWATER: I swim two and half kilometres a day, I walk, I exercise all the time. I'm in a synchronised swimming team and I really resent the fact that I have to actually justify my existence and my ability to live in the world in a bigger body in a way that I am happy with.

JENNY BROCKIE: But we're all talking about health tonight, I mean the whole show is about weight and health so it's not an unreasonable"¦

KELLI – JEAN DRINKWATER: You're talking about surgery and we haven't actually talked about the possibility that you can actually live in your life in your body.

JENNY BROCKIE: No, but we have, we have talked about that. All I'm saying is that a question to anyone about what they eat in the context of this program, anyone in this room is perfectly reasonable, I think.

WOMAN: If you can, being directed at fat people.

JENNY BROCKIE: No, it's not about being fat or not being fat. It's about what everybody eats. It's about what everybody eats and what health is..

KELLI – JEAN DRINKWATER: But that is not what we are being asked.

JENNY BROCKIE: No, no, no, I'm not conflating anything. I'm saying I think it's perfectly reasonable in the context of a discussion where you've got research that suggests that people who are overweight and people who are obese can be more prone to particular health problems. I think it's quite reasonable that in that context when we're talking about diet, we talking about losing weight, gaining weight, whether people are not happy or not happy with their weight, for someone to say what's your diet, in this room, in this context, seems to be perfectly reasonable.

JENNIFER LEE: I think those questions have been asked a lot and I guess what we're saying is that there are other ways to frame a discussion about fat, not just about health. And also I do think that it's problematic that you're asking individual people are you healthy because even though that person"¦

JENNY BROCKIE: I'm not asking anyone if they're healthy.

JENNIFER LEE: Well not necessarily you.

JENNY BROCKIE: No, hang on, don't put words in my mouth, don't put words in my mouth, somebody asked, and I just want to know, are you prepared to answer the question, is anyone prepared to answer the question about what do you eat? No, what do you eat, what sort of stuff, wasn't that your question?

SHARNY KIESER: Are they healthy.

JENNY BROCKIE: What was your question Sharny?

JENNIFER LEE: Yeah, she wanted to know what I eat.

SHARNY KIESER: Because Julius asked, sorry I don't know your name.

JENNIFER LEE: Jenny.

SHARNY KIESER: Julius asked you before Jenny what you ate and you avoided the answer.

JENNIFER LEE: No, I answered the question differently, what I'm saying"¦

SHARNY KIESER: If you're healthy I want to know.

JENNIFER LEE: I said that I wouldn't answer that question because I felt that a lot of thin people would not be asked that question. We're being asked a justify an existence and I will just"¦

SHARNY KIESER: I'll tell you what I eat, I'll tell you what I eat every single day.

JENNIFER LEE: I'll just finish my statement and that is that I think this conflation of fat and health is one thing but another thing is whether a fat person's healthy or not is not necessarily the primary question that I think we should focus on the whole time here.

JENNY BROCKIE: But it becomes a public health issue when it costs the community money.

JENNIFER LEE: Alright and I'm an academic and I earn and I play 35 percent tax.

JENNY BROCKIE: If a lack of health with a smoker, if a lack of health with a smoker costs the community money it becomes a point of discussion. So why shouldn't it be a discussion about anything where there is evidence that it maybe costing the community money for people to be carrying extra weight?

JENNIFER LEE: Because I think it frames fat as a drain on society and my response is a lot of us work, a lot of us pay taxes. You know, we're not just a drain on society and that, that kind of constant barrage of your costing this, you're costing that, first of all assumes an individual is the same as a group and also assumes that we are only a drain on society. And then we talk about fat hatred as if, oh, you know, it comes out of nowhere.

KELLI – JEAN DRINKWATER: I just think the way is discussion is running is very indicative of the general prevailing attitude towards fatness and the refusal to even accept that potentially there can be other ways of living in a healthy body.

SHARNY KIESER: You keep piping up saying fat power, fat power, I just want to know what are you eating, like I just want to know and I'll tell you what I eat and we can work out"¦

KELLI – JEAN DRINKWATER: That's what it comes down too, like what you're saying is incredibly, like it's such a small equation that you want to know what I eat. I eat salad, I eat meat, I don't eat carbs because they don't agree with me. You know, I eat a lot of fruit and vegetables, I'm primarily vegetarian.

JENNY BROCKIE: Hang on one minute, hang on one minute, I want to ask her a question. Heather, there are some people who just can't lose weight no matter what they do? If we leave surgery out of it, I guess we getting back to how much of it is environmental, you know, how much weight is environmental is what you actually do with your body and how much is genetic?

HEATHER YEATMAN: It is very difficult to lose weight once you've put it on and the figures cited earlier, 3 to 5 percent success rate with dieting, if you go into those cycles of dieting you're likely to end up weighing more than if you didn't diet at all. You can carry extra weight sort of BMI up to around 30 and in fact be slightly healthier than if you're normal to low weight. So there is a lot of social stigma associated with carrying extra weight that we're not dealing with, within our society which is forcing people into some of these drastic things.

JENNY BROCKIE: I guess the reason I'm asking that question is the blame factor. You know, sitting behind all of this in a judgment about people's weight is very often blame. Is the idea that you're bringing it on yourself, you must eat, your point, you must eat badly, you must have a terrible diet and so on. I'm just wondering if we know the extent to which weight is, you know, something that you acquire through your behaviour and extent to which for which some people it is just genetic. No matter what they do they're going to be big?

MAN: The answer to that is definitely and categorically no. Everyone can lose weight, there's a simple equation, it's called energy in, energy out. If your fat, you exercise and that's the energy out and the energy in is the fat that you carry on your body, everyone can lose weight. I know it's hard but the question was, are there people that can't lose weight and the answer to that is no.

LOUISE ADAMS: That's actually not true.

JENNY BROCKIE: Okay, Louise you're saying that's not true?

LOUISE ADAMS: No, that's absolutely, categorically wrong. There are - of course what you're saying is true that genetics haven't changed but our environment has changed and the genes and the environment interact and genetically there are many people who are very efficient at hanging onto body weight and will struggle with a calorie deficit to lose weight and keep it off, and that is just simple biology and there's a lot of research to sort of show that what you're saying isn't correct.

JENNY BROCKIE: We have to wrap up, we have to wrap up, we're running out of time and we have to wrap up. Wendy, there's a question I wanted to ask you, are you treating the symptom and not the cause with the surgery?

DR WENDY BROWN: I'm treating my patient. I'm treating the person who comes to me and asks for help and I don't always get it right, no surgeon gets it right all the time. There's no such thing as a magic bullet or a magic solution but I hope by forming a relationship with my patient then I can identify what their needs are and I can try to help them as best I can.

JENNY BROCKIE: Okay, final comment from you Heather.

HEATHER YEATMAN: We really need to be looking at this systematically and getting away from just individuals because every individual's got their own story. We need to be really thinking as a society what we're doing to encourage acceptance absolutely, but also enabling as the next generation, our children, to live as healthy as possible as well as ourselves. So you know, promoting access to healthy food that is cheap and affordable and enjoyable and knowing how to prepare that, having confidence to do that but also really focusing on positive relationships between people.

JENNY BROCKIE: Kate? Final comment from you?

KATE FINLAY: Be informed, be 100 percent informed about any decision you make, whether it be diet and exercise, surgery, remaining overweight and being happy with yourself, just be informed of what the outcomes going to be for your future, your children's future, your family's future, that's all.

JENNY BROCKIE: Okay, we have to wrap it up here, thanks everyone very much for tonight but you can keep talking on-line of course. I'd be interested in your thoughts on fat activism and surgery for weight loss, so do get online and have a chat about that.