Silent Assassin: One famous country town and its battle of the bulge

It has been literally renamed Tim-Tamworth for a day, has been cruelly dubbed "Fatworth" by some locals and once hosted an eight-metre tall, 300-kilogram Big Mac next to its war memorial. But the bustling regional centre has a serious problem with obesity - and it's growing.

Experts discuss type 2 diabetes on the Voice of Real Australia podcast.

The suburb of West Tamworth is officially regarded as the fattest in Australia. According to 2017-18 Australian Health Policy Collaboration data, a whopping 93.8 per cent of the suburb's residents are either overweight or living with obesity.

That's up from 79.8 per cent in 2014-2015.

Official figures show at least 3790 people in Tamworth are living with diabetes, more than in equivalent country cities like Orange (2160) and Wagga Wagga (3650).

Retired GP Dr Lyn Allen has watched as Tamworth's milk bars and corner shops of the 1980s were replaced by fast-food chains and reckons they've done a fat lot of good for local waistlines.

"I began working in 1980, and in 1980 we had very little diabetes," Dr Allen said.

"As the population has had access to a lot more fast-food and processed stuff in the supermarkets, diabetes has become a huge problem as with all the things that go with it.

"My first scales were 110 kilograms. By the time I retired in 2017, my scales were 250 kilograms."

Dr Allen said a "normal" weight was previously considered around the 70-80 kilo mark.

"If you look at someone who weighs three times that with the same sized heart, you can imagine the effect on their body," she said.

"If they were educated, maybe they would make another choice if they realised what it would do to them. Places like McDonald's, it's not everyday food. Just like junk in the supermarket, they eat it all the time."

So incensed was Dr Allen by the proposal to build a fourth McDonald's outlet in the city, she took her concerns to a council meeting to speak against the development.

But the burger giant's local franchisee Adrian Sippel says fast-food restaurants alone cannot be blamed for the prevalence of diabetes.

He points to the healthier options his outlets offer.

"Over the past few years, we've included healthier options on our menus and have committed to helping our customers make more informed decisions about their food choices," he said. "We have introduced salads and wraps, reduced the sugar content of our buns to just five per cent and offer healthier substitutes in Happy Meals including wraps, fruit bags and yoghurt.

"McDonald's has a long history of being part of the Tamworth community. We support local sports clubs and encourage people to enjoy Macca's as part of a balanced lifestyle."

Tamworth's fourth McDonald's will open in December and is expected to inject more than $5 million into the economy and create 120 new jobs.

Despite his city's health statistics and burgeoning burger business, Tamworth state MP Kevin Anderson reckons the community does a good job when it comes to food and exercise.

"I think we need to get better and look at what we do to get people moving," he said. "Schools are doing a great job with healthy tuck shops and eating options and alternatives, but there has to be education at home as well - what's being put on the table at home matters."

Asked if local, state and federal governments should play a bigger role in education about healthy eating, Mr Anderson said he felt there was "a lot of work going on already".

Active Kids vouchers were a great example of the work the NSW government had done, along with investment in sports infrastructure to encourage exercise.

Gomeroi man Ray Kelly, an exercise physiologist who runs the Too Deadly for Diabetes program for Indigenous communities, is worried about increasing chronic health issues in younger age groups.

"For a start in Tamworth at every high school you would have a number of children with type 2 diabetes and diagnosed, but there would be many more in the early stages," he said.

"At this stage what we are seeing is kids being diagnosed in their 20s and 30s. When I grew up in that area your 50s was young to be diagnosed. These people have passed the healthiest years of their life and will spend the majority on medications and in poor health.

"What that means is seeing cardiologists and kidney experts, poorer mobility and mental health [and] it's a determining factor for dementia.

"People think that type 2 diabetes is bad now. It's nothing. We will have a tsunami of mental health issues if we don't get onto it."

Mr Kelly, who recently co-hosted the SBS documentary series Australia's Health Revolution with Dr Michael Mosley, welcomed Diabetes Australia's recent formal acknowledgement that type 2 diabetes can be put into remission through weight loss achieved by dietary and lifestyle changes.

"I was like a dog with a bone after that ... I do want to change the world, people laugh about it and say one person can't change the world, but you can't if you don't try," he said. "We taught people how to live with it and if you do that you set the bar low, but what if we set the bar high?"

Jen Avery is one Tamworth resident reclaiming her health after a type 2 diabetes diagnosis.

"It was probably 12 years ago I was diagnosed," Ms Avery said. "I was very overweight and I had an infection that wouldn't go away, so my GP did a test and I was diagnosed. That's when I started my struggle to manage it. I was pre-diabetic but no matter what I did it wouldn't go away. I went onto oral medications and then I went onto insulin.

"Honestly, I just went into denial. I didn't think it was a big deal. When I'm feeling a bit stressed I go to that place of 'it's not something life-threatening, I don't need to worry' but I do because of your eyes, kidney health, all those sorts of things. And I do need to worry about it."

Ms Avery says she has lost 25 kilograms and is inching closer to remission while following the Defeat Diabetes program led by sports physician Dr Peter Brukner.

"The difference between then and now is that I truly know I need to exercise and eat properly if I want to have a reasonable life," she said.

Since she began the program, she has come off insulin and feels "200 per cent better".

"I feel different, I recognise I have it but I don't think of myself as being sick. I know I have a chronic illness. I'm in control of it now, it's not in control of me."