Obesity: we know what to do

OVER the past decade, Australia’s weight problem has worsened. Since the Obesity Policy Coalition (OPC) launched in June 2006, we’ve seen a rise in obesity rates among many demographics, while the burden of disease for poor diets and obesity has increased.

It’s costing us financially, physically and socially at a national, community and individual level.

As explained in the MJA recently, Australia lacks a sustained, comprehensive and strategic approach to prevention, together with adequate funding, coordination and monitoring.

In 2011, Australia’s spending on prevention and public health as a share of total recurrent health spending was 2.0% (versus New Zealand’s 6.4%, Finland’s 6.1% and Canada’s 5.9%).

When you consider the large proportion of preventable disease related to diet and obesity, as well as the direct economic costs of $3.8 billion a year, it is extremely concerning that Australia still does not have a national obesity strategy.

Public health experts have been advocating for a variety of different actions and strategies to address this very serious health problem for a number of years. Many of these are cost-effective and some would go further, providing funds to bolster prevention spending.

While there is a well recognised suite of actions to address Australia’s weight problem, a lack of a clear and consistent call to action by health organisations means that this has not been well communicated to the policy makers who can bring about these changes.

This lack of consistency is one element hindering progress at a national level.

Health organisations are starting to align their obesity policy advocacy efforts – proposing a clear suite of actions that will ensure that governments develop and implement an effective strategy to tackle this urgent health problem.

• Related: MJA InSight -- Put tax on sugared drinks on table
• Related: MJA InSight -- Prevention policy “flapping in the wind”
• Related: MJA InSIght -- Obesity measures missing
• Related: MJA -- Obesity management in general practice: does current practice match guideline recommendations?

As we head into the federal election and the start of the OPC’s second decade, let’s reflect on what policies must be introduced or strengthened to reduce the impact of overweight and obesity.

Action required: 20% levy on sugary drinks

We know that price is an important lever which can be highly effective in influencing sugary drink consumption. We know from the experience in Mexico and from our research that increasing the price of sugary drinks in Australia has the potential to reduce consumption and improve population weight and health outcomes, if the tax is set at a sufficiently high level. Meanwhile, a 20% price hike can raise at least $400 million per year for much-needed obesity prevention initiatives.

The OPC and other health bodies were relieved to see that the goods and services tax was not extended to fresh fruit and vegetables as previously considered. Such a tax would have been a disincentive for eating a healthy diet.

The revenue raised from a tax on sugary drinks, meanwhile, has the potential to have the opposite effect and can be used to subsidise healthy food for low-income families.

Action required: Interpretive food labelling

The new interpretive front-of-pack labelling system, the Health Star Rating System, is an important policy development. However, its effectiveness has been hampered by the watering down from a mandatory to a self-regulatory arrangement.

It also continues to co-exist with the industry Daily Intake Guide which it was meant to replace to reduce consumer confusion.

Food companies can choose whether to use the scheme or not, so many products do not carry the stars. Widespread adoption of the stars is necessary for shoppers to compare products and use the rating system as it was intended.

It also appears that some companies are using it selectively on products. Self-regulation can create a very uneven playing field, putting those companies who have adopted the scheme across all product lines at a potential commercial disadvantage.

Action required: Reduce children’s exposure to junk food marketing

We need to consider if business as usual is going to support families, schools and communities to raise healthy, happy children.

With few children eating a healthy diet and up to 40% of their energy coming from junk food, we must consider why we allow junk food and drink companies to self-regulate and to:

• continue to sponsor children’s sport;
• make their own rules about what can be marketed to children, with sugary breakfast cereals and chicken nuggets considered healthier choices; and
• target children through digital platforms such as Facebook.

This constant bombardment of food and drink advertising means unhealthy products have become the wallpaper for a generation where more than a quarter are overweight or obese. Not placing meaningful controls on promotion, and justifying this by saying that parents are responsible, takes the focus off those who manufacture and promote highly processed food.

In conclusion, the need for action on diet and weight is being increasingly understood and acted on in communities that are hit hardest by this problem.

In some places, the leadership is coming from local government, in others it is groups like the YMCA or local community health services. State and territory governments are also playing an important role, such as funding education campaigns like LiveLighter and establishing policy frameworks for a range of settings.

These activities are very important, but alone they are not enough.

It should be a priority for the federal government to establish a national obesity prevention strategy to tackle the drivers of our obesogenic environment, some of which are outlined above.

Until we see national leadership tackle the problem, we will continue to fail to improve diets and slow obesity, making no impact on its growing burden of preventable disease on the hospital system, the economy and families.

Jane Martin is Executive Manager of the Obesity Policy Coalition.