The 21st century is making our kids obese

THE 21st century is making our children overweight, obese and “bubble-wrapped”, says a leading Australian expert on paediatric obesity.

Professor Louise Baur, Head of Child and Adolescent Health at the University of Sydney, says that if she had to narrow down to one driver of the increases in rates of overweight and obesity in Australian children, it would come down to “the 21st century”.

“In comparison with the childhood obesity rates of other OECD countries, we are fifth for girls and eighth for boys,” Professor Baur tells MJA InSight, in an exclusive podcast.

“We’re behind the US, who are number one, and we’re behind New Zealand, but I don’t think we should be taking any pride in that. We still have a large number of children affected – in terms of overweight, one in four school-age children are affected, and in terms of obesity, about 6% to 8% of school-age children are affected.”

Dramatic changes in the way children eat and spend their leisure time are the big drivers of the “obesity epidemic”, Professor Baur believes.

“We have dramatic changes in our food environments and also our physical activity environments. Over the past few decades, we’ve seen the rise of readily available, cheaper, often low quality food; the marketing of junk food and soft drinks to children and young people; and the relatively higher prices of better quality food.

“We’ve seen the rise of motorised transport and of sedentary behaviour; screen time – the world comes to children now.

“When we were children, we would ride our bikes to and from school. Now schools don’t allow them to because they are concerned about safety enroute. Parents are more concerned about road and pedestrian safety – some of that concern is real and some of it, I think, is more an imagined concern.

“We have somewhat bubble-wrapped children so it’s more difficult for them to get incidental activity getting around and seeing their mates and spending time outside. We have cocooned children quite a lot.”

Professor Baur is the co-author of a Narrative Review published by the MJA on contemporary approaches to the prevention and management of paediatric obesity, which examines prevention strategies – both school-based and community-based – and management plans, including family-based behaviour change, pharmacotherapy, bariatric surgery and health service delivery considerations.

“In terms of obesity prevention, there needs to be integrated action from pre-conception, through pregnancy and early childhood, and across the age and developmental spectrum,” Baur and colleagues wrote.

“Several strategies outside the health sector hold promise for influencing obesity on a population scale. These include fiscal policies to reduce consumption of sugar-sweetened beverages, the strict regulation of unhealthy food marketing to children, public transport policies to promote active transport, and urban planning approaches that support active communities.”

• MJA Editorial: Protecting our children from obesity: challenges and opportunities

Ensuring equity of access to services across the country is also a priority.

“Coordinated health care pathways are required in each health region, linking primary care through to tertiary care services, which include bariatric surgery for older adolescents,” they wrote.

“Overall, curbing the problem of obesity is achievable and can be realised through a combination of smart governance across many sectors, community initiatives, the support of individual efforts, and clinical leadership.”

Professor Baur tells MJA InSight that politicians and policy makers across multiple portfolios and levels of government need to see beyond the vested interests.

“When you think about the drivers of obesity, and preventing it in the first place, they essentially all lie outside the health system,” she says.

“I have no doubt the health ministers at both federal and state level are very aware of the costs of obesity and of some of the drivers that need to be addressed,” she says. “I would be incredibly surprised if there were any health minister around our country who still thought that [obesity] was a role of personal responsibility.

“We know that is a nonsense. We know that people are responding physiologically to a pathological environment, called 21st century Australia.

“But it is challenging. Obesity still remains highly stigmatised. It costs a lot of money and it has profound health and psychological consequences.

“We need to get beyond blaming people for this and get on to treating it and preventing it.

“None of us want to see our children emerging into adulthood with lots of risk factors for diabetes and heart disease. That’s not what should be happening.”

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