Technical Paper 1:
Obesity in Australia: a need for urgent action
1 - Executive summary
One of the greatest public health challenges confronting Australia and many other industrialised countries is the obesity epidemic. Australia is one of the most overweight developed nations, with over 60% of adults and one in four children overweight or obese.
The prevalence of overweight and obesity has been steadily increasing over the last 30 years. Obesity is particularly prevalent among men and women in the most disadvantaged socio-economic groups, people without post-school qualifications, Indigenous Australians and among many people born overseas.
Tackling obesity is about reshaping behaviours for positive outcomes in an environment of nutritional abundance that serves aesthetic and emotional needs as well as nutritional requirements. Food and alcohol play an important part in the social fabric of life, and simply lecturing people or taking a prohibitionist approach is unlikely to be successful or appropriate.
It will be important to work together as a nation to solve this serious problem. Individuals and families, communities, health services, non government organisations, industry and governments will need to all be actively engaged and to agree on priorities for action to enable overweight and obesity to be tackled in Australia.
Obesity is a relatively new area for prevention globally. There is no simple solution or singular approach. These factors speak to a ‘learning by doing’ approach – that is, the staged trialling of a package of interventions accompanied by good monitoring and evaluation. Behaviour change is an essential component of any response to obesity; however, this is a complex process for individuals that extends beyond education and the provision of information.
Achieving long-term, sustainable change is difficult, resource-intensive and time-consuming. In order to halt and reverse the rise in overweight and obesity in Australia, the following initiatives are likely to be required.
Reshape the food supply towards lower risk products and encourage physical activity
- Review the taxation system to enable access to healthier foods and active recreation (for example, increase tax breaks for fitness-related products and recreational activities, and for schools and workplaces to provide healthy foods). Provide disincentives for unhealthy foods by considering increasing taxes for energy-dense foods. Taxing unhealthy foods may provide an incentive to manufacturers to change their production processes to reduce the fat, salt or sugar content in order to maintain their market share.
- Regulate the amount of trans fats, saturated fat, salt and sugar content in foods.
- Provide subsidies for the transportation of fresh foods in rural and remote areas.
- Curb inappropriate advertising and promotion including consideration of banning the advertising of energy-dense, nutrient-poor foods and beverages on free-to-air television during children’s viewing hours (i.e. between the hours of 6.00am and 9.00pm), and reducing or removing such advertising in other media such as print, internet, radio, in-store and via mobile telephone.
- Develop effective, adequately funded and long-term media advertising and public education campaigns to improve eating habits and levels of physical activity, with specific media advertising and targeted public education for priority population groups.
- Enhance food labelling by introducing a national system of food labelling to support healthier choices, with simple and comprehensible information on trans fats and saturated fats as well as sugar and salt and standardised serve sizes. This would apply to food for retail sale as well as on food purchased when eating out, and be available in settings such as restaurants, food halls and takeaway shops.
Reshape urban environments towards healthy options
- Encourage school communities to support initiatives in schools that enable healthy eating and physical activity, such as healthy breakfast and lunch programs, removal of unhealthy foods from vending machines and ‘walking school bus’ programs.
- Implement comprehensive community-based interventions that encourage and support healthy lifestyles among all population groups, particularly in areas of disadvantage and among groups at high risk of unhealthy weight gain.
- Encourage employers and workplaces (both large and small) to develop comprehensive programs that support healthy eating and physical activity.
- Develop evidence-based guidelines to ensure policies and building design encourage healthy eating and physical activity, such as travel expenses promoting walking or cycling to work; improved stairwells to encourage use; and the provision of shower and bike parking facilities.[1]
- Introduce incentive schemes to encourage healthy behaviours and weight management including contributions to gym memberships, active travel in expense policies, and the availability and promotion of competitively priced healthy food choices on-site (including vending machines).
- Facilitate the adoption of consistent town planning and general building design that encourage greater levels of physical activity, and reorient urban obesity-promoting environments through appropriate infrastructure investments. For example, develop state and municipal plans to re-orient public transportation and increase urban density, support farmers’ markets, build bicycle paths and footpaths, and protect open spaces.
- Expand supply and support training of relevant health workers such as primary healthcare workers, health promotion workers, nutritionists and dietitians.
- Develop and disseminate evidence-based clinical guidelines and other multidisciplinary training packages for health and community workers.
- Expand community placements for the training of the primary healthcare workforce.
- Fund programs to educate patients in primary healthcare settings about nutrition, physical activity and the management of overweight and obesity.
- Have targeted programs to encourage healthy eating for pregnant women and breastfeeding for newborns.
- Support ongoing research on effective strategies to address social determinants of obesity in Indigenous and low-income communities.
- Develop tailored approaches and services to reach Indigenous and low-income groups, particularly through partnerships with local governments that focus on obesity-promoting environments, and mobilise programs in schools and other community settings.
Build the evidence base, monitor and evaluate effectiveness of actions
- Develop a comprehensive national research agenda for overweight and obesity.
- Expand the national nutrition and physical activity survey to cover adults, children and the Indigenous population, and ensure the inclusion of biomedical risk factors for chronic disease. This survey needs to become a permanent national five-yearly study.
- Australia lacks a comprehensive national food strategy. Such a policy should be considered in the context of preventative health, and more specifically for its role in the prevention and reduction of rates of overweight and obesity in Australia. In the UK, for example, the 2008 document ‘Food Matters’ sets out a future strategic framework that integrates food safety, food production and agricultural policy, and addresses issues with climate change to ensure a safe and sustainable food supply. Such a strategy would be invaluable in Australia.