‹‹Back to About the House Magazine: Issue 38 – September 2009

When fat becomes the norm

Australians are becoming fatter and the rate of obesity is accelerating. A report by the House of Representatives Health Committee has called for action to tackle a serious and growing national health problem.

Story: Geoffrey Maslen

For years Australians have sneered at television images of overweight Americans: the grossly flabby men and women with their fat little kids, whole families bulging out of their too-tight clothes. Just look at those portly parents and their podgy offspring, we smirk.

But no-one wins in the obesity stakes and Australians have little to be proud of because we, too, have become slothful and over-fed Norms. Remember Norm—the famous cartoon couch potato who tried to turn most of us off junk food and too-little exercise? Now we have joined Norm as we head down that road paved with good intentions.

A survey by the Bureau of Statistics found that more than two in every three Australian men and more than half the women were overweight or obese in 2007-2008 compared with 1995 when the previous survey was conducted. In those 12 years, the proportion of both sexes who had put on far more fat had markedly increased.

Not only have too many of us adults ignored the message that being overweight or obese is seriously harmful to our health, but we have allowed a new generation to follow in our fat footsteps. On current trends, the proportion of children who are overweight or obese is expected to double in the next 30 years when 60 per cent of seven to fifteen year- olds will be excessively plump.

In a report published in the Medical Journal of Australia in July, West Australian researchers noted that nearly a third of children in their study were unhealthy because of their weight, diet and lack of exercise. They found 29 per cent of 14-year-olds and 25 per cent of eight-year-olds were in a high-risk cluster facing future health problems such as heart disease, diabetes or stroke.

Lead author Dr Rae-Chi Huang, from the University of Western Australia’s school of medicine, said the study proved there was no room for complacency on child health. It showed the problem was wider than just the 6-8 per cent of children who were officially classified as obese.

“It’s not alarmist to say it’s an epidemic,” Dr Huang said. “But it’s a strange epidemic because we are not going to reap all the full effects for many years. These kids are on a track to bad health and we have to turn them around—the earlier the better.”

Soon after the Rudd government was elected, Health Minister Nicola Roxon said the government was committed to making obesity prevention a National Health Priority Area. As more and more details emerged about the scale of overweight and obesity in Australia, Ms Roxon asked the House of Representatives Health Committee to investigate the issue.

The committee’s report Weighing it up was released in June this year following a lengthy inquiry that took its members across Australia, visiting capital cities, regional areas and rural and remote communities to gather information on what the health costs of an overweight community actually meant.

The committee received 158 submissions and held 13 public hearings to canvass the views of different people with an interest in the subject. They included doctors, allied health professionals and patients, hospital administrators, health economists and academic experts, urban planning bodies, and the food industry.

“We visited a number of hospitals, schools and programs that promote healthy eating and the benefits of physical exercise in various guises,” said committee chair Steve Georganas (Member for Hindmarsh, SA). “We heard from federal, state and local government officials about diverse public health campaigns, policies and activities that seek to prevent and manage the obesity epidemic in children, youth and adults.”

Mr Georganas said evidence to the committee suggested that the cost to the Australian economy of obesity last year was more than $8 billion. That included costs to the health system as a result of rising rates of diabetes, cardiovascular disease and the complications associated with surgery and other interventions.

But in its evidence to the committee, national consulting firm Access Economics estimated the total costs of obesity to be a staggering $58 billion, and rising. That is almost triple the amount Australia spends on defence each year.

Access Economics calculated the financial costs of obesity, not counting Australians who were simply overweight, at $8.28 billion. This included $3.6 billion in lost productivity, $2 billion for health system costs, and $1.9 billion carer costs, with the net cost of lost “wellbeing” amounting to a further $50 billion.

The committee’s inquiry began at the same time as the federal government’s National Preventative Health Taskforce was examining the burden of chronic disease caused by obesity, tobacco and excessive consumption of alcohol. Ms Roxon had announced establishment of the taskforce in April last year, saying it had been asked to develop a national preventative health strategy.

Lobbyists who presented evidence to the House committee —and who are critical of some of its recommendations—hope the taskforce report, which went to the minister at the end of June, will take a stronger line in areas such as junk food advertising while providing an action plan and timeline for its implementation. The taskforce report and the minister’s response are yet to be released.

Meantime, the committee’s findings continue to be debated. The 200-page report provided 20 recommendations that the committee believes governments, industry, individuals and the broader community should adopt “to reverse our growing waistlines”.

“Our report differs [from the taskforce report] in that it also, importantly, serves as a platform for many stakeholders to share their views and tell their stories,” the committee says in Weighing it up.

“As some of the text and photos in our report attest, there are some quite exciting and innovative solutions already underway, from well-designed urban developments to council-run exercise programs in parks to community gardens and cooking classes. The committee has been pleased by the interest in the inquiry and believes that there is real momentum in the community to do more.”

Mr Georganas said the committee wanted to send a positive message about tackling the problems caused by obesity: “There are terrific programs and projects, encouraging people to eat more nutritious food and to do more exercise. Councils are putting in walking trails and facilities, school programs are making it easier for children to walk to school and community groups are setting up exercise sessions for all ages.”

Among its recommendations, the committee said state and federal governments should gather more detailed information about the weight of Australians and their levels of physical activity, develop better public health campaigns to tackle obesity and promote the benefits of healthy lifestyles, introduce stronger regulation of weight loss products and programs, and establish a registry of bariatric surgery that involves various surgical procedures to assist in weight loss.

But the committee’s proposal that the food industry and government should jointly develop guidelines aimed at lowering sugar, salt and fats in processed food and develop consistent nutritional advice on food labels has attracted criticism.

The Obesity Policy Coalition said while the committee made many excellent recommendations, it had bowed to pressure from the processed food industry. The coalition claimed the committee had taken “a soft approach” to two of the key drivers of obesity: inappropriate and excessive marketing of unhealthy foods, and lack of clear front-of-packet labelling.

“If any inroads are to be made in the area of obesity, government needs to start making some tough policy decisions and stop sitting on its hands. This is a feather duster approach to prevention—touching several things lightly but not disturbing the status quo and the real drivers of obesity,” the coalition’s senior policy adviser Jane Martin said.

“We have had self-regulation for decades while Australians’ waistlines continue to expand. Our children should be protected from the unfettered bombardment of junk  food advertising in their everyday life. Surveys show the vast majority of Australians recognise that junk food advertising is a driver of obesity and want the government to intervene.”

The coalition was formed in 2006 with the aim of influencing changes in policy and regulations to support obesity prevention, particularly among children. Its members include the Cancer Council Victoria, Diabetes Australia, Vic Health and the World Health Organization Collaborating Centre for Obesity Prevention at Deakin University in Victoria.

“We know from public health successes in the areas of tobacco control and road safety that a strategy to address overweight and obesity will require a comprehensive portfolio of interventions, including policies and regulations that will dampen demand for unhealthy food,” Ms Martin said.

“While we welcome the recommendation to create a set of food labelling guidelines, these must act to guide people to healthier choices. The government cannot afford to delay action in this area any longer. The inquiry is proposing to spend significant amounts on the end results of obesity such as gastric banding surgery yet its recommendations on the prevention side—where a greater impact can be made—are seen as less urgent. “

The Australian Food and Grocery Council has defended self-regulation for the industry and endorsed the committee’s recommendation of further research into the effects of food advertising on children. The council’s chief executive, Kate Carnell, a former ACT Chief Minister and a member of the Preventative Health Taskforce, said it would be “helpful to all concerned to have robust research undertaken on this issue”.

In giving evidence to the inquiry, the advertising industry cited research from the Australian Communications and Media Authority which it said had failed to link obesity and television advertising. But among its recommendations, the House committee said the Health Minister should commission research into the effect of junk food advertising on the eating behaviour of children “and other vulnerable groups”.

Regarding a role for industry in combating obesity, the House committee said if industry failed to make changes “within a reasonable timeframe”, the federal government should consider imposing regulations.

Dr Lyn Roberts, chief executive of the Australian Heart Foundation, and another member of the Preventative Health Taskforce, said she believed there was a need to tighten regulations for all forms of food advertising and promotion directed at children.

“The foundation wants new regulations to be developed that encourage the promotion of nutritious foods to children to normalise and reinforce healthy eating. We are keen to work closely with the Australian government to support new measures to address obesity,” Dr Roberts said.

Susan Anderson, national director of healthy weights at the Heart Foundation, said the organisation wanted a ban on commercial food beverage advertising to children aged under 16. Ms Anderson said the foundation took a strong stance and believed all marketing—from free-to-air or paid television, in the cinema, on the internet and via emails, as well as sponsorship of school and children’s sports, and point-of-purchase promotions—should be banned.

“Our view is that children, kids under 16, are vulnerable to commercial exploitation and we want regulations imposed that provides them with a high level of protection,” she said.

“Despite what the food industry might say, we do know that marketing to children is dominated by nutrient-poor, energy-dense foods. There is also evidence that TV advertising does influence children’s preferences, their beliefs, their purchase requests and, for children younger than eight, their ability to distinguish between advertisements and regular programs.”

During a visit to Deakin University in July, New Zealand expert on marketing Professor Janet Hoek said governments should regulate advertising of “energy dense and nutrient poor” foods. Professor Hoek is a principal investigator into obesity at the University of Otago and was an expert adviser to New Zealand’s inquiry into type 2 diabetes and obesity.

She said opponents of regulating advertising of junk food often described government intervention to promote public health as “nanny state” and accused regulators of trying to assume a decision-making role that belonged with individuals.

“Recently, proposals in New Zealand that would regulate food marketing and food supply have been dismissed in this way. Yet governments have often intervened to promote public health and have a long history of intervening in areas where the public is at risk.

“We have seen this in relation to the use of child labour, the wearing of seat belts, drinking and driving and, more recently, the control of swine flu. Yet more people are likely to die from chronic diseases caused by smoking and obesity than they are from swine flu.”

In its report, the House Health Committee commented on the need for a “whole-of-society” response to obesity. While this should be led by the federal government, the committee said other governments, non-government agencies, the private sector and individuals are all involved, not least because the causes of obesity are complex and diverse.

But the report also drew attention to the ways individuals and groups are acting to reduce the burden caused by an overweight and obese population. It said one federally-funded scheme that offers preventative benefits is the Active After-school Communities project that encourages primary school children to undertake non-competitive physical activities, including circus skills and dance, at 3,250 schools and out-of-school care centres across the nation.

Members of the committee visited a primary school at Lake Macquarie involved in the program and felt the effects of various activities, including a tug-of-war. They recommended the Health Minister should continue to support the scheme and consider ways to expand it to more sites across Australia. On the Gold Coast, committee members took part in a Tai Chi class as part of the city council’s Active and Healthy Program which offers “an activity you can participate in” every day of the week across the city for 48 weeks a year. The programs are free or low cost and cater to all age groups.

At Westgarth Primary School in Melbourne, members were impressed by the skill and enthusiasm displayed by children working in a vegetable garden inspired by the Stephanie Alexander Kitchen Garden project. They learnt from pupils about natural pesticides and fertilisers and later watched as the children prepared the food for lunch.

“Many of the community and school garden projects the committee came into contact with demonstrated numerous flow-on benefits,” the Weighing it up report stated. “While these programs are not the whole solution, they are a vital part of the overall solution. These often small, local programs initiate incremental change that creates a snowball effect, contributing substantially to the effort to combat the national obesity epidemic.”

Weighing it up is available www.aph.gov.au/house/committee/haa/obesity/report.htm and for more information email haa.reps@aph.gov.au or phone (02) 6277 4145.

The big picture

• Australia has the fifth highest rate of adult obesity in the world behind the United States, Mexico, Britain and Greece.

• As many as three million Australians are obese.

• Two per cent of adult Australians are morbidly obese: their body mass index (a measure of their weight in relation to their height) is 40 or more.

• Almost 650,000 Australians have cardiovascular disease and more than 240,000 have type 2 diabetes because they are obese.

• Overall, 68 per cent of adult men, 55 per cent of women and 21 per cent of children aged 5-17 in Australia are overweight or obese.

• High body weight contributes 7.5 per cent to the burden of disease, almost the same as that caused by tobacco.