Obesity Strategy
3.1
The causes of obesity are myriad, as are the impacts, and the potential
solutions. The committee heard extensive evidence around the importance of
bringing all factors in the obesity policy debate under one roof.
National Obesity Strategy
3.2
Australia does not have an overarching strategy to combat obesity. Many
of the policy areas required to identify the causes, impacts and potential
solutions to the obesity problem span every level of government. There was broad
support across the spectrum of evidence received for a whole-of-government strategy
to be put in place.
3.3
Submitters highlighted the need for coordination to ensure that policy
drivers are in place across social, education, economic and health policy
fields. Professor Steve Allender from the Global Obesity Centre at Deakin
University proposed a 'comprehensive national obesity strategy with high-impact
and sustained public education campaigns around diet, physical activity and
sedentary behaviour.'[1] This was a view supported by the Australian Medical Association among others.[2]
3.4
The Charles Perkins Centre at the University of Sydney also emphasised
the broad policy reach that is required from a national strategy, and the
levers necessary to ensure it is being implemented and evaluated effectively:
If Australia is to make significant progress on halting and
reversing the rise in childhood obesity, there is a need for a much stronger
regulatory approach on issues such as the marketing, labelling, content, and
pricing of unhealthy foods and beverages. This must take place within a
comprehensive policy approach that addresses the social, economic and cultural
drivers of unhealthy diets, and is underpinned by a national obesity strategy,
accompanied by appropriate federal government infrastructure, monitoring and
surveillance of food, nutrition, physical activity, and obesity, and
substantial, sustained funding.[3]
3.5
The Queensland Nurses and Midwives' Union concurred and recommended that
a strategy be developed involving 'business, communities, schools, childcare
and healthcare facilities'.[4]
3.6
Others cited international examples of national strategies to tackle
obesity such as those in the United Kingdom (UK), Canada, and New Zealand.[5]
3.7
The Consumers Health Forum of Australia (CHF) stressed that a strategy
was needed because education campaigns focussing solely on the role of the
individual to arrest or reduce obesity have failed:
CHF has consistently advocated for
a national, whole-of-society obesity strategy. This is because recent reports
show that years of public education campaigns have failed to reverse the rise
in obesity, showing that it is well past time for individual-oriented
prevention to become a priority. Most alarming is the rising rate of
childhood obesity, which indicates a future where health levels and life
expectancy will decline.[6]
3.8
The committee explored reasons why such a strategy has not been
developed to date. The Public Health Association of Australia (PHAA) suggested
that the complexity of such a strategy, and the necessity for it to align with
other broader public policy goals, such as increased physical activity and
healthy nutrition, was a significant barrier.[7]
3.9
Dr Alan Barclay, a practicing dietician, provided the committee with an
illustration of the complexity of all the factors that influence obesity:
Figure 3.1—Obesity System Map
3.10
Largely impenetrable, the map, originally devised by the UK Government
Office for Science as part of its Foresight Programme, was provided by a number
of submitters[8] to show how many variables impact the propensity of obesity, and the measures
required to address it.
3.11
In addition to a national strategy, NCDCFREE (Non-Communicable Diseases)
proposed that governments of all levels have their own obesity strategies:
[W]e understand and emphasise the importance of local action
for global health – that is, states, cities, local governments and individual
communities should be supported and encouraged to develop their own obesity
strategies and obesity prevention projects.[9]
National Obesity Taskforce
3.12
In April 2008, the Australian Government established the National
Preventative Health Taskforce to develop a National Preventative Health
Strategy by June 2009. The strategy was to provide a blueprint for tackling the
burden of chronic disease caused by obesity, tobacco and excessive consumption
of alcohol.[10] The agency responsible for the taskforce and strategy, the Australian
National Preventative Health Agency, ceased operations on 30 June 2014.[11]
3.13
Many submitters proposed the establishment of a new national obesity
taskforce, tasked with the responsibility of developing and managing a national
obesity strategy. The Heart Foundation proposed the taskforce due to the
complexity of the issue, and the requirement for a coordinated, whole-of-government
response:
Existing dietary and physical inactivity patterns are a
result of the lack of health supportive policies across a broad range of
government portfolios such as health, agriculture, transport, urban planning,
environment, food processing, distribution, marketing, and education. In the
Australian context this responsibility is also spread across all levels of
government.
These complex contributing factors and policy settings
highlight the need for a centrally coordinated national obesity taskforce to
drive programs across government portfolios and promote cooperation across all
levels of government.[12]
3.14
This was a view espoused by the Obesity Policy Coalition (OPC),[13] and shared with a number of other submitters.[14]
3.15
The role of the taskforce and its various responsibilities is discussed
throughout the report. The driving theme when the taskforce was discussed was
that it should be responsible for providing a whole-of-government strategic
direction to tackle obesity. For this to occur, submitters stressed the
importance of a consistent funding stream to support the taskforce, and for
membership from all levels of government, and all key stakeholders. The taskforce
would be responsible for the management and distribution of funding.
3.16
Many submitters cited the OPC's eight recommendations, as outlined in
its Tipping the Scales report, as being the responsibility of a
taskforce to implement:
- Toughen restrictions on junk food advertising
- Set food reformulation targets
- Make Health Star Ratings mandatory
- Develop an active transport strategy
- Fund public health education campaigns
- Add a 20 per cent health levy to sugary drinks
- Establish a national obesity taskforce
- Monitor diet, physical activity, and weight guidelines[15]
The role of the food industry in a
national obesity strategy
3.17
The membership of a taskforce was subject to some commentary during the
inquiry. The central point was how much of a role the food industry should have
in driving the policy agenda. This is a point that was repeated in the context
of national dietary guidelines and healthy food partnerships.
3.18
The issue of undue influence from the food manufacturing sector
concerned a number of submitters, and is discussed in greater detail in the
context of the health star rating system in Chapter 4. The PHAA pointed to the
inherent conflict of interest of the food industry and efforts to curtail
overweight and obesity:
[T]here are various industry forces that see it as a threat
to their market share. It may be the sugar industry in Australia and the
concerns with the prospect of being able to sell that sugar. The majority of
sugar that's grown in Australia, as I understand, is exported, but if, for
example, there's a levy on sugar-sweetened beverages, and that means less sugar
in that product nationally, that means a reduction in the sale of sugar. That
is one example. We've got junk food industries. We've got industries that
essentially promote and sell food that is unhealthy, and we're seeing a
pushback from those industries, absolutely unquestionably, in trying to stop
whatever policies might influence their market share.[16]
3.19
As discussed in Chapter 4, the industry needs to be involved in many
aspects of a comprehensive strategy, and in particular how that strategy is
implemented, however the committee heard that this role should be limited given
the impact of previous steps to increase healthy food and lifestyle choices:
[T]here has been evidence, where industry has been involved,
of watering down of strategy—for example, front-of-package labelling shifting
from a mandatory approach to a voluntary approach. So I think it's important to
recognise that industry does have an impact on how policies are generated and
how they're regulated.[17]
National Dietary Guidelines
3.20
The Australian Dietary Guidelines (ADG) are developed by the National
Health and Medical Research Council with advice from experts on the Dietary
Guidelines Working Committee and funding from the Australian Government
Department of Health.[18] The current version was released in 2013, and is the fourth iteration since
first developed in 1982.[19]
3.21
The frequency of the guidelines being reviewed was raised by the
committee, in response to concerns around ensuring they are underpinned by the
best available scientific knowledge. This point was addressed by Dr Barclay who
suggested that the guidelines be updated every five years rather than the
current 10 years:
Dietary guidelines are fairly conservative. They need to be
updated, though, and they need to be updated every five years, as they are in
the [United States]. Getting back to Senator Di Natale's question about what we
can do, one thing is to have a five-year rolling update of dietary guidelines,
like North America has. That way we keep on top of the science, and we don't
still promote what was the best science of the day because now new science has
proven that that maybe wasn't as accurate as we would have liked it to be.[20]
Committee view
3.22
While many of the elements that would constitute a strategy are being
undertaken at various levels, this fragmented approach has not been able to
deliver the necessary impetus to alter the trajectory of the obesity problem in
Australia.
3.23
The committee is therefore strongly of the view that what is required is
a whole-of-government approach at the federal level, a coherent and committed Council
of Australian Governments' position, both underpinned by the inclusion in a
taskforce of key stakeholders from all sectors. There is an excellent and so
far under-utilised research and evidence base for what works in different
jurisdictions, and locally around Australia. The committee wants to see all of
this evidence utilised in the development of the strategy.
3.24
Key to the success of a strategy is the composition, role and
responsibilities of the Taskforce. The inclusion of all stakeholders from all
sectors is critical to the taskforce adopting a comprehensive and coordinated
response to the obesity problem. The committee's view is that the taskforce
should be the single authority responsible for the national obesity strategy,
and it should be managed by the Commonwealth Department of Health and furnished
with the requisite authority and budget to drive the agenda forward.
3.25
The ADG are a crucial benchmark in terms of recommended nutrition for
the population. They appear to be generally uncontroversial and supported by
all stakeholders. However, given the ongoing advances in nutritional science, the
committee was convinced of the value of updating the guidelines more regularly
than they are currently.
3.26
The membership of the taskforce, and in particular the inclusion of the
food manufacturing sector, was raised by several submitters. Public health
advocates maintain that while the sector should be key stakeholders, their
contribution should be limited to a consultancy role, but should not take any
part of the decision-making of the taskforce. The committee concurs with this
view.
Recommendation 3
3.27
The committee recommends the establishment of a National Obesity
Taskforce, comprising representatives across all knowledge sectors from federal,
state, and local government, and alongside stakeholders from the NGO, private
sectors and community members. The Taskforce should sit within the Commonwealth
Department of Health and be responsible for all aspects of government policy
direction, implementation and the management of funding.
Recommendation 4
3.28
The committee recommends that the newly established National Obesity
Taskforce develop a National Obesity Strategy, in consultation with all key
stakeholders across government, the NGO and private sectors.
Recommendation 5
3.29
The committee recommends that the Australian Dietary Guidelines are
updated every five years.
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