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Healthy change: a report on the Senate Select Committee into the Obesity Epidemic

 

By 2025, just seven years from now, around four-fifths of Australian adults are predicted to be overweight or obese. Vested interests and political inaction are formidable obstacles to change, but the effort to tip the scales on this epidemic is growing in intensity.

 

Last September, more than 35 leading community, public health, medical and academic groups came together for the first time calling for urgent action to address the country’s obesity and diabetes epidemic. They undertook a process aimed at determining the most urgent elements to be addressed.

Led by the Obesity Policy Coalition (OPC) and Deakin University’s Global Obesity Centre, their  ground-breaking report, Tipping the Scales, identified eight clear, practical, evidence-based recommendations to tackle obesity.

The recommendations include placing tougher restrictions on junk food advertising to children; setting food reformulation targets; making Health Star Ratings mandatory; funding health education campaigns; developing an active transport strategy; establishing a national obesity taskforce; monitoring diet, activity and weight guidelines; and placing a 20 per cent ‘sugar levy’ on drinks.

Then, in May, the leader of the Australian Greens, Senator Richard Di Natale, tabled a motion that led to the establishment of the Senate Select Committee into the Obesity Epidemic in May.

The Committee, which will deliver its findings in November, has heard evidence from stakeholders across public health, allied health, clinical medicine, the food industry, economics, advertising and parent groups.

A few point to localised programs that show promise, such as the healthy eating initiatives for early childhood settings run by The Victorian Healthy Eating Advisory Service and the NSW Healthy Children’s Initiative.

Many more of the 150 submissions endorse the Tipping the Scales report’s recommendations and agree that the important factors influencing health are due to broader cultural, environmental and societal factors, rather than poor lifestyle choices.

Calling for change

 

Rob Moodie, Professor of Public Health at Melbourne University and former VicHealth CEO, says chronic diseases such as cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease are also industrial diseases.

‘We call them lifestyle diseases but they’re industrial epidemics with giant corporations behind them,’ says Moodie. ‘Of the world’s 100 largest economies, 69 are corporations. They have become very powerful. They inherently oppose any form of regulation, discredit genuine scientists and target them nastily while funding alternative science.’

Obesity is one of these health scourges.

‘The [obesity] public health problem can’t be left up to the food industry to fix. They have an imperative to make a profit for their shareholders. They don’t have an imperative to create a healthy, active Australia. What we need are a national obesity strategy and regulatory measures such as a levy on sugary drinks.’

More than 35 jurisdictions have introduced a levy on sugary drinks – including the United Kingdom – but in Australia both major political parties and parts of the food industry continue to resist the idea.

In the UK, the sugar levy on drinks has already caused some companies to reduce the amount of sugar in their products. Yet in Australia, politicians remain sensitive to the so-called ‘sugar seats’ where sugar cane growers have considerable political weight, notably in marginal electorates where every vote counts.

 

What’s working

 

In the absence of a national obesity strategy, setting food reformulation targets and improving the Health Star Rating system represent two small steps in the right direction. Both tactics have already seen positive results in promoting healthy eating choices and reducing risk factors for chronic disease.

Nationally, targets for the reduction of high-risk nutrients, including sugar, as well as sodium and saturated fats, are now being explored by the Reformulation Working Group of the Healthy Food Partnership, an initiative which sees representatives from government, the public health sector and the food industry working together on strategies to tackle obesity and encourage healthy eating. The draft targets, across 36 food categories, are now open to public consultation.

VicHealth Principal Program Officer Jenny Reimers observes that reformulation targets for sodium content in processed foods have proven to be a cost-effective way of reducing salt-related high blood pressure, a key risk factor for conditions including heart disease, stroke and kidney disease. The setting of salt targets, recommended by the Victorian Salt Reduction Partnership of which VicHealth is a member, is an especially promising tactic among people who are less able or less motivated to read the nutrition information panels of the products they buy and consume.

‘[Reading nutrition panels] not only takes time, but you need a fair amount of numerical and English literacy to do it as well. But if you know that all the products in a particular food category, such as bread, have reduced their risk nutrients to within a healthy range, it’s much easier.’

Established over a longer period, the Health Star Rating system is undergoing its five-year review. While some aspects need to be ironed out, there is consensus across consumer and health organisations to make front-of-pack star ratings mandatory.

The ratings appear on only 28 per cent of supermarket items and mostly on products that score well. Some companies are using the rating as a marketing tool on their healthier products while leaving it off their junk food items, and many food multinationals have opted out of the system altogether.

 

Kids and advertising

 

Alice Pryor, Campaigns Manager at Parents’ Voice, says many parents feel they are to blame for the current state of their children’s health.

‘It’s a parent’s responsibility to be looking after the health of their children, but we can’t ignore the fact that they’re not doing that in complete isolation from the real world,’ says Pryor. ‘Almost every environment you take children into is not conducive to them making healthy choices.’

She highlights the influence of junk food advertising on childhood obesity. ‘Children under the age of nine or 10 don’t understand advertising. They see ads as part of the story they’re watching. Cancer Research UK found that children are twice as likely to be obese if they can remember seeing a junk food ad every day compared to children who can’t recall any.

‘It’s fascinating that the advertising industry and the food industry say parents are the ultimate controllers of what their kids eat, that they don’t market to kids, and that even if they did, parents should just say no.’

If advertising to kids didn’t work so well, she says, food companies wouldn’t do it.

‘I think the comedian Charlie Pickering put it best when he said that self-regulation of junk food marketing to kids is not like putting the fox in charge of the henhouse, it’s like putting the fox in charge of designing the henhouse after the fox has already told you he doesn’t think hen safety is his responsibility,’ says Pryor.

One clear message to come from the submissions is that addressing obesity requires a systemic focus on reducing social and economic disadvantage as well as wide-ranging regulatory and other policies.

‘Australia needs a national food and nutrition strategy,’ says Reimers. ‘In addition to ensuring the health and sustainability of our food supply, we need a national strategy outlining how we we will tackle the problem of poor diets which are a huge risk factor for death and disability.’

‘We need a national strategy outlining how we we will tackle the problem of poor diets which are a huge risk factor for death and disability.’ Jenny Reimers, VicHealth Principal Program Officer – Healthy Eating

Disadvantaged especially vulnerable

 

One of the 150 submissions to the Senate Select Committee into the Obesity Epidemic was from Australia’s first specialist obesity service, the Nepean Blue Mountains Family Obesity Service.

Based at the Nepean Hospital in far western Sydney, it services an area with one of the country’s highest levels of childhood overweight and obesity.

In its submission, the service’s team of endocrinologists, diabetes educators, dietitians, clinical psychologists and physiotherapists noted, ‘The typical paediatric patient engaging with our tertiary service tends to live a stressful life. One or both parents of this child are obese, often living on minimal incomes, and have high stress and/or medical co-morbidities.

‘These children suffer psychological illness due to bullying and weight stigma and feel excluded from school and peer interactions. They can also have multiple medical conditions including diabetes, sleep disorders and joint and mobility limitations.’

The submission points out that existing policies and programs are doing very little to curb obesity, saying, ‘Laws and legislation at each level of government, community-based interventions and health promotion in the area have failed these children.’