NACCHO Aboriginal Health and #Obesity : Download #TippingtheScales Report Leading health orgs set out 8 urgent actions for Federal Government

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 30 + NACCHO Obesity articles published last 5 years

Read over 30+ NACCHO Nutrition and Healthy foods published last 5 years

Thirty-four leading community, public health, medical and academic groups have today united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

In the ground-breaking new action plan, Tipping the Scales, the agencies identify eight clear, practical, evidence-based actions the Australian Federal Government must take to reduce the enormous strain excess weight and poor diets are having on the nation’s physical and economic health.

Led by the Obesity Policy Coalition (OPC) and Deakin University’s Global Obesity Centre (GLOBE), Tipping the Scales draws on national and international recommendations to highlight where action is required. Areas include:

  1. Time-based restrictions on TV junk food advertising to kids
  2. Set clear food reformulation targets
  3. Make the Health Star Rating mandatory by July 2019
  4. Develop a national active transport strategy
  5. Fund weight-related public education campaigns
  6. Introduce a 20% health levy on sugary drinks
  7. Establish a national obesity taskforce
  8. Develop and monitor national diet, physical activity and weight guidelines.

OPC Executive Manager Jane Martin said the eight definitive policy actions in Tipping the Scales addressed the elements of Australia’s environment which set individuals and families up for unhealthy lifestyles, rather than just focusing on treating the poor health outcomes associated with obesity.

Watch video HERE : How does junk food marketing influence kids

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese. This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult,” Ms Martin said.

“The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 But Australia still has no strategy to tackle our obesity problem. It just doesn’t make sense.

“Without action, the costs of obesity and poor diet to society will only continue to spiral upwards. The policies we have set out to tackle obesity therefore aim to not only reduce morbidity and mortality, but also improve wellbeing, bring vital benefits to the economy and set Australians up for a healthier future.”

Professor of Epidemiology and Equity in Public Health at Deakin University, Anna Peeters, said the 34 groups behind the report were refusing to let governments simply sit back and watch as growing numbers of Australians developed life-threatening weight and diet-related health problems.

“For too long we have been sitting and waiting for obesity to somehow fix itself. In the obesogenic environment in which we live, this is not going to happen. In fact, if current trends continue, there will be approximately 1.75 million deaths in people over the age of 20 years caused by diseases linked to overweight and obesity, such as type 2 diabetes, cancer heart disease, between 2011-20501,” Professor Peeters said.

“Obesity poses such an immense threat to Australia’s physical and economic health that it needs its own, standalone prevention strategy if progress is to be made. There are policies which have been proven to work in other parts of the world and have the potential to work here, but they need to be implemented as part of a comprehensive approach by governments. And they need to be implemented now.

“More than thirty leading organisations have agreed on eight priorities needed to tackle obesity in Australia. We would like to work with the Federal Government to tackle this urgent issue and integrate these actions as part of a long-term coordinated approach.”

In addition to the costs to society, the burden of obesity is felt acutely by individuals and their families.

As a Professor of Women’s Health at Monash University and a physician, Professor Helena Teede sees mothers struggle daily with trying to achieve and sustain healthy lifestyles for themselves and their families, while having to deal with the adverse impact of unhealthy weight, especially during pregnancy.

“As a mother’s weight before pregnancy increases, so does the substantive health risk to both the mother and baby. Excess weight gain during pregnancy further adds to these risks and is a key driver of infertility, long-term obesity, heart disease and type 2 diabetes, while for the child, their risk of becoming overweight or obese and developing chronic diseases in later life greatly increases,” Professor Teede said.

“The women I see are generally desperate for help to improve their lifestyle and that of their families. They want to set themselves and their families up for healthy, long lives.

“Currently, there is a lot of blame placed on individuals with unhealthy diets and lifestyles seen as being due to individual and family discipline. Women from all backgrounds and walks of life struggle with little or no support to achieve this. It is vital that we as a community progress beyond placing all responsibility on the individual and work towards creating a policy context and a society that supports healthy choices and tips the scales towards obesity prevention to give Australian families a healthy start to life.”

The calls to action outlined in Tipping the Scales are endorsed by the following organisations: Australian Chronic Disease Prevention Alliance (which includes the Heart Foundation, Cancer Council Australia, Kidney Health Australia, Diabetes Australia and the Stroke Foundation), Australian Health Policy Collaboration (AHPC), Australian Medical Students’ Association (AMSA), Australian & New Zealand Obesity Society (ANZOS), Australasian Society of Lifestyle Medicine, Baker Heart & Diabetes Institute, CHOICE, Consumers Health Forum of Australia, Deakin University’s Global Obesity Centre (GLOBE), Institute For Physical Activity and Nutrition (IPAN), Monash Centre for Health, Research and Implementation (MCHRI), LiveLighter, Menzies School of Health Research, The University of Melbourne’s Melbourne School of Population & Global Health, Melbourne Children’s (which includes The Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute and the University of Melbourne), the National Rural Health Alliance Inc, Nutrition Australia, Obesity Australia, Obesity Policy Coalition, Obesity Surgery Society of Australia & New Zealand, Parents’ Voice, Public Health Association of Australia and Sugar By Half.

Download the Tipping the Scales action plan and snapshot at opc.org.au/tippingthescales


1. Obesity Australia. Obesity: Its impact on Australia and a case for action. No time to Weight 2. Sydney, 2015.

NACCHO Aboriginal Health and #childhood #obesity : How #junkfood brands befriend kids on #socialmedia

ABS Overweight and obesity

  • In 2014-15, 63.4% of Australian adults were overweight or obese (11.2 million people). This is similar to the prevalence of overweight and obesity in 2011-12 (62.8%) and an increase since 1995 (56.3%).
  • Around one in four (27.4%) children aged 5-17 years were overweight or obese, similar to 2011-12 (25.7%).

ABS National Health Survey: First Results, 2014-15  

Download this graphic as a poster HERE

LL_ATSI_junkfoodandhealth_infographic

”  We examined how six “high-fat-sugar-salt” food brands approached consumers at an interactive, direct and social level online in 2012 to 2013 (although the practice continues).

If a stranger offered a child free lollies in return for their picture, the parent would justifiably be angry. When this occurs on Facebook, they may not even realise it’s happening.

We found food brands being presented online and interactively in four main ways: as “the prize”, “the entertainer”, the “social enabler” and as “a person”.

Using Facebook, advergames and other online platforms, food marketers can create deeper relationships with kids than ever before. Going far beyond a televised advertisement, they are able to create an entire “brand ecosystem” around the child online.

The latest National Health Survey found that around one in four Australian kids aged 5-17 were overweight or obese.

Food marketers promoting unhealthy options to kids online should be held to account.”

From the Conversation Four ways junk food brands befriend kids online

” Australian households spend the majority (58 per cent) of their food budget on discretionary or ‘junk’ foods and drinks, including take-aways (14 per cent) and sugar-sweetened beverages (4 per cent), according to new research.

Ill health due to poor diet is not shared equally, with some population groups, such as Aboriginal and Torres Strait Islander people and people who are disadvantaged socioeconomically, more at risk.”

Professor Lee, an Accredited Practising Dietician see article 2 Aussies spending most of food budget on junk food

Picture above from WHO Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030

Read NACCHO 20 Articles on Obesity

Read NACCHO 20 Articles on Nutrition Healthy Foods

Article 1 Four ways junk food brands befriend kids online

If a stranger offered a child free lollies in return for their picture, the parent would justifiably be angry. When this occurs on Facebook, they may not even realise it’s happening.

There was outrage after a recent report in The Australian suggesting that the social media company can identify when young people feel emotions like “anxious”, “nervous” or “stupid”. Although Facebook has denied offering tools to target users based on their feelings, the fact is that a variety of brands have been advertising to young people online for many years.

We’re all familiar with traditional print and television advertising, but persuasion is harder for children and parents to detect online. From using cartoon characters to embody the brand, to games that combine advertising with interactive content (“advergames”), kids are exposed to a pervasive ecosystem of marketing on social media.

The blurring of the line between advertising, entertainment and socialising has never been greater, or more difficult to fight.

Kids are vulnerable to junk food advertising

Junk food advertising aimed at both adults and children is nothing new, but research shows that young people are particularly vulnerable.

Their minds are more susceptible to persuasion, given that the part of their brain that controls impulsivity and decision-making is not always fully developed until early adulthood. As a result, children are likely to respond impulsively to interactive and attractive content.

While the issue of advertising junk food to children through television and other broadcast media gets a lot of attention, less is understood about how children are consuming such marketing online.

How brands interact online

We examined how six “high-fat-sugar-salt” food brands approached consumers at an interactive, direct and social level online in 2012 to 2013 (although the practice continues).

Analysing content on official Facebook pages, website advergames and free branded apps, we coded brand placements as primary, secondary, direct or implied brand mentions.

While the content may not be explicitly targeted at children, the colours, skill level of the games and the prizes are attractive to younger people. The responses on Facebook in particular show that young consumers often interact with these posts, sharing comments and reposting.

We found food brands being presented online and interactively in four main ways: as “the prize”, “the entertainer”, the “social enabler” and as “a person”.

1. The prize

The fast food company Hungry Jack’s Shake and Win app has been offered since 2012. By “shaking” the app, it tells you, using your smartphone GPS, which Hungry Jack’s outlet is closest and where you can redeem your “free” offer or discount.

In this way, it combines several interactive elements to push the user towards immediate consumption with the brand coded as a reward.

Hungry Jack’s Shake and Win app screens captured on May 17th 2017. iTunes/Hungry Jacks

2. The entertainer

Free branded video game apps or advergames are also used to engage young consumers, disguising advertising as entertainment.

In the 2012 Chupa Chups game Lol-a-Coaster (which is not currently available on the Australian iTunes store), for example, we found a lollipop appeared as part of game play up to 200 times in one minute. The game is simple to play, full of fun primary colours and sounds, and the player is socialised to associate the brand with positive emotion.

Chuck’s Lol-A-Coaster: an interactive game for Chupa Chups.

3. The social enabler

Brands often leverage Facebook’s “tagging” capability to spread their message, adding a social element.

When a company suggests that you tag your family and friends on Facebook with their favourite product flavour, for example, the young consumer is not only using the brand to connect with others, but letting the brand connect to their own Facebook network. For a brand like Pringles, this increases their reach on social media.

A post on the Pringles’ Facebook page on October 13th, 2016. Facebook/Pringles

4. The person

Some brands also use a humanised character, like Chupa Chups’s Chuck, to voice the brand and post messages to consumers on Facebook.

Often this character interacts with the consumer in a very human way, asking them about their everyday lives, aspirations and fears. This creates the possibility of a long-term brand relationship and brand loyalty.

A Chupa Chups post on September 2nd, 2014 showing the character, Chuck. Facebook/Chupa Chups

Brands need to clean up their act

Using Facebook, advergames and other online platforms, food marketers can create deeper relationships with kids than ever before. Going far beyond a televised advertisement, they are able to create an entire “brand ecosystem” around the child online.

The latest National Health Survey found that around one in four Australian kids aged 5-17 were overweight or obese. Food marketers promoting unhealthy options to kids online should be held to account.

In Australia, the food marketing industry is mostly self-regulating. Brands are meant to abide by a code of practice which, if breached, holds them account through a complaints-based system.

While some companies have also pledged, via an Australian Food and Grocery Council code, not to target child audiences using interactive games unless offering a healthy choice, the current system is too slow and weak to be a real deterrent. That needs to change.

While online food marketing may be cheap for the corporations, the price that society pays when it comes to issues such as childhood obesity is immeasurable.

Article 2 Aussies spending most of food budget on junk food

According to Professor Amanda Lee, who is presenting her research at the Dietitians Association of Australia’s National Conference in Hobart this week, healthy diets are more affordable than current (unhealthy) diets – costing households 15 per cent less.

But according to Australian Health Survey data, few Australians consume diets consistent with national recommendations.

“Less than four per cent of Australians eat adequate quantities of healthy foods, yet more than 35 per cent of energy (kilojoule) intake comes from discretionary foods and drinks, which provide little nutrition – and this is hurting our health and our hip pocket,” said Professor Lee, from the Sax Institute.

She said the figures are particularly worrying because poor diet is the leading preventable cause of ill health in Australia and globally, contributing to almost 18 per cent of deaths in Australia, while obesity costs the nation $58 billion a year.

Her research found that, although healthy diets cost less than current (unhealthy) diets, people in low income households need to spend around a third (31 per cent) of their disposable income to eat a healthy diet, so food security is a real problem in these households.

She added that policies that increase the price differential between healthy and unhealthy diets could further compromise food security in vulnerable groups.

“At the moment, basic healthy foods like fresh vegetables and fruit are except from the GST, but there’s been talk of extending this to all foods. If this were to happen, the cost of a healthy diet would become unaffordable for low-income families,” said Lee.

Lee said Australia needs a coordinated approach to nutrition policy – a call echoed by the Dietitians Association of Australian, the Public Health Association of Australia, the Heart Foundation and Nutrition Australia.

NACCHO Aboriginal Health and #junkfood : Download @aihw Report Impact of overweight & obesity on health

Picture above : Nutritionists and dieticians throughout Australia have been criticizing on social media the recent Mc Donald’s  advertising during sports TV for the ” Made for Family ” of Burger , Coke and Chips recommending the #junkfood as not the preferred family meal

” Overweight and obesity, as well as many of the linked chronic diseases, is highly prevalent among Aboriginal and Torres Strait Islander people, with this also varying by socioeconomic group.

Overweight and obesity is a major public health issue, with nearly 2 in 3 adults and 1 in 4 children in Australia considered overweight or obese (AIHW 2016c).

The Australian Burden of Disease Study (ABDS) 2011 modelled the impact of overweight and obesity and showed it is one of the leading risk factors for ill health and death (AIHW 2016a).”

Download the AIHW report HERE : AIHW Obesity Burden of Disease

 ” Outcomes of the meeting included support the public health objectives to reduce chronic disease related to overweight and obesity.

This will include evaluating the effectiveness of existing initiatives and identify potential new initiatives, such as how the food regulation system can facilitate healthy food choices and positively influence the food environment.”

Australian Ministers, the New Zealand Minister responsible for food safety and the Australian Local Government Association met in Adelaide today and agreed the priority areas for the food regulation system for both countries for 2017 – 2021. They also discussed the latest updates on food labelling of sugar and fats and oils and released the two year progress review report on the implementation of the Health Star Rating system. 

The meeting was chaired by the Australian Government Assistant Minister for Health, Dr David Gillespie.

Download Communique HERE : Final Communique 28 April 2017

  • Childhood obesity has been labelled one of the most serious public health issues of the 21st century.
  • Overweight and obese children typically grow into overweight and obese adults, who are susceptible to chronic complaints such as diabetes and cardio vascular disease. These diseases place considerable burdens on national health systems and economies.
  • It can be argued therefore that policy which encourages healthy eating habits is desirable.  However, the increasing availability of foods high in fat, sugar and salt (so called junk foods) across the world has made eating healthily a challenge. 
  • This challenge, according to some research, is compounded by advertising that adversely influences people’s food preferences and consumption patterns. As a consequence of this research, there has been considerable advocacy which has urged governments to place limitations on the advertising of junk foods, particularly to children. 

 

APH : Marketing obesity? Junk food, advertising and kids

“Obesity is markedly more prevalent amongst people of Aboriginal and Torres Strait Islander descent compared to all Australians, with 25 per cent of men and 29 per cent of women being obese.

Aboriginal and Torres Strait Islander communities need information that is culturally appropriate, evidence-based, easily understood, action-oriented and motivating. There is also the need to promote healthy eating to facilitate community ownership and does not undermining the cultural importance of family social events, the role of elders and traditional preferences for some foods. Food supply in Indigenous communities needs to ensure healthy, good quality food options are available at competitive prices.

Primary health care services have a central role in promoting and improving Aboriginal and Torres Strait Islander health and the sector needs specialised training and resources to implement new initiatives and provide culturally appropriate advice.”

Department of Health Website

OBESITY – AUSTRALIA’S BIGGEST PUBLIC HEALTH CHALLENGE

Download AMA Position Statement on Obesity 2016

obesity-2016-ama-position-statement

NACCHO Articles about Obesity

“For Australia’s Aboriginal and Torres Strait Islander peoples, “diet is the single most important factor in the chronic disease epidemic facing Aboriginal communities.” The resolution commits governments “to reverse the rising trends in overweight and obesity and reduce the burden of diet-related noncommunicable diseases in all age groups.”

Dr Mark J Lock is an ARC Discovery Indigenous Research Fellow at the School of Medicine and Public Health, University of Newcastle. See Croakey article Part 2

“Jamie Oliver on behalf of the Wadeye community, I invite you to visit us and teach us to understand healthy eating and nutritious food. Our community would be pleased take you collecting bush tucker traditional way, and you can teach us new skills.

Being healthy means our kids have a better chance in life, and your visit would help make our community strong for the future and ensure our kids to grow up healthy and deadly.”

Hope to hear from you soon,
From Julie see full letter below

“We need all sides of politics to take these issues seriously, to support effective policies and water down the alcohol and junk food and junk drink industries that currently are undermining our health.

In the Medical Journal of Australia, we argue that we are losing the war against alcohol and weight-related illnesses because our nation lacks a comprehensive approach to prevention.”

By Professor Rob Moodie, Melbourne School of Population and Global Health, University of Melbourne.He worked  for NACCHO Member , Congress, the Aboriginal Community controlled health service in Central Australia from 1982-1988.

Full article

NACCHO #Worldhealthweek Obesity News: : Is diet the single most important factor in the chronic disease epidemic facing Aboriginal communities.”

Australian Healthcare Reform Alliance (AHCRA) policy proposals are not driven by ideology but have their foundations in research, evidence and broader policy review.

 ” Aboriginal communities should take advice from the fast food industry “

NACCHO’s 2013 #junkfood V Health campaign reached 20 Million + worldwide

Thus, advocacy for reducing sugar intake, support for plain packaging of tobacco and the better funding of primary and preventive care align with the basic principles of the social determinants of health in achieving better health outcomes.

To underpin this work AHCRA draws on research, aggregated data and reports from reputable sources.

A recent study published by the Australian Institute of Health and Welfare (AIHW) provides insight into the contribution of overweight and obesity to the health burden of chronic disease.

Download the AIHW report HERE : AIHW Obesity Burden of Disease

It highlights the importance of reducing overweight and obesity to prevent the onset and/or reduce the severity of associated diseases in the population.

Health impacts from being overweight or obese are not always immediate, particularly for lifestyle-related diseases, and depend on when exposure occurs and the associated disease.

In this report, only asthma was identified as a linked disease with a direct association in childhood; however, childhood obesity is a risk factor for chronic disease in adulthood and later life.

As well, being overweight and obese in mid-life is associated with increased dementia risk in late life, demonstrating a time lag from exposure to disease development. Other studies also show a reduction in cancer risk in adults who experienced weight loss 10 years prior, also suggesting a time lag.

The result is that prevention and intervention efforts focused on maintaining a healthy weight in children, as well as reducing existing overweight and obesity in all age groups, are likely to result in increased health gains in the future.

This report updates and extends estimates of the burden due to overweight and obesity reported in the Australian Burden of Disease Study 2011 to include people under 25, revised diseases linked to overweight and obesity based on the latest evidence, and estimates by socioeconomic group.

The report includes scenario modelling to assess the potential impact on future health burden if overweight and obesity in the population continues to rise or is reduced. The enhanced analysis in the report shows that 7.0% of the total health burden in Australia in 2011 is due to overweight and obesity, and that this burden increased with increasing level of socioeconomic disadvantage.

 

Aboriginal #Earlychildhood #Obesity Study : We need to reduce the prevalence of overweight/obesity in the first 3 years of life

“People who are obese in childhood are at increased risk of being obese in adulthood, which can increase the risk of cardiovascular disease, some types of cancer, diabetes, and arthritis,”

Research found reducing consumption of sugary drinks and junk food from an early age could benefit the health of Indigenous children, but that this is just one part of the solution to improving weight status.

“We know that Indigenous families across Australia – in remote, regional, and urban settings – face barriers to accessing healthy foods. Therefore, efforts to reduce junk food consumption need to occur alongside efforts to increase the affordability, availability, and acceptability of healthy foods,”

 Ms Thurber, PhD Scholar, from the National Centre for Epidemiology and Population Health at ANU.

A major study into the health of Aboriginal and Torres Strait Islander children has found programs and policies to promote healthy weight should target children as young as three.

Lead researcher Katie Thurber from The Australian National University (ANU) said the majority of Indigenous children in the national study had a health body Mass Index (BMI), but around 40 per cent were classified as overweight or obese by the time they reached nine years of age.

Download the Report Here Thurber BMI Trajectories LSIC

Latest national figures show obesity rates are 60 per cent higher for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians.

In 2013, around 30 per cent of Indigenous children were classified as overweight or obese, and two thirds of Indigenous people over 15 years old were classified as overweight or obese.

Key messages

•  The majority of Aboriginal and Torres Strait Islander children nationally have a healthy Body Mass Index
•  However, more than one in ten Aboriginal and Torres Strait Islander children in Footprints in Time were already overweight or obese at 3 years of age, and there was a rapid onset of overweight/obesity between age 3 and 9 years
•  We need programs and policies to reduce the prevalence of overweight/obesity in the first 3 years of life, and to slow the onset of overweight/obesity from age 3-9 years
•  Reducing children’s consumption of sugar-sweetened beverages and high-fat foods is one part of the solution to improving weight status at the population level
•  To enable healthy diets, we need to (1) create healthier environments and (2) improve the social determinants of health (such as financial security, housing, and community wellbeing). Creating healthy environments is complex, and will require both increasing the affordability, availability, and acceptability of healthy foods and decreasing the affordability, availability, and acceptability of unhealthy foods
•  Programs and policy to promote healthy weight need to be developed in partnership with Aboriginal and Torres Strait Islander communities
•  Despite higher levels of disadvantage, most Aboriginal and Torres Strait Islander children maintain a healthy weight; we need programs and policies that cultivate environments and circumstances that will enable all Aboriginal and Torres Strait Islander children to have a healthy start to life
 

Ms Thurber said improving weight status would have a major benefit in closing the gap in health between Indigenous and non-Indigenous Australians.

“Obesity is a leading contributor to the gap in health,” Ms Thurber said.

“We want to work with Aboriginal and Torres Strait Islander families and communities, as well as policy makers and service providers, to think about what will work best to promote healthy weight in those early childhood years.

“We want to start early, and identify the best ways for families and communities to support healthy diets, so that all Aboriginal and Torres Strait Islander children can have a healthy start to life.”

The research used data from Footprints in Time, a national longitudinal study that has followed more than 1,000 Indigenous children since 2008. It is funded and managed by the Department of Social Services.

Professor Mick Dodson, Chair of the Steering Committee for the Footprints in Time Study and Director of the ANU National Centre for Indigenous Studies, said Aboriginal and Torres Strait Islander children deserve the best possible start in life.

“This study shows just how important it is to support them, their families and their communities to provide a healthy diet and opportunities for physical activity,” Professor Dodson said.

Ms Thurber said using the Footprints in Time study, researchers for the first time were able to look at how weight status changes over time for Aboriginal and Torres Strait Islander children, enabling them to identify pathways that help children maintain a healthy weight.

The research has been published in Obesity.

Aboriginal Health #obesity : 10 major health organisations support #sugartax to fund chronic disease and obesity #prevention

Young Australians, people in Aboriginal and Torres Strait Islander communities and socially disadvantaged groups are the highest consumers of sugary drinks.

These groups are also most responsive to price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption ,

A health levy on sugary drinks is not a silver bullet – it is a vital part of a comprehensive approach to tackling obesity, which includes restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.

We must take swift action to address the growing burden that overweight and obesity are having on our society, and a levy on sugary drinks is a vital step in this process.”

Rethink Sugary Drink campaign Download position statement

health-levy-on-sugar-position-statement

Read NACCHO previous articles Obesity / Sugartax

Amata SA was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

See NACCHO Story

SBS will be showing That Sugar Film this Sunday night 2 April at 8.30pm.

There will be a special Facebook live event before the screenings

 ” The UK’s levy on sugar sweetened beverages will start in 2018, with revenue raised to go toward funding programs to reduce obesity and encourage physical activity and healthy eating for school children.

We know unhealthy food is cheaper and that despite best efforts by many Australians to make healthier choices price does affect our decisions as to what we buy.”

Sugar tax adds to the healthy living toolbox   see full article 2 below

 ” Alarmingly, with overweight becoming the perceived norm in Australia, the number of people actively trying to lose weight is declining.   A recent report by the Australian Institute of Health and Welfare found that nearly 64 per cent of Australians are overweight or obese.  This closely mirrors research that indicates around 66 per cent of Americans fall into the same category.

With this apparent apathy towards personal health and wellbeing, is it now up to food and beverage companies to combat rising obesity rates?

Who is responsible for Australia’s waistlines?  Article 3 Below

Ten of Australia’s leading health and community organisations have today joined forces to call on the Federal Government to introduce a health levy on sugary drinks as part of a comprehensive approach to tackling the nation’s serious obesity problem.

The 10 groups – all partners of the Rethink Sugary Drink campaign – have signed a joint position statement calling for a health levy on sugary drinks, with the revenue to be used to support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

This latest push further strengthens the chorus of calls in recent months from other leading organisations, including the Australian Medical Association, the Grattan Institute, the Australian Council of Social Services and the Royal Australian College of General Practitioners.

Craig Sinclair, Chair of the Public Health Committee at Cancer Council Australia, a signatory of the new position statement, said a health levy on sugary drinks in Australia has the potential to reduce the growing burden of chronic disease that is weighing on individuals, the healthcare system and the economy.

“The 10 leading health and community organisations behind today’s renewed push have joined forces to highlight the urgent and serious need for a health levy on sugary drinks in Australia,” Mr Sinclair said.

“Beverages are the largest source of free sugars in the Australian diet, and we know that sugary drink consumption is associated with increased energy intake and in turn, weight gain and obesity. Sugary drink consumption also leads to tooth decay.

“Evidence shows that a 20 per cent health levy on sugar-sweetened beverages in Australia could reduce consumption and prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years, while generating $400-$500m in revenue each year to support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

“The Australian Government must urgently take steps to tackle our serious weight problem. It is simply not going to fix itself.”

Ari Kurzeme, Advocacy Manager for the YMCA, also a signatory of the new position statement, said young Australians, people in Aboriginal and Torres Strait Islander communities and socially disadvantaged groups have the most to gain from a sugary drinks levy.

The Rethink Sugary Drink alliance recommends the following actions to tackle sugary drink consumption:
• A public education campaign supported by Australian governments to highlight the health impacts of regular sugary drink consumption
• Restrictions by Australian governments to reduce children’s exposure to marketing of sugar-sweetened beverages, including through schools and children’s sports, events and activities
• Comprehensive mandatory restrictions by state governments on the sale of sugar-sweetened beverages (and increased availability of free water) in schools, government institutions, children’s sports and places frequented by children
• Development of policies by state and local governments to reduce the availability of sugar-sweetened beverages in workplaces, government institutions, health care settings, sport and recreation facilities and other public places.

To view the position statement click here.

Rethink Sugary Drink is a partnership between major health organisations to raise awareness of the amount of sugar in sugar-sweetened beverages and encourage Australians to reduce their consumption. Visit www.rethinksugarydrink.org.au for more information.

The 10 organisations calling for a health levy on sugary drinks are:

Stroke Foundation, Heart Foundation, Kidney Health Australia, Obesity Policy Coalition, Diabetes Australia

the Australian Dental Association, Cancer Council Australia, Dental Hygienists Association of Australia,  Parents’ Voice, and the YMCA.

Sugar tax adds to the healthy living toolbox 

Every day we read or hear more about the so-called ‘sugar tax’ or, as it should be more appropriately termed, a ‘health levy on sugar sweetened beverages’.

We have heard arguments from government and health experts both in favour of, and opposed to this ‘tax’. As CEO of one the state’s leading health charities I support the state government’s goal to make Tasmania the healthiest population by 2025 and the Healthy Tasmania Five Year Strategic Plan, with its focus on reducing obesity and smoking.

However, it is only one tool in the tool box to help us achieve the vision.

Our approach should include strategies such as restricting the marketing of unhealthy food and limiting the sale of unhealthy food and drink products at schools and other public institutions together with public education campaigns.

Some of these strategies are already in progress to include in our toolbox. We all have to take some individual responsibility for the choices we make, but as health leaders and decision makers, we also have a responsibility to create an environment where healthy choices are made easier.

This, in my opinion, is not nannyism but just sensible policy and demonstrated leadership which will positively affect the health of our population.

 Manufacturers tell us that there are many foods in the marketplace that will contribute to weight gain and we should focus more on the broader debate about diet and exercise, but we know this is not working.

A recent Cancer Council study found that 17 per cent of male teens drank at least one litre of soft drink a week – this equates to at least 5.2 kilograms of extra sugar in their diet a year.

Evidence indicates a significant relationship between the amount and frequency of sugar sweetened beverages consumed and an increased risk of developing type 2 diabetes.  We already have 45,000 people at high risk of type 2 diabetes in Tasmania.

Do we really want to say we contributed to a rise in this figure by not implementing strategies available to us that would make a difference?

I recall being quite moved last year when the then UK Chancellor of the Exchequer George Osborne said that he wouldn’t be doing his job if he didn’t act on reducing the impact of sugary drinks.

“I am not prepared to look back at my time here in this Parliament, doing this job and say to my children’s generation… I’m sorry. We knew there was a problem with sugary drinks…..But we ducked the difficult decisions and we did nothing.”

The UK’s levy on sugar sweetened beverages will start in 2018, with revenue raised to go toward funding programs to reduce obesity and encourage physical activity and healthy eating for school children. We know unhealthy food is cheaper and that despite best efforts by many Australians to make healthier choices price does affect our decisions as to what we buy.

In Mexico a tax of just one peso a litre (less than seven cents) on sugary drinks cut annual consumption by 9.7 per cent and raised about $1.4 billion in revenue.

Similarly, the 2011 French levy has decreased consumption of sugary drinks, particularly among younger people and low income groups.

The addition of a health levy on sugar sweetened beverages is not going to solve all problems but as part of a coordinated and multi-faceted approach, I believe we can effect change.

  • Caroline Wells, is Diabetes Tasmania CEO

3. Who is responsible for Australia’s waistlines? from here

Alarmingly, with overweight becoming the perceived norm in Australia, the number of people actively trying to lose weight is declining.   A recent report by the Australian Institute of Health and Welfare found that nearly 64 per cent of Australians are overweight or obese.  This closely mirrors research that indicates around 66 per cent of Americans fall into the same category.

With this apparent apathy towards personal health and wellbeing, is it now up to food and beverage companies to combat rising obesity rates?

Unfortunately it is not clear cut.  While Big Food and Big Beverage are investing in healthier product options, they also have a duty to shareholders to be commercially successful, and to expand their market share. The reality is that unhealthy products are very profitable.  However companies must balance this against the perception that they are complicit in making people fatter and therefore unhealthier with concomitant disease risks.

At the same time, the spectre of government regulation continues to hover, forcing companies to invest in their own healthy product ranges and plans to improve nutrition standards.

The International Food and Beverage Alliance (a trade group of ten of the largest food and beverage companies), has given global promises to make healthier products, advertise food responsibly and promote exercise. More specific pledges are being made in developed nations, where obesity rates are higher and scrutiny is more thorough.

However companies must still find a balance between maintaining a profitable business model and addressing the problem caused by their unhealthy products.

An example of this tension was evident when one leading company attempted to boost the sale of its healthier product lines and set targets to reduce salt, saturated fat and added sugar.  The Company also modified its marketing spend to focus on social causes.  Despite the good intentions, shareholders were disgruntled, and pressured the company to reinstate its aggressive advertising.

What role should governments play in shaping our consumption habits and helping us to maintain healthier weights? And should public policy be designed to alter what is essentially personal behaviour?

So far, the food and beverage industry has attempted to avoid the burden of excessive regulation by offering relatively healthier product lines, promoting active lifestyles, funding research, and complying with advertising restrictions.

Statistics indicate that these measures are not having a significant impact.  Subsequently, if companies fail to address the growing public health burden, governments will have greater incentive to step in.  In Australia, this is evident in the increased political support for a sugar tax.  The tax has been debated in varying forms for years, and despite industry resistance, the strong support of public health authorities may see a version of the tax introduced.

Already, Australia’s food labelling guidelines have been amended and tightened, and a clunky star rating system introduced to assist consumers to make healthier choices. Companies that have worked to address and invest in healthy product ranges must still market them in a responsible way. Given the sales pressure, it is tempting for companies to heavily invest in marketing healthier product ranges.  However they have an obligation under Australian consumer law to ensure products’ health claims do not mislead.

We know that an emboldened Australian Competition and Consumer Commission (ACCC) is taking action against companies that deliberately mislead consumers.  The food industry is firmly in the its sights, with a case currently underway against a leading food company over high sugar levels in its products. This shows that the Regulator will hold large companies to account, and push for penalties that ‘make them sit up and take notice.’

At a recent Consumer Congress, ACCC Chair Rod Sims berated companies that don’t treat consumers with respect.  He maintains that marketing departments with short-term thinking, and a short-sighted executive can lead to product promotion that is exaggerated and misleading.  All of which puts the industry on notice.

With this in mind, it is up to Big Food and Big Beverage to be good corporate citizens.  They must uphold their social, cultural and environmental responsibilities to the community in which they seek a licence to operate, while maintaining a strong financial position for their shareholders. It is a difficult task, but there has never been a better time for companies to accept the challenge.

Eliza Newton, Senior Account Director

NACCHO Aboriginal Health and #Obesity #junkfood : 47 point plan to control weight problem that costs $56 billion per year

junk

 ” JUNK food would be banned from schools and sports venues, and a sugar drink tax introduced, under a new blueprint to trim the nation’s waistline.

The 47-point blueprint also includes a crackdown on using junk food vouchers as rewards for sporting performance and for fundraising.

State governments would be compelled to improve the healthiness of foods in settings controlled by them like hospitals, workplaces and government events.

And they would have to change urban planning rules to restrict unhealthy food venues and make more space for healthy food outlets. “

Originally published as Move to ban junk food in schools

Updated Feb 21 with press release from Health Minister Greg Hunt See below

The Australian Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives

“In my view, we should be starting to tax sugary drinks as a first step. Nearly every week there’s a new study citing the benefits of a sugary drinks tax and and nearly every month another country adopts it as a policy. It’s quickly being seen as an appropriate thing to do to address the obesity epidemic.”

A health economist at the Grattan Institute, Stephen Duckett, said the researchers had put together a careful and strong study and set of tax and subsidy suggestions.see article 2 below  

One hundred nutrition experts from 53 organisations working with state and federal bureaucrats have drawn up the obesity action plan to control the nation’s weight problem that is costing the nation $56 billion a year.

The review of state and federal food labelling, advertising and health policies found huge variation across the country and experts want it corrected by a National Nutrition Policy.

The nation is in the grip of an obesity crisis with almost two out of three (63 per cent) Australian adults, and one in four (25 per cent) Australian children overweight or obese.

Obesity is also one of the lead causes of disease and death including cancer.

More than 1.4 million Australians have Type 2 diabetes and new cases are being diagnosed at the rate of 280 per day.

Stomach, bowel, kidney, liver, pancreas, gallbladder, oesophagus, endometrium, ovary, prostate cancer and breast cancer in postmenopausal women have all been linked to obesity.

Half of all Australians are exceeding World Health Organisation’s recommendations they consume less than 13 teaspoons or sugar a day with most of the white stuff hidden in drinks and processed food, the Australian Bureau of Statistics Health Survey shows.

Teenage boys are the worst offenders consuming 38 teaspoons of sugar a day which makes up a quarter of their entire calorie intake.

Dr Gary Sacks from Deakin University whose research underpins the obesity control plan says it’s time for politicians to put the interests of ordinary people and their health above the food industry lobbyists

“It’s a good start to have policies for restricting junk foods in school canteens, but if kids are then inundated with unhealthy foods at sports venues, and they see relentless junk food ads on prime-time TV, it doesn’t make it easy for them to eat well,” he said.

That’s why the experts want a co-ordinated national strategy that increases the price of unhealthy food using taxes and regulations to reduce children’s exposure to unhealthy food advertising.

The comprehensive examination of state and federal food policies found Australia is meeting best practice in some areas including the Health Star Rating food labelling scheme, no GST on basic foods and surveys of population body weight.

While all States and Territories have policies for healthy school food provision they are not all monitored and supported, the experts say.

Jane Martin, Executive Manager of the Obesity Policy Coalition and a partner in the research, said a piecemeal approach would not work to turn the tide of obesity in Australia.

“When nearly two-thirds of Australians are overweight or obese, we

know that it’s not just about individuals choosing too many of the wrong foods, there are strong environmental factors at play – such as the all pervasive marketing of junk food particularly to children,” she said.

The new policy comes as a leading obesity experts says a tax on sugary drinks in Australia would be just as logical as existing mandatory controls on alcohol and tobacco

Professor Stephen Colagiuri from the University of Sydney’s Charles Perkins Centre claims a ‘sugar tax’ help individuals moderate their sugary beverage intake, in much the same way as current alcohol, tobacco, and road safety measures like seat belts and speed restrictions preventing harmful behaviours.

The UK will introduce a sugar tax next year and in Mexico a sugar tax introduced in 2014 has already reduced consumption of sugary drinks by 12 per cent and increased the consumption of water.

Australian politicians have repeatedly dismissed a sugar tax on the grounds it interferes with individual rights.

However, Professor Colagiuri says “individual rights can be equally violated if governments fail to take effective and proportionate measures to remove health threats from the environment in the cause of improving population health.”

Originally published as Move to ban junk food in schools

ARTICLE 2 Australia would save $3.4bn if junk food taxed and fresh food subsidised, says study 

fruit-and-veg

O as published in the Guardian

Australian researchers say subsidising fresh fruit and vegetables would ensure the impact of food taxes on the household budget would be negligible. Photograph: Dave and Les Jacobs/Getty Images/Blend Images

Health experts have developed a package of food taxes and subsidies that would save Australia $3.4bn in healthcare costs without affecting household food budgets.

Linda Cobiac, a senior research fellow at the University of Melbourne’s school of public health, led the research published on Wednesday in the journal Plos Medicine.

Cobiac and her team used international data from countries that already have food and beverage taxes such as Denmark, but tweaked the rate of taxation and also included a subsidy for fresh fruit and vegetables so the total change to the household budget would be negligible.

They then modelled the potential impact on the Australian population of introducing taxes on saturated fat, salt, sugar and sugar-sweetened beverages, and a subsidy on fruits and vegetables. Their simulations found the combination of the taxes and subsidy could result in 1.2 additional years of healthy life per 100 people alive in 2010, at a net cost-saving of $3.4bn to the health sector.

“Few other public health interventions could deliver such health gains on average across the whole population,” Cobiac said.

The sugar tax produced the biggest gains in health, followed by the salt tax, the saturated fat tax and the sugar-sweetened beverage tax.

The fruit and vegetable subsidy, while cost-effective when added to the package of taxes, did not lead to a net health benefit on its own, the researchers found.

The researchers suggest introducing a tax of $1.37 for every 100 grams of saturated fat in those foods with a saturated fat content of more than 2.3%, excluding milk; a salt tax of 30 cents for one gram of sodium above Australian maximum recommended levels; a sugar-sweetened beverage tax of 47 cents a litre; a fruit and vegetable subsidy of 14 cents for every 100 grams; and a sugar tax of 94 cents for every 100ml in ice-cream with more than 10 grams of sugar per 100 grams; and 85 cents for every 100 grams in all other products.

The taxes exclude fresh fruits, vegetables, meats and many dairy products.

“You need to include both carrots and sticks to change consumer behaviour and to encourage new taxes,” Blakely said. “That’s where this paper is cutting edge internationally.

“We have worked out the whole package of taxes with minimal impact on the budget of the household, so you can see an overall gain for the government. The government would be less interested in the package if it was purely punitive, but this provides subsidies and savings to health spending that could be reinvested back into communities and services.”

He said taxing junk foods also prompted food manufacturers to change their products and make them healthier to avoid the taxes.

“For those who might say this is an example of nanny state measures, let’s consider that we don’t mind asbestos being taken out of buildings to prevent respiratory disease, and we’re happy for lead to be taken from petrol. We need to change the food system if we are going to tackle obesity and prevent disease.”

A health economist at the Grattan Institute, Stephen Duckett, said the researchers had put together a careful and strong study and set of tax and subsidy suggestions. “This is a very good paper,” he said.

“In my view, we should be starting to tax sugary drinks as a first step. Nearly every week there’s a new study citing the benefits of a sugary drinks tax and and nearly every month another country adopts it as a policy. It’s quickly being seen as an appropriate thing to do to address the obesity epidemic.”

A Grattan Institute report published in November found introducing an excise tax of 40 cents for every 100 grams of sugar in beverages as part of the fight against obesity would trigger a 15% drop in the consumption of sugary drinks. Australians and New Zealanders consume an average of 76 litres of sugary drinks per person every year.

In a piece for the Medical Journal of Australia published on Monday, the chair of the Council of Presidents of Medical Colleges, Prof Nicholas Talley, wrote that “the current lack of a coordinated national approach is not acceptable”.

More than one in four Australian children are now overweight or obese, as are more than two-thirds of all adults.

Talley proposed a six-point action plan, which included recognising obesity as a chronic disease with multiple causes. He also called for stronger legislation to reduce unhealthy food marketing to children and to reduce the consumption of high-sugar beverages, saying a sugar-sweetened beverage tax should be introduced.

“There is evidence that the food industry has been a major contributor to obesity globally,” he wrote. “The health of future generations should not be abandoned for short-term and short-sighted commercial interests.”

Press Release 21 February Greg Hunt Health Minister

The Australian Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives.

PDF printable version of Turnbull Government committed to tackling obesity – PDF 269 KB

The Turnbull Government is taking action to tackle the challenge of obesity and encourage all Australians to live healthy lives.

But unlike the Labor Party, we don’t believe increasing the family grocery bill at the supermarket is the answer to this challenge.

We already have programmes in place to educate, support and encourage Australians to adopt and maintain a healthy diet and to lead an active life – and there’s more to be done.

Earlier this month, the Prime Minister flagged that the Government will soon be announcing a new focus on preventive health that will give people the right tools and information to live active and healthy lives. This will build on the significant work already underway.

Yesterday, we launched the second phase of the $7 million Girls Make Your Move campaign to increase physical activity for girls and young women. This is now being rolled out across Australia.

Our $160 million Sporting Schools program is getting kids involved in physical activity. Already around 6,000 schools across the country have been involved – with many more to come. This is a great programme that Labor wants to axe.

Our Health Star Rating system helps people to make healthier choices when choosing packaged foods at the supermarket and encourages the food industry to reformulate their products to be healthier.

The Healthy Weight Guide website provides useful advice including tips and tools to encourage physical activity and healthy eating to achieve and maintain a healthy weight.

The Healthy Food Partnership with the food industry and public health groups is increasing people’s health knowledge and is supporting them to make healthier food and drink choices in order to achieve better health outcomes.

We acknowledge today’s report, but it does not take into account a number of the Government programs now underway.

Obesity and poor diets are complex public health issue with multiple contributing factors, requiring a community-wide approach as well as behaviour change by individuals. We do not support a new tax on sugar to address this issue.

Fresh fruit and vegetables are already effectively discounted as they do not have a GST applied.

Whereas the GST is added to the cost of items such as chips, lollies, sugary drinks, confectionery, snacks, ice-cream and biscuits.

We’re committed to tackling obesity, but increasing the family’s weekly shop at the supermarket isn’t the answer

NACCHO Aboriginal Health and Chronic Disease #prevention

 

prevention

 ” The Australian Chronic Disease Prevention Alliance recommends that the Australian Government introduce a health levy on sugar-sweetened beverages, as part of a comprehensive approach to decreasing overweight and obesity, and with revenue supporting public education campaigns and initiatives to prevent chronic disease and address childhood obesity.

A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia.

Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns[42].

Health levy on sugar-sweetened beverages

ACDPA Position Statement

Key messages

  •  The Australian Chronic Disease Prevention Alliance (ACDPA) recommends that the Australian Government introduce a health levy on sugar-sweetened beverages (sugary drinks)i, as part of a comprehensive approach to decreasing overweight and obesity.
  •  Sugar-sweetened beverage consumption is associated with increased energy intake and in turn, weight gain and obesity. Obesity is an established risk factor for type 2 diabetes, heart disease, stroke, kidney disease and certain cancers.
  •  Beverages are the largest source of free sugars in the Australian diet. One in two Australians usually exceed the World Health Organization recommendation to limit free sugars to 10% of daily intake (equivalent to 12 teaspoons of sugar).
  •  Young Australians are the highest consumers of sugar-sweetened beverages, along with Aboriginal and Torres Strait Islander people and socially disadvantaged groups.
  •  Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption.
  •  A health levy on sugar-sweetened beverages in Australia is estimated to reduce consumption and potentially prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years. The levy could generate revenue of $400-$500 million each year, which could support public education campaigns and initiatives to prevent chronic disease and address childhood obesity.
  •  A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity epidemic in Australia. Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, and effective public education campaigns.

i ‘Sugar-sweetened beverages’ and sugary drinks are used interchangeably in this paper. This refers to all non-alcoholic water based beverages with added sugar, including sugar-sweetened soft drinks and flavoured mineral waters, fortified waters, energy and electrolyte drinks, fruit and vegetable drinks, and cordials. This term does not include milk-based products, 100% fruit juice or non-sugar sweetened beverages (i.e. artificial, non-nutritive or intensely sweetened). 2

About ACDPA

The Australian Chronic Disease Prevention Alliance (ACDPA) brings together five leading non-government health organisations with a commitment to reducing the growing incidence of chronic disease in Australia attributable to overweight and obesity, poor nutrition and physical inactivity. ACDPA members are: Cancer Council Australia; Diabetes Australia; Kidney Health Australia; National Heart Foundation of Australia; and the Stroke Foundation.

This position statement is one of a suite of ACDPA statements, which provide evidence-based information and recommendations to address modifiable risk factors for chronic disease. ACDPA position statements are designed to inform policy and are intended for government, non-government organisations, health professionals and the community.

www.acdpa.org.au

Chronic disease

Chronic diseases are the leading cause of illness, disability, and death in Australia, accounting for around 90% of all deaths in 2011[1]. One in two Australians (i.e. more than 11 million) had a chronic disease in 2014-15 and almost one quarter of the population had at least two conditions[2].

However, much chronic disease is actually preventable. Around one third of total disease burden could be prevented by reducing modifiable risk factors, including overweight and obesity, physical inactivity and poor diet[2].

Overweight and obesity

Overweight and obesity is the second greatest contributor to disease burden and increases risk of type 2 diabetes, heart disease, stroke, kidney disease and some cancers[2].

The rates of overweight and obesity are continuing to increase. Almost two-thirds of Australians are overweight or obese and one in four Australian children are already overweight or obese[2]. Children who are overweight are also more likely to grow up to become overweight or obese adults, with an increased risk of chronic disease and premature mortality[3].

The cost of obesity in Australia was estimated to be $8.6 billion in 2011-12, comprising $3.8 billion in direct costs and $4.8 billion in indirect costs[4]. If no further action is taken to slow obesity rates in Australia, the cost of obesity over the next 10 years to 2025 is estimated to total $87.7 billion[4].

Free sugars and weight gain

There is increasing evidence that high intake of free sugarsii is associated with weight gain due to excess energy intake and dental caries[5]. The World Health Organization (WHO) strongly recommends reducing free sugar intake to less than 10% of total energy intake (equivalent to around 12 teaspoons of sugar), or to 5% for the greatest health benefits[5].

ii ‘Free sugars’ refer to sugars added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

In 2011-12, more than half of Australians usually exceeded the recommendation to limit free sugar intake to 10%[6]. There was wide variation in the amounts of free sugars consumed, with older children and teenagers most likely to exceed the recommendation and adults aged 51-70 least likely to exceed the recommendation[6]. On average, Australians consumed around 60 grams of free sugars each day (around 14 teaspoons)[6]. Children and young people were the highest consumers, with adolescent males and females consuming the equivalent of 22 and 17 teaspoons of sugar each day respectively [6].

Beverages contribute more than half of free sugar intake in the Australian diet[6]. In 2011-12, soft drinks, sports and energy drinks accounted for 19% of free sugar intake, fruit juices and fruit drinks contributed 13%, and cordial accounted for 4.9%[6]. 3

Sugar-sweetened beverage consumption

In particular, sugar-sweetened beverages are mostly energy-dense but nutrient-poor. Sugary drinks appear to increase total energy intake due to reduced satiety, as people do not compensate for the additional energy consumed by reducing their intake of other foods or drinks[3, 7]. Sugar-sweetened beverages may also negatively affect taste preferences, especially amongst children, as less sweet foods may become less palatable[8].

Sugar-sweetened beverages are consumed by large numbers of Australian adults and children[9], and Australia ranks 15th in the world for sales of caloric beverages per person per day[10].

One third of Australians consumed sugar-sweetened beverages on the day before the Australian Health Survey interview in 2011-12[9]. Of those consuming sweetened beverages, the equivalent of a can of soft drink was consumed (375 mL)[9]. Children and adolescents were more likely to have consumed sugary drinks than adults (47% compared with 31%), and consumption peaked at 55% amongst adolescents[9]. Males were more likely than females to have consumed sugary drinks (39% compared with 29%)[9].

Australians living in areas with the highest levels of socioeconomic disadvantage were more likely to have consumed sugary drinks than those in areas of least disadvantage (38% compared with 31%)[9]. Half of Aboriginal and Torres Strait Islander people consumed sugary drinks compared to 34% of non-Indigenous people[9]. Amongst those consuming sweetened beverages, a greater amount was consumed by Aboriginal and Torres Strait Islanders than for non-Indigenous people (455 mL compared with 375 mL)[9]. 4

The health impacts of sugar-sweetened beverage consumption

WHO and the World Cancer Research Fund (WCRF) recommend restricting or avoiding intake of sugar-sweetened beverages, based on evidence that high intake of sugar-sweetened beverages may increase risk of weight gain and obesity[7, 11]. As outlined earlier, obesity is an established risk factor for a range of chronic diseases[2].

The Australian Dietary Guidelines recommend limiting intake of foods and drinks containing added sugars, particularly sugar-sweetened beverages, based on evidence of a probable association between sugary drink consumption and increased risk of weight gain in adults and children, and a suggestive association between soft drink consumption and an increased risk of reduced bone strength, and dental caries in children[3].

Type 2 diabetes

Sugar-sweetened drinks may increase the risk of developing type 2 diabetes[3]. Evidence indicates a significant relationship between the amount and frequency of sugar-sweetened beverages consumed and increased risk of type 2 diabetes[12, 13]. The risk of type 2 diabetes is estimated to be 26% greater amongst the highest consumers (1 to 2 servings/day) compared to lowest consumers (<1 serving/month)[13].

Cardiovascular disease and stroke

The consumption of added sugar by adolescents, especially sugar-sweetened soft drinks, has been associated with multiple factors that can increase risk of cardiovascular disease regardless of body size, and increased insulin resistance among overweight or obese adolescents[14].

A high sugar diet has been linked to increased risk of heart disease mortality[15, 16]. Consuming high levels of added sugar is associated with risk factors for heart disease such as weight gain and raised blood pressure[17]. Excessive dietary glucose and fructose have been shown to increase the production and accumulation of fatty cells in the liver and bloodstream, which is linked to cardiovascular disease, and kidney and liver disease[18]. Non-alcoholic fatty liver disease is one of the major causes of chronic liver disease and is associated with the development of type 2 diabetes and coronary heart disease[18].

There is also emerging evidence that sugar-sweetened beverage consumption may be independently associated with increased risk of stoke[19].

Chronic kidney disease

There is evidence of an independent association between sugar-sweetened soft drink consumption and the development of chronic kidney disease and kidney stone formation[20]. The risk of developing chronic kidney disease is 58% greater amongst people who regularly consume at least one sugar-sweetened soft drink per day, compared with non-consumers[21].

Cancer

While sugar-sweetened beverages may contribute to cancer risk through their effect on overweight and obesity, there is no evidence to suggest that these drinks are an independent risk factor for cancer[7]. 5

A health levy on sugar-sweetened beverages

WHO recommends that governments consider taxes and subsidies to discourage consumption of less healthy foods and promote healthier options[22]. WHO concludes that there is “reasonable and increasing evidence that appropriately designed taxes on sugar-sweetened beverages would result in proportional reductions in consumption, especially if aimed at raising the retail price by 20% or more”[23].

Price influences consumption of sugar-sweetened beverages[24, 25]. Young people, low-income consumers and those most at risk of obesity are most responsive to food and beverage price changes, and are likely to gain the largest health benefit from a levy on sugary drinks due to reduced consumption[23]. While a health levy would result in lower income households paying a greater proportion of their income in additional tax, the financial burden across all households is small, with minimal differences between higher- and lower-income households (less than $5 USD per year)[26].

A 2016 study modelled the impact of a 20% ad valorem excise tax on sugar-sweetened beverages in Australia over 25 years[27]. The levy could reduce sugary drink consumption by 12.6% and reduce obesity by 2.7% in men and 1.2% in women[27]. Over 25 years, there could be 16,000 fewer cases of type 2 diabetes, 4,400 fewer cases of ischaemic heart disease and 1,100 fewer strokes[27]. In total, 1,600 deaths could potentially be prevented[27].

The 20% levy was modelled to generate more than $400 million in revenue each year, even with a decline in consumption, and save $609 million in overall health care expenditure over 25 years[27]. The implementation cost was estimated to be $27.6 million[27].

A separate Australian report is supportive of an excise tax on the sugar content of sugar-sweetened beverages, to reduce consumption and encourage manufacturers to reformulate to reduce the sugar content in beverages[28]. An excise tax at a rate of 40 cents per 100 grams was modelled to reduce consumption by 15% and generate around $500 million annually in revenue[28]. While a sugary drinks levy is not the single solution to obesity, the introduction of a levy could promote healthier eating, reduce obesity and raise revenue to combat costs that obesity imposes on the broader community.

There is public support for a levy on sugar-sweetened beverages. Sixty nine percent of Australian grocery buyers supported a levy if the revenue was used to reduce the cost of healthy foods[29]. A separate survey of 1,200 people found that 85% supported levy revenue being used to fund programs reducing childhood obesity, and 84% supported funding for initiatives encouraging children’s sport[30].

An Australian levy on sugar-sweetened beverages is supported by many public health groups and professional organisations.

 

NACCHO Aboriginal Health #Obesity and the #sugartax : Barnaby Joyce on the merits of a sugary drinks tax

 sugartax

Amata was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

The thing that I say in community meetings all the time is that, the reason we’re doing this is so that the young children now do not end up going down the same track of diabetes, kidney failure, dialysis machines and early death, which is the track that many, many people out here are on now,”

Mai Wiru, meaning good health, and managed by long-time community consultant John Tregenza.

The Sugar Trip on Australian Story  View HERE

” With most complex issues, you start somewhere.  You come up with evidence-informed policies and you try them out.  You rigorously evaluate their performance, and learn by doing.

But not with obesity.  “Complexity” is the new enemy of action.  Since the causes of obesity are complex, every “single” policy advanced in response can be dismissed as a dangerously simplistic solution to a complex problem.

Welcome to obesity, the problem we’re not allowed to start to fix.

Except with personal responsibility, of course.!!!

A tax on sugary drinks will get National Party politicians in trouble with sugar producers, and Liberal Party politicians in trouble with big food.

The real problem is that it might work.  Based on the experience of Mexico, a sugary drinks tax will very likely cause consumers to purchase fewer sugary drinks.

Despite batting it away, a tax on sugary drinks is on the public agenda, and it’s here to stay.  I don’t see the sugary drinks industry winning on this issue indefinitely.

Partly because Australian health researchers will keep it on the agenda.”

 Edited highlights from :   Sydney Health Law

sugar

 

“We need a national healthy weight strategy which includes a comprehensive approach to tackle overweight and obesity in all parts of Australia.

“While there’s no silver bullet for reducing overweight and obesity rates, there are key policies which we know can make a significant difference to the health of all Australians.”

The Obesity Policy Coalition recommends four key actions by government to address the obesity problem:

  1. Develop and implement a long-term, comprehensive, integrated strategy to address obesity.
  2. Take action to substantially reduce children’s exposure to unhealthy food marketing.
  3. Introduce a 20 per cent tax on sugar-sweetened beverages and use the money raised to offer healthy food subsidies for people on low incomes and to support obesity prevention initiatives.
  4. Make the Health Star Rating System mandatory, to ensure it is displayed on all packaged food products.

The Healthy Communities: Overweight and obesity rates across Australia, 2014-15 report finds that in 2014-15:

  • The percentage of overweight or obese adults ranged from 53% in Northern Sydney to 73% in Country SA
  • Overweight and obesity rates were generally higher in regional PHN areas than in metropolitan PHN areas
  • After excluding adults who were overweight, the percentage of obese adults ranged from 16% in Central and Eastern Sydney to 38% in Country SA
  • The obesity rate was 25% or higher in 18 of the 28 PHN areas for which results were available.

Once more with feeling…Barnaby Joyce on the merits of a sugary drinks tax

When I looked up from marking exams and saw the look on Barnaby Joyce’s face, I just knew he was seeing red about the Grattan Institute’s proposal for a sugary drinks tax, levied at a rate of 40 cents per 100 grams of sugar.

The Grattan Institute report estimates that such a tax would reduce the consumption of sugary drinks by about 15% and generate up to half a billion dollars that could help to pay for a broad array of obesity-related programs.

Imagine!  A public health policy that fights obesity, diabetes and tooth decay AND generates revenue.

The National Party hate the idea. Deputy Prime Minister and Leader of the Nationals, Barnaby Joyce told reporters: Pictured here with the Asst Minister for Rural Health Dr David Gillespie

barnaby

“If you want to deal with being overweight, here’s a rough suggestion: stop eating so much, and do a bit of exercise.  There’s two bits of handy advice and you get that for free.  The National Party will not be supporting a sugar tax”.

Well that’s what he said.

But here’s what I heard: “We know that obesity and diabetes are out of control.  But we have ideological objections to being part of the solution”.

The same day that Minister Joyce shared these thoughts with reporters, the Australian Food and Grocery Council issued a press release saying that it was seeking a “constructive response to obesity”.

“Obesity is a serious and complex public health issue with no single cause or quick-fix solution”, explained the AFGC, but “it is not beneficial to blame or tax a single component of the diet”.

Personal responsibility…the answer to obesity, traffic accidents, terrorism, Zika virus, perhaps everything?

In a limited sense, Barnaby Joyce is right.

The only cure for personal obesity is personal responsibility.

But personal responsibility has turned out to be a spectacularly poor solution to “societal obesity”.

By societal obesity, I am referring to the trend towards overweight and obesity that has arisen over the past few decades and now affects the majority of adult men and women (and more than one in four children).

Since each of us is an individual, and because we live in a culture that prizes individual autonomy, it’s easy to fall into the trap of believing that individual effort, personal motivation, is the solution to the world’s ills.

But just as the global epidemics of obesity and diabetes were not caused by a catastrophic, global melt-down in personal responsibility, personal responsibility is equally unlikely to provide the magic solution.

That’s where public policies come in.

Governments know all this, but with the exception of tobacco control, they seem reluctant to apply their knowledge in the area of preventive health.

The fact is, from road traffic accidents to terrorism, smart governments:

  • acknowledge the complexity of the factors that contribute to societal problems;
  • They acknowledge that multiple interventions are needed, in many settings;
  • They acknowledge that possible solutions need to be trialled now, under conditions of uncertainty, instead of handing the problem to future generations.
  • They monitor the actions they take, because healthy public policy is a dynamic, ongoing process; and finally
  • They give a damn.  Meaning that they recognise they are accountable to the community for helping to solve difficult, societal problems, and for the performance of the public policies they administer.

Imagine if Australia’s government took that approach with obesity.

The debate about a sugary drinks tax is here to stay: it will never go away

A tax on sugary drinks will get National Party politicians in trouble with sugar producers, and Liberal Party politicians in trouble with big food.

The real problem is that it might work.  Based on the experience of Mexico, a sugary drinks tax will very likely cause consumers to purchase fewer sugary drinks.

Despite batting it away, a tax on sugary drinks is on the public agenda, and it’s here to stay.  I don’t see the sugary drinks industry winning on this issue indefinitely.

Partly because Australian health researchers will keep it on the agenda.

It will come back, and back.  Especially as evidence of its success accumulates overseas.

One conversation worth having is how revenues from a sugary drinks tax might support agricultural producers in rural Australia, helping to cushion them from the adverse effects (if any) of the tax and creating incentives for the production of a sustainable and healthy food supply.

That is simply one question worth considering during the process of developing a national nutrition policy (which we don’t currently have).

In the meantime, Australian health advocates need to broaden their base.

Advocacy for public policy action on obesity needs to become more closely integrated with advocacy on food security.   And advocacy in both areas needs to be linked more closely to action on reducing health inequalities.

But enough about all that.  You really came here for Barnaby, didn’t you?

OK, here he is:

The ATO is not a better solution than jumping in the pool and going for a swim. The ATO is not a better solution than reducing your portion size. So get yourself a robust chair and a heavy table and, halfway through the meal, put both hands on the table and just push back. That will help you lose weight.”

healthy-xmas

NACCHO Aboriginal Health Debate : # A sugary drinks tax could recoup some of the costs of #obesity while preventing it

bjoyce

Personal responsibility, not the Australian Tax Office, should determine how much sugar Australians consume, says Barnaby Joyce. Often as not, Barnaby’s recovery program involves half a packet of Marlboros, which he calls bungers.

Barnaby was much agitated on Wednesday about the suggestion by the Grattan Institute that a tax on high-sugar fizzy drinks might go some way towards alleviating Australia’s obesity problem.

“This is one of the suggestions where right at the start we always thought was just bonkers mad,” he declared, adding his party would not be supporting a sugar tax.

This shouldn’t knock you cold with surprise. Barnaby is the leader of the Nationals. Name a sugar-growing area and you’ll find a Nationals or a Liberal National Party member at the local school fete knocking back a mug of raw sugar-cane juice and proclaiming it God’s food.

But Barnaby wasn’t simply stopping at political solidarity with his northern MPs.

He had some Barnaby-advice on how you might lose weight without taxing sugar.

“People are sitting on their backside too much, and eating too much food and not just soft drinks, eating too many chips and other food,” he lectured.

“Well, so the issue is take the responsibility upon yourself. The Australian Taxation Office is not going to save your health, right. Do not go to the ATO as opposed to go to your doctor or put on a pair of sandshoes and walk around the block and…go for a run.

The ATO is not a better solution than jumping in the pool and going for a swim.

The ATO is not a better solution than reducing your portion size.

“So get yourself a robust chair and a heavy table and halfway through the meal, put both hands on the table and just push back. That will help you lose weight.”

Barnaby Joyce, living miracle, offers a health plan : Pictured above David Gillespie Assistant Minister for Rural Health and Member for Lyne

Note 1: The Federal electorates of Lyne which takes in Taree and Port Macquarie has been identified at the Number One stroke ‘hotspot’ in Australia.Refer

Note 2 : The Minister is not to be confused with David Gillespie Author of How Much Sugar and Sweet Poison : Why Sugar makes us fat .

xsweet-poison_jpg_pagespeed_ic_k1m_7kl1yc

In the wake of the progress report on Closing the Gap, the Indigenous Affairs Minister Nigel Scullion has declared sugary soft drinks are “killing the population” in remote Indigenous communities.

Key points:

  • Closing the Gap report found worst health outcomes found in remote communities
  • One remote community store drawing half of total profits from soft drink sales, Senator Scullion says
  • Senator Scullion says he thinks attitudes to soft drink are changing

According to evidence provided to Senate estimates today, at least 1.1 million litres of so-called “full sugar” soft drink was sold in remote community stores last financial year.

NACCHO Health News Alert : Scullion says sugary soft drinks ‘killing the population’ in remote Aboriginal communities

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Grattan Institute report

 ” Obesity is a major public health problem  In Australia more than one in four adults are now classified as obese, up from one in ten in the early 1980s.

And about 7% of children are obese, up from less than 2% in the 1980s.

The sugary drinks tax  revenue could be spent on obesity programs that benefit the disadvantaged, reducing the regressivity of the tax.

While the beverage and sugar industries are strongly opposed to any tax on sugar, their concerns are overblown.

A sugar-sweetened beverages tax will reduce domestic demand for Australian sugar by around 50,000 tonnes, which is only about 1% of all the sugar produced in Australia. And while there may be some transition costs, this sugar could instead be sold overseas (as 80% of Australia’s sugar production already is).

A tax on sugary drinks is a public health reform whose time has come.

The Conversation

A sugary drinks tax could recoup some of the costs of obesity while preventing it

In our new Grattan Institute report, A sugary drinks tax: recovering the community costs of obesity, we estimate community or “third party” costs of obesity were about A$5.3 billion in 2014/15.

Obesity not only affects an individual’s health and wellbeing, it imposes enormous costs on the community, through higher taxes to fund extra government spending on health and welfare and from forgone tax revenue because obese people are more likely to be unemployed.

In our new , A sugary drinks tax: recovering the community costs of obesity, we estimate community or “third party” costs of obesity were about A$5.3 billion in 2014/15.

We propose the government put a tax on sugar-sweetened beverages to recoup some of the third-party costs of obesity and reduce obesity rates. Such a tax would ensure the producers and consumers of those drinks start paying closer to the full costs of this consumption – including costs that to date have been passed on to other taxpayers. There is the added benefit of raising revenue that could be spent on obesity-prevention programs.

The scope of our proposed tax is on non-alcoholic, water-based beverages with added sugar. This includes soft drinks, flavoured mineral waters, fruit drinks, energy drinks, flavoured waters and iced teas.

While a sugary drinks tax is not a “silver bullet” solution to the obesity epidemic (that requires numerous policies and behaviour changes at an individual and population-wide level), it would help.

Why focus on sugary drinks?

Sugar-sweetened beverages are high in sugar and most contain no valuable nutrients, unlike some other processed foods such as chocolate. Most Australians, especially younger people, consume too much sugar already.

People often drink excessive amounts of sugary drinks because the body does not send appropriate “full” signals from calories consumed in liquid form. Sugar-sweetened beverages can induce hunger, and soft drink consumption at a young age can create a life-long preference for sweet foods and drinks.

We estimate, based on US evidence, about 10% of Australia’s obesity problem is due to these sugar-filled drinks.

Many countries have implemented or announced the introduction of a sugar-sweetened beverages tax including the United Kingdom, France, South Africa and parts of the United States. The overseas experience is tax reduces consumption of sugary drinks, with people mainly switching to water or diet/low-sugar alternatives.

There is strong public support in Australia for a sugar-sweetened beverages tax if the funds raised are put towards obesity prevention programs, such as making healthier food cheaper. Public health authorities, including the World Health Organisation and the Australian Medical Association, as well as advocates such as the Obesity Policy Coalition, support the introduction of a sugar-sweetened beverages tax.

What the tax would look like

We advocate taxing the sugar contained within sugar-sweetened beverages, rather than levying a tax based on the price of these drinks, because: a sugar content tax encourages manufacturers to reduce the sugar content of their drinks, it encourages consumers to buy drinks with less sugar, each gram of sugar is taxed consistently, and it deters bulk buying.

The tax should be levied on manufacturers or importers of sugar-sweetened beverages, and overseas evidence suggests it will be passed on in full to consumers.

We estimate a tax of A$0.40 per 100 grams of sugar in sugary drinks, about A$0.80 for a two-litre bottle of soft drink, will raise about A$400-$500 million per year. This will reduce consumption of sugar-sweetened beverages by about 15%, or about 10 litres per person on average. Recent Australian modelling suggests a tax could reduce obesity prevalence by about 2%.


Author provided/The Conversation, CC BY-ND

Low-income earners consume more sugar-sweetened beverages than the rest of the population, so they will on average pay slightly more tax. But the tax burden per person is small – and consumers can also easily avoid the tax by switching to drinks such as water or artificially sweetened beverages.

People on low incomes are generally more responsive to price rises and are therefore more likely to switch to non-taxed (and healthier) beverages, so the tax may be less regressive than predicted. Although a sugar-sweetened beverages tax may be regressive in monetary terms, the greatest health benefits will flow through to low-income people due to their greater reduction in consumption and higher current rates of obesity.

The revenue could also be spent on obesity programs that benefit the disadvantaged, reducing the regressivity of the tax.

While the beverage and sugar industries are strongly opposed to any tax on sugar, their concerns are overblown. Most of the artificially sweetened drinks and waters, which will not be subject to the tax, are owned by the major beverage companies.

A sugar-sweetened beverages tax will reduce domestic demand for Australian sugar by around 50,000 tonnes, which is only about 1% of all the sugar produced in Australia. And while there may be some transition costs, this sugar could instead be sold overseas (as 80% of Australia’s sugar production already is).

A tax on sugary drinks is a public health reform whose time has come.

NACCHO Aboriginal Health and Obesity : Should Doctors be taught how to discuss their patients’ excess weight ?

ATSI Obesity

” Being overweight or obese increases the risk of a range of health conditions, including coronary heart disease, Type 2 diabetes, some cancers, respiratory and joint problems, sleep disorders and social problems. The excess burden of obesity in the Indigenous population is estimated to explain 1 to 3 years (9% to 17%) of the life expectancy gap in the NT .

Obesity is estimated to contribute 16% of the health gap between Aboriginal and Torres Strait Islander peoples and the total Australian population

Obesity is associated with risk factors for the main causes of morbidity and mortality among Aboriginal and Torres Strait Islander peoples. It impacts largely through diabetes (half of the obesity burden) and ischaemic heart disease (40%) “

Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report

Download the report ATSI Overweight and Obesity

Download ANPHA Obesity Prevalence Trends

 “With 80% of adults and close to one-third of children expected to be overweight or obese by 2025, doctors are increasingly likely to be working with people who are overweight or obese.

An individual’s weight is a complex and sensitive issue, which may be related to many factors that are not only medical but social, environmental and emotional. The skills to address the issue in a way that communicates the health risks of being overweight without judgement and without inciting negative responses are not easy to acquire or universally taught.”

From The Conversation Adrienne Gordon  Neonatal Staff Specialist, NHMRC Early Career Research Fellow, University of Sydney and Kirsten Black Associate Professor & Joint Head of Discipline Obstetrics, Gynaecology and Neonatology, University of Sydney see full article below (2)

The 2012–13 Health Survey included height and weight measurements to allow body mass index (BMI) scores to be calculated. In 2012–13, 66% of Indigenous Australians aged 15 years and over had a BMI score in the overweight or obese range (29% overweight and 37% obese). Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians (after adjusting for differences in the age structure of the two populations).

Indigenous obesity rates varied geographically. Obesity was highest in inner regional areas (40%) and lowest in very remote areas (32%). Rates were similar in major cities (37%) and in outer regional and remote areas (38%). By jurisdiction, obesity rates ranged from 41% in NSW to 29% in the NT. Indigenous women had higher rates of obesity (40%) and lower rates of overweight (26%) compared with Indigenous men (34% and 31% respectively). Of those adult Indigenous women who had an underweight or normal measured BMI, 44% had a waist circumference of 80cm or more, indicating increased risk of developing chronic disease. For both Aboriginal and Torres Strait Islander males and females, the rates for overweight/obesity increased with age, with 80% of the population aged 55 years and over being overweight or obese. Higher proportions of Torres Strait Islanders were overweight/obese than in the Aboriginal population (73% versus 65%).

The 2012–13 Health Survey showed obesity was strongly associated with chronic disease biomarkers (being obese increased the risk of abnormal test results for nearly every chronic disease tested for in the survey). Indigenous obese adults were 7 times more likely to have diabetes than those of normal weight/ underweight (17% compared with 2%). Those who did not meet the physical activity guidelines were more likely to be obese (44%) than those who met the guidelines (36%).

Childhood is a critical period in which inequalities in health determinants such as socio-economic status and overweight/ obesity emerge (Jansen et al. 2013). In 2012–13, Aboriginal and Torres Strait Islander children aged 2–14 years were more likely than non-Indigenous children to be underweight (8% compared with 5%); were less likely to be in the normal weight range (62% compared with 70%); and more likely to be overweight or obese (30% compared with 25%). Obesity rates for Indigenous children increased from the age of 5, with the highest rates at 10–14 years of age (12%). High BMI is found to be a predictor of short sleep duration for children (Magee et al. 2014), which impacts on school performance (measure 2.04) and engagement in physical activity (measure 2.18). It is not possible to compare 2012–13 Health Survey results with previous surveys as the latest results are based on measured BMI rather than self-reported height and weight (as was done before). Research shows rates of overweight/ obesity have increased more rapidly in Aboriginal than non-Aboriginal school-aged children in NSW (Hardy et al. 2014).

In December 2013, national Key Performance Indicators data provided by Australian Government-funded Indigenous primary health care organisations, found that 27% of clients aged 25 years and over were overweight, and 41% were obese (AIHW 2014w).

Obesity is associated with other health risk factors and social determinants of health. One example is prolonged financial stress, which is a predictor of obesity (Siahpush et al. 2014) (see measure 2.08). Low income is associated with food security problems (Markwick et al. 2014) and subsequent dietary behaviour (see measure 2.19). Evidence also shows that incarceration is associated with weight gain and obesity in Indigenous youth (Haysom et al. 2013) (see measure 2.11).

Implications

Given the health risks associated with being obese or overweight, the situation for Aboriginal and Torres Strait Islander peoples requires urgent attention. It is second only to tobacco consumption in terms of contribution of modifiable risk factors to the health gap experienced by Aboriginal and Torres Strait Islander peoples (Voset al. 2007).

An evaluation of a school-based health education programme for urban Indigenous youth found promising results in physical activity, breakfast intake and fruit and vegetable consumption (Malseed et al. 2014), all of which are core components of healthy weight management. Likewise, opportunities exist for obesity prevention in young children through practice-nurse brief interventions (Denney-Wilson et al. 2014).

Reversal of obesity is difficult even in the absence of environmental and social barriers. Therefore, early intervention to prevent the onset of excessive weight gain is likely to be the most effective strategy (Thurber et al. 2014). Studies reporting success in reducing obesity have a number of common characteristics, including: a focus on physical activity and diet opposed to diet alone; the ability to accommodate the preferences of participants; a group focus; and choice between a number of physical activities. Programmes must also be culturally acceptable, conveniently located, easily incorporated into the daily schedule and show goal attainment that is realistic and appropriate (Canuto et al. 2011).

The Australian Government’s Indigenous Australians’ Health Programme aims to actively promote healthier lifestyle choices with culturally secure community education, health promotion and social marketing activities. A Healthy Weight Guide consisting of an interactive website and printed resources is currently being developed to provide guidance and information for consumers to help them achieve and maintain a healthy weight. The guide includes information for Aboriginal and Torres Strait Islander peoples.

Doctors need to be taught how to discuss their patients’ excess weight

Health professionals repeatedly report a lack of confidence in knowing how to address obesity in their patients. They report minimal, if any, training on obesity as well as limited resources for effective conversations and insufficient clinical time to be able to do this well.

Starting a conversation about weight requires not only empathy but awareness of strategies people can use to manage weight issues and an understanding of the range of local services available to assist. It has been shown that although behavioural and medical strategies can be effective, uninformed discussion in the clinic can disengage, stigmatise or shame patients, which then has negative impacts on the outcomes.

Many patients do expect weight-loss guidance from health professionals and the discussion can influence outcomes. In fact, having the conversation and formally diagnosing and documenting excess weight or obesity is the strongest predictor of having a treatment plan and weight-loss success.

Choice of language is crucial

Research has identified the terms “fat” and “fatness” are the least preferred terms. The words “obese” and “obesity” have also been found to arouse negative responses. The National Institute of Clinical Excellence in the UK suggests patients may be more receptive if the conversation is about achieving or maintaining a “healthy weight”.

The STOP Obesity Alliance in the US suggests using “people first” language such that a person “has” obesity rather than “is” obese, similar to “having” cancer or diabetes.

This is part of a debate about whether obesity should be labelled as a disease rather than a risk factor.

Regardless of how this issue is classified, doctors and patients both require the knowledge to understand effective therapies do exist and obesity treatment is not futile. Losing 5-10% of body weight can have a significant impact on risk factors such as blood pressure and can lower the risks of later health problems such as heart disease or type 2 diabetes.

This sort of weight loss also often improves other factors more immediately beneficial to the patient, such as energy levels, mood and mobility.

 

A communication style that encourages shared decision-making and helps people change their behaviour is key. The objective is not to solve the problem but to help the patient begin to believe change is possible and develop a plan about health goals.

Let’s take the case of a woman who presents with urinary incontinence. The woman may describe the problem of needing to wear sanitary pads because of daily leaking of urine. Factors such as obesity will worsen the problem, but the woman may not be aware of this.

The doctor might say:

I hear you’re concerned about your loss of urine, is that correct? Let’s talk about that; and would it be OK to discuss your weight too, as that may be related?

The practitioner might listen for a willingness to have further discussion and then pose a goal-orientated question:

If, as part of our plan to help your urinary symptoms, you decide to work on getting to a healthier weight, what might be a first step?

Repercussions for our kids

For men and women of reproductive age the conversation is potentially not just about their own health but also about that of their children. Women who have higher pre-conception weight and pregnancy weight gain are at increased risk of developing diabetes and heart disease in later life and are less likely to lose weight after they give birth.

This vicious cycle results in larger babies that are predisposed to short-term risks as newborns, longer-term risks of increased childhood obesity and an increased lifetime risk of obesity, diabetes and heart disease.

Between 1985 and 1995 the rate of excess weight and obesity in childhood increased by 50% and obesity tripled in Australia. Animal studies also suggest obesity in the male parent can increase the chance of their offspring developing obesity or diabetes.

The intergenerational nature of obesity therefore means until we address overweight and obesity in adults who are planning a pregnancy, it may be impossible to lower rates of childhood obesity.

The framing of the issue as a problem for patients’ own health as well as for the health of their children is even more complex. However, unless there is a greater understanding of this risk and more training of doctors in talking to patients about obesity this will be difficult to tackle.

Currently, many health professionals remain uncomfortable and unsure in this area of practice. Ensuring the workforce is skilled will also mean there is the ability to discuss weight when it is not the primary issue a patient presents with, but where an important conversation at a critical life stage may actually have lasting effects on patients’ health and that of their children.


Adrienne Gordon will be online for an Author Q&A between 4 and 5pm AEST on Wednesday, 17 August, 2016. Post any questions you have in the comments below.