Overweight and obesity are highly prevalent across the globe and Australia is no exception. In Australia 63% of adults and 25% of children are overweight or obese and these rates have increased substantially over the past 20 years. According to the OECD, Australia is fifth in the list of advanced countries with the most overweight or obese populations in the world – after Mexico, the United States, Chile and New Zealand.
Statistics also show that the level of overweight and obesity in Australia varies according to geographical location (people living in major cities are leaner), and other more general factors such as age (people tend to get fatter as they get older) and socioeconomic group (those in lower socioeconomic positions are substantially more likely to be overweight or obese).
The recent McKinsey Global Institute report, Overcoming Obesity: An initial economic analysis, states that the global economic impact of obesity amounts to roughly $2 trillion annually (2.8% of global GDP) and reiterated what I think innately makes sense to us all – if we’re to tackle the high and frequently increasing rates of overweight and obesity in our populations we’re going to need to come at it with all guns blazing.
The McKinsey Global Institute also says: “Our research suggests that an ambitious, comprehensive, and sustained portfolio of initiatives by national and local governments, retailers, consumer-goods companies, restaurants, employers, media organisations, educators, health-care providers, and individuals is likely to be necessary to support broad behavioural change. These levers must address different population segments and deploy different mechanisms for impact.”
For those of us working in obesity prevention, at whatever level, this simply makes good sense. Being overweight or obese is linked to an increased risk of 10 cancers as well as a number of other chronic diseases, so efforts to promote healthy eating and increased physical activity need to be embedded across society – from individuals and their families, to organisations and communities and in the policies that influence them. This reflects the well endorsed socio-ecological view that the environment can influence population health and also highlights the interdependency of all levels of society.
The National Health and Medical Research Council, and World Cancer Research Fund funded the InFANT Program, designed and trialled by myself and other researchers from Deakin University’s Centre for Physical Activity and Nutrition Research, provides a valuable example of an evidence-based programme for obesity prevention in Australia that unapologetically focusses on the family unit.
This programme – which helps new families to promote healthy eating and physical activity behaviours in their infants from birth – has shown promise in improving the diets of mother and child and in reducing children’s television viewing, but programmes such as this cannot work in isolation. And here lies the rub – the political will to move beyond individual responsibility and education as the means for preventing obesity is usually impossible to secure.
Why Australia focussed on individual responsibility
Interestingly, Australia was one of the first countries in the world to produce a government report on obesity prevention; but in his analysis of progress in obesity prevention over the last 20 yearsProfessor Boyd Swinburn states that because the report “came from the government’s research agency and was not embedded in government policy or bureaucracy, most of its important recommendations remained unimplemented”.
Generally speaking, neither the Australian nor the New Zealand governments have supported policies which are very likely to make a difference at the population level, and to reach those most at risk. The clear preference for these governments is to push an agenda that focuses on individual responsibility. The individual is a much easier target to line up, and to divest responsibility to.
A fundamental problem with this approach is that it’s likely to increase the socioeconomic disparities in obesity prevalence – individuals and families with more resources and education are the most likely to do well in their efforts to prevent obesity – and yet, these people are the least at risk. If we’re to ensure that everyone benefits from obesity prevention initiatives in Australia we must ensure that we don’t inadvertently increase socioeconomic disparities by endorsing approaches that focus only on an individual level.
We must also ensure that moving from single approaches to a portfolio of initiatives can be sustained, and that we balance programmes that may be time-bound with longer term sustainable, policy and built environment changes.
Obesity prevention in Australia has improved
On the up side, Australia provides some encouraging examples of initiatives that have sought to bridge the gaps by working across the whole of community in a concerted way. For example, Healthy Together Victoria, an initiative directed by Victoria’s Department of Health and Human Services, employs a system-wide vision of addressing the predictors of overweight and obesity.
It is within this broad reaching framework that the Infant Program sits; one of a suite of healthy living programmes targeting different parts of the life course. Importantly these programmes are not posited as stand alone solutions to community obesity. Rather, they form one part of a complex system-wide vision seeking to address broad-ranging risk factors in sustainable ways.
High-level research & innovation needed
Obesity prevention in Australia has come a long way but it still has a long way to go. It is worth reinforcing the McKinsey Global Institute’s proposition that we need an “ambitious, comprehensive, and sustained portfolio of initiatives” to prevent obesity and its associated impacts on the health and economies of countries around the globe. An important part of this is the need to support high-level research and innovation to find and evaluate approaches that will benefit the many in cost effective and sustainable ways.
My thanks to colleagues, Associate Professor Elizabeth Denney Wilson (University of Technology Sydney) and Dr Penny Love (World Health Organization – Collaborating Centre for Obesity Prevention Deakin University) for their input into this blog.
Author: Dr Karen Campbell