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Govts, urban planners need to get involved to shrink the nation’s waistline


Recent reports suggest that Australian children are consuming less carbonated sweet drink and eating more fruit and vegetables. It has also been observed that rates of childhood overweight and obesity have plateaued.
Despite these fairly positive indications, overweight and obesity continue to be a significant public health issue in Australia.
In fact, the latest figures from the Organisation and Development for Economic Cooperation show that Australia (with 28.3 per cent of the adult population obese) has jumped from being the world’s fifth fattest nation to the fourth fattest, behind the US (36.5 per cent), Mexico (32.4 per cent) and New Zealand (28.4 per cent). And, looking at the growth rate, it may not be too long before we are in third position.
While it is difficult to put an exact cost on overweight and obesity, data from the Australian Diabetes, Obesity and Lifestyle (AusDiab) study indicates that the total direct cost of overweight and obesity was $21 billion in 2005 (with estimated indirect costs of over $50 billion a year).
Understandably, the costs associated with overweight and obesity will increase in parallel with its prevalence within the community. To this must be added the personal and social costs for individuals (both adults and children) who are overweight or obese.
The AMA has been particularly vocal on this issue. As doctors, we see patients who are overweight and obese, as well as those affected by the associated chronic diseases.
We can provide our patients with medical advice, support and refer them on for additional weight loss support as necessary. But even with the best medical care and support, there can continue to be barriers to weight loss.
These barriers, along with practical suggestions about supporting medical practitioners to assist with weight loss, have been highlighted in AMA submissions on the recently revised Australian Dietary Guidelines, as well as the National Health and Medical Research Council’s publication Management of Overweight and Obesity in Adults, Adolescents and Children for Primary Health Care Professionals.  
While it is important to support medical practitioners in their interactions with patients regarding weight loss, it is also important to consider those strategies which can have an impact for the greatest number of people.
Such initiatives often require Government participation or action, and may invoke ‘nanny state’ concerns.
However, if Australians are serious about reducing the size of our waist lines (and the associated costs), broadly-focused and far-reaching measures using principles of public health advocacy must be part of the solution.
Prevention of overweight and obesity is a worthwhile goal, particularly among children and young people.
The AMA has a long-standing policy calling for efforts to reduce the exposure of children and young people to junk (energy dense; nutrient poor) food advertising.  While the initial focus was on reducing exposure to television advertising, we are increasingly aware of other media platforms such as social networking sites, and even mobile phone applications, which target children and young people with loyalty programs, meal vouchers, premium offers and merchandise.
This sort of advertising can promote unhealthy eating habits by triggering a preference for salty, sugary and fatty foods and establish brand loyalty.
Despite suggestions from the AMA, other health care organisations and consumer groups, it is fairly evident that self-regulation in this area has not worked.
The AMA also supports urban designs that encourage people to undertake recommended amounts of physical activity.
In a recent column I previewed the update of AMA’s Position Statement on physical activity.
The update acknowledges the need for Government decision making – including planning and development-related decisions at all levels – to factor in ways of increasing physical activity.
We know that convivial streetscapes, lighting, pedestrian-friendly walkways, cycle paths and storage facilities can all increase participation in physical activity, particularly active transport.
Because lack of physical activity is independently associated with a range of health conditions, the benefits of increasing physical activity are much broader than weight loss alone, though this remains a substantial issue.
The AMA has also campaigned for the introduction of a simple and uniform approach to front-of-pack food labelling.
This type of food labelling can help consumers to make healthier choices through the provision of informative, relative and easy to understand ‘at a glance’ information on packaged foods.
As a key stakeholder, the AMA has been part of the Federal Government’s Front of Pack Labelling Stakeholder Working Group, along with other health groups and representatives of the food industry and retailers.
With the bulk of the technical work done, the Health Star Rating system was recently approved by the nation’s food and health Ministers.
It should be implemented in the new year, and its introduction should be supported by an appropriate public awareness campaign. 
Front-of-pack food labelling is not a panacea to reducing rates of overweight and obesity but, in combination with other measures including reducing exposure to junk food advertising and increasing opportunities to participate in physical activity, it will ultimately go a long way towards addressing overweight and obesity in Australia. 
With its adverse effect on the health of our patients, and its effect as a driver of health care spending, the AMA will continue to speak out on this important public health issue.