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Another day, another anti-obesity campaign, but will this one work?

Merely two months into the new year and we have already seen a plethora of local and international efforts aimed at curbing what appears to be the inexorable rise of obesity. Some of these initiatives…

Many proposed measures for curbing obesity around the work are aimed at restricting the intake sugar from soft drinks. Robert Huffstutter

Merely two months into the new year and we have already seen a plethora of local and international efforts aimed at curbing what appears to be the inexorable rise of obesity. Some of these initiatives are starting to reset the agenda for the community discussion around obesity.

Within the last week, there have been calls for the US Food and Drug Administration (FDA) to restrict the amount of “caloric sweeteners” in beverages because the scientific consensus is that the level of added sugars in those products is unsafe. And a ten-point action plan, including a 20% tax on soft drinks, to act against obesity before it becomes “unresolvable” has been presented to government bodies by the UK Academy of Medical Royal Colleges.

In Australia, Western Australia’s graphic, hard-hitting obesity prevention campaign against “toxic fat” has been launched in Queensland. And the Heart Foundation, Cancer Council Australia and Diabetes Australia launched a new mass media campaign called “Rethink sugary drink” in January.

The latter campaign was borrowed from similar efforts in New York, informing people in a slightly humorous, informative and thoughtful way that many soft drinks or other sugary beverages contain up to “16 packs of sugar in one can of soft drink”. The nutritional principle embodied in the tagline is that these are “empty calories”, with little nutritional value. And that, in order to maintain “energy levels”, other sources of food including complex carbohydrates may be much better than an excess of simple sugars.

To evaluate whether such campaigns are a good idea or a waste of effort, let’s consider this last attempt in detail. First, to contextualise the campaign – it fits as part of a complex set of activities in the area of obesity prevention. Obesity is a complex problem with no single solution, and rates have increased dramatically over the last 20 years. It’s associated with the increase in chronic (preventable) diseases, but no single program or intervention will rapidly fix the problem.

There’s some opposition to current obesity prevention efforts. Some clinicians advocate that public health approaches, such as media campaigns, should be replaced by increased rates of bariatric (stomach banding) surgery, while, at the other end of the spectrum, are some sociologists who claim we are stigmatising obese people, not solving the problem.

Interestingly, both these apparently divergent opinions are similarly focusing on individual people who are overweight or obese. A public health approach to prevention usually takes a broader perspective than that and requires a long-term sequence of “upstream” strategies.

A combination of mass media campaigns, policies and regulations, and restricting smoking environments were responsible for Australia’s remarkable successes in tobacco control from 1983. For the more recent issue of obesity prevention, we might need to consider more food regulation and policies that restrict fat content in food; limiting junk-food advertising to children; and creating active commuting and incidental physical activity opportunities in our communities.

All these measures are competing in the political space, with lobbyists from the food industry presenting alternate views to government. A recent paper in the prestigious medical journal, The Lancet, opined that efforts at self-regulation for the food industry have proved ineffective in reducing widespread exposure to unhealthy foods, so we clearly need to do more public health advocacy on this issue.

But implementing health policy is not a linear or logical process. We still live in a food environment characterised by a plethora of vending machines and local stores offering sweetened soft drinks. Add to that fast-food marketing that offers low-cost carbonated beverages and sweetened fruit juices in every suburb.

In terms of energy balance on whole-of-population level, even small contributions, such as the amount contributed by sweetened beverages, could tip total energy intake toward incremental annual weight gain, as opposed to weight maintenance. So, if we replaced sweetened drinks with water, the total number of calories not consumed would be significant enough to make a real contribution to preventing obesity.

Which brings us back to the role of mass media campaigns and social marketing. Two national “Measure Up” and “Swap It, Don’t Stop It” obesity prevention campaigns between 2008 and 2012 increased community awareness about the problem of obesity, and identified the potential for making small changes to our lifestyles to prevent weight gain. A logical next step might be an advocacy-focused campaign.

The original “Rethink sugary drink” campaign was introduced by New York’s Mayor Michael Bloomberg, and it was accompanied by policies to restrict super-sized sugared beverage sales. The measure was vigorously countered by the beverage industry , which even started litigation against the board of health for restricting their trade.

But as with tobacco companies, when an industry “doth protest too much”, it may point to an effective public health policy.

The current campaign re-focuses community thinking away from obese people by using acceptable weight range models to demonstrate the silliness of eating 16 packs of sugar. It’s an effective cue to get people thinking about the similar sugar content of soft drinks. And it aims to increase community concern and, in turn, to increase pressure on government to act. It’s an antecedent to policy change.

If effective, the advocacy campaign will emphasise the need for sweetened beverage regulation as a necessary public health strategy. Ideally, this would be followed by government responses to provide regulatory limits to the currently untrammelled distribution and marketing of sugary drinks. And that will reduce total energy intake across the population.

The campaign also demonstrates the important independent role of the non-government organisation sector in Australia as the “conscience of the population”, which helps catalyse governments into action.

Hopefully, the campaign has sufficient intensity; low-budget campaigns are unlikely to have sufficient reach to influence the community. There’s a long way to go, but the net sum of our efforts are making progress in obesity prevention. And this advocacy campaign is an important contributor on the “long and winding road” to improved population health.

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60 Comments sorted by

  1. Sue Ieraci

    Public hospital clinician

    "But as with tobacco companies, when an industry “doth protest too much”, it may point to an effective public health policy."

    Spot on!

    If we add the fact that there is no single, magic bullet solution, we are heading somewhere.

    Just like other public health campaigns, we need a mix of strategies - some education, some harm-minimisation, some regulation, some incentives, some financial disincentives, some culture changes, some re-framing of aims.

    And, perhaps more than anything, a focus on overall health outcomes rather than appearance or sports performance.

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    1. Robert Peers

      General Practitioner

      In reply to Sue Ieraci

      to adrian and sue---hey you guys, no magic bullet, no single solution, eh?

      there might be two such bullets:

      1. it's a real shock how much sugar is in these disgusting drinks--we rarely drank these up the bush in the 1950s, and even on stinking hot days, us kids were quite happy to wait till we got home, to swig some chilled water or weak lemon cordial from the fridge

      so they've got to go, these stupid drinks

      2. garvan institute researchers--and stress expert george chrousos, too--have…

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Robert Peers

      So, Robert Peers, let's say you shoot your magic bullets today.

      Tomorrow, all sweet carbonated drinks disappear from the market without protest, right?

      Next day, everyone in the world starts eating lots of "grains, nuts, legumes and citrus", and anxious people get magic supplements.

      There you go - all fixed in three days. Who needs public health experts when you can just ask Robert?

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    3. Robert Peers

      General Practitioner

      In reply to Sue Ieraci

      hi sue we actually do have some public health experts in this nutritionally dumb country--two superb fully-imported finns, helping professor james dunbar in s-w victoria, with diabetes and heart disease prevention

      the finns have almost wiped out the coronary epidemic in northern karelia, thanks to nutritionally aware MEDICALS pushing low-fat diet, and maybe more traditional oat porridge [which provides anti-anxiety inositol, very protective against vascular disease]

      no nobel prize for that

      so consider my public health diet ["PHD"] and despair!!

      my magic inositol is not only anti-anxiety, but also anti-ageing, energising, anti-cancer [in high doses], anti-diabetic and anti-neurodegenerative [alzheimer's, parkinson's]

      tell your experts that

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    4. Henry Franceschi

      Director, NCD Treatment Centers

      In reply to Robert Peers

      As a doctor trained in scientific method you might consider a little more modesty.

      For example, a quick check to see if the claims about INOSITOL on WebMed are reliable enough to support its role as a “magic bullet” reveals the following:

      “How does it work?
      Inositol might balance certain chemicals in the body to possibly help with conditions such as panic disorder, depression, obsessive-compulsive disorder, and polycystic ovary syndrome.”

      Wow! Let’s dissect that mouthful.

      What this…

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    5. Sue Ieraci

      Public hospital clinician

      In reply to Robert Peers

      "my magic inositol is not only anti-anxiety, but also anti-ageing, energising, anti-cancer [in high doses], anti-diabetic and anti-neurodegenerative [alzheimer's, parkinson's]"

      Invoke the word "magic", claim it fixes everything from alzeimer's to cancer, and the reader KNOWS it can't be true.

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    6. Robert Peers

      General Practitioner

      In reply to Sue Ieraci

      hi sue

      i knew you would take the bait!!

      hey, how come you ask laypeople for evidence on this forum, to show that superior medical types only believe in evidence, but are content to ignorantly dispute my claims re inositol, without asking for my references?

      if there's one thing i relish, it's seeing unscientific medicals going into meltdown when confronted with a colleague who does science--nutritional biochemistry, nutrigenomics and molecular biology

      i was once asked, at a drug dinner…

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  2. John Zigar

    Engineer, researcher

    As I’ve mentioned in many forums, I believe in evidence based medicine and evidence based food policies. The recommendations coming from out of the woodwork are not necessarily evidence based and are discriminatory. My dad, brother and father are fat (not obese, just fat). I admit it. My wife and mother-in-law are skinny. My mother-in-law and my wife eat healthy foods. My mother-in-law was recently diagnosed with type II diabetes. My wife has frightingly high levels of cholesterol and whatever else…

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    1. Gary Cassidy

      In reply to John Zigar

      You start out stating your belief in evidence based food policies, etc. Then go on to present anecdotal experiences which go against evidence based research?

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    2. Sue Ieraci

      Public hospital clinician

      In reply to John Zigar

      John Zigar, you clearly don't know a representative sample of the community.

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    3. John Zigar

      Engineer, researcher

      In reply to Sue Ieraci

      In reply to Gary and Sue, no I won't and yes I do.

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    4. John Zigar

      Engineer, researcher

      In reply to Gary Cassidy

      In response to Gary and Sue, please read http://healthland.time.com/2013/01/02/being-overweight-is-linked-to-lower-risk-of-mortality/

      The report says, amongst other things, that
      "...being overweight may lead to a longer life."

      Hmmm, my 'anecdotal evidence' is therefore supported by research. The researchers examined data on 43,265 participants enrolled in the Aerobics Center Longitudinal Study between 1979 and 2003. The researchers categorized obese participants as “metabolically healthy…

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    5. Sue Ieraci

      Public hospital clinician

      In reply to John Zigar

      John - you seem to be confusing population risk with individual risk. We all know about life-long smokers who live to a ripe old age - but a vast number also have severe lung and/or heart disease. Unfortunately, we can't always predict who will fall into which camp.

      An individual is subject to a multitude of influences: from genetics/heredity to many different aspects of lifestyle.

      "Normal" weight is, of course, a bell curve. People at the very high end are statistically more likely to suffer…

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    6. Gary Cassidy

      In reply to John Zigar

      I think the evidence is pretty abundant that obesity is a risk factor for various non-commutable diseases. As a society we are trending toward higher levels of obesity (not toward some measure of optimal BMI (in regard to mortality)). I recall reading a BMI vs "overall mortality" study a few years back (sorry no reference noted) and the optimal BMI was around 27-28 but the curve was very flat through the healthy range and kicked up significantly into the obese and underweight ranges, I recall there were also various limitations to the study including no measure for quality of life, no correction for weight loss before death (due to disease), no correction for lifestyle or diet.

      It seems that BMI is also not the preferred measure of overweight/obesity health risks for individuals either - tape measure around the tummy is preferred.

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    7. John Zigar

      Engineer, researcher

      In reply to Sue Ieraci

      Sue, I am not confusing ‘population risk with individual risk’. Read the study! The study done in 2005 and repeated in 2007 clearly shows that only the severely obese have a significantly increased mortality, up by 29 per cent. Otherwise, extra weight appears to be protective. Underweight people, meanwhile, have a 10 per cent higher rate of premature death than those of normal size. The results are published in the Journal of the American Medical Association.

      You claim that: “The flip side of…

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  3. Trevor Kerr

    ISTP

    You've left out two major factors, Adrian.
    One, people have different taste systems, so some types of fat may appeal to some and be repellent to others.
    Two, your use of 'calorie' is typical of the confusion over measures of energy content. I'd like you to have another look at what you've written, and suggest whether or not a rigorous campaign to stamp out the use of "calorie" (and Calorie) in favour of "Kilojoules" may sharpen the focus of academics and educators, or whether a more concrete and easily understood standard measure, such as, "teaspoons of sugar" (what is a 'pack'?), would be more effective.
    I'm not sure "toxic" is a helpful, let alone accurate, descriptor of any type of fat.

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  4. James Jenkin

    EFL Teacher Trainer

    If indeed there is a 'plethora of local and international efforts' aimed at reducing obsesity, why are people putting on weight?

    Is the mix of strategies not yet right? Did anti-smoking initiatives do something that health initiatives don't?

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    1. Reema Rattan

      Editor at The Conversation

      In reply to James Jenkin

      I guess because it takes time for things to work. And the efforts haven't been translated into tangible action yet.

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  5. John Doyle
    John Doyle is a Friend of The Conversation.

    architect

    All well meaning but ultimately due to fail. There is NO WAY vested interests will give ground easily.
    The only way forward is from the ground up not from the top down. The top down has been giving out bad advice for 30 years at least or from back about when these epidemics started. The vested interests didn't start the rot. They saw advantage in taking on board the appallingly bad science behind nutritional advice back then and they will fight to keep the bad advice alive. We see universities in…

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  6. nadine Gibbons

    logged in via email @tpg.com.au

    why not get manufacturers to reduce sugar levels by 1 or 2 tsp per annum, or 10% of the original per annum? Going to non sugar sweetners can be dangerous for some people - see aspartane problems on medical sites. reducing slowly will trick taste buds into accepting the changes. Yes we are eating too much sugar in too many formats - it is a cheap filler. As a cook, I have reduced sugar in many recipies with no decrease in quality of the food and no complaints from the eaters. Some food does need a sugar ratio to be retained, but they are not as many as one may think. Also there are still not enough people who realise that low fat does not equal low calorie I had to explain to my own husband that the sugar he was eating in sweets and cordials converted to fat in his body.

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    1. wilma western

      logged in via email @bigpond.com

      In reply to nadine Gibbons

      excellent comments Nadine. Sue - what is the evidence that there are significant health risks from non-sugar sweeteners?

      As well as the very high kilojoule content of sugary areated drinks, what about the full-fat sweel flavoured milk? Some people hop into these oblivious of the high joules - well .milk is healthy isn't it?

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    2. Reema Rattan

      Editor at The Conversation

      In reply to wilma western

      You my want to consider the whole of a food rather than just one component of it. Milk has nutrients as well as fats, as opposed to soft drinks.

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    3. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to wilma western

      The main problem with artificially sweetened drinks is that they are just as acidic as those sweetened with sugar. The acidity damages tooth enamel, increasing the risk of decay. That acid attack is especially hazardous if the drinks are taken as many 'sips'.

      Top tennis players who really do benefit from sports drinks during gruelling performance set a good example by taking a swig of water immediately after their acidic sports drink. That dilutes the acid.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Rosemary Stanton

      The other issue with artificially sweetened drinks is that they encourage a sweetness habit, unfettered by concerns about energy intake. The culture around "sports drinks" also encourages them to be "thrown down" in large volumes.

      Flavoured milk for children has not only the advantage of other nutrients, but the protein and fat content mean that it isn't likely to be consumed as rapidly, or in as large volumes, as clear liquids.
      Of course, everything should be consumed within an overall balance of nutrients and energy, but there is no need for absolutism.

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    5. Gary Cassidy

      In reply to Sue Ieraci

      "The other issue with artificially sweetened drinks is that they encourage a sweetness habit" - the same argument can be said of our most ubiquitous added sweetener - sucrose (or HFCS in the US), or (increasingly) added fructose.

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      There is a difference here, Gary.

      Weight-conscious people tend to be more cautious about intake of sugar-sweetened drinks, due to the energy implications.

      Sweet drinks that are low-energy are more likely to be consumed with less restraint, simply because of the lack of energy consequences.

      Behavioural research has shown that high consumption of sweet drinks can lead to a sweetness habituation, encouraging further intake of sweetened foods (I posted a link to a study on another thread where we talked about this). It's not a physiological addiction, but a behavioural habituation.

      It comes down to this: no absolutism, but no excess.

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    7. Gary Cassidy

      In reply to Sue Ieraci

      Yes I agree that there is a difference - particularly in the scope of the study that you refer to.

      However, in regard to "The other issue with artificially sweetened drinks is that they encourage a sweetness habit", my opinion is that the same argument (sweetness habit) applies to sugar sweetened beverages and foods.

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    8. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      Perhaps so, Gary, but my point is that the artificial sweetening removes a natural restraint on consumption that would make many people minimise intake (if they were consuming energy).

      Many people would restrict their intake of a sugar-laden drink but not restrict their diet-drink intake (why else would people drink that stuff?)

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  7. Bernie Victor

    Martial Arts Instructor

    The success of The Anti-smoking campaign came with a lot of evidence of the associated health risks. This campaign was targeted at Adults who smoke.

    Shouldn't we be targeting the education of parents as one of the main focuses in trying to curb obesity as they are the providers of what their kids consume.

    There is a direct relationship between higher education and decreased rates of smoking, l wonder if it is the same for parents of overweight children.

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  8. Trevor Kerr

    ISTP

    Would Adrian like to examine the concept of Moral Hazard in relation to anti-obesity campaigns?
    Like, who gains from the outcry over increasing prevalence of obesity? Put it another way, how many public health units would badger the government to fund their anti-obesity desks if most citizens were able to maintain desirable BMIs using innate common sense and good, basic schooling?
    So, flawed anti-obesity policies benefit the designers of those flawed policies. Tax-payers are left to pay the bills…

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    1. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Trevor Kerr

      It's fair to assume advertising works or companies wouldn't spend millions of dollars on it. Combine such clever persuasive tactics with widespread availability of junk food (not just in supermarkets and food stores but at service stations and sporting premises and events and on short plane flights), peer pressure that 'normalises' consumption of fast foods and junk food in every lunchbox and at almost every eating occasion, and a culture where travelling times and work commitments of the main family…

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    2. Judith Olney

      Ms

      In reply to Rosemary Stanton

      You make a good point Rosemary, about the normalisation of the consumption of junk foods. I would add that there is a push by the food and beverage industry, to normalise the over-consumption of all food and drinks except the healthy ones.

      This is exacerbated by the view that we "need" to eat at least three times a day, and "need" to snack between meals. Unless a person has a health condition such as diabetes, or others, that require a person to eat small, frequent meals, we humans do not "need…

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    3. Sue Ieraci

      Public hospital clinician

      In reply to Trevor Kerr

      Trevor Kerr - "how many public health units would badger the government to fund their anti-obesity desks if most citizens were able to maintain desirable BMIs"

      Are you proposing that public health units are intentionally doing their job badly in order to retain their funding?

      The cross-fertilisation of marketing ideas into public health is a good principle - but will require public health units to expend MORE money - not less. Commercial organisations spend money on advertising to increase profits. In health, profits are never realised because needs are never met - the goalposts always move.

      Preventative medicine does not save money overall. It leads to better health outcomes and longevity, but any theoretical savings are swallowed up by increasing expectations, more complex interventions and costs at the end of life.

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Judith Olney

      Judith - there is something important in your observation about the constant carrying of drink bottles.

      It seems to me that the recommendations of sports scientists, coaches and physiologists, in an aim to maximise performance for high-end professional athletes, have leaked into the general community.

      One certainly does need rehydration and restoration of muscle glycogen after running a marathon, or riding a leg of the tour de France. Not so much for walking around the block, or a social game of tennis, however.

      The issue here is that the practices required to achieve high-end sports performance are not necessarily practices that achieve good health overall. The legacy of these practices can include ruined joints, poor sleep patterns and amenorrhoea, amongst others.They are very much about muscle strength, endurance, weight minimisation and appearance - not wellbeing.

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    5. Rosemary Stanton

      Nutritionist & Visiting Fellow at University of New South Wales

      In reply to Sue Ieraci

      Sports drinks have a place in endurance activity, but companies have pushed them well beyond that limited market. And so we have parents buying sports drinks for kids who run around the park and others using them when they're doing little more than walking.

      The idea that if you're thirsty, you're already dehydrated was pushed through a Liquids for Living program a few years ago and continues to be pushed by companies selling drinks and those they sponsor.

      It's not a sign of malnutrition or dehydration when you feel hungry and thirsty several times a day. You just need food and water.

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    6. Trevor Kerr

      ISTP

      In reply to Rosemary Stanton

      Rosemary, have you read Alain de Botton's 'The Pleasures and Sorrows of Work', his chapter on Biscuit Manufacture? Some of it is accessible at http://www.amazon.com/Pleasures-Sorrows-Work-Vintage-International/dp/0307277259.
      Another factor playing on the possibility of diverting funding, from, say, corrective medical procedures to education & prevention, is the "investment" of practitioners in their income streams. A history of the management of peptic ulcer is a good case in point.

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  9. Gary Cassidy

    My local vending machine sells 600ml soft drinks for $3.50, many service stations sell them from upwards of $4. They are already very very expensive when brought as a convenience item (yet people still buy them). However they are quite cheap when brought from a supermarket. I don't believe that a small tax of 20% will make a large difference in consumption volumes. How about a minimum flat rate cost per 1 packet of sugar equivalent - say 30c per packet. That will make a 16 sugar packet beverage cost…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Gary Cassidy

      Why do we have to buy drinks from vending machines at all? (with their associated plastic containers)

      All schools still have "bubblers", and many public places have water fountains - there's nothing wrong with Australian town water - either straight from the tap or, if you must carry around a bottle, filled from the tap.

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    2. Gary Cassidy

      In reply to Sue Ieraci

      Never considered that!

      Yes. The removal of all vending machines from everywhere would be a good thing.

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  10. Margo Saunders

    Public Health Policy Researcher

    The problem with so many of these campaigns, especially about obesity, is that they are confused about whether the aim is to change people's thinking or their behaviour. Australians have a generally low level of health literacy (and we have no national health literacy strategy), but a lack of information and an abundance of misunderstandings are often compounded by a 'so what?' attitude -- long-term 'health' is not paramount for everyone (as Rosemary has so succinctly explained), especially given…

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    1. James Jenkin

      EFL Teacher Trainer

      In reply to Margo Saunders

      Is it really about 'health literacy' Margo? Doesn't any high-schooler know junk food makes you fat, and vegetables and exercise are good for you?

      I think you hit the nail on the head with the example of your husband - people like eating unhealthy food.

      So then it becomes an ideological question. Is it the Government's role to encourage us do things for our own good? Or is it none of their business?

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    2. Margo Saunders

      Public Health Policy Researcher

      In reply to James Jenkin

      Some people will eat what they want to eat, regardless, even if they are aware of and understand the associated risks. But it is a real challenge to ensure that the relevant information is conveyed in ways which are meaningful for each person. Some people will also reject the information, especially given the problem of ‘proving’ that doing thinks like changing one’s eating patterns will reduce the risks of particular diseases and conditions. ‘Low response efficacy’ (beliefs that a recommended action…

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  11. Louise Bee

    logged in via Facebook

    This article was interesting and thought provoking. Many countries are learning to 'manage' what is becoming a major health crisis. There was much mention made of sugary drinks, which is only one small element of the problem but it also highlights how Big business and mass marketing can override a government's efforts to turn things around.
    It will be interesting to see whether Australia is successful in the latest strategy to reduce obesity rates. There are many views about to do it, but as has been said in the forums, there is no magic bullet.

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  12. Margo Saunders

    Public Health Policy Researcher

    "Ideally, this would be followed by government responses to provide regulatory limits to the currently untrammelled distribution and marketing of sugary drinks." Well, yes. Ideally, we would have government responses to provide regulatory limits to a lot of things that fuel obesity.
    But last time the Coalition was in Government and Mr Abbott was Health Minister, we had a government whose ideology was that the entire food-&-physical-activity thing is about 'individual responsibility' and parents controlling what their children do, and a complete refusal to acknowledge the role of everything that influence those 'decisions'.
    Australia has no Surgeon-General or high-profile anti-obesity champions like Michelle Obama -- or even a body like the US Institute of Medicine. So we can only hope that Australian experts (and that includes the heads of the royal medical colleges) have been preaching, very strongly, to the unconverted, and will continue to do so over the coming months.

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    1. Trevor Kerr

      ISTP

      In reply to Trevor Kerr

      OK, read that NYT article, let me talk to myself.
      One, Geoffrey Bible (Rupert Murdoch's Aussie pal at Philip Morris 10 years ago) gets a mention, in the section on marketing Kraft products.
      Two, maybe we ought to be looking at more user-friendly standard measures for sugar, salt & fat. Like, teaspoonful. Then, at the supermarket shelf, with the right app on the smartphone, it would be possible to scan an item's barcode to bring up it's sugar-salt-fat content in tspns.
      Then, by mining the data, it would be possible to see which components are of more concern. There are plenty of low-salt alternatives, so maybe that message is out. The next best is probably sugar, or sucrose-equivalents.
      Trying to drive the full package (lower sugar, salt & fats) through the public health channel could be too hard.
      If the smartphone app is worth pursuing then maybe run it past a digital marketing shop.

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    2. Trevor Kerr

      ISTP

      In reply to Trevor Kerr

      My blog now!
      Mike Daube http://www.abc.net.au/unleashed/4533636.html is onto the spoonful concept.
      Spoonful (teaspoon) is instantly accessible to all. Heaps better than Calorie or KJ or gram or grain.
      "Every extra spoonful of sugar (sucrose) is one too many"
      Switches easily to NaCl and saturated fats.

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    3. Trevor Kerr

      ISTP

      In reply to Margo Saunders

      Thanks, put it on my Samsung. It's a fair bit of effort, though, not likely to be much use to busy mum in the aisle with one hand free. Barcode scanner is way to go. Maybe with an instant price comparison of items across vendors. Heinz low-salt beans $1.25 at Woolies? Look, right now $1.05 at Coles, down the mall.

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    4. Margo Saunders

      Public Health Policy Researcher

      In reply to Trevor Kerr

      Traffic light tracker was apparently primarily developed as a platform for advocacy. There is another app called Food Switch where you scan the barcode. See:
      http://www.bupa.com.au/health-and-wellness/tools-and-apps/mobile-apps/foodswitch-app
      and media report:
      http://www.smh.com.au/digital-life/smartphone-apps/phone-app-gives-consumers-green-light-on-food-buys-20120117-1q4sy.html
      (Thanks to Jane Martin from the Obesity Policy Coalition for this information.)

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    5. Margo Saunders

      Public Health Policy Researcher

      In reply to Trevor Kerr

      Excellent (and depressing) article, Trevor, which provides stark insights into the US health care system (which, as we know, differs from the Australian one in essential ways).

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    6. Sue Ieraci

      Public hospital clinician

      In reply to Margo Saunders

      "Australia has no Surgeon-General "

      No - we call ours Chief Health Officer. There is one in each state and one federally. They are involved in many public health issues.

      The previous one, John Horvath, was involved in tsunami disaster relief and pandemic flu management as well as campaigns about vaccination and prevention/management of chronic disease.

      The current one is Chris Baggoley. He overseas work in nine National Health Priority Areas, including diabetes, obesity and chronic disease.

      There is also a federal population health division, with sub-sections looking at chronic disease, healthy living, smoking cessation etc.

      Perhaps there are no celebrities involved, but Australian has had a few recent public health "wins", including tobacco plain-packaging and alco-pops regulation.

      DO we need a celebrity anti-obesity campaigner?

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    7. Margo Saunders

      Public Health Policy Researcher

      In reply to Sue Ieraci

      Who in Australia has heard of the Chief Health Officer? The US Surgeon-General has a quite different stature (& level of available resources) & commands a significant degree of political, media and public attention.
      As for the federal & state/territory population health bureaucracies -- I know. I worked there and know how, and under what conditions and constraints they operate. Do we need some high-profile advocates? Yes, at both the political and the media levels, but not 'celebrity' to the exclusion of credible.

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    8. Robert Peers

      General Practitioner

      In reply to Margo Saunders

      Hi Margo

      can you tell us what works and doesn't work, inside a public health bureaucracy, please? you obviously know something

      as for surgeon-generals, i think sue ieraci might be wrong about the federal guy--i think states have chief "health" officers, but in canberra our man chris baggoley is called chief "medical" officer, as if health had anything to do with medicine

      i rang his office once, and amused a nice chap there, with my querulous complaint, that the "health" dep't had no [chief…

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  13. Justin Grossbard

    Director

    I think better labeling, education and bans on certain advertising is the right direction. I have found that doing this on www.457visacompared.com.au was able to significantly change behavior in test but ONLY at the point of sale. McDonalds etc now have KJ on the menu but each item should show the % of KJ vs recommended amounts.

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  14. Margo Saunders

    Public Health Policy Researcher

    @Robert P.: Bureaucracies can be tough -- I often felt that I was spending more time & effort fighting battles within health depts. rather than directing that effort to support improvements in public health. The bureaucratic & decision-making structures in Australia are not helpful, especially since managerialsm replaced those with specialist knowledge and so much decision-making became top-down. Australia has no massive national infrastructure like the US Centers for Disease Control and Prevention…

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