tag:theconversation.com,2011:/au/topics/obese-nation-3287/articlesObese Nation – The Conversation2017-10-23T09:41:29Ztag:theconversation.com,2011:article/856162017-10-23T09:41:29Z2017-10-23T09:41:29ZOverweight kids: tackling childhood obesity is about more than just diet and exercise<figure><img src="https://images.theconversation.com/files/191031/original/file-20171019-1086-cesxsx.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>A recent <a href="http://www.who.int/mediacentre/news/releases/2017/increase-childhood-obesity/en/">World Health Organisation report</a> revealed that the number of obese children and adolescents – aged five to 19 years – worldwide has risen tenfold in the past four decades. </p>
<p>Worryingly, it also predicts that “obese” is likely to become the new norm. The report stated that:</p>
<blockquote>
<p>If current trends continue, more children and adolescents will be obese than moderately or severely underweight by 2022.</p>
</blockquote>
<p>The number of overweight or obese infants and young children increased from 32m globally in 1990 to <a href="http://www.who.int/end-childhood-obesity/facts/en/">41m in 2016</a>. The vast majority of overweight or obese children live in developing countries, where the rate of increase has been more than 30% higher than that of developed countries.</p>
<p>And in the UK, <a href="http://content.digital.nhs.uk/ncmp">recent research</a> shows that 9% of four and five year-olds are now classed as obese – with the proportion rising to 20% for 10 to 11-year-olds. </p>
<p>Efforts to reverse this growing trend have mainly focused on two aspects of a child’s life: diet and physical activity. The aim has been to try and regulate a child’s dietary habits by decreasing calorific intake. This is most commonly through the reduction in sugar, while at the same time boosting the amount of exercise children get. </p>
<p>But what is often ignored is a child’s ability to move effectively. It is one thing to say that a child should be more physically active, but quite another for a child to develop the competence and confidence required to engage in physical activity. </p>
<h2>Changing lifestyles</h2>
<p>Most adults tend to think this is something that will happen naturally as part of child’s development – through play and sports participation. But because of the way the world has changed over recent decades – think less time for running around outside and more time inside looking at screens – opportunities for children to move are in decline. </p>
<p>In this way, a child’s “play radius” – the distance a child travels from their home to play – <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-8-15">has shrunk by 90% in a single generation</a>. </p>
<p>A decrease in walking and an increase in transport by car, train or bus also limits children’s opportunities to play. Combine this with the <a href="http://www.tandfonline.com/doi/abs/10.1080/17408989.2011.582489">lack of specialist physical education teachers in primary schools</a> and the result is children’s movement development can no longer be left to chance. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191032/original/file-20171019-1052-1f0uoci.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The way children play has changed.</span>
<span class="attribution"><span class="source">Pexels</span></span>
</figcaption>
</figure>
<p>Effective movement for children in the early stages of development, (roughly four to seven years of age) can be assessed by their ability to perform fundamental movement skills. This includes how they run, catch, throw and balance. These skills are often viewed as the building blocks for participation in sport and physical activity. And there is growing evidence that supports the positive relationship between “movement competence” and physical activity in <a href="http://www.tandfonline.com/doi/abs/10.1080/00336297.2008.10483582">early childhood</a> – showing the importance of appropriate movement skills for children.</p>
<p>Evidence suggests that the “movement competence” of four to seven year-olds, in the UK, is average or below average in relation to their peers <a href="http://www.sciencedirect.com/science/article/pii/S0167945715300312">in most other countries</a>, which, alongside childhood obesity levels, clearly indicates the UK’s poor standing in children’s health.</p>
<h2>Getting children moving</h2>
<p>But one glimmer of hope comes from a new movement assessment app called <a href="https://itunes.apple.com/gb/app/movement-assessment-tool/id1253503754?mt=8">Start to Move</a>. The app is based on an assessment tool that enables primary school teachers – who are well placed to spot these skills – to measure, record and track the fundamental movement skills of children aged four to seven years old. And this data can then be used to help policymakers and practitioners alike recognise what support is needed to ensure all children have appropriate movement skills.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=414&fit=crop&dpr=1 600w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=414&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=414&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=520&fit=crop&dpr=1 754w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=520&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/191033/original/file-20171019-1072-49cqka.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=520&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Let’s get kids moving again.</span>
<span class="attribution"><span class="source">Pexels</span></span>
</figcaption>
</figure>
<p>This is important because although findings from previous research studies are useful in providing a snapshot of children’s “movement competence” only a <a href="http://backup.ons.gov.uk/wp-content/uploads/sites/3/2015/11/Overview-of-the-UK-Population-November-2015.pdf">very small number of children</a> have been <a href="http://journals.sagepub.com/doi/abs/10.2466/10.25.pms.121c14x0">measured</a>. So a more widespread understanding of children’s movement is a positive next step – particularly as we stand, globally, on the brink of a situation where “obese” will be more common than “underweight”.</p>
<p>It is crucial then that every solution available is looked into to reverse this worrying trend, because it is clear that current methods are falling short in many places. But ultimately this is about more than just the figures and obesity rates, this is about making sure the next generation of adults are suitably prepared for a sustainable active lifestyle.</p><img src="https://counter.theconversation.com/content/85616/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Morley receives funding from the Youth Sport Trust. </span></em></p>One in five children are now obese by the time they turn 11.David Morley, Professor of Youth Sport and physical activity, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/65502012-07-05T20:08:21Z2012-07-05T20:08:21ZRegulation and legislation as tools in the battle against obesity<figure><img src="https://images.theconversation.com/files/12638/original/x442krk8-1341456815.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fresh minimally-processed foods are more expensive than energy-dense, nutrient-poor processed foods.</span> <span class="attribution"><span class="source">Alexander Baxevanis</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today Kerin O'Dea considers measures that could work to stop the epidemic while Rob Moodie and Kate Taylor <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">talk about how little</a> the Australian government is doing.</em></p>
<hr>
<p>Obesity has recently overtaken tobacco as the major burden of disease in Australia. Part of this is due to Australia’s success in reducing smoking – although the most disadvantaged sectors of society continue to smoke at unacceptably high levels.</p>
<p>There are lessons from the achievements of the tobacco campaigns and interventions that could be applied to obesity.</p>
<h2>Lessons from tobacco</h2>
<p>Social marketing activities have been successfully combined with national legislation to bring about major reductions in smoking. Innovative social marketing sets the scene for change. Legislation (when it is acted upon) provides the disincentives or incentives for healthier behaviours. </p>
<p>First, there were restrictions, then total bans on advertising. Then came legislation for smoke-free workplaces, which over time has extended to all enclosed public places where people gather for any activity (with the exception of some casinos), such as travel, shopping, entertainment or other recreation. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=842&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=842&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=842&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1059&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1059&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12630/original/gr6bd68s-1341455255.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1059&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tobacco control offers lessons for what we can do to curb obesity.</span>
<span class="attribution"><span class="source">AAP Image/Department of Health and Ageing, Australian Government</span></span>
</figcaption>
</figure>
<p>Progressively, the tax on tobacco products has been increased. And, most recently, the government has introduced plain packaging legislation. </p>
<p>In the face of these efforts, smoking rates have plummeted and health has improved significantly.</p>
<h2>And obesity?</h2>
<p>As with smoking, obesity also impacts more seriously on the most economically disadvantaged. This is likely to be related to what has been called “the economics of food choice” – energy-dense, nutrient-poor processed foods are much <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">cheaper in terms of calories per dollar</a> than are fresh minimally-processed foods that are the recognised basis of a healthy diet. These include fresh plant foods, wholegrain cereals, lean meats and fish. </p>
<p>This difference in price is because the globalised food system generates a huge quantity of processed foods rich in fat, sugar and salt, which provide energy (calories or kilojoules) at very low cost. Over the last 30 years (coinciding with the obesity epidemic), this has become ever more pronounced. </p>
<p>Relative to the GDP of the United States, for instance, the cost of sugar and sweetened beverages has fallen while the cost of fresh fruit and vegetables has risen sharply resulting in a two- to threefold differential since 1980. </p>
<p>It’s also been argued that diets rich in processed foods are relatively depleted in protein, and that this may be a driver of over-consumption of energy in the form of carbohydrates and fats. This is known as the “<a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0025929">protein leverage hypothesis</a>”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12631/original/5g5fqqrf-1341455448.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Inadequate protein in processed foods may be driving over-consumption.</span>
<span class="attribution"><span class="source">Adria Richards</span></span>
</figcaption>
</figure>
<h2>What could work?</h2>
<p>So what are the regulatory approaches that could be applied to obesity? We could start with a commitment to clear product information. This must include a simple and clear food labelling system driven by independent public health principles. </p>
<p>Traffic-light labelling was put forward in the recent excellent government-commissioned report “<a href="http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/content/labelling-logic">Labelling Logic</a>”. But it fell over at the usual hurdle of needing industry support to gain further traction. Imagine if the tobacco industry had needed to support previous efforts to reduce smoking!</p>
<p>Still, some progress is being made, with major fast food chains in some jurisdictions now required to include kilojoule counts on their foods and beverages. Some restaurants are also beginning to do this voluntarily. </p>
<p>But we should go further. Internationally, there are now examples of taxes being applied to unhealthy products. France taxes all sweetened drinks, for instance, while Denmark recently introduced a “fat tax”, and Peru plans to tax junk foods. </p>
<p>One of the major arguments against taxes on unhealthy foods is that it will be regressive – impacting much more on people with low income. This is a serious issue but it’s also been argued that a more comprehensive approach, which includes both taxes on unhealthy foods and subsidies on healthy foods, could neutralise its regressive impact while also maximising health benefits. </p>
<p>Such measures might also help bring relative prices on healthy and unhealthy foods back to where they were before the obesity epidemic took off in earnest 30 or so years ago. But, learning again from tobacco, no single approach to obesity is likely to be effective on its own, and progress will almost certainly be incremental. Action will be needed in many fronts – regulation of advertising and marketing, incentives for good industry practice, and regulation of pricing to drive healthier choices. Effective social marketing campaigns will be needed every step of the way.</p>
<p>And, of course, it’s not just the food supply that will need to adapt. We will also need action in other areas that encourage incidental physical activity at the population level – <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">urban planning</a> to encourage walking, cycling and the use of public transport and workplace innovations.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=511&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=511&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=511&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=642&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=642&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12633/original/yszbtzw9-1341455708.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=642&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Urban design to encourage active transport will also help.</span>
<span class="attribution"><span class="source">Tejvan Pettinger</span></span>
</figcaption>
</figure>
<p>There’s no doubt that the food supply remains the key target for action. The processed food industry is an extraordinarily powerful and influential lobby in Australia and throughout the world. It successfully lobbied against traffic-light labelling in the European Union and has influenced dietary and nutrition recommendations in many jurisdictions including the United Nations. </p>
<p>The Australian government has a policy of partnership with the food industry. But the truth is that industry is unlikely to support significant public health initiatives to address obesity. </p>
<p>The impact of the various interventions in other countries will provide crucial insight for future interventions in Australia. While we have been world leaders in in the fight against big tobacco, we are quite timid when it comes to the processed food industry. Over time (and hopefully in years, not decades), the financial pressures on the health system from the burgeoning burden of disease attributable to overweight and obesity will probably be the trigger to push governments into action.</p>
<p><strong>This is final part of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p><img src="https://counter.theconversation.com/content/6550/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerin O'Dea does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today Kerin O'Dea…Kerin O'Dea, Professor of Population Health and Nutrition, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/67142012-07-05T20:07:59Z2012-07-05T20:07:59ZIndustry-sponsored self-regulation: it’s just not cricket<figure><img src="https://images.theconversation.com/files/12580/original/dyv8hbnw-1341361492.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Powerful bodies benefit from sponsorship by junk food companies, making regulation more difficult.</span> <span class="attribution"><span class="source">David Gardiner</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today Rob Moodie and Kate Taylor talk about how little the Australian government is doing to stop the epidemic while Kerin O'Dea <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">considers measures that could work</a>.</em></p>
<hr>
<p>The world keeps getting fatter and no country has yet successfully managed to reduce adult rates of overweight and obesity. Rates are levelling in a few countries – sometimes at low levels as in Japan, Korea, and Switzerland and sometimes at levels comparable to Australia, as in Hungary and England. Australia has also seen instances of flattening in trends (but at high levels) in <a href="http://www.nature.com/ijo/journal/v35/n7/full/ijo201164a.html">pre-school children</a>, but adult rates continue to rise.</p>
<figure><table><thead><tr><th>Country</th><th>Year</th><th>Prevalence %</th></tr></thead><tbody><tr><td>USA</td><td>2008</td><td>33.8</td></tr><tr><td>Mexico</td><td>2006</td><td>30</td></tr><tr><td>Scotland</td><td>2008</td><td>27</td></tr><tr><td>New Zealand</td><td>2007</td><td>26.5</td></tr><tr><td>Ireland</td><td>2007</td><td>25</td></tr><tr><td>Australia </td><td>2007</td><td>24.5</td></tr><tr><td>Canada </td><td>2008</td><td>24.2</td></tr><tr><td>England</td><td>2009</td><td>23</td></tr></tbody></table><figcaption>Ranked rates of measured obesity 2010</figcaption></figure>
<p>Countering obesity should be a government priority, because excess weight creates a significant drag on countries’ health budgets and productivity. And the role governments can play was the focus of a <a href="http://www.srfood.org/images/stories/pdf/officialreports/20120306_nutrition_en.pdf">recent report</a> by the <a href="http://www.srfood.org/">UN Special Rapporteur on the right to food</a>, Olivier De Schutter. The report outlines <a href="http://www.srfood.org/index.php/en/component/content/article/1-latest-news/2054-five-ways-to-tackle-disastrous-diets-un-food-expert">key policy actions</a> to improve health and nutrition.</p>
<p>They include:</p>
<ul>
<li><p>Taxing unhealthy food, including soft drink, and subsidising fruit and vegetables; </p></li>
<li><p>Regulating foods high in saturated fats, salt and sugar; </p></li>
<li><p>Regulating to reduce unhealthy food advertising to children, as recommended by the World Health Organisation (WHO).</p></li>
</ul>
<p>Interventions like these are important because they protect the most vulnerable in society – the poorest and the young.</p>
<h2>Local efforts</h2>
<p>In Australia, the <a href="http://www.preventativehealth.org.au/">Preventative Health Taskforce</a> has provided a <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lp">blueprint for action</a> against obesity. It recognised governments’ key role in reducing unhealthy food marketing to children, improving labelling, and investigating tax and pricing strategies. </p>
<p><iframe id="tc-infographic-231" class="tc-infographic" height="511" src="https://cdn.theconversation.com/infographics/231/51b510dae3dbdc335d66f9e509ae030ddc8dd8d1/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<figure><figcaption><a href="https://cdn.theconversation.com/infographics/231/51b510dae3dbdc335d66f9e509ae030ddc8dd8d1/site/index.html">Click here</a> to open in new window or republish.</figcaption></figure>
<p>Sadly, such measures have yet to be implemented or seriously considered. Rather, the government has focused on elements such as policies in children’s settings around food supply and active play, <a href="http://www.coag.gov.au/.../national_partnership/national_partnership_on_preventive_health.pdf">funding for community interventions</a> and <a href="http://swapit.gov.au/">social marketing campaigns</a> – all softer options favoured in the political satire, <a href="http://www.abc.net.au/tv/hollowmen/#/home">The Hollowmen</a>.</p>
<p>At the same time, there’s been a focus on <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/food-health-dialogue">partnership with industry</a>. While this is important, it has also led to a clear reluctance to <a href="http://www.abc.net.au/am/content/2010/s2898084.htm">leverage regulatory</a> and fiscal measures because of lobbying by the many industries that profit from high and growing consumption of their products.</p>
<p>This is a significant lost opportunity because tax and pricing measures result in the largest health gains in the shortest time frame. Australian research has shown that they are also the <a href="http://www.sph.uq.edu.au/bodce-ace-prevention">most cost-effective interventions</a>, with a <a href="http://www.nature.com/ijo/journal/v35/n7/full/ijo2010228a.html">10% tax</a> resulting in large health gains, particularly for low-income groups. A number of countries – including Denmark, Hungary, Finland, and France – have legislated to tax fat or sugar.</p>
<p>Labelling of packaged food has also been considered. Former health minister Dr Neal Blewett led a <a href="http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/content/labelling">review</a> that recommended traffic-light labelling on the front of packs, among other things. In a surprising move, however, the Australian <a href="http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/Content/ADC308D3982EBB24CA2576D20078EB41/$File/FoFR%20response%20to%20the%20Food%20Labelling%20Law%20and%20Policy%20Review%209%20December%202011.doc">government argued</a> that there was not enough evidence to justify this system. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A number of countries have legislated for a fat tax.</span>
<span class="attribution"><span class="source">Jun Seita</span></span>
</figcaption>
</figure>
<p>Instead, it has established a working group of food industry and public health organisations to develop options for an alternative scheme. Yes Minister, anyone? It appears we haven’t learnt anything from Europe, where industry spent more than <a href="http://www.corporateeurope.org/news/red-light-consumer-information">one billion Euros</a> fighting against traffic light labelling.</p>
<p>One of the key battlegrounds in Australia remains unhealthy food marketing to children, a major driver in normalising poor diets for life. With marketing becoming increasingly sophisticated and <a href="http://www.lifelessserious.com.au/">integrated over a range of platforms</a>, direct targeting of children and adolescents is easier and cheaper than ever before. And social media makes it ever more effective. Advertisements masquerading as games, for instance, are increasingly popular, moving from television to the internet into mobile phone apps.</p>
<h2>The dangers of self-regulation</h2>
<p>This is what is happening under government-endorsed, industry-formulated self-regulation – marketers are way ahead of any weak, industry-sponsored controls. Despite calls for a national approach, the <a href="http://www.acma.gov.au/WEB/STANDARD/pc=PC_410243">Australian Communications and Media Authority</a> and Australian health ministers have treated the issue as a hot potato, <a href="http://www.anpha.gov.au/internet/anpha/publishing.nsf/Content/communique-20110822">currently vesting responsibility</a> with the Australian National Preventative Health Agency. This group has been asked to do yet another review of the evidence, organise a seminar and undertake some monitoring. At best we might see stronger self-regulation.</p>
<p>All over the world, governments fear the power of the many industries associated with the obesity epidemic. It’s not just the producers, manufacturers and retail giants, but also the advertisers, public relations companies and media. All have major economic interests in marketing of unhealthy foods and beverages, including alcoholic drinks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Numerous industries have economic interests in marketing unhealthy foods and beverages.</span>
<span class="attribution"><span class="source">Tom Lawrence</span></span>
</figcaption>
</figure>
<p>And, of course, a country as interested in sport as Australia also has to contend with powerful bodies, such as Cricket Australia, who benefit from the sponsorship of junk food companies and from the money made by leading players who relentlessly promote such products to Australian children. In this light, the <a href="http://www.katelundy.com.au/2012/06/23/australian-sport-tackles-binge-drinking/">recent move by the government</a> working with a range of sporting groups to reduce the influence of alcohol should be welcomed and expanded. </p>
<p>We have a lot of experience in good public health policy we could build on. Successive Australian governments have strong records in tobacco control, particularly the current government. It must use these experiences in its efforts to drive down overweight and obesity. It’s unfortunate but unavoidable that the long-term benefits of managing obesity require taking a political stand in the short term. The action the government is taking on tobacco is tremendous. We need similar determination in the face of the obesity epidemic.</p>
<p><strong>This is part fifteen of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Moodie receives funding from Department of Health and Ageing.</span></em></p><p class="fine-print"><em><span>K Taylor declares no conflicts of interest.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today Rob Moodie…Rob Moodie, Professor of Public Health, The University of MelbourneKate Taylor, Visiting Fellow at Nossal Institute for Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/72332012-07-04T20:37:11Z2012-07-04T20:37:11ZWant to stop the obesity epidemic? Let’s get moving<figure><img src="https://images.theconversation.com/files/12547/original/kq9657wt-1341283213.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Depending on their age, children should accumulate between one and three hours of physical activity a day.</span> <span class="attribution"><span class="source">Kymberly Janisch</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it – Australia is becoming an obese nation. This series looks at how this has happened and, more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Here, Jo Salmon looks at the role physical activity and exercise play in healthy lifestyles, while Billie Giles-Corti and Carolyn Whitzman <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">discuss ways to change our obesogenic environment through urban design</a>.</em></p>
<hr>
<p>Moving throughout the day should be as natural as breathing and as habitual as brushing your teeth. As well as the obvious health gains, there are social, economic and environmental benefits from having a physically active society. </p>
<p>Inactivity is a <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">leading contributor</a> to the burden of disease and plays a major role in <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Australia’s obesity epidemic</a>. The infographic below shows just how quickly obesity is increasing in Australia and how the trajectory will continue unless we change our ways. </p>
<p><iframe id="tc-infographic-231" class="tc-infographic" height="511" src="https://cdn.theconversation.com/infographics/231/51b510dae3dbdc335d66f9e509ae030ddc8dd8d1/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<figure><figcaption><a href="https://cdn.theconversation.com/infographics/231/51b510dae3dbdc335d66f9e509ae030ddc8dd8d1/site/index.html">Click here</a> to open in new window or republish.</figcaption></figure>
<h2>How much activity is enough?</h2>
<p>Current public health guidelines recommend adults undertake at least 30 minutes of at least moderate-intensity physical activity five days per week. This need not be structured exercise; three ten-minute brisk walks a day (to the bus stop or to buy lunch) is sufficient. </p>
<p>Recommendations for children vary depending on their age. Kids under five should accumulate at least three hours of physical activity every day – this includes any level of movement, from light-intensity play through to vigorous activity. Five- to 18-year-olds should aim for at least 60 minutes of moderate- to vigorous-intensity activity per day. </p>
<p>Limits to television viewing, computer use and video games are also recommended for young people: zero screen time under two years; a maximum of one hour per day for two- to five-year-olds; and no more than two hours per day from five- to 18-year-olds. </p>
<h2>Who’s responsible for our activity levels?</h2>
<p>The Commonwealth <a href="http://www.health.gov.au/">Department of Health</a> is in the process of reviewing and updating its physical activity recommendations across the lifespan. But government initiatives and policies that promote physical activity and movement are the responsibility of more than just the health department. </p>
<p>Few people consider the role of state justice departments, for instance, in ensuring we have a safe environment to walk the streets free from concerns about our personal safety or that of our children. Or the role of bodies such as Parks Victoria, which are responsible for maintaining, improving and identifying new locations for accessible parks and public open spaces. </p>
<p>Urban planners, property developers, architects, engineers, teachers, local government agencies, as well as the transport, sport and recreation, and health sectors all have important roles to play in a coordinated approach. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12548/original/wkc3gd44-1341283476.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If you want your kids to get more exercise, play and be physically active with them.</span>
<span class="attribution"><span class="source">Mike Baird</span></span>
</figcaption>
</figure>
<h2>How can we get Australians moving?</h2>
<p>It’s never too early to begin promoting movement and physical activity, particularly if it’s intended to prevent unhealthy weight gain. </p>
<p>The <a href="http://www.deakin.edu.au/health/cpan/infant/index.php">Melbourne InFANT Program</a> at Deakin University has identified that first-time parents with three- to 18-month-old children are particularly receptive to information about their child’s healthy eating and physical activity behaviours. They’re also interested to learn about the risks associated with extensive television viewing time from a young age. This type of program could be offered to all first-time parents through their child and maternal health centres. </p>
<p>Programs in preschools such as the <a href="http://www.healthinfonet.ecu.edu.au/key-resources/programs-projects?pid=45">NSW Tooty Fruity Vegie</a> initiative promotes the consumption of fruit and vegetables and teaches young children basic movement skills such as throwing, catching, jumping, skipping and kicking. This program has had a significant impact on the participants’ skill mastery, even several years later.</p>
<p>It’s disturbing that the single largest decline in physical activity during childhood occurs when a child starts primary school. <a href="http://www.deakin.edu.au/health/cpan/behavioural-epide/Transform-Us!.php">Children sit</a>, on average, around 5.7 hours out of a 6.5 hour school day. There’s no doubt the curriculum is crowded, but it is possible to meet these educational demands in active ways, such as playing <a href="http://www.kidspot.com.au/discoverycentre/7---9-years-Physical-Hopscotch-maths-game+11351+538+sponsor-activity.htm">hopscotch maths</a>, delivering standing lessons, or giving active homework. Some of these curriculum-based strategies are <a href="http://www.biomedcentral.com/1471-2458/11/759/">currently being tested</a> by a team from Deakin University. </p>
<p>Active transport to school initiatives (such as the <a href="http://www.travelsmart.gov.au/schools/schools2.html">Walking School Bus</a>) have received support from state and local governments but funding is rarely sustained. There may be a role for the transport sector and urban planners in promoting active commuting or public transport to and from school by identifying safe routes, further subsidising fares or even introducing free travel for children on their school route. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12559/original/m4m88gyz-1341296148.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Flickr MoBikeFed</span></span>
</figcaption>
</figure>
<p>One policy initiative for schools to consider is early dismissal of children who are walking or cycling home from school. This should be a strong incentive for children to use active transport and would reduce the injury risk from the car pick up rush after school hours. </p>
<p>What about the role of families and parents in supporting children’s physical activity?</p>
<p>There are surprisingly few published studies worldwide that have examined the most effective approaches for promoting a child’s physical activity in the home. Family-based initiatives are challenging: the home is a private space and as health researchers, is it our business to be telling adults how to parent their child? </p>
<p>We do know, however, that some parents value and seek advice about their child’s weight or activity levels. So encouraging parents to play and be active with their children, along with limiting screen time, is generally a sensible way to promote physical activity.</p>
<p>The sport and recreation sector can play a more substantial role in promoting family-based activities, not just through children’s participation in organised sports but through engagement in active play; linking in with programs run by the Heart Foundation (<a href="http://www.heartfoundation.org.au/sites/jumpropeforheart/pages/default.aspx/">Jump Rope for Heart</a>) or by working with Parks Victoria in running <a href="http://www.juniorrangers.com.au/">free activity programs</a> in our extensive public open spaces.</p>
<p>This is just a brief snapshot of some programs and policies that could be offered to encourage and support more active lifestyles for children. I haven’t touched on the potential role of the primary health care sector in encouraging activity among adults, or on the duty of care of employers to ensure that their staff are not <a href="https://theconversation.com/office-workers-its-time-to-beat-the-bulge-and-quit-the-sit-5557">sitting for hours every day</a> at a work desk.</p>
<p>Hopefully in future we’ll see more sectors and organisations help to make active lives the easy choice. It’s important that government and non-government physical activity policies and initiatives support all members of the population to be active – from early childhood to older adulthood.</p>
<p><strong>This is part thirteen of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong></p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/7233/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jo Salmon receives funding from the National Heart Foundation of Australia, the National Health and Medical Research Council, the Australian Research Council, and the Diabetes Australia Research Trust. She is affiliated with Deakin University.</span></em></p>OBESE NATION: It’s time to admit it – Australia is becoming an obese nation. This series looks at how this has happened and, more importantly, what we can do to stop the obesity epidemic. Here, Jo Salmon…Jo Salmon, Alfred Deakin Professor, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/64452012-07-04T20:36:37Z2012-07-04T20:36:37ZFat of the land: how urban design can help curb obesity<figure><img src="https://images.theconversation.com/files/12522/original/bv7b449y-1341206020.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People living in the suburban sprawl walk less, drive more, and spend more time in sedentary pursuits.</span> <span class="attribution"><span class="source">katie chao and ben muessig/Flickr</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Here Billie Giles-Corti and Carolyn Whitzman discuss ways to change our obesogenic environment through urban design while Jo Salmon <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">looks at the role physical activity and exercise play in healthy lifestyles</a>.</em></p>
<hr>
<p>Compared with our grandparents, feeding, clothing, and entertaining ourselves has never been easier: a one-stop weekly shopping centre trip in a car, facilitated by convenient parking and light-weight maneuverable shopping trolleys that allow us to whiz around the supermarket with ease. </p>
<p>In fact, these days people don’t even need to leave home to do their food shopping, order takeaway food, bank or pay bills, shop for clothing or household goods, “visit” with their friends, read the newspaper or amuse themselves. Using the internet or telephone, activities that used to involve some level of activity or a short walk, can be done with “anywhere, anytime” convenience.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12312/original/bcbjwshb-1340848403.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The internet and telephone have made life easy but it’s not all good news.</span>
<span class="attribution"><span class="source">teoruiz/Flickr</span></span>
</figcaption>
</figure>
<p>If we couple this lifestyle of convenience with a media environment that advertises and provides an attractive array of easily-accessed, low-cost and tasty, high-fat, high-sugar foods – it’s not surprising that obesity is such a huge problem.</p>
<p>Australia is one of the global leaders in the obesity epidemic, with two-thirds of Australian adults and a quarter of Australian children, overweight or obese. Alarm bells are ringing in health circles about the impact this will have on all the major preventable diseases: type 2 diabetes, cardiovascular disease and cancer. These diseases will get worse unless we can help people maintain a consistent belt size throughout their life.</p>
<p>Poor diet, lack of physical activity and other sedentary behaviours are the main culprits in the obesity epidemic. People choose how active they are and what they eat. But their local environments – their neighbourhood, local parks and streets, as well as their homes, workplaces and schools - provide opportunities and barriers that affect those choices. </p>
<p>There’s widespread agreement that we’ve created obesogenic environments that encourage both inactivity and overeating. So what can be done about it?</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=799&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=799&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=799&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1004&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1004&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12314/original/wvsk647k-1340849060.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1004&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People are more likely to walk and cycle if they live in safe, compact, pedestrian-friendly neighbourhoods.</span>
<span class="attribution"><span class="source">Marionzetta/Flickr</span></span>
</figcaption>
</figure>
<p>For a start, we could improve neighbourhood design to get people out of their cars and onto the streets. People are more likely to walk and cycle if they live in safe, compact, pedestrian-friendly neighbourhoods characterised by connected street networks, access to nearby destinations such as shops and parks, mixed uses of building such as housing above shops, and high population density. </p>
<p>People living in the suburban sprawl walk less, drive more, and spend more time in sedentary pursuits, such as watching television or cruising on the internet, than those living in compact, pedestrian-friendly neighbourhoods. We need to plan services in new communities so that schools, shops, public transport, and parks arrive at the same time as housing – so that residents can develop good walking, cycling and public transport habits from the outset. </p>
<p>At the same time, we need to share the resources available in established suburbs closer to the city where there’s already good access to parks, jobs, and public transport. This means increasing the number of people who live in inner-city suburbs and giving more people access to existing shops and services.</p>
<p>We also need to think about quality and access to open space: parks, ovals, play grounds, and school grounds. The way open space is designed gives people cues about how it is to be used – is this open space simply for vandals and hoons, or does it say to local residents (regardless of age), “this space is open for active business, come and join in”? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=516&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=516&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12298/original/s9skmt9q-1340846344.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=516&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The way open space is designed gives people cues about how it is to be used.</span>
<span class="attribution"><span class="source">Grant MacDonald</span></span>
</figcaption>
</figure>
<p>Similarly, we need to make the most of what’s called “blue space” – waterways, such as creeks, lakes, rivers and beach fronts. We know that in wealthy areas, blue spaces are opened up and invite the public to be active with walking and cycling paths, but is this true in lower-income areas?</p>
<p>There’s growing evidence that people who drive long distances to work are more likely to gain weight. Reducing commute times would not only be good for the environment, it would also be good for our waistlines – particularly if it involved walking or cycling to rapid public transport. This requires the right types of jobs to be available locally – what type of local business activation models could assist?</p>
<p>We need to give people choices so that healthy options are easy to pick – in neighbourhoods, schools and workplaces. Policies ensuring there’s plenty of fruit, water, and healthy take-away food – not just high-fat, high-salt, high-sugar alternatives – give people the opportunity to make healthier choices. </p>
<p>Providing access to community garden spaces encourages children and adults to develop a love of fresh food has the potential to have a positive impact on our waistlines too.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12300/original/95k5w3k5-1340847107.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Community gardens encourage people to develop a love of fresh food.</span>
<span class="attribution"><span class="source">RDPixelShop/Flickr</span></span>
</figcaption>
</figure>
<p>And we need to think carefully, as a community, about how happy we are about the way unhealthy food is marketed and actively promoted so readily to children and young people. This normalises unhealthy food choices. We may need restrictions on the marketing of fast food to children in the mass media, at school and at sporting events.</p>
<p>These are choices to be made not only by individuals and families, but also by society. Planning and policy interventions are crucial to correct a serious market failure that is promoting unhealthy lifestyles, at the expense of the health and well-being of the nation and the future life expectancy of our children. </p>
<p>We have choices to make as a society. We know what we prefer – how about you?</p>
<p><br></p>
<p><strong>This is part fourteen of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strat egies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6445/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Billie Giles-Corti receives funding from the NHMRC and Australian Urban Infrastructure Network. Professor Giles-Corti is a Fellow of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Carolyn Whitzman receives funding from Australian Urban Infrastructure Network and is a member of the Planning Institute of Australia.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Here Billie Giles-Corti…Billie Giles-Corti, Professor of Health Promotion & Director McCaughey VicHealth Centre, The University of MelbourneCarolyn Whitzman, Associate Professor of Urban Planning, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/63722012-07-03T20:37:56Z2012-07-03T20:37:56ZTwo books, one big issue: Why Calories Count and Weighing In<figure><img src="https://images.theconversation.com/files/12465/original/6gvrvjyg-1341193790.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People tend to exaggerate their intake of foods they think are healthy in dietary surveys.</span> <span class="attribution"><span class="source">somethingstartedcrazy</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Here Rosemary Stanton reviews two recent books on the subject while Anthony Capon provides an <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">energy system perspective of obesity</a>.</em></p>
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<p>While there’s no doubt about obesity’s increasing prevalence, there are doubts about its importance, its causes and appropriate solutions. And the contrast between views is evident in two new books tackling the topic.</p>
<p>Professor Marion Nestle is no stranger to controversy. Head of the department of nutrition, food studies and public health and professor of sociology at New York University, Nestle is outspoken about the way our food choices are manipulated, most famously expressed in her book <a href="http://www.foodpolitics.com/food-politics-how-the-food-industry-influences-nutrition-and-health/">Food Politics: How the Food Industry Influences Nutrition</a> and Health. Nestle has teamed with Malden Nesheim, professor emeritus and former director of the division of food sciences at Cornell University to pen <a href="http://www.ucpress.edu/book.php?isbn=9780520262881">Why Calories Count: From Science to Politics</a>.</p>
<p>In <a href="http://www.ucpress.edu/book.php?isbn=9780520266254">Weighing In: Obesity, Food Justice and the Limits of Capitalism</a>, Julie Guthman, associate professor in the community studies department at the University of California, takes a different perspective, querying the extent of the obesity problem and the science and solutions proposed to counter it. Guthman’s expertise is on surer ground in the section of her book where she examines the relevance of neoliberal economic policy to obesity.</p>
<p>Nestle and Nesheim take the traditional approach, assuming that obesity is a problem and citing increased risks of coronary heart disease, high blood pressure, type 2 diabetes, certain cancers (endometrial, breast, colon), stroke, liver, and gallbladder disease, sleep apnoea and respiratory problems, osteoarthritis, and gynaecological problems, such as abnormal menses and infertility.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=235&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=235&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=235&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=295&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=295&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12488/original/7m92dcjt-1341200381.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=295&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Guthman believes factors environmental toxins, such as those from plastics, are the major cause of obesity.</span>
<span class="attribution"><span class="source">Edinburgh Greens</span></span>
</figcaption>
</figure>
<p>Guthman acknowledges that Americans are growing fatter but considers the dangers to be exaggerated. She also argues against claims made by Nestle and <a href="http://www.laca.org.au/index.php/sustainable-living/food-production/agriculture/472-michael-pollan-deep-agriculture-podcast-on-abc-fora">others that people eat more</a> when food is abundant and cheap. Starting with her own body mass and increased blood glucose levels, which she puts down to environmental toxins or perhaps middle age, Guthman believes factors, such as toxins that disrupt endocrine function, are the major cause of obesity.</p>
<p>For straight science, I can’t go past Nestle and Nesheim’s book. It gives a succinct and scientifically accurate account of the “facts” of energy, it’s textbook-standard, well referenced from peer-reviewed sources and it’s easy and compelling reading with the science softened by practical interpretation.</p>
<p>By contrast, Guthman’s ideas and referencing on straight scientific issues is all over the shop, giving book authors and journalists’ opinion pieces equal billing with peer-reviewed journals. This muddies her challenge of the causes and consequences of obesity.</p>
<p>Experienced interpretation is essential with dietary surveys. If people ate only what they told researchers, the majority of adults in countries such as Australia or the United States would not be overweight. Nestle and Nesheim understand the “struggle to estimate intake” and quote doubly-labelled water studies demonstrating that <a href="http://www.nal.usda.gov/fnic/DRI/DRI_Energy/energy_full_report.pdf">under-reporting of food intake</a> ranges up to 45%, and is more common in those who are overweight or of low education or income status. </p>
<p>Foods that are perceived as “bad for you” are typically under-reported while many people exaggerate their intake of <a href="http://www.cnpp.usda.gov/">foods they think are healthy</a>. As Nestle and Nesheim note, the food available for consumption within the United States has expanded, and even allowing for increased wastage, overall consumption has increased. Guthman doesn’t accept this and also doubts “that contemporary jobs involve less toil.”</p>
<p>Twin studies have given us firm evidence of the genetic component of obesity, but also the interactions between the environment and genes. Overfeeding always increases weight, but to <a href="http://jn.nutrition.org/content/127/5/943S.long">different degrees</a> according to genetic factors. Again, Guthman ignores the body of research, declaring that “some people are fat no matter what they do, and some are thin no matter what they do.”</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12487/original/v94vbqxk-1341200227.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Community gardens get a hammering for the way they have virtually no hope of achieving ‘food justice’.</span>
<span class="attribution"><span class="source">PDX Water Bureau</span></span>
</figcaption>
</figure>
<p>Guthman does acknowledge that Body Mass Index (BMI) has increased in America since 1980, but insists there’s no evidence that people eat more than previous generations, nor that the varying incidence of obesity with socioeconomic status is due to differences in energy intake. Instead, Guthman proposes that the real culprits are environmental toxins used in making and storing the cheap food supply. This includes chemicals used for pest control, livestock growth enhancers (more widespread in the United States, but limited to beef cattle in Australia), plastic containers used for food and water, and synthetic food processing aids. </p>
<p>Scientists, including Nestle, are <a href="http://www.foodpolitics.com/">interested in such issues</a>, but Guthman claims the lack of scientific attention to toxic exposure as the prime cause of obesity is due to a “deep investment in the energy balance model.” Perhaps Guthman should read the documented information in Nestle and Neshiem’s book.</p>
<p>While the level of scientific expertise differs between the authors of the two books, both are critical of the current food system. Nestle and Nesheim concentrate on the “eat more” environment pushed by the need to satisfy food companies’ continued demand for growth and increased profits. Guthman swings into a well-argued section examining the pluses and minuses of various solutions to the current US food system. Smaller farms, local foods, organic foods, “local” foods, “slow food”, school and community gardens and spread of “foodie” ideas get a hammering (often deserved) for the way they are set up and run with virtually no hope of achieving “food justice”. </p>
<p>Guthman offers some challenging arguments, including the validity of using the lens of obesity to view health disparity and food injustice. She argues compellingly on the futility of pushing for better food choices when external factors prohibit such changes occurring among those who really need them.</p>
<p>Of the two books, my inclination favours Nestle and Nesheim’s well presented book. Nonetheless, the latter sections of Guthman’s book provide a compelling perspective on the need to engage with issues of food production and adequate wages and entitlements so that everyone can eat well. I suspect that Guthman’s call to change the emphasis from the market to the state, from consumption to production and from individual castigation of the obese to social justice would also sit well with Nestle and Nesheim.</p>
<p><br></p>
<p><strong>This is part eleven of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6372/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rosemary Stanton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Here Rosemary…Rosemary Stanton, Nutritionist & Visiting Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/79142012-07-03T20:37:40Z2012-07-03T20:37:40ZPutting health at the heart of sustainability policy<figure><img src="https://images.theconversation.com/files/12555/original/2qcg8dkw-1341295402.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obesity can be seen as a carbon store on our waistlines originally sourced from coal mines and oil wells.</span> <span class="attribution"><span class="source">Bobcatnorth/Flickr</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today Anthony Capon provides an energy system perspective of obesity while Rosemary Stanton <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">reviews two recent books</a> on what the epidemic means and how to end it.</em></p>
<hr>
<p>We sometimes forget that the extra kilograms on our waistlines are a “carbon store”. So it’s timely for this website to publish a series on the obesity epidemic during the week when Australia’s carbon tax comes into effect. </p>
<p>Most of the debate about carbon regulation focuses on extrasomatic energy. That’s energy produced and used outside the human body (such as by power stations, solar panels and motor vehicles). Whereas, obesity is a problem with our somatic (human body) energy account. </p>
<p>But there’s value in understanding the obesity epidemic from a wider, energy system perspective. </p>
<p>In the second half of the 20th century, the ready availability of fossil fuel energy enabled sedentary ways of moving, working and recreation. We now use motor vehicles to propel ourselves around cities and towns, and escalators, lifts and movable walkways to move around buildings. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12565/original/6rqv8t76-1341296424.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We use motorised lawn mowers and leaf blowers in our gardens.</span>
<span class="attribution"><span class="source">normanack</span></span>
</figcaption>
</figure>
<p>Most Australians use labour-saving devices on a daily basis. We use washing machines, vacuum cleaners and dishwashers in our homes. We use motorised lawn mowers and leaf blowers in our gardens. And many Australians spend much of their working day sitting at a desk. Even labouring work, which traditionally required intensive physical activity, can now be relatively sedentary because of the diverse range of power-assisted tools and motorised equipment available. </p>
<p>Increasingly, people are choosing television and video games rather than active forms of recreation. At the same time, we live in an era in which food energy is readily available and relatively cheap. And our food supply is highly dependent on fossil fuels for fertilisers, transport and other inputs.</p>
<p>As individuals, our fat stores arise from an energy imbalance – too much energy in, and too little energy out. So, if we think about obesity from an energy system perspective, this combination of sedentary ways of living, and food intake (in excess of need), has been enabled by the ready availability of fossil fuel energy in recent decades. </p>
<p>So obesity, too, can be seen as a carbon store on our waistlines originally sourced from coal mines and oil wells. Clearly, this is not a sustainable way of living. But that doesn’t mean this is a call for a return to old-fashioned ways of living – the so-called “good old days”. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12556/original/94j9zxqg-1341295620.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Escalators, lifts and movable walkways to move around buildings, making us even more sedentary.</span>
<span class="attribution"><span class="source">Roland Peschetz</span></span>
</figcaption>
</figure>
<p>Rather, it’s a call for us to understand that there have been unintended consequences from technological advances. We need to acknowledge these unintended consequences and account for them when making policy. </p>
<p>An energy system perspective enables us to understand the obesity epidemic as a consequence of maladaptation to our contemporary habitat, which is now mostly urban. We have progressively designed much of the opportunity for incidental physical activity out of this habitat. </p>
<p>To address this, somatic energy (obesity) needs to become a central consideration in sustainability policy. Government, industry and community leaders should better understand these relationships and ensure that our response to climate change, and other global environmental changes (such as urbanisation and industrial food production), accounts for them. </p>
<p>We should plan, design and develop our cities to enable us to do most of our daily business (such as getting to school and work, shopping for food and other necessities, and accessing health services) by walking, cycling and using mass transit. That means “engineering” physical activity back into our urban environment and our daily life. </p>
<p>Policies that encourage active urban travel, and discourage private motor vehicle use, will provide larger health benefits than policies focusing on lower emission motor vehicles. So while electric cars don’t directly produce emissions (both toxic air pollutants and greenhouse gas emissions), for instance, drivers are still sedentary and don’t have the health advantages of active travel. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12558/original/tn39nbzq-1341296091.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Policies that encourage active urban travel and discourage private motor vehicle use, will provide large health benefits.</span>
<span class="attribution"><span class="source">Ian Britton</span></span>
</figcaption>
</figure>
<p>More generally, there’s an important and positive message here – low carbon ways of living are healthy ways of living. </p>
<p>The concept of <a href="http://www.thelancet.com/series/health-and-climate-change">health co-benefits from action on climate change</a> is now recognised as relevant to sustainability policy. These “co-benefits” - additional health benefits beyond those from the mitigation of climate change - extend from physical activity to diet (a vegetable-rich diet being better for health and leading to less greenhouse gas emissions from food production) and air quality (a transition to renewable energy generation will reduce toxic air pollution from coal-fired power stations). </p>
<p>We should ensure that human health and well-being is central in energy and sustainability policy. As we move into the era of carbon pricing and regulation, we should seize the opportunity to realise these additional health benefits from low carbon ways of living. </p>
<p>Low carbon human waistlines (healthy population weight) could be an additional benefit of effective carbon regulation in Australia. </p>
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<p><br></p>
<p><strong>This is part twelve of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/7914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Capon receives funding from the CSIRO Flagship Collaboration Fund. </span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today Anthony…Tony Capon, Professor of Planetary Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/70992012-07-02T20:43:40Z2012-07-02T20:43:40ZInnovative strategies needed to address Indigenous obesity<figure><img src="https://images.theconversation.com/files/12492/original/h5dm5dp5-1341202489.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just beyond the built community lies a health-promoting environment providing cultural, spiritual and physical nourishment.</span> <span class="attribution"><span class="source">misha.penkov/Flickr</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today Julie Brimblecombe discusses the incidence of obesity in Indigenous communities.</em></p>
<hr>
<p>After tobacco, overweight and obesity <a href="http://www.ncbi.nlm.nih.gov/pubmed/19047078">contributes most heavily</a> to the disease burden affecting Aboriginal and Torres Strait Islander Australians. It accounts for <a href="http://www.ncbi.nlm.nih.gov/pubmed/19047078">16% of the health gap</a> between Indigenous and non-Indigenous Australians, and is linked with physical inactivity, which accounts for a further 12% of the gap.</p>
<p>Type 2 diabetes, cardiovascular disease and kidney failure – each driven by obesity – are all rife among this population. Promising inroads have been made into tobacco cessation through political commitment, legislation, and community support. But obesity prevention in remote Indigenous Australia has <a href="http://www.aihw.gov.au/publication-detail/?id=10737418989&tab=2">not received equal attention</a>.</p>
<p>For the individual most often affected by diseases associated with overweight and obesity during what should be the most productive years of his or her life, the social, health and economic <a href="http://www.ncbi.nlm.nih.gov/pubmed/20201759">costs of obesity</a> are enormous. And this effect ripples through society. </p>
<p>Paradoxically, the poor are most affected, and many remote Indigenous households are now dealing with the <a href="http://www.aihw.gov.au/publication-detail/?id=10737418989&tab=2">double burden</a> of obesity in adult members and under-nutrition in children.</p>
<p>Traditionally, Indigenous Australians were physically lean and did not gain weight with age. Thirty years ago, a small family group of Aboriginal people living “a traditionally oriented lifestyle” in north-east Arnhem Land were <a href="http://www.ncbi.nlm.nih.gov/pubmed/3277018">extremely slim</a> (BMI of 16.7). And showed no risk of type 2 diabetes or heart disease.</p>
<p>Fast forward 20 years and this <a href="http://www.ncbi.nlm.nih.gov/pubmed/16260061">picture had completely changed</a>. Half of the population in a north-east Arnhem Land community aged 15 years and over (47.3%) were still considered lean (BMI of less than 22), and this was particularly the case for young people (15 to 24 years), all of whom showed no sign of type 2 diabetes. In those of middle-age (35 to 64 years), however, <a href="http://www.ncbi.nlm.nih.gov/pubmed/16260061">38% of the study population</a> were overweight or obese. </p>
<p>Many factors contribute to people becoming overweight or obese in remote Indigenous communities. Most such communities are <a href="http://www.ncbi.nlm.nih.gov/pubmed/10600438">obesogenic environments</a> because food prices (in the NT) are <a href="http://digitallibrary.health.nt.gov.au/dspace/handle/10137/504">45% more</a> than urban centres; few healthy fast food options exist; there are limited recreational facilities and safe walking paths; and there’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/22171852">inadequate housing</a>. What’s more, there are often poor cooking and storage facilities and limited opportunities to access meaningful information on healthy food. </p>
<p>It’s <a href="http://www.who.int/nutrition/publications/obesity/WHO_TRS_894/en/">now recognised</a> that these factors are largely driven or controlled by elements that are external to the individual. At a national level, strategies are increasingly focusing less on the individual and ideas of a lack of self-control, and more on <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/nphs-roadmap/$File/nphs-roadmap.pdf">better understanding and modifying</a> the obesity-promoting environment. </p>
<p>The environment is complex, and like strategies for tobacco cessation, lowering obesity levels requires a coherent, multi-level, multi-sector <a href="http://dro.deakin.edu.au/view/DU:30001708">integrated approach</a> – supported by political will and resources. But the environment of remote Indigenous communities is also unique in a number of ways – and this may make it more conducive to effective action. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12494/original/2sm9n4gv-1341203087.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When Indigenous Australians lived a traditional lifestyle, their diets were rich in lean animal foods that provided abundant protein, and sources of slowly digested carbohydrate.</span>
<span class="attribution"><span class="source">Marguerite Carstairs</span></span>
</figcaption>
</figure>
<p>First, remote communities have the benefit of a food system that can be more clearly demarcated and defined than the urban setting. Second, in general, community leaders are highly committed to health improvement and support an integrated and holistic approach that resonates with an Aboriginal view of health. This can promote excellent coherence within a community, encouraging different sectors to work together.</p>
<p>In many settings, just beyond the built community lies a health-promoting environment that provides cultural, spiritual and physical nourishment for many community residents. The remote community Gunbalanya in Arnhem Land, for instance, overlooks a wetlands billabong teeming with long-necked turtle, file snack and fresh water fish. </p>
<p>Just down the track from the Nyirripi community in Central Australia, bush tomatoes and sultanas line the unsealed road and honey-ants are plentiful. Community elders are desperate to maintain these environments and their spiritual, cultural and physical connection to the land. They are also eager to educate and connect the younger generations to this environment.</p>
<p>When Indigenous Australians lived a <a href="http://www.ncbi.nlm.nih.gov/pubmed/1685581">traditional hunter-gatherer lifestyle</a>, their diets were rich in <a href="http://www.ncbi.nlm.nih.gov/pubmed/3796233">lean animal foods</a> that provided abundant protein, and sources of slowly digested carbohydrate. Energy dense foods were highly-prized and limited by season and their procurement burned calories. </p>
<p>Now, food stores in remote communities stock mainly energy-dense, nutrient-poor processed foods that are high in fat, sugar and salt. These processed foods provide <a href="http://www.ncbi.nlm.nih.gov/pubmed/19450199">excessive calories</a> at a relatively low price, compared with the high expense of fresh nutrient-rich foods (fruit, vegetables, lean meats, fish, dairy and whole-grain cereals). So cheap refined carbohydrates and processed foods now make up the bulk of the diet available to most people living in remote Indigenous communities. </p>
<p>There’s no question that the <a href="http://www.ncbi.nlm.nih.gov/pubmed/12270018">price of food</a> influences <a href="http://www.ncbi.nlm.nih.gov/pubmed/15450626">consumption patterns</a>. So <a href="http://www.ncbi.nlm.nih.gov/pubmed/20680126">economic levers</a> are a logical approach to help move the dietary balance closer to the traditional diet and improve health outcomes – and many Aboriginal people in communities support this.</p>
<p>Tax policies, although getting traction in the United States, United Kingdom and Denmark, need closer consideration in Australia, as remote Indigenous families may be <a href="http://www.ncbi.nlm.nih.gov/pubmed/16372919">the hardest hit</a>. They already spend a greater part of their budget on food. Subsidies are likely to be more effective. </p>
<p>Rigorous <a href="http://www.ncbi.nlm.nih.gov/pubmed/19450198">testing of solutions</a> is needed to inform fiscal policy to curb overweight and obesity in remote Indigenous Australia. </p>
<p>Aboriginal people living in remote communities are among Australia’s poorest. Yet they pay much more for food, and have limited availability to a healthy diet. Innovative economic strategies are needed to help alter this imbalance.</p>
<p><strong>This is part ten of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/7099/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Brimblecombe receives funding from The National Health and Medical Research Council and The Fred Hollows Foundation.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today Julie Brimblecombe…Julie Brimblecombe, Senior Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/79412012-07-01T20:47:55Z2012-07-01T20:47:55ZEducation, wealth and the place you live can affect your weight<figure><img src="https://images.theconversation.com/files/12381/original/h4ztpq69-1340930568.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australians from higher socioeconomic backgrounds are less likely to struggle with excess weight.</span> <span class="attribution"><span class="source">Ed Yourdon</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it – Australia is becoming an obese nation. This series looks at how this has happened and, more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Here, Kathryn Backholer and Anna Peeters look at the relationship between socioeconomic status and weight, while Suzie Ferrie explains <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">why a fat tax won’t be enough to curb the problem.</a></em></p>
<hr>
<p>We’ve long known that a person’s social and economic position in society greatly influences their health and well-being. The higher your place on the socioeconomic ladder – which takes into account income, wealth, education, occupation, ethnicity, and where you live – the lower your risk of ill health.</p>
<p>Excess weight presents a <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">relatively new threat</a> to health equity. In Australia, the prevalence of obesity is <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442453186">almost double</a> among those living in the most disadvantaged neighbourhoods, compared with those living in the wealthiest areas. </p>
<p>Level of education also has a strong correlation with rates of obesity. Our analysis of weight gain among <a href="http://www.bakeridi.edu.au/ausdiab/">Australian adults</a>, published on Friday in the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2012.00885.x/abstract">Australian New Zealand Journal of Public Health</a>, found that in 2000, the prevalence of obesity was just 14% among those with a degree qualification. This rose to 20% for those with a diploma, and 23% for those who had only completed high school.</p>
<p>Five-year weight gain followed a similar socioeconomic pattern. Between 2000 to 2005, those with a lower level of education were 30% more likely to become overweight and twice as likely to become obese, compared to those with a degree qualification.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12371/original/4ygyys8j-1340929458.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australians with a degree qualification are less likely to be obese than those with lower levels of education.</span>
<span class="attribution"><span class="source">jeco</span></span>
</figcaption>
</figure>
<p>Projecting these unequal trends in weight gain forward, we estimate that one in three Australian adults with a degree qualification will be obese by 2025. For those who have only completed high school, this figure could be as high as one in two.</p>
<p>The implications of these projected trends are that lower socioeconomic groups will bear an even greater burden of <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">obesity related diseases</a>, such as diabetes and cardiovascular disease.</p>
<h2>Why the inequity?</h2>
<p>There are a number of potential reasons for the social disparities in weight gain. Gradients in the prevalence of obesity are mirrored by inequalities in health behaviours, including quality of diet and physical activity levels, and in the exposure to obesogenic (obesity inducing) environments.</p>
<p>Clearly, people make individual choices as to what they eat, how much they eat, and how much energy they expend. But these choices are made in the social, cultural and economic context within which an individual lives. The ability to pursue healthy choices can be compromised by social, financial, and physical pressures. And these pressures increase as a person’s socioeconomic position decreases.</p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1747-0080.2010.01490.x/abstract">Research confirms</a> that the proportion of income needed to buy a basket of healthy food is approximately three- to four-times greater for those on a low income than it is for high-income earners. On the other hand, high energy diets are generally associated with lower costs, making them more affordable to lower-income groups.</p>
<h2>Individual or population-wide targets?</h2>
<p>Internationally, governments are making a creditable effort to prevent further increases in obesity. Recent examples include a “<a href="https://theconversation.com/is-a-fat-tax-the-answer-to-australias-obesity-crisis-3712">fat tax</a>” in Denmark and the <a href="https://theconversation.com/smaller-drink-sizes-mean-better-health-lessons-from-new-york-city-7540">proposed banning of “super-sized” sugary drinks in New York</a>. But there has been little analysis about the potential impact of these strategies on different socioeconomic groups. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12385/original/xpr33fd3-1340932868.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Buying healthy food makes a bigger dent in the budgets of lower-income households.</span>
<span class="attribution"><span class="source">Jack Amick</span></span>
</figcaption>
</figure>
<p>Whether an obesity intervention is targeted at individual behaviour, at the population level, or somewhere between the two, it’s important to consider the potential effect across the entire social gradient. Once implemented, ongoing evaluations should monitor the health-equity impact to ensure that the policy itself doesn’t widen the social divide in obesity prevalence. </p>
<p>Some obesity prevention strategies may be more effective among those with a higher socioeconomic position, widening the difference between social strata. Interventions that focus solely on information and knowledge, and require a high level of behaviour change, for example, are likely to be of greater benefit to those from more socioeconomically advantaged backgrounds. </p>
<p>Conversely, population approaches to prevention, which alter the environment in which we live to encourage a healthy lifestyle, are more likely to benefit all members of the population more equally. We saw this with Australia’s population-based tobacco control strategies. Clean indoor air laws and increasing the price of tobacco products had an <a href="http://www.tobaccoinaustralia.org.au/downloads/chapters/Ch9_Disadvantage.pdf">equal or greater effect</a> among lower-income adults.</p>
<h2>Getting our priorities right</h2>
<p>If we don’t act to narrow the social gradient of obesity, we’re likely to see a widening of health inequalities over the coming decades.
But to address the problem effectively, we need to systematically consider the effects of obesity prevention policy across all sub-groups of the population.</p>
<p>Levelling life’s playing field so that everyone has the same opportunity to make healthy choices must be regarded as a political health priority.</p>
<p><br></p>
<p><strong>This is part nine of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong></p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong> </p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/7941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Peeters has received funding from National Health & Medical Research Council, Australian Research Council, Australian National Preventive Health Agency, VicHealth, Allergan Australia, The Global Corporate Challenge(c) . She is affiliated with Baker IDI Heart and Diabetes Institute, Monash University and the Australian and New Zealand Obesity Society.</span></em></p><p class="fine-print"><em><span>Kathryn Backholer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>OBESE NATION: It’s time to admit it – Australia is becoming an obese nation. This series looks at how this has happened and, more importantly, what we can do to stop the obesity epidemic. Here, Kathryn…Kathryn Backholer, Research Officer, Baker Heart and Diabetes InstituteAnna Peeters, Head, Obesity & Population Health, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/64432012-07-01T20:47:44Z2012-07-01T20:47:44ZWhy a fat tax is not enough to tackle the obesity problem<figure><img src="https://images.theconversation.com/files/12317/original/t65cqsbk-1340850521.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A fat tax maybe not be enough of an answer to Australia's obesity epidemic.</span> <span class="attribution"><span class="source">HoskingIndustries/Flickr</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Here Suzie Ferrie explains why a fat tax isn’t enough to deal with the problem while Kathryn Backholer and Anna Peeters <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">look at the relationship between socioeconomic status and weight</a>.</em></p>
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<p>We often hear calls for a junk food tax or “fat tax” when there’s discussion of Australia’s growing obesity problem. The idea behind such a tax is that it would enable governments to subsidise healthy foods so that they’re more affordable, and make unhealthy foods comparatively expensive so people buy less of them. </p>
<p>But would they really? Is cost really the most powerful determinant of what food products people buy?</p>
<p>Let’s consider the likely effects of a junk food tax. <a href="https://theconversation.com/is-a-fat-tax-the-answer-to-australias-obesity-crisis-3712">Researchers claim</a> that a 20% tax on a can of soft drink would be a sufficient deterrent to purchasing it. </p>
<p>It’s easy to visualise this: someone approaches the refrigerator in a convenience store wanting to buy a drink and ready to make a decision based on taste and cost. If a soft drink is more expensive than low-fat milk or water, it becomes less attractive and we could see a change in buying behaviour – and the attendant reduction in the consumption of obesity-promoting products.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12316/original/js6qw2z4-1340850504.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most meal options are not arrayed together for a simple price comparison.</span>
<span class="attribution"><span class="source">Flickr/thinkpanama</span></span>
</figcaption>
</figure>
<p>But the junk food tax idea falls over in other situations where food choices are made – when factors other than price come into play. Family dinner options, for instance, are rarely arrayed together in one location for a simple price comparison. </p>
<p>In lower-income areas, where obesity is disproportionately more common, main roads are lined with takeaway food outlets and the only greengrocer may not have a car park (let alone a drive-through service). Part of the attraction of takeaway food is that it provides instant satisfaction while demanding little in the way of (cooking) skills or (nutritional) knowledge. </p>
<p>Dinner options that require food preparation may be out of the question for people living in housing with inadequate cooking and food storage facilities. So, although I can prepare a vegetable and lentil curry with brown rice, followed by apple crumble with real egg custard, for a total of $3.39 per person, in disadvantaged communities this might not compare favourably with the “Five-dollar Meal Deals” offered by various takeaway chains, even if the meals were taxed until they became “Ten-dollar Meal Deals.” </p>
<p>And regardless of the price, it may be hard to sell my healthy $3.39 meal to someone accustomed to takeaway’s <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">addictively sweet and salty and fatty flavours</a>, low in vegetables and high in melt-in-the-mouth starches.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12326/original/nx7s72qj-1340851918.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Unlike fast-food outlets, a greengrocer may not have a car park or a drive-through service.</span>
<span class="attribution"><span class="source">neubie/Flickr</span></span>
</figcaption>
</figure>
<p>When people claim that healthy food is expensive, they are sometimes simply observing that processed foods labelled “diet” are priced higher, or that high-energy junk foods supply more (unneeded) calories per dollar than vegetables do. Both claims are true, but trivial.</p>
<p>But sometimes they are actually pointing out, correctly, that the real cost of my meal is more than $3.39 – that, unlike the takeaway alternative, this home-cooked dinner cost nearly an hour of my time. An hour that I might not be inclined to spare if I were tired and footsore from a hard low-income job and trying to feed fractious children as soon as possible. </p>
<p>And that my home-cooked meal required a number of different skills and resources I might take for granted, such as cooking ability and a functional kitchen. And that it would cost more than $50 if I had to fund the start-up cost of all the ingredients – the kilogram of flour and the bottle of oil, and so on – instead of just using (and costing) smaller amounts of items I already had.</p>
<p>My $3.39 meal is very nutritious. Unlike the takeaway meal, it provides the full spectrum of essential vitamins and minerals, as well as beneficial fibre and health-protective plant substances, at around 2800kJ per serve. Five-dollar meal deals, on the other hand, typically overfeed, with one meal providing 4300kJ or more (over half of a day’s requirement), as well as less protein and more fat than my version. </p>
<p>Better food labelling might help consumers realise this. But labelling also works best when your options are equally convenient and equally available, sitting side by side for comparison on the supermarket shelf or a food outlet’s menu. When this is not the case, labelling loses much of its power to influence food choices. Just as price manipulation strategies, such as a “fat tax”, do.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12386/original/wdb7t9gw-1340933139.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The time taken to prepare a healthy meal may not be available to those tired and footsore from a hard low-income job and trying to feed fractious children as soon as possible.</span>
<span class="attribution"><span class="source">Donovan Mueller</span></span>
</figcaption>
</figure>
<p>Efforts to combat obesity need to look beyond simple pricing strategies, to the underlying knowledge and skills that influence food choices. Just as physical activity is now compulsory at school, basic cooking (real basics, not just biscuits and pizza) should be an integral part of the personal development and life skills curriculum for all kids. </p>
<p>And rather than merely requiring a sink and food preparation area as they do now, building codes need to be updated so that adequate cooking facilities are mandatory in all dwellings. Communal kitchens are another suggestion worth considering. </p>
<p>An emphasis on improving skills means that rather than just punishing poor food choices, we equip people to make better ones - every day at home, not just in the convenience store.</p>
<p><br></p>
<p><strong>This is part eight of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzie Ferrie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Here Suzie Ferrie…Suzie Ferrie, Clinical Affiliate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/61272012-06-28T20:05:54Z2012-06-28T20:05:54ZFilling the regulatory gap in chronic disease prevention<figure><img src="https://images.theconversation.com/files/12294/original/9xyr48h4-1340784997.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The first public health laws governed sanitation and led to clean piped drinking water.</span> <span class="attribution"><span class="source">Darren Stueber</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today, we look at whether we can regulate to curb the epidemic. Here Bebe Loff and Helen Walls argue there’s a “gap” in regulation waiting to be filled by the government while Fiona Haines <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">considers what kind of measures are possible</a>.</em></p>
<hr>
<p>Britain first enacted public health laws during the 19th century. They governed sanitation – piped drinking water and disposal of human wastes. This “sanitary reform” had a significant public health effect. In fact, in 2007 readers of the <a href="http://www.bmj.com/">British Medical Journal (BMJ)</a> voted these reforms the <a href="http://www.bmj.com//content/334/7585/111.2?variant=extract">most important medical milestone</a> since 1840.</p>
<p>With its focus on populations rather than individuals, law is a central aspect of public health practice. The experience of many other areas of public health – from smoking to infectious disease control – has also shown that informed legislative reform measures can be potent, equitable, and cost-effective.</p>
<p>Obesity-related chronic diseases account for <a href="http://www.deakin.edu.au/buslaw/law/dlr/docs/vol14-iss2/vol14-2-10.pdf">60% of preventable deaths</a> in developed countries, and by 2020, they will account for <a href="http://circ.ahajournals.org/content/97/6/596.full">70% of deaths</a> in developing countries. Despite this, we currently lack laws relating to obesity and chronic diseases. Tobacco control is a notable exception and we will consider the lessons we can learn from it below.</p>
<p>Environmental or structural changes are needed because education and treatment strategies are ill-suited to control obesity, and generally benefit those in higher socioeconomic brackets. So it’s unsurprising that we are <a href="http://books.google.co.uk/books/about/Public_Health_Law_and_Regulation.html?id=KZqTZq_IMwIC&redir_esc=y">increasingly hearing calls</a> for regulatory approaches to address obesity and its attendant chronic diseases. </p>
<p>Historically, food industry regulation has addressed acute safety concerns, such as food poisoning, rather than nutrition-related chronic disease, which has been characterised as amenable to individual choice. This has to change if we are to address today’s epidemic of obesity and chronic diseases.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12293/original/stbc6k9v-1340784403.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Earthquakes precipitated changes to building codes.</span>
<span class="attribution"><span class="source">BBC World Service</span></span>
</figcaption>
</figure>
<h2>Lessons from history</h2>
<p>So how can governments start the process of instituting regulations for better health? A look at the historical context of enacting laws to protect public health may suggest what compels governments to legislate.</p>
<ul>
<li>Crisis-driven law<br></li>
</ul>
<p>Physical catastrophes have often catalysed regulation. Building codes, such as laws enacted following the Great Fire of London, for instance, have been reactive and designed to avoid future damage. Earthquakes have also precipitated changes to building codes.</p>
<p>Concern in the 1950s and 1960s about smog in from cars in Los Angeles was a “crisis” to which legislators had to respond. Similarly, cholera outbreaks in 19th century England catalysed the sanitation reform mentioned above. </p>
<ul>
<li>Law to control dissent (and preserve capital)<br></li>
</ul>
<p>Britain was in depression in the 19th century and revolution was feared. Historically, regulation has been most easily enacted when it protects the elite. Sanitary law was enacted to ensure that the poor were in sufficiently good health to provide their labour, rather than claim relief in workhouses. By addressing problems of the poor, it protected the interests of the wealthy. </p>
<p>The <a href="http://www.historyhome.co.uk/peel/p-health/sanrep.htm">Sanitary Report</a> preceding the reforms addressed problems related to living conditions only incidentally. Disease outbreaks, sewers and water were mentioned, but so too were morality and “character”. </p>
<p>The new laws forced improvements in public health, eventually making the state the ultimate guarantor of health and environmental quality standards. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12292/original/3395ygct-1340784288.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Scientific evidence has led to regulations for vehicle emission control.</span>
<span class="attribution"><span class="source">Steven Buss</span></span>
</figcaption>
</figure>
<ul>
<li>Scientifically-informed law<br></li>
</ul>
<p>Scientific evidence was relatively unimportant in early public health regulation, but more recently, science has precipitated regulations such as with vehicle emission control. Scientists attributed air pollution to cars and Rachel Carson’s 1962 book <a href="http://books.google.co.uk/books?id=6sRtTjwwWYEC&printsec=frontcover&dq=Silen+Spring&hl=en&sa=X&ei=aaDrT_bqB-TYigfjjdXLBQ&ved=0CD0Q6AEwAA#v=onepage&q&f=false">Silent Spring</a> awakened the informed public to the dangers of pollution, catalysing the environmental movement.</p>
<p>But science is only ever a partial explanation for public health regulation. And as scientific evidence becomes more credible, industry usually produces its own experts to support contrary views.</p>
<ul>
<li>Political philosophies<br></li>
</ul>
<p>Political philosophies shape law reform, be it a belief in free markets or in welfare governance. <a href="http://cspinet.cc/reports/obesity.pdf">Many researchers</a> have <a href="http://www.who.int/whr/2002/en/">suggested ways</a> in which the <a href="http://www.ncbi.nlm.nih.gov/pubmed/15683074">regulatory environment</a> could support <a href="https://www.mja.com.au/journal/2010/192/7/wanted-politicians-champion-health-not-obesity">better nutrition</a> and <a href="https://theconversation.com/death-by-suburban-sprawl-better-urban-planning-will-combat-sedentary-lifestyles-3395">physical activity</a>. So why is government so slow to regulate in this area?</p>
<p>The examples above illustrate the kind of circumstances that enable reform, as does the regulatory experience with tobacco. Let’s turn to that now.</p>
<h2>Lessons from tobacco</h2>
<p>Tobacco and junk food are similar in their addictiveness, health impact, costs to the community, and the powerful industries behind each. As a legislative target, tobacco, an addictive carcinogen, has advantages over obesity. Unsafe when used as intended, tobacco regulation has a simple goal – to prevent people from using it at all. In terms of addictiveness, junk foods and tobacco may be similar, but food is necessary for survival. </p>
<p>Diseases associated with nutrition are multi-causal, often tied to a balance of energy consumption and energy expenditure. While there’s compelling evidence of a direct cause-and-effect relationship between cigarette smoking and poor health, less evidence links particular foods to nutrition-related diseases.</p>
<p>But the key obstacle to enacting policy and legislation, as was formerly the case with the tobacco industry, is opposition from the food industry. Naturally, the latter has strongly opposed legislative and regulatory approaches, as these may restrict its profitability.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12291/original/yyfm955v-1340784196.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tobacco is an easy legislative target because it’s an addictive carcinogen.</span>
<span class="attribution"><span class="source">durera_toujours/Flickr</span></span>
</figcaption>
</figure>
<p>The tobacco industry once fostered a debate about “sound science”. The food industry has tried to create similar confusion about links between nutrition, obesity and chronic diseases, by emphasising that physical inactivity increases obesity and minimising the role of food. Industry also supports health promotion measures that are likely to increase consumer confusion rather than promoting healthy eating.</p>
<p>For tobacco, a strong body of evidence effectively communicated to the public catalysed a crisis, leading to government action. Similarly, pressure on governments to respond to obesity and resulting chronic diseases will grow as scientific evidence links them to disability and premature mortality. But as long as obesity and the chronic diseases it causes are perceived as matters personal choice, legislative reform will not be forthcoming.</p>
<p>The growing body of evidence regarding the reasons for and impact of obesity among those least well-off may also create social concern, advancing regulatory reform. But as with climate change, legislating to prevent chronic diseases runs counter to the government’s usual priorities. </p>
<p>We face chronic health and environmental crises today – increasing epidemics of obesity and nutrition-related disease, and environmental challenges, such as climate change. Regulation can help us address them but it seems that these crises must become acute before governments will act. </p>
<p><br></p>
<p><strong>This is part seven of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong> </p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6127/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bebe Loff has received funding from NHMRC and VicHealth funding.</span></em></p><p class="fine-print"><em><span>Helen Walls receives funding from the National Heath & Medical Research Council (NHMRC).</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today, we look…Bebe Loff, Associate Professor and Head of Human Rights & Bioethics, Monash UniversityHelen Walls, Research Fellow at National Centre for Epidemiology and Population Health, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/62842012-06-28T20:05:40Z2012-06-28T20:05:40ZPreventing weight gain: the dilemma of effective regulation<figure><img src="https://images.theconversation.com/files/12287/original/b3n3jrz4-1340780668.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Government attention is diverted away from the problem during the regulatory reform process.</span> <span class="attribution"><span class="source">Kristina Alexanderson</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today, we look at whether we can regulate to curb the epidemic. Here Fiona Haines discusses the barriers to regulations that would help end the obesity epidemic while Bebe Loff and Helen Walls argue <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">there’s a “gap” in regulation waiting to be filled</a> with government action.</em></p>
<hr>
<p>The burden of obesity is costly to individuals whose health is poor and who are often stigmatised. And it’s costly to governments through increased health costs. So, why isn’t more being done?</p>
<p>Tackling obesity effectively will involve increased regulation, such as requiring clear labels on food to make sure people know what is healthy (so-called traffic light labelling) and prohibiting junk food advertising to children during peak viewing hours. Both of these measures are recommendations of the 2009 <a href="http://www.health.gov.au/internet/preventativehealth/publishing.nsf/content/tech-obesity">Preventative Health Task Taskforce</a>. And both make sense. But, getting effective regulation in place is hard. Why is it so difficult?</p>
<p>Firstly, regulatory reform is challenging for government. During the process of regulatory reform, government attention is diverted away from the problem at hand (in this case obesity) to responding to business concerns with their profitability. And to reassuring the population at large (often in the wake of some public pressure) that the government really is taking the problem seriously. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Front-of-packet traffic-light labelling would be an effective way to signal what foods are healthy.</span>
<span class="attribution"><span class="source">Ian Clark</span></span>
</figcaption>
</figure>
<p>Dig a little deeper and what is at issue is political legitimacy that must be maintained (and preferably enhanced if you are the incumbent government) through the reform process. </p>
<p>Regulatory reform always takes place in the context of maintaining political legitimacy. In turn, political legitimacy (or political risk as I call it in <a href="http://www.e-elgar.co.uk/bookentry_main.lasso?id=13769">The Paradox of Regulation</a>) rests on the horns of a dilemma between “keeping the economy going” (which often translates into responding to business demands) and “making people feel safe” (essentially, reassurance). </p>
<p>But a government tending to its legitimacy cannot simply be dismissed as engaged in a cynical political ploy. It may be, but without legitimacy governments struggle and ultimately fall. Legitimacy is critical to any government – of whatever persuasion.</p>
<p>It does mean, though, that regulatory reform is fraught – and the loser is too often a potentially effective measure to deal with a social problem. Governments across the world – including our own – have swung into action against obesity at least at the level of inquiries, recommendations and policy initiatives. But how well these translate into action depends on how a government manages its political risk. </p>
<p>The bargaining process often sees businesses taking some steps to appease government and public demands, such as putting labels on food, but not ones that communicate clearly and effectively, or a voluntary (and small) reduction in television advertising of junk food to children. It also sees governments reassuring us, by such measures as public campaigns with cute figures encouraging us to “exercise more”. Measures such as these are unlikely to make much of an impact in reducing our collective waistlines.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Limiting junk food advertising to children during peak viewing hours would be an effective measure.</span>
<span class="attribution"><span class="source">RichardBH/Flickr</span></span>
</figcaption>
</figure>
<p>Decisive action by governments – the oft-cited “strong political leadership” is critical to effective regulation. This must be based on weighing up available evidence and not just showing strength for the sake of it. Evidence is tricky, though. Pushing for “more research” is a common stalling tactic.</p>
<p>And there are additional challenges. Even if measures supported by the best available evidence (such as traffic light labelling on the front-of-food packaging and removing advertising junk food to children between 6am and 9pm as recommended in the <a href="http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/taking-preventative-action">Government’s response</a> to the National Preventative Health Taskforce) are implemented, regulation is no panacea. </p>
<p>Regulation suggests that you can reduce a problem (such as obesity) while keeping all the benefits (to individuals, companies and governments) that have led to higher rates of obesity. These benefits are part of a very long list that includes cheap takeaway food, sprawling suburbs with affordable housing but little public transport or amenities, short meal breaks, long working hours, quick treats for ratty kids when you’re tired from a long day’s work, high profits in the food processing industries, foods that are transportable and keep for long periods without spoiling and so on. </p>
<p>Regulation acts a bit like a “surgical bombing raid” – it promises much, but often delivers less.</p>
<p>The Commonwealth Government was wrong in rejecting traffic light labelling. But, comprehensive measures to tackle obesity will not come in a single convenient package. Tackling obesity in a serious manner will bring considerable public benefit. But it creates losers – both powerful businesses and ordinary folk – in the short term. That is our dilemma.</p>
<p><br></p>
<p><strong>This is part six of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6284/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Haines received funding from the Australian Research Council for her work in book The Paradox of Regulation: what regulation can achieve and what it cannot.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today, we look…Fiona Haines, Professor of Criminology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/32182012-06-27T20:43:55Z2012-06-27T20:43:55ZRecipe for disaster: creating a food supply to suit the appetite<figure><img src="https://images.theconversation.com/files/12239/original/psxnbyhn-1340759950.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A hedonic response working in concert with our primary tastes encourages consumption.</span> <span class="attribution"><span class="source">amanda tipton</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and, more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today we look at how we got here, with Russell Keast explaining how, by creating food to suit our appetite, we have found the recipe for nutritional disaster, while <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">Garry Egger looks</a> at economic growth and why we should use the economic slowdown to try to shrink our waistlines.</em></p>
<hr>
<p>For all but the past 10,000 years, the hominin species (two-legged primates) on the human evolutionary tract have been hunter-gatherers. And over millions of years of natural selection, our senses developed and were refined to help us navigate the local environment. </p>
<p>Of critical importance to our survival was the ability to make correct food choices and our sense of taste informed the hunter-gatherer about the suitability of food for consumption. </p>
<p>When a potential food was placed in the mouth, the five-taste primaries informed the brain about essential nutrients and toxins:</p>
<ul>
<li>sweet elicited by sugars reflecting carbohydrate,</li>
<li>umami elicited by glutamic and other amino acids reflecting protein content,</li>
<li>salt elicited by sodium and other ions (Na+) reflecting mineral content,</li>
<li>sour elicited by free hydrogen ions (H+) reflecting excessive acidity, and</li>
<li>bitter reflecting potential toxins in foods.<br></li>
</ul>
<p>Working in concert with these tastes is a hedonic response with sweet, salty and umami qualities being appositive (working together) and encouraging consumption. Meanwhile excessive sour and bitter tastes are aversive and promote the rejection of the food. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=602&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=602&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=602&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=757&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=757&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12245/original/8wzydmp5-1340761373.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=757&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Decisions on whether to swallow or spit the food are critical to preservation of life.</span>
<span class="attribution"><span class="source">Gary & Anna Sattler</span></span>
</figcaption>
</figure>
<p>Decisions on whether to swallow or spit the food are critical to preservation of life. Appetitive responses to foods that contained fats, salt and sugars ensured these biologically prized yet scarce nutrients were consumed. Over millions of years of evolution, the sense of taste guided the hunter-gatherer to essential nutrients and away from potential toxins.</p>
<h2>The downside of civilisation</h2>
<p>Then, approximately 10,000 years ago, the Neolithic revolution was underway and included human mastery of agriculture and animal husbandry, meaning a secure food supply and the end of the need for hunter-gathering. Civilisations were established around a secure food supply. </p>
<p>Arguably, there’s been more change in the food supply in the past 50 years than any other 50-year period – with the establishment of fast food empires, multinational food companies, hyper-supermarkets, and a food supply heavily based on our appetitive response.</p>
<p>In westernised societies, we live in a vastly different environment to our hunter-gatherer forebears. Our appetitive response is now a relic of evolution, and there hasn’t been enough time since the Neolithic revolution for any adjustment to the human genome. </p>
<p>Food companies produce foods that appeal to our appetitive desires. But, driven by appetite, we now consume excess quantities of energy, fats, salts and sugars, leading to diseases of civilisation including obesity, hypertension and related pathologies. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=564&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=564&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12237/original/k7nnzfqx-1340758851.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=564&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We now have a food supply based in our appetitive response.</span>
<span class="attribution"><span class="source">Ken-ichi Ueda</span></span>
</figcaption>
</figure>
<p>One answer is to produce foods that are appetitive and nutritious, yet contain low concentrations of fats, salts and sugars. While such strategies have the potential for significant health benefits, it will not be easy, as the following example with salt (sodium) illustrates.</p>
<h2>What’s a grain of salt?</h2>
<p>Sodium, in the form of manufactured sodium chloride (salt), is found in abundance in the modern diet and excessive sodium consumption is linked to hypertension, cardiovascular disease and other diseases. It’s predicted that a modest 15% reduction in dietary salt may avert 8.5 million cardiovascular-related deaths worldwide over ten years, making salt reduction a priority for food industries and governments alike. </p>
<p>In westernised societies, approximately 75% of our dietary salt intake is from manufactured foods, so the pressure is on food companies to reduce the level of salt added to foods. Salt has certain functionality in foods – palatability and consumer acceptance are the most commonly cited constraints to salt reduction by the food industry and large reductions in salt content of foods often result in declines in palatability and consumer acceptance of those foods. </p>
<p>This can be seen in the Bliss Point graph below: </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=462&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=462&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=462&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=581&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=581&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12159/original/wvj9z2hk-1340604662.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=581&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Russell Keast</span></span>
</figcaption>
</figure>
<p>The bliss point region represents the intensity of saltiness and the concentration of sodium at which the optimal level of liking occurs. </p>
<p>Salt added to food at low concentrations may result in the food not being salty enough to be perceived and too bland to be liked, while a higher concentration will increase liking until an optimal level is reached. But further increases in concentration will result in the food becoming too salty, and liking will then decrease. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=942&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=942&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12236/original/3ddy9y8w-1340758747.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=942&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Higher concentrations of salt will increase liking until an optimal level is reached.</span>
<span class="attribution"><span class="source">SurvivalWoman/Flickr</span></span>
</figcaption>
</figure>
<p>So the challenge of how can salt be removed while maintaining consumer liking and acceptance of a product remains. </p>
<p>The significant change in the food environment over the past 50 years has coincided with increased prevalence of diet-related diseases. The appetitive response to certain nutrients aided the hunter-gather survive by making appropriate food choices, but we now have a secure food supply and our appetite is leading us down a path to disease states rather than survival. </p>
<p>As the food supply has been refined in response to drivers of appetite, we have created a food environment that promotes obesity, hypertension and certain cancers. The challenge is to develop a food supply that meets not only our nutritional needs, but also fulfils our hedonic requirements.</p>
<p><br></p>
<p><strong>This is part four of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/3218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Russell Keast receives funding from The Heart Foundation.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and, more importantly, what we can do to stop the obesity epidemic. Today we look…Russell Keast, Associate Professor in Food and Nutrition, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/62602012-06-27T20:42:55Z2012-06-27T20:42:55ZWhat’s economic growth got to do with expanding waistlines?<figure><img src="https://images.theconversation.com/files/12257/original/48qgqmxs-1340769043.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Highly processed and fattening but very tasty and easy to get food is partly responsible for the obesogenic environment.</span> <span class="attribution"><span class="source">Toban Black</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today we look at how we got here, with Garry Egger discussing economic growth and why we should use the economic slowdown to try to shrink our waistlines while <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Russell Keast explains</a> how, by creating food to suit our appetite, we have found the recipe for nutritional disaster.</em></p>
<hr>
<p>According to Andy Warhol, everyone has his or her 15 minutes of fame. Looking back at four decades as a health scientist, I’m afraid mine will probably be the development of “GutBusters”, the world’s first men’s “waist loss” program in 1991.</p>
<p>GutBusters lasted for over a decade before it was taken over by a big weight-loss company and closed down for being unprofitable. Men don’t like to admit there’s anything wrong with their health and hence won’t pay for it. </p>
<p>So ended my 15 minutes. But if the truth be told, I probably would have closed it down myself. Not because of its commercial failure, but because of the ethical challenge of taking money from men who lost weight but put it all back on when they went back into the “obesogenic” environment.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12256/original/xkkbbyb2-1340768317.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some families are more prone to gaining weight than others.</span>
<span class="attribution"><span class="source">o soy andRë</span></span>
</figcaption>
</figure>
<h2>The curse of prosperity</h2>
<p>There’s a tendency to think that obesity is a genetic problem. This is encouraged by the fact that some families are more prone to gaining weight than others. It’s partly true, but in the absence of an environment that promotes obesity, only a tiny minority cursed by their genetic lot would get fat. That’s why the history of humanity is one of leanness, rather than fatness.</p>
<p>What, then, is it in our modern environment that has made around 60% of Australians overweight or obese, given that this epidemic only began around 1980? The answer of course, lies in our food supply (highly processed, high fattening but very tasty and easy to get) and inactivity (through leisure-saving and entertainment technology such as cars, television, and computers).</p>
<p>But a good health scientist doesn’t just look for the immediate cause of a disease. She also looks at the cause of the cause. What then has led us to fattening food and an inactive lifestyle? Quite clearly, it is the affluence resulting from a system of macro-economics (economic growth) that began around the time of the industrial revolution and was kicked along by post-depression policies.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12247/original/fqryctvn-1340763051.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Entertainment technology breeds inactivity.</span>
<span class="attribution"><span class="source">Rad Jose</span></span>
</figcaption>
</figure>
<p>There’s no doubt that economic growth has been the biggest single positive influence on human health throughout history. Our life spans have more than doubled and infectious diseases have all but been eliminated (well, not quite, but we’ll discuss that another time) – all as a result of increased growth.</p>
<p>Does this mean such improvements will continue indefinitely? </p>
<p>In economic terms (as in all limited systems), there comes a time when further investment leads to diminishing rates of return. Growth beyond this is no longer rewarding. As one writer so eloquently put it, “growth beyond maturity is either obesity or cancer.” In other words, things grow, hit a sweet spot where all is the best it can be, then proceed to decline.</p>
<h2>Pulling on the brakes</h2>
<p>Unlike animals that run away and leave a good meal if frightened by predators, humans have a tendency to want to milk the sweet spot to its maximum. Like Cinderella, we often stay too long at the ball, only to find our carriage has turned into a pumpkin. It’s a well-recognised phenomena used in explanations such as the Peter Principle, where someone will rise to a level above his or her competency in a work environment in an effort to find an even nicer sweet spot.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12246/original/vxv4p45n-1340762814.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Stopping the growth train will take a long time.</span>
<span class="attribution"><span class="source">Jim Mead</span></span>
</figcaption>
</figure>
<p>Economic growth hit the end of its sweet spot in the western world around 1980, the time at which the obesity epidemic got its kick start. Since then, obesity rates have increased almost in parallel with increases in Gross Domestic Product (GDP), that ridiculous measure of human achievement that politicians cling to.</p>
<p>But the economic sweet spot, like all sweet spots eventually had to come to an end.
And contrary to the belief of many economists (and politicians) about the current economic crisis being a problem of not enough growth, a more reasoned view would be that it’s a sign of the death throes of the 200-year growth era.</p>
<p>Stopping the growth train (even though it’s heading for a cliff) takes a long time. And few are even talking (at least in public) about stopping it at this stage. Even fewer have considered the effects of not doing so on our health. The uncertainty in world financial markets may make the next few years the time to do so. After all, it was an economist who said “never let an impending crisis go to waste.”</p>
<p><br></p>
<p><strong>This is part five of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6260/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Garry Egger receives funding from the Australian Research Council for a grant on personal carbon trading and obesity.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today we look…Garry Egger, Professor of Health and Human Sciences, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/78162012-06-26T20:48:05Z2012-06-26T20:48:05ZMapping Australia’s collective weight gain<figure><img src="https://images.theconversation.com/files/12143/original/d6zhwzmp-1340594730.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One in four Australians are now obese. But when – and how – did we gain this weight?</span> <span class="attribution"><span class="source">Kyle May</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. Today we launch a series looking at how this has happened and, more importantly, what we can do to stop the obesity epidemic.</em></p>
<hr>
<p>In Australia today, around two-thirds of adults and a quarter of children are overweight or obese. This is a dramatic change from the landscape just 30 years ago when we first collected national data on weight and height. </p>
<p>In 1980, around 60% of Australian adults had a healthy weight; today this has almost halved to around 35%. In 1980, just 10% of adults were obese. In 2012, this figure tips 25%. The infographic below shows just how quickly obesity is increasing in Australia. And why it’s not an exaggeration to call it an epidemic. </p>
<p><iframe id="tc-infographic-231" class="tc-infographic" height="511" src="https://cdn.theconversation.com/infographics/231/51b510dae3dbdc335d66f9e509ae030ddc8dd8d1/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<figure><figcaption><a href="https://cdn.theconversation.com/infographics/231/51b510dae3dbdc335d66f9e509ae030ddc8dd8d1/site/index.html">Click here</a> to open in new window or republish.</figcaption></figure>
<p>The same trend is seen <a href="http://www.who.int/mediacentre/factsheets/fs311/en/index.html">around the world</a>, with around a third of adults and almost one in five children in the United States obese. In some island nations, the prevalence is higher still, with more than half of Samoan and Tongan women classified as obese. </p>
<p>In Australia, we see a higher prevalence of obesity in a number of marginalised populations, such as Aboriginal and Torres Strait Islander adults, Australians living outside the major cities, and those living in more socioeconomically deprived areas. </p>
<p>With excess weight and obesity increasing your likelihood of developing many major chronic diseases, disability and early death, governments and communities around the world are working to halt, or at least slow, this trend.</p>
<p>Some encouraging reports have <a href="http://www.ncbi.nlm.nih.gov/pubmed/20973911">emerged</a> recently from Australia, the United States and several European countries that show rates of obesity are stabilising in children. But the good news is limited to specific age groups and time periods (and the studies are yet to be replicated to confirm the results). Overall, rates of childhood overweight and obesity remain high. </p>
<p>There are two key objectives in dealing with Australia’s collective weight gain: we must both prevent the ongoing shift towards a heavier population, and increase the proportion of children and adults at a healthy weight. But before we can even contemplate either, we need to understand the drivers of these trends.</p>
<h2>Why do we gain weight?</h2>
<p>A person’s weight gain is generally caused by an imbalance between energy intake and energy expenditure. This appears simple, but the factors driving this imbalance at a population level are incredibly complex, making simple solutions elusive.</p>
<p>It’s commonly understood that the overweight and obesity we experience today is a normal response to an abnormal environment – often referred to as the obesogenic environment. The premise of this idea is that as humans we’re programmed to conserve energy, storing it up for a time when food is scarce. But most of us now live in an environment where food is plentiful. </p>
<p>On top of this, our need to expend energy in daily life has disappeared. Within our lifetimes we’ve seen the dominant move towards sedentary jobs and leisure-time pursuits, such as watching television, playing computer games and shopping online. We all also recognise the ease and affordability of foods high in energy.</p>
<p>The data supports our anecdotal understanding of these trends. While difficult to measure accurately, a <a href="https://www.mja.com.au/journal/2004/181/9/obesity-epidemic-both-energy-intake-and-physical-activity-contribute">comparison</a> of Australian energy intake from the mid-1980s to the mid-1990s shows an increase in daily energy intake of around 13% for children and 3% to 4% for adults. This latter increase, of around 350kJ a day (approximately half a can of soft drink, or a slice of bread), equates to an eventual weight gain of around 3.5kg. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=541&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=541&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=541&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=680&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=680&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12136/original/rpc26fzy-1340592141.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=680&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our daily energy intake increased by 3% to 4% in the ten years to 1995.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>Similar trends have occurred in the United States, with a 2004 Centres for Disease Control and Prevention (CDC) <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm">report</a> indicating daily energy intake between 1970 and 1990 increased by around 7% in men and 22% in women.</p>
<p>Unfortunately, it’s difficult to measure exercise and activity levels over time. A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/21647427">report of US workers</a> suggested that while almost half of jobs in the 1960s entailed at least moderate levels of activity, less than 20% do so now. </p>
<p>Trends in overall physical activity levels are more difficult to compare, as different studies generally evaluate different aspects of total physical activity (leisure time, occupational activity, incidental movement, among other measurements). But most Australian and US data suggest recreational activity levels have decreased slightly over past decades.</p>
<p>A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/21872749">review</a> by Boyd Swinburn and his colleagues proposes a framework for understanding the combined forces of changes in our energy intake and activity levels. Prior to the 1960s, the dominant change was decreased levels of physical activity, but this had no observable effect on population weight status as food remained a limiting factor. Subsequent to the 1960s, the rapid changes in food availability, composition and marketing drove rapid increases in population weight, now against a backdrop of minimal activity. </p>
<p>The authors also highlight the strong correlation between national economic status and obesity: the move to affordable and accessible high-energy foods requires a certain level of economic wealth and activity. In this sense, the obesity epidemic can be seen as a detrimental outcome of our society’s over-consumption.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12138/original/58ftmgrt-1340592433.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">With sedentary jobs and leisure-time pursuits, we’re not expending the energy we used to.</span>
<span class="attribution"><span class="source">Flickr/justingaynor</span></span>
</figcaption>
</figure>
<p>Clearly, our food and activity environments require the dominant focus in our efforts to tackle population weight gain. But there are a number of other contributors to weight gain that are also being evaluated for their potential role in achieving healthy population weight. </p>
<p>At an individual level, we <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2932668/">know that</a> the in utero environment influences the future child’s weight and chronic disease pathways, with both under- and over-nutrition linked to excess weight gain later in life. We also know that factors such as lack of sleep, low-quality sleep, and use of particular medications, life stages such as pregnancy, and specific genetic variations are also predictive of weight gain. Work to determine the importance of these factors at a population level is ongoing. </p>
<p>There are also newly identified candidates predictive of weight gain, including exposure to environmental toxicants such <a href="http://www.nrdc.org/health/effects/qendoc.asp">endocrine disruptors</a>, <a href="http://www.foodstandards.gov.au/consumerinformation/bisphenolabpa/">Bisphenol A</a> (BPA), <a href="http://en.wikipedia.org/wiki/Phthalate">phthlates</a> and persistent organic pollutants. New studies have also suggested a link between some viral infections, such as <a href="http://virus.stanford.edu/adeno/adeno.html">human adenovirus</a>, and obesity.</p>
<h2>Reversing the trend</h2>
<p>Successful population health campaigns to improve the levels of healthy weight, activity and nutrition in our population will need to focus on addressing the overarching drivers of the food and activity environments, while also taking into account these other factors that predict individual variation in weight gain. </p>
<p>The launch last year of the <a href="http://www.anpha.gov.au/internet/anpha/publishing.nsf/Content/26A8DC3218FDABA0CA2578F100059B4F/$File/ANPHA-Strategic_Plan.pdf">Australian National Preventive Health Agency’s Strategic Plan</a> recognises the importance of this approach. It’s critical that we continue to work towards implementing a range of interventions appropriate for each stage of prevention and treatment, from childhood to adulthood.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=904&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=904&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=904&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12142/original/vyt3n7bw-1340593938.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We need a range of interventions to halt Australia’s obesity epidemic.</span>
<span class="attribution"><span class="source">Ben Matthews</span></span>
</figcaption>
</figure>
<p>Currently, only a third of Australian adults have a healthy weight. If these trends continue, this could decrease to around one quarter over the next decade. There is a real risk that if we are not able to reverse these trends, very soon we will become conditioned to this new demographic, just as smoking was considered “normal” in the 1960s. </p>
<p>To prevent the burden of diabetes, heart disease, arthritis and cancer that will arise from these trends, we need strong and wide-reaching action to drive decreases in energy consumption, particularly within Australia’s vulnerable population groups.</p>
<p><br></p>
<p><strong>This is the first part of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part two: Explainer: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/7816/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Peeters has received funding from National Health & Medical Research Council, Australian Research Council, Australian National Preventive Health Agency, VicHealth, Allergan Australia, The Global Corporate Challenge(c) . She is affiliated with Baker IDI Heart and Diabetes Institute, Monash University and the Australian and New Zealand Obesity Society.</span></em></p><p class="fine-print"><em><span>Dianna Magliano has been the recipient of two ARC linkage grants.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. Today we launch a series looking at how this has happened and, more importantly, what we can do to stop the obesity epidemic…Anna Peeters, Professor Epidemiology & Equity in Public Health, Deakin UniversityDianna Magliano, Senior Epidemiologist, BakerIDI, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/70112012-06-26T20:47:52Z2012-06-26T20:47:52ZExplainer: overweight, obese, BMI – what does it all mean?<figure><img src="https://images.theconversation.com/files/11949/original/55qrhff3-1340171174.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Labelling a person as “obese” may not always be helpful in prompting positive changes in behaviour.</span> <span class="attribution"><span class="source">HighContrast</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. Today we launch a series looking at how this has happened and, more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>We start by setting the scene with a <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">map illustrating the extent of the problem</a> and some tools to understand what this means: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">how excess weight causes disease</a> and here, how we measure obesity.</em></p>
<hr>
<p>Australians are getting fatter and there’s no dispute over how this increasing weight is affecting our health. Different methods of assessing body fat can give different interpretations of just how much excess weight a person is carrying, but all methods point in the same direction when applied over time. </p>
<p>The most common measure of body fat and associated health risks is body mass index (BMI). BMI was developed as a simple way to compare different groups of people, based on the correlation between height and weight as an indicator of excess body fat. </p>
<p>BMI is calculated by dividing weight in kilograms by the square of height in metres – a simple online calculator is <a href="https://www.betterhealth.vic.gov.au/tools/body-mass-index-calculator-for-adult">available here</a>. A healthy BMI for an adult is between 18.5 and 25 kg/m². Between 25 and 30 kg/m² is considered overweight and 30 kg/m² and above obese. At a population level, high rates of body fat above 30 kg/m² indicate an increased risk of death and disease. </p>
<p>BMI is the main measure used for international obesity guidelines and is recommended by the <a href="http://apps.who.int/bmi/index.jsp?introPage=intro_3.html">World Health Organization</a>. But BMI isn’t perfect. People with the same body weight and height can have different proportions of body fat to lean muscle mass. Athletes with high muscle mass, for instance, can have a lower proportion of body fat than less muscular people, so a BMI calculation can put them into an overweight or obese category, even though their risk of obesity related disease is very low.</p>
<p>This is a frequently cited criticism of BMI, but it needs to be put into perspective. Such people are in the minority and a quick visual inspection will clearly show that it’s muscle, not fat, that such people are carrying the most of.</p>
<p>People from an Asian background tend to have more body fat on a leaner frame, so a lower BMI healthy-weight-range can be used. Conversely, people of a Pacific Islander background tend to have a higher proportion of lean muscle mass compared with fat, so a higher BMI healthy-weight-range is often recommended.</p>
<p>While BMI is a useful measure of overall health risks, it fails to take into account the distribution of fat throughout the body. For this reason, waist circumference was developed as a simpler and potentially more accurate measure of disease risk. Waist circumference is not only a gauge of body fat, but it specifically targets the most dangerous type of fat: visceral fat.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=366&fit=crop&dpr=1 600w, https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=366&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=366&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=460&fit=crop&dpr=1 754w, https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=460&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/11950/original/rdzx8csp-1340171206.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=460&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Waist circumference is a simple way of predicting disease.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>Visceral fat is found between the organs of the abdomen and contributes to belly fat. There’s a strong correlation between central obesity and cardiovascular disease, insulin resistance, type 2 diabetes, <a href="http://www.hindawi.com/journals/jnume/2012/476380/">inflammatory diseases</a>, high blood pressure and other obesity related diseases.</p>
<p>For men, the aim is to have a waist circumference below 94cm; for women it’s 80cm. Measures above 102cm for men and 88cm for women carry a very high risk of developing type 2 diabetes, high blood pressure, cardiovascular disease and even some forms of cancer. For people of an Asian background, slightly lower waist circumference goals apply: under 90cm for men and 80cm for women.</p>
<p>More recently, estimates of body fat percentage and health risks have looked at waist-to-hip ratio and even waist-to-height ratio. Both these measures take into account central fat stores so can give a better health risk estimate than BMI. For men, a waist-to-hip ratio below 0.9 and 0.8 for women correspond to a healthy weight BMI.</p>
<p>An advantage of using waist measures for body fat estimates is that it takes away the stigma of needing to step on the scales. It also allows for the use of cut-off values that avoid terms of overweight and obesity, and instead focus on the risk of <a href="http://www.nhlbi.nih.gov/health/health-topics/topics/ms/">metabolic disease</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/11951/original/cmyhq6sh-1340171223.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women should aim to have a waist circumference below 80cm; men below 94cm.</span>
<span class="attribution"><span class="source">Fybridphotos</span></span>
</figcaption>
</figure>
<p>Labelling a person as “obese” may not always be helpful in affecting positive behaviour changes, especially when a person already acknowledges that they’re carrying a bit of extra weight. “Unhealthy BMI”, “above the healthy weight range”, and “excess weight” can all carry the same message about the need to shed excess weight for better health and reduced risk of disease.</p>
<p>Another technique to measure body fat is by bioelectrical impedance. This method involves passing a small electrical current through the body, normally by a specialised set of scales that a person stands on. The scales measure water volume and, by the use of special algorithms, arrive at a body fat percentage estimate. The accuracy of such machines can vary dramatically, especially around the cheaper end of the price range.</p>
<p>By far the most accurate way to measure body fat is by <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/MRI_scan">magnetic resonance imaging</a> (MRI), <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/CT_scan?open">computed tomography</a> (CT) or <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/X-ray_examinations?open">X-ray</a> scanning, but such methods are not realistic for the public to use and belong firmly in the world of research.</p>
<p>So long as the limitations of a weight assessment method are understood, methods such as BMI and waist circumference are quick and simple validated ways to assess weight and disease risk that can be used by health professionals and the public alike.</p>
<p><br></p>
<p><strong>This is part two of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p>
<p><br>
<em>See more <a href="https://theconversation.com/topics/explainer">Explainer articles</a> on The Conversation.</em></p><img src="https://counter.theconversation.com/content/7011/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Crowe does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. Today we launch a series looking at how this has happened and, more importantly, what we can do to stop the obesity epidemic…Tim Crowe, Associate Professor in Nutrition, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/70612012-06-26T20:47:19Z2012-06-26T20:47:19ZExplainer: how does excess weight cause disease?<figure><img src="https://images.theconversation.com/files/11953/original/zy338hyd-1340173826.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We all know obesity increases our risk of chronic disease, but how does excess fat actually affect our body?</span> </figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. Today we launch a series looking at how this has happened and, more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>We start by setting the scene with a <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">map illustrating the extent of the problem</a> and some tools to understand what this means: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">how we measure obesity</a> and here, an explanation of how excess weight affects our body and causes disease.</em></p>
<hr>
<p>When you consider the potential for a shortened lifespan and increased risk of a long list of diseases, it’s no wonder Australia’s obesity epidemic is causing so much concern. According to the <a href="http://health.gov.au/internet/main/publishing.nsf/Content/7AF116AFD4E2EE3DCA256F190003B91D/$File/adults.pdf">National Health and Medical Research Council</a>, obesity causes, worsens, or increases your risk of a raft of diseases, including: </p>
<ul>
<li>diabetes, </li>
<li>obstructive sleep apnoea, </li>
<li>polycystic ovarian syndrome, </li>
<li>hypertension, </li>
<li>abnormal lipids, </li>
<li>heart attack and stroke, </li>
<li>some cancers, </li>
<li>fatty liver. </li>
</ul>
<p>So how does obesity cause or contribute to these problems? The answer is complex, as there are multiple mechanisms. But the most important factor is that fat causes resistance to insulin, the hormone responsible for regulating metabolism. </p>
<p>When the body accumulates excess fat, it’s either stored in fat cells, where it’s relatively safe, or deposited in tissues, such as the liver and muscles. </p>
<p>In the liver, fat drives the increased production of glucose (sugar). In muscles, excess fat impairs the action of insulin to stimulate the body’s cells to use this glucose as a source of energy. The resulting insulin resistance forces the pancreas to overproduce insulin, in an effort to maintain normal blood glucose levels. </p>
<p>This is dramatically demonstrated in patients who have <a href="http://www.aidsinfo.nih.gov/ContentFiles/Lipodystrophy_FS_en.pdf">lipodystrophy</a>, a genetic or autoimmune disorder in which there is a deficiency of fat cells. These people have nowhere to store fat, except in liver and muscle, and develop severe insulin resistance, diabetes and fatty liver.</p>
<h2><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/diabetes_explained?open">Diabetes</a></h2>
<p>Obesity affects the body’s ability to produce insulin. This is caused by stress on the insulin-producing pancreatic islet (β) cells and excess fat directly damaging these islet cells. </p>
<p>In people with a genetic predisposition to diabetes, the combination of insulin resistance, direct fat toxicity and genetic predisposition leads to the failure and death of islet cells. The result is a relative deficiency of insulin and the development of <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/diabetes_explained?open">type 2 diabetes</a>.</p>
<h2><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Sleep_apnoea">Obstructive sleep apnoea</a></h2>
<p>Obstructive sleep apnoea (OSA) occurs when there is an excess of fat around the neck which increases the collapsibility of the air passage to the lung, particularly during sleep. The resulting reduction of blood oxygen tells the sleeper’s brain to wake up and take a deep breath. This happens repeatedly during the night, preventing the individual from getting enough sleep. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/sKv8WqexNOQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Polycystic_ovarian_syndrome">Polycystic ovarian syndrome</a></h2>
<p>The high insulin levels resulting from insulin resistance stimulate the ovary to make an excess of male-type hormones (normally produced in small amounts in women). This over-production of hormones can lead to acne, facial hair and the production of ovarian cysts. Polycystic ovarian syndrome is also a common cause of infertility.</p>
<h2><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/hypertension_means_high_blood_pressure">Hypertension</a></h2>
<p>Hypertension, or high blood pressure, means the heart has to work harder than usual to pump blood to the arteries. </p>
<p>Insulin has been shown to increase blood pressure by causing the kidney to retain salt and by activating the sympathetic (adrenaline) nervous system. Salt increases the amount of water that is retained (and therefore the volume of the blood), while the increased sympathetic activity narrows some blood vessels. The increased fluid and decreased vessel volume combine to increase blood pressure.</p>
<h2>Abnormal lipids (<a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/cholesterol_explained">high cholesterol</a>)</h2>
<p>The body produces cholesterol, a type of fat, to perform a number of metabolic processes such as creating hormones and bile. </p>
<p>The typical lipid abnormalities seen in people with obesity are elevated triglyceride (known as a “storage fat”) and a low HDL-cholesterol (or good cholesterol). While still under investigation, there is some evidence to suggest that elevated triglycerides are caused by fat-induced insulin resistance. </p>
<p>Low HDL-cholesterol is bad because its role is to take cholesterol from the blood vessels to the liver for removal. Low HDL means that this cleaning function doesn’t occur, leaving harmful cholesterol to remain in the blood vessels.</p>
<h2>Increased risk of <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcsite.nsf/pagesvideo/sfe_chd_1?open">heart attack</a> and <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/stroke_signs_and_symptoms?open">stroke</a></h2>
<p>As described above, obesity causes multiple cardiovascular risk factors such as impaired glucose tolerance, high blood pressure and abnormal lipids. These lead to excess fat deposition in the blood vessels, including those supplying the heart muscle and the brain. </p>
<p>When these fatty plaques rupture, a clot forms over them, blocking the vessel and resulting in a heart attack or a stroke, depending on which artery the clot forms in.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/fifDxtxiAyY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>Increased incidence of <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cancer_explained?open">cancer</a></h2>
<p>The increased risk of cancer, particularly of the breast and bowel, with obesity has been documented in several <a href="http://www.nature.com/nrc/journal/v4/n8/abs/nrc1408.html">large surveys</a>. The mechanisms of this link are not yet fully understood and are currently the subject of much research.</p>
<h2><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Liver_disease_fatty_liver_disease">Fatty liver</a></h2>
<p>Excess fat accumulation in the liver can cause damage leading to liver-cell death, and in genetically susceptible people, can even cause <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Liver_problems_primary_biliary_cirrhosis">cirrhosis</a> (end-stage liver disease which requires a liver transplant). </p>
<p>The high prevalence of obesity means that fat-induced cirrhosis is overtaking excess alcohol or viral hepatitis as the commonest cause of cirrhosis. </p>
<p>Researchers are still investigating the mechanisms underpinning the links between obesity and various chronic diseases, but there’s no doubt excess weight poses a serious health risk. Urgent action is needed to halt Australia’s obesity epidemic. </p>
<p><br></p>
<p><strong>This is part three of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong> </p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p>
<p><br></p>
<p><em>See more <a href="https://theconversation.com/topics/explainer">Explainer articles</a> on The Conversation.</em></p><img src="https://counter.theconversation.com/content/7061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joseph Proietto received funding from the National Health and Medical Research Council to investigate the link between obesity and abnormal lipids.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. Today we launch a series looking at how this has happened and, more importantly, what we can do to stop the obesity epidemic…Joseph Proietto, Professor of Medicine, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.