Over the past three decades, the Australasia region has outpaced other regions of the world with the largest absolute increase in [adult obesity](http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60460-8/abstract). Poor diet and high body mass index have overtaken tobacco as the leading risk factors for disease and early death in Australia.
It’s clear that much more needs to be done, but where should we best focus our efforts? Should it be on education and campaigns imploring people to eat better and do more exercise? Or on policy changes that will pull the levers to promote behaviour change at the population level?
The simple answer is that we need to do both. Australia’s world-leading approach to reducing smoking illustrates the power of graphic social marketing campaigns that emphasise the importance of individual behaviour change.
But Australia’s success has come about from combining these powerful and emotive campaigns with hard policies such taxation increases and mandated smoke-free environments, which have worked cumulatively to reduce the prevalence of smoking.
The so-called obesogenic environment is well recognised as a key driver of the obesity epidemic in Australia and globally. If we do not acknowledge the need to fundamentally change our environments to foster healthy lifestyles, it’s unlikely we will see improvements.
We can’t expect this to happen without some dramatic changes to how we approach food policy. While highly processed foods are cheap, aggressively marketed and readily available, we should not be surprised that they make up around one third of the energy in our diets, while vegetable intake continues to fall not just in adults, but also children.
Importantly, we also need to consider that the associated burden of chronic disease falls disproportionately across the population, with those with low socioeconomic status most at risk.
At present the ultra-processed food industry is a major obstacle to meaningful change. They have consistently opposed stronger regulation, including policies that will reduce the consumption of energy dense, nutrient poor, highly-processed products. The industry knows that if people eat less, they make less profit, so oppose policies which will impact their bottom line.
The industry fought the implementation of front-of-pack traffic light labelling and worked to undermine the new star labelling system – which, as a consequence, will be a self-regulatory scheme. Their response to recommendations to regulate unhealthy food marketing by the Preventative Health Taskforce resulted in more self-regulation, which is the equivalent of students marking their own homework.
The charade has been perpetuated by companies continuing to add further layers of complexity, none of which deliver a meaningful reduction in the amount of unhealthy food marketing children are exposed to. The progressive watering down of the voluntary rules means companies can now define Kit Kats and Coco Pops as “healthier” options, appropriate for marketing to children, despite being completely at odds with the recently reviewed dietary guidelines.
Despite this, we are now seeing a growing community awareness of, and opposition to, the industry’s self-serving tactics. In the absence of a national strategy to address obesity we have seen a number of communities fighting to try to stop chain fast food outlets being placed in their towns, including Tecoma in the Yarra Valley near Melbourne.
Many of these efforts have been frustrated by rigid planning regulations that prevent local councils from prioritising the health and well-being of local residents when considering these types of developments. But Victoria and South Australia have established prevention systems which provide resources to local governments, including to Ararat, which was the focus of ABC’s Four Corners earlier this week.
With financial support and commitment from other levels of government, a community like Ararat can support healthy eating and active lifestyles in a range of settings, including schools and workplaces. The community-focused approach empowers local governments to determine approaches that work within their locality and to improve the health and well-being of the families who live there.
These grass roots changes offer hope for the future. But we must invest money and resources to support these types of initiatives and scale up that success – Ararat is just one example.
It would be a triumph of hope over experience to think that we can change the behaviour of Australians without creating environments that make the healthy choice, the easy choice. The deterioration of diets and the continuing rise in chronic diseases has been nothing short of drastic, so it will take equally bold and decisive action to make a real difference to improving the health and well-being of Australians into the future.
We also need to look to government for leadership in implementing the recommendations of the World Health Organization and other bodies to restrict the promotion, availability and price of ultra-processed foods to make a substantive impact. This overdue step would make up the core elements of a national strategy to address excess weight and obesity. We cannot wait – now is the time.