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Lessons for Australia from US reversal of childhood obesity

Childhood obesity prevalence is alarmingly high in many developed countries; in Australia, one in four children is overweight or obese, while in the United States, it’s one in three. But recent American…

Prioritising physical activity and healthy eating is having a positive impact on childhood obesity in the United States. Korean Resource Center/Flickr

Childhood obesity prevalence is alarmingly high in many developed countries; in Australia, one in four children is overweight or obese, while in the United States, it’s one in three. But recent American data shows this number is falling for the first time in 40 years.

The data suggest that US actions for obesity prevention are working. And it highlights the need for Australia to take comprehensive action if we want to see similar decreases.

Small declines in obesity among schoolchildren have been observed in 11 US cities, counties and states. And data from almost 12 million low-income preschoolers also shows declines in obesity in 19 US states, while obesity rates in a further 21 states remained steady.

Obesity inequality

Collecting data for low-income groups is important; in both the United States and Australia, obesity is more common among people with lower income and access to fewer educational and environmental resources.

While even a small reduction in obesity prevalence in children is good news, the changes in the US have not been equal across the population. In a number of the US jurisdictions reporting decreased childhood obesity, there has been less or no progress among minority groups and the poor.

The reasons for this are likely to centre on structural barriers to better eating, faced by people with low income and low education levels, who live in more disadvantaged areas.

We know, for example, that there are more unhealthy food stores and unsafe parks in more disadvantaged neighbourhoods in the US. The drop in obesity in some low-income preschoolers is likely due to the combination of strategies aimed at people with social disadvantage, with broad structural changes (such as school nutrition standards) that can reach all children.

One example of the US success is the state of Mississippi, which did exactly that. Since community leaders introduced a raft of measures to prioritise physical activity and healthy eating, obesity prevalence among schoolchildren has fallen from 43% to 37%.

In 2003, the state’s department of education created an office of healthy schools to implement coordinated school health programs. This led to nutrition standards for food sold in school vending machines in 2006. The following year, standards were set for physical education and school meals, snacks and drinks.

The state’s actions were set against a background of federal initiatives, including improved nutritional standards for school lunches and breakfasts and a nutrition program for women, infants and children.

Good eating habits from a young age are important. Coqui the Chef/Flickr

But even in Mississippi the difference in obesity prevalence between black and white students has increased in recent years.

What’s being done in Australia?

In Australia, federal initiatives are restricted to support for social marketing, unaccompanied by broader structural policies. Indeed, a recent study of government school canteens showed only half of them met nutrition recommendations.

This approach risks continued increases in childhood obesity and a widening of social inequalities in obesity.

Some states have used the funds provided through the COAG national partnership agreements on preventive health for a broad range of obesity prevention initiatives.

The strengths of approaches such as Healthy Together Victoria and OPAL in South Australia are that they combine system-wide policy with numerous complementary local activities, addressing both activity and nutrition in a range of settings.

Healthy Together Victoria acts in 12 areas to provide a range of healthy lifestyle initiatives in children’s settings, workplaces and communities. OPAL is active across 20 South Australian communities, and combines health information messages with local changes such as improved nutrition in sporting facilities.

We expect to see obesity prevalence among children in the target communities remaining the same, and possibly even decreasing. But we could expect to see greater and more equitable effects if Australia had mandatory standards supported by nationwide policies.

Child and adolescent obesity rates are still unacceptably high in the United States, and the observed decreases are small. But new data suggests they are applying brakes on the obesity epidemic.

It’s critical to recognise that the reversal is the result of very large, broad and intensive obesity prevention efforts.

The Australian government needs to throw its weight behind state obesity prevention initiatives if we are to follow in the footsteps of the United States. It’s time for us to develop policies to enforce nutrition and activity standards in the key childhood settings.

Join the conversation

11 Comments sorted by

  1. rory robertson
    rory robertson is a Friend of The Conversation.

    former fattie

    One important part of the forward on this matter is to correct or retract self-published and nonsense-based Group of Eight university "science" papers seeking to exonerate sugar as a key driver of obesity, starting with this one: http://www.australianparadox.com/

    Perhaps the University of Sydney could be more careful about giving PhDs to people who are not very good at basic maths and struggle to know the difference between up and down (Section 2 in the link above).

    This all matters because…

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    1. rory robertson
      rory robertson is a Friend of The Conversation.

      former fattie

      In reply to Rory Cunningham

      It is not spam, Rory C.. It is part of a determined effort to try to lift the quality of Australia's scientific record, Group of Eight quality control in research, dietary advice and public health. I'm sorry if you are not enthusiastic supporter of my efforts.

      In any case, I assume that ongoing public exposure of an outrageously faulty paper that was self-published by highly influential yet unreliable and highly conflicted scientists increases the chance that someone influential at the University…

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

    architect

    Good to see a change in direction.
    I believe we must have government intervention in turning the tide.
    The food and health industry is a very big player in our nations and is well entrenched vested interest players with the ear of governments.
    Individual action, people taking their health and diet into their own hands, has been until now the only way to make a difference, because they read the evidence and not just accept the propaganda from vested interests and, to their shame, the government itself.
    The poor and disadvantaged do not get to see they are being manipulated.
    Lack of experience with real foods are not foreign to poor from the land but the situation is more difficult for the urban poor.
    That's where government can help, and it needs to.

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  3. Barry Nicholson

    Engineer

    People with lower incomes...? Have you not seen pictures of Clive Palmer?
    The central issue is that people who are not obese due to a medical condition are lazy/don't want to take the time to learn basic cooking/want instant gratification/have no will power/like sugar & fat/were never taught nutrition/ or any combination of the above. Good food is not expensive.

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    1. rory robertson
      rory robertson is a Friend of The Conversation.

      former fattie

      In reply to Barry Nicholson

      Barry, most people who are overweight are not particularly lazy or lacking in "will power". They simply have been eating and drinking the wrong foods and drinks. They have been doing that in large part because modern nutrition "science" incompetently forced us down the profoundly unhealthy low-fat/pro-carb/pro-sugar path.

      It really is extraordinary that spectacularly faulty papers on nutrition can be self-published and recklessly defended by "scientists" at the highest levels of Group of Eight "science", in this case negligently seeking to exonerate harmful sugary drinks as a menace to public health: http://www.australianparadox.com/

      Barry, you are an engineer. Any thoughts on how "scientists" managed to "find" that the four charts in the link above trend down not up?

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    2. Barry Nicholson

      Engineer

      In reply to rory robertson

      Hi Rory,
      well I'm not sure this, probably pretty obscure, paper has much influence on what people eat, but I can guess that the authors are being very creative in their analysis. I note their defense regarding the distinction between available sugar and consumption may be valid, but then there is no data in their paper which supports their conclusion (on the issue of four-fold and five-fold, I think they are using the term to mean an increase from the original amount, so four-fold increase is 5…

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    3. rory robertson
      rory robertson is a Friend of The Conversation.

      former fattie

      In reply to Barry Nicholson

      Thanks for coming back, Barry. This is a big issue for me, because to me it seems obvious that excess sugar consumption - including via sugary softdrinks - is at the heart of the disastrous trends towards obesity and type 2 diabetes in the US, Australia and pretty well everywhere else: http://care.diabetesjournals.org/content/33/11/2477.full.pdf

      That's why I am proposing a ban on all sugary drinks in all schools across the world. (That's all!): http://www.australianparadox.com/pdf/Sugary-Drinks-Ban.pdf

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    4. Barry Nicholson

      Engineer

      In reply to rory robertson

      Hi Rory, yes your passion for the subject comes through loud and clear. I would just caution that the best way to introduce change is gradually and in a positive way, otherwise you may come across as untrustworthy.
      A lot of people's livelihoods depend on sugar, including in some of the poorest countries, so focusing on one aspect of an issue may miss the opportunity to introduce change by ignoring the critical barriers.
      When I went to school we all had to drink ("free") milk, for example - was that a good thing?

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    5. rory robertson
      rory robertson is a Friend of The Conversation.

      former fattie

      In reply to Barry Nicholson

      Barry,

      I'm not sure how you came up with the idea of "untrustworthy". My name is on everything I write, and I've been chipping away for 18 months. My critique of the University of Sydney's pro-sugar "research" is unscathed, because what I write is factual, if a little long-winded.

      My main argument is that the University of Sydney should correct or retract its outrageously faulty paper seeking to exonerate sugary softdrinks as a key driver of global obesity. Here's further graphic evidence…

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  4. George Papadopoulos

    logged in via LinkedIn

    "One example of the US success is the state of Mississippi, which did exactly that. Since community leaders introduced a raft of measures to prioritise physical activity and healthy eating, obesity prevalence among schoolchildren has fallen from 43% to 37%."

    Perhaps the methods used in Mississippi were not optimal, but a reduction of obesity from 43 to 37% is not that significant. It is a strong hint that there are other factors behind childhood obesity that are not being addressed/explored.

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