Why we’re losing the battle of the bulge: the politics of obesity prevention

Political responses to obesity have been more about creating a spectacle of “doing something” than solving the problem. Bruce A Stockwell

There’s no doubt that obesity has received considerable political attention over the past decade. But data recently released by the Australian Institute of Health and Welfare shows Australians are losing the battle of the bulge, with the proportion of overweight and obese Australians rising from 56% in 1995, to 61% in 2007-08.

Most policy responses have focused on downstream interventions such as social marketing campaigns and funding for school and community programs. But although important, these are expensive responses unlikely to make a dent in obesity levels.

Few policies that target the upstream drivers of the problem and reduce the toxicity of the food environment – such as bans on junk-food marketing to children, effective front-of-pack food labelling and taxing unhealthy products – have received political support.

One might argue therefore, that political responses to date have been more about creating a spectacle of “doing something” rather than actually solving the obesity problem. The question is why.

Obesity as a political challenge

Obesity has been called the “climate change of public health” and a “brilliant test of political capability”. And rightly so. Tackling the upstream causes of obesity challenges the interests of powerful industries (food, beverage and advertising). It requires interventions across multiple policy sectors (education, health, media and finance) at multiple levels (local, national and global).

The complexity of the problem means there is a long list of experts and stakeholders who must be consulted in the policy development process.

Compared with tobacco, which has 30 years of concerted research, advocacy and regulation behind it, obesity is also a relatively “young” social issue, receiving political attention in only the previous decade (see below).

Political attention to obesity (and related issues), measured by monthly frequency of Federal Parliamentary Hansard records containing each word.

It takes time for advocates to mobilise cohesively around the issue and generate the political support needed for change. It’s less a question of whether that change will eventuate. It’s more about how soon.

Research bias, evidence and policy

A historical bias towards more technically feasible and less politically contentious clinical and settings-based research reinforces the idea that obesity results from the poor choices of individuals rather than an increasingly obesogenic environment. This has also resulted in a scarcity of evidence to support many upstream interventions.

The federal government has de-prioritised obesity by applying this logic. The script reads: “more evidence is required before taking action”. But this is a classic chicken or the egg problem. Will junk-food marketing restrictions reduce childhood obesity? It’s very difficult to design an experiment to rigorously answer this question, without implementing the policy first.

And in research, no number of positive outcomes can confirm a scientific theory (take, for instance, that marketing unhealthy foods and beverages contributes to the childhood obesity problem). But in politics, a single non-scientific counter example can be logically decisive (Quebec and Sweden have marketing bans with no decline in obesity).

The proportion of overweight and obese Australians rose from 56% in 1995, to 61% in 2007-08. Ann Gordon

Governments must instead enact policy by enlisting both evidence-informed as well as values-based justifications and by drawing parallels to successful responses to other public health epidemics (such as tobacco), as well as learning from developments overseas.

This is known as “action-orientated” policy-making, where evidence emerges from the acts of implementation and monitoring of effects.

Such an approach is still informed by the best available evidence, but also gives considerable weight to community values. Importantly, the preference is for “doing something” rather than waiting for the evidence.

Framing competitions

Obesity, like most social problems, involves debates over liberties. At what point should governments restrict the freedoms or autonomy of some (the food and beverage industry) to protect the health of others (the public)? This involves framing competitions about what and who causes “harm” and, therefore, who should be responsible for fixing the problem.

The marketing of junk food, for example, is considered by public health advocates as harmful to the health and rights of children, while restrictions are considered by industry as harmful to commercial freedom, jobs and economic growth. The former also highlight the economic costs of obesity, harms to health and the contribution of obesity to social inequalities. The latter uses “slippery slope” language, framing industry – and the income and jobs that they provide – as vulnerable if regulation is imposed.

The powerful nanny state metaphor is also deployed to override political reason, by conjuring the idea of government as a coddling nanny restricting individual (but in reality, commercial) freedoms, and denying the responsibility of parents.

Effective front-of-pack food labelling is needed to tackle the upstream drivers of obesity. ijclark

The economic clout of the food and beverage industry makes their arguments particularly powerful, especially when they talk about protecting the livelihoods of rural and blue-collar communities in times of financial crisis.

The paradox of industry culpability

As with tobacco, highlighting industry blame can accelerate public support for action, uniting advocates and shifting blame away from the individual. Yet with obesity, motivating political support in this way is problematic. Unlike smoking, everyone eats. Public health advocates are not talking about the termination of an entire industry – only the unhealthy parts.

Industry can, therefore, be both a part of the problem and part of the solution. And industry groups recognise this. Companies have diversified their product portfolios, implemented social responsibility campaigns, and pre-emptively “self regulated” their marketing, food labelling and reformulation activities. These actions are a powerful delay tactic, and lessen the appetite of government to implement stronger regulation.

A political platform for change

The government has deferred many tough decisions about obesity to regulatory agencies or reviews – the children’s television standards review and the Henry tax review are just two examples of non-health actors favouring economic rationalism, rather than public health outcomes, in their decision-making frameworks.

Many Australian policymakers firmly believe personal responsibility is the main solution to the obesity issue. While few deny the role of the individual, such emphasis detracts from the role of government in protecting public health and doesn’t align well with addressing the upstream causes of the problem.

The voices of political advocates like former health minister Nicola Roxon and former senators Guy Barnett and Bob Brown must be buttressed, rather than drowned out by a chorus of opposition.

It took decades for similar views to change about tobacco and so the same might be said for obesity. Beliefs and norms among our policy leaders must shift, in order to create a supportive platform for change.