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.
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.