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 considers measures that could work to stop the epidemic while Rob Moodie and Kate Taylor talk about how little the Australian government is doing.
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.
There are lessons from the achievements of the tobacco campaigns and interventions that could be applied to obesity.
Lessons from tobacco
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.
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.
Progressively, the tax on tobacco products has been increased. And, most recently, the government has introduced plain packaging legislation.
In the face of these efforts, smoking rates have plummeted and health has improved significantly.
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 cheaper in terms of calories per dollar 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.
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.
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.
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 “protein leverage hypothesis”.
What could work?
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.
Traffic-light labelling was put forward in the recent excellent government-commissioned report “Labelling Logic”. 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!
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.
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.
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.
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.
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 – urban planning to encourage walking, cycling and the use of public transport and workplace innovations.
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.
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.
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.
This is final part of our series Obese Nation. To read the other instalments, follow the links below:
Part three: Explainer: how does excess weight cause disease?
Part twelve: Putting health at the heart of sustainability policy
Part thirteen: Want to stop the obesity epidemic? Let’s get moving
Part fourteen: Fat of the land: how urban design can help curb obesity