Australia has plenty of ideas to tackle obesity. Can we put them into action?

Obesity

Weight is a big problem for Australia. 

Two-thirds of adults and a quarter of children are overweight or obese, and if nothing changes those numbers are projected to rise.

“Rise” is the cold-blooded way to put it. “Skyrocket” might capture the scale a little more clearly. Skyrocketing weight means skyrocketing risk of illnesses — among them diabetes, heart disease, some cancers — and early death, which means skyrocketing health costs, estimated to run to almost $100 billion by 2025.

The understandable reaction to those kinds of statistics is Oh my god! Why isn’t anyone doing anything about it?!

Well, they’re trying.

In December 2018, a senate committee tasked with exploring solutions to the obesity “epidemic” published its final report. Based on submissions from dozens of health experts and food industry advocates, it recommended 22 policies aimed at reversing — or at least halting — the obesity trend.

Those policies include changes to how food is formulated, labelled and advertised, especially to children; a tax on sugar-sweetened beverages; and the foundation of a national taskforce to combat obesity.

“It’s a very good report… it’s strong and evidence-based. It’s great to see,” says Jane Martin, executive manager of the Obesity Policy Coalition (OPC), which advocates for practical and robust solutions to obesity.

Eight of those solutions are outlined in Tipping the Scales, a report OPC published in 2017 that broadly aligns with the senate committee’s recommendations.

The report is backed by almost 40 major public health, medical, community and academic groups — including the Heart Foundation, the Cancer Council and Nutrition Australia — in a remarkable show of unity, given such groups have historically been criticised for an apparent failure to agree on anything.

“Tipping the Scales shows there is widespread consensus among public health and research and community groups around what needs to be done [to prevent obesity],” Martin says. “That’s come through very strongly in these [senate] recommendations.”

(I put it to Martin that Tipping the Scales is the public health equivalent of the Avengers — ragtag groups coming together to take on an enemy they couldn’t conquer solo. “Exactly,” she laughs. “That’s how I like to think of it.”)

RELATED: More than two-thirds of Australians are overweight or obese

The World Health Organisation deems obesity one of the most serious public health challenges of the 21st century, asserting that its fundamental cause is “an energy imbalance between calories consumed and calories expended”.

To many, that’s interpreted as “If you’re obese, it’s your own fault for eating too much and moving too little” — a stance adopted by many politicians.

“The only person responsible for what goes into my mouth is me,” said Tony Abbott in 2006, when he was Minister for Health. Queensland MP George Christensen, who had most of his stomach surgically removed in 2017 to help him lose more than half of his then-176kg weight, blamed it on his own “poor eating choices and exercise choices,” reported the Courier-Mail.

It’s certainly true there are many things people can, and should, do to manage their weight (and myriad reasons they don’t). But it’s crude to peg obesity as just a personal responsibility problem caused by gluttony, sloth and too little willpower.

Saying two-thirds of adults are overweight because they ate too much is like saying a tennis pro lost a match because she didn’t score enough points. It’s true, but it’s absurdly simplistic.

“[Obesity is] simple in one way in that people are eating too much. But the reasons for that are complicated,” Martin tells Coach.

“Yes there is individual responsibility, but we have to stop blaming the individual and look to why people behave in the way that they do.”

The prime recommendations of the senate report are changing the way we talk about obesity to “avoid stigma and blame”, reasoning that framing the problem that way makes it harder to tackle.

“[Obesity] is a problem faced by millions of people, and it’s not that they’ve all lost their willpower,” Martin says. “Everyone hasn’t just decided to sit on the couch! There are a much deeper societal forces at work, and they’re what need to be unpicked.”

Here’s one example of those deep societal forces: our lives — our jobs, our means of transportation — don’t demand a lot of physical activity. Ancient humans needed to move to meet their basic survival needs; the opposite is true of modern humans. Even those us who exercise frequently are still, on the whole, pretty sedentary.

RELATED: Don’t blame sugar or laziness for the obesity epidemic — the real culprit is way more complicated

And here’s another, more insidious example of those forces:

What foods are next to the registers at your supermarket? Likely to be deeply discounted? In the vending machines at your workplace or school? Advertised on prime time TV and during major sporting events? Easy to get delivered to your door at any time of day? Offered as snacks on planes?

It’s unlikely to be the foods the Australian Dietary Guidelines want you to eat a lot of. It’s very likely to be the foods those guidelines want us to eat little of — ultra-processed, cheap, convenient discretionary foods that corporate giants scientifically craft to activate your brain’s most primitive receptors, driving you to eat as much of them as possible.

(A side note. In fairness, I was offered an apple on a recent midmorning Qantas flight… but only after I turned down the cookie.)

Discretionary food — the polite term for junk food — is everywhere. It’s so pervasive it’s invisible. And that omnipresence didn’t just happen:  the food industry has deliberately constructed a system where less nutritious choices are easy, and more nutritious ones are hard.

“We’re all making decisions all day every day about food, and a lot of that is shaped by our environment,” Martin says. “You’re choosing [what you eat], but you’re choosing between a lot of unhealthy things which are cheap and quick and easy.”

She dubs the food industry as “one giant nudge unit” — shove unit is probably closer to the reality.

“We’re being nudged in directions without really being aware of how that is happening, and we are being persuaded and pushed and influenced.”

The food industry not only influences you, but public health policy — such as health star ratings, a food labelling system delayed and stymied by the industry’s role in its development. The current health star ratings are useful, but greatly diluted by the fact they’re not mandatory, so food manufacturers can choose to omit them from low-scoring products. (Both the senate obesity report and Tipping the Scales push for mandatory health stars.)

RELATED: Health Star Ratings, explained

Martin says food industry influence is also the reason it’s taking so long to have added sugar documented on nutrition information panels (another of the senate report’s recommendations) — something manufacturers claim is just too difficult to calculate.

“If you make something, know how much sugar is in it. You have a recipe, work it out,” says Martin. “How hard is it just to get something simple like that? Everything is very difficult and very slow. [The food] industry complicates it and slows it all down and muddies the water and the science.”

RELATED: Australians have no way of telling how much added sugar is in our food. That’s likely to change

Martin has a background in tobacco control, and says she moved into obesity policy when she started to see parallels in the food industry — particularly the influence junk food advertising had on her children and their everyday lives.

She recalls a fast food giant’s sponsorship of her daughter’s school basketball team, and how she was deemed a “fun sponge” when she objected.

“But I didn’t want to be made the fun sponge!” she says. “The food industry made me a fun sponge.”

Cancer Council NSW analysis shows children are exposed to three junk food ads per hour of television they watch — and that’s just TV. Every parent will relate to this PSA made by Cancer Council Victoria (one of the founding partners of the Obesity Policy Coalition) which spotlights how pervasive marketing to children is.

“It’s a junior version of the tobacco industry, targeting kids instead of adolescents,” Martin says. She believes it’s become much worse in the last decade as that marketing has progressed into the digital and social media space — where it’s subtler, and parents often have little clue what their offspring see.

“Macca’s and Kinder Surprise have these apps, and it’s all advertising dressed up as fun and entertainment for kids” she says. “Even if you think the Kinder Surprise game is fun and interesting, it’s better for your child not to be exposed to that marketing. It rubs off and gets into their heads and you want to protect them from that.”

RELATED: Yep, junk food advertising probably makes teenagers (and everyone else) eat more junk food

I think it’s fair enough the food industry does its best to sell us food — that’s capitalism, right? But it doesn’t follow the food industry’s efforts to sell food (and the big consequences that has for obesity) should go unchecked, or that it should be trusted to self-regulate, which Martin calls a “charade”.

“They set their own rules, making up their own exam, giving themselves 100 percent,” she says. “It’s so frustrating.”

RELATED: Tax sugary drinks, urge health experts

Proposals to dampen the food industry’s influence (particularly proposals to introduce a sugar tax) are typically countered with the ol’ nanny state argument, implying it’s not the government’s role to smack soft drinks and hamburgers from our hands.

“But you have to strap your child into a car seat. No one is fighting against those things to protect children in a car,” Martin says. “So why aren’t we protecting children when they’re at home with their family from these corporate influences?”

She adds that polling shows a high level of public support for government interventions, including a sugar tax.

RELATED: The truth about the obesity paradox

Taxing unhealthy food, banning junk food advertising to kids, promoting more physical activity, a national strategy to do something about obesity — each solution is so obvious it makes you wonder, Why hasn’t anyone done this already?

Well, they’ve tried.

In 2009, a preventive health taskforce set up by Kevin Rudd proposed pretty much exactly those measures to combat obesity. Three years later, that taskforce was derided as “a wasteful failure” — the federal government had ignored, or didn’t have the political will, to implement its core strategies.

Despite the strength of the 2018 senate report, it may be doomed to the same fate.

This Sydney Morning Herald report documents the political back-and-forth leading up to the release of the senate committee’s recommendations — many of which aren’t even backed by the whole committee (which is chaired by Greens senator Richard di Natale). It would be funny, if it was an episode of Veep. In real li`fe, it’s depressing.

“The irony is it’s not that the solutions [to obesity] we lack,” Martin says. “It’s the implementation of those solutions that is the main problem.”

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But she’s cynically hopeful the senate report’s recommendations will be implemented — because the public and social costs of obesity will eventually override the food industry’s power, in the same way the public and social costs of smoking conquered the tobacco industry.

“[Tobacco regulation] did happen, and [it was] quite a politically challenging thing to do,” she says.

At the very least, some degree of national obesity strategy is coming: at a Council of Australian Governments meeting in October, Senator Bridget McKenzie announced an obesity summit, to be held in Canberra on February 15.

Martin says a national strategy is urgently needed to build on the smaller-scale strategies already implemented by many state, territory and local governments

“They’re doing what they can but there are levers they just cannot push, and it’s undermining their investment and commitment,” she says. “Making the healthy choice the easy choice takes a lot of change at a lot of different levels, and the commonwealth level is one.”

RELATED: Get squatting, lunging and pressing to combat childhood obesity

What’s clear is that there is no single solution to obesity (especially not one as simple as telling people Just eat less!), because there is no single cause. The dozens of contributing factors are documented in the oft-cited obesity system map developed in 2007 by the UK government’s Foresight project, which looks like giant bowl of dropped spaghetti.

It’s dizzying. But a complex problemis not the same as an impossible one.

“Often complexity is used as an excuse not to act,” Martin says. “Although there’s complexity I think a lot of the [obesity] solutions haven’t been implemented. The harder stuff we haven’t tried yet, such as really protecting children from junk food marketing.”

She argues that although the trajectory of obesity will be hard to slow, and harder to reverse, anything that even slightly changes people’s behaviour will help.

“It’s taken [the food] industry 30 years to create this problem. It’s not going to turn around in a couple of years,” she says. “We have to change [people’s] behaviour, which is challenging, but things like taxes work, and we’ll see an impact on trends over time.”

Losing weight is tough for an individual. People often lament that they don’t know even where to begin, but almost every health expert recommends starting with small, practical steps — making minor changes, and building on them.

I put it to Martin that losing weight for a population is kind of similar — that Tipping the Scales and the senate committee’s report offers small and practical recommendations, scaled up for an overweight society.

“Breaking down what we have to do for government and individuals helps to simplify it a little bit. Then it’s not such a big, insurmountable problem,” she says.

“Small things combined can be very powerful. They can be powerful in a bad way and they can be powerful in a good way.”

[“source=coach.nine.com.au”]