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An evidence-based five-point plan to tackle child obesity in Australia

Few challenges are a greater threat to the health of Australians than obesity. Weight gain has now become the norm—the biological and social path of least resistance. Within a decade and without significant government intervention, more Australians are expected to be obese than normal weight.

Opportunities to stem the tide of obesity do exist – we have the evidence and largely we know what to do. Here is an evidence-based five-point policy plan, a lifeSPANS approach, that focuses on our kids to move the health agenda forward.

Obesity is a complex problem, caused by many inter-connected factors including genetics, our environment and our access to, as well as affordability and awareness of, healthier choices.

Over the past century, our food systems and environments have shifted from a focus on seasonal, fresh and relatively calorie-poor staples with minimal processing or meat, to ones where junk foods and processed foods are ubiquitous, heavily advertised, hugely profitable and for many communities arguably the only feasible “choice”.  As a result, poor nutrition is now the leading risk factor for disease in our country.

Fewer than 4 per cent of Australians are eating according to the Australian Dietary Guidelines and it’s no longer possible to balance this high energy diet with increased physical activity alone. At the same time, city living has come with many benefits, but increasingly automated and digitalised lifestyles have seen physical activity become something that must be sought out rather than an unavoidable component of daily lives. This complexity means it’s not enough to focus on individual behaviour change without taking into account the environment that supports or inhibits that change.

The answer to obesity will never be in telling people what to do, guilting them for making unhealthier choices in a confusing consumption landscape, or by simply banning things. We also know that education and knowledge will get us only so far. The real answers lie not even in inspiring populations to make hundreds of healthier decisions each and every day in the face of a seductively obesogenic, social milieu.

If we are to drive long-term, sustained and scalable change, we must tweak the system to ensure those healthier choices become the path of least resistance — and eventually preferred.

Australia currently spends more than $2 billion on preventive health each year or around $89 per person. The argument is often made that we should increase spending on preventive health. But research conducted by the Australian Prevention Partnership Centre has shown that the question is not only how much we spend, but also where we target that spending.

Opportunities to stem the tide of obesity do exist – we have the evidence and largely we know what to do. Here is an evidence-based five-point policy plan, a lifeSPANS approach, that focuses on our kids to move the health agenda forward.

Schools as platforms for health

Schools alone cannot solve the child obesity epidemic; however, it is unlikely that child obesity rates can be reversed without strong school-based policies to support healthy eating and physical activity. Children and adolescents consume 19-50 per cent of daily calories at school and spend more time there than in any other environment away from home. Evidence suggests that “incentives” are unlikely to result in behaviour change, but peer pressure might. Therefore, learning among friends offers a unique opportunity to positively influence healthy habits.

Providing free, healthy school meals, including more fruit and vegetables, results in improved knowledge of a healthy diet, healthier eating at home and improved school performance. Providing meals to all children supports low-income families and helps address health inequalities and stigma. We also need to remove sugary drinks and junk foods from remaining school canteens, ensure food and cooking education is a mandatory and supported component of curricula nationwide, and provide the school infrastructure necessary to support healthier habits.

Pricing that’s fair to families

Today’s food environment sees increased availability of lower cost, processed foods high in salt, unhealthy fats and added sugars. People have less time to prepare meals and are influenced by aggressive food marketing. This leads to food inequality, with those from low socio-economic backgrounds at greater risk from obesity and other related chronic diseases.

Food prices should be adjusted in relation to nutritional content. Policymakers must shift their pricing focus to reflect the true cost to society of products that contribute to chronic disease. Legislating, for example, to introduce a sugar tax, would encourage industry to reformulate products and make the whole food environment healthier as well as unlock crucial funding for healthcare and prevention programmes which should focus on lower-income families. Such pricing policies are not sin taxes or bans, they represent effective policies and a pricing approach that is fair. They are also backed by evidence and supported by the public.

Advertising that supports our kids

The food industry knows that marketing works, otherwise they would not spend almost $400 million annually on ads in Australia alone. Three of four commercial food advertisements are for unhealthy products and evidence suggests that food advertising triggers cognitive processes that influence our food choices, similar to those seen in addiction. Studies also demonstrate that food commercials including the use of cartoons influence the amount of calories that children consume and the findings are particularly pronounced in overweight children. Fast food advertising at sporting and arts events further reinforces a dangerous and confusing notion that sees the direct association between societal heroes or elite athleticism and the unhealthiest of foods. Ending all junk food advertising to children, including any use of cartoons in the advertisement of food and drinks, is an important step to support our kids.

Nutrition labelling that makes sense to everyone

Nutritional information can be confusing for parents, let alone children. Food packaging often lists nutritional information in relation to portion size, meaning a product with a higher figure may simply be larger rather than less healthy. While the Health Star Rating system, implemented in 2014, has made substantive progress, it remains voluntary. Efforts should be made to make food labels easier to understand and make consistent, evidence-based and effective labelling mandatory. This has been done in many countries and would provide stronger incentives for manufacturers to reformulate products, reducing sugar, fat and salt content. Clearer and consistent information would help support families to make informed choices about their food.

Supply chain systems as solution-catalysts

Coordinated strategies are needed to make lower cost, healthy foods available for all communities. Cities and large organisations such as schools and hospitals could collaborate to purchase food as collectives, thus driving demand, building markets and market size and improving economies of scale. By leveraging collective purchasing power, institutions can catalyse the availability of sustainable and healthy foods to also support wider, positive food environment change.

LifeSPANS approach

Solving our fulminant health crisis resulting from obesity is complex – but this complexity cannot be an excuse for political and societal inaction. A LifeSPANS approach provides a simple framework based on evidence to further action to protect the health of our most vulnerable, our kids.

This story first appeared on John Menadue – Pearls and Irritations 

Alessandro Demaio

Dr Alessandro Demaio, or Sandro, trained and worked as a medical doctor at The Alfred Hospital in Australia. While practicing as a doctor he completed a Master in Public Health including fieldwork to prevent diabetes through Buddhist Wats in Cambodia. In 2010, he relocated to Denmark where he completed a PhD with the University of Copenhagen, focusing on non-communicable diseases. His doctoral research was based in Mongolia, working with the Ministry of Health. He designed, led and reported a national epidemiological survey, sampling more than 3500 households. Sandro held a Postdoctoral Fellowship at Harvard Medical School from 2013 to 2015, and was assistant professor and course director in global health at the Copenhagen School of Global Health, in Denmark. He established and led the PLOS blog Global Health, and served on the founding Advisory Board of the EAT Foundation: the global, multi-stakeholder platform for food, health and environmental sustainability. To date, he has authored over 23 scientific publications and more than 85 articles and blogs. In his pro bono work, Dr Demaio co-founded NCDFREE, a global social movement against noncommunicable diseases using social media, short film and leadership events – crowdfunded, it reached more than 2.5 million people in its first 18 months. Then, in 2015, he founded festival21, assembling and leading a team of knowledge leaders in staging a massive and unprecedented, free celebration of community, food, culture and future in his hometown Melbourne. In November 2015, Sandro joined the Department of Nutrition for Health and Development at the World Health Organization’s global headquarters, as Medical Officer for noncommunicable conditions and nutrition. From 2017, he is also co-host of the ABC television show Ask the Doctor – an innovative and exploratory factual medical series broadcasting weekly across Australia. Sandro is currently fascinated by systems-innovation and leadership; impact in a post-democracy; and the commercial determinants of disease. He also loves to cook.

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