Behind The Medical Headlines

WEIGHING IT UP DOWN UNDER: OBESITY - AN AUSTRALIAN PERSPECTIVE

• Dr A Dunbar, Honorary Senior Lecturer and General Practitioner, Greater Green Triangle University Dept of Rural Health, Flinders and Deakin Universities, Victoria, Australia

Summary

Whilst Australia has been recognised with sporting achievement, obesity levels in Australia are now similar to those in the UK and US. Dr Ann Dunbar provides an overview of attempts to combat obesity in Australia.

Declaration of interests: No conflict of interests declared

Australia is seen as a highly successful sporting nation but paradoxically is succumbing to sedentary activities. The incidence of obesity and overweight is following the same trends as North America and UK.

The AusDiab study surveyed lifestyle factors, socio-economic factors, obesity and the incidence of diabetes between 1999 and 2000. It was a cross sectional study of over 20,000 people from 42 sites throughout Australia, and showed that 67% of males and 52% of females aged 25 and over were overweight, with 19.1% and 21.8% being considered obese. Perhaps even more worrying were the figures from the Sentinel Site for Obesity Prevention in Victoria which reported last year that 26.7% of children aged between seven and eleven are overweight with 7.9% of this total considered to be obese. This compares badly with the national data from 1985 giving figures of 12.1% overweight with 1.7% obese.

A recent report from the Organisation for Economic Co-operation and Development (OECD) ranked Australia fourth in the world for obesity and growing at the fastest rate. As in every other country where obesity is an increasing problem, the healthcare costs for individuals and states mount with the growing levels of associated morbidity. So what has gone wrong in Australia and what is being done about it? The Federal Government has set up a National Obesity Prevention Group and similar initiatives exist at State level. There is no doubt that obesity is much higher on the health agenda now, and increasing amounts of health funds are being directed towards research. This is, as yet, not being translated into significant improvement in the overall figures. The promise of funds by politicians lags behind their delivery, and there is a suspicion that hospital deficits take priority over funding for prevention.

There are local centres of excellence that are having some impact. For instance the Sentinel Sites for Obesity Prevention are seeking to produce effective collaboration between health professionals and the community in order to try and prevent obesity in children. Here and in other areas of Victoria an increase in nutritional advice and back up is helping schools to provide guidance on healthy lunches, and educational sessions for parents are hoping to promote healthier eating patterns at home (Figure 1). School-based programs that promote healthier lifestyles, with increased activity and healthier food choices have been shown to be effective in a controlled trial. However, changes are only sustainable where the input is multifocused. For instance, individual education is provided for both children and parents, together with population-based education, and popular myths about diet and weight gain are addressed and challenged.

Many health professionals would say that maintaining a healthy weight must remain an individual responsibility but when the costs of healthcare provision are considered there must be an onus to help produce a less ‘obesogenic’ environment. To achieve it requires coordinated action involving all sectors of society in a concerted and maintained effort. The health promotion sector is a poor cousin of the global food industry, but unless a partnership can be formed to advertise and promote a healthier diet, society may be the loser. Alternatively, legislation will be needed to limit the marketing of unhealthy food similar to the limitations placed on tobacco advertising and other successful tobacco control policies.

The other side of the equation is of course physical activity. It is clearly important that physical activity be encouraged safely. Convenient public transport would help to reduce the car culture, and urban planners should perhaps give more priority to pedestrians and cyclists. We must encourage our children to be fit and active, but this needs the cooperation of local government, schools and the providers of sporting facilities. Health professionals cannot be effective in isolation. Obesity is as big an epidemic now as infectious diseases were in the past. Waterborne diseases were only eliminated when safe water supplies, sewage control and provision for satisfactory personal hygiene were made available. Similarly, the solution for obesity lies in coordinated action by many public bodies, as well as by properly informed individuals.

There are issues that are perhaps more amenable to action by our profession. The teaching of nutrition within our medical schools has not had high priority and this has allowed the unopposed proliferation of crank diets. If information given by health professionals is not consistent and accurate then people will seek advice elsewhere, and in some instances the advice given may not promote good health in the long term. For instance, many would question the benefits of the Atkins Diet that encourages a low carbohydrate intake. It certainly achieves weight loss but at a cost yet to be determined. Education is not only about giving information in an understandable way it is also about correcting previously held views that are incorrect.

There is no visible quick fix here in Australia. Our problems are mounting but they are being addressed, at least in part. Action is now more coordinated and the problems of obesity are well publicised. Cooperation with local authorities is increasing but with competing agendas, progress is slow. In the past, Australia has sometimes moved from having the worst problems to having the best solutions. Levels of road traffic accidents and smoking provide us with good examples. Seatbelts and random breath testing of drivers were introduced here long before they were in the UK. Smoking rates are among the lowest in the world. All three major effects were brought about through firm government action. Will Australia be first to control the junk food industry?

References

1. Catford JC, Caterson ID. Snowballing obesity: Australians will get run over if they just sit there. MJA 2003; 179(11/12):577-9.
2. Waters EB, Baur LA. Childhood obesity: modernity’s scourge. MJA 2003; 178(9):422-3.
3. Cameron AJ, Welborn TA, Zimmet PZ. Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). MJA 2003; 178(9):427-32.
4. Caterson ID. What should we do about overweight and obesity? MJA 1999; 171:599-600.
5. Planet Health Program Reduces Obesity in Middle-School Girls. Around the School. News and notices of the Harvard School of Public Health. 9 April 1999.