To set the scene for a National Health Summit on Obesity in Melbourne last week, an episode from the satirical political drama, The Hollowmen, was screened, providing a reality-check for the discussions.
The episode, “Fat Chance”, showed a national obesity plan being developed on the run, and significantly downgraded following industry opposition and pressure.
As public health consultant Rebecca Zosel reports below for the Croakey Conference News Service, the episode is likely to provide some useful tips for those seeking to advance key recommendations from the Summit.
Rebecca Zosel writes:
The development of a national obesity strategy is one of six priority areas for action on obesity put forward by a national summit convened recently by the Council of Presidents of Medical Colleges (CPMC).
Representatives of the CPMC will meet with health and shadow health ministers and other political representatives next Monday (November 21) to progress the recommendations from the National Health Summit on Obesity.
The priority areas for action identified at the Summit, held in Melbourne on 9 November, were:
1. Recognise obesity as a chronic illness
Lobby for obesity to be classified as a chronic disease for MBS and diagnostic related grouping purposes, so that doctors and other health professionals can better manage the disease.
Ensure that the government, health professionals and public all recognise obesity as an important chronic disease.
2. Build health professional capacity
Fill the ‘clinical toolbox’ to support the prevention, treatment and management of obesity in the community, including targeted training for health professionals, clinical pathways/clinical practice guidelines and other MBS packages to make medications more accessible and increase equitable access to bariatric surgery.
3. Health professionals lead by example
All medical colleges and practitioners to lead by example and have healthier food and drink available in hospitals and health services, universities and medical college and association facilities, making the healthy choice the easy choice in the places where health professionals live, work and learn.
4. Pre-conception education and care
Introduce a national initiative to provide obesity prevention education and care for all women prior to conception.
5. National obesity strategy
Adopt and implement a comprehensive, evidence-based national obesity strategy, which includes environmental planning.
6. Food regulation and reformulation – implement a sugar sweetened beverage tax
Regulate the food and drink industry by implementing a sugar sweetened beverage tax, using the revenue raised to fund health initiatives that prevent and treat obesity.
Support food re-formulation initiatives that drive changes to the composition of processed foods to improve diets. Food reformulation initiatives have so far aimed at reducing salt, trans-fatty acids, saturated fatty acids, sugars and total energy. Evidence suggests the Health Star Rating Food Labelling System will, amongst other things, motivate food manufacturers to reformulate products and develop healthier products.
Despite the different perspectives and priorities evident at the Summit, delegates reached consensus around these actions.
A draft consensus statement has been prepared and will be finalised this week. CPMC will take the consensus statement, including the six-point plan, to the Australian Government next week.
CEO Angela Magarry said:
The Chair of the Council and members of the Executive will meet with the Assistant Health Minister, Health Minister, shadow Health minister, leader of the Greens and independents on Monday 21 November with obesity one of the top issues on the table for discussion.
As the Prime Minister of Australia told us recently, the challenge with obesity is finding the right set of recommendations which everyone can use and the Council has that set in the six-point plan.”
CPMC will recommend that the Australian Government take urgent action, including the establishment of a national taskforce that comprises at a minimum, all of the experts in the room at the Summit.
The Summit followed a number of obesity-focused events occurring nationally (Australian and New Zealand Obesity Society’s ASM) and internationally (Childhood Obesity Summit, Obesity Week).
It was unique because it was the first time all medical colleges have come together around obesity.
In attendance were the College Presidents and CEOs (from most CPMC members), the Australian Medical Association (AMA), senior government officials, representatives from a number of government bodies including NHMRC and ACSQHC, professional associations, not-for-profit, academia and industry.
Professor Nick Talley, CPMC Chairperson, believes that Australia should lead the world in resolving the obesity epidemic. He was pleased with the outcomes of the Summit, describing it as a “very successful meeting”.
“We came up with six points which we will follow up to ensure that we get some action in terms of helping to both prevent and treat obesity more effectively,” he said.
National leadership needed
Participants recognised that existing work was occurring at the local and state and territory levels, and highlighted the need for national leadership.
Professor Anna Peeters, Professor of Epidemiology and Equity in Public Health at Deakin University, told the Summit:
There has been increasing action on obesity at the levels of state and local government in Australia such as kilojoule labelling and the Live Lighter campaign.
There has also been great leadership from various community organisations, such as a number of hospitals and YMCA Victoria who have gone soft drink free in the past 12 months.
There is now a great opportunity for the federal government to provide leadership at the national level.”
Ms Jane Martin, Executive Manager of the Obesity Policy Coalition, was impressed with the Summit outcomes, but disappointed that tighter regulation of food marketing was not among the nominated priorities.
She said: “I’m pleased to see that the CPMC were bold and brave with their policy asks, although it is disappointing that food marketing is not considered a key issue.”
To demonstrate the need for restricted junk food advertising to children, Martin points to the Happy Meal website in Australia (see screenshot below).
Restricting junk food advertising to children is in line with recent international commitments to act and is the number one priority to tackle obesity for a coalition of 73 leading health and obesity experts in the UK.
It is also in line with WHO recommendations on the marketing of food and non-alcohol beverages to children and their recent call for urgent action to protect children from digital marketing of food
Achieving the six-point plan may not be all clear sailing.
Some immediate tensions around priority actions 1 and 6 were evident in comments from Principal Medical Adviser to the Australian Government Department of Health, Dr Bernie Towler.
Towler gave the impression that mandatory codes of conduct for the food industry are not high on the government’s agenda.
Discussion at the summit addressed barriers to treatment. The question of whether existing MBS chronic disease management item numbers could be used by doctors to help treat patients with obesity, even though currently obesity is not officially classified as a ‘disease’, was debated.
Towler indicated that reclassifying obesity as a chronic disease in the MBS (priority area 1) was unnecessary, and reassured attendees that existing MBS chronic disease management item numbers could be used, as they refer to chronic conditions more broadly.
National obesity strategy
There were strong calls for a national obesity strategy, including from Talley and Professor Andrew Wilson, Co-Director of the Menzies Centre for Health Policy.
Dr Bastian Seidel, President of the Royal Australian College of General Practitioners (RACGP), emphasised the urgency of having a comprehensive approach to tackle obesity.
There are no simple solutions to a complex problem. We can’t just tell our patient to lose weight and to exercise more, that’s just too simplistic.
We need a comprehensive, evidence-based and multi-pronged approach to tackle the growing obesity epidemic now, and not in five or ten years.”
Peeters believes that a national strategy will bring stakeholders together to maximise impact across the care continuum:
There has traditionally been a fragmented approach to obesity advocacy, reflecting the difficulty in achieving any progress at a federal or state level.
Now that we have an emerging number of effective prevention and treatment approaches we need to move to a more cohesive approach, making it clear that all stakeholders understand the need for best practice action on prevention, treatment and management to reduce the burden of obesity for all Australians.”
A recently formed national consensus on obesity prevention, developed by a number of stakeholders (see below), may provide the medical groups with a strong starting point for obesity prevention priorities and action.
The CPMC was broadly supportive of the key elements of the consensus statement, including a tax on sugar sweetened drinks.
A national obesity strategy is high on the agenda of the AMA, which issued a statement just ahead of the Summit, calling on the Federal Government to take national leadership in implementing such a strategy.
Simon Tatz, AMA Public Health Manager, said the AMA strongly supported action on obesity, including a focus on prevention.
He reiterated the AMA’s support for a national obesity strategy (AMA Position Statement on Obesity 2016), and a National Physical Activity Strategy which “would serve as a significant adjunct to the obesity strategy”.
The need for food regulation and reformulation was recognised and included within CPMC’s six-point plan.
The significant international movement around #sugartax was noted (below), and a sugar tax in Australia unanimously supported.
Beyond stigma and victim blaming
The Hollowmen highlights tensions between personal responsibility and societal responsibility paradigms.
Dr Georgia Rigas, GP and Chair of the RACGP’s Obesity Management Network, spoke of the impact of obesity stigma, which results in discrimination and inequitable healthcare access for people with obesity.
Rigas emphasised the importance of using appropriate language, and flagged an Obesity Australia resource Rethink Obesity: A media guide on how to report on obesity.
An explicit commitment to a social determinants of health approach to obesity within the medical group’s six-point plan may be beneficial.
This would reinforce and support practices that are based on an understanding that the widespread occurrence of obesity in Australia is not a failure of individual willpower but a failure of society and a result of the conditions in which we live, work, learn and play.
The Hollowmen’s “Fat Chance” episode highlighted the powerful influence of industry on government policy.
Dr Margaret Chan, Director of the World Health Organization, recently urged governments to muster the political will to take on the food and soda industries, saying: “If governments understand this duty, the fight against obesity and diabetes can be won. The interests of the public must be prioritised over those of corporations.”
Jane Martin flagged the strong public support for the introduction of policy initiatives to support healthy eating, stating that achieving action on obesity is not an issue of public support, but of political will.
Effective policies such as controls on unhealthy food marketing and sugary drink taxes, are strongly opposed by the ultra-processed food industry, together with others who have a vested interest.
Substantial political capital is necessary to implement these types of policies, often resulting in softer, less effective measures being adopted instead.”
A positive outlook was evident at the conclusion of the Summit.
As the immediate Past President of the Australian and New Zealand Obesity Society, I see the recent show of leadership by CPMC on obesity as a very significant step.
Acting on their consensus items of improving the coverage of obesity in medical training, acting to improve access to effective obesity treatments for all Australians, leading by example by improving the food environments in all Australian hospitals and lending their support to advocacy for national obesity prevention strategies such as a sugary sweetened drinks tax will make a substantial difference in our ability to prevent and manage obesity in the coming decade.”
As noted previously, medical groups are powerful allies that can provide leadership and political and social clout in supporting public health responses.
Let’s hope Australia’s response to this pressing public health issue doesn’t mirror The Hollowmen, where an initial six-point plan was downgraded to a two-point plan (an awareness campaign and a voluntary code of conduct) following industry opposition and pressure.
Reporting via Twitter
Health Minister Sussan Ley presented via a video link.
Professor Andrew Wilson examined the evidence surrounding impacts and interventions
Professor Louise Baur presented on health professional education and training, and life course considerations
Professor Tim Gill on lifestyle and behaviours (presented on his behalf by Professor Louise Baur)
Dr Melanie Lowe: Environmental considerations
Professor Anna Peeters: Health research, policy, planning and translation
Jane Martin presented on community engagement and regulatory mechanisms
Professor Joseph Proietto on effective therapies
ABC journalist Sophie Scott facilitated discussions
Discussion and commentary
Final words to The Hollowmen? (Hopefully not)
Thanks to all who participated in the #PreventObesity16 discussion on Twitter (there were more than 4.5 million Twitter impressions and 317 participants from November 1-15). Read the Twitter transcript here.