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Time to tackle obesity, another threat to global health and wellbeing

Introduction by Croakey: Almost 70 percent of Australians are living with overweight or obesity, say experts who are calling for greater action on this looming public health crisis.

While Australia is leading the world in its public health responses to COVID-19 and tobacco use, we remain laggards in addressing the many factors contributing to increasing rates of overweight and obesity, they say.

Their call comes as the World Health Organization last week released an action framework to promote healthy foods in public facilities.

The framework aims to increase the availability of healthy foods, and reduce preventable diseases and deaths from high consumption of sodium and salt, sugars and fats, particularly trans fats. It also seeks to address the inadequate consumption of whole grains, legumes, vegetables and fruit.

“Public places that serve the entire community, including our most vulnerable populations, must be places where healthy diets are promoted not discouraged,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Now is the time for governments to lead by example through ensuring that the food served or sold in public settings contributes to healthy diets and saves lives. No public funds should be spent on food contributing to unhealthy diets.”

In the the article below, a group of Australian experts — Professor Louise Baur of the CRE in Early Prevention of Obesity in Childhood, Professor Timothy Gill of The University of Sydney, Professor Anna Peeters of Deakin University, Divya Ramachandran of the Weight Issues Network, Professor Lucie Rychetnik of The Australian Prevention Partnership Centre, Professor Helen Skouteris of Monash University, and Professor Helena Teede of the Monash Centre for Health Research and Implementation — outline the urgent need for greater action on this public health crisis.


Louise Baur, Timothy Gill, Anna Peeters, Divya Ramachandran, Lucie Rychetnik, Helen Skouteris, and Helena Teede write:

The speed with which humanity has developed promising vaccines against COVID-19 has been truly staggering and is a tribute to international collaborations in science and technology.

But when the urgency of coronavirus begins to subside, we mustn’t forget the even larger health crisis of obesity that is still looming and threatens to dwarf the burden of death and disability caused by the pandemic.

More than 1.9 billion people worldwide now have overweight or obesity. As a result, they are at risk of debilitating chronic conditions such as cancer, cardiovascular diseases, asthma, dementia, and osteoarthritis. As also seen during the pandemic, the higher a person’s BMI, the more complications they are likely to experience from other conditions.

Heightened risk

The Centers for Disease Control and Prevention recently reported that 73 percent of nurses hospitalised with COVID-19 in the United States were affected by obesity, while another study found a COVID-19 vaccine to be less effective in people with a high BMI.

People with obesity are more likely to get very sick or die of influenza; they are more likely to die during surgery or after a car accident than those of a healthy weight.

Yet the conditions in which we live today support and encourage unhealthy dietary behaviours and poor levels of physical activity. The external social, political and economic environment to which we are exposed in our daily lives has a profound effect on the way people live and behave.

Living with obesity

Last month, the Weight Issues Network (WIN) provided a glimpse of what it is like to live with obesity. People with lived experience spoke of the personal costs of living with obesity, the detrimental impacts of shame and stigma, of health systems that are not adequately geared to treat people with obesity, and of an environment that not only aggravates the problem, but acts as a barrier to those trying to improve health.

While those with obesity are stigmatised and blamed for an apparent lack of willpower, we know that in many cases it is their biological predisposition combined with an obesity causing (obesogenic) environment that drives the rise in obesity rates across Australia and the world.

So, when we can find an effective vaccine against a previously unknown virus in less than a year, why are we finding it so hard to prevent and find better solutions and treatment options for obesity?

As public health researchers, we would like to see a shift from the focus on individual willpower to a more coordinated effort to support environments that are conducive to good health.

Today diets are influenced by the wide availability of highly processed, high energy-dense but nutrient-poor foods that are relatively low in price, sold in large portion sizes and aggressively marketed. This has led to a disproportionate intake of what are termed “discretionary” or non-core food and drinks which encourages excess calorie intakes. In addition, we now consume up to one-third of food away from home and eat a large amount of ready prepared foods.

In this environment, just maintaining your weight is difficult and losing weight is a serious challenge.

Massive cost

With almost 70 percent of Australians now living with overweight or obesity and an annual cost to individuals, their families and the economy of an estimated $8.6 billion, action to stem the tide of increasing rates of obesity has never been more critical.

An analysis of the 2011–12 National Nutrition and Physical Survey showed that Australian adults source 35 percent of their energy, and children and adolescents nearly 40 percent of their daily energy intake, from discretionary foods that are high in saturated fat, salt, and/or added sugars.

The current economic system is also a factor as it drives over-consumption and profit growth at the expense of public health.

There are fewer opportunities for physical activity due to changing modes of work, study and leisure. Poor urban design, inadequate cycle paths and limited public transport options discourage people from walking or cycling to destinations and instead promote car use.

Screens and the internet mean we are sitting for longer and our children are spending much less time engaging in physical activity for play.

Parents indicate concerns over traffic as well as stranger safety and so prevent children from playing outside, and an absence of footpaths inhibits walking and cycling to school.

Healthier urban design

We need healthier communities and urban design that both prevents obesity and supports those living with obesity to achieve their goals. That means planning better food outlets, providing adequate and inclusive outdoor facilities, and ensuring that urban design considers the needs of all people, regardless of size, ability or age. And that means supporting parents, especially those affected by economic and social disadvantage, to nurture their children’s growth through healthy eating and activity from birth.

Australia has a world leading track record in public health efforts with COVID, and we are also leading the world in public health efforts to combat tobacco use. Yet we have one of the worst track records in public health efforts around unhealthy weight.

Our community needs leadership and support. We have a clear roadmap to guide us. As we have united as a scientific, policy and practice community in the face of COVID-19, now it’s time to work together to protect Australians against the other threat to global health and wellbeing.

Professor Louise Baur is Director of the CRE in Early Prevention of Obesity in Childhood.

Professor Timothy Gill is Professor of Public Health Nutrition, The University of Sydney

Professor Anna Peeters is Director of the CRE in Food Retail Environments for Health, Deakin University.

Divya Ramachandran is Chairperson of the Weight Issues Network

Professor Lucie Rychetnik is Co-director of The Australian Prevention Partnership Centre.

Professor Helen Skouteris is Director of the CRE in Health in Preconception and Pregnancy, Monash University.

Professor Helena Teede is Director of the Monash Centre for Health Research and Implementation.