Late last night, the House of Reps Standing Committee on Health and Ageing released its report on the inquiry into obesity in Australia, called Weighing it up: Obesity in Australia.
It has taken a safe line on food industry regulation, calling for a “phased” approach, urging that self-regulation be the first option, and that there should be government intervention only if that fails. This was despite hearing evidence that self-regulation is already failing to provide a healthy food supply.
It also seems to put quite a bit of weight, pardon the pun, on obesity treatment rather than prevention, at least judging by the recommendations and their ordering.
The most interesting recommendation is the suggestion that tax incentives be used to improve the affordability of fresh, healthy food and access to physical activity programs for all Australians, particularly those living in rural and remote areas.
In brief, the report calls for:
• economic modelling in order to establish the cost implications of obesity and the cost-benefits of various interventions
• regular and ongoing surveillance and monitoring of Australians’ weight, diet and physical activity levels, and that the data gathered is used to formulate, develop and evaluate long-term policy responses
• national, territory and state governments to work through the Australian Health Ministers’ Advisory Council to develop and implement long- term, effective, well-targeted social marketing and education campaigns about obesity and healthy lifestyles, and ensure that these marketing
campaigns are made more successful by linking them to broader policy responses to obesity
• the Committee recommends that the Minister for Health and Ageing continue to support the Federal Government’s Active After-school
Communities program and consider ways to expand the program to more sites across Australia
• public funding for bariatric surgery, including multidisciplinary support teams, for those patients that meet appropriate clinical guidelines.
• develop a national register of bariatric surgery including data on the number of patients, the success of surgery and any possible complications
• obesity should be put on the Medicare Benefits Schedule as a chronic disease requiring an individual management plan
• explore ways that GPS collate data on the height and weight of their patients, and the data be utilised to generate statistics on the level of obesity in Australia
• AHMAC consider adopting a tiered model of health care for obesity management, incorporating prevention,community-based primary care and acute care
• the Treasurer and the Minister for Health and Ageing should investigate the use of tax incentives to improve the affordability of fresh, healthy food and access to physical activity programs for all Australians, particularly those living in rural and remote areas
• the Minister for Health and Ageing commission research into the effect of the advertising of food products with limited nutritional value on the eating behaviour of children and other vulnerable groups
• the Federal Government use the results of the Food Standards Australia New Zealand food labelling review to create a set of standard guidelines to ensure that food labels provide consistent nutritional information. Using these guidelines the Federal Government should work with industry to develop and implement this standardised food label within a reasonable timeframe.
• he Committee recommends that the Federal Government work with all levels of government and the private sector to develop nationally
consistent urban planning guidelines which focus on creating environments that encourage Australians to be healthy and active
• the Minister for Health and Ageing fund research into the causes of obesity and the success or otherwise of interventions to reduce overweight and obesity
• the Minister for Health and Ageing adopt a phased approach regarding regulations on the reformulation of food products. Industry should be encouraged to make changes through self-regulation but if industry fails to make concrete changes within a reasonable timeframe the Federal Government should consider regulations
• the Minister for Health and Ageing engage with peak bodies such as the Australian Food and Grocery Council, the Dietitians Association of Australia, and the Heart Foundation, to develop and implement a Healthy Food Code of Good Practice tailored to Australian conditions.
• the Minister for Health and Ageing review the adequacy of regulations governing weight loss products and programs with the intention of ensuring that they can only be sold and promoted if nutritionally sound and efficacious. The review should also examine ways to improve industry compliance with the Weight Management Council of Australia’s Weight Management Code of Practice
• the Minister for Health and Ageing encourage private and public employers to adopt programs and incentives that will promote active and healthy lifestyle choices by all Australians within the workplace
• The Committee recommends that the Federal Government continue to support initiatives such as community garden projects, cooking classes
and the Stephanie Alexander Kitchen Garden Program
•The Committee recommends that the Minister for Health and Ageing explore ways to enhance the How do you measure up? campaign website
and further develop it as a central repository of information about the benefits of healthy eating and exercise.
The report makes much of the fact that existing guidelines to encourage healthy eating and activity have not been widely implemented. A cynic might point out that there have been many other reports also urging governments and industry to tackle obesity that have not been widely implemented. History teaches that researchers and governments alike are much better at describing problems than doing anything about them.
Our government has already wasted many millions with the Measure Up campaign that is designed to make overweight people aware that their weight might carry a risk. I have not seen any evidence that this campaign has had any effect on obesity levels, but read that they are considering throwing more of our money at it. Ironically Health departments are addicted to “evidenced-based treatments and interventions” and only support programs with evidence. Proponents of lap banding can afford to invest on getting the evidence, as the cost and profit return is so high. Meanwhile there are not the funds to assess many of the quality commercial lifestyle based programs that are provided at a community level at an affordable cost to those who want a solution (versus those who need it but don’t want it or don’t want to or can’t pay for it).
The rules of evidence and the title “approved provider” should be high if the risks are high (surgery). Equally the rules of evidence and access should be low if the risks are low. The risks of prescribing a healthy diet and exercise are low for most except the minority at-risk individuals. Governments believe that “health” should only be delivered by Medicare approved providers: doctors, dieticians and exercise physiologists. But overweight is primarily a lifestyle caused condition that for most overweight people does not require medication and surgery, but lifestyle (diet and physical activity) modification. There are affordable accessible commercial lifestyle programs (provided by gyms and commercial diet programs) available and for many they are successful and affordable, but as they are not provided by doctors (et al) they are not “approved” for rebates. While the government considers the divisive issue of throwing money at expensive surgery and ineffective public awareness campaigns, why not consider helping people who want to help themselves and helping business (who employ people) at the same time. Rebates can be provided on a “no-risk” basis. Instead of subsidising courses, they could provide REBATES ON RESULTS. This means that people have to make and effort to get the rebate. No result = no cost to government.
To the argument that no funds should go to help these people… The community already pays a huge a growing price for the overweight and obese in extra medicare claims and hospital queues. And so it’s a good investment to reduce the community burden with affordable solutions. Clearly it will take fresh thinking at a government level to think outside the “approved provider” rules.
Er? What?
Where are the policies regarding the gradual reduction of salt & sugar in manufactured food? Or even replacement of ordinary sugar with low gi sugar? Where are the suggestions to increase fibre content of foods made with white flour?
Where is the suggested action against those manufacturers who choose to lag behind in making such reductions, substitutions or additions?
The solutions are out there…