A national health summit on obesity will be held in Melbourne on Wednesday, convened by the Committee of Presidents of Medical Colleges, and will canvass recommendations including a tax on sugary drinks and restrictions on junk food advertising to children.
Public health consultant Rebecca Zosel, who will cover the summit for the Croakey Conference News Service, asks below whether strong medical leadership might help provide a necessary tipping point, leading to some long overdue policy action.
Rebecca Zosel writes:
Obesity is one of our most important yet most neglected public health problems.
The issue is beset by significant gaps between what we know (the evidence) and what we do (practice and policy). The burden of disease is large, yet our investment is relatively small.
We have proven strategies to prevent and treat obesity, yet many are not implemented. The evidence to support action greatly exceeds our efforts, and there is increasing pressure from across the community for this to change.
The National Health Summit on Obesity may be the tipping point we so desperately need in Australia.
The Summit, to be launched by the Minister for Health, Sussan Ley, on Wednesday 9 November, is convened by the Committee of Presidents of Medical Colleges, the peak specialist medical body in Australia.
CPMC Chairperson, Professor Nick Talley, said: “The summit is unique as it is the first time all medical colleges have come together around this health issue.” Obesity is a health problem that touches every medical speciality and most families in society.
Talley said: “Convening a Health Summit is aimed at bringing many of the key parties together from health and other sectors to examine the evidence and issues, tackle the controversies, recognise national and international success stories, identify potential policy and practice initiatives that can be achieved by stakeholders, and make recommendations to the Australian Government.”
Medical groups are powerful allies that can provide leadership and political and social clout in supporting public health responses. Ms Jane Martin, Executive Manager of the Obesity Policy Coalition, said it was time the medical community used its influence and reputation to sway politicians.
“If [doctors] come out and push a policy and take a stand, politicians will understand who’s going to back them [when they take on the big industries],” Ms Martin said. “Leadership from the medical and allied health professions is really needed.”
The prioritisation of obesity by the medical colleges provides a great opportunity to bolster our efforts to halt the rise of obesity. It will take a broad range of partners working across the continuum of care and across the lifespan, from prevention to treatment, to make a difference. It is reassuring to see a public health paradigm with a focus on prevention within the Summit program.
Delivering better health is about more than healthcare, and requires a focus on changing the conditions in which people are born, grow, work and age. In the words of Sir Michael Marmot, “What’s the point of treating people and then sending them back to the conditions that made them sick in the first place?”
Obesity: the problem
The case for action to tackle obesity is strong and well known to many. As a nation, we all bear the substantial and growing economic and social costs of obesity and its consequences, especially diabetes.
The annual financial cost of obesity in Australia is estimated to be $8.6 billion.
It is important to recognise that the burden of disease is not borne equally across the population. Socio-economic differences exist, with obesity prevalence greater in those with greater disadvantage.
Understanding the relationship with social and economic disadvantage is critical both for understanding contributors to the problem, and developing solutions. A focus on reducing disparities must sit alongside a focus on reducing obesity prevalence.
Obesity is threatening our life expectancy and, if left unchecked, the general population’s life expectancy may drop for the first time in over 1,000 years and our children may live shorter lives than us.
Obesity in Australia: A snapshot of the issue
|Prevalence||· Almost 2 in 3 adults (63%) and 1 in 4 children (25%) are overweight or obese
· Rates of obesity have increased quickly over time; 10% more adults are overweight or obese than in 1995
|Severity||· Excess weight, especially obesity, is a major risk factor for cardiovascular disease, Type 2 diabetes, some musculoskeletal conditions and some cancers. As the level of excess weight increases, so does the risk of developing these conditions.
· Overweight and obesity (high BMI) is the second highest contributor to burden of disease, after dietary risks. Smoking is the third highest.
|Equity||· The burden of disease is not borne equally across the population; prevalence is greater in those with greater disadvantage (e.g. Indigenous population, remote area of residence, lower SEIFA, education and income)|
Obesity: the solutions
The obesity summit will not dwell on the size of the problem, but will focus stakeholder thinking on evidence-based actions for preventing and addressing obesity in the community. As Jane Martin states: “We know what needs to be done, we just need to work out how to do it and then get on with it.”
Talley believes that Australia should lead the world in resolving the obesity epidemic. This will require political leadership. He highlights the importance of having a comprehensive, multi-pronged approach that traverses the breadth of social, environmental, regulatory and medical interventions, backed with bipartisan support.
“One intervention on its own is unlikely to work, but a series of evidence-based interventions will make a difference,” he said.
Professor Louise Baur, Professor of Child and Adolescent Health, University of Sydney, acknowledges the importance of preventing obesity and says adequate resources and treatment services with clear care pathways and a skilled workforce are critical.
Baur also prioritises the need to address institutional bias, stating that: “Obesity stigma and weight bias are alive and strong, and experienced within the family, peers, health professionals and particularly within institutions.”
The thinking of the Summit’s Scientific Advisory Committee members is closely aligned with Dr Margaret Chan, Director of the World Health Organization, who recently urged governments to avoid victim blaming and a ‘personal responsibility’ paradigm.
Instead, she urged them to recognise the social determinants of health and muster the political will to take on the food and soda industries.
In Dr Chan’s words: “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 identified barriers to progress in reducing overweight and obesity as outlined in the Lancet, in particular lobbying by the processed food industry, and the centrality of regulatory change to tackling obesity. “All of our successes in public health have involved legislation, such as tobacco control, the road toll and HIV,” she said.
Drawing on her extensive background in tobacco control, Martin noted that we can’t always wait to have the perfect evidence before we act.
“When Australia led the world in introducing plain packaging on cigarette packets, we were the first to do it, so there was no real-world evidence that it would work,” she said.
“But we knew enough from the research that it was likely to be effective. Sometimes we have to learn by doing and take into account the breadth of evidence; randomised-controlled trials shouldn’t be the standard by which all policy decisions are made.”
Martin criticised the ineffectiveness of industry self-regulation around unhealthy food marketing, and flagged the strong public support for the introduction of policy initiatives to support healthy eating.
Key recommendations to be considered include:
- 20 percent tax on sugary drinks
This is in line with WHO recommendations and previous statements from the CPMC. Recent research shows that a sugar levy will reduce sales, prevent further growth in obesity prevalence and result in significant healthcare savings.
- National obesity strategy
Obesity is a leading risk factor for disease and identified as one of nine National Health Priority Areas, yet there is no national strategy. A national strategy will provide clear actions to tackle obesity that sit under the impending high-level National Strategic Framework for Chronic Conditions (due late 2016).
- Restricting junk food advertising to children
This is in line with recent international commitments to act and 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.
• Access the full list of potential recommendations to be considered.