Sur­veys to mea­sure suc­cess are crit­i­cal in the obe­sity bat­tle

The Weekend Australian - Travel - - Health - LES­LEY RUS­SELL

THE Rudd La­bor Gov­ern­ment has said it will make obe­sity a na­tional health pri­or­ity. This is a wel­come first step to­wards con­certed na­tional ac­tion to ad­dress this grow­ing, costly health prob­lem, but it is a long way from putting in place longterm ini­tia­tives to tackle obe­sity and its causes.

Obe­sity costs Aus­tralia around $21 bil­lion ev­ery year in health and dis­abil­ity costs, pre­ma­ture death and pro­duc­tiv­ity losses. A study by Med­ibank Private puts the cost of un­healthy work­ers at $7 bil­lion a year, and over­weight peo­ple are, on av­er­age, 15-20 per cent less pro­duc­tive be­cause they have more days off work and higher rates of dis­abil­ity.

Obe­sity now af­flicts 3.24 mil­lion Aus­tralians, and this could dou­ble to over 7 mil­lion peo­ple within 20 years if cur­rent trends per­sist un­abated and un­ad­dressed. A quar­ter of Aus­tralian chil­dren and ado­les­cents are over­weight or obese, and this is of­ten linked to den­tal dis­ease, emo­tional and be­havioural prob­lems, bul­ly­ing and learn­ing de­lays. Re­cent stud­ies pub­lished in the NewEng­land Jour­nal of Medicine high­light that to­day’s over­weight ado­les­cents are in­creas­ingly likely to die as rel­a­tively young adults of coro­nary heart dis­ease. A com­men­tary which ac­com­pa­nied th­ese stud­ies warned that if steps were not taken to re­verse the prob­lem of obe­sity, the chil­dren of each suc­ces­sive gen­er­a­tion were des­tined to be fat­ter and sicker than their par­ents, and that by 2050 obe­sity could shorten life ex­pectancy by two to five years.

Obe­sity is a ma­jor con­tribut­ing fac­tor to the in­creas­ing rates of a raft of costly chronic dis­eases, such as type 2 di­a­betes, heart dis­ease, stroke, mus­culo-skele­tal prob­lems and can­cer that cur­rently cost the health care sys­tem an es­ti­mated $873 mil­lion a year. A re­cent Fore­sight Re­port says that be­ing obese re­duces life ex­pectancy more than smok­ing, and that the obe­sity cri­sis in Aus­tralia could take at least 30 years to re­verse.

The warn­ing signs have been clear but largely ig­nored for over a decade. The Aus­tralasian So­ci­ety for the Study of Obe­sity is­sued its na­tional obe­sity strat­egy in 1995. There have been more than a dozen re­ports, strate­gic plans and guide­line doc­u­ments since then, and count­less sum­mits, work­shops and con­fer­ences. The Coun­cil of Aus­tralian Gov­ern­ments an­nounced that obe­sity would be tack­led as part of the Aus­tralian Bet­ter Health Ini­tia­tive in Fe­bru­ary 2006, and the Aus­tralian Health Min­is­ters’ Con­fer­ence an­nounced an Obe­sity Ac­tion Plan in April 2006.

To date, ac­tion at the fed­eral level has been lim­ited. Cur­rent fed­eral spend­ing on tack­ling obe­sity is less than $25 mil­lion an­nu­ally, and ef­forts have been ham­pered by a re­luc­tance of gov­ern­ment to en­ter cer­tain ar­eas, such as ad­ver­tis­ing, where it seems real gains could be made. The states have been more will­ing to make larger in­vest­ments and quicker to recog­nise the pay-offs. In De­cem­ber 2006, Vic­to­ria kicked off a $110 mil­lion plan to tackle obe­sity and di­a­betes, which the Vic­to­rian Trea­sury es­ti­mates will re­turn $3.5 bil­lion in bud­get ben­e­fits.

How­ever, there’s a ma­jor prob­lem be­cause we cur­rently have no way to know if any of the ini­tia­tives im­ple­mented — af­ter-school ac­tiv­i­ties, lifestyle scripts from doc­tors, ad­ver­tis­ing cam­paigns, and private health sub­si­dies for gym mem­ber­ships — are mak­ing a dif­fer­ence, be­cause we have no rel­e­vant, reg­u­lar na­tional sur­veys. The last Aus­tralian Schools Health and Fit­ness Sur­vey was con­ducted in 1985, and the last Na­tional Nu­tri­tion Sur­vey in 1995.

Th­ese must be­come on­go­ing stud­ies so that there is data to in­form new poli­cies and mea­sure the im­pact of those in place. It is only through re­peated sur­veys, done by the same peo­ple us­ing the same sur­vey in­stru­ment, that we are able to as­sess progress and eval­u­ate the suc­cess of in­di­vid­ual ini­tia­tives.

Obe­sity is due to a raft of causes that fun­nel down to eat­ing too much and mov­ing too lit­tle. We can no longer af­ford the lux­ury of re­gard­ing obe­sity as a private thing, a mat­ter of char­ac­ter that could be solved if peo­ple just took ac­tion. As with smok­ers, the ma­jor­ity who are fat wish to quit their habit, but can­not.

This is not a prob­lem to hand to the churches and self-help groups (on the grounds that be­ing fat is due to lack of char­ac­ter and self-dis­ci­pline) or the schools (on the grounds that it is an ed­u­ca­tional prob­lem) or the par­ents (be­cause they don’t switch off the TV enough and aren’t at home enough to su­per­vise af­ter­noon snack­ing and com­puter games). This is not about who is to blame, it’s about who can help fix the prob­lem.

There needs to be com­mu­nity own­er­ship of the obe­sity prob­lem and a will­ing­ness to see a part­ner­ship be­tween gov­ern­ment, busi­ness, the food and drink in­dus­tries, me­dia, con­sumer and health groups as the way to tackle its causes. Na­tional lead­er­ship to co-or­di­nate a whole-of-gov­ern­ment approach across all lev­els of gov­ern­ment and long-term in­vest­ments com­men­su­rate with the size of the prob­lem are es­sen­tial.

The take out les­son is clear: if Aus­tralians are to live long, healthy lives and Aus­tralia is to have a sus­tain­able health care sys­tem, a sound econ­omy and a pro­duc­tive work­force, then we must act now. Mak­ing obe­sity a na­tional health pri­or­ity can make this hap­pen, but en­sur­ing that it hap­pens will be a key re­spon­si­bil­ity of the new fed­eral gov­ern­ment. Les­ley Rus­sell is the Men­zies Foun­da­tion Fel­low at the Men­zies Cen­tre for Health Pol­icy at the Univer­sity of Syd­ney / Aus­tralian Na­tional Univer­sity

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