We need more high level conversations in Australia about overweight and obesity. Not enough powerful people regard these attributes as a problem, least of all one that they could help solve. We need to extend the ideas of participatory democracy and summitry to address obesity.
According to Access Economics, obesity cost Australia $21 billion in 2006 in health and disability costs, premature death and productivity losses. It is estimated that obesity now afflicts 3 million Australians, a figure that will increase to 7 million people by 2025 if current trends persist unabated and unaddressed. Overweight and obesity in children are strong predictors of obesity in early adulthood.
The obesity crisis – accompanied by a raft of costly chronic diseases such as type 2 diabetes, heart disease, stroke, musculoskeletal problems and cancer – costs the health care system about $4 billion 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.
Given the size of the problem of overweight and obesity it is staggering that we have so little by way of national information about what we weigh and what we eat. 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 sufficient recent 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.
One effective model is the National Health and Nutrition Examination Survey (NHANES) which collects information on and assesses the health and nutritional status of the general population in the United States. Initially known as the National Health Examination Survey, the nutrition component was introduced in the 1970s. National surveys were taken periodically between 1974 and 1994. In 1999, NHANES became continuous and ongoing, in order to make it relevant and timely when informing health policies and programs. It examines all age groups and is conducted in two year cycles.
In 2007 I attended an excellent symposium in Canberra, the Healthy Lifestyle Forum to Help Combat Childhood Obesity, hosted by the indefatigable Senator Guy Barnett, a political champion of those who have concerns about childhood obesity and its prevention and treatment. What was especially encouraging was that representatives of the food, media and advertising industries attended and participated in discussions about what might be done. Long pilloried as the causes of the problem of childhood obesity, and understandably defensive and suspicious as a result, they nevertheless came up with constructive suggestions about what we might do.
First, they argued (without dissent) that there needs to be community ownership of the problem of obesity. If asthma is a National Health Priority, and if diabetes is, so surely should obesity be. The notion that obesity is a disease may upset some, but by nominating it as a health priority, there is no need to spend time on a fruitless debate as to whether it is a disease or not. This has, of course, now been adopted by the current federal government.
The second suggestion, which also came from the group of industry representatives that met during the symposium with a few public health academics and others, was that the Prime Minister should put his hand on the wheel in relation to obesity and childhood obesity in particular. He should convene a meeting of his ministers (not the bureaucrats at this point) with the chief executives (not middle management) of the farmers’ associations, urban developers, food wholesalers and retailers, the alcohol industry, the advertising industry, urban planners and developers and the media for this purpose.
The point of the meeting would be to establish that we face a major problem with obesity, that it is due to a raft of causes that funnel down to eating too much and moving too little, and that this is not a problem to hand to the churches (because being fat is due to lack of character and self-discipline) or the schools (because 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 a blame game.
Like the symposia that Bill Clinton organizes that seek, and get, top level commitment from competitive donors and captains of industry, so the prime ministerial meeting with ministerial colleagues from trade and industry, education, agriculture and the treasury, together with industry CEOs, would expect those attending to commit to action to address the problem. As the industry representatives reminded us at the Barnett seminar, if the CEO commits to something, it happens. It could be called ‘Child of Summit 2020′ and be a worthy progeny of that splendid event.
Thanks to Braedon Donald for her editorial comments.