OVERWEIGHT, AND CHRONIC DISEASES IN POLICY BRIEF

SUMMARY

 In Australia, rates of overweight and obesity have Persons aged 18 and over- Proportion overweight or risen alarmingly in recent decades in all age 6 groups, with the increase most marked among obese people in 1995 and 2014-2015 obese adults.  Overweight and obesity in adults and children is associated with significant health impacts and economic burdens.

 A comprehensive range of interventions is urgently required to achieve behaviour change, improve diets and lifestyles, and reduce the burden of chronic disease in Australia. WHAT ARE THE STATISTICS?

In Australia, the proportion of men and women aged 18 years and over that is overweight or obese has increased significantly in recent decades. In 1995, Perhaps of most concern has been the dramatic rise 64.9% of males and 49.4% of females were in the proportion of the population who are obese overweight or obese. However, in 2014–2015 the (with a BMI of 30 or more). This proportion has proportions had climbed to 70.8% of males and increased across all age groups over time, up from 56.3% of females.1 Australia’s adult obesity rate has 18.7% in 1995 to 27.9% in 2014–15, an increase of been estimated to be the fifth highest amongst OECD almost 10%. countries.2 In 2014–15, around 27.2% of all Australian children aged 5–17 years were either There is a concerning social and economic gradient overweight or obese, with 7.4% living with obesity.3 evident in overweight and obesity trends with people in lower socio-economic groups more likely to be Rates of overweight and obesity increase with age. overweight and obese than those in higher socio- Of men aged 45 years and over, almost four in five economic groups.7 Aboriginal and Torres Strait (79.4%) were overweight or obese in 2014-15, while Islander Australians also experience two in three women (65.7%) of the same age were 8 4 disproportionately high rates of obesity. The overweight or obese. prevalence of overweight and obesity is also higher Data released by Roy Morgan Research in 2014 has among people living in regional and remote areas 9 found that around 11 million Australians are currently compared to those living within major cities. overweight by an average of 16.5 kilograms.5

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CAUSES OF OVERWEIGHT AND significant. Dietary risk factors are estimated to contribute 35% and 33% of the disease burden OBESITY respectively and high body mass contributes 21% 21 Engaging in physical activity while minimising and 49% respectively. consumption of discretionary (energy dense, nutrient is also associated with a range of poor) food and drink is the best way to maintain a very serious health problems and increases the risk healthy weight. Modelling indicates that the increased of premature illness and death later in life.22 energy intake that has occurred over the past few Research shows that 25–50% of obese adolescents decades is more than enough to explain the parallel remain obese into adulthood.23 Studies also suggest 10 increase in body weight. This increased energy that the risk of and all-cause intake has occurred mainly as a result of increased mortality is elevated among those who were consumption of energy-dense, nutrient poor (high fat overweight during childhood.24 If current trends 11 and/or sugar) foods and beverages. continue, approximately 1.75 million deaths will have The consumption of energy dense, nutrient poor been caused by overweight and obesity between 25 foods has increased significantly among adults and 2011 and 2050. children over the past 30 years. For example, one ECONOMIC IMPACTS third of adults and almost half of children drink sugary drinks daily.12 Young Australians, in particular, are If the obesity epidemic in Australia is not checked, it commonly high consumers of energy dense, nutrient is estimated that by 2025, 83% of males and 75% of poor products such as soft drink, burgers and chips.13 females over 20 will be overweight or obese. This would have an enormous impact on health care Australian adults’ diets are comprised, on average, of spending, chronic disease and quality of life.26 The 35% ‘junk’ food including sugary drink and alcohol. costs of overweight and obesity are already very Amongst children, 40% of the diet is made up of 14 significant with the total annual cost of obesity in ‘junk’ food . Australian households spend 58% of Australia in 2011–2012 has been estimated to be their food budget on unhealthy foods and drinks and 15 $8.6 billion, including $3.8 billion in direct costs and just 15% on fruit and vegetables . Data from the $4.8 billion in indirect costs.27 Using a measure that National Health Survey 2014–2015 has shown that includes loss in wellbeing, estimates reach around 7% of Australian adults, and 5.4% of children, meet $120 billion a year, which is equivalent to 8% of the the recommended 5 serves of vegetables per day, economy’s annual output.28 with fruit consumption also generally falling short of recommended serves.16 In the long term, it is expected that the economic costs of obesity will increase significantly, and HEALTH IMPACTS possibly double, due to the prevalence and incidence 29 Poor diets and high body mass index are the major of . risk factors contributing to Australia’s significant 17 WHAT ACTION HAS BEEN TAKEN disease burden, ahead of smoking-related illness. Overweight and obesity lead to heightened risk of TO ADDRESS OBESIT Y IN developing chronic diseases including cardiovascular AUSTRALIA? disease and . A recent review of more than one thousand studies by International Agency In 2008 the (Government) for Research on found that that being announced the assembly of the National Preventative overweight or obese increases risk for at least 13 Health Taskforce (Taskforce) to develop strategies to types of cancer, including common such as tackle chronic disease caused by tobacco, alcohol 30 breast and colon.18 and obesity. In September 2009 the Taskforce released a final report entitled Australia: The Obesity is also the leading risk factor for type 2 19 Healthiest Country by 2020 – National Preventative diabetes. Even being overweight significantly Health Taskforce Strategy – The Roadmap for Action increases the risk.20 The contribution of overweight (the Roadmap). The Roadmap outlined 27 and obesity to cardiovascular disease and diabetes is

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recommended actions designed specifically to guidance on a range of evidence-based policy reduce and control obesity in Australia. The interventions that governments should consider, to recommendations focused on preventative health reduce the burden of NCDs. Further the recent World measures and were proposed to be implemented in a Health Organization’s Commission on Ending staged manner from 2009. In 2010, the then Childhood Obesity Report35 provides a model Government published its response to the Roadmap, comprehensive strategic approach, strategic indicating its plans and intended actions. objectives and policy options. Eight years have now passed since the Roadmap Policy interventions that have been identified as most was released and overall progress has been pressing for Australian governments in addressing disappointing, with preventative health not a high obesity include:36 priority for the current Government. Of particular  Adoption of a whole-of-government obesity concern was the 2014 abolition of the Australian prevention strategy ; National Preventative Health Agency (ANPHA), which had been set up in 2011 to drive preventative  Reducing children’s exposure to marketing for health initiatives and research. Commonwealth unhealthy foods and beverages on television as funding provided to states to deliver healthy lifestyle well as other platforms including sport intervention programs under the National sponsorship; Preventative Health Agreement was also stopped.  Improving the Health Star Rating System, an Although state and territory governments’ interpretive front of pack labelling system, to approaches to obesity prevention vary, there are inform healthy choices; several examples of strong leadership at the state  Provision of funding for sustained, effective mass government level. Important initiatives include the media education campaigns to improve diets and NSW government’s commitment to reduce childhood prevent obesity; obesity through actively monitoring rates of overweight and obesity, increasing community  Commit sustained funding and ongoing support education and introducing and resourcing a healthy for a comprehensive diet and nutrition survey canteen strategy.31 The Australian Capital Territory’s conducted every 5–10 years; Towards Zero Growth – Healthy Weight Action Plan  Establish targets for national population dietary 2013, sets out cross-sectoral responsibilities, intake and for reductions in key nutrients in major priorities and goals for the improvement of health 32 food categories; within the Territory. Local governments have also become key drivers of health promotion and  Interventions to reduce consumption of sugar- prevention policy. For instance, the Victorian Public sweetened beverages, including a health levy on Health and Wellbeing Plan include actions by sugary drinks. municipalities to reduce sugary drinks. Victorian For more information about the types of regulatory municipalities are becoming leaders in creating reforms and policies that are needed to address healthy drinks environments by adopting strategies to overweight and obesity in Australia, please refer to increase access to water and reduce consumption of the OPC’s Policy Briefs and submissions, available at sugary drinks33 with the assistance of the Victorian www.opc.org.au. Government’s Healthy Choices guidelines. POLICY ACTION NEEDED

There is increasing support and impetus from the international community and peak health bodies to take decisive policy action on overweight and obesity. The World Health Assembly’s Global Action Plan for the Prevention and Control of Non- communicable Diseases 2013–202034 provides

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ABOUT THE OBESITY POLICY Swinburn BA, Jolley D, Kremer PJ, Salbe AD, Ravussin E. COALITION Estimating the effects of energy imbalance on changes in body weight in children. American Journal of Clinical Nutrition 2006; The Obesity Policy Coalition (OPC) is a coalition 83(4): 859-863. 11 World Health Organisation. Childhood overweight and obesity: between the Cancer Council , Diabetes what are the causes? : World Health Organisation, 2010 12 Victoria and the Global Obesity Centre at Deakin http://www.abs.gov.au/ausstats/[email protected]/Lookup/4364.0.55.007 main+features7102011-12 University, a World Health Organization Collaborating 13 Australian Bureau of Statistics, Australian Health Survey: Centre for Obesity Prevention. The OPC advocates Nutrition First Results – Foods and Nutrients 2011-2012 14 Australian Bureau of Statistics, 2014 for evidence-based policy and regulatory change to http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4 address overweight, obesity and unhealthy diets in 364.0.55.007~2011- 12~Main%20Features~Discretionary%20foods~700 Australia, particularly among children. 15 Australian Bureau of Statistics, 2016 http://www.abs.gov.au/ausstats/[email protected]/featurearticlesbyCatalog CONTACT US ue/3CCECBE0A2EAA300CA25805700170F57?OpenDocument 16 Australian Bureau of Statistics, Australian Health Survey: First Obesity Policy Coalition Results, 8 December 2015. 17https://www.healthdata.org/sites/default/files/files/country_profiles 615 St Kilda Road /GBD/ihme_gbd_country_report_australia.pdf Melbourne, Victoria, Australia 3004 18 Lauby-Secretan, B., et al., 2016. Body fatness and cancer— viewpoint of the IARC Working Group. New England Journal of Phone (03) 9514 6100 Medicine, 375(8), pp.794-798. 19 Oguma, Y., Sesso, H.D., Paffenbarger, R.S. and Lee, I.M., Fax (03) 9514 6800 2005. Weight change and risk of developing type 2 Website: www.opc.org.au diabetes. Obesity, 13(5), pp.945-951. 20 Ibid. Email:[email protected] 21 Australian Instirute of Health and Welfare 2016. Australian Burden of Disease study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. @opcaustralia BOD 4. : AIHW http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129 555476 22 World Health Organisation. Obesity: Preventing and Managing facebook.com/ObesityPolicyCoalition the Global Epidemic WHO Technical Report Series 894, Geneva 2000; Holman C, Smith F., Implications of the obesity epidemic for the life expectancy of Australians. Report to the Western Australian Institute for Public Health Advocacy. School of Population Health, REFERENCES University of , 2008. World Health Organisation. Diet, Nutrition and the Prevention of Chronic Diseases. WHO Technical Report Series 916. Geneva 2003. 1 Australian Bureau of Statistics, National Health Survey: First 23 Must A, Strauss R. Risks and consequences of childhood and results, 8 December 2015, adolescent obesity. International Journal of Obesity Related http://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4 Metabolic Disorder 1999; 23 Suppl 2: S2-11. 364.0.55.001~2014-15~Main%20Features~Key%20findings~1 , 24 Must A, Strauss R. Risks and consequences of childhood and http://www.abs.gov.au/ausstats/[email protected]/mf/4364.0.55.001. adolescent obesity. International Journal of Obesity Related 2 OECD. Health at a Glance 2017 – OECD Indicators. 2017, p80. Metabolic Disorder 1999; 23 Suppl 2: S2-11. 3 Australian Bureau of Statistics., see no 1. 25 Gray V and Holman C (2009) Deaths and premature loss of life 4 ibid caused by overweight and obesity in Australia 2011-2050. 5 Roy Morgan Research, Article no. 5674, ‘Spotlight on Australia’s 26 Michelle Haby et al., “Future predictions of body mass index and Health: our weight continues to rise and our mental wellbeing is on overweight prevalence in Australia, 2005-2025 Health Promotion the decline’ 8 July 2014. International 27(2). 6 ibid 27 Obesity Australia (2015). Obesity: Its impact on Australia and a 7 Harris, B, Fetherston, H & Calder, R. Australia’s Health Tracker case for action. No time to Weight 2. Sydney. by Socio-Economic Status 2017. Australian Health Policy 28 The Herald/Age (2011). Lateral Economics Index of Australia’s Collaboration: Melbourne, Victoria University, November 2017. Wellbeing: Final Report. Available at: 8 Australian Bureau of Statistics. Australian Aboriginal and Torres https://lateraleconomics.com.au/wp- Straight Island Health Survey: Biomedical Results, 2012-2013. content/uploads/2014/02/Fairfax-Lateral-Economics-Index-of- 9 Australian Bureau of Statistics. Australian Health Survey: First -Wellbeing-Final-Report.pdf Results, 2014–15: Australian 29 Department of Economic and Social Affairs. World economic Bureau of Statistics; 2014 [updated 22.03.2016. Available from: and social survey 2007. Development in an ageing world. New http://www.abs.gov.au/ausstats/[email protected]/mf/4364.0.55.001. York: United Nations, 2007. 10 Swinburn B, Sacks G, Ravussin E. Increased food energy Vos T, Goss J, Begg S, Mann N., Projection of health care supply is more than sufficient to explain the US epidemic of expenditure by disease: a case study from Australia. Brisbane: obesity. American Journal of Clinical Nutrition 2009; 90(6): 1453- School of Population Health, University of Queensland, 2007, 1456. 30 Australian Government Department of Health and Ageing. New health taskforce on prevention – Tobacco, alcohol and obesity

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priorities, 9 April 2008, available at http://www.health.gov.au/internet/ministers/publishing.nsf/Content/ mr-yr08-nr-nr046.htm 31 Government, Tackling Childhood Obesity, https://www.nsw.gov.au/improving-nsw/premiers-priorities/tackling- childhood-obesity/ 32 Australian Capital Territory Government – Towards Zero Growth – Healthy Weight Action Plan 2013. 33 Rethink Sugary Drinks, Local governments as leaders on reducing sugary drink consumption. http://www.rethinksugarydrink.org.au/downloads/local-government- as-leaders.pdf 34 World Health Assembly, Sixty-Sixth Session, Follow-up to the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases, 25 May 2013 (A66/A/CONF./1) 2013; World Health Organization, Global Action Plan for the Prevention and Control of Noncommunicable Diseases, 2013. 35 World Health Organisation, Report of the Commission into Ending Childhood Obesity, Geneva Switzerland, 2016. 36 The Healthy Food Environment Policy Index (Food-EPI) that was developed by INFORMAS, Tipping the Scales, Australian Obesity Prevention Consensus, http://www.opc.org.au/tipping-the- scales.aspx

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