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Advice on legislation or legal policy issues contained in this paper is provided for use in parliamentary debate and for related parliamentary purposes. This paper is not professional legal opinion.
Briefing Paper No. 08/2012 by Edwina Schneller

This Briefing Paper seeks to present an overview of the debate on obesity, presenting key statistical data, discussing the factors that contribute to obesity and reviewing the government policies, national and NSW, formulated to address the issue. The paper starts with a comment on the health and economic impacts of obesity.

Please note that a detailed technical review of obesity in terms of scientific literature, prevention options and effective initiatives undertaken both nationally and internationally is provided in the National Preventative Health Taskforce (NPHT) report, Technical Report 1, Obesity in Australia: a need for urgent action, including addendum for October 2008 to June 2009. A systematic scientific literature review was recently released by the National Health and Medical Research Council (NHMRC), in support of the revision of the Australian Dietary Guidelines: A review of the evidence to address targeted questions to inform the revision of the Australian Dietary Guidelines.

Issues in the obesity debate [2]: The World Health Organization (WHO) defines overweight and obesity as "abnormal or excessive fat accumulation that may impair health." The recognition of obesity as a public health problem has only occurred in recent decades. In 2005 the disease was described as a "global epidemic" and considered by WHO as a worldwide public-health crisis.

There is clinical evidence that overweight and obesity is a risk factor for a range of diseases, including cardiovascular disease, Type II diabetes, some musculoskeletal conditions and cancers. Further, the longer a person is obese, the higher the risk of premature mortality.

In 2008, the economic cost of obesity to Australia was estimated to be $58.2 billion; with a cost of $19 billion in NSW.

Classifying overweight and obesity [3]: Body Mass Index (BMI) is the main measure used in international obesity guidelines and is relied on by WHO as a population measure for obesity. BMI is defined as a person's weight in kilograms divided by the square of their height in meters.
Prevalence of Obesity [4]: According to the WHO 2012 report, 2.8 million people world-wide die each year as a result of being overweight or obese. In 2008, it was estimated that half a billion men and women over the age of 20 were obese, with women more likely to be obese than men. Worldwide the prevalence of obesity almost doubled between 1980 and 2008.

In 2011-12, based on measured BMI, 28.3% of Australian adults and 7.6% of children (aged 5-17) were obese. This represents a 3.3% increase of Australian adults since the last National Health Survey 2007-08, when there were approximately 3 million obese Australians. The national rates of overweight and obesity do not differ markedly between the States or Territories with Western Australia having the highest prevalence of overweight or obesity (63%) and the ACT the lowest (59%). Australia's obesity prevalence is comparable to Canada, the United Kingdom and Ireland (20-24%), and reflects the same level recorded for the United States in the early 1990s.

Although obesity is widely distributed amongst the Australian population, its distribution is not even. The greatest prevalence occurs in the following population sub-groups: Aboriginal and Torres Strait Islanders peoples; those in the most disadvantaged socioeconomic groups; those living in rural and remote areas as opposed to urban areas; and people born overseas in particular in Southern & Eastern Europe, the Pacific Islands and the Middle East.

New South Wales Prevalence and Trends [5]:The NSW Adult Population Health Survey results for 2011 reveal that there has been a significant increase in the proportion of adults who are overweight or obese (41.5% in 1997 compared to 52.6% in 2011), with the prevalence being higher amongst males than females.

The NSW Child Population Health Survey for 2009-2010 reported that 18.5% of children were overweight and 10.1% were obese. The findings for NSW reflect the national trend of obesity being more prevalent amongst certain population sub-groups.

Factors Contributing to the Development of Overweight and Obesity [6]: Australia's Health 2012 states that "A person's health and well-being is influenced by a complex interplay of societal, environmental, socio-economic, biological and lifestyle factors". Each of these is considered.

Biology [6.1]
The NHMRC acknowledges that genetics and epigenetic changes (changes in gene expression caused by mechanisms other than changes in the DNA sequence) may in part explain why some individuals have an increased risk of developing overweight and obesity than others.

Environment [6.2]
There are five key urban characteristics comprising both the natural and built environment that influence physical activity and may therefore impact on obesity:

    · Transport infrastructure, foot paths and cycle ways;

    · Facilities for physical activities, which may include outdoor sports facilities, playgrounds and natural green spaces such as bushland and parks.

    · Street connectivity and design, which reflects the ease of travel between households, shops and places of employment.

    · Mixed land uses (residential, commercial, industrial and agricultural) as well as community and recreation facilities are often associated with shorter travel distances.

    · Residential density, a higher residential density may mean that there are more people to use a range of activities and institutions within a smaller area, often leading to shorter walking distances (as opposed to use of a car) to such destinations.

Lifestyle Behaviours [6.3]
The following life-style choices are modifiable risk factors for obesity: Dietary behaviours; Level of physical activity; Smoker status; and Alcohol consumption
This Briefing Paper focuses on dietary behaviours and physical activity levels at both a national and State level.

Dietary behaviours
The most current detailed national data for Australian adults' food and nutrient in-take was conducted 16 years ago in the 1995 National Nutrition Survey and five years ago for children aged 2-16 in the 2007 Australian National Children's Nutrition and Physical Activity Survey. The data is therefore "rather dated."

The NHS 2007-08 provides the latest national data on selected dietary behaviours (the intake of fruit and vegetables). It warned that the data should be interpreted with care, as survey respondents had difficulty in estimating quantities consumed. According to the NHS 2007-08 only (51%) of the Australian population aged 15 years and over consumed the recommended two or more serves of fruit per day; while only 1 in 11 (9%) consumed the recommended five or more serves of vegetables. The just released first results of the AHS 2011-13 indicate a further decrease with (48.3%) of Australians consuming the recommended two or more serves of fruit per day; while only (8.3%) consumed the recommended five or more serves of vegetables.

For NSW, in 2010, 56.4% of adults consumed the recommended two serves of fruit per day. However, only 9.5% of adults consumed the recommended five serves of vegetables per day. The 2011 NSW 'Adult' Population Health Survey (persons aged 16 years and over) below shows that this consumption has further decreased, with 52% of adults consuming the recommended serves of fruit per day and only 8.6% of adults consuming the recommended serves of vegetables per day.

The 2010 Schools Physical Activity and Nutrition Survey (SPANS) Report found that 95.9% of primary school aged children and 42.1% of high school aged children met fruit consumption recommendations. However, only 43.6% of primary school aged children and 20.1% of high school aged children met recommendations for vegetable consumption.

Level of physical activity
Nationally, the NHS 2007-08 provides the latest data about physical activity for adults and children aged 5-17 years old. The survey included questions about exercising for sport, recreation and fitness, as well as walking for transport. The Children's Survey 2007 provides data for slightly younger children aged 2-16 years. The physical activity module used in the NHS 2007-08 is being repeated in the Australian Bureau of Statistics, AHS 2011-2013.

According to NSW Health, in 2011, 54% of adults undertook adequate levels of physical activity each week. More men (59.6%) than women (48.5%) reported adequate levels of physical activity.These proportions have declined slightly when compared with the 1998 NSW Health Survey, which reported that (65%) of all males and (57%) of females undertook a minimum of 150 minutes of accumulated physical activity throughout a week.
In respect of children, the 2010 Schools Physical Activity and Nutrition Survey (SPANS Report) indicated that less than half (46.4%) of Years K, 2 and 4 students spent 60 minutes or more per day in physical activity. Boys (50.5%) were more likely to do so than girls (42.2%); from 2004 to 2010, there was a significant decline in physical activity among students in Years 6, 8 and 10, with the exception of Year 10 girls. This is a reversal of the gains observed between 1997 and 2000.

Government Responses - National [7]: In November 2008, the States, Territories and the Commonwealth entered into a National Partnership Agreement on Preventative Health (NPAPH) "In an attempt to improve the health of Australians and reduce pressure on the health system". The Agreement commits the Australian Government as well as State and Territory Governments to address the rising prevalence of lifestyle-related chronic diseases, including obesity, by implementing programs and activities that promote healthy behaviours in the daily lives of Australians. The NPAPH initially provided $872.1 million for health prevention over six years from 2009-10, extended on 28 June 2012 to June 2018.

Government Responses - NSW [7]: Over the past decade or so NSW Governments have sought to address the obesity issue by various means. In 2002, for example, the Carr Government convened the Childhood Obesity Summit. In 2010, NSW was the first Australian jurisdiction to introduce mandatory nutrition information labelling for certain prescribed food businesses. As a result, from 1 February 2012 any food business that sells standard food items at 20 or more locations in New South Wales or at 50 or more locations in Australia is required to display the nutritional information of their standard food items.

Subsequent to the "NSW 2021: A Plan to Make NSW Number One", the NSW Office of Preventative Health was opened on 29 June 2012 with Professor Chris Rissell of the University of Sydney's School of Public Health being the inaugural Director. A Ministerial Advisory Committee on Preventive Health was also established in June 2012. The NSW 2021 plan includes the performance benchmarks for obesity set under the NPAPH and the following specific targets for overweight and obesity:

    · Reduce overweight and obesity rates of children and young people (5-16 years) to 21% by 2015; and

    · Stabilise overweight and obesity rates in adults by 2015, and then reduce by 5% by 2020.

The NSW Ministry of Health is in the process of developing the NSW Strategy for the Prevention of Overweight and Obesity 2012-2016.