Protecting our children from obesity: challenges and opportunities

The reluctance of Australian policy makers to take evidence-based action on childhood obesity is unacceptable

Despite the threat of shorter lifespan for the first time in generations, Australian policy makers remain reluctant to protect our children from increasing levels of obesity. Yet the reasons for this crisis and the need to act, especially on the aggressive marketing of energy-dense food and drink, are both well understood. The World Health Organization has provided an action plan to translate evidence into action,1 and a narrative review in this issue of the MJA sets out clearly the scale and nature of the problem and what can be done to address it.2

Yet progress is at a snail’s pace. Overcoming the barriers to action and seizing the opportunities require an understanding of the reasons for political and bureaucratic hesitancy, and taking action to exert influence in the corridors of power.

Political decision making is much more complex than simply relying on evidence. In 1977, the South Australian Royal Commission into the Non-Medical Use of Drugs stated that “the most persuasive misunderstanding that affects a Commission such as ours is the belief that crucial policy questions can be resolved by carefully weighing up the scientific, medical and statistical evidence”.3

Faced with many competing pressures, policy makers are often tempted by the path of least resistance. There is now good evidence of the benefits of a levy on sugary drinks. Pioneers, such as the Mexican government, illustrated that consumption fell with clear health benefits. The industry responded in other markets, such as the United Kingdom and recently Australia, by pledging reformulation of their products. This action begs the question as to why they did not do so earlier.

Yet, precisely because measures such as this are so effective, the soft drinks industry has deployed vast resources to prevent them. Here in Australia, Daube has identified 46 direct and indirect lobbyists for junk food on the Australian Government Register of Lobbyists,4 stressing that this is a very conservative estimate, not least because of the limited scope of the register.

Arguments advanced by these lobbyists are often based on cherry picking or claiming “lack of evidence”. They exploit the concept of “energy balance” to divert attention to inadequate exercise and away from the impact of their own products.5 They have learnt from the tobacco lobby to dissemble and sow doubt, and argue complexity as an excuse to do nothing, while simultaneously arguing that education is all that is needed. Despite compelling evidence that self-regulation is ineffective,6 they portray any action by government to legislate or regulate as the “nanny state”.

In marked contrast, the WHO maintains the importance of legislation and regulatory instruments “to implement key interventions to reduce childhood obesity”.1 It calls for a coordinated approach from all government sectors, including food and agriculture, education, commerce and industry, sport and recreation, ensuring health in all policies.

While the evidence for a sugar levy is straightforward, the politics in Australia are not. The seat of Dawson, held by controversial Coalition MP George Christensen, who has previously threatened to resign from the Liberal National Party,7 demonstrates the importance of “sugar seats”. Dawson is the biggest sugar-growing area in the country and suffered a swing of over 4% towards Labor at the last election. With such a slim majority, the Prime Minister cannot afford to lose Christensen’s support.

Yet, even in such challenging circumstances, there are opportunities. Health professionals working in a methodical and coordinated manner can influence government. Kotter’s eight-step change management model has been modified to ten steps for planning or evaluating advocacy action,8 while the Public Health Advocacy Institute of Western Australia has provided guidelines in the form of an advocacy toolkit.9 The global tobacco control movement internationally draws inspiration from the achievements of public health advocates in Australia,10 as do those arguing for gun control to reduce the continuing losses of tens of thousands of American lives every year.11

The Health Star Rating (HSR) is a front-of-pack food labelling system that provides an example of an effective public health advocacy. The HSR was initially developed in partnership with industry. However, after agreement by all involved on both the system and the algorithm that underpins it, some industry elements worked vigorously to undermine it. Public health advocates launched a coordinated and vigorous lobbying effort of their own so that the system, although not yet mandatory, was eventually adopted by the Australia and New Zealand Ministerial Forum on Food Regulation and the HSR now appears on over 10 000 food items.

Understanding how power works and intervening when appropriate is not only a role for public health and other health professionals, it is also a responsibility. Childhood obesity can be prevented by tackling both downstream and upstream causes. Health professionals, who see the problem on a daily basis, must make much more concerted efforts to influence governments.