BRIEFING

www.acys.info/facts

IN AUSTRALIA

YouthOverweight & Obesity

Briefing by NAOMI MARSH

AUGUST 2012

2NO.

1VOL

Overview 2

What is the issue? 2

Why are these issues important? 4

Long-term health implications for 4 individuals and young people

Cost to public health 5

Key features 6

Lack of research and monitoring of trends 6

Limited understanding of the issue 7

National activity 10

Where to from here? 12

Further reading 13

Useful links 13

References 14

‘Obesity’ and ‘overweight’ are terms used to describe the condition of a person with an excess of body fat. Overweight and obesity affects young people’s psychological wellbeing and increases the risk of developing chronic health conditions and adult obesity.

Contents

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Overview

According to the Australian Institute of Health and Welfare (AIHW 2011) around one in four young people aged 12 to 24 years is currently overweight

or obese. The prevalence of ‘obesity and overweight’ among Australian young people has significant implications for their personal health and wellbeing, as well as broader social and policy considerations, such as the public health costs associated with related health conditions.

Although there is news media coverage of this issue, there remains a limited understanding of the causes of overweight and obesity, and how young people are affected within the general Australian population. As part of the Australian Clearinghouse for Youth Studies (ACYS) Face the facts series, this briefing aims to bring to the attention of decision-makers some of the key statistics, policy implications and opportunities relating to youth and overweight and obesity, and to raise the importance of this issue.

What is the issue?Despite the fact that statistics and analysis of overweight and obesity among young people are inconsistently collected, there is evidence to suggest that the

prevalence of overweight and obesity in young people is a significant global issue (AIHW 2004, p.4; Department of Health and Ageing 2003; Finucane, Stevens, Cowan et al. 2011). In some (low- to middle-income) countries the onset of overweight and obesity has been very rapid, while in other countries it has occurred at a much slower pace.

In Australia, it is reported that over the past 20 years overweight has doubled and obesity has tripled among young people (Booth et al. 2007; Magarey, Daniels & Boulton 2001). More recent nationally representative data has suggested that the rates of overweight and obesity may be slowing or even plateauing, particularly among school-aged adolescents (Garnett, Baur & Cowell 2011). Indeed, in a study based on measured body

What is overweight and obesity?‘Obesity’ and ‘overweight’ are terms used to describe the condition of a person with an excess of body fat. According to the most common understanding, obesity and overweight occur when a person has more energy intake from food and drink than they expend in physical activity over an extended period of time (AIHW 2004, p.5).

The International Obesity Task Force (IOTF) has developed a range of age- and sex-specific standards of body mass index (BMI) in order to categorise whether people are above the

average range and can be classified as overweight or obese (AIHW 2004). In health care settings, Australian standards for measuring overweight and obesity in children and young people at the population level are based on those available at the US Centers for Disease Control, and available at http://www.cdc.gov/growthcharts/.

Overweight and obesity are commonly measured by using BMI – dividing a person’s weight in kilograms by the square of their height in metres (kg/m2) (AIHW 2004, p.2).

Some researchers argue that BMI has limitations as a measurement tool in that it cannot account for muscle weight, and does not account for ‘ethnic variations’ in weight and fat distribution (Biggs 2006; WHO 2011). Although acknowledging such limitations, the vast majority of clinicians and public health researchers do not have major concerns with the use of anthropometry – BMI and waist measurements – as it is clinically viable, and, due to its wide usage, enables comparisons across population groups within and across nations (WHO 2011).

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mass index (BMI) of a random sample of New South Wales schoolchildren by Hardy and colleagues (2012), it was suggested that obesity (not overweight) has been statistically stable since 1997 among 6- to 16-year-olds.

While the slowing and potential plateauing of rates is good news, it is still high, with an estimated 25% of adolescent boys and 20% of girls currently reported as either overweight or obese in Australia, and deserving the attention of decision-makers (Booth et al. 2007; see also Gill et al. 2009). Also concerning are reports that the prevalence of obesity and overweight is growing faster in young adults than in older adults (Allman-Farinelli et al. 2008). In a recent study it was highlighted that, especially in young women, central adiposity (fat concentrated around the waist of an individual) increased faster than total adiposity between 1985 and 2007 (Garnett, Baur & Cowell 2011, p.1). This is worrying as increases in central adiposity may lead to increased risk of metabolic and cardiovascular problems.

The AIHW (2011, pp.65-67) also notes that only 44% of young people aged 12 to 24 are currently meeting the National Physical Activity Guidelines. There are also reports that young people in the United States, Australia and Europe are spending more than two hours per day in front of screens (i.e. watching television/DVDs/videos and computer use). These rates are of concern because sedentary behaviours, and screen time in particular, track across the life course (Hardy et al. 2011). Of the few studies that have examined the effects of sedentariness on health in children and adolescents, the findings suggest sedentary behaviours, and excessive screen time in particular, are associated with adverse health outcomes (Biddel, Pearson, Ross & Braithwaite 2010). Among girls aged 11 to 15, sedentariness and excessive screen time are associated with lower cardiorespiratory fitness (Hardy et al. 2009), and, among 15-year-old boys, weekday screen time which exceeds two hours (outside of school time) is associated with an increased risk of insulin resistance, a precursor of type 2 diabetes mellitus (Hardy et al. 2010).

According to figures from between 2007 and 2008, only 5% of young Australians aged 12 to 24 are meeting the National Health and Medical Research Council’s (NHMRC) Australian dietary guidelines, with most lacking sufficient intake of fresh fruit and vegetables (AIHW 2011, pp.68-70). In a recent national survey, conducted by the Cancer Council and the Heart Foundation, it was found that 76% of high school students do not eat the recommended four serves of fresh vegetables each day (Cancer Council Australia 2011).

In contrast to other significant causes of preventable death and disability, including use of tobacco, alcohol

Only 5%of Australians aged 12 to 24 met the NHMRC’s Australian dietary guidelines in Australia in 2007/08.(AIHW 2011, pp.68-70)

Spent on obesity related health conditions EACH YEAR

Young people in Australia are affected by obesity and being overweight

Spent on obesity-related health conditions EACH YEAR

CONTRIBUTING TO

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and other drugs, and infectious diseases, no country has yet been able to negate the prevalence of overweight and obesity with public health policies (Swinburn et al. 2011, p.804). At least in the Australian context, this lack of success has been in spite of media attention and policy- and community-driven programs aimed at promoting health and wellbeing. Hardy and colleagues (2012) argue that although public health interventions may be ‘doing no harm’ within the Australian community, and contributing to a slowing or plateauing of rates of overweight and obesity, it is significant that programs have not been either sufficient or appropriate enough to reduce overweight and obesity in young Australians.

Why are these issues important?

The prevalence of obesity and overweight in young Australians has significant implications for the health of Australians and the Australian health-care system.

Long-term health implications for individual young people

There are a number of diseases and conditions commonly associated with overweight and obesity that young people may develop if their overweight and obesity continues into adulthood (see diseases outlined in Tables 1 and 2 adapted from Department of Health and Ageing 2009b). According to recent research by the Murdoch Childrens Research Institute (MCRI 2012), the negative health effects associated with overweight and obesity may not be experienced until an individual is in adolescence, despite their being overweight or obese during their childhood.

According to 2007–08 figures, adult individuals who were overweight or obese were 1.9 times more likely than people with normal BMI to have type 2 diabetes, 1.7 times as susceptible to high blood pressure, 1.7 times as likely to have high cholesterol and 1.4 times as likely to have heart disease. The likelihood of experiencing chronic conditions is directly related to increased BMI, and therefore people at the obese end of the spectrum are highly susceptible (ABS 2009, p.5). For example, individuals with obesity are more than 2.7 times as likely to have type 2 diabetes as those within the normal BMI range (p.5).

TABLE 1 Diseases and conditions connected to overweight and obesity

Slightly increased risk Moderately increased risk Greatly increased risk

Cancer (breast, endometrial, colon)

Reproductive abnormalities

Impaired fertility

Polycycstic ovaries

Skin complications

Cataract

Varicose veins

Musculo-skeletal problems

Bad back

Stress incontinence

Oedema/cellulitis

Coronary heart disease

Stroke

Raised uric levels

Osteoarthritis

Respiratory disease

Hernia

Psychological problems

Type 2 diabetes

Gall bladder disease

High blood pressure

High cholestrol levels

Insulin resistance

Hardening of arteries

Sleep apnoea

Breathlessness

Asthma

Social isolation/depression

Daytime sleepiness/fatigue

ASSOCIATED WITH METABOLIC CONSEQUENCES

ASSOCIATED WITH WEIGHT

(DEPARTMENT OF HEALTH & AGEING 2009b)

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Other long-term health problems associated with obesity and overweight among young people include long-term psychological and social problems caused by being overweight or obese, such as low self-esteem, loneliness and experience of bullying (Royal College of Physicians of London 2004).

Cost to public healthThe implications of obesity and overweight, as experienced by young Australians, present an important public health issue for Australia (Denney-Wilson & Baur 2007; Dixon, Eckersley & Banwell 2003; Productivity Commission 2010). Using data from 2007 to 2009, the AIHW estimates that 23.3% of Australians between 12 and 24 years are overweight but not obese, and 11.3% are obese (AIHW 2011).

Eckersley (2011) argues that if such rates continue, as these young people transition into adulthood, the long-term health consequences of their overweight and obesity will cause enormous strain on Australia’s health system, ballooning related costs from the current $58.2 billion each year (Access Economics 2008; see also Productivity Commission 2010). Eckersley also argues that current rates may even see a potential decline in the life expectancy of today’s young people in Australia.

TABLE 2 Tracking health outcomes from childhood to adulthood

Psychological dysfunction

Social isolation

Body dissatisfaction possibly leading to eating disorders

Obstructive sleep apnoea

Orthopaedic complications (minor and major)

Gastrointestinal disorders, cardiovascular, endocrine and orthopaedic problems

Reproductive system abnormalities

Menstrual abnormalities

High intra-abdominal adipose tissue

Insulin resistance and pre-diabetes

Type 2 diabetes

High blood pressure

High cholesterol

High prevalence of cardiovascular disease risk factors

Tracking of cardiovascular mortality and morbidity into adulthood

High level of C-reactive protein (may lead to coronary heart disease)

Immediate adverse health problems

Short-termadverse health problems

Long-term (carry into adulthood) adverse health problems

(DEPARTMENT OF HEALTH & AGEING 2009b)

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Key features

Overweight and obesity among young Australians is such an important public health issue that it is critical that it emerges as an issue for discussion in the

Australian political context. The following section provides an overview of factors that may be contributing to the lack of policy success in reducing the prevalence of overweight and obesity among young people in Australia.

Lack of research and monitoring of trends

The AIHW (2004, p.3) has acknowledged that the relationship between young Australians and overweight and obesity is an under-researched area. For example, a paper by the AIHW (2004) on the topic Risk factors data briefing, relied on research from the 1985 Australian Health and Fitness Survey (AHFS) and the 1995 National Nutrition Survey (NNS).

Recent years have seen the relationship between young people, overweight and obesity become increasingly explored by researchers. It is also positive that data from the ABS National Health Surveys (NHS) in 2007 and 2008 have become available and are used by researchers interested in the topic. For example, the NHS from this period includes data on the BMI for children aged 5 to 17 years, as well as information on usual consumption of fruit and vegetables. In October 2012 the results of the 2010-11 Australian Health Survey will be released,

including new information about diet and exercise, sourced through the Nutrition and Physical Activity Survey, which can then be analysed by BMI status.

Although there is increasing attention on the issue of the relationship between young people and overweight and obesity in Australia, it continues to be acknowledged in the existing literature that more research needs to be undertaken to form a comprehensive evidence base on this issue for decision-makers (Biggs 2006).

Recent Australian studies have highlighted that a particular need to support research into specific areas, such as the independent impact of sedentary behaviours on the health of young people (such as in Hardy et al. 2010, p.647) and adults (Healy et al. 2008). Other studies have also noted that more research is needed in Australia that focuses on lifestyle intervention programs, as currently there is limited evidence on models that provide clinically effective long-term weight management in young people that are sustainable within a community setting (such as in Nguyen et al. 2012).

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There are many potential reasons for the relationship between youth and overweight and obesity to be an under-researched area, including:

�� The issue has been sensationalised by some media outlets, and therefore not taken seriously by the community and decision-makers, although it is an issue of major significance to the current and future health of young Australians;

�� Researchers are concerned about reinforcing moral panic; however, alcohol consumption is a topic for youth research despite its similar treatment by the news media;

�� When compared to topics such as alcohol use, obesity is an ‘unsexy’ issue due the lack of dramatic and immediate associated risk factors;

�� There is a lack of understanding of the severity of the problem;

�� Concern exists about ‘undoing’ programs designed to improve young people’s self-esteem; and

�� There is a chicken and egg relationship between research and policy/programs, whereby government investment in research tends to be associated with government policy priorities, and so researchers may have difficulty finding resources to support their interest in obesity (in order to bring it to the attention of decision-makers) if it is not already an issue of interest to these same decision-makers.

The AIHW (2004, p.6) suggests that without improved data collection and monitoring of BMI nationally it is impossible to track trends of overweight and obesity across the Australian population, let alone to ascertain whether current national and state-based policy interventions are having any impact.

The need for better population monitoring and research in this area is critical to ensuring overweight and obesity gain the attention and understanding of decision-makers so that future strategic responses can be well-considered and structured (Gortmaker et al. 2011; Lobstein, Baur & Uauy 2004).

Limited understanding of the issue

Although there is a growing body of research within Australia, there is a lack of understanding of the relationship between young people and overweight and obesity in the Australian community. A particular area of much confusion in the community is how individuals come to be overweight and obese.

Within Australia, King (2011) argues that there is a common perception that individuals have a large degree of control over their health. However, with the prevalence of overweight and obese individuals within the community, King (p.743) states that overweight and obesity is not ‘really down to laziness or overeating but that our biology has stepped out of kilter with society and social forces’. King argues that instead of viewing it as an issue that affects and can be mitigated by individuals, it is important to recognise the substantial impact of environmental factors and social trends on the increasing prevalence of overweight and obesity among Australians.

Browne and Speight (2012) from the Australian Centre for Behavioural Research in Diabetes also acknowledge that a range of environmental factors contribute to increasing rates of overweight and obesity. They argue that it is necessary to acknowledge these risk factors, otherwise there is a danger of creating social stigma that portrays overweight and obese people as lazy, greedy and undisciplined, which may have impacts on these individuals’ relationships in family, romantic and workplace contexts, as well as contribute to emotional and psychological conditions such as depression and anxiety.

40%60%

Energy intakeAround 60% of boys and 40% of girls in NSW drink at least one cup (250 mL) of soft drink per dayNEW SOUTH WALES’ SCHOOLS PHYSICAL ACTIVITY AND NUTRITION SURVEY (SPANS) IN 2010 (HARDY ET AL. 2011)

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Some of the environmental and social factors that have been associated with rising rates of overweight and obesity among young people include:

Increasing energy intake�� Diets have become increasingly high in fat and energy in recent years. Factors such as reduced time for cooking, readily available energy-dense foods (take-away) and drinks, and larger serving sizes are suggested to have contributed to this problem (AIHW 2004, p.5). Findings in the New South Wales’ Schools Physical Activity and Nutrition Survey in 2010 (Hardy et al. 2011) suggested that around 60% of boys and 40% of girls drink at least one cup (250 mL) of soft drink per day (Rissel et al. 2012) and that the frequency of consuming energy dense nutrient poor foods is high (such as described in Hardy et al. 2011; Rangan et al. 2009; Rangan, Kwan et al. 2011)

Advertising power �� Advocacy groups such as parents’ jury and the Cancer Council NSW’s (2012) ‘fat free TV’ campaign argue that parents are often blamed for the obesity experienced by their children, despite parents being

influenced by the pressure applied by their children to purchase energy-dense foods, and the influence of advertisements promoting unhealthy habits and foods (Hebden et al. 2011; Kelly et al. 2010; Kelly et al. 2011)

Increasingly sedentary lifestyles�� Young Australians now participate in many activities that do not use much energy. For example, instead of going for bike rides young people aged 5 to 14 years in 2001 reported that playing computer games (68.9%) or watching television (96.9%) were among their favourite pastimes (AIHW 2004, p.5).

�� Catford and Caterson (2003) also state that the Australian population has become more disinclined to participate in physical activity than in the past. This factor has also been associated with the increased use of cars and the perception that children will be unsafe if they walk or ride their bikes alone (AIHW 2004, p.5).

�� The AIHW (2004, p.5) argues that in recent years parents have become increasingly busy and less likely to play with their children, thus contributing to the decrease in physical activity of young Australians.

All young people

10% 20% 30% 40% 50%

Young people in major cities

Young peoplein other areas

Lowest SES areas

Highest SES areas

REMOTENESS

SES

% Obese

% Overweight

Remoteness and socioeconomic statusPrevalence of overweight or obesity among young people aged 12–24 years, by selected population groups, 2007–08.(AIHW 2011)

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Ethnic and Indigenous background�� There is evidence to suggest that obesity and overweight in young Australians may relate to ethnic or Indigenous backgrounds.

Lobstein, Baur and Uauy (2004) highlight that the prevalence and incidence of diabetes among Indigenous Australians living in urban areas are significantly higher compared with those living in traditional homelands.

In 1995 and 1997 it was highlighted that there was a higher prevalence of overweight and obesity among schoolchildren with backgrounds of Middle-Eastern or continental European origins, compared with children from either Asian or English-speaking backgrounds (Booth et al. 2001).

The AIHW suggests that there is a critical need to collect more data and analysis on the rates and prevalence of overweight and obesity across the population of Australian young people, as much is still unknown about how overweight and obesity is distributed among different social groups (AIHW 2004, p.3).

Socioeconomic status�� Increasingly, research findings also suggest that young people from low socioeconomic backgrounds are more likely to be overweight or obese, both internationally and within Australia (Power & Parson 2000; Booth et al. 2001; Tennant, Hetzel & Glover 2003; Shrewsbury & Wardle 2008; Hardy et al. 2012; Morley et al. 2012).

Lack of action �� Awareness of the impact of overweight and obesity on population health and wellbeing can be seen in the plethora of international, national and state reports, and strategic plans. However, the conversion of this concern to action remains largely unrealised (Swinburn et al. 2011; Gortmaker et al. 2011). This is particularly true for the relationship between young people and overweight and obesity, as much of the attention by decision-makers has been focused on population-wide campaigns and interventions.

It should be noted that none of these factors work in isolation. In a study using data from the 2009 and 2010 National Secondary Students’ Diet and Activity (NaSSDA), Morley and colleagues (2012) argue that while much research has focused on the impact of one behavioural factor on overweight and obesity rates, such as lack of exercise, there has been limited research assessing the impact a range of factors may have, as well as the relationships between factors. Similarly, Lobstein, Baur and Uauy (2004) discuss the example of prolonged television viewing, commonly associated with overweight and obesity in public discourse, highlighting that television viewing is usually mediated by an individual’s energy intake and general activity level.

If policy solutions to the issue of overweight and obesity among young Australians are to be successful, there needs to be greater understanding of what causes overweight and obesity within the community, otherwise public health campaigns and interventions may be ineffective in gaining the support of the population.

0%

20%

40%

60%

80%

100%

20%25%

Boys & girlsIt is estimated that 25% of adolescent boys and 20% of adolescent girls currently reported as either overweight or obese in Australia.(BOOTH ET AL. 2007, GILL ET AL. 2009)

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Since 2008, the Australian and New Zealand Obesity Society (ANZOS) has released an annual league table on how the states and territories

are performing in obesity prevention (ANZOS 2011) in order to encourage governments to prioritise action on obesity.

Experts compare the progress of each state and territory across a range of obesity prevention benchmarks, including how each government is helping to enable access to healthy food, reducing the promotion of unhealthy foods, and supporting exercise as a lifestyle choice, such as by investing in better urban design.

Recently ANZOS has highlighted South Australia, Western Australia and Queensland as ‘gold medal’ states that are setting a positive example in obesity prevention (ANZOS 2011). Dr Anna Peeters (ANZOS 2010) of Monash University has commented that these three states all share ‘strong leadership’, each having bipartisan support for policies that go ‘beyond healthy food policies in schools, expanding into health care, government and sporting facilities’. For example, Queensland, winner in 2011, has invested in innovative policies such as Q2, which includes obesity reduction targets for Queenslanders, as well as establishment of strong partnerships between various levels of government and non-government organisations (ANZOS 2011).

ANZOS Public Health Sub-Committee, and senior policy advisor for the Obesity Policy Coalition, Jane Martin, (ANZOS 2011) also highlighted New South Wales for

its implementation of progressive policies such as regulation to mandate energy information on chain fast food menus and in outlets.

Despite improvements in policies across a number of states, ANZOS has warned that there needs to be more improvement. Despite difficulties due to regional issues and the potential of policies such as the Nutrition And Physical Activity Program, ANZOS granted the Northern Territory the ‘couch potato’ award for the third consecutive year due to its lack of progress in implementing obesity prevention strategies.

ANZOS (2011) also argues that there needs to be a more comprehensive national approach to obesity prevention. In particular, ANZOS (2010) has highlighted that the lack of progress in restricting junk food advertising to children has been counter-productive to policies that promote a healthier lifestyle. ANZOS (2011) has also argued that, with the Blewett Labelling Logic report currently under review, governments across the country have an opportunity to have a real impact on obesity rates, with ‘common-sense recommendations such as traffic light labelling on packaged food and fast food menus’.

National activity

Gold medal statesSouth Australia, Western Australia and Queensland are setting a positive example in obesity prevention(ANZOS 2011)

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Although policy efforts to curb rising rates of overweight and obesity have generally been ad hoc throughout the states, there has been some national movement in this area. One such effort was the establishment of the National Obesity Taskforce (NOT) in 2003. The NOT outlined a national strategy called Healthy Weight 2008 that focused on young people and children, advocating increasing physical activity and healthy diet. Also in 2008, Australian health ministers made obesity a National Health Priority Area.

In recent years national policy efforts to curb the rate of overweight and obesity within the Australian population have included the National Preventative Health Strategy (NPHS), coordinated by the National Preventative Health Taskforce (NPHT), which focuses on confronting chronic diseases caused by obesity, tobacco and excessive consumption of alcohol through primary prevention strategies. (For more information on how the NPHS aims to address obesity. See NPHT 2009.)

Another of the population-wide policy efforts to address the rising prevalence of preventable lifestyle-related diseases, including overweight and obesity, is the National Partnership Agreement on Preventative

Health (NPAPH), announced in 2008. The NPAPH builds upon the Council of Australian Government’s (COAG) already established Australian Better Health Initiative and aims to support the National Healthcare Agreement by funding programs that will ameliorate pressure on the health system in the long term (Department of Health and Ageing 2009a). From 2009 the NPAPH committed $872.1 million over six years, which is the largest investment ever made to health prevention in Australia. The NPAPH states that each state and territory will commit to supporting programs that promote healthy behaviours in all population groups, such as balanced diet, plenty of exercise and reducing the rates of unhealthy behaviours like smoking. Although not specific to young people or overweight and obesity, the policy framework does highlight children and young people as a cohort that requires support in encouraging healthy behaviours.

As part of the NPAHP, COAG supported the establishment of the Australian National Preventative Health Agency (ANPHA) on 1 January 2011 (ANPHA 2011). Of the $872 million committed by the Australian Government to health prevention, ANPHA has been allocated $133.2m of this funding over four years, including funding for social marketing campaigns ($102.0m), Agency functions ($17.6m), the research fund ($13.1m), and a workforce audit ($0.6m).

Another current initiative coordinated by the Australian Government, through the ANPHA, is Swap It Don’t Stop It, the new phase of the Measure Up campaign. The campaign focuses on encouraging people of all ages to make small changes that will help them to ‘swap’ unhealthy habits for ones that will lower their risk of overweight and obesity (Australian Government 2012). In March 2012, the Minister for Health Tanya Plibersek and Mark Butler, Minister for Social Inclusion, Mental Health and Ageing, announced the allocation of almost $4 million towards 13 new research projects focused on preventative health. A number of these were focused on obesity, such as Becky Freeman’s project which looked at online food and beverage advertising to young people and children (Plibersek & Butler 2012).

The NHMRC has also developed dietary guidelines in recent years to support other public health interventions focused on combating overweight and obesity. These guidelines highlight the importance of consuming a high proportion and wide range of nutritious foods, while limiting the amount of foods that have high fat, sugar and salt content. It should be noted that these guidelines are currently under review.

Within the research field, the Australasian Child and Adolescent Obesity Research Network (ACAORN) was

10%

20%

30%

40%

50%

60%

70%

80%

% Obese

% Overweight but not obese

12–17years

12–17years

18–24years

18–24years

% Underweight/normal weight

Body massYoung people aged 12–24 years by body mass index category, 2007–08.(AIHW 2011)

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established in November 2002 through support from the NSW Department of Health. ACAORN acts to support researchers to network and collaborate on projects, working to establish a body of knowledge on the relationship between young people and overweight and obesity within the region.

However, many interest groups within the field are concerned that national efforts to curb overweight and obesity are not going far enough, or are too ad hoc to make coordinated and concerted change. For example, the National Rural Health Alliance believes that more needs to be done to support people who are obese and overweight in rural and regional communities as current national strategies are ineffective at reducing rates (ABC 2011). Similarly, Swinburn and colleagues (2011, p.804) advocate that policy interventions aimed at combating obesity and overweight should focus more on addressing the environments that encourage poor diet and limited physical activity, rather than seek to alter the behaviour of individuals.

Focusing on environmental factors will require government and other decision-makers to adopt a broader and more collaborative approach to the issue. Rutter (2011, p.747) argues that solutions to the ‘wicked problem’ of obesity will require the collaboration of professionals, individuals, organisations and sectors in order to be effective in reducing the prevalence of overweight and obesity in the community. For example, Rutter argues that clinical solutions need to be supported by nutritionists and policies designed to influence the environment, in order to support a ‘broad ecological approach’.

However, policies cannot be formulated without a strong evidence and research base. The need for more research and monitoring of trends in this area, particularly in regards to young people, must first be rectified before investing in policy solutions. This sentiment is echoed by Swinburn and colleagues (2011, p.804), who argue that the dearth of policy success in the obesity sphere requires immediate ‘evidence-creating policy action’. In particular, they advocate investment that focuses on reducing supply-side drivers of obesity (p.804).

Also important to consider is the lack of evaluation of existing policy initiatives, and whether they have been able to reduce the prevalence of obesity and overweight in the communities in which they are implemented. It is critical that the progress of current policies be monitored and reviewed, otherwise resources and energy may be directed into areas that are not appropriate or effective.

Where to from here?Unlike issues such as alcohol abuse or tobacco use, which have received much attention from the public and decision-makers, overweight and obesity in young people remains an issue that receives scant attention beyond reports in the news media, or within broad public health interventions.

This lack of attention is in spite of obesity and overweight being a major health issue for young people, affecting one in four young Australians, and contributing to the $58 billion spent on obesity-related health conditions each year. For example, the Australian and New Zealand Adolescent Health Conference ‘Youth Health 2011: It’s totally important!’ did not have one item on the program that mentioned obesity (Youth Health 2011: It’s totally important!, 2011).

Overweight and obesity in young people is often placed in the ‘too hard basket’, and Australia is currently facing the real possibility that this will remain an ever-increasing public health issue. Relying on the media to present overweight and obesity in young people as an important issue will not be enough, as media attention can be seen as reactive and limited in scope, and therefore provide limited evidence for decision-makers. It is critical that policy-makers and researchers rely on and develop a body of knowledge on young people and overweight and obesity in Australia.

It is also important that key messages about overweight and obesity reach the public to inform public discussion about the influence of factors and therefore the need for a more broad approach regarding significant long-term health implications for individuals and the community. In a recent article in the Medical Journal of Australia it was suggested that 25% of cancers to be diagnosed in Australia by 2025, or 43,000 cases, could be prevented simply by changes in diet and physical activity (Baade et al. 2012). This staggering figure reaffirms the need for government, researchers and other decision-makers to focus on the relationship between young people and overweight and obesity, as inaction will not only have significant implications for the health of individuals directly affected, but will also have significant public health costs.

Without greater understanding by the general community and decision-makers of the prevalence and effects of obesity on the lives of young people, any attempts to reduce rates through policy or public discussion may be based on misinformation, and as a result be ineffective.

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Useful links

Australian Government bodies

Australian Institute of Health and Wellbeingwww.aihw.gov.au/

Australian National Preventative Health Agencyhttp://anpha.gov.au/internet/anpha/publishing.nsf/Content/home-1

Department of Health and Ageingwww.health.gov.au/

National Preventative Health Taskforcehttp://www.preventativehealth.org.au/

Research

Australian Child and Adolescent Obesity Research Network (ACAORN) ACAORN coordinates research collaboration among Australian child and adolescent obesity research groupswww.acaorn.org.au

Australian Medical Association (AMA)AMA members are registered medical practitioners and medical students www.ama.com.au

Australian & New Zealand Obesity Society (ANZOS)ANZOS is a scientific organisation of medical practitioners, dietitians,

scientists and other health care professionals interested in obesity research, treatment or public health initiatives directed at the prevention of obesitywww.anzos.com

International Association for the Study of Obesity (IASO)The leading global professional organisation concerned with obesity operates in more than 50 countries around the world, with a mission to improve global healthwww.iaso.org

International Obesity Task Force (IOTF)In collaboration with the World Health Organisation, the IOTF’s mission is to inform the world about the urgency of the (obesity) problemwww.iotf.org

National Health & Medical Research Council (NHMRC) The NHMRC onsolidates within a single national organisation the often independent functions of research funding and development of advice. It aims to bring together and draw upon the resources of all components of the health systemwww.health.gov.au/nhmrc

Obesity and Population Health Research Unit (OPHRU)Based at Monash University, the OPHRU research program aims to build the evidence base for public health policy regarding the prevention of obesity and its consequent diseaseswww.med.monash.edu.au/epidemiology/ophru/index.html

Specific interest groups

Cancer Councilwww.cancer.org.au

Diabetes Australia www.diabetesaustralia.com.au

Heart Foundation of Australia www.heartfoundation.com.au

Nutrition Australiawww.nutritionaustralia.org

Parents Jury The Parents Jury is a web-based network of parents who wish to improve the food and physical activity environments for children in Australiawww.parentsjury.org.au

Obesity Policy Coalition (Vic based)www.opc.org.au

Obesity Prevention Australiawww.obesityprevention.com.au

Further reading

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ReferencesAccess Economics 2008, The growing

cost of obesity in 2008: three years on, Report for Diabetes Australia, Canberra.

ABC 2011, Remote areas need ‘spe-cific obesity plan’, ABC, retrieved from, <http://www.abc.net.au/news/stories/2011/05/06/3209742.htm?site=gippsland>.

Allman-Farinelli, M., Chey, T., Bau-man, A., Gill, T., James, W. 2008, ‘Age, period and birth cohort ef-fects on prevalence of overweight and obesity in Australian adults from 1990 to 2000’, European Journal of Clinical Nutrition, v.62, pp.898-907.

Australian Bureau of Statistics (ABS) 2009, ‘Smoking, risky drinking and obesity’, Australian Social Tends 4102.0, retrieved from, <http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features30Dec+2009>.

Australian Government 2012, Become a swapper: swap it don’t stop it, Australian Government, retrieved from, <http://measureup.gov.au/internet/abhi/publishing.nsf/Con-tent/become-a-swapper-lp>.

Australian Institute of Health and Welfare (AIHW) 2004, A rising epidemic: obesity in Australia children and adolescents, AIHW, retrieved from, <http://www.aihw.gov.au/workarea/downloadasset.aspx?id=6442471181>.

Australian Institute of Health and Wel-fare (AIHW) 2011, Young Austral-ians: Their health and wellbeing, AIHW, retrieved from, <http://www.aihw.gov.au/WorkArea/Down-loadAsset.aspx?id=10737419259&libID=10737419258>.

Australian National Preventative Health Agency (ANPHA) 2011, About the Agency, ANPHA, retrieved from, <http://anpha.gov.au/internet/anpha/publishing.nsf/Content/aboutanpha>.

Australian & New Zealand Obesity Society (ANZOS) 2010, SA and

WA are leading the pack in obesity prevention, The Crikey Health Blog, retrieved from, <http://blogs.crikey.com.au/croakey/2010/10/21/sa-and-wa-are-leading-the-pack-in-obesity-prevention-while-the-nt-and-nsw-are-chain-draggers/>.

Australian & New Zealand Obesity Society (ANZOS) 2011, Queens-land reclaims gold medal for action on obesity, ANZOS, retrieved from, <https://anzos.com/index.php?option=com_docman&Itemid=24>.

Baade, P.D., Meng, X., Sinclair, C. & Youl, P. 2012, ‘Estimating the future burden of cancers preventable by better diet and physical activity in Australia’, Medical Journal of Australia, v.196, pp.337-40.

Biddle, S.J., Pearson, N., Ross, G.M. & Braithwaite, R. 2010, ‘Tracking of sedentary behaviours of young people: A systematic review’, Preventative Medicine, v.51, n.5, pp.345-51.

Biggs, M. 2006, Overweight and obesity in Australia, Parliament of Australia Parliamentary Library, retrieved from, <http://www.aph.gov.au/library/intguide/sp/obesity.htm>.

Booth, M., Chey, T., Wake, M., Arm-strong, T., Hesketh, K. & Mathur, S. 2001, ‘The epidemiology of overweight and obesity among Australian children and adolescents 1995-97’, Australian and New Zea-land Journal of Public Health, v.25, n.2, pp.162-69.

Booth, M.L., Dobbins, T.A., Denney-Wilson, E., Hardy, L.L. & Okely, A.D. 2007, ‘Trends in the preva-lence of over-weight and obesity among Australian children and adolescents 1985–1997–2004’, Obesity 2007, v.15, pp.1089–95.

Browne, J.L. & Speight, J. 2012, ‘Back off, fatists – blame games don’t help anyone’, The Conversation, retrieved from, <http://thecon-versation.edu.au/back-off-fatists-

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Cancer Council Australia 2011, High school students graduat-ing to be tomorrow’s cancer and cardiovascular patients, Can-cer Council Australia, retrieved from, <http://www.cancer.org.au/Newsmedia/mediareleases/mediareleases2011/9February2011.htm>.

Cancer Council NSW 2012, Fat free TV guide: Tips and facts for parents, Cancer Council NSW, re-trieved from, <http://www.fatfreetv.com.au/contact>.

Catford, J.C. & Caterson, I.D. 2003, ‘Snowballing obesity: Australians will get run over if they just sit there’, Medical Journal of Austral-ia, v.179, n.11/12, pp. 577-79.

Denney-Wilson, E. & Baur, L.A. 2007, ‘Adolescent obesity: Making a dif-ference to the epidemic’, Interna-tional Journal of Adolescent Medi-cal Health, v. 19, n.3, pp.235-43.

Department of Health and Age-ing 2003, Healthy weight 2008 – Australia’s future, the national action agenda for children and young people and their families. Report of the Obesity Task Force, Department of Health and Ageing, Canberra, retrieved from <www.heathactive.gov.au>.

Department of Health and Age-ing 2009a, National Partnership Agreement on Preventative Health, Canberra, retrieved from <http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pre-vention-np>.

Department of Health and Ageing 2009b, About Overweight and Obesity, Department of Health and Ageing, Canberra, retrieved from, <http://www.health.gov.au/internet/main/publishing.nsf/con-tent/health-pubhlth-strateg-hlthwt-obesity.htm>.

Dixon, J., Eckersley, R. & Banwell, C. 2003, ‘The big picture: The eco-

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nomic and socio-cultural determi-nants of obesity’, Healthlink: The Health Promotion Journal of the ACT Region, Autumn, pp.10-11.

Eckersley, R. 2011, ‘A new narrative of young people’s health and wellbe-ing’, Journal of Youth Studies, v.14, n. 5, pp. 627-38.

Finucane, M.M., Stevens, G.A., Cowan, M.J. et al. 2011, ‘National, regional, and global trends in body mass index since 1980: systemic analysis of health examination surveys and epidemiological stud-ies with 960 country-years and 9.1 million participants’, The Lancet, v.377, pp. 557-67.

Garnett, S.P., Baur, L.A., & Cowell, C.T. 2011, ‘The prevalence of increased central adiposity in Australian school children 1985 to 2007’, Obesity Reviews 2011, v.12, pp.887-96.

Gill, T.P., Baur, L.A., Bauman, A.E. et al. 2009, ‘Childhood obesity in Australia remains a widespread health concern that warrants popu-lation-wide prevention programs’, Medical Journal of Australia, v.190, n.3, pp.146-48.

Gortmaker, S.L., Swinburn B.A., Levy D., et al. 2011, ‘Changing the future of obesity: science, policy, and action’, The Lancet, v.378, pp.838-47.

Hardy, L.L., Dobbins, T.A., Denney-Wilson, E., Okely, A.D. & Booth, M.L. 2009, ‘Sedentariness, small-screen recreation, and fitness in youth’, American Journal of Preventative Medicine, v.36, n.2, pp.120-25.

Hardy, L.L., Denney-Wilson, E., Thrift, A., Okely, A.D. & Baur, L.A. 2010, ‘Screen time and metabolic risk factors among adolescents’, Ar-chives of Pediatrics and Adolescent Medicine, v.164, n.7, pp. 643–49.

Hardy, L.L., King, L., Espinel, P., Cosgrove, C. & Bauman, A. 2011, SPANS 2010 NSW Schools Physical Activity and Nutrition Survey: Full Report, Centre for Health Ad-vancement NSW, retrieved from,

<http://www.health.nsw.gov.au/pubs/2011/spans_full.html>.

Hardy, L.L., Cosgrove, C., King, L., Venugopal, K., Baur, L.A. & Gill, T. 2012, ‘Shifting curves? Trends in thinness and obesity among Australian youth, 1985 to 2010’, Pediatric Obesity, v.7, n.2, pp.92-100.

Healy, G.N., Wijndaele, K., Dunstan, D.W., Shaw, J.E., Salmon, J., & Zimmet, P.Z. 2008, ‘Objectively measured sedentary time, physical activity, and metabolic risk: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab)’, Diabe-tes Care, v.31, n.2, pp.369-71.

Hebden, L.A., King, L., Grunseit, A., Kelly, B. & Chapman, K. 2011, ‘Advertising of fast food to children on Australian television: the impact of industry self-regulation’, Medical Journal of Australia, v.195, n.1, pp.20-24.

Kelly, B., Halford, J.C., Boyland, E.J., Chapman, K., Bautista-Castano, I., Berg, C. et al. 2010, ‘Televi-sion food advertising to children: a global perspective’, American Journal of Public Health, v.100, n.9, pp.1730-736.

Kelly, B., Chapman, K., King, L. & Hebden, L. 2011, ‘Trends in food advertising to children on free-to-air television in Australia’, Austral-ian and New Zealand Journal of Public Health, v.35, n.2, pp.131-34.

King, D. 2011, ‘The future challenge of obesity’, The Lancet, v.378, pp.743-44.

Lobstein, T., Baur, L. & Uauy, R. 2004, ‘Obesity in children and young people: A crisis in public health’, Obesity Reviews, v.5, n.1, pp.4-85.

Magarey, A.M., Daniels, L.A. & Boulton, T.J. 2001, ‘Prevalence of overweight and obesity in Austral-ian children and adolescents: reas-sessment of 1985 and 1995 data against new standard international definitions’, Medical Journal of Australia, v.174, n.11, pp.561-64.

Morley, B.C., Scully, M.L., Niven, P.H., Okely, A.D., Baur, L.A., Pratt, I.S.

& Wakefield, M.A. 2012, ‘What factors are associated with excess body weight in Australian second-ary school students?’, Medical Journal of Australia, v.196, n.3, pp.189-92.

Murdoch Childrens Research Institute (MCRI) 2012, ‘Study shows full health effects of obesity not felt until adolescence’, MCRI, retrieved from, <http://www.mcri.edu.au/news/2012/june/study-shows-full-health-effects-of-obesity-not-felt-until-adolescence.aspx>.

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Nguyen, B., Shrewsbury, V.A., O’Connor, J, Steinbeck, K.S., Lee, L., Hill, A.J., Shah, S., Kohn, M.R., Torvaldsen, S., Baur, L.A 2012, ‘Twelve-month outcomes of the loozit randomized controlled trial’, Arch Pediatr Adolesc Med, v.166, n.2, pp.170-77.

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