Bulging Aussies

This week the Pediatrics journal reported there are hundreds of thousands of US children who are too obese to safely fit into child care seats. Rates of childhood obesity are increasing so fast that car seat designers obviously can’t keep up with the change.

Obesity levels in Australian children aren’t far behind the US and are increasing at 1 per cent a year. This means about 40,000 young children in Australia are becoming overweight or obese every year. Our rates are increasing faster than in any other country. By 2020 there will be an extra two million adults who are obese.

Will we be able to prevent this? Will we be able to even halt the inevitability of these figures? In the 70s, 80s and the first half of the 90s we witnessed what the Medical Journal of Australia has referred to as a “conspiracy of sedentariness”. But in this decade there has been an enormous response in the media, in fact column inches and film feet has been the only response that has been commensurate with the size of the problem itself.

We have had summits and citizens juries, strategies and action plans, and national and state obesity task forces. So why, despite all the action, have we made so little impact and why do we seem to be so powerless?

Let me explain. During the last 30 years, the cultural changes that promote overweight and obesity in Australia have been far more profound and are far more entrenched than we realise. Manual labour at work and in our homes has diminished at the same time as we rely even more on our cars for transport to work, school and leisure. Active play and entertainment have been replaced by bum-to-couch TV viewing, videos, computer and electronic games. We used to be paid to expend energy, now we have to pay to expend energy.

The development of a hyper-safe parenting culture has meant that it has become good parenting not to let children walk to school or play in the neighbourhood for fear of stranger danger. At the same time food manufacture and promotion has changed so that high energy food and drinks have become our staples, and enabled us to slam killer-calories down our gullets at the fastest rate in our history. Only 2 per cent of young Aussie men eat the recommended levels of fruit and veggies.

Work patterns have changed so that children are baby-sat with TVs and computers, and family meals have been usurped by fast food super-sized alternatives.

This is all underpinned by the fact current market forces promote overweight and obesity. Inactive transport and entertainment sell much better, and are advertised much more than active transport and active entertainment. Similarly fast food sells much better than slow and healthy food. Whether we like it or not, it is the market, not health, that rules. Of course we have our own individual choices to make, but there is little doubt that trying to be physically active and eat healthily has never been more difficult.

There is simply too much money to be made in obesity for us to stem the tide. McDonalds have been lauded for changing their offerings to include healthy food but the result is that more adults are now eating more hamburgers. Until Maccas, KFC, Coca Cola and Mars start to make a lot more money in healthy food and beverages than they do in junk food and high calorie drinks we will be stuffed, both literally and metaphorically.

To reverse these deeply entrenched changes and to encourage the market to correct itself we will need some equally radical but politically indigestible approaches. And we will need them to happen together.

Ban fast food advertising in peak times for kids; stop food manufacturers making false claims of the health value of their products; subsidise healthy food; revitalise school canteens, introduce community gardens to schools with food preparation and meals at schools; ensure fun and fitness pervades school time and after school; get 70 per cent of primary school kids walking 70 per cent of the time to school: prioritise pedestrians and cyclists over car drivers on all local roads; and invest in public transport. How do we fund this? It’s easy - hypothecated taxes on petrol and on toxic sugar, fat and salt combinations in food.

These could all happen, but they won’t, and because they won’t in ten years there will be hundreds of thousands more little Aussies who are overweight, a million extra obese big Aussies and an enormous amount of disease and unhappiness that could have been prevented.

Yesterday the National Obesity Taskforce reported back to federal and state ministers for health on their progress to date. But despite their good intent it isn’t health ministers alone who will solve this problem. They are but junior partners to treasurers, just as we as doctors have far less capacity to prevent the problem than do private and public sector economists. Mr Costello controls many more of the levers to solve the problem than does Mr Abbott.

I plan to read this article again in 10 years - if I’m wrong, and overweight and obesity levels have started to drop I will happily eat my hat, as well as ten Big Macs in a row. This is one argument I would love to lose, but sadly, I am sure I’ll be saying “I told you so”.