Obesity – not just child obesity – has reached crisis proportion in New Zealand, and our rate is rising. We lag behind only Greece and Italy amongst OECD countries in incidence of obesity in the adult population.
One in three NZ adults are obese; one in ten children (aged 2-14 years) are. Both rates are significantly higher for Maori and Pacific individuals. The MOH estimates that 10-15% of children are obese in Hawke’s Bay.
Apart from its impact on individuals’ health, widespread obesity will generate unbearable cost on society, as the health system and budget become overwhelmed by the need to treat obesity-fueled diabetes, heart disease, stroke, some cancers and organ failure.
We simply cannot afford our current obesity trajectory.
The MOH plan involves health sector actions (e.g. individual and family intervention for weight management and proper eating and exercise, access to nutrition programmes, intervention targets for DHBs), increased support for physical activity and sport, a broad public information and awareness campaign, and voluntary food industry efforts.
The specific health target is as follows: “By December 2017, 95 per cent of obese children identified in the Before School Check (B4SC) programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.” Families so referred will have improved access to nutrition and physical activity programmes.
Sport NZ and Regional Sports Trusts will be expected to provide more sport opportunities for young people in communities where participation rates are low and the risk of poor health is higher.
Health Promoting Schools (HPS) support will be expanded to 150 more decile 1-4 primary and intermediate schools, and those with high Māori, Pasifika or vulnerable groups. HPS supports school communities to be more proactive about their health and wellbeing.
Women in pregnancy will be targeted for screening and guidance. According to MOH, an estimated one third of women of normal weight and 60% of obese women gain more weight than recommended during pregnancy. They are more likely to be diagnosed with type 2 diabetes and gestational diabetes.
And, says the World Health Organisation (WHO), their children are predisposed to increased fat deposits associated with metabolic disease and obesity. Children who have suffered from under-nutrition and are born with low birth-weight are at much greater risk of obesity when faced with overnutrition and a sedentary lifestyle later in life.
Broad population approaches will include promoting the voluntary Health Star Rating system (nutrition labeling), a national media campaign focused on childhood obesity (targeting parents and caregivers), and a review of the Code of Advertising as it applies to food advertising.
Regarding the food and beverage industry, the MOH plan says:
“Discussions have been held on the role industry can play in helping to address childhood obesity. These discussions have included the possibility of voluntary industry pledges, and changes to food labelling, marketing and advertising to children.”
For some critics, this is a weak spot in the MOH initiative.
The Ministry cites an interim report from WHO as an important resource for shaping its initiative. Sir Peter Gluckman, chief science adviser to the prime minister, served as co-chairman of WHO’s Commission on Ending Childhood Obesity set up to address the issue (Helen Clark was also one of 15 commissioners).
WHO’s view of the situation is summarized in the interim report:
“None of (the) upstream causal factors are in the control of the child, and childhood obesity therefore should not be seen as a result of lifestyle choices by the child. Given that childhood obesity is influenced by biological and contextual factors, governments must address these issues by providing public health guidance, education and establishing regulatory frameworks to address developmental and environmental risks, in order to support families’ efforts to change behaviours.
“Obesity itself is a direct cause of morbidities in childhood including gastrointestinal and orthopaedic complications, sleep apnoea, and the accelerated onset of cardiovascular disease and diabetes … Obesity in childhood can also contribute to behavioural and emotional difficulties, such as depression, lead to stigmatization and poor socialization and appears to impair learning.
“Critically, childhood obesity is a strong predictor of adult obesity, which has well known health and economic consequences, both for the individual and society as a whole.”
WHO’s report offers a robust suite of policy recommendations, and in many respects the MOH programme incorporates the report’s main principles.
But more worth noting is where WHO and MOH diverge. And that is principally in the area of more direct fiscal and regulatory interventions.
For example, the WHO report strongly endorses taxation of sugar-sweetened nonalcoholic beverages, arguing:
“Low-income consumers and their children have the greatest risk of obesity in many societies and are most influenced by price and such fiscal policies could encourage this group of consumers to make healthier choices as well as providing an indirect educational signal to the whole population.
“The evidence available to date makes a case for applying taxes to products such as sugar-sweetened non-alcoholic beverages as the most feasible to implement.” WHO mentions spill-over benefits in the reduction of dental caries in children.
Then there’s the issue of food and beverage marketing, where the WHO report is very firm:
“There is unequivocal evidence that the marketing of unhealthy foods and nonalcoholic beverages is related to childhood obesity. Despite the increasing number of voluntary efforts by industry, exposure to marketing of unhealthy foods remains a major issue and there is a need for change that will protect all children equally.
“…voluntary initiatives that are not subject to independent audit and oversight are likely insufficient.
“Regulatory and statutory approaches may be needed to ensure that changes reach the desirable level and apply to forms of marketing that are not currently covered under voluntary codes. Regulation will provide equal protection to all children regardless of socio-economic group.
“There needs to be clarity as to the range of healthy products that can be marketed, and consideration of both direct and indirect marketing strategies, including pricing, promotion and placement.”
Taxation and regulation! Nasty concepts to some governments.
A local perspective
BayBuzz asked Hawke’s Bay paediatrician and NZ’s Children’s Commissioner Dr Russell Wills for his ‘take’ on the MOH initiative. He applauds the initiative as helpful in areas like food labeling, public awareness and fostering exercise.
However, he worries that the intention to intervene with families who have obese children could backfire harmfully if those expected to provide advice are not properly skilled to provide parent training. With properly skilled parent training, family-centred weight reduction programmes can be quite successful, he notes; but not so effective without. “We don’t want to set parents up to fail.”
More broadly, Dr Wills believes the MOH initiative is not commensurate with the crisis level of the problem. Favouring the WHO blueprint, he cites three areas of shortcoming: failure to tax sugar, particularly in fizzy drinks; reliance on purely voluntary restraints on marketing high fat, high sugar foods to children; and lack of mandatory rules on healthy food in schools.
“The Government just hasn’t gone far enough,” he commented on Radio NZ. Referring to obesity as a health crisis, Dr Wills urges: “We have to be brave and do things that are unpalatable … we are all going to pay the price of high obesity in New Zealand”.