- 1 Key policy priorities in summary
- 2 Implement a comprehensive national obesity prevention strategy
- 3 Create environments that support healthy food choices
- 4 Create environments that support increased physical activity
- 5 Develop economic interventions for preventive health
- 6 Encourage healthy weight, increased physical activity and healthy eating through social marketing
- 7 References
Key policy priorities in summary
Implement a comprehensive national obesity prevention strategy
Overweight and obesity, physical inactivity and poor diet are responsible for a significant proportion of the cancer burden in Australia. In 2017, the Obesity Policy Coalition and the Global Obesity Centre (GLOBE) published Tipping the Scales, a consensus statement drawing upon national and international evidence to address obesity in Australia. This consensus statement is endorsed by Cancer Council Australia and over 30 other community, public health, medical and academic groups. The eight evidence-based actions identified to be included in a national obesity prevention strategy are:
- Time-based restrictions on TV junk food advertising to kids
- Set clear food reformulation targets
- Make the Health Star Rating mandatory by July 2019
- Develop a national active transport strategy
- Fund weight-related public education campaigns
- Introduce a 20% health levy on sugary drinks
- Establish a national obesity taskforce
- Develop and monitor national diet, physical activity and weight guidelines.
Cancer Council Australia recommends that in order to reduce the cancer burden attributable to these factors, a comprehensive national obesity prevention strategy should be developed and implemented. This strategy should be coordinated by the Federal Government, employ a multi-sectoral approach, and involve all levels of government, as well as non-government and community organisations, the health sector, the media, employers and schools. Community education campaigns to raise awareness, shift attitudes and motivate behaviour change are also needed.
Australians in lower socioeconomic groups, people living in rural and remote areas and Aboriginal and Torres Strait Islander peoples have higher rates of obesity and overweight and must have special consideration as part of this strategy.
The key evidence-based policy priorities that this strategy should address are outlined below.
Create environments that support healthy food choices
Australia currently does not have a national strategy for improving population nutrition. This is an area where Australia is significantly lagging behind other countries, and is a priority area for action. An integrated national food and nutrition plan is needed to improve the availability of affordable, accessible and nutritious food and reduce the availability and promotion of unhealthy food for all Australians.
Health star rating
Front-of-pack food labelling is an area where Australia is meeting global best practice benchmarks. However, the Health Star Rating (HSR) system is currently voluntarily implemented and there are a number of anomalies in how it can be applied to foods. There are some foods for which the ratings are not aligned with the Australian Dietary Guidelines. Recommended areas to address:
- Give fresh fruit and vegetables and minimally processed counterparts a HSR of 5
- Do not treat fruit juices and fruit concentrates the same as whole fruits
- Change the definition of Fruit, Vegetable, Nut and Legume (FVNL) to remove fruit juices and fruit juice concentrates
- Remove the protein contribution to positive points in the algorithm
- Limit HSR for foods high in added sugar
- Limit HSR for products high in sodium or saturated fat
- Discriminate between core and discretionary foods
- Cap confectionery to 1 star
- Clarify the ‘as prepared’ rules to reflect the product with water only or drained, with no exemptions.
These anomalies and some inconsistencies surrounding the uptake of the HSR across product ranges need to be addressed to enable comparison between products. By making the system mandatory and introducing a timeframe for industry to comply, consumers will benefit more from front-of-pack labels. In addition, a funded public education campaign is required to increase awareness and understanding of the system.
Increasing the nutritional quality of packaged and processed foods through product reformulation is critical to improving population nutrition. In order to ensure that food manufacturers comply with reformulation goals, it is important that the Healthy Food Partnership establishes clear reformulation targets for the relevant nutrients in specific food categories, with accompanying time frames, and strict penalties for those manufacturers who fail to meet these targets.
Nutrition content and health claims
Nutrition content and health claims on food labels are influential in consumer purchasing decisions. There is no restriction of nutrition content claims on foods that are less healthy, so these claims frequently appear on unhealthy foods. To prevent consumer confusion from claims being on unhealthy products, all products should be required to meet the Nutrition Profiling Scoring Criteria.
Eating food high in added sugars increases overall energy intake while reducing opportunities to eat more nutritious foods and can lead to weight gain. The Australian Dietary Guidelines advise Australians to limit their intake of foods and drinks containing added sugars. The World Health Organization recommends that added sugars for adults and children should only be 10% of their daily energy intake. However, added sugars are not adequately identified under current labelling requirements. Adopting recommendation 12 of the Labelling Logic Review could address this issue by providing information on the label which identify added sugars. It is important for consumers to be aware of added sugars in foods to allow them to make informed choices.
There is strong evidence that food and beverage marketing influences the types of food and beverages children demand, desire and consume. In Australia, current industry self-regulatory approaches aimed at restricting the marketing of unhealthy food and beverages to children have proved ineffective. This is an area where Australia is significantly lagging behind global best practice, and is a priority area for action. Improvements to current regulations are needed, including mandatory restrictions on unhealthy food and beverage marketing on television between 5.30 pm and 9.30 pm when the greatest numbers of children are likely to be watching, as well as Government endorsed standards for what constitutes ‘healthy’ food and drink. Cancer Council supports government regulation of unhealthy food marketing to children. Regulations should apply to all media and forms of marketing, including TV, radio and print advertising, online marketing, food company websites, social media, sports sponsorship, on-pack and in-store promotions and outdoor advertising, which is appeals to children aged under 16 years, or to which a high number of children under 16 years are likely to be exposed.
Create environments that support increased physical activity
Evidence suggests that an individual’s physical environment can influence their physical activity levels. Policies and planning regulations relating to housing, urban design and development and transport infrastructure that promote active living are critical. All levels of government together with urban planners, developers and Infrastructure Australia need to work together to ensure built environments encourage and support people to be more physically active. This will involve upgrading existing environments as well as ensuring new developments support active living.
Active transport interventions that promote walking and cycling, as well as the provision of safe travel environments, provide a practical and sustainable means of increasing physical activity levels in the population. All levels of governments led by COAG, together with the transport sector and Infrastructure Australia, will need to work together to develop and implement an integrated national active transport strategy that encourages more walking, cycling and public transport use.
Develop economic interventions for preventive health
Price is one factor that influences people’s lifestyle choices, and the Federal Government needs to investigate the potential use of fiscal levers such as taxation incentives, grants, pricing and subsidies to encourage physical activity and healthy diets.
Currently, basic foods such as fresh fruit and vegetables are not subject to the goods and services tax (GST), and this has been identified as an area where Australia is meeting global best practice benchmarks. It is important that this exemption is maintained. There are opportunities for government to further subsidise healthy food options, increasing their affordability, particularly in remote communities where fresh produce can cost up to 30% more than in urban areas.
The introduction of higher taxes on energy dense and nutrient poor food products, such as sugar-sweetened beverages, in order to reduce consumption, has been identified as an area where Australia is significantly lagging behind other countries, and is a priority area for action. Cancer Council Australia recommends that the Federal Government implement a sugar-sweetened beverage health levy to effect a price increase of at least 20%, aimed at changing purchasing habits, achieving healthier diets and raising revenue for initiatives aimed at promoting healthy weight.
Public awareness of the link between obesity, poor diet and physical inactivity and cancer is low. Social marketing campaigns to raise community awareness and educate the community have been shown to be essential to support behaviour change. There is an urgent need for the Federal Government to implement a sustained, effective, and adequately funded social marketing campaign, focused on the adverse health outcomes associated with obesity, poor diet and physical inactivity. A funded social marketing campaign could not only raise awareness of the cancer risk but also provide behaviour change strategies to help people reduce their risk. In order to maximise the effectiveness of such a campaign, restrictions on the advertising of unhealthy food and beverages are also required.
- Obesity Policy Coalition and Global Obesity Centre. Tipping the scales - Australian Obesity Prevention Consensus. Melbourne, Australia: Obesity Policy Coalition; 2017 Available from: http://www.opc.org.au/downloads/tipping-the-scales/tipping-the-scales.pdf.
- Hughes C, Wellard L, Lin J, Suen KL, Chapman K. Regulating health claims on food labels using nutrient profiling: what will the proposed standard mean in the Australian supermarket? Public Health Nutr 2013 Dec;16(12):2154-61 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23308399.
- National Health and Medical Research Council. Australian dietary guidelines. Canberra: NHMRC; 2013 Available from: https://www.nhmrc.gov.au/_files_nhmrc/file/publications/n55_australian_dietary_guidelines1.pdf.
- World Health Organization. Guideline-Sugars intake for adults and children. Geneva: WHO; 2015 Available from: http://who.int/nutrition/publications/guidelines/sugars_intake/en/.
- Day K and Clemons R. Sugar savings: How much added sugar can you avoid in one year? [homepage on the internet] CHOICE; 2017 Available from: https://www.choice.com.au/food-and-drink/nutrition/sugar/articles/added-sugar#year sugar savings.
- Blewett AC N, Goddard N, Pettigrew S, Reynolds C and Yeatman H. Labelling logic - review of food labelling law and policy (2011). Canberra, Australia: Department of Health; 2011 Available from: https://www.choice.com.au/~/media/9023443697c640adbf014dbbfec52199.ashx?la=en.
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- Harrison MS, Coyne T, Lee AJ, Leonard D, Lowson S, Groos A, et al. The increasing cost of the basic foods required to promote health in Queensland. Med J Aust 2007 Jan 1;186(1):9-14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17229024.
- Kippen R, James E, Ward B, Buykx P, Shamsullah A, Watson W, et al. Identification of cancer risk and associated behaviour: implications for social marketing campaigns for cancer prevention. BMC Cancer 2017 Aug 17;17(1):550 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28818048.