THE release in 1997 of the National Health and Medical Research Council’s report, Acting on Australia’s Weight: a Strategic Plan for the Prevention of Overweight and Obesity, was supposed to be a watershed.

Associate Professor Tim Gill

Executive Officer, Australian and New Zealand Obesity Society

This was the first time a national agency anywhere in the world had produced a national action plan that recognised the seriousness of the growing obesity problem and set out a strategy to deal with it.

Great anticipation surrounded the level and vigour of action on treatment and obesity prevention it would stimulate.

Alas, after several years of procrastination, several government taskforces and innumerable additional reports (with mostly the same recommendations) the original report has been re-branded from Acting on Australia’s Weight to ‘Waiting on Australia to Act’ by health advocates frustrated by continued unwillingness by successive Australian governments to take up the tougher recommendations required.

All governments now acknowledge the seriousness of the public health problem of obesity and the financial and social burden of obesity-related conditions.

However, they proffer a confusing range of reasons for their unwillingness to act upon recommendations from their own expert committees.

Among the most perplexing rationales for inaction include: obesity is not a disease; we cannot act without certainty that this intervention will be effective; obesity is a lifestyle problem that requires personal rather than government action; and we do not want to create a nanny state.

In isolation, some of these justifications appear valid, especially when espousing a need for evidence-based policy and a desire to avoid causing unintended harm.

However, few stand up to critical analysis within the context of type of response required to make headway.

Since the release of Acting on Australia’s Weight, the prevalence on obesity has risen from 18.7% to 28.3% and now almost two-thirds of Australian adults are overweight or obese.

The predicted avalanche of weight-related chronic disease is beginning to emerge. The level of type 2 diabetes has more than doubled since 1995 and now affects 4.2% of the adult population.

Every day 280 Australians develop diabetes, and the Baker IDI Institute estimates there will be 2.5—3 million people with diabetes by 2025 and about 3.5 million by 2033. These sorts of figures should see governments eager to identify and support any action. Instead we have reached a point where the range of strategies acceptable to governments is narrowing. Potentially effective interventions have been ruled off the table as a consequence of a combination of political, philosophical and technical considerations.

It is true there are no easy or quick solutions to the problem of Australia’s expanding weight. It is also true that governments alone cannot solve this problem; it will take a concerted effort from individuals, communities, professionals, industry and all sectors of society.

Governments must provide leadership, however. This necessitates tough decisions in the face of corporate resistance and public self-interest that demonstrate commitment in tackling obesity and perceptions around this issue.

Telling people battling with genetic and physiological liabilities overlaid with an environment that promotes sedentary behaviour and overconsumption of food that they must take personal responsibility is not leadership.

But preparedness to embrace a range of structural, regulatory or fiscal reforms that have the potential to push the environment in a direction that supports appropriate behaviour change provides a clear indication of the government’s stance.

This display of leadership is likely to achieve more in terms of modelling and endorsement of additional action than the direct impact of the intervention itself. And that is the role of government.