Childhood Obesity in Australia Childhood

¶ … Childhood Obesity in Australia

Childhood obesity is an epidemic that has been given considerable attention in the media as well as at the policy level. It is an epidemic that continues to rise and has been estimated to impact over 25% of the youth population in Australia (Heshketh et al. 2005). In fact, according to the World Health Organization (WHO 1997) in 2005 there were approximately 20 million children worldwide under the age of 5 that were categorized as obese. The WHO (1997) expects that by the year 2015 that this number will increase to 2.3 billion. Obesity has been defined on the basis of standard body mass index (BMI) cut points for both gender and sex. Specifically overweight is classified as a BMI of over 25 with obesity at 30.

While these numbers are daunting it is the health and social impacts that are of the greatest concern. Obesity is correlated with an increased risk of high blood pressure, heart disease, stroke, asthma, cancer, skeletal disorders, and sleep apnea (de Silva et al. 2010). This is further confounded by the social stigma that is associated with obesity in many cultures. This is particularly concerning when one takes into consideration that obesity is considered to be a preventable condition.

The widespread prevalence of this epidemic has made the development of preventative and management strategies challenging. This is confounded by the controversy surrounding how this issue should be framed, who should accept responsibility for change, and what should be done at the policy level to intervene. It is clear that childhood obesity has gained increasing attention from key stakeholders, the media, and national surveys such as the National Nutrition Survey of 1995.

Underlying Values and Assumptions

Since many interventions have been focused on the modifiable aspects of obesity such as lack of physical exercise and the consumption of energy dense food, this has led to the underlying assumption that obesity is a condition that is the direct result of choices made by and the lifestyle of the individual (Heshketh et al. 2005). Schools at times have been targeted as the source of unhealthy food consumption in children, however, studies have shown that less than a third of all food intake occurs in this environment. This has led to the assumption that the family household is the key factor in the provision of food for the child and therefore a significant link to the development of obesity, particularly those children between the ages of 5 and 14 years (Margarey 2008). Portrayal of the issue both in the media and in intervention strategies have targeted parents as the point of intervention since they had been identified as the persons to blame for this epidemic. Coveney (2008) describes this common belief that childhood obesity is the direct results of childrearing practices with parents failing to protect their children from becoming obese or overweight.

There has also been evidence to suggest that the prevalence of obesity is not spread equally across populations. In fact, it is commonly recognized that a relationship exists between obesity and socioeconomic status and that socioeconomic factors are significant predictors of childhood obesity primarily in children ages birth to 7 (Venn et al. 2007). These factors include wealth or income, environment lived in, educational level or success, and stress. It is widely assumed, and with significant evidence, that individuals with lower socioeconomic status are at increased risk of developing obesity (Coveney 2008). Expectedly this has tied the issue of childhood obesity right back in to the role of the parent as socioeconomic status of the child is typically related to the socioeconomic status of the parent and according to Coveney (2008) their inability to ensure that their children eat properly balanced diets and receive adequate exercise. This allows us to establish a causal link between socioeconomic status and obesity with the question of whether the social consequences of obesity are also circular in nature.

Another underlying assumption has been that the media's portrayal of food is linked to the development of childhood obesity. In fact the manner in which television advertises food is one of the most frequently mentioned links to childhood obesity. This may be due to the fact that there has been significant efforts made to market to young children with the goal of developing brand recognition and loyalty (Story and French, 2004). The hope is that this brand recognition will result in intrinsic purchase behavior if early exposure to marketing occurs. Further, marketers believe that young children have significant influence over the purchases that occur in the household, particularly for foods, and therefore they are perceived as an ideal audience for targeted marketing (Story and French, 2004). In fact, it has been found that children are exposed to upwards of 360,000 television commercials by the time they graduate from high school with the most frequent advertising occurring during children's television shows. Further, it has been shown that unhealthy breakfast cereals are the most frequently advertised food product targeting this age group with little advertisement of fruits and vegetables (Story and French, 2004). Therefore it can be observed that the exposure to food advertisement in children is consistent with the unhealthy eating habits that are being reported.

Representation of the Problem

The amount of attention that has been given to this issue has dramatically increased over time and it has emerged as a more significant public health problem than ever before. In fact there have been more than 5000 articles published in newspapers discussing childhood obesity in Australia in the period from 2002 to 2005 (Udell and Mehta 2008). These articles as well as other forms of media have looked at both the causes and potential solutions to this epidemic. The media attention paid to this issue can be credited with a great deal of the knowledge of the epidemic as well as the facilitation of action to intervene before the epidemic gets further out of control.

National Policy Responses

Australian policy makers have attempted to respond to the increasing incidence of childhood obesity in the population. There have been Summits as well as research efforts to get aid in understanding as well as the development of intervention strategies to address this epidemic. In 1997, the National Health Research Council published its work Acting on Australia's Weight, which was a strategic plan to implement prevention efforts to address obesity (Margarey 2008).Then in 1998, the WHO also published a report recognizing the complexity of the issue of obesity while pointing to decreased physical activity and poor dietary consumption as the key factors contributing to an increasingly overweight society.

In 2002 a summit was held that focused on childhood obesity prevention. This helped to elevate the issue of childhood obesity to a government priority and resulted in the launching of the Prevention of Obesity in Children and Young People Government Action plan 2003-2007(GAP). This plan resulted in initial policy recommendations that focused on the social, economic, environmental, and behavioral factors that are linked to the childhood obesity epidemic. This plan identified specific actions that the governmental programs needed to take in order to be contributors to the fight against obesity in children with a priority on health schools, active communities, parental role modeling, increased knowledge and education, and community support (Udell and Mehta 2008).

Despite these policy responses, progress toward decreasing childhood obesity has been hindered by ineffective intervention strategies (Henderson et al.2009). While the Australian government was able to identify childhood obesity as a problem, appropriate response strategies were less clear. Therefore policy interventions have focused on creating a better understanding and framing of the issue for the community, developing an understanding of the views of the individuals and families impacted by obesity, examining of existing approaches and determining what new ideas may be more effective, and recommending future courses of action in both the long and short-term (Heshekth et al. 2005).

One such national policy response has been Healthy Weight 2008. Healthy Weight 2008 was a national framework designed to address childhood obesity. The key focus of this strategy is to support youth and their families in their homes as well as the larger community in order to ensure that underlying environmental and lifestyle contributors to obesity are addressed and replaced with adaptive behaviors. This strategy called for a multi-faceted and multi-setting approach that identifies what actions is necessary and who is responsible for ensuring that appropriate action is taken. Collaboration between health sector professionals, governmental sectors, community members, family, educational professionals, and other stakeholders are believed to be imperative to the success of this strategy.

This strategy requires that organizations utilize evidence based intervention strategies, align their programs with governmental strategic plans, and value existing efforts and not duplicate efforts. The plan further encourages groups and organizations seeking to offer intervention programs to be creative in their approach to policy and action research and monitoring. While the plan identifies the first stage actions, the first stage of the plan being four years, it does not identify long-term strategies.

Development of Policy Responses

The first step in the development of these policy strategies was to identify that a problem existed with childhood obesity and frame the problem so that it could brought to light and intervention strategies debated. While some of the framing of this issue may have been based upon misinformation, policymakers did attempt to frame the problem which is in line with the Australian policy development cycle. This initial framing is an example of how misinformation can lead to poor policy decisions. When looking at childhood obesity from a policy perspective it is imperative to understand the difference between obesity prevention and obesity treatment and this has often been confused in attempts to develop policies for the Australian people (O'Dea 2005).

The Australian policy cycle is comprised of stages including problem identification, analysis of policy options, policy instrument, consultation, coordination, decision, implementation, and evaluation. While this policy process seems sequential, it is important to note that there may be times when different aspects of the cycle need to be revisited or taken out of order. Where this policy response begins to veer away from the policy development cycle is in the manner in which implements and evaluates the success. Healthy Weight 2008 calls for the engagement of individual, family, community, and organizational stakeholders in the intervention development process as well as collaboration amongst stakeholder groups to ensure the best possible outcomes. However, the strategic plan does not see past its initial four-year phase and does not establish long-term planning or security such as funding streams or success reporting mechanisms. In order for any plan to be truly successful it must have built into it an evaluation process so that progress can be tracked and the plan can be changed to meet the needs of the individuals being serviced.

Key Stakeholders Influence on Policy Response

Stakeholders have played a significant role in the identification of childhood obesity as a problem in Australia as well as ensuring that steps are taken to provide effective intervention programs. These have included community stakeholders such as groups, schools, communities, organizations, sports clubs, and parents. Stakeholders were actively engaged in the policy response process and encouraged to see the mutual benefit that resolution to this epidemic could provide. Stakeholders were encouraged to engage in cross sector collaboration which helped to address the many causal possibilities associated with obesity and to recognize that many of these causes are not health related. This coupled with actions such as the healthy schools canteen program, which regulated what foods can be sold in the school environment, provided valuable motivation for the cultural and behavioral changes necessary to sustain long-term results.

Policy Responses and Evidential Underpinnings

The policy responses have encouraged a shift in focus from looking at obesity as an epidemic that needs to be blamed on something such as poor parenting skills or low socioeconomic status to focus on the views of potential participants in intervention programs (Heshketh et al. 2005). These viewpoints and consultations with engaged individuals has provided valuable evidence into the multi-faceted nature of this epidemic and has allowed for the introduction of multi-level responses so that all causal factors can be addressed resulting in behavioral change.