Technical Paper 1:
Obesity in Australia: a need for urgent action
2.2 - Those at special risk
While overweight and obesity are widely distributed among Australian adults and children, there are some significant variations in its distribution across the Australian population. Obesity is particularly prevalent among men and women in the most disadvantaged socio-economic groups, people without post-school qualifications, Aboriginal and Torres Strait Islander peoples, and among many people born overseas, as outlined below:
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- Among Aboriginal and Torres Strait Islander people, high body mass is the second highest contributor to disease burden (11.4%), after tobacco use (12.1%). In comparison, among the general Australian population, high body mass is the third highest contributor to disease burden (7.5%), after tobacco use (7.8%) and high blood pressure (7.6%).
- In 2004–2005, after adjusting for differences in age structure and survey non-response, approximately 60% of Indigenous Australians aged 18 years and over were overweight, of whom 31% were obese.
- Indigenous Australians were:4
- 1.2 times as likely as non-Indigenous Australians to be overweight
- 1.9 times as likely to be obese
- over three times as likely to be morbidly obese (BMI >40).
- Across all age groups, Indigenous Australians were more likely than non-Indigenous Australians to be obese. The greatest differences in obesity rates were observed among young people aged 18–24 years (2.4 times as high as the rate for non-Indigenous Australians) and among people aged 65 years and over (2.1 times as high).
- There are significant differences in overweight and obesity for adults from different regions of birth and cultural backgrounds. On average, people born overseas who arrived in Australia before 1996 had a slightly lower age standardised rate of obesity (15%), while the rate was even lower (11%) for more recent arrivals (between 1996 and 2006) compared to the adult obesity rate of 18% in 2004–2005. However, adults born in Southern and Eastern Europe and the Oceania region (excluding Australia) were more likely to be overweight or obese (65% and 63% respectively), while adults born in South East Asia were least likely to be classified in this way (31%).
- Among school children the differences in overweight and obesity are also marked. A New South Wales study  found that overweight and obesity prevalence was around 50% in Year 8 boys of Middle Eastern descent, compared with 26% from English-speaking backgrounds. Prevalence in boys of European background was also high.Similarly, there is evidence that obesity is significantly more prevalent among boys and girls of all ages from Pacific Islander backgrounds. Among adolescents, those most likely to be obese (four to five times more likely) were boys and girls of Pacific Islander or Middle Eastern/Arabic background.
- Populations from certain ethnic and cultural backgrounds in Australia that are disproportionately more overweight and/or obese suffer higher rates of diabetes and cardiovascular disease. For example, the prevalence of type 2 diabetes among Asian Australians (including those from the Indian subcontinent, East Asia and South East Asia) has been reported to be increasing at a disproportionately high rate compared to non-Asian Australians.[18, 20]
Data on weight status from national health surveys provide evidence of the difference in weight related to socio-economic status. In 2001 the most striking differences between the most and least disadvantaged socio-economic groups were observed in the prevalence of obesity rather than overweight.
- Women in the most disadvantaged socio-economic group had nearly double the rate of obesity (22.6%) of those in the most advantaged group (12.1%).
- Men in the most disadvantaged group were also significantly more likely to be obese than those in the most advantaged group (19.5% compared with 12.7%).
Between 1995 and 2001, the gap (rate ratio) between the highest and lowest socio-economic quintiles for obesity slightly increased in conjunction with the absolute increases seen for adults of both sexes (Fig. 1).
Current research at Deakin University aims to determine at what age socio-economic influences on physical activity and eating emerge by following a cohort of children aged 5–6 and 10–12 years over a five-year period. While adults from lower socio-economic groups have lower levels of physical activity and healthy eating than those from more advantaged backgrounds, these differences are not as clear for children. Evidence seems to suggest that many problems become apparent once adolescents leave school. This may be a key point at which to target appropriate dietary and physical activity initiatives.
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In general, rural and remote populations have poorer health than their metropolitan counterparts with respect to several health outcomes. Increasingly higher rates of overweight and obesity are found between major cities, inner regional areas and outer regional and remote areas for both men and women (Fig. 2).