Technical Paper 1:
Obesity in Australia: a need for urgent action
3.1 - What could be achieved in obesity control
It is difficult to set targets for obesity prevalence, as no country has been successful in reversing the trend of rising levels of overweight and obesity, and few jurisdictions have set targets for specific reductions in the prevalence of obesity. Importantly, it is not only reductions in the prevalence and incidence of overweight and obesity that should be the target of health reforms. Population health measures such as obesity prevalence are affected by many factors, and it takes many years to have an impact on personal behaviours and health outcomes. In the short term, therefore, policy reforms should at least aim to reduce the rate of increase in obesity. Over a five-year period, for example, the best that might be seen in changes in prevalence of overweight and obesity at the population level would be a gradual slowing of the rate of increase. In the UK, for example, the comprehensive cross-government obesity strategy ‘Healthy Weight, Healthy Lives’ aims to reduce childhood overweight and obesity to 2000 levels by 2020.[35]
Policy reforms in the first instance should also target the disproportionate distribution of obesity in Australian society, and focus on reducing the inequity in prevalence between population sectors; for example, obesity is particularly prevalent among men and women in the most disadvantaged socio-economic group, people without post-school qualifications, those with the lowest equivalent income, Aboriginal and Torres Strait Islander peoples, and among many of those born overseas.[5, 36]
Some international studies have modelled the impact of various scenarios targeting chronic conditions on population health outcomes. For example, a Dutch study modelled a national approach to obesity control. In an attempt to develop a basis for policy targets for a potential national action plan on overweight and physical inactivity, researchers simulated the cost-effectiveness of a population-level community-based intervention to 13.3 million people over five years. The results suggested that if an intervention consisting of social marketing and mass media strategies, self-help support groups, risk factor screening and/or counselling in various settings was offered to 90% of the population, and an intensive lifestyle or multi-component weight loss program was offered to 10% of overweight adults, the prevalence rate of moderate overweight (currently 36.1%) could be reduced by 1.6 percentage points and obesity (currently 11%) by 1.2 percentage points. The prevalence rate of physical inactivity (currently 11%) could be decreased by 2 percentage points. The cost of the intervention, based on two existing Dutch projects, would be €470 million (AUD$731.2 million) or €7 (AUD$11) per adult per year. At this level of funding, using a conservative methodology, the study found that costs per quality adjusted life year (QALY) gained were far below those reported for intensive glycaemic control and a reduction in serum cholesterol levels in diabetics.[37]
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The US Centers for Disease Control and Prevention (CDC) commissioned a dynamic simulation model of diabetes prevalence and complications, for use in designing and evaluating intervention strategies.[38] As part of the study, the impact of three scenarios on diabetes rates to 2050 were modelled. The three scenarios were:
- enhanced clinical management
- increased management of pre-diabetes
- reduced obesity prevalence (primary prevention).
Figure 6: Model output for 3 intervention scenarios compared with the baseline scenario for diabetes prevalence (a) and complication-related deaths (b)
Source: Jones et al. 2006[39]