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Taking on Australia's big fat epidemic

June 25, 2004

A dangerous epidemic is imperiling the lives of more than one million Australian children.

The livers of kids with this condition start to degenerate, their hormones become deranged, their arteries clog up, they often have difficulty breathing when awake and sometimes stop breathing while asleep, and they can develop joint deformities.

If left untreated, the condition places immense stresses on the heart which could cause a stroke or heart attack, can severely impair mobility and may lead to blindness, kidney failure and eventually death.

The epidemic is called obesity.

More than one-quarter of Australia's children are now classified as obese, and obesity expert Associate Professor Kate Steinbeck says their number is growing with frightening speed.

"We are setting up a whole generation who will be intrinsically unhealthy from a very early age," she said.

"I think we will just see an explosion of illness following on from childhood obesity."

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One of the major concerns is type two diabetes, a known consequence of obesity that until now has struck those aged in their 50s and 60s.

"We're going to start seeing that in the 20s and 30s and that's going to bring on all the problems of early heart disease, blindness, renal disease, dialysis," Prof Steinbeck said.

Recently, Australian scientists discovered that obese children have the blood vessels of a pack-a-day smoker.

There's also evidence that they're more likely to have high blood pressure, high cholesterol and insulin resistance.

"They can get fatty liver, sleep apnoea, they're more likely to have asthma, they're more likely to have orthopaedic problems ... that need surgery to prevent deformities," said Prof Steinbeck, the director of metabolism and obesity services at the Royal Prince Alfred Hospital in Sydney.

Doctors in Australia believe food advertising should be restricted during children's television programs, saying impressionable young minds are too easily hooked by the cartoons and jingles that push foods with high energy content and low nutritional value.

Of 13 OECD countries including the United States and England, Australia has the highest number of television food advertisements during children's programming, the Coalition on Food Advertising to Children (CFAC) has found.

An average of 12 food ads are aired per hour during children's programs, and more than three quarters of the foods advertised are high in fat, sugar and salt.

Less than three per cent are unprocessed fruit and vegetables.

By comparison, strict restrictions in Sweden and Austria allow just one food advertisement per hour of children's programming.

Studies published in paediatric and marketing journals have demonstrated a significant association between children's exposure to television advertising and parents' purchases of advertised foods.

Other trials have shown children snack more often and are significantly more likely to prefer high fat, salt or sugar foods over healthy options following exposure to advertisements.

Dr Michael McDowell, paediatrician and author of the Royal Australasian College of Physicians' (RACP) policy on children and the media, says the multi-million dollar business of marketing food to kids goes much further than simple commercial television.

"The sophistication of the techniques to access children's brains is really impressive," Dr McDowell said.

"Cross-referencing between films and magazines and toy products and fast food outlets, programs and advertisements, it's all enmeshed now so it's very hard for children to cognitively discriminate between advertising and normal content."

Peer pressure is another effective marketing tool, Dr McDowell said, using "critical mass amongst the kids".

"You get a whole bunch of kids who all believe that it's necessary for their wellbeing and they're all talking to each other in the playground, and then individual children, if their parents deny them access to that product, feel that they're hard done by," he explained.

"If every birthday party your child gets invited to is at one of the fast food outlets, then it's very hard to make a stand that puts you at odds with the rest of the community."

Although Dr McDowell concedes that bans on advertising would encourage food companies to use more insidious marketing techniques, he believes they would still be effective.

"It's a way of saying to parents that this exploitation of children is harmful, just the same way as in banning cigarette advertising the government is saying that promotion of this particular product is harmful to your health," he said.

"It encourages people to take a more active stand on the issue."

But advertising can't take all the blame for expanding waistlines.

Kaye Mehta, a nutritionist and the chairwoman of the CFAC, says the environment in which today's children grow up is increasingly "obesogenic".

"Labour-saving devices and mechanised transport encourage a sedentary lifestyle, while other technological advances have cultivated a food system which supplies a large range of highly processed, energy dense foods," Ms Mehta said.

An increasing urban sprawl that makes it impractical to walk or cycle, easy access to computers and television and the dwindling back yard all discourage kids from physical play.

It's the biggest public health crisis facing Australia in this century, Mr McDowell says.

"If we had an epidemic of polio or something everybody would be waving their hands around, but here we have a public health crisis and a very passive government response," he added.

Prime Minister John Howard has resisted bans on food advertising, but the government is encouraging schools to involve children in two hours of physical education a week.

Prof Steinbeck says it's a small step in the right direction.

"There are lots of ways you need to intervene and some of them have to do with the individual but it's not all up to the individual," she said.

"We need to start looking at how environments can be changed."

Child-friendly playing spaces should be made available in all neighbourhoods, bicycle riding and walking on footpaths should be safe and easy and public transport should be more available, she says.

Healthy foods also should be easy to access and reasonably-priced.

"We need to be making it easier to make healthy choices because now it is often very difficult to make those choices," Prof Steinbeck said.

"It has to involve urban planners, transport departments, education departments, and it will have to involve legislature as well."

If no action is taken to halt the growth of obesity, Prof Steinbeck says the community will pay with an enormous blow-out in health costs.

"Disease will be hitting young people when they should be productive, earning members of the community," she said.

"This is something that needs to be addressed right now."