15 January 2020

Prevention alone is not enough on obesity, AMA says

Obesity Policy Public Health

A national obesity strategy is long overdue, the AMA says, but the proposal up for debate ignores the role of treatment for a prevention-only approach, offering little for those already living with obesity.

In its submission on the Council of Australian Governments Health Council consultation paper, the AMA says while prevention would be the ideal focus, “the reality is a significant portion children and adults are already overweight or obese”.

“It is concerning that the scope contained with the draft National Obesity Strategy explicitly rules out any actions around the treatment of obesity,” the submission says.

“Medical practitioners are a highly trusted source of information and advice making them well placed to identify and support patients who are overweight or obese.

“Advice and support … from a medical practitioner not only increases motivation to lose weight, it also increases engagement in weight-loss behaviours. This makes the distinction between early intervention and treatment in the draft strategy problematic in a practical sense.”

The consultation paper says the number of obese Australians has doubled in the past decade, and that at the current rate more than two-thirds will by overweight or obese by 2030. It says the direct and indirect costs to the health system amounted to almost $12 billion in 2018.

The paper emphasises “government leadership for a whole-of-society response” and primary and secondary prevention, which it says are more effective, less expensive and “have a greater population impact than managing and treating obesity”.

It explicitly rules out covering “tertiary prevention actions (e.g., treatment of obesity and/or obesity-related complications)”.

The AMA says the strategy should also incorporate the support and treatment that GPs offer their overweight and obese patients.

It is also disappointed that the strategy does not promote a tax on sugary drinks, such as is in place in Mexico and the UK. (A study published this week in BMC Medicine calculates a 30% reduction in volume of sugar sold in drink form in the UK between 2015 and 2018, during which time the tax was announced and implemented and large drinks firms reduced their sugar volumes; but the authors say the study was not designed to measure the impact of the tax).

“Governments should recognise that those sections of the food industry that market and profit from energy-dense and nutrient-poor food products are not bearing the full costs of their activity but are shifting costs onto the public sector and general community,” the AMA says.

The proposal also includes no specific targets or measurable outcomes, aiming only for “more people eating healthy food, more people being physically active, more people at a healthy weight”, and so on. This suggests “a perceived risk of failure”, the AMA says.

The AMA is even mildly critical of the strategy’s commitment to sustainability, saying sustainability indicators “must also not undermine healthier food choices, as it is possible that some whole foods may impact on the environment more than highly processed foods and beverages”.

On the question of reducing stigma, also prominent in the draft, the AMA says that “within the medical setting, terminology such as ‘morbid obesity’ is a clinically appropriate and often necessary, despite negative perceptions”.