NPHT Report Roadmap for action
3/21/2011
Action on obesity in Australia
Assoc Prof Tim Gill Boden Institute for Obesity, Nutrition, Exercise & Eating Disorders
Outline 1.0 Current 2.0 The
obesity prevalence and trends in Australia
response?
3.0 National 4.0 Current
frameworks of action
government initiatives
2
1
3/21/2011
The prevalence of overweight and obesity in men and women in 2000 (National health Survey 2007/08) 80.0 70.0 60.0
Per cent
50.0
obese male
42.1 40.0
30.9
30.0
Overweigh t but not overweight male obese Obese obese female
overweight female
20.0 25.6
24.0
10.0 0.0 Males
Females 2001
2
3/21/2011
Trends in BMI in Australia 1980-2008 Per cent 1980
1989
1995
2001
2004–05
2007–08
40
30
20
10
0 Overweight
Obese
Self-reported height and weight, 18 years plus, various NHS surveys
Prevalence of overweight and obesity in Australian children aged 7-15 years, 1985–2007
3
3/21/2011
Early rapid weight gain in young adulthood
Mean weight change over five years according to baseline age Mean change in weight (kg)
4.0
3.4 3.5 3.5
3.0
Males Females All
2.5 2.5 2.5
2.0
1.6
1.9 1.8 1.3
1.0
0.7 0.4
1.5 1.4
0.5
0.0 -0.3 -0.3 - 0.3
-1.0 -2.0
-1.9
- 2.2 -2.4
-3.0
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
Baseline age (years)
≥ 75
Total
AusDiab Study IDI 2006
4
3/21/2011
Adult Australian Trends in Overweight and Obesity Rate of Weight gain faster in young adults
Australia’s Health, AIHW 2008 Canberra
http://www.aihw.gov.au/publications/index.cfm/title/10585
Prevalence of diagnosed diabetes in Australia 1989-2008 Per cent 818,000 3.8%
4 3 2
193,000 1.2%
1 0 1989–90
1995
2001
2004–05
2007-08
Source: AIHW analysis of ABS National Health Surveys
5
3/21/2011
Obesity is associated with high costs
Financial cost of obesity Net cost of lost well-being Total cost of obesity
$ 3.8 billion $17.2 billion $21.0 billion
The economic costs of obesity. Access Economics, 2006.
Average weight 1996 . . 2014?? urban
85 80
25.7
26.7
rural/remote 27.7
28.7
29.7
75 70 65
Average weight gain 0.46 kg per year
19 96 19 98 20 00 20 02 20 04 20 06 20 08 20 10 20 12 20 14
60
6
3/21/2011
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2005
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2015
7
3/21/2011
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2025
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2035
8
3/21/2011
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2045
BMI Distribution: Australian Trend 1980-2008
2008
BMI
9
3/21/2011
Trends in childhood overweight and obesity in NSW school children (SPANS study)
The Response…
10
3/21/2011
National frameworks for addressing obesity in Australia
11
3/21/2011
Developing a framework • What to target? (outcomes) • Who to target? • Where to intervene (settings)? • How? (What interventions?) • When? (Timeframe and sequence of actions)
What outcomes? Overall goals: Reduce the burden associated with weightrelated illness, through a continuum … Preventing weight gain Improved weight management Addressing early risk Effective management of those with
established risk
12
3/21/2011
Who? Need to achieve a balance between different groups Largest contribution to health burden comes from people at normal risk (larger numbers) than from people at higher or established risk (smaller numbers)
Prevalence of Diabetes according to BMI 70
60
Prevalence (%)
50
40
30
20
10 0 18.00
22.00
20.00
26.00
24.00
30.00
28.00
34.00
32.00
38.00
36.00
BMI
42.00
40.00
46.00
44.00
50.00
48.00
UNPUBLISHED DATA
13
3/21/2011
Numbers of cases of Diabetes according to BMI 100
Cases (n)
80
60
40
20
0 18.00
22.00
20.00
26.00
24.00
30.00
28.00
34.00
32.00
38.00
36.00
BMI
42.00
40.00
46.00
44.00
50.00
48.00
UNPUBLISHED DATA
Identifying high risk Groups
14
3/21/2011
The burden of obesity is not shared equally among the community
• • • •
Indigenous communities Socio-economically disadvantaged Remote and rural communities Certain ethnic groups (Southern European and Middle Eastern)
Comparisons for obese females Per cent 40 35 30 25 20 15 10 5 0 Lowest SES
Highest SES
Outer and remote
Inner regional Major cities
Indigenous females
All females
Prevention of cardiovascular diseases, diabetes and chronic kidney disease (AHIW 2009, Cat. no. PHE 118)
15
3/21/2011
Comparisons for obese males Per cent 40 35 30 25 20 15 10 5 0 Lowest SES
Highest SES
Outer and remote
Inner regional Major cities
Indigenous males
All males
Prevention of cardiovascular diseases, diabetes and chronic kidney disease (AHIW 2009, Cat. no. PHE 118)
Existing Disease
16
3/21/2011
Who? • • • • • •
Whole population Children and young adults Older Australians Aboriginal and Torres Strait Islanders People living in rural and remote areas People with established risk (overweight, obese, other risk factors for weight-related chronic disease) • Those with existing chronic weight-related disease ?
Where to intervene ?
17
3/21/2011
National Obesity Task Force Framework for Children and Young people
National Obesity Task Force Adult framework OUTCOME Environmental and Behavioural Changes at Whole Population Level
Community projects
Health Sector services and systems
Cross-sector actions
Community awareness
Health workforce capacity
Cross-sector workforce awareness
Policy Initiatives Research and Evaluation Monitoring and Surveillance Leadership
18
3/21/2011
How? Defining comprehensive action
NPHT Report Roadmap for action
19
3/21/2011
NPHT Report Roadmap for action The Strategy sets out a phased ‘roadmap for action’ that is: Progressive Determined Comprehensive Sustained …..over the next ten years and beyond
NPHT Report Roadmap for action 1. Drive environmental change - throughout the community to increase levels of physical activity and reduce sedentary behaviour 2. Drive change within the food supply - to increase availability and demand for healthier food products 3. Embed physical activity and healthy eating in everyday life 4. Encourage people to improve their levels of physical activity and healthy eating - through comprehensive social marketing 5. Reduce exposure of children and others to marketing, advertising, promotion and sponsorship - of energy-dense, nutrient-poor foods and beverages
20
3/21/2011
NPHT Report Roadmap for action 6. Strengthen, skill and support primary healthcare and public health workforce - to support people to make healthy choices 7. Address maternal and child health - enhancing early life and growth patterns 8. Support low income communities - to improve their levels of physical activity and healthy eating 9. Reduce obesity prevalence and burden among Indigenous Australians 10. Build the evidence base, monitor and evaluate the effectiveness of actions
Infrastructure support • • • • • • •
Establish a National Preventive Health Agency Create a web-based clearing house for organisational plans & achievements and conduct periodic surveys of barriers and enablers to action Establish a national recognition and awards scheme Undertake a workforce audit and develop a workforce strategy Establish prevention as a priority for the Health Workforce Australia Agency Implement and extend the National Health Risk Survey program Develop a National Strategic Framework for preventive health research supported by: strategic research fund research register network of research centres
21
3/21/2011
Government response to the NPHT Report Roadmap for action
2020 targets
- Halt and reverse rise in overweight and
obesity If obesity can be stabilised at current
levels - reduce an estimated 1.25 million deaths…..and save half a million lives between now and 2050
22
Action on obesity in Australia
Assoc Prof Tim Gill Boden Institute for Obesity, Nutrition, Exercise & Eating Disorders
Outline 1.0 Current 2.0 The
obesity prevalence and trends in Australia
response?
3.0 National 4.0 Current
frameworks of action
government initiatives
2
1
3/21/2011
The prevalence of overweight and obesity in men and women in 2000 (National health Survey 2007/08) 80.0 70.0 60.0
Per cent
50.0
obese male
42.1 40.0
30.9
30.0
Overweigh t but not overweight male obese Obese obese female
overweight female
20.0 25.6
24.0
10.0 0.0 Males
Females 2001
2
3/21/2011
Trends in BMI in Australia 1980-2008 Per cent 1980
1989
1995
2001
2004–05
2007–08
40
30
20
10
0 Overweight
Obese
Self-reported height and weight, 18 years plus, various NHS surveys
Prevalence of overweight and obesity in Australian children aged 7-15 years, 1985–2007
3
3/21/2011
Early rapid weight gain in young adulthood
Mean weight change over five years according to baseline age Mean change in weight (kg)
4.0
3.4 3.5 3.5
3.0
Males Females All
2.5 2.5 2.5
2.0
1.6
1.9 1.8 1.3
1.0
0.7 0.4
1.5 1.4
0.5
0.0 -0.3 -0.3 - 0.3
-1.0 -2.0
-1.9
- 2.2 -2.4
-3.0
25 – 34
35 – 44
45 – 54
55 – 64
65 – 74
Baseline age (years)
≥ 75
Total
AusDiab Study IDI 2006
4
3/21/2011
Adult Australian Trends in Overweight and Obesity Rate of Weight gain faster in young adults
Australia’s Health, AIHW 2008 Canberra
http://www.aihw.gov.au/publications/index.cfm/title/10585
Prevalence of diagnosed diabetes in Australia 1989-2008 Per cent 818,000 3.8%
4 3 2
193,000 1.2%
1 0 1989–90
1995
2001
2004–05
2007-08
Source: AIHW analysis of ABS National Health Surveys
5
3/21/2011
Obesity is associated with high costs
Financial cost of obesity Net cost of lost well-being Total cost of obesity
$ 3.8 billion $17.2 billion $21.0 billion
The economic costs of obesity. Access Economics, 2006.
Average weight 1996 . . 2014?? urban
85 80
25.7
26.7
rural/remote 27.7
28.7
29.7
75 70 65
Average weight gain 0.46 kg per year
19 96 19 98 20 00 20 02 20 04 20 06 20 08 20 10 20 12 20 14
60
6
3/21/2011
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2005
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2015
7
3/21/2011
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2025
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2035
8
3/21/2011
Example of forecast growth in obesity in next 30 years (mid-aged men) Healthy
Overweight
Obese
2045
BMI Distribution: Australian Trend 1980-2008
2008
BMI
9
3/21/2011
Trends in childhood overweight and obesity in NSW school children (SPANS study)
The Response…
10
3/21/2011
National frameworks for addressing obesity in Australia
11
3/21/2011
Developing a framework • What to target? (outcomes) • Who to target? • Where to intervene (settings)? • How? (What interventions?) • When? (Timeframe and sequence of actions)
What outcomes? Overall goals: Reduce the burden associated with weightrelated illness, through a continuum … Preventing weight gain Improved weight management Addressing early risk Effective management of those with
established risk
12
3/21/2011
Who? Need to achieve a balance between different groups Largest contribution to health burden comes from people at normal risk (larger numbers) than from people at higher or established risk (smaller numbers)
Prevalence of Diabetes according to BMI 70
60
Prevalence (%)
50
40
30
20
10 0 18.00
22.00
20.00
26.00
24.00
30.00
28.00
34.00
32.00
38.00
36.00
BMI
42.00
40.00
46.00
44.00
50.00
48.00
UNPUBLISHED DATA
13
3/21/2011
Numbers of cases of Diabetes according to BMI 100
Cases (n)
80
60
40
20
0 18.00
22.00
20.00
26.00
24.00
30.00
28.00
34.00
32.00
38.00
36.00
BMI
42.00
40.00
46.00
44.00
50.00
48.00
UNPUBLISHED DATA
Identifying high risk Groups
14
3/21/2011
The burden of obesity is not shared equally among the community
• • • •
Indigenous communities Socio-economically disadvantaged Remote and rural communities Certain ethnic groups (Southern European and Middle Eastern)
Comparisons for obese females Per cent 40 35 30 25 20 15 10 5 0 Lowest SES
Highest SES
Outer and remote
Inner regional Major cities
Indigenous females
All females
Prevention of cardiovascular diseases, diabetes and chronic kidney disease (AHIW 2009, Cat. no. PHE 118)
15
3/21/2011
Comparisons for obese males Per cent 40 35 30 25 20 15 10 5 0 Lowest SES
Highest SES
Outer and remote
Inner regional Major cities
Indigenous males
All males
Prevention of cardiovascular diseases, diabetes and chronic kidney disease (AHIW 2009, Cat. no. PHE 118)
Existing Disease
16
3/21/2011
Who? • • • • • •
Whole population Children and young adults Older Australians Aboriginal and Torres Strait Islanders People living in rural and remote areas People with established risk (overweight, obese, other risk factors for weight-related chronic disease) • Those with existing chronic weight-related disease ?
Where to intervene ?
17
3/21/2011
National Obesity Task Force Framework for Children and Young people
National Obesity Task Force Adult framework OUTCOME Environmental and Behavioural Changes at Whole Population Level
Community projects
Health Sector services and systems
Cross-sector actions
Community awareness
Health workforce capacity
Cross-sector workforce awareness
Policy Initiatives Research and Evaluation Monitoring and Surveillance Leadership
18
3/21/2011
How? Defining comprehensive action
NPHT Report Roadmap for action
19
3/21/2011
NPHT Report Roadmap for action The Strategy sets out a phased ‘roadmap for action’ that is: Progressive Determined Comprehensive Sustained …..over the next ten years and beyond
NPHT Report Roadmap for action 1. Drive environmental change - throughout the community to increase levels of physical activity and reduce sedentary behaviour 2. Drive change within the food supply - to increase availability and demand for healthier food products 3. Embed physical activity and healthy eating in everyday life 4. Encourage people to improve their levels of physical activity and healthy eating - through comprehensive social marketing 5. Reduce exposure of children and others to marketing, advertising, promotion and sponsorship - of energy-dense, nutrient-poor foods and beverages
20
3/21/2011
NPHT Report Roadmap for action 6. Strengthen, skill and support primary healthcare and public health workforce - to support people to make healthy choices 7. Address maternal and child health - enhancing early life and growth patterns 8. Support low income communities - to improve their levels of physical activity and healthy eating 9. Reduce obesity prevalence and burden among Indigenous Australians 10. Build the evidence base, monitor and evaluate the effectiveness of actions
Infrastructure support • • • • • • •
Establish a National Preventive Health Agency Create a web-based clearing house for organisational plans & achievements and conduct periodic surveys of barriers and enablers to action Establish a national recognition and awards scheme Undertake a workforce audit and develop a workforce strategy Establish prevention as a priority for the Health Workforce Australia Agency Implement and extend the National Health Risk Survey program Develop a National Strategic Framework for preventive health research supported by: strategic research fund research register network of research centres
21
3/21/2011
Government response to the NPHT Report Roadmap for action
2020 targets
- Halt and reverse rise in overweight and
obesity If obesity can be stabilised at current
levels - reduce an estimated 1.25 million deaths…..and save half a million lives between now and 2050
22
