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From the Editor
Healthy weight
2008: Still waiting on Australia to act?
Obesity and its attendant
problems have long been a matter of concern to both the medical community
and the public obesity is a hazard to health and detriment to well-being.
It is common enough to constitute one of the most important medical and
public health problems of our time.
Because of the epidemic proportions of obesity, the task force stressed
the importance of proceeding with action.
Such statements are likely to sound familiar to those of us currently
working in health and medicine. What is surpris-ing is that these are
not extracted from recent publications. They come from a report edited
by George Bray published a quarter of a century ago. While obesity is
currently a topical issue, it is by no means a new phenomenon.
Researchers have been voicing concern about this epi-demic, emphasising
the need for research into its causes and prevention, and calling for
action to halt increases in its prevalence, since the 1970s.
Given these longstanding concerns, one might ask what progress have we
made in tackling this problem? It would appear that, on the whole, we
have not progressed very far. Over the past 20 years, obesity has increased
worldwide. Table 1 shows strong parallels between rec-ommendations for
reducing obesity made in the late 1990s (2,3), and in the recently released
report of the National Obesity Taskforce (4), with those made 25 years
earlier (1). The fact that the same recommendations are being made repeatedly
over time, with no apparent impact on the incidence of obesity, suggests
that they have not been implemented effectively, if at all. The most recent
of these documents provides some novel recommendations,
such as a stronger focus on ‘upstream’, environmental interventions,
and the implementation of ‘whole of com-munity’ approaches.
However, while such strategies are intuitively appealing given their potential
to be wide
reaching, there is currently no evidence supporting the use of these approaches
in combating obesity (5,6). After 25 years of lamenting the seriousness
of this problem and the need for research, we continue to have a poor
understand-ing of the underlying drivers of the obesity epidemic.
Why have we made such little progress? Australia pro-vides a good case
study. Despite being the first country to develop a national plan for
obesity prevention in 1997 (2), the following six years have seen little
by way of action in terms of obesity prevention programs on the ground.
In
fact, at the 2003 Scientific Meeting of the Australasian Society for the
Study of Obesity, it was suggested that the 1997 National Health and Medical
Research Council doc-ument ‘Acting on Australia’s Weight’
would be more appropriately titled ‘Waiting on Australia’s
Act’! Devel-oping
recommendations is only one step in addressing the obesity epidemic; it
is imperative that action is taken to implement and evaluate them.
Is the apparent lack of progress in tackling the epi-demic due to governments
not caring about the issue? In Australia, obesity is recognised as a major
contributor to the burden of disease (7) and the Federal government has
invested significant resources in the development of its obesity prevention
plan. State governments have also held numerous forums to consider how
best to tackle obesity. It is clear that obesity is an issue of national
concern.
Is the lack of progress
due to a lack of expertise? The evidence suggests otherwise. The International
Associa-tion for the Study of Obesity comprises over 7000 professionals
in 32 national associations. National and international conferences focusing
on obesity are well attended. There are also three major international
journals that focus on the issue (International Journal of Obesity, Obesity
Research, Obesity Reviews).
We argue that an important
explanation for the lack of progress in tackling obesity is the lack of
a research evi-dence base to underpin prevention efforts. This situation
may be partly attributable to the fact that we operate in a climate that
requires governments to be seen to be taking
action, i.e. delivering obesity prevention programs. How-ever, funding
research to create the necessary evidence base is not considered as ‘action’.
It is therefore perhaps not surprising that, contrary to recommendations
dating back to the 1970s, there has been little obesity prevention research
conducted (8). We thus find ourselves in a catch-22
situation in which governments require evidence before they act, yet the
provision of funds to create the evidence base is a low priority. This
situation does not appear to have changed since the publication of Bray’s
report: ‘Obesity is a chronic condition with adverse effects…
How is it possible that such a widespread condi-tion, which is a product
of our environment, has not received more recognition in our health research
priorities?’ (1).
Action is required
on two fronts. Firstly, it is essential that governments invest in research
now, in order to pro-vide the evidence necessary upon which to base effective
action. Secondly, there must be adequate resources to implement recommendations
based on existing and
emerging evidence.
Clearly considerable
effort has been put into the latest Obesity Taskforce report. Let us hope
that this effort is not wasted, and that adequate resources are devoted
to build-ing the evidence base and implementing and evaluating these recommendations.
Without a significant ongoing
investment in research and its translation into public health action,
we may well be asking the same question as that posed in Bray’s
report, another 25 years from now.
Kylie
Ball and David Crawford
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