3rd July 2015, Volume 128 Number 1417

Steven Kelly, Boyd Swinburn

New Zealand has the third largest percentage of overweight and obese children in the OECD after Greece and Italy.1 New Zealand has one third of children overweight or obese compared to Australia which has only one quarter of children in this category. Currently 11% of New Zealand children are obese.

There is an under appreciation of the problem, as obesity has become normalised in our society. A recent survey shows that over half of parents with obese children believed that their child was a normal weight.2 Nine out of ten parents of obese children aged 2 to 4 years believed that their children were a normal weight. The cause for the rapid rise in obesity over the last 30 years is due primarily to an over consumption of calories. The particular problem is that the calories have been in an energy dense and nutrient poor form in both food and sugary drinks. We are continually told that if we exercise more we will lose weight. This is a myth, you cannot eat your way out of a bad diet. Over the last 30 years of the obesity epidemic, physical activity has changed very little.3

We are biologically designed to live in a land of lean. The problem now is that we live in a land of plenty. The current environment we live in, is the obesogenic environment. It consists of energy-dense, palatable, cheap and readily available food. There is pervasive and persuasive food marketing and reduced access to physical activity. All of these factors have caused the obesity epidemic. The New Zealand Medical Association has released a landmark document, “Tackling obesity” that sets the scope and solutions to New Zealand’s obesity epidemic.4 In this publication, it advises that a multipronged approach will be required to reverse the effect of the obesogenic environment. The solution will require a collective response from healthcare professionals, policy makers, food industry, parents, individuals, community groups and government. There is no single solution to obesity. The government however must provide the leadership and be willing to act through legislation and regulatory control where needed. Community-based approaches, such as Healthy Families NZ, and other non-regulatory measures are essential, but are unlikely to be sufficient to reverse New Zealand’s unacceptably high prevalence of childhood obesity.

Children cannot be held responsible for their obesity and parents and society need to protect them from the obesogenic environment. Eighty percent of obese children will become obese adults. Therefore, childhood obesity predicts the future health and weight of the population. Despite multiple opportunities in the last 10 years for the government to act seriously on obesity, little has been achieved. The financial implications to New Zealand of not tackling the obesity epidemic will threaten the viability of the public health service due to the escalating costs of treating obesity related diseases, especially diabetes. Obesity and chronic diseases have become the single greatest health challenge of the 21st Century. For example, if New Zealand follows the obesity trends of the US, the risk of a child developing diabetes at some point in their life could be one in three.6

It is important that obesity interventions introduced into the population are safe, effective and supported by the evidence. Education about how to navigate the obesogenic environment are important, but it is clear from cost-effectiveness studies that these are far weaker compared to policies that actually change the underlying problem of the obesogenic environment.7 There is now a substantial evidence base of strategies that are cost saving or cost neutral to the government. Clearly the cost of action is going to be far less than the costs of inaction.

Several groups of New Zealand experts have recommended that the government introduce the following effective strategies to combat childhood obesity.4,8 They are all based on good scientific evidence.

  1. Restrictions on junk food marketing to children
  2. An excise tax on sugary drinks
  3. Healthy food service policies implemented in all schools and early childhood centres

The food industry is concerned with its financial profit and not with the health of the population. This year, KFC have sponsored the ICC Cricket World Cup and Super 15 rugby and you will have seeen billboards around town as well as many television advertisements. McDonalds sponsored X Factor. This sponsorship is sending a clear message to children that promotes consumption of energy-dense, nutrient-poor food. It implies that by consuming this food, children will be healthy like their idols. It assumes that if they eat junk food all they need is some exercise to prevent obesity and stay healthy. This is clearly wrong and exploits the vulnerable nature of children.

There is now considerable evidence of harm caused by sugar sweetened beverages. We know that sugar calories promote excessive calorie consumption, fat storage and also rotten teeth. Many countries have now introduced taxes on unhealthy foods including Hungary, France, Mexico and some states in the US. Results from modelling studies suggest that tax on unhealthy foods is the single most cost effective approach to tackling obesity.

The Minister of Health, Dr Jonathan Coleman, must be congratulated for making childhood obesity a priority issue. Through an all-of-society approach with assistance from the government we can now expect to see a reversal in childhood obesity. In essence, this will be producing a society where the healthy choice is the easy choice.

Summary

New Zealand has an unacceptably high rate of childhood obesity at 11 percent of children. The cause is due to an over consumption of food particularly in the form of junk food. To reverse this serious problem an all of society approach with leadership from the government is going to be required. The consequence of ignoring the problem will threaten the future viability of the health service.

Author Information

Steven Kelly, Department of General Surgery, Christchurch Hospital, Riccarton Ave, Christchurch 4710, New Zealand. Boyd Swinburn, Professor of Population Nutrition and Global Health, University of Auckland, Alfred Deakin Professor, Co-Director, WHO Collaborating Centre for Obesity Prevention, Deakin University, Melbourne

Correspondence

Steven Kelly, Department of General Surgery, Christchurch Hospital, Riccarton Ave, Christchurch 4710, New Zealand

Correspondence Email

stevenkelly@clear.net.nz

Competing Interests

Nil

References

  1. www.oecd.org/els/health-systems/Obesity-Update-2014.pdf
  2.  www.health.govt.nz/publication/understanding-excess-body-weight-new-zealand-health-survey
  3.  Luke A, Cooper RS. Physical activity does not influence obesity risk: time to clarify the public health message. Int J Epidemiol 2013;42:1831–6.
  4.  www.nzma.org.nz/__data/assets/pdf_file/0015/32082/NZMA-Policy-Briefing-2014_Tackling-Obesity.pdf
  5. Venkat Narayan K et al. Lifetime risk for diabetes mellitus in the United States. JAMA 2003;290(14): 1884-1890
  6.  www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61746-3.pdf
  7.  www.who.int/bulletin/volumes/93/5/14-145540.pdf?ua=1