Childhood obesity--time for a concerted effort across the community.

Some might think that the rise in overweight and obesity in children has been a recent surprise and to some extent this is true. The rise in prevalence has really only been in the last 15 years and the rate of increase is accelerating (1-5). In some ways the problem crept up, as it is only very recently that childhood obesity has become an issue in the public arena. Suddenly parents are asked to take responsibility for their child's health and health professionals are becoming concerned (6). For several decades there has been an ongoing debate regarding whether overweight children proceed to becoming overweight adults (7). The variations in definition of overweight over time, and the different environmental factors that are experienced in different eras make longitudinal studies hard to generalise. There is some evidence (7) that there is an increased risk of obesity in adulthood if childhood obesity is present, but the relationship of childhood overweight to chronic disease markers in adulthood is not yet clear. What we can be certain of though, is if the number of children who are overweight continues to rise, and if even a small proportion of them proceed to become overweight and obese adults, then the health system will not be able to cope with the increased demand for services (5).

DAA's leadership role

The Dietitians Association of Australia (DAA) has as its mission advocating for 'better food, better health, better living for all' and has a social responsibility to be actively engaged in promotion of solutions to this potential crisis. An Australian government initiative was announced recently offering resources to assist in primary interventions (6). However, these interventions are focused at the individual level, which, although critical, are unlikely to be successful in the long term if offered in isolation. We need structural changes as well. As Nestle (8) points out the politics of obesity are complex. In a market economy the ability to sell goods is important for success, which makes messages of moderation, smaller portion sizes and 'eating less' very hard to promote at an institutional level. This makes it even more critical for organisations such as DAA to take a leadership role. We can do this at the individual level, where practitioners take responsibility for assisting individuals and groups within their sphere of influence and we can do this at a group level, where we work with government and industry to effect real and meaningful change.

Dietetic services and Medicare

DAA has therefore adopted a proactive role at several levels in order to make a contribution to the solution of this problem. It is such a complex problem that members and the Association as an entity have critical roles to fulfil across the system. At the organisational level DAA has had success having dietetics services included in the new variations to Medicare, actioned in July of this year. This sees complex weight management (as it is in most cases of childhood obesity) as eligible for benefits. It will augment the excellent public services currently available and improve access to services generally. DAA (9) also provides statements to the media, with six this year also focused on childhood obesity. These included a reminder of the need for sustainability and coordination if the government's approach to weight management for children is to be successful, the need for only healthy foods to be advertised to children, and the need to showcase Australian research on childhood obesity. DAA provides expert information to the media, government and members to assist in the provision of consistent messages. The organisation is a part of the Healthy Weight Alliance, a group of professional bodies committed to a cooperative effort to try to address obesity in general and childhood obesity in particular.

DAA provides members with information to enhance best practice delivery of services and now offers a mechanism for members to access peer-reviewed resources, including innovative programs to address overweight and obesity.

Food supply developments

Individual members are also making a contribution to the improvement of the food supply--both in the production of new products and in influencing policy within both the public and private sector to reduce portion sizes, improve ingredients and provide more comprehensive health promotion. We also see dietitians actively participating in research, and in this issue there are articles that address these facets of the food system, bringing new knowledge forward that contributes to the provision of sustainable solutions.

If we, as a nation, are to turn the epidemic of childhood obesity around, it will take a concerted effort from many organisations, professionals and individuals across the whole community. It will not simply be up to parents to manage the problem or to schools. We must make the environment in which we live conducive to weight management for all people. Nutrition professionals are a critical resource for the nation and have a major role to play, but they cannot work in isolation. We must share our expertise and experience with other groups and we must work at all levels of society to make a difference. This is how we can achieve our mission of advocating for 'better food, better health, better living for all'. Hopefully in another decade, we can look back on success through these partnerships.

References

1. Chinn S, Rona RJ. Prevalence and trends in overweight and obesity in three cross sectional studies of British children 1974-94. BMJ 2001;322:24-6.

2. Kain J, Uauy R, Vio F, Albala C. Trends in overweight and obesity prevalence in Chilean children: comparison of three definitions. Eur J Clin Nutr 2002;56,200-4.

3. McCarthy HD, Ellis S, Cole T. Central overweight and obesity in British youth aged 11-16 years: cross sectional surveys of waist circumference. BMJ 2003;326:624-6.

4. Muntner P, He J, Cutter JA, Wildman PP, Whellon PK. Trends in blood pressure among children and adolescents. JAMA 2004;291;17:2107-14.

5. Witt W. Why we're losing the war against obesity. American Demographics Dec 2003/Jan 2004;25:27-31.

6. Prime Minister of Australia. Building a healthy, active Australia http://www.pm.gov.au/news/media_releases/media_Release953.html. Accessed 5 August 2004.

7. Must A. Does overweight in childhood have an impact on adult health? Nutr Reviews. 2003;61:139-42.

8. Nestle M. The ironic politics of obesity [editorial]. Science 2003;299:781.

9. Dietitians Association of Australia. http://www.daa.asn.au. Accessed 7 August 2004.

Professor Sandra Capra AM

President, Dietitians Association of Australia