Documented facts from qualified experts contributed to the Committee’s 23 recommendations, 22 of which were unanimously approved. One recommendation triggered a dissenting report by four members of the committee.
Some of the issues raised have occupied much of my life for the last 55 or so years. They include:
- Food labelling reforms targeting added sugar so that people could clearly identify the content of added sugar from front-of-pack labelling. This should be separate from the proposal to include added sugar in the Nutrition Information Panel on packaged foods.
- A levy on sugar-sweetened drinks, with the price modelled on international best practice and the anticipated improvement of health outcomes. The levy should be graduated according to the sugar content.
- Regulating the marketing and advertising of unhealthy food to children. This would focus on children defined as those aged 16 and under, be applied to television, radio, gaming and online and use a definition of unhealthy food developed independently.
- Other recommendations were for better urban planning and physical activity initiatives to increase access to regular exercise in schools and neighbourhoods, and public health campaigns specifically related to diabetes, including prevention, identification of early signs, and good management of all forms of diabetes.
Weight
Other factors are involved, but being overweight or obese is the major modifiable risk factor for type 2 diabetes.
Body weights of Australians have changed over the last 50 years. In the 1960s, 5% of Australian children were overweight or obese. By 1995, the level had risen to 20%, and by 2022 to 28% of children. In the 1980s, paediatricians reported that they rarely saw a child with type 2 diabetes. Now, 10% of children in Australia live with type 2 diabetes.
Among adults, figures that rely on experts weighing and measuring people are only available from the 1980s, but self-reported data from the 1960s indicates only about 10% of adults were overweight, and obesity was rare.
Excess body fat is a significant and growing issue throughout the world. If current trends continue, experts estimate that more than half of the world’s adult population and about a third of children in developed countries will be either overweight or obese in the next 10 years.
Changes
The increasing incidence of excess body fat can be attributed to what we eat and how much energy we use in physical activity. Both have changed.
The typical Australian diet has changed dramatically over the last 60 years. Until supermarkets sprang up in the 1960s, around 800 different foods were commonly available. A marketing manager for one of the supermarkets at that time told me his company would need to sell around 2000 foods to survive. The typical supermarket these days stocks over 30,000 of the 50,000 or so food products available.
Some changes have been good. We now have a wider selection of many types of vegetables, different varieties of many dairy products, including cheeses and yoghurt, more nuts and many interesting foods that introduce us to the cuisines of other countries.
Sadly, the majority of foods that line most supermarket shelves play havoc with health. They’re ultra-processed: high in sugar, unhealthy fats, salt and additives. Such foods now make up 50-60% of the average Australian’s diet. They’re easy to eat (little chewing needed) and very convenient for busy people.
Occasional consumption of almost any food would be unlikely to cause problems for most people. However, with the drastic curtailment of physical activity in our push-button, spray-and-wipe, screen-dominated lifestyle {where we don’t even wind down a car window or dial a telephone any more,} these foods are a major problem.
Food availability has changed and many of the least nutritious items are cheap. Portion sizes have increased, eating is now less formal, junk foods are advertised – but carrots and beans aren’t. And advertising works – especially on children. Australia does have some guidelines on advertising to children, but it is left to the companies themselves to decide what is ‘healthy’. There is no control over what advertising children can be exposed to online.
Sizes of packaged foods and drinks have also increased. Larger fridges mean we buy more. Packets of crisps are now twice as big, sliced breads have thicker slices, soft drinks went from 170 mL to 375 mL and now 600 mL and they’re no longer restricted to birthdays or special occasions. Small cupcakes have morphed into muffins, often so big that they are sometimes described as ‘almost as big as your head’!
Fast food brands appeared in Australia in the 1970s and numbers and chains have multiplied. Competition is keen, advertising has increased: the two largest fast food companies spent $382 million in Australia last year. Sales are increased with ‘meal deals’ and products described as ‘big’, ‘jumbo’ or ‘whoppers’. More fat, salt and kilojoules!
Before the 1980s, eating at a restaurant was something you might do for some special occasion. Fast food chains made it common at the end of a busy week. Now, take–away meals, often delivered to the door, have become ‘normal’, often several times a week. (Notice that few contain many vegetables, apart from chips, often cooked in an unhealthy type of fat.)
Of course, it’s not just foods that have changed. When women moved into the workforce, the whole family – mum, dad, the kids – had less time for physical activity. Many families now need a second car and children may be driven to school with a lunchbox of pre-packaged snacks and drinks. Supermarkets now have whole aisles devoted to pre-packaged products for children’s lunchboxes.
Exercise has many virtues, including the fact that it helps control appetite. With enough physical activity, the quantity most people eat will match their body’s kilojoule needs. Of course, that doesn’t mean we don’t need to think about what’s in the foods and drinks we’re consuming, but the internal appetite control does help avoid excess weight.
It’s not just sugar
Type 2 diabetes was once called ‘sugar diabetes’. Once you have diabetes, sugars are a problem. But avoiding overweight, obesity and type 2 diabetes involves controlling all excess kilojoules – including those from fat and alcohol.
Take-home message
The Government Committee’s evidence-based recommendations offer solutions. Unfortunately, the only one causing dissent was the recommendation to add a levy to sugary drinks. Just this week, the British Medical Journal published evidence that one year since such a levy was introduced in Britain, daily consumption of sugar has fallen by 11 g in adults and 5 g in children.
Sadly, our food and physical activity environment is now conducive to obesity and type 2 diabetes. We’ve reached the point where ordinary Australians will get fat unless they take positive steps to avoid all those things that will result in gaining weight.
