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									                                                                                                                  STRATEGIC INTER-GOVERNMENTAL
                                                                                                                       NUTRITION ALLIANCE

Issue No 11                                 Promoting Healthy Weight                                                    April 2003

         Obesity Action – from                                                               other
       awareness to starter’s gun                                                         Foodviews:
When the history of the successful           television food advertising in               Obesity action – from
control of the obesity epidemic in           promoting obesity in children was            awareness to starter’s gun                              1
                                                                                          A note from the editor                                  2
Australia is written some time in the        considered baseless, and
                                                                                          Do you live in an Obesogenic
future, 2002 might be designated the         recommendations to governments to            environment?                                            2
“Year of Awareness”. It seems that the       influence the food supply and reduce         Breastfeeding and the prevention of
media, politicians, and the public have      food marketing directed at children          obesity                                                 4
really started to sense the magnitude of     were opposed.                                Overweight & obesity: facts & figures                   5
the obesity problem and the challenge                                                     Who is gaining weight in Australia?                     8
                                             At least the debate is starting to happen
of turning it around.                                                                     Maintaining weight, preventing weight
                                             at high levels, although it is still stuck
                                                                                          gain and managing obesity                               9
The regular newspaper articles, the          in two camps, public health and the          National physical activity guidelines
state-organised obesity forums, and the      food industry, with governments mostly       for Australians                                        10
establishment of an Obesity Taskforce        uncommitted as yet.                          Australian recommendations for
are all signs of this awakening, although                                                 children’s and youths’ physical activity               11
                                             In New Zealand, the results of the
I doubt that most people would yet                                                        Body Weight and Physical Activity
                                             National Nutrition Survey which were
name overweight/obesity as the single                                                     for Australians                                        11
                                             published in 1998 showed a substantial       Physical activity taskforces – what
biggest preventable threat to the health
                                             increase in obesity prevalence from the      they are, and their role in promoting
of Australian children.
                                             previous survey in 1989. At the time,        physical activity and healthy weight                   12
This issue has been more than an             Robert Quigley, the Ministry of Health       Family food environments of 5-6
Australian phenomenon. In 2002, the          nutritionist in charge of the survey,        year-old-children: does socioeconomic
World Health Organisation developed          made an interesting analogy between          status make a difference?                              13
its position on the role of diet and         the process of getting action on obesity     PHAA Position statement on promoting
nutrition on chronic disease (final draft    and a 4x100metre relay race. He felt         healthy weight                                         15
released March 2003) and obesity was         that he and the survey team were the         The DAA tackles obesity                                16
highlighted as being increasingly            first runners in the relay and that they     Healthy weight – NZ national activities                18
                                                                                          10,000 steps Rockhampton                               19
important in the aetiology of the main       had done their bit by defining the size
                                                                                          Food hopscotch game                                    20
diseases that affect developed and           and nature of the issue. In fact, this is    International 5 A Day Symposium                        21
developing countries. The report also        often the role of surveys and research       Commonwealth roundup                                   24
identified the critical importance of        with the researchers being the initial       ACT roundup                                            25
‘obesogenic’ environments and called         advocates for action. Remember back          NSW roundup                                            26
for national and international policies      ten years ago when the Australasian          NT roundup                                             27
to improve the food environment.             Society for the Study of Obesity             QLD roundup                                            28
                                             published ‘Healthy Weight Australia’ –       SA roundup                                             31
During the consultation period, the                                                       TAS roundup                                            31
                                             the first of several key Australian
report was supported by non-                                                              VIC roundup                                            32
                                             documents that have strongly advocated
government organisations (NGOs),                                                          WA roundup                                             33
                                             for action on obesity but have led to no
although many felt its                                                                    What’s on                                              36
recommendations could have been
stronger. However, it was roundly            The next runners in the relay came
criticised in the submissions from the       from the policy arms of various
food industry, particularly in the many      government departments and Quigley
submissions coordinated by the sugar         said that they weren’t even in the
industry. The linking of a high sugar        stadium when the baton was ready to
intake to dental caries and obesity was      be passed on. The third leg runners
particularly contested, the role of          were the holders of the government

purse strings and they didn’t even           to the team managers – making sure
know the race was on. The final leg of       that the event takes place in a coherent
course belonged to the NGOs and              manner and at a world-class standard.
other agencies that would do the actual
                                             A lot of expectations have been built up
work to address the obesity epidemic.
                                             over 2002 and Australia is well
They had known about the race for a
                                             positioned to recapture some of the
long time and they were all stripped
                                             international leadership it seems to
down and warmed up ready to go. In
                                             have lost in the years since the 1997
fact, they had already been practicing
                                             NHMRC report on ‘Acting on
amongst themselves for some time but
                                             Australia’s Weight’.
that had been pretty ineffectual without
backing from the other members of the        It is going to be more like a 4x
                                                                                        For further information contact:
team.                                        marathon relay than a 4x100 metres,
                                                                                        Professor Boyd Swinburn
                                             but however long it is, it needs all the   Centre of Physical Activity and Nutrition
This analogy is probably applicable to
                                             runners on the track and it needs to       School of Health Sciences
many countries besides New Zealand.
                                             start.                                     Deakin University
In Australia in 2003, most of the                                                       Email:
runners know about the race and the          Will history record that 2003 was the      Ph: (03) 9251 7096
crowd is also gathering with interest.       year that the starter’s gun was fired?
The Obesity Taskforce could be likened

                                     A Note from the Editor
There is considerable political and          Boyd Swinburn’s Views provide a            We look forward to presenting the
public interest worldwide in the             perspective brought into sharp focus by    revised Dietary Guidelines for
increasing health problem of                 his recent work identifying effective      Australians, Dietary Guidelines for
overweight and obesity, the theme of         interventions addressing overweight        Children and Adolescents and the
this issue of FOODChain. Health              and obesity in Australia.                  Infant Feeding Guidelines in the
Ministers have recently called together                                                 August 2003 issue.
                                             There are a number of papers outlining
a National Obesity Taskforce to map
                                             current activity to address the problem:   Thank you to SIGNAL members, all
out an Australia plan for action.
                                             government initiatives, nutrition and      authors, and to Jenny Leong and
SIGNAL and SIGPAH meet and work
                                             physical activity programs and research    Gemma Bacon who assisted in the
together to identify ways to address this
                                             results. The data quantifying the          production of this issue.
major problem in Australia and will
                                             problem are presented; of particular
provide advice to the Taskforce.                                                        Enjoy.
                                             concern is the rate of increase!
                                                                                        Christina Pollard
It has been a pleasure bringing together
                                             I hope you enjoy the paper on the          Editor, FOODChain
papers from those working in the areas
                                             International 5 A Day Symposium in         Ph: (08) 9222 2062
of public health nutrition and physical
                                             Berlin. It was a very inspiring
activity for this issue. With each new
                                             conference and the Australian
theme we have been widening our
                                             delegation was keen to share what was
readership, in particular with this issue
we welcome those readers working in
the area of improving physical activity.

      Do you live in an Obesogenic Environment?
A number of years ago, Boyd Swinburn         discourage physical activity1,2            money’ and in some restaurants, one
and colleagues coined the phrase             Nevertheless, a review by French et al.3   needs to seek out child-size portions or
‘obesogenic environments’1 to describe       provides some persuasive evidence          entrees if wanting what was once a
physical and policy environments that        supporting the concept.                    regular size meal.
may be contributing to the global            For example, in terms of nutrition, one    From a physical activity perspective,
epidemic of overweight and obesity.          need look no further than the common       ‘obesogenic environments’ include
Despite its intuitive appeal, as yet there   muffin or a box of popcorn at the          those with poor access to recreational
are few empirical studies directly           movies to realise that, for some foods,    facilities, but also those with an
supporting the notion of an                  serving sizes have grown exponentially     infrastructure that discourages
‘obesogenic environment’ and its             over the last decade or two. King-size     incidental activity, walking and cycling
relationship to overweight and obesity.      or even ‘super king-large’ serving sizes   (eg cul de sacs). Consequently,
‘Obesogenic’ environments promote            are now equivalent to ‘good value for      recently there has been a growing
excessive food consumption and

recognition of the need to re-think the         access to recreational facilities than        Reference:
way we design buildings and                     advantaged neighbourhoods13. In               1. Swinburn B, Egger G, Raza F. Dissecting
                                                                                                  obesogenic environments: the development and
communities in terms of urban                   Perth, which has a relatively high
                                                                                                  application of a framework for identifying and
planning, transport and road                    standard of living by national and                prioritising environmental interventions for
networks4,5 with a view to encouraging          international standards14, we were                obesity. Prev Med 1999; 29:563-70.
the community to be more active.                unable to replicate these findings.                                           .
                                                                                              2. Poston WS, 2nd, Foreyt JP Obesity is an
Much of this push reflects a                    Nevertheless, we have found some                  environmental issue. Atherosclerosis 1999;
sustainability perspective, however, the        evidence that the quality of the physical         146:201-9.
health sector has much to gain by               environment may be associated with            3. French S: Annu Rev Public Health 2001; 22.
                                                                                              4. Kumanyika S. Minisymposium on obesity:
working with partners outside of health         body composition15.
                                                                                                  Overview and some strategic considerations.
to achieve outcomes that support both                                                             Annu Rev Public Health 2001; 22:293-308.
                                                Examination of the concept of
environmental and physical health                                                             5. Caterson I. What should we do about overweight
                                                ‘obesogenic environments’ is consistent
agendas.                                                                                          and obesity? MJA 1999; 171:599-600.
                                                with an ecological perspective that
                                                                                              6. Burry J. Obesity and virtue. Is staying lean a
Human beings are ill-adapted to the             considers the interaction between                 matter of ethics? MJA 1999; 171:609-610.
conditions of perpetual plenty and              individuals and their physical and social     7. Sallis, J.F., Bauman A., Pratt M. Environmental
physical leisure enjoyed by so many in          environments. A systems approach                  and policy interventions to promote physical
contemporary society6. Energy                   suggests that subtle shifts in the                activity’ Prev Med 1998;15(4): 379-397.
expenditure associated with daily living        environment will produce subtle shifts        8. Giles-Corti B, Donovan R. Increasing walking:
has been declining since                        in behaviour. The effects of these                the relative influence of individual, social
                                                                                                  environmental and physical environmental
industrialisation. This decline is              subtle shifts may go unnoticed until a
                                                                                                  factors. Am J Pub Health ; in press.
associated with the growth in the               problem emerges. For example, in the          9. Giles-Corti B, Donovan R. Socio-economic
availability and uptake of labour saving        UK it has been suggested that small               differences in recreational physical activity levels
technologies (epitomized by the ABC’s           shifts in incidental activities without           and real and perceived access to a supportive
Nigella Lawson’s electronic pepper              sufficient compensatory declines in               physical environment. Prev Med ; 2002:35(601-
grinder!), a reduction in the use of            food intake may explain the secular               611).
public transport, and the current               trends in overweight16.                       10. Ball K, Bauman A, Leslie E, Owen N. Perceived
                                                                                                  environmental aesthetics and convenience and
design of buildings, communities and
                                                Understanding how physical                        company are associated with walking for exercise
appliances4. Together these factors
                                                                   environmental factors          in Australian adults. Prev Med 2001; 33:434-440.
have the potential to                                                                         11. Brownson RC, Baker EA, Housemann RA,
increase sedentariness        ‘Obesogenic’ environments interact with individual                  Brennan LK, Bacak SJ. Environmental and
                                promote excessive food             and social                     policy determinants of physical activity in the
and thus minimise
                                                                   environmental                  United States. Am J Pub Health 2001:
energy expenditure.                 consumption and
                                                                   correlates of behaviour        91(12)1995-2003.
                                  discourage physical
Interest in the concept                                            is an important and        12. Ellaway A, Anderson A, Macintyre S. Does area
of ‘obesogenic                            activity                 growing field.                 of residence affect body size and shape? Int J
                                                                                                  Obesity 1997; 21:304-308.
environments’ is                                                   Internationally, a small
                                                                                              13. Macintyre S, Maciver S, Sooman A. Area, class
paralleled by interest in the physical          but growing number of multi-                      and health: Should we be focusing on places or
activity research literature on real and        disciplinary research groups are                  people? J Soc Policy 1993; 22:213-234.
perceived environmental factors                 exploring this issue. The jury is still       14. Giles-Corti B, Donovan R. The relative influence
associated with physical activity7. Our         out on what factors are most                      of individual, social and physical environment
own research has found that access to a         important. However, it is hard to                 determinants of physical activity. Soc Sci Med
supportive physical environment is              imagine that in the future well designed          2002; 54:1793-1812.
strongly associated with walking8,9 and a       studies that include objective measures                                                     ,
                                                                                              15. Giles-Corti B, Macintyre S, Clarkson JP Pikora T,
                                                                                                  Donovan RJ Environmental and lifestyle factors
number of studies show that negative            of the environment, won’t find that               associated with overweight and obesity in Perth,
perceptions of the environment are              poor access to supportive physical and            Australia Am J Health Promotion (under review).
associated with lower levels of                 policy environments directly or                              .
                                                                                              16. James WP A public health approach to the
activity9,10,11. In the West of Scotland,       indirectly contribute to overweight and           problem of obesity. Int J Obesity & Related Met Dis
those who reported more negative                obesity.                                          1995; 19:S37-45.
features of their local neighbourhood           For further information contact:
(ie more litter, graffiti, vandalism etc)       Associate Professor Billie Giles-Corti
were also less likely than others to            School of Population Health
report going for a two mile walk in             The University of Western Australia
their local neighbourhood in the last
                                                Ph: (08) 9380 1257
year (Anne Ellaway, personal
In Glasgow, Ellaway and colleagues
found that the area of residence was
associated with overweight and
obesity12, and that disadvantaged
neighbourhoods in Glasgow had poorer

     Breastfeeding and the Prevention of Obesity
How important is the relationship            relationship between obesity and a         socioeconomic status, birthweight, and
between overweight in infancy and            history of breastfeeding6. Obesity was     sex. The adjusted odds ratio for obesity
later overweight and obesity, and does       assessed as having a BMI above the         (BMI > or = 98th percentile) was
the method of infant feeding make a          97th percentile. The prevalence of         0.70 (0.61-0.80).
difference? Conventional wisdom was          obesity in children who had never been
that there was a period of relative          breastfed was 4.5% compared to 2.8%        Taken together these studies provide
grace. Chubby babies were a sign of          in breastfed children. The odds            powerful support for the hypothesis
good health in many societies.               ratio(OR) for obesity was 0.75 (0.57-      that breastfeeding, and particularly
                                             0.98) and for overweight 0.79(0.68-        exclusive breastfeeding is protective
Children who were overweight at one                                                     against the development of obesity into
and three years old were thought to                                                     adolescence. Since it is known that
have no increased risk of obesity as          Gillman and colleagues studied 15000      obese adolescents are very likely to be
adults, but after that age the risk           children whose mothers were               obese adults the importance of
increases regardless of parental weight1.     participants in the Nurses Health         breastfeeding as a preventive measure
                                              Study7. The wealth of data available in   can be seen.
However a large multicentre trial of
                                              this study allowed for adjustment for a
20,000 infants followed in detail for                                                   Dietz summarised the current
                                              range of potentially confounding
seven years showed that rapid weight                                                    assessment of programs for childhood
                                              factors. The results were summarised
gain during the first four months of life                                               obesity: “only reducing the number of
                                              “Our findings indicate that infants who
was associated with an increased risk of                                                hours children watched television
                                              were predominantly fed breast milk in
overweight status at age seven years2.                                                  qualified as a potentially effective
                                              the first 6 months of life had a lower
Also of concern is that                                                                 preventive and therapeutic strategy for
                                                                prevalence of
more than 60% of            Also of concern is that more overweight 9 to 14             childhood obesity”1 He then stated that
overweight children            than 60% of overweight                                   recent studies show that
                                                                years later. Compared
have at least one                                                                       “breastfeeding may be added as a
                             children have at least one         with infants
additional risk factor                                                                  preventive intervention”10.
                               additional risk factor for       predominantly fed
for cardiovascular
                               cardiovascular disease,          infant formula, the     How much could be gained in Australia
disease, such as raised
                                 such as raised blood           estimated relative      by increasing the prevalence of
blood pressure,
                             pressure, hyperlipidaemia,         reduction in risk was   exclusive breastfeeding to six months?
hyperlipidaemia, or
                                 or hyperinsulinaemia           approximately 22%.
hyperinsulinaemia3.                                                                     It is possible to extrapolate the Gilman
                                                                In addition, the
There has been                                                  apparent protective     results to Australia, where currently
interest in feeding methods and the           effects were larger with increasing       around 50% of Australian infants are
growth of infants, child and adult            duration of breastfeeding”7.              exclusively breastfed to six months.
obesity for many years. However in                                                      Assuming this could be increased to
                                              The National HANES (NHANES) III           80% or 90%, this would represent a
early studies the difficulty of isolating
                                              survey provided further evidence for an   reduction of 6.6% or 8.8% in the
confounding factors led to inconclusive
                                              association between breastfeeding and     prevalence of adolescent obesity.
results. For example in a paper in
                                              obesity. Hediger analysed a sample of
1980 Kramer recognised the difficulty                                                   For younger children the results of
                                              2685 US-born children between the
of studying obesity and breastfeeding                                                   Armstrong and colleagues from
                                              ages of 3 and 5 years8. After adjusting
and in particular the difficulty of                                                     Scotland suggest a risk reduction of
                                              for potential confounders, there was a
isolating the effects of social class and                                               about 30% in obesity at 39-42months
                   4                          reduced risk of being at risk of
associated factors . To overcome these                                                  in breastfed children9. If these rates
                                              overweight in “ever breastfed”
difficulties Kramer undertook a further                                                 hold in later follow-up this suggests an
                                              children, adjusted odds ratio of 0.63
study and found that being overweight                                                   even more powerful effect for
at 12 months was related to feeding                                                     breastfeeding than the Gilman results.
method – breastfed babies were                The most recent major study, and
lighter5. We now know that breastfed          possibly the most rigorous, came from     To summarise our current knowledge:
infants are likely to be about 0.5 Z          Scotland, where the incidence of          ●   Overweight infants are more likely
scores less at 12 months, about 4-500         breastfeeding is lower than in the USA        to become overweight children,
grams.                                        or Germany9. A population-based               adolescents and adults.
                                              sample of 32,200 Scottish children
Recent studies have applied more                                                        ●   Breastfeeding to six months of age
                                              were studied at age 39-42 months in
rigorous epidemiology to larger sample                                                      reduces the rate of overweight and
                                              1998 and 1999. The prevalence of
sizes with an increase in the quality of                                                    obesity.
                                              obesity was significantly lower in
the evidence. Von Kries analysed
                                              breastfed children, and the association
cross-sectional data from 9400
                                              persisted after adjustment for
German children to assess the

●    Given the other known benefits of               2.   Stettler, N., B. Zemel, et al. (2002). “Infant       6.  von Kries, R., B. Koletzko, et al. (1999). “ Breast
     breastfeeding, increasing the rate of                Weight Gain and Childhood Overweight Status in           feeding and obesity: cross sectional study.” BMJ
                                                          a Multicenter, Cohort Study.” PEDIATRICS                 319: 147-150.
     exclusive breastfeeding to six                       109(2): 194-199.                                     7. Gillman, M. W., S. L. Rifas-Shiman, et al.
     months would be a very worthwhile               3.   Fagot-Campagna, A., D. Pettit, et al. (2000).            (2001). “Risk of overweight among adolescents
     public health measure.                               “Type 2 diabetes among North American                    who were breastfed as infants.” Jama 285(19):
                                                          children and adolescents: an epidemiologic               2461-7.
For further information contact:
                                                          review and a public health perspective.”             8. Hediger, M., M. Overpeck, et al. (2001).
Professor Colin Binns
                                                          J Pediatrics 136: 664-72.                                “Association between infant breastfeeding and
School of Public Health
Curtin University of Technology                      4.   Kramer, M. S. (1981). “Do breast-feeding and             overweight in young children.” JAMA 285: 2453-
Email:                        delayed introduction of solid foods protect              2460.
Ph: (08) 9266 2952                                        against subsequent obesity?” J Pediatr 98(6): 883-   9. Armstrong J & Reilly JJ. Breastfeeding and
                                                          7.                                                       lowering the risk of childhood obesity.
Reference:                                           5.   Kramer, M. S., R. G. Barr, et al. (1985).                Lancet. 2002 Jun 8;359(9322):2003-4.
1.   Dietz, W. H. (2001). “The obesity epidemic in        “Determinants of weight and adiposity in the         10. Dietz, W. H. (2001). “Breastfeeding may help
     young children.” BMJ 322(7282): 313-314.             first year of life.” J Pediatr 106(1): 10-4              prevent childhood overweight.” JAMA 285(19):

              Overweight and Obesity: facts & figures
The prevalence and distribution                      Table 1: Proportion of adults (≥ 19 years) within the body mass index
of overweight & obesity                              (BMI)* categories; 1995 NNS1
                                                                                                      Proportion of age group
(Adapted from Marks GC et al 2001).                  BMI Categories               Age group        Male (%)      Female (%)
The most recent national data on                                                    (Years)
overweight and obesity from                          Underweight (BMI ≥ 18.5)                       19-24                 2.4                      5.4
measurements of heights and weights
come from the 1995 National                                                                         25-44                 0.5                      2.2
Nutrition Survey (NNS).

                                                                                                    45-64                 -                        1.0
The measure most commonly used to                                                                   ≥ 65                  0.5                      1.6
assess body weight and identify
underweight, overweight and obesity is                                                              ≥ 19 (All)            0.6                      2.2
the Body Mass Index (BMI). Table 1
presents the BMI results for adults                  Overweight (BMI ≥ 25 - < 30 19-24                                    27.7                    17.4
from the 1995 NNS by age group and                                                                  25-44                 46.1                    24.7
gender and show that1:
                                                                                                    45-64                 50.4                    35.5
●    64% of men and 47% of women
     were either overweight or obese;                                                               ≥ 65                  48.0                    35.6
     overall 2.2% of females and 0.6%                                                               ≥ 19 (All)            45.2                    28.8
     of males were classified as
                                                     Obese (BMI ≥ 30)                               19-24                 9.9                     8.6
●    the proportion of overweight
     and/or obese increased with age for                                                            25-44                 16.2                    14.5
     both men and women,                                                                            45-64                 25.4                    25.1
●    amongst those 19 to 24 years of                                                                ≥ 65                  19.1                    22.9
     age, one in three males and one in
     four females were overweight or                                                                ≥ 19 (All)            18.5                    18.2
                                                     *BMI = (weight in kilograms)/(height in metres)2
 ●   for those 45 to 64 years of age,                 ●   the highest proportions of adults                      body fat is the waist-to-hip ratio
     three of every four males and                        who were underweight were aged                         (WHR). This ratio is calculated by
     almost two of every three females                    19-24 years with more women than                       dividing the abdominal circumference
     were overweight or obese,                            men underweight in each age                            (cm) by the hip circumference (cm). A
                                                          group.                                                 WHR greater than 0.9 in men and 0.8
 ●   the extent of obesity appeared not
                                                                                                                 in women indicates abdominal obesity
     to differ between men and women,                 The distribution of body fat can
                                                                                                                 and an increased risk of certain
     but the extent of overweight cerdid              influence an individual’s risk of
     at all ages, and particularly for men            conditions such as Type 2 diabetes and
     aged 25-44 years when it was 20%                 cardiovascular disease. The simplest
     higher, and                                      ratio that measures the distribution of

                    Table 2: Proportion of adults (≥ 19 years) with abdominal obesity; 1995 NNS1

                                                          Proportion with waist to hip ratio > cut-off(%)
                              Age group (Years)           Male (WHR >0.9)            Female (WHR >0.8)
                                 19-24                          12.6                      11.7
                                 25-44                          45.6                      22.3
                                 45-64                          77.8                      48.0
                                 ≥ 19 (All)                     55.5                      36.3

The trends for WHR were similar to            The results show that:                      ●   the different age-related patterns
those for BMI. A higher proportion                                                            for boys and girls are likely
                                              ●   amongst boys the proportion
of men than women in each age group                                                           associated with differences in age
                                                  overweight did not change with
were abdominally obese, and the                                                               of onset of puberty;
                                                  age, while the group most at risk
highest proportion of abdominal                                                               for both boys and girls one of
                                                  of overweight were boys aged 12-        ●
obesity was found in the older age                                                            every four to five children were
                                                  15 years;
group for both sexes.                                                                         either overweight or at risk of
                                              ●   for girls the proportion overweight
Table 3 presents the BMI results for                                                          overweight;
                                                  and at risk of overweight was
children and adolescents from the                                                             the highest proportions
                                                  greatest in the youngest age group      ●
1995 NNS by age group and gender.                                                             underweight were aged 9-11 years
                                                  shown (9-11 years);
For this age range the BMI categories                                                         with more boys than girls
are age specific.                                                                             underweight in each age group.
                    Table 3: Proportion of children and adolescents (9-18 years) within the body
                    mass index (BMI) categories; 1995 NNS1
                                                                   Proportion of age group
                    BMI Categories          Age group              Male (%)         Female (%)
                    Low BMI for age               9-11                       5.2               1.5
                                                  12-15                      3.4               -
                                                  16-18                      1.8               -

                    At risk of overweight         9-11                       13.3              16.3
                                                  12-15                      20.3              11.9
                                                  16-18                      14.7              13.7

                    Overweight                    9-11                       7.0               10.1
                                                  12-15                      7.2               6.5
                                                  16-18                      7.0               6.0

Trends 1983/5 to 1995                         Body Mass Index in Adults                  increased with age from 1.3 units for
                                                                                         those aged 25-34 years to 2.9 units for
(Adapted from Cook P, Rutishauser IHE,        Body mass index increased significantly
                                                                                         those aged 55-64 years.
Seelig M 2001)                                between 1983 and 1995. For men, the
                                              increase was 1.7 units and for women       Energy Intake in Adults
The 1995 NNS are compared with                2.5 units with the result that median
data from the 1983 NNS (adults) and                                                      Overall there was a statistically
                                              BMI was above 25 for men and women
the 1985 ACHPER Survey (children                                                         significant increase in mean energy
                                              in 1995.
10-15 years) to estimate trends3. The                                                    intake of around 350kJ between 1983
comparisons are adjusted to account           All age groups experienced a significant   and 1995 (3-4% increase). In food
for differences in design and methods         increase in BMI. For women, but not        terms this increase represents the
between the surveys.                          for men, the increases in BMI              equivalent of about one slice of bread
                                                                                         per day.

The estimate of energy intake for the             energy intake would have been                    1995, by 0.8kg/m2 and 0.9kg/m2
1995 survey adjusted for design                   underestimated by about 40%.                     respectively.
differences was about 150kJ above that
                                                  Body Mass Index in Children                      Further health measurement surveys
for the total 1995 NNS estimate for
                                                                                                   are needed to keep track of trends in
Australia. If the total NNS estimate had          Mean body mass index increased
                                                                                                   overweight and obesity.
been used for the comparison between              significantly for both boys and girls
1983 and 1995 the difference in                   aged 10-15 years between 1985 and
                         Table 4: Estimated BMI for children aged 10-15 years.
                                                           95% CI mean                                    Test of
                                 Sample size Mean BMI Lower        Upper    Median                      significance
                         1985        2,533             19.0         18.9       19.1      18.6                  *
                         Total       543               19.8         19.5       20.1      19.2

                         1985        2,506             19.3         19.2       19,5      19.0                  *
                         Total       486               20.2         19.9       20.5      19.8

                         *Difference between estimated means for 1985 and 1995 comparable subset is statistically
                          significant at the 0.01 level.

Energy intakes in children                         are also included (an additional $120.5         References
                                                   million).                                       1 Australian Bureau of Statistics 1998, National
The increase in energy intake between                                                                  Nutrition Survey Nutrient Intakes and Physical
1985 and 1995 was statistically                    Lifestyle interventions that result in a            Measurements Australia 1995, Catalogue No
significant for both boys and girls aged           weight loss of 5kg in all Australians               4805.0, Australian Bureau of Statistics, Canberra.
10-15 years. The absolute increases of             who are overweight or obese would               2. Ball M, Wilson B, Robertson I, Russell D 1993,
                                                                                                       Obesity and body fat distribution in New
1,400kJ for boys and 900kJ per day for             reduce the prevalence of overweight                 Zealanders: a pattern of coronary heart disease
girls represent proportional increases             and obesity from 55% to                             risk, New Zealand Medical Journal 106:69-72.
of 15% and 11% respectively. In food               approximately 40% (eg by consuming                          ,
                                                                                                   3. Cook P Rutishauser IHE, Seelig M 2001,
terms, this level of increase represents           diets reduced in fat and energy along               Comparable data on food and nutrient intake and
the equivalent of between 3 and 4                  with a regular physical activity                    physical measurements from the 1983, 1985 and
slices of bread per day.                           program). This could reduce the health              1995 national nutrition surveys. Commonwealth
                                                                                                       Department of Health and Aged Care, Canberra.
                                                   care costs associated with Type 2
Costs                                                                                              4. Marks GC, Coyne T, Pang G 2002, Type 2
                                                   diabetes by $18.6 million per year, or              Diabetes Costs in Australia – the potential
(Adapted from Marks GC, Coyne T, Pang G 2002).
                                                   up to $45.1 million per year if the cost            impact of changes in diet, physical activity and
The cost of obesity in Australia has               of complications is also considered.                levels of obesity, Commonwealth Department of
been conservatively estimated at 2% of             These estimates do not factor in the                Health and Aged Care, Canberra.
the total health budget5 or $840                   cost of implementing the programs to            5. Segal L, Carter R, Zimmet P 1994, The costs of
million (in 1992-3 dollar terms per                                                                    obesity: the Australian perspective,
                                                   achieve the weight changes, and do not
                                                                                                       Pharmacoeconomics 5:S45-52.
year).                                             include indirect costs. The estimates
The impact of reducing levels of                   will be about 10% greater in current
obesity in health care costs is illustrated        costs.
by assessing its impact on Type 2                  Geoff Marks1, Ingrid Coles-
diabetes costs. An increasing BMI is               Rutishauser1,2, Karen Webb3
associated with greater risk of Type 2             1
                                                   University of Queensland, 2Deakin
diabetes. The total health care cost of
                                                   University, 3University of Sydney
Type 2 diabetes in 1993-94 in Australia
was $216.7 million of which $89.1                  For further information contact:
million (41%) can be attributed to                 Geoff Marks
overweight and obesity. These costs                Australian Food and Nutrition
are substantially greater if the costs of          Monitoring Unit
complications resulting from diabetes              Email:
                                                   Ph: (07) 3365 5392

                 Who is Gaining Weight in Australia?
The spiralling epidemic of obesity          underweight or healthy weight women.               For further information contact:
worldwide has of late been receiving                                                           Dr Kylie Ball
                                            Given the high risk of weight gain                 Physical Activity and Nutrition
increasing attention in both the                                                               Research Unit
                                            observed among younger women in
scientific literature and popular media                                                        Deakin University
                                            this study, the second paper2
internationally. In many developed                                                             Email:
                                            investigated the risk of weight gain               Ph: (03) 9251 7310
countries more than half of the adult
                                            among a group of young adult women
population are now overweight or                                                         Reference:
                                            in more detail. This population study
obese. Longitudinal data from                                                                                               ,
                                                                                         1. Ball K, Crawford D, Ireland P Hodge A. Patterns
                                            examined baseline and four-year
countries such as the United States and                                                      and demographic predictors of five-year weight
                                            follow-up data from the cohort of                change in a multi-ethnic cohort of men and
the United Kingdom have shown that
                                            young women participating in the                 women in Australia. Public Health Nutrition (in
large numbers of children and adults,
                                            Australian Longitudinal Study on                 press).
including those who are already
                                            Women’s Health, a nationwide                 2. Ball K, Brown W, Crawford D. Who does not
overweight, are continuing to gain                                                           gain weight? Prevalence and predictors of weight
                                            longitudinal study assessing factors
weight throughout life.                                                                      maintenance in young women. International
                                            associated with health among three
                                                                                             Journal of Obesity 2002; 26: 1570-1578.
Up until recently, there has been no        cohorts of Australian women. Analyses
longitudinal data on weight change in       of weight change data from a total of
the Australian population. Serial cross-    8,726 young women aged 18-23 years
sectional data have suggested that the      at baseline showed that
prevalence of overweight and obesity        only 44% of the women             Women who were
has increased in Australia over recent      reported maintaining their married, mothers, and
decades. However, there is no               weight (within 5%) over          in non-professional
knowledge of weight change patterns in      the four-year study period; occupations, and who
individuals over time; or of which          41% had gained weight                were already
individuals or groups are gaining weight    and 15% had lost weight.
                                                                             overweight, were at
and becoming obese.                         Women who were
                                                                               increased risk of
                                            married, mothers, and in
The first two longitudinal studies on                                            weight gain
weight change in large Australian adult
                                            occupations, and who
population samples are about to be
                                            were already overweight, were at
published. The first of these papers1
                                            increased risk of weight gain. In
reports on investigations of the
                                            addition, women who ate take-away
patterns and demographic predictors of
                                            food frequently and who spent long
five-year weight change in a large
                                            periods of time in sedentary pursuits
multi-ethnic cohort of almost 30,000
                                            were at risk of gaining weight.
men and women aged 35-69 years.
                                             These first Australian studies of adult
Using data collected as part of the
                                             weight change provide important
Melbourne Collaborative Cohort Study
                                             insights relevant to Australia’s obesity
(MCCS), these analyses showed that
                                             epidemic. The findings of widespread
weight gain was a common pattern
                                             weight gain across both samples
throughout the five-year study period
                                             studied, but particularly among
among the participants. Men on
                                             younger women and women who were
average gained 1.6kg and women
                                                          already overweight, are a
2.4kg. Younger (35-44
years) men and, in               A common pattern cause for alarm. The
particular, women gained        throughout the five- prevention of weight gain
                                  year study period       and obesity across the
more weight than older
                                                          entire population should be
adults, and were at highest          among the
                                                          an urgent public health
risk of major weight gain        participants. Men
                                                          priority. In particular,
(≥ 5kg). Among men,            on average gained young-mid adulthood
higher initial body weight       1.6kg and women          appears to be a critical
was associated with                     2.4kg             time to intervene to
decreased likelihood of
                                                          prevent future weight gain.
major weight gain, whereas among
women, those initially overweight or         Dr Kylie Ball and Associate Professor
obese were about 20% more likely to          David Crawford
experience major weight gain than

Maintaining Weight, Preventing Weight Gain and
              Managing Obesity
The level of obesity continues to climb         the common objective for all Australian            The risk of premature mortality may
rapidly in Australia with the latest            adults and the base for all obesity                only become appreciable at BMI levels
figures from the 1999/2000 AusDiab              management strategies. The                         of 30 kg/m2 or more but the risk of
study showing that around                                       association between                many common, chronic conditions
19% of adult males and                                          elevated BMI and                   actually begins to increase quite rapidly
                                  Recent research is
20% of adult females are                                        increased risk of ill health       from a BMI below 21 kg/m2. For
now obese . In total,                 indicating that           is clear and consistent.           example, the risk of coronary heart
67% of adult males and                 preventing (or                                              disease in women at a BMI of 26 is
                                   minimising) weight           However, recent research
52% of adult females are                                                                           already twice that of a women with a
classified as overweight.      gain in adulthood is a has shown that weight                        BMI of 21, whilst for men the risk is
                                                                gain, per se, is also
These figures indicate the more productive and                                                     1.5 times in those with a BMI of 26
                                                                associated with increased
weight of a substantial          effective strategy for                                            compared to 21. The same
                                                                health risk and that this
proportion of the adult        limiting weight-related risk is independent of                      comparison for diabetes shows an
population already falls           illness at both an                                              eight-fold increase in risk for women
                                                                absolute BMI. Willett et
outside the defined                   individual and                                                            and a four-fold increase
                                                                al2 has shown
“healthy weight range”              population level                                                            for men.
                                                                strong              The widespread use
and it would appear that
                                                                relationships                                   Assessments of health risk
an investment of expertise                                                        of a BMI classification
                                                between weight gain and                                         based only on absolute
and resources into programs to assist                                                 system based on
                                                increasing levels of                                            level of BMI or BMI grade
these Australians to lose weight must                                             defined cut-points for can be misleading and
                                                diabetes, hypertension,
be made a priority.                                                                    overweight and
                                                gall bladder disease and                                        increases in weight in
However, the development of clinical            coronary heart disease.                obesity tends to         those within acceptable
and public health obesity management
strategies which focus too heavily on
achieving a weight within the
acceptable body mass index (BMI)
range is flawed logic and may even be
counter-productive to the maintenance
                                                Therefore, a large weight
                                                gain in a lean individual
                                                may carry equivalent risk
                                                to maintaining a stable,
                                                but slightly elevated BMI
                                                in an overweight
                                                                                   distract from the fact BMI ranges often attract
                                                                                         that BMI is a          no concern from health
                                                                                    continuous variable care professionals.
                                                                                        and that the            There are a number of
                                                                                   relationship between other important reasons
                                                                                    BMI and ill health is       why a focus on weight gain
of good health. Instead, recent                 individual. The                    also continuous and prevention should be
research is indicating that preventing          combination of an
                                                                                           graded               central to all strategies to
(or minimising)                                          elevated BMI
                                                                                                                tackle the obesity
weight gain in                                           together with
                          A large weight gain in                                                   problem. Although the process of
adulthood is a more                                      ongoing weight gain, however,
                          a lean individual may                                                    weight gain is still poorly understood, it
productive and                                           leads to greatly magnified levels
                         carry equivalent risk to                                                  is widely recognised that once a person
effective strategy for                                   of risk.
                          maintaining a stable,                                                    has entered a phase of weight gain, the
limiting weight-
                           but slightly elevated         Assessment of data from the               longer the period of weight gain the
related illness at
                          BMI in an overweight           Nurses Health Study has shown             more difficult it becomes to slow or
both an individual
                                  individual             that women who entered                    reverse. Almost all weight gain in
and population level.
                                                         adulthood obese and put on                adulthood is fat gain and is usually
Furthermore, this                                        more than 20kg during                                        associated with a
message of preventing weight gain is            the 18 years of follow-up were              shifting the focus        disproportionate
equally appropriate and beneficial              70 times more likely to develop away from weight loss increase in abdominal
regardless of whether an individual is          diabetes than those who entered                  to weight            fat stores.
currently within a normal BMI range             adulthood lean and maintained              maintenance also           Consequently, the
or overweight or even obese. Of                 their weight over time3.                  avoids exacerbating relationship between
course, there are additional benefits to
                                                The widespread use of a BMI              inappropriate dieting BMI and risk varies
be gained by achieving and maintaining
                                                classification system based on             behaviours which           with age and there
a moderate weight loss in those who
                                                defined cut-points for                    have been reported appears to be similar
are overweight but sometimes even
                                                overweight and obesity tends to in teenage girls and variations between the
modest weight loss goals are beyond
                                                distract from the fact that BMI is           young women              absolute BMI and the
the achievement of some individuals.
                                                a continuous variable and that                                        level of health risk
There are numerous reasons why                  the relationship between BMI and ill               between different ethnic groups.
weight gain prevention should serve as          health is also continuous and graded.              These issues are redundant at a

population level if the major focus is     For further information contact:                       2.   Colditz GA, Willett WC, Rotnitzky A, Manson
weight gain and not absolute BMI.          Dr Tim Gill                                                 JE. Weight gain as a risk factor for clinical
                                           NSW Centre for Public Health Nutrition                      diabetes mellitus in women. Ann Intern Med
In addition, weight maintenance can        Email:                                    1995 122:481-6.
also serve as an appropriate goal of       Ph: (02) 9351 3758                                     3.   Willett WC, Dietz WH, Colditz GA. Guidelines
                                                                                                       for healthy weight. N Engl J Med 1999 341:6
weight control programs in individuals     Reference:
with an existing weight problem4 and       1. Dunstan D et al. Diabesity & Associated
                                                                                                  4.   Rossner, S. Factors determining the long term
shifting the focus away from weight            Disorders in Australia: The final Report of the
                                                                                                       outcome of obesity treatment. In P Bjorntorp
loss to weight maintenance also avoids         Australian Diabetes, Obesity and Lifestyle Study
                                                                                                       and BN Brodoff (Eds), Obesity, Philadelphia, J B
                                               (AusDiab). Melbourne, International Diabetes
exacerbating inappropriate dieting             Institute, 2000.
                                                                                                       Lippincott. 1992.
behaviours which have been reported
in teenage girls and young women.

                 National Physical Activity Guidelines
                            for Australians
Physical activity refers to any bodily     So, how much physical activity do                      In 1999, in light of the growing
movement produced by skeletal              people need to do to reap health                       scientific evidence and the release of
muscles that results in energy             benefits? According to the research,                   the US Surgeon’s General’s report on
expenditure. Research shows that           even moving from being inactive to                     the topic, the Australian Department of
being physically active has a range of     doing a little bit of physical activity                Health and Ageing developed National
benefits and that being inactive is a      such as a ten minute walk a day will                   Physical Activity Guidelines for Australians.
major risk factor which can contribute     decrease the risk of illness                           The guidelines set out the minimum
to poor health. Physical activity plays                                                           levels of physical activity required for
                                           However, adults should aim to
a role in the prevention and                                                                      good health. They are not intended for
                                           undertake 30 minutes of moderate-
management of a number of health                                                                  high level fitness and sports training
                                           intensity physical activity (such as brisk
conditions including: cardiovascular                                                              and for best results they should be
                                           walking, or equivalent), which can be
disease; Type 2 diabetes; some cancers                                                            combined with healthy eating habits.
                                           accumulated in bouts of ten minutes,
(particularly colon cancer); injury
                                           on five days a week, in addition to                    The promotion of physical activity for
(particularly falls in the elderly); and
                                           activities of every day living (such as                health is now a policy of all Australian
unhealthy weight. In addition,
                                           household chores). This adds up to                     State, Territory and Commonwealth
physical activity can help with:
                                           about 150 minutes of moderate-                         health departments. The guidelines are
musculoskeletal health; mental health;
                                           intensity physical activity per week.                  available free of charge by telephoning
stress; insomnia; and general tiredness.
                                                                                                  1800 020 103 and asking for the PHD
                                                                                                  publications request line.

      National Physical Activity Guidelines                                                       For more information on the benefits
                                                                                                  of physical activity and strategies to
                 for Australians                                                                  promote health enhancing physical
                                                                                                  activity in different settings refer to
                                                                                                  Bauman A, Bellew B, Vita P Owen N,
  1. Think of movement as an opportunity, not an                                                  Getting Australia active: towards better
     inconvenience.                                                                               practice for the promotion of physical activity.
                                                                                                  National Public Health Partnership.
  2. Be active every day in as many ways as you can.                                              Melbourne, Australia, March, 2002.
                                                                                                  This can be downloaded from
  3. Put together at least 30 minutes of moderate-                                      
     intensity physical activity on most, preferably all,                                         For further information contact:
                                                                                                  Catharina van Moort
     days.                                                                                        Assistant Director
                                                                                                  Nutrition and Physical Activity Section
  4. If you can, also enjoy some regular, vigorous                                                Department of Health and Ageing
     exercise for extra health and fitness.                                             
                                                                                                  Ph: (02) 6289 7939

                       Department of Health and Aged Care 1999

 Australian Recommendations for Children’s and
              Youths’ Physical Activity
Physical activity participation is related     these recommendations, based on best         At the completion of this report, the
to the optimal development and                 available evidence, will encourage           Commonwealth plans to progress to
functioning of many physical,                  health care professionals to promote         phase two: consultations on the
physiological, educational, social and         physical activity participation in young     recommendations, and development of
psychological processes in children and        people, and that the recommendations         Australian physical activity
youth. It is also widely believed that         will encourage the planning and              recommendations for children and
regular physical activity in childhood         implementation of school and                 youth.
and adolescence may facilitate                 community-based programs to enhance
                                                                                            The most recent international
participation in an active lifestyle in        young people’s participation in health-
                                                                                            guidelines for young people’s physical
adulthood, and that physical activity in       promoting physical activity.
                                                                                            activity were released by the United
childhood and adolescence may help to
                                               In March 2002, the Department of             Kingdom in 2001. These state that to
reduce the risk of chronic diseases of
                                               Health and Ageing commissioned               optimise current and future health:
adulthood. While a number of
                                               researchers at the University of
medical and public health organisations                                                     ●   all young people should participate
                                               Queensland’s School of Human
have issued position statements                                                                 in at least one hour per day of
                                               Movement Studies to draft a discussion
endorsing the promotion of lifetime                                                             moderate intensity physical activity,
                                               paper to facilitate the development of
physical activity in young people, there                                                        and
                                               Australian recommendations for both
are no widely endorsed Australian                                                               at least twice per week, some of
                                               children’s and youths’ participation in      ●
recommendations regarding the dosage                                                            these activities should help to
                                               health-promoting physical activity.
of physical activity for children and                                                           enhance and maintain muscular
youth.                                         The discussion paper is intended to:
                                                                                                strength and bone health.
The development of such                        (1) provide an overview of the evidence
                                                                                            Interpretation of these guidelines from
recommendations was identified in the              linking physical activity to health
                                                                                            a practical sense suggests that
Strategic Inter-Governmental Forum                 benefits in children and
                                                                                            opportunities should be provided for
on Physical Activity and Health                    adolescents,
                                                                                            children to be active, not only through
(SIGPAH) work plan in 2000, and by             (2) review existing guidelines for young     structured physical activities such as
experts attending a Physical Activity              people’s participation in health-        sport, or physical education, but also
and Health Measurement Workshop in                 promoting physical activity,             through play, recreation and transport.
2000 as a priority for Commonwealth
action. Such recommendations on                (3) provide physical activity                For further information please contact:
                                                   recommendations suitable for the         Kerri Edwards
young people’s physical activity                                                            Project Officer
participation will be used by the                  Australian setting, and                  Nutrition and Physical Activity Section
Commonwealth to support policy                 (4) assess the ability of existing           Department of Health and Ageing
development, and as a tool to set and                                                       Email:
                                                   measurement tools to monitor             Ph: (02) 6289 3609
measure benchmarks and monitor                     against the National Physical Activity
progress toward health-related policy              Guidelines for Australians.
objectives. A broader objective is that

Body weight and Physical Activity for Australians
The Dietary Guidelines for Australian Adults   foods. The guidelines are not ranked in      population and decreased physical
are nearing the end of a process of            order of importance and individual           activity appears to be involved as a
review which began in December                 guidelines should not be considered in       contributory factor. Increased physical
2000. The new third edition focuses            isolation. Nevertheless, this article will   activity on a population basis is likely to
more on food groups and lifestyle              focus on the guideline most closely          form an important part of control
patterns than earlier editions and was         relating to body weight and physical         measures leading to improved health at
released for public consultation in            activity.                                    any weight. The National Physical Activity
2001.                                                                                       Guidelines for Australians also refer to
                                               A recommendation relating to physical
                                                                                            dietary intake by including the
The guidelines aim to provide dietary          activity may seem out of place in a set
                                                                                            recommendation “… for best results
advice to healthy, independent adults          of dietary guidelines. However, the
                                                                                            combine an active lifestyle with healthy
and apply to the total dietary intake –        health issues relating to overweight and
their purpose is not to be used to             obesity are recognised to impact on a
assess the healthiness of individual           large proportion of the adult

One of the issues considered and                recommendation. Many nutritionists         A recommendation in the revised
discussed in detail while revising the          are familiar with the U- or J-shaped       guideline to ‘eat according to your
guideline was a move towards a                  mortality curves relating BMI to           energy needs’ suggests a very dull and
recommendation to prevent weight                mortality. It should be pointed out        mechanical approach to the food we
gain in healthy adults rather than              that these curves relate to weight         eat. This is where consideration of the
attaining and maintaining a                                  measured at one point in      totality of the dietary guidelines is
specific weight range. The The Australian adult time, not to weight                        important. The other dietary
second edition of the                population is no        change. For healthy           guidelines provide recommendations
Dietary Guidelines for          longer in a position to people, weight gain                which relate to the enjoyment of our
Australians included the          ‘maintain a healthy appears to be a health risk          food, the importance of eating safe
guideline ‘Maintain a              body weight’. As a        that is independent of        food, recommendations about the
healthy body weight by              result, the dietary      actual BMI.                   general proportions of different food
balancing food intake and            guideline to the                                      groups to aim for and the importance
                                                             The revised draft guideline
regular physical activity’.       general public must is not intended to                   of minimising our intake of certain
                                    now be directed                                        food components.
Since publication of that                                    discourage people who are
guideline in 1992, the           towards reversing the overweight or obese from            The scientific background papers for
proportion of the                   population trend         losing some of their body     the Dietary Guidelines for Australian Adults
Australian population—             towards increasing        fat. It is well-understood    have been written for the use of health
both children and                   mean body mass           that a modest weight loss     professionals. It is planned that revised
adults—classified as                       index             of 5-10% of starting body     consumer friendly material explaining
overweight or obese has                                      weight is sufficient to       the dietary guidelines will also be
increased substantially. The Australian         achieve relevant health benefits.          produced.
adult population is no longer in a                                                         For further information contact:
                                                However the revised guideline
position to ‘maintain a healthy body                                                       Malcolm Riley
                                                recognises the difficulty of sustained
weight’. As a result, the dietary                                                          Nutrition & Dietetics Unit
                                                weight loss for people overweight or       Monash University
guideline to the general public must
                                                obese, acknowledges that a return to a     Email:
now be directed towards reversing the
                                                healthy weight range for many people
population trend towards increasing
                                                who are overweight or obese is unlikely    Ph: (03) 9594 5511
mean body mass index (BMI). The
                                                and recognises that the avoidance of       Editor’s note:
difficulty of achieving this should not
                                                further weight gain in adult life is a     The theme of the next issue of FOODChain
be underestimated – the new draft
                                                successful outcome of weight               is the Australian Dietary Guidelines and will
guideline recognises that a first step
                                                management.                                focus on the revised Dietary Guidelines for
towards reversing the trend is to stop
the current apparent increase.                  Being physically active (i.e. not being    Australians, the Dietary Guidelines for
                                                physically inactive or sedentary) is       Children and Adolescents and Infant Feeding
For most healthy independent                                                               Guidelines.
                                                associated with important health
Australian adults, the prevention of
                                                benefits at any weight. The importance
weight gain throughout their adult life
                                                of physical activity is independent of
is a practical and health enhancing
                                                weight and independent of weight loss.

Physical Activity Taskforces – what they are, and
  their role in Promoting Physical Activity and
                  Healthy Weight
Over the past decade, the concept of a        regional city of Wollongong in NSW in        compositions, different leadership and
Physical Activity or Nutrition                1995, as part of a National Heart            different agendas and degrees of
‘Taskforce’ has become popular among          Foundation auspiced three year               support. In NSW, the Taskforce was
state and federal jurisdictions in several    community wide intervention to               auspiced by the NSW Health
countries, as a way of integrating the        encourage people to be more active.          Department, and included diverse
multi sectoral partners required for          Since then there have been physical          stakeholders from government and
public health action. There are few           activity taskforces developed in New         non-government sectors1. The more
guidelines or theories which underpin         South Wales (NSW), in Queensland             recent taskforces in Qld and lead
their development, and as a result they       (Qld), as a Lead agency committee in         agency committee in Vic were chaired
have developed in an ad hoc fashion.          Victoria (Vic), and most recently in         by Sport and Recreation.
                                              Western Australia (WA).
One of the earliest Physical Activity                                                      A most exciting recent initiative has
Taskforces was developed in the               All these taskforces have had different      occurred in WA. Their Physical Activity

Taskforce 2001, chaired by the               Few have had a specific nutritional          physical activity, where this connection
Premiers Department, had specific and        orientation, around the promotion of         is made quite explicit. However it will
clear resourcing from the major              healthy weight or around reducing the        be a great challenge to bureaucracies,
stakeholders, including the Premiers         obesity epidemic through increasing          as well as to the disciplines involved in
Department, Health, Education,               physical activity. This was usually seen     public health nutrition and physical
Planning and Infrastructure and Sport        as just one of the many initiatives that     activity to cooperate in a way that
and Recreation2. This concept of an          physical activity taskforces might           creates meaningful interagency work
integrated taskforce with a mandate          contribute to, and one which involved        towards common goals.
and specific resourcing will allow it to     engaging specifically with the health
                                                                                          The common strategies required
develop better strategic and integrated      sector, whereas much of the other
                                                                                          increasing physical activity to a level
community wide actions.                                     work of physical activity
                                 However it will be a                                     sufficient to contribute to obesity
                                                            taskforces engaged
At the national level,           great challenge to                                       prevention and weight maintenance
                                                            agencies outside of the
various attempts have                                                                     will necessitate policy and
                                bureaucracies, as well health sector.
been made to bring                                                                        environmental changes, many of which
                                 as to the disciplines
agencies together,                                            In the past six months,     require long-term commitment of both
particularly through ‘Active      involved in public          particularly around the     stakeholders and decision makers. This
Australia’ initiative, which      health nutrition and        epidemic of interest in     will be a major challenge, as reversing
involved a strategic              physical activity to        childhood obesity, the      the trends towards increasing
partnership between                   cooperate               linkage between physical    sedentarism3 and increasing weight4 are
Health and Sport and            in a way that creates         activity and obesity has    among the most difficult public health
Recreation. This has          meaningful interagency been made more strongly,             challenges of the next decade.
waned due to recent            work towards common both in various Australian             For further information contact:
changes to the Sport and                 goals                states and in North         Adrian Bauman
Recreation policy                                             America. The new            NSW Centre for Physical
regarding physical activity, which has         construction of ‘Obesity Taskforces’ is    Activity and Health
                                                                                          University of NSW
led to a return by that sector to its          a next generation of organisational
traditional values around elite and            developments, and it is hoped that they    Ph: (02) 9828 6000
organised sport. Internationally,              will work closely with Physical Activity
Taskforces and Physical Activity               Taskforces towards common goals.
                                                                                          1. West Australian PATF
coalitions have existed in New Zealand,        One negative aspect of developing    
in various European counties, and in           separate taskforces is that cooperation    2. Bauman A, Armstrong T, Davies J, Brown W,
North America. Few of these have               is not mandated, but is hoped for.                                        .
                                                                                              Owen N, Bellew B, Vita P Trends in physical
survived long term, because their              Obesity and nutritional taskforces have        activity participation and the impact of integrated
planning processes are politically driven      an important overlap around physical           campaigns among Australian adults, 1997-1999.
and short term and their funding is            activity promotion in terms of weight          Aust NZ J Public Health (in press 2003).
                                                                                          3. Booth ML. Chey T. Wake M. Norton K. Hesketh
limited or negligible.                         maintenance and obesity prevention,
                                                                                              K. Dollman J. Robertson I. Change in the
                                               ranging from early childhood through           prevalence of overweight and obesity among
Most physical activity taskforces have
                                               the life span. Conceptually this is part       young Australians, 1969-1997. American Journal of
had a clear agenda around increasing
                                               of the new World Health Organisation           Clinical Nutrition. 2003; 77(1):29-36
population rates of participation in
                                               policy development around diet and
physical activity, sport and recreation.

          Family Food Environments of 5-6 year old
            children: Does Socioeconomic status
                     make a difference?
There are many factors of family               ●   opportunities for parental             metropolitan Melbourne and Geelong,
environment which influence children’s             modelling of food intake and food      a total of 1659 families. A self-
food intake and preferences. These                 related behaviours17-20.               completion questionnaire was sent to
include:                                                                                  parents or carers of children in their
                                               This study, conducted under a grant
                                                                                          first year of school which included
●   food availability and accessibility1-8,    from Diabetes Australia Research, by
                                                                                          measures of the profile of respondents,
                                               Campbell et al aims to describe the
●   access to media9-11,                                                                  family meal structures, parental views
                                               family food environment of 5-6 year
    child-parent feeding                                                                  on meal preparation, food availability
●                                              olds and examine how they vary by
    relationships1,12-16, and                                                             and media exposure.
                                               maternal education.
                                                                                          Mothers with higher education
                                               The study sample was selected from 28
                                                                                          reported their family eating the evening
                                               schools who agreed to participate in

meal together less often and feeling         of takeaway meals, and the differences                    15. Johnson SL, Birch LL. Parents’ and children’s
dissatisfied with it. A study by Epstein     in reported food availability,                                adiposity and eating style. Pediatrics 1994; 94:
et al21 “demonstrated the power of           affordability and quality, provide
                                                                                                       16. Birch LL, Fisher JO. Mothers’ child feeding
parental role modelling in the               important examples of areas that need                         practices influence daughter’s eating and weight.
promotion and maintenance of weight          to be considered in the design of                             Am J Clin Nutr 2000; 71:1054-1061.
loss, and suggests that parent               nutrition promotion strategies targeting                  17. Lau RR, Quadrel MJ, Hartman KA.
participation and modelling of               families and their children.”(S560)                           Development and change of young adults’
behaviour change is instrumental in                                                                        preventive health beliefs and behaviour: influence
                                             Full article available:                                       from parents and peers. J Health Soc Behav 1990;
promoting eating and activity                                                                              31: 240-259.
management skills acquisition by             Campbell K, Crawford D, Jackson M,                        18. Harper LV, Sanders KM. The effect of adults’
children. Further work provides              Cashel K, Worsley A, Gibbons K &                              eating on young children’s acceptance of
evidence that in an older age group,         Birch LL. 2002. Family food                                   unfamiliar foods. J Exp Child Psychol 1975; 20:
eating with parent(s) may be important       environments of 5-6 year old children:                        206-214.
for dietary intake. In that study            Does socioeconomic status make a                          19. Gillman MW, Rifas-Shiman SL, Frazier AL,
                                             difference? Asia Pacific J Clin Nutr                          Rockett HR. Camargo CA Jr, Field AR et al
Gillman et al19 examined the
                                                                                                           Family dinner and diet quality among older
associations between frequency of            11(Suppl): S553-S561.                                         children and adolescents. Arch Fam Med 2000l 9:
families eating heir evening meal            References:                                                   235-240.
together and several measures of diet        1. Birch L, Fisher J. Development of eating               20. Tibbs T, Haire-Joshu D, Schechtman K,
quality in a large national sample of 9-         behaviours among children and adolescents.                Brownson R, Nanney M, Houston C et al The
14 year old children. Results showed             Pediatrics 1998; 101: 539.                                relationship between parental modeling, eating
                                             2. Birch LL, Birch D, Marlin DW, Kramer L. Effects            patterns, and dietary intake among African-
that eating family dinner together was                                                                     American parents. J Am Diet Assoc 2002; 101:
                                                 of instrumental consumption on children’s food
associated with healthful dietary intake                                                                   535-541.
                                                 preference. 1982; 3: 125-134.
patterns, including more fruits and          3. Birch LL, Markin DW. I don’t like it: I never          21. Epstein LH, Valoski A, Wing RR, McCurley J.
vegetables, less fried food and soda, less       tried it: effects of exposure on two-year old             Ten year follow-up of behavioural, family-based
saturated and trans fat, lower glycemic          children’s food preferences. Appetite 1982: 3:            treatment for obese children. J Am Med Assoc
load, and more fibre and                         353-360.                                                  1990; 264: 2519-2523.
micronutrients from food.”(S559)             4. Birch LL, McPhee L, Shoba BC, Pirok E et al.           22. Cook KA, Goldberg J, Rogers BL, Tucker KL.
                                                 What kind of exposure reduces children’s food             Relationships between use of television during
While families with middle and least                                                                       meals and children’s food consumption patterns.

                                                 neophobia? Looking versus tasting. Appetite 1987;
educated mothers reported eating                 9: 171-178.                                               Pediatrics 2001: 107:E7.
                                                                                                       23. Borzekowski DL, Robinson TN. The 30-second
together more often, they were more          5. Sullivan SA, Birch LL. Pass the sugar, pass the
                                                 salt: experience dictates preference. Dev Psychol         effect: an experiment revealing the impact of
likely to watch television while eating                                                                    television commercials on food preferences of
                                                 1990; 26: 546-551.
the evening meal. This was particularly                                                                    preschoolers. J Am Diet Assoc 2001: 101: 42-46.
                                             6. Hearn MD, Baranowki T, Baranowki J, Doyle C,
more prevalent in families with least            Smith M, Lin LS et al. Environmental influences
educated mothers. Coon et al reported            on dietary behaviour among children. Availability
children who normally viewed                     and accessibility of fruits and vegetables enable
television during meals ate fewer fruits         consumption. J Health Education 1998; 29: 26-32.
and vegetables, and more pizzas, snack       7. Gibson EL, Wardle J, Watts CJ. Fruit and
                                                 vegetable consumption, nutritional knowledge and
foods, and soft drink.22 However there           beliefs in mothers and children. Appetite 1998;
was the belief that food advertising did         31:205-228.
not have a strong influence on               8. Skinner J, Carruth B, Moran J et al. Toddlers’
children’s eating habits. Contrary to            food preferences: concordance with family
this, a US research found that children          members’ preferences. J Nutr Education 1998;
2-6 years old exposed to videotape               30:17-22.
with embedded commercials were               9. Gorn G, Goldberg M. Behavioural evidence of
                                                 the effects of televised food messages on children.
significantly more likely to choose the          J Consumer Res 1982; 9: 200-205.
advertised items than children who saw       10. Taras H, Sallis J, Patterson T et al. Television’s
the same videotape without                       influence on children’s diet and physical activity.
commercials. 23                                  Dev Behav Pediatrics 1989; 10: 176-180.
                                             11. Robinson T, Killen J. Ethnic and gender
This study found mothers in the least            differences in the relationships between television
educated group were twice as likely to           viewing and obesity, physical activity and dietary
report buying takeaway meals for the             intake. J Health Education 1995; 26: S91-S98.
evening meal two or more times a             12. Birch LL. The influence of social-affective
week. This may be due to lower                   context on the formation of children’s food
                                                 preferences. Child Dev 1980; 51: 856-861.
socioeconomic families use of fast-food
                                             13. Fisher JO, Birch LL. Restricting access to
chains rather than restaurants as an             palatable foods affects children’s behavioural
opportunity for eating out.                      response, food selection, and intake. Am J Clin
                                                 Nutr 1999; 69: 1264-1272.
The authors conclude there should be
                                             14. Fisher JO, Birch LL. Restricting access to foods
“consideration of the opportunities for          and children’s eating. Appetite 1999; 32: 405-419.
the modelling of healthy eating, the use

    Public Health Association of Australia: Position
      statement on promoting healthy weight
The following position statement on        within the range of 18.5 (kg/m2) to less            the prevalence of cardiovascular
promoting healthy weight has been          than 25 (kg/m2) is classified as healthy            disease, some types of cancer,
prepared by the Public Health              weight for adults1. In advocating for               arthritis, gallstones and sleep
Association of Australia’s (PHAA) Food     public health policy that promotes                  apnoea.
and Nutrition Special Interest Group       healthy weight, the PHAA notes that:
                                                                                            iii)Healthy weight, underweight,
and draws on the policy principles and
                                           i) The prevalence of overweight and                  overweight or obesity co-exists with
recommendations contained in the
                                              obesity in Australia is at epidemic               malnutrition in a significant
PHAA policy statements related to this
                                              proportions and continues to rise as              proportion of the Australian
                                              a consequence of an imbalance in                  population as a consequence of food
Healthy weight is a body weight that is       energy consumption and                            insecurity adversely impacting on
associated with normal growth and             expenditure                                       dietary quality and quantity.
development in children, and
                                           ii) Overweight and obesity is a major            iv) A significant proportion of the
protection against many chronic
                                               public health problem contributing               population use unhealthy dietary
diseases amongst adults. A weight that
                                               to the apparently increasing                     practices and/or smoking for weight
results in a Body Mass Index (BMI)
                                               incidence of diabetes, as well as to             control.

Table 1. PHAA Policy statements and recommendations for promoting healthy weight
Area                                  Policy

Food and health                       ●        Taxation and subsidies should support ease of access for all to healthy food.
                ●        Commonwealth, State and Territory Governments should take direct action
                                               levels to use their purchasing power in the market to ensure that the food
                                               supply under their control offers affordable nutritious food. This includes
                                               government catering organisations, hospitals, schools, daycare centres, welfare
                                               services and workplaces.
The prevention and                    ●        That Commonwealth and State health departments, and NGO’s, support research
management of overweight                       that aims to identify successful public health interventions aimed at reversing the
and obesity in Australia                       trend of and unhealthy weight gain and to identify ways in which to promote
                                               weight loss among those who are already overweight.
                                      ●        All relevant state, territory and local governments and non-government
                                               organisations should initiate, promote and support public education programs
                                               to increase the adoption of regular moderate physical activity by all Australians.
Physical activity                     ●        All relevant State, Territory and local governments should be encouraged to
                                               provide and promote safe urban and rural environments that encourage and
                                               support people being physically active as part of daily life.
                                      ●        The “Active Australia” initiative is strongly endorsed as an inter-sectoral,
                                               comprehensive national strategy; complementary initiatives such as supportive
                                               environments, sustainable transport and local government-based
                                               approaches are also strongly supported.
                                      ●        Employers should be encouraged to provide staff with the opportunity or
                                               incentive to participate in workplace or outside physical activity programs.
                                      ●        Children and adolescents should be encouraged and supported to be physically
                                               active through school based physical activity programs and community initiatives.
Television food advertising           ●        Legislation be introduced to ban all television food advertising at times
during children’s viewing                      when children comprise the majority of the viewing audience.
times                                 ●        Non-advertising messages consistent with recommendations for healthy eating to
                                               be screened during children’s viewing time.

The PHAA believes that the foundation         requires policy interventions that focus     ii) Promote equity in achieving healthy
for promoting healthy weight is to            on promoting food security and                   weight, providing an emphasis on
ensure that all Australians have equal        changing the social and structural               policies and programs that lead to
access to the basic foods needed for          influences that create ‘obesogenic’              the greatest improvements occurring
health and the underlying determinants        environments and barriers to                     in those groups with the greatest
of the recent increase in                                    opportunities for healthy         need.
obesity are related to                                       eating and active
                                 Urban design, ready                                       iii)Develop and implement multi-
environmental,                                               lifestyles. There are
                             availability of inexpensive three important                       sectoral initiatives that address
technological, social and                                                                      society, population and individual
economic changes in               (and often heavily         considerations that
                                                                                               level strategies and not rely solely on
society. Urban design,        marketed) energy dense should inform these
                                                                                               measures that try to persuade or
ready availability of                    foods               policy initiatives:
                                                                                               coerce individuals to change their
inexpensive (and often        and drinks, globalisation, i) Base policy on                     behaviour.
heavily marketed) energy         our reliance on cars        adequate evidence where
dense foods and drinks,                                                                    For further information contact:
                              and consumer changes available. However,                     Pieta Laut
globalisation, our reliance have all contributed to where adequate evidence                Executive Director
on cars and consumer                                                                       PHAA Inc
                             reduced physical activity is not available, useful
changes have all                                             policy initiatives could      Email:
                                         and to                                            Ph: (02) 6285 2373
contributed to reduced
physical activity and to       increased consumption be established based on               Reference:
                                                             incomplete but
increased consumption of of energy-dense foods suggestive evidence,                        1. World Health Organization. Obesity: Preventing
energy-dense foods.                                                                        and Managing the Global Epidemic: Report of the
                                                             sound theory, common          WHO consultation of obesity. Geneva: World Health
Therefore the PHAA further believes             sense and prudence.                        Organisation, 1997.
that the promotion of healthy weight

                              The Dietitians Association        of Australia tackles Obesity
                                              growing problem that deserves national
                                              priority action.
                                              DAA is the largest nutrition focused
                                                                                           The burgeoning national
                                                                                           Pharmaceutical Benefit Scheme(PBS)
                                                                                           expenditure as ageing baby-boomers
                                                                                           develop chronic diseases is surely
                                              member organisation in Australia, with
                                                                                           enough to convince governments and
                                              over 2000 dietitian members. DAA
                                                                                           their forward-looking constituents of
                                              believes that just as Australia has been a
The Dietitians Association of Australia                                                    the value of investing more in
                                              world leader in public health action on
(DAA) and its members are committed                                                        sustainable preventative action. DAA
                                              tobacco, road safety measures and
to being part of the solution to obesity                                                   commends the State Governments for
                                              HIV/AIDS, we can take a lead in
in Australia. DAA recently established                                                     taking this initiative.
                                              finding better ways to prevent and
the Acting on Obesity Working Party           manage childhood obesity. DAA is             Sub-optimal physical activity is
whose first task was to respond to the        keen to work with all stakeholders -         certainly a significant contributing
NHMRC draft Clinical Guidelines for           governments, non-government                  factor to children being overweight but
the Management of Overweight and              organisations, industry, community           focusing on activity alone is not
Obesity in Adults and Children and            organisations and key individuals in         enough. Improving diet is also critical.
Adolescents. The Guidelines will              addressing this major threat to the          We need to get children eating less and
provide an important resource to guide        health and welfare of Australians.           moving more. A comparison of the
DAA in the development of dietetic                                                         1985 and 1995 National Nutrition
practice guidelines for obesity               Key issues                                   Survey data shows the average energy
management. DAA looks forward to              There are many factors causing the           intake in children increased by over
the opportunity to work with the              current increase in childhood obesity        10% in children aged 10-15years,
NHMRC on a dissemination and                  and effective prevention and                 mostly from carbohydrate-based foods.
evaluation plan to assist health              management will require a “whole of          Over that same time the incidence of
professionals in implementing the             community” approach. This should             obesity in Australian children tripled
guidelines.                                   involve health and education                 and combined overweight/obesity more
DAA is concerned at the increasing            professionals, governments, the food         than doubled. Changes in the food
incidence of childhood obesity and            industry and families working together.      supply, with increasing availability and
chronic diseases related to obesity in        As a society we are also concerned           promotion of high-energy snack and
our population. It is a major and             about escalating acute health care costs.

take-away foods, is probably              eating is increased. We also need to        3. Dietetic Services
contributing to this increased energy     use every opportunity we have to            Australian children and their parents
intake. We need to find ways to           develop the ability of children to          need the support of their community
rebalance the quality of children’s       understand the choices there are to         and the guidance of health
diets.                                    make.                                       professionals in preventing and
                                                                                      managing overweight and obesity.
It is important that children have the    2. School Canteens                          Australia’s dietitians are a major
skills and knowledge to make better       School canteens should have a key role      resource, working throughout the
informed food choices. There has          in modelling healthy eating and             community in acute healthcare,
been a significant decline in resources   reinforcing messages about good             community and public health settings
devoted to nutrition education in this    nutrition, with over 80% of students        and in government, industry and the
country – both in school curricula and    using their canteen regularly. For many     private sector. While Australia lags
as government funded national             years dietitians have worked in the         behind most developed countries in
education programs to the public. The     development of guidelines and               per capita numbers of dietitians, they
home is also changing as an               standards for healthy canteen choices       are the largest group of professionals
environment to learn about food.          and in establishing the voluntary           with the expertise to work in this field
More food is eaten away from the          accreditation system of the School          and DAA is well placed to organise and
home, and what is eaten at home is less   Canteens Association. There is still        support their participation in action on
likely to be prepared from basic          work to be done to ensure these             childhood overweight and obesity.
ingredients than it once was. These       guidelines are updated and
phenomena need to be addressed            implemented more widely.                    Food supply and public health
through actions that target families,                                                 initiatives are critical approaches with
schools and the media.                    3. Fruit and Vegetables                     outcomes in the medium to long term,
                                          We know that the average fruit and          but some individuals need help now.
Australia is fortunate to have an
                                          vegetable intake of Australian children     Children who are overweight, and their
abundance of healthy food (though
                                          is too low, and promoting increased         parents, need expert support and
equity in distribution is an issue),
                                          intake is likely to improve dietary         guidance in managing their individual
efficient food production, processing
                                          quality and reduce overall energy           lifestyle, food and health issues.
and manufacturing industries, and a
                                          intake. It is also a current national       Children and parents who are
well developed regulatory system. But
                                          strategy of Eat Well Australia. DAA has     concerned that they are heading for
to enjoy our food, and to enjoy and
                                          been active in working with food            trouble deserve guidance and
preserve good health, we and our
                                          retailers to promote messages to            encouragement to act early.
children need to know how to use food
wisely and to live in environments        increase vegetable and fruit                DAA has recently taken the initiative
where healthy choices are easy choices.   consumption through the Coles 7 A Day       and embarked on a project to promote
                                          program. Research indicates that both       and support dietetic best-practice in
Key approaches                            awareness of healthy eating and eating      managing overweight and obesity. But
identified by DAA                         behaviour can change as a result of         access is a real issue. Australia can
                                          programs that target the barriers to        produce more dietitians but we need to
1. Advertising
                                          increased consumption. However to           make better use of them in the
Advertising of individual foods –         have a sustainable impact on health         community. While expenditure on
especially high energy snack and take     outcomes, the various approaches from       high technology acute care goes
away foods - to children is not           health and other sectors need to be         through the roof, Medicare does not
balanced by messages about a healthy      coordinated, expanded and maintained.       support dietetic services so this
diet in general. High levels of           DAA advocates a nationally coordinated      expertise in largely confined to acute
children’s television viewing is          ‘umbrella’ program to promote               health care settings or the affluent part
associated with reduced activity and      vegetable and fruit consumption that        of the community that can afford
significant exposure to influence on      includes campaigns to specifically target   private care.
eating behaviour. Young children’s        young children and parents. Such a
inability to make informed judgements     national program should be                  Let us look at some creative models:
about television content should not be    collaboration between government,           ●   providing tax breaks for
exploited. DAA advocates action to        non-government organisations,                   expenditure on obesity
decrease the number of television food    industry and the community involving            management and prevention (such
advertisements during children’s          health, agriculture, trade and                  as is now available in the USA)
viewing times that breach Australian      consumers in drawing diversely
Broadcasting Authority’s Children’s       developed campaigns together to             ●   providing Medicare rebates for
Television Standards. DAA also believes   promote clear effective messages and            best-practice management on
that the current standards should be      improve access, especially for                  referral
strengthened so that the proportion of    disadvantaged groups and those in rural     ●   providing children, parents and
advertisements promoting healthy          and remote areas.                               teachers with greater access to

   dietetic and exercise professionals     1) Strengthen the guidelines for food     4) Increase access to dietitians for
   through the school system, to              advertising to children and improve       individuals, schools, community
   monitor weight and run                     monitoring and compliance                 services and public health planning.
   intervention and prevention             2) Encourage all schools to implement
   programs                                                                          For further information contact:
                                              healthy canteen policies to support    Sue Cassidy
Call for action                               better nutrition for children          Professional Services Dietitian
DAA proposes the following resolutions                                               Dietitians Association of Australia
                                           3) Support funding for a national         Email:
for action :                                  multisector campaign promoting         Ph: (02) 6282 9555
                                              vegetable and fruit consumption

Healthy Weight - New Zealand National Activities
In 1999 the results of the 1997 New        The Government’s response has been        Peoples have higher rates of obesity
Zealand national nutrition survey of       through the development by the            than the New Zealand population as a
adults were released. The survey           Ministry of Health of a comprehensive     whole. Because of this the Obesity
reported that 35% of the New Zealand       strategy named ‘Healthy Eating –          Action Coalition is working to directly
adult population were overweight with      Healthy Action Oranga Kai Oranga          involve Maori and Pacific groups within
a further 17% who were considered          Pumau, aimed at increasing healthy        the Coalition.
obese1. Obesity rates have increased       eating, and physical activity and         The changes in the health sector in
from 11% of the population in 1989,        reducing obesity. The strategy has        New Zealand over the past decade have
to 17% in 1997.                            been informed by broad consultation       had a significant impact on the delivery
These survey results confirmed fears       with many health organisations in New     of public health services. The funding
about the increasing rates of obesity      Zealand who wait with interest the        and provision of public health services
                                           strategies launch planned for early
and were a ‘call to action’ for health                                               is now managed by the Ministry of
organisations across New Zealand. In       2003. ANA will continue to support        Health in contrast to the split between
December 2000, the Minister of             the facilitation of a cooperative         policy, funding and provision that
Health introduced a comprehensive          approach to implement the strategies      existed previously.
New Zealand Health Strategy with the       of Healthy Eating- Healthy Action
                                           between its member organisations and      The Government is currently
need for action to improve nutrition,
                                           the wider public health nutrition and     consulting on a review of the Public
increase levels of physical activity and
                                           physical activity sector.                 Health Legislation. The Public Health
reduce obesity identified as three of
                                                                                     Bill will replace the Health Act 1956.
the thirteen key population health         However, the need to change the           While it is early days, with the
objectives.                                environment in which we live and          Coalition’s first annual general meeting
Agencies for Nutrition Action (ANA) is     work to one that supports physical        planned for March 2003, it is hoped
an incorporated society made up of six     activity and healthy eating, remains a    that strong advocacy will be a key
principal member organizations. Since      priority that cannot be addressed by      factor in addressing New Zealand’s
it began in 1992, it has worked to         policy alone. This is the rationale       obesity epidemic.
strengthen cooperative efforts to help     behind the recent establishment of an
                                           Obesity Action Coalition whose focus      For further information on ANA contact:
New Zealanders achieve and maintain                                                  Christina McKerchar
a healthy weight throughout life. The      will be advocating for effective          Executive Officer
promotion of consistent messages           measures aimed to reduce the              Agencies for Nutrition Action
about the importance of healthy eating     prevalence of obesity. This Coalition     Email:
                                           aims to bring together agencies with an   Ph: 064 3 374 6909
and physical activity for quality and
length of life is a key aim of ANA’s       interest in advocating for obesity        For further information on the Obesity
approach. The six principal members        prevention in order to be a strong and    Action Coalition contact:
                                           united voice that cannot be ignored by    Susie Greene
are: Cancer Society, National Heart                                                  Email:
Foundation, National Diabetes Forum,       government. The Coalition will
New Zealand Nutrition Foundation,          advocate for public policy, and           Reference:

New Zealand Dietetic Association, and      legislation to positively influence       1. Russell DG, Parnell WR, Wilson NC et al. 1999.
                                           obesity rates. The Coalition will also        NZ Food NZ People: Key results of the 1997 National
Te Hotu Manawa Maori. In 2001,                                                           Nutrition Survey. Ministry of Health. Wellington.
ANA released a discussion document         provide a forum for letting members
‘Healthy Weight New Zealand 2001’          know what advocacy is being planned
calling for a robust national obesity      so that organizations can support and
prevention strategy to be well             strengthen each others activities.
supported by regional and local            In New Zealand, Maori and Pacific

            10,000 steps Rockhampton:
    Attacking Waistlines Through Increasing Steps
                                             direction about the amount of activity     Central Queensland University in
                                             which would be necessary to maintain       Rockhampton, and an advisory and
                                             or improve health1. Later focus group      evaluation group which is located in
                                             testing in Rockhampton suggested           Brisbane. While the original strategies
                                             acceptance of the ‘10,000 steps’ theme     were selected by the researchers and
                                             by the local community, with               initiated using a predominantly ‘top-
                                             reiteration of the notion that not         down’ approach, there has been
                                             everyone would achieve ’10,000’ steps      significant collaboration with
                                             – but rather that ‘every step counts’.     interested community sectors during
                                                                                        the initial development and
                                             It is important to note that the project
‘10,000 steps Rockhampton’ is a                                                         implementation phases (eg with local
                                             does not rely simply on distribution of
multi-strategy health promotion                                                         media organisations, the Council, local
                                             pedometers. Instead, there are five
program which aims to create and                                                        health services, the Heart Foundation,
                                             key strategies which are being used to
implement sustainable community                                                         management of the shopping mall etc).
                                             improve the social and physical
based strategies which will increase         supports which are needed if people        We anticipate that this ‘bottom-up’
levels of physical activity. As the name     are to increase the number of steps        input will increase as the newly formed
suggests, the project is based in            they take. These are:                      Local Physical Activity Taskforce
Rockhampton, a regional city                                                            increases its influence, and members of
(population about 60,000) in central         (1) a media based awareness-raising
                                                                                        the comminutycommunity become
Queensland, geographically located on            campaign,
                                                                                        more ‘engaged’ with the project. This
the tropic of Capricorn, about 600 km        (2) promotion of physical activity by      will be essential in terms of
north of Brisbane. Key industries in             health professionals,                  sustainability and behaviour change.
the region are cattle, coal, sugar, grain,
wool, seafood and mineral exploration,
with coal and beef the major export
income earners.
Rockhampton was selected for this
seminal project for two reasons.
                                             (3) improving social support for
                                                 physical activity through group
                                                 based programs targeting
                                                 disadvantaged sectors of the
                                             (4) working with the community to
                                                                                        Process evaluation of each of the
                                                                                        strategies will involve collection of key
                                                                                        indicators relating to the level of
                                                                                        implementation (eg the number of
                                                                                        general practitioners recommending
Firstly, it is fairly typical of most                                                   activity to their patients). Feedback
Queensland towns in terms of socio-              improve policies and environmental
                                                 support for physical activity, and     from community residents, key
demographic characteristics, though it                                                  stakeholders and service providers
does demonstrate some disadvantage in        (5) the establishment of a ‘micro-         about feasibility, satisfaction, and issues
terms of unemployment and low                    grants’ fund to which community        relating to sustainability, will also be
income compared with the more                    groups can apply for assistance with   recorded.
affluent southeast region of                     small, innovative physical activity
Queensland. Secondly, high                       enhancing projects.                    Outcome evaluation will involve
proportions of both men and women                                                       assessment of physical activity and
in Rockhampton have a BMI >25, and           The strategies have been introduced on     selected determinants at the onset and
almost 70% of middle-aged men are            a rolling basis throughout the first 18    completion of the project.
classified as overweight or obese.           months of the project. Each one            Representative samples of
                                             complements those that preceded it,        Rockhampton residents, and of
Why 10,000 steps?                            and serves to provide opportunities        residents of another Queensland town
The central coordinating theme of the        and support for physical activity,         with similar socio-demographic
project is the promotion of pedometer        especially amongst the more                characteristics, will be invited to
use to raise awareness and provide           disadvantaged (and therefore hard to       complete computer-assisted telephone
motivation for physical activity. The        reach) sectors of the population. This     interviews before and after the
pedometers act as a self-monitoring          multi-strategy ‘layering’ of               intervention.
instrument and reflect a goal-setting        interventions is designed to address
approach which quantifies the targeted       the multi-level individual social and      This is the first time that a multi-
daily amount of physical activity, with a    environmental determinants of physical     strategy whole community physical
focus on accumulation. Our more              activity2.                                 activity intervention project, with a
prescriptive approach was initially                                                     central coordinating theme based on a
based on focus group discussions             The project is being coordinated by a      prescriptive ‘dose’ of physical activity,
which suggested that older people, in        small team of project staff and            has been trialed in Australia.
particular, wanted much firmer               academic researchers based at the

                                            1                                          References
It is hoped that this project will inform    School of Human Movement Studies,
the development of models for the           University of Queensland; 2 School of      1. Brown WJ, Fuller B, Lee C, Cockburn J,
                                                                                           Adamson L. (1999) Never too late: older
promotion of physical activity which        Health and Human Performance,
                                                                                           people’s perceptions of physical activity. Health
can be sustained in Rockhampton and         Central Queensland University; 3School         Promotion Journal of Australia, 9 (1) 55-63.
disseminated to other communities           of Public Health, Queensland               2. Sorenson G, Emmons E, Hunt MK, Johnston D.
throughout Australia, and that              University of Technology.                      Implications of the results of community
ultimately, we will be able to              For further information contact:
                                                                                           intervention trials. Annual Review of Public Health,
demonstrate improvements in the BMI                                                        1998:19:379-416.
                                            Professor Wendy Brown
profile of this Queensland community.       School of Human Movement Studies
                                            University of Queensland
Wendy J Brown1 , Kerry Mummery2 ,           Email:
Elizabeth Eakin3 , Stewart G Trost1         Ph: (07) 3365 6446
Grant Schofield2 & Peter Abernethy1

   The Food Hopscotch Game : Hop Your Way to
        Healthy Eating and Physical Activity!
                                                                                       Department of Education,
                                                                                       Employment and Training.
                                                                                       The hopscotch game will be launched
                                                                                       in February 2003, as a kit that will
                                                                                       include the Turtle Food Hopscotch
                                                                                       Mat, Teachers Resource Handbook, The
                                                                                       Australian Guide To Healthy Eating
                                                                                       Package, laminated picture cards,
                                                                                       plastic food models and an evaluation
                                                                                       sheet. Most of the lesson ideas
                                                                                       provided with the game are based on
                                                                                       the traditional children’s game of
                                                                                       hopscotch. For those of you who can
                                                                                       not remember playing hopscotch, the
                                                                                       game involves hopping within squares
                                                                                       and collecting a token without stepping
                                                                                       on lines and losing your balance.

Childhood is a critical time for                                                       The Food Hopscotch Game will be
                                            healthy eating and how to incorporate
forming healthy lifestyle behaviours. If                                               pilot tested in ten Northern Territory
                                            a variety of nutritious foods into their
children learn healthy eating and                                                      Primary Schools mid 2003. Future
                                            daily diet. The game promotes the
lifestyle habits early, they are better                                                plans include professional development
                                            Australian Guide to Healthy Eating and
equipped to make healthy choices                                                       for teachers in the use of the resource
                                            physical activity.
throughout life to reduce their risk of                                                kit as part of the Northern Territory
                                            The Food Hopscotch Game, using the         Health and Physical Education
developing chronic disease.
                                            turtle motif, was developed by Linda       Learning Area of the Northern
The need for children to learn healthy      Hill, Aboriginal Nutrition Adviser, as a   Territory Curriculum Framework and
eating and engage in physical activity      fun game to teach children about food      evaluation of the kit and its use in
has been highlighted with the               and health. The turtle is a popular and    Northern Territory urban and rural
increasing prevalence of childhood          essential food for Indigenous people       primary schools.
obesity in Australia and other              living in coastal areas in the NT. The
industrialised nations. The 1995                                                       Robin Lion, Linda Hill and Debbie
                                            turtle image is also a way of promoting
National Nutrition Survey found that                                                   Smith
                                            bush foods in Indigenous
14.3% boys and 16.4% girls aged 0-14        communities.                               For further information contact:
years are overweight and 3.7% boys                                                     Robin Lion
                                            The major sponsors of the of The Food      Email:
and 5.6% girls are obese1.                                                             Ph: (08) 89228221
                                            Hopscotch Game Project are Unilever
The Food Hopscotch Game is a nutrition      Australasia, Northern Territory            Reference:
education tool, developed in the            Department of Health and Community         1. Australian Institute of Health and Welfare 2002.
Northern Territory, that helps children     Services and the Northern Territory            Australia’s health 2002. Canberra: AIHW
to understand the importance of

                      International 5 A Day Symposium
                                            vegetable and nut promotion to bring         ●   moves towards sustainable
                                            back to Australia. The delegates                 development.
                                            represented all sectors – state and
                                            federal government, non-government
                                            organisations, industry, academia, and       ●   bottlenecks and production, and
                                            consultancy – ensuring a diversity of        ●   convenience and marketing –fruit
                                            perspective.                                     and vegetables are bulky and heavy,
“We would like all of you to go             World Health Organisation                        they are not presented attractively,
completely berserk on your marketing        perspective                                      need partnerships with schools and
campaigns and we can’t see any              Dr. Pekka Puska (Director, Department of         supermarkets to create demand.
downside, that is of course, provided       Non Communicable Disease Prevention and      Negative exploitation:
you address sustainablility.”               Health Promotion, WHO) said that
                                            nutrition is becoming the leading            ●   don’t let promoting fruit and
Dr Derek Yach, Executive Director, (Non-                                                     vegetables get hijacked by other
communicable Disease & Mental Health,       public health strategy in the face of
                                            changing lifestyles and the increasing           agendas, and
                                            cost of the burden of disease. The           ●   processing or branding can increase
This call to action to increase fruit and   importance of this is evidenced in the           costs by 10-20%, therefore need to
vegetable consumption was made to the       WHO Global Strategy for Diet and                 address access and availability to
176 delegates from 26 countries             Physical Activity, which identifies the          lower SES groups.
attending the 3rd Biennial International    promotion of fruit and vegetable
5 A Day Symposium in Berlin in January      consumption as critical.
                                            Chronic disease accounts for 60% of
It was held in conjunction with Fruit       deaths, and 43% of the global burden
Logistica, the largest annual fresh         of disease. In 1990, 49% of
produce trade show in Europe. The
World Health Organisation (WHO)
supported the Symposium which was
hosted by the German ‘5 am Tag’ and
The Produce for Better Health
Foundation of the USA.
                                            communicable diseases were due to
                                            perinatal and nutritional deficiencies.
                                            In 2020 it is predicted these will fall to
                                            22%. In 1990, 27% of deaths were
                                            due to non-communicable diseases. In
                                            2020 it is predicted these will rise to
Symposium delegates represented all         43%.                                         Obesity and nutrition and
continents and both the developed and       Public health must drive action. Of the      physical activity transition
developing world. Australia was one of      ten leading risk factors, seven of them,     Barry M Popkin, PhD, Professor of
only a few countries present that did       (including alcohol) are strongly linked      Nutrition, School of Public Health,
not have a national public health           to diet and physical activity. The focus     University of North Carolina, US,
program promoting fruit and vegetable       on diet, nutrition and physical activity     described the nutrition transition and
consumption.                                has not been adequate.                       how disease morbidity and mortality
                                                                                         and adult obesity in the middle-income
Increasing fruit and vegetable              In the WHO Strategy WHA 53.17,               world is increasing. Half of the new
consumption is an international priority    54.8 and 55.23 there is strong language      cases of diabetes in the world are in
and many countries have been working        about the practical means of promoting       China and India. The increase in
in the promotion area with a variety of     fruit, vegetables, grains and cereals.       overweight and obesity is of particular
partnerships, systems and innovations.
                                            The direct benefits:                         concern worldwide.
The conference provided an
opportunity to show-case the work of        ●   health promotion and disease             In just eight years (between1989 and
the National Vegetable and Fruit                prevention,                              1997) there has been a doubling of
Coalition, the WA Department of                                                          overweight in men and a tripling in
Health’s Go for 2 & 5 fruit and
                                            ●   reduction in overweight and              women in China. In Mexico in 1999
vegetable social marketing campaign             obesity,                                 the National Nutrition Survey revealed
and the Coles 7 A Day campaign.             ●   new marketing options, and               that 60% of women were overweight
                                                                                         or obese compared with Asia, where
Horticulture Australia Limited (HAL)        ●   increased agriculture.                   10 to 25% are overweight or obesity
supported an Australian delegation of
                                            The displacement benefits:                   and it is close to doubling every
seven people to collaborate on
                                                                                         decade. In Egypt, 66% of women and
gathering key learnings from around         ●   fruit and vegetable consumption          50% or men are overweight or obese.
the world on health-based fruit,                replaces soft drinks and other           In South Africa 60% of women and
                                                snacks, and                              25% or men are overweight or obese.

The increase in prevalence of               obesity is more frequent among rich.       on, they are looking for preventatives
overweight and obesity (per year)                                                      (eg. antioxidants).
                                            These results have implications for
highlights the likely extent of the
                                            Australia, we need to consider the         In an urgent call for action Dr Riboli
problem for the future. Popkin
                                            social distribution of obesity when        described how in1954 tobacco was
reported that in Australia 0.24% men
                                            targeting strategies and developing        identified as a carcinogen. Research
per year becoming overweight or obese
                                            information. This requires adequate        continued and by the mid 1970’s and
and 0.58% of women compared with
                                            data to develop appropriate actions (eg    80’s 3,000 chemical compounds had
the US where 0.55% men per year
                                            adequate nutrition and physical activity   identified 36 specific carcinogens. His
becoming overweight or obese and
                                            monitoring, and information on SES         plea was simple, “it took 30 years to
only 0.39% of women.
                                                                                       identify the carcinogens. This
Alarmingly, in Mexico the rate of                                                      represents a huge delay. The message
increase for women is 2.4%, six times                                                  is “we should not delay by waiting for
the US rate per year.                                                                  the evidence. Go now with what we
                                                                                       know and monitor what happens.”
Decreases in physical activity, work and
transport and major shifts in energy                                                   The EPIC European Prospective
density (urbanisation, increased income                                                Investigation into Cancer and
and production) were all identified as                                                 Nutrition, Lifestyle and Genetic
contributing to the increases in weight                                                Pre-disposition.
gain. For example, China has had                                                       Nutrition has a category of its own and
                                            status). It also highlights the need to
major shifts in energy density:                                                        lifestyle is defined as (smoking, physical
                                            consider environmental factors.
●   an increase of 13% in total intake                                                 activity and alcohol). The EPIC study
                                            Dr Karen Loch, European Centre on          collects over 2000 variables per
●   added sugar has increased a             Health of Societies in Transition, UK,     subject. Sitting height is collected as it
    dramatic extra 100 to 300 kcals/day     highlighted the concern that “Policy       is considered an independent measure
●   large increase in animal foods          makers don’t see low consumption of        of long bones and growth.
                                            fruit and vegetables as an important
●   reduction in fibre and total fruit      risk factor – we need to link with the     Some interesting findings were
    and vegetable intake                    concerns of the day ie obesity.”           presented in relation to fruit and
●   increase in % energy from fat to        Don’t wait, start now with what we
    greater than 10%.                       know
                                                                                       ●   Murcia (Italy) has the highest
                                            Among calls for better and more                production of fruit and vegetables
Social distribution of obesity                                                             in all of Europe and the lowest
Carlos A. Monterio MD PhD Professor         convincing scientific evidence the point
                                            was made that epidemiological                  cancer incidence. This emphasises
of Nutrition at the Department of                                                          that consumption is related to
Nutrition, School of Public Health,         evidence provides the key but does not
                                            open the lock to solving health                supply, quality and availability.
University of Sao Paulo, Brazil, spoke
about nutrition-related non-                problems. What is needed is the key        ●   There is a 25% reduction in
communicable diseases increasing,           to increasing consumption.                     colorectal cancer with an increase
particularly those whose risk factors are   Professor Dr. Klaus Hoffken, President         in fibre of 25 grams AND 70% of
unbalanced diet, sedentary behaviour,       of The German Cancer Society                   the population need to increase
and obesity. He asserts that                emphasised that nutrition presents an          fibre. (cereals and legumes are
environment determines behaviour. In        issue equal to that of smoking. Half of        important).
1997, Monterio and Popkin studied           cancers could be cured by preventative     ●   Vegetarians are not the people with
sample of 157,844 subjects, men and         measures. Dr. Elio Riboli                      the highest fruit and vegetable
women and found the same results for        (International Agency for Research on          intake. They appear to be more
SES in each country.                        Cancer, IARC) said that the most               meat avoiders than fruit and
He concluded that the social                important thing people should do to            vegetable consumers. Their intake
distribution of obesity in the              prevent cancer is “don’t smoke, don’t          of sugary foods is high.
developing world is shifting towards        smoke, don’t smoke”. However, he
                                            followed this with the observation that    Advocacy
the poor. In earlier stages of economic                                                Advocacy is a set of skills to create a
development poor women are                  “60% of the population already don’t
                                            smoke and 50% of cancer cases are in       shift in public opinion to mobilise
protected from obesity. Only very                                                      action.
poor men are protected. Environment         people who don’t smoke”. He asserted
plays a key role. Obesity increases         that nutrition is most likely the second   The US ‘5 A Day’ program has
along with Gross National Product           cause (considering both causal and         successfully advocated for:
(GNP) per capita, at a GNP of $250-         prevention characteristics). Initially
                                            epidemiologists were looking for
                                                                                       ●   Nutrition policy - 2000 Dietary
300 obesity is five times higher among                                                     Guideline for Americans, Healthy
the poor. When the GNP is >$1,500           carcinogens (cause) and 25 years later
                                                                                           People 2010 (NCI, 1998)

●   Agriculture policy - farm bill review   Promotions                                        Implications for Australia
    6 to 10 years                           Nancy Tucker, Vice President Global               It is clear that generic fruit and
●   Nutrition Assistance Programs           Development, PMA made the                         vegetable promotions with government,
    –school lunch, breakfast, WIC           comment that “Making changes in                   industry and other non-government
                                            population behaviour will only come from          agencies working together make good
●   Research - USDA and NIH                 retail partnerships.”Presentations from           sense. The Australian National
    Research agendas, nutrition             major retail chains highlighted the need          Vegetable and Fruit Coalition is
    monitoring, GAO (General                for a retailer ‘point of difference’ and          building partnerships to lead the way
    Accounting Office) report               that it is possible to promote fruit and          for Australian action. We must act
Of interest to Australia is that            vegetables under generic branding and             now.
successful ‘5 A Day’ advocacy managed       achieve this.                                     Finally, the Symposium highlighted that
to ‘salvage’ the nutrition monitoring       Recommended levels for fruit and                  it is very important to monitor what
system in the US!                           vegetable consumption around the                  you do. We need to know what is
One strategy used was to identify how       globe vary from 1/2 a kilo (Finland), to          working and what is not. This is
much Federal spending falls short of        3 times A Day (Hungary) to 5 A Day                essential when considering actions to
addressing public health needs. Only        (UK), 5 + ( New Zealand), 6                       address overweight and obesity.
4.5% of US Department of Agriculture        (Denmark), 5 – 9 (USA), 5 – 10                    Timely, ongoing Australian National
(USDA) spending is used to promote          (Canada)10 , 2 + 5 (Australia), and 10            Nutrition Surveys are essential. The
fruit and vegetables. The USDA Food         (France) . What constitutes a serve also          Danish delegation highlighted that
Guide Pyramid recommends diets              varies in size and composition.                   there National Nutrition Survey found
comprise of 33% fruit and vegetables.                                                         an increase of 38% in fruit and
                                            It was evident that current                       vegetable consumption in Denmark!
The advocacy recommendation was for         consumption and cultural differences
proportional spending in line with                                                            We need to have the system in place to
                                            influence fruit and vegetable                     capture these results as we work. We
USDA dietary recommendations. The           promotions as you can see from some
GAO Report to Congressional                                                                   need to ‘salvage’ the nutrition
                                            of the pictures. Although there were              monitoring system in Australia!
Requesters stated that                      many interesting innovations, I thought
Fruit and vegetables enhanced Federal       I would share one strategy that is                This paper prepared by Christina
efforts to increase consumption could       relevant in view of the current public            Pollard is based on personal
yield health benefits to all Americans.     health actions to reduce overweight               observations, delegation discussions
                                            and obesity among Australian children.            and reports: Sarah Pennell, HAL;
                                            In Brazil 70% of the food provided in             Frances Warnock, Vegetable and Fruit
                                            schools must be minimally processed               Officer, SIGNAL; Christina Pollard,
                                            foods. This recommendation clearly                Department of Health in WA; Leigh
                                            promotes the consumption of fruit and             Reeve, Dietitians Association of
                                            vegetables and other core foods. Many             Australia; Felicity Robson, The Harvest
                                            products promoted in Australian school            Company; Monique Ceretto, Beyond
                                            canteens are processed, relatively high           the Square Communications; Shelley
                                            in fat, sugar and salt. Promotion of              Woodrow, Nutrition Education
                                            Core Foods can positively change the              Consultant.
                                            eating habits of children.
Political advocacy from as many
government departments as possible
very important, the US program
involves Agriculture, Defense, and
Health. There is a need to do
projections on the impact of increasing
consumption on produce supply. It is
important to consider economic
benefits as well as health benefits.
Many countries are meeting the
challenge through fruit and vegetable
provisions via food service (e.g through    In summary, Terry Humerfield,
schools, worksites, and welfare             Produce Marketing Association, said
programs). This type of program             “The value of the symposium itself is in
needs to be socially and politically        allowing people from around the world who
acceptable. The systems are set up in       have similar programs to share their
the UK and US, however, long term           programs, frustrations and dreams. The
evaluation is still being conducted.        presentations were good, the breaks even
                                            better, the sharing was brilliant. It energises
                                            people to go back and keep trying.”

      Commonwealth Roundup
The Commonwealth Department of             Clinical guidelines for the                   undergone final technical editing and
Health and Ageing develops,                management of overweight and                  independent review, and are expected
implements and evaluates national          obesity                                       to be presented to the Council for
policy, resources and initiatives in the                                                 endorsement in mid 2003. Consumer
areas of healthy eating and nutrition,     Work is continuing with the National          resources are currently being produced
physical activity and healthy body         Health and Medical Research Council           to promote the key messages contained
weight – on a whole of population          on the development of national clinical       in the guidelines. It is expected the
basis. Current activities which will       guidelines for the management of              revised versions will be released along
help to address the problem of             overweight and obesity in adults and          with associated consumer resources in
overweight and obesity include:            children. Draft guidelines were               mid-2003.
                                           released for public consultation during
National Obesity Taskforce                 December 2002 and January 2003.               Recommended Dietary Intakes
                                           Work on supporting consumer
Australian Health Ministers agreed at      resources is also expected to begin this      The National Health and Medical
their meeting on 29 November 2002,         year.                                         Research Council together with the
that:                                                                                    Department and the New Zealand
                                           Sentinel site for obesity prevention          Ministry of Health have commenced a
●   overweight and obesity are
                                                                                         joint review of the Recommended Dietary
    significant public health problems     The Department and Deakin                     Intakes for Use in Australia (1991) and
    that threaten the health gains made    University, Victoria, is jointly funding a    the current New Zealand
    by Australians in the last century     Sentinel Site for Obesity Prevention in the   Recommended Dietary Intakes. A
    and require a national response,       Barwon region of Victoria under the           working party has been established to
●   a National Obesity Taskforce be        Public Health Education and Research          oversee the review of the
    established under the auspices of      Program. The Sentinel Site for Obesity        recommendations which will consider
    the Australian Health Ministers        Prevention aims to build the                  current local and inter-national
                                           knowledge, skills and evidence needed
    Advisory Council, and                                                                evidence-based research. It is
                                           to prevent obesity among children and         anticipated the review will be a two
●   the Taskforce provide an interim       adolescents and thereby, position
    report to Health Ministers in six                                                    year process.
                                           Australia as a world leader in the field
    months followed by a final report in                                                 For further information contact:
                                           of obesity prevention.
    12 months.                                                                           Mia Fuso
                                           PaperWeight                                   or
The Commonwealth Department of
Health and Ageing will play a key role     The Department’s biannual electronic          Leticia White
in relation to the Taskforce and in        newsletter for health professionals and
progressing a Commonwealth response        other key stakeholders includes articles
to the obesity issue.                      on the latest research, programs and
Membership of the Taskforce, terms of      interventions on overweight and
reference and working arrangements         obesity and related issues. Articles are
are topics for discussion at the meeting   contributed by the Commonwealth and
of the Australian Health Ministers         State/Territory governments, academics
Advisory Council on 27 February            and researchers and the non-
2003.                                      government sector, Issues are available
                                           on the Department’s website at:
Standard definitions of overweight
and obesity                                g/hlthwt/paperweight.htm
Australian standard definitions of         Australian Dietary Guidelines
overweight and obesity for both adults
                                           The Department is funding the
and children and adolescents have
                                           National Health and Medical Research
recently been endorsed for inclusion in
                                           Council review of Australian dietary
the 12th edition of the National Health
                                           guidelines – the Dietary Guidelines for
Data Dictionary. The submission put
                                           Australians and the Dietary Guidelines for
together by the Department was based
                                           Children and Adolescents (including the
on the latest research and developed in
                                           Infant Feeding Guidelines for Health
consultation with key experts.
                                           Workers). The draft scientific
                                           background papers have completed a
                                           public consultation process, have

      ACT Roundup
Public Health Nutrition Plan               Launch of the ACT Health                   resource to assist with networking,
                                           Promotion Website                          information sharing and planning.
In November 2002 ACT Health
released the ACT Health Action Plan        The ACT Chief Minister, Jon Stanhope,      It is envisaged that the information
2002, which sets the directions for        launched in November 2002 the new          collected will be easily accessible via
public health services in the ACT for      ACT Health Promotion website               the ACT’s new health promotion
the next three to five years.              (          website. If you are interested in
                                           This website developed by ACT Health       providing information about your
The Plan includes the vision for health,
                                           is an exciting new professional support,   project or finding out what’s happening
the values that underpin our health
                                           resource and communication tool that       in the ACT please contact:
system and strategic areas of focus. It
                                           will benefit a range of government and     Alanna Williamson,
also provides the strategic framework                                                 Health Promotion Unit
for public health and will be used to      non-government workers.                    Email:
guide more detailed health planning        Nurses, GPs, nutritionists, occupational   Ph: (02) 62050871
and service delivery.                      therapists, teachers, youth workers and
Within this plan there is a strong         policy workers will be able to easily      FOODWIZE: A Youth Workers Guide
strategic focus on the need to promote     access information on a broad range of     To Nutrition
healthy living and wellbeing, with         health promotion issues and programs.      FOODWIZE is a train-the-trainer
priorities for action including a focus    The website includes up to date            package that provides youth workers
on nutrition. Priorities for action in     information on health promotion            with the tools to educate young people
nutrition include:                         activities in the ACT, links to key        on nutrition and food-related life skills.
●   the development of a public health     publications, improved access to best      FOODWIZE was developed in
    nutrition plan with a focus on:        practice information, and a calendar of    response to a Needs Assessment
                                           local events.                              conducted by ACT Community Care in
      - prevention of overweight           The site has about 130 pages of            2001 and 2002. Familiarising youth
        andobesity in children and         content, and allows interactive access
                                                                                      workers with this package will
        prevention of further weight       to information in its various databases.   empower them with the knowledge
        gain in adults,                    The website contains 56 nutrition          and tools to educate young people on a
      - increasing the consumption of      related links (eg policies, plans,         broad range of nutrition and food-
        vegetables, legumes and fruit,     campaigns, reports, organisations).        related issues.
                                           Since its launch in November the           The manual includes the FOODWIZE
      - promoting optimal nutrition        website has had on average 37
        for women, infants and                                                        Fact Sheet Series, one-on-one session
                                           individual visitors a day.                 ideas and group session activities. The
                                           ACT health promotion workers are           fact sheet series explore issues of Food
     - improving nutrition amongst         encouraged to get involved with the        and Mood, Body Talk, Skin Food,
         vulnerable groups, and            website by using online forms to           Moving and Grooving, Smile Food,
●  in partnership with other agencies      submit content, participating in           Food or Drugs? Vegetarian eating,
   and the food industry, the              information and training sessions and      Pregnancy food, and snack ideas as well
   development of strategies to            providing feedback to the website          as general healthy eating for young
   improve the nutritional value of the    managers.                                  people.
   food served through schools,            For further information contact:           For further information contact:
   restaurants and take-away venues,       Ingrid Coote                               Anne Embry
   with an emphasis on ensuring low        Health Promotion Unit                      Community Nutritionist
                                           Email:             ACT Community Care
   or no cholesterol fats are used in      Ph: (02) 6205 3312                         Ph: (02) 6205 1587
   food preparation.                       Website address:                           Or
Within ACT Health, the Health                                                         Julie Clift
                                           Public Health Nutrition Directory          Health Promotion Officer
Promotion Unit in collaboration with
                                                                                      ACT Community Care
Community Care Nutritionists will be       The Health Promotion Unit, ACT             Ph: (02) 6205 2734
working during 2003 on the                 Health and Healthpact auspice the
                                                                                      To order a copy of the Foodwize manual
coordination, development and              ACT Nutrition Advisory Group, that         contact:
implementation of an ACT Public            has been formed to support a co-           Gayle Harding
Health Nutrition Plan.                     ordinated approach to public health        Child, Youth and Women’s Health Program
                                           nutrition issues in the ACT.               ACT Community Care
For further information contact:                                                      Email:
Anna Perkins                               To assist the work of this group the       Ph: (02) 6205 1197 Fax: (02) 6205 1180
Health Promotion Unit                      Health Promotion Unit is currently         Hardcopy manuals cost $40.00 each +
Email:                                                        GST (includes postage and packaging)
Ph: (02) 6207 2499
                                           developing an information directory of
                                           public health nutrition projects in the    Electronic manuals cost $20.00 each +
                                           ACT. This directory will be a useful

      NSW Roundup
EatWell NSW                                   develop and maintain self esteem in    document called Best Options for
                                              thousands of young people from         Promoting Healthy Weight in NSW should
The five public health nutrition
                                              more than 360 schools, by              be available by March 2003. This
proposed priority areas were strongly
                                              encouraging them to participate in     report is designed to:
supported throughout the extensive
                                              performing arts.                       ●  identify promising areas for the
consultation process. These priorities
concern healthy weight, increased          NSW Health is also funding the               prevention of weight gain at a state
intake of vegetables and fruit,            Australian Child and Adolescent              and local level. These include new
breastfeeding, food security and           Obesity Research Network, and                initiatives as well as building on
achieving effective and sustainable        working with the Department of               existing nutrition and physical
effort. The final draft of EatWell NSW     Education and Training to consider           activity interventions,
was presented at the March meeting of      regulatory/policy options to ensure       ●  provide the rationale and evidence
the NSW Health Policy Review               healthy school canteens.                     of effective interventions in selected
Committee for endorsement.                 Further information about the Summit         action areas,
Response to the NSW Childhood              is available from                         ●  identify examples of existing
                                                  projects within selected action
Obesity Summit
                                           For further information contact:
                                                                                        areas, and
At the NSW Childhood Obesity               Kate Hawkins or Liz Develin               ●  identify areas for further analysis
Summit held in September 2002,             Email:           and review in the interests of
delegates presented 145 resolutions to     Ph: (02) 9391 9661
                                                                                        improved planning and
the NSW Government, aiming to              Childhood Obesity Website                    implementation of the proposed
address the problem of childhood                                                        actions.
overweight and obesity in NSW. (See        The NSW Health Childhood Obesity
December 2002 Food Chain for               Website, launched at the time of the      Fruit and Veg Toolkit Evaluation
details). The NSW Government is            Summit, is undergoing reconstruction.     The NSW Fruit and Vegetable Tool Kit,
currently in the process of developing a   The modified site will be a stand-alone   disseminated in 2001, is a guide to
whole of government ten-year action        information source for both health        planning, implementing and evaluating
plan in response to the Summit             professionals and the community about     local fruit and vegetable tastings. The
recommendations.                           overweight and obesity. It will include   recently completed evaluation of the
                                           an interactive component that enables     controlled dissemination strategy
In December 2002 the NSW Minister          children to enter information about
for Health announced a series of health                                              focussed on uptake and usage of the
                                           their eating and physical activity        Tool Kit. The evaluation showed that
initiatives as the first part of the NSW   behaviour and receive individualised
Government’s response to the Summit.                                                 most respondents had utilised and
                                           feedback. The new site will be            were very satisfied with the Tool Kit.
These initiatives include:                 launched in early 2003.                   It also showed that there was an
●   The establishment of a                 For further information contact:          apparent shift in the settings selected
    ‘Collaborative Centre for Obesity      Sarah Yallop                              for fruit and vegetable promotional
    Research’ at Westmead Children’s       Email:
                                                                                     activities, with more activities in
                                           Ph: (02) 9391 9549
    Hospital, with funding of $1.5                                                   schools and health planning contexts
    million over 3 years,                  NSW Centre for Public Health              and less in community settings. The
●   Provision of funding to Sydney         Nutrition (CPHN)                          evaluation also indicates that key
    Markets to promote fruit and           The first two reports in the Monitoring   aspects of the Tool Kit’s success include
    vegetable consumption in schools,      Series developed by the CPHN are due      participation by the target group in
                                           for release in early 2003. These          development and distribution of the
●   Provision of funding of $250,000                                                 resource, provision of workshops and a
    to the School Sports Foundation to     concern promotion of healthy weight
                                           and consumption of vegetables and         small grants scheme to assist
    promote the teaching of basic                                                    implementation. A report about the
    sports skills,                         fruit. The third report of the series,
                                           which presents a planning framework       grant scheme is due in March 2003.
●   An annual grant of $250,000 for        and a menu of options for                 An evaluation report is available.
    three years to the NSW School          interventions to improve food security,   For further information contact:
    Canteen Association to promote                                                   Sarah Yallop
                                           has been distributed for comment by       Email:
    availability of healthy food choices   stakeholders. (See December Food          Ph: (02) 9391 9549
    in school canteens, and                Chain for description of reports). The
●   An annual grant of $800,000 for        Centre has been pleased to recruit Ms
    three years to promote the Rock        Lesley King to the position of Manager.
    and Croc Eisteddfods, which            A draft version of another key

NSW Intersectoral Physical activity                                                                      be supported through training and
plan                                                                                                     education and the NRG@OOSH
NSW Health has recently completed                                                                        project aims do that’ Ms Cooke said.
the evaluation of the statewide plan                                                                     Across Australia more than 100,000
‘Simply Active Everyday: a plan to promote                                                               children are cared for by OOSH care
physical activity in NSW 1998-2002’.                                                                     services so it is essential to consider
Within this plan, NSW Health worked                                                                      the food provided. “Snacks contribute
in collaboration with other government                                                                   to approximately one-third of
agencies, industry and non-                                                                              children’s daily nutrition requirements,
government organisations to promote             Eating well at, before and after school care is vital.
                                                                                                         so the food provided should be
physical activity in NSW.                       improve food safety practices, food
                                                                                                         healthy” Ms Cooke said. An ideal
For further information contact:                safety and nutrition policies, and
                                                                                                         afternoon tea should contain a dairy or
Kate Hawkins                                    nutrition and food safety training for
                                                                                                         high calcium food, a cereal based food,
                                                staff.” Lara Cooke, of the Health
Ph: (02) 9391 9539                                                                                       a fruit or vegetable and a drink. For
                                                Promotion Service, South East Health
                                                                                                         an excellent afternoon tea a good or
Eating well at before and after                                                                          moderate iron source should also be
school care                                     “The project supports the increasing                     provided.
(adapted from Media release 12 December 2002)   focus on quality in before and after
                                                                                                         The project is funded by the Health
A new project to support kids to eat            school care services” Ms Cooke said.
                                                                                                         Promotion Service, South East Health
well at before and after school care is         Research has shown that children in                      and is working with OOSH services,
being developed with childcare and              before and after school care may not                     the Network for Children’s Services,
health services in the South Eastern            be receiving adequate amounts of                         local councils and nutritionists.
suburbs of Sydney.                              nutritious food, especially food that is
“NRG@OOSH is working with 42                                                                             If you would like to receive a copy of
                                                high calcium and iron. Through the
Out of School Hours (OOSH) care                                                                          ‘Checklist for planning afternoon tea’,
                                                research OOSH services staff also
services in supporting them to increase                                                                  contact:
                                                identified the need for more
the number of children who are                                                                           Lara Cooke
                                                information about food activities for
provided with food and drinks that                                                                       Ph: (02) 9350 1787
                                                children, nutritious ideas for afternoon
meet Australian Dietary Guidelines for          tea and the food requirements for
Children. The project also aims to              children. “It is important for staff to

      NT Roundup
Market Basket Survey                             percent of family income required to                    positions. Other positions will be
Analysis of the fourth NT wide survey            purchase the basket of foods was 27%                    Aboriginal Health Workers and Child
of remote community stores has been              in a Darwin supermarket and 35% in                      Health Nurses. These positions will
completed. Seventy rural and remote              the remote stores.                                      further enhance the GAA program and
stores in the Northern Territory were                                                                    enable the implementation of the
                                                 Growth Assessment and Action
surveyed between April and June 2002.                                                                    program throughout the whole of the
These surveys looked at the cost,                (GAA)                                                   Territory.
availability and quality of a ‘healthy           The GAA program is well established in
                                                                                                         For further information contact:
family basket’ of food as well as                Central Australia and in the period
                                                                                                         Carrie Turner
collecting information on store                  1999 – 2001 there has been a 24%                        Project Officer
ownership and management                         reduction in the numbers of                             Nutrition and Physical Activity Unit
characteristics. The cost of the healthy         underweight children and a 42%                          Email:
                                                 reduction in the rates of wasting. The                  Ph: (08) 8999 2695
basket of foods was, on average, 27%
more expensive in remote stores in the           Menzies School of Health Research is                    Batchelor Institute Food and
NT than the average cost in a                    currently undertaking an evaluation of
                                                                                                         Nutrition courses
supermarket in Darwin. This was                  the whole GAA program and this will
                                                                                                         As we enter the academic year for
largely due to an increase in costs of           involve chart audits in 15 remote
                                                                                                         2003 Batchelor Institute of Indigenous
fruit and vegetables in Darwin so that           community health clinics as well as
                                                                                                         Tertiary Education is introducing a new
the overall Darwin basket was higher.            qualitative evaluation.
                                                                                                         course - Certificate II in Health
The cost of the food basket increased            Child Health Positions                                  Support Services (Food Support
by 2% in remote stores and by 0% in              Recruitment has commenced for 25                        Services). This course is in addition to
district centre supermarkets compared            new positions in child health, of these                 the existing courses of Diploma,
to the same period last year. The                at least three will be nutritionist                     Advanced Diploma and Bachelor of

Indigenous Health Studies (Food and         Nutrition Lecturer. This means that        This year also marks the graduation of
Nutrition). The certificate II course       both student enrolments and staff          the first graduate from the Bachelor of
unlike the other courses is to be           positions have tripled in the last 3       Indigenous Health Studies (Food and
delivered in remote communities             years, with current student numbers in     Nutrition) - Lynette Dewis from
throughout the Northern Territory           the Higher Education courses over 50.      Cairns.
instead of on campus at the Institute.      This demonstrates the level of             For more information contact:
Together with the introduction of this      enthusiasm of Indigenous students          Meg Adam
course comes a new position for a           wanting to learn more about nutrition!     Email:
                                                                                       Ph: (08) 8939 7423

        QLD Roundup
Eat Well Queensland launch                  launched the State’s public health food    “Developed by the Queensland Public
                                            and nutrition strategy. “Eat Well          Health Forum, the strategy looks at
                                            Queensland: Smart Eating for a Healthier   food supply, promoting healthy eating,
                                            State” as part of fulfilling her           increasing consumption of vegetables
                                            commitment to addressing the causes        and fruit, enhancing the health of
                                            of health problems.                        mothers, infants and children and
                                                                                       helping Queenslanders to achieve a
                                            “It is a very complex problem and one
                                                                                       healthy weight”, Ms Edmond said.
                                            which requires a multi-pronged
                                            approach. The Strategy is a call to        The Queensland Public Health Forum
                                            action for a range of measures and the     is a partnership of 18 government
                                            appointment of the nutritionists           departments, non-government
                                            demonstrates the Government is             organisations and professional
                                            serious about this issue” Ms Edmond        associations, including Queensland
Eat Well Queensland 2002-2012: Smart        said.                                      Health.

Eating for a Healthier State was launched                                              “In Queensland, diet-related diseases
                                            Ms Edmond said there were a range of
by the Hon Wendy Edmond, Minister                                                      account for at least 14 percent of the
                                            existing programs that would be
for Health on behalf of the Premier the                                                annual hospital budget. The Health
                                            supported by the $1.75 million boost
Hon Mr Peter Beattie on February 19                                                    2020 health vision statements found
                                            to Queensland Health’s nutritionist
at the Brisbane Markets. A wide range                                                  that one-third to one-half of the
                                            workforce this year with $2 million in
of inter-sectoral stakeholders attended                                                burden of disease and injury was
                                            recurrent funding.
the launch. The Queensland Public                                                      preventable,” Ms Edmond said.
Health Forum is now establishing an         Staff will be located in Cooktown,
Eat Well Queensland Implementation          Cairns, Mt Isa, Weipa, Wujal; Wujal,       “These initiatives will be at the
Steering Committee.                         North Peninsula Area and Cape York,        forefront in our fight to reduce
                                            the Sunshine Coast, Harvey Bay,            Queensland’s high rates of diet-related
Health 2020                                 Rockingham, Fraser Coast,                  disease such as cardiovascular disease,
Smart State: Health 2020 a vision for the   Redcliffe/Caboolture, Brisbane North,      diabetes and some forms of cancer.
future was launched early this year and     Southern Queensland, the South Coast,      “We now recognise that by improving
has a strong focus on health promotion      West Moreton, Logan/Beaudesert and         health and wellbeing through nutrition
and prevention. The document is             Charleville. Two positions will be         programs, we can start to chip away at
available at:                               located in corporate office to support     the factors that cause the chronic      the development of Statewide               diseases which are so devastating to our
0/default.asp                               programs.                                  community and our health system.
                                            To reduce health inequalities among        “The importance of Eat Well
Queensland Nutrition strategy               Aboriginal and Torres Strait Islander
(media release 19 February 2003)                                                       Queensland is that is sets out a
                                            peoples, 11 Indigenous Child Health        framework to do this. It is a plan for
On 19 February 2003, the Queensland         Workers and Nutrition Workers will be      action and a call for action.”
government announced that their             employed with a focus on Cape York
                                            and the Northern Peninsula areas           For further information contact
government was paving the way to a
                                                                                       Dr Amanda Lee
healthier Queensland by appointing an       initially. These will include an           Email:
additional 27 nutritionists to help         Indigenous Child Health Program            Workforce
children and adults around the State to     Coordinator for North Queensland.
avoid obesity and the health problems                                                  Staff Update
                                            Supporting all Queenslanders to make
associated with being overweight.           healthier food choices was the key         Christina Stubbs, Bronwyn Ashton and
Health Minister Wendy Edmond                focus of Eat Well Queensland.              Helen Vidgen have been appointed as
                                                                                       Senior Public Health Nutritionists to

co-ordinate statewide programs under         travel and work overseas.                     updated, and new resources developed
the enhanced investment in nutrition                                                       including:
announced in the 2002/3 budget               Congratulations to Simone Lowson
                                             who has been appointed to the position        ●   a Practical Activity Booklet which
process.                                                                                       provides facilitators with ideas on
                                             of Director Southern Public Health
Christina Stubbs’ responsibilities           Unit Network. The appointment of a                activities that can be conducted as
include logistical support for               range of zonal Public Health                      part of the program (eg. ice
implementation of Eat Well Queensland,       Nutritionists and Nutrition Promotion             breakers),
statewide co-ordination of Lighten Up to     Officers, and five Community                  ●   “Fat in Food” and “What’s in
a Healthier Lifestyle program, the Healthy   Nutritionists is currently being finalised        Food” posters (which graphically
Food Access Basket project and chairing      by Simone and Dr Anita Groos.                     demonstrate the amount of fat in
the Nutrition and Dietetic Working                                                             commonly eaten foods),and
Group for the Queensland Health,             Creating a Healthier Queensland
Allied Health Core Practice Project.                                                       ●   CD ROM which contains the flip
                                             Interim evaluation of Creating a
Amongst other activities, this working                                                         charts for the program (costing
                                             Healthier Queensland Workshops has
group is refining a service delivery                                                           approx $30).
                                             been completed. Seven workshops
model across the continuum of care           were conducted across Queensland
aligned with the framework of Eat Well                                                     Indigenous mother and child
                                             between July 2001 and December                nutrition training
Queensland.                                  2002, with 315 participants
For further information contact:             completing the workshops held in
Christina Stubbs                             Townsville, Brisbane, Cairns, Bamaga,
                                             Innisfail, Nambour, Longreach,
Bronwyn Ashton is responsible for the        Rockhampton, Hervey Bay, Gympie,
Food Standards area and is a member          Maroochydore, Napranum, Wujul
of the national Health Claims Policy         Wujul, Moranbah, Laura, Boigu Island,
Advisory group and both the                  and Lockhart River. Feedback about
Fortification and Dietary Supplements        the quality of the workshops has been
Working Groups. Bronwyn is keen to           very positive, with over 95% of
support better co-ordination of public       participants rating the quality of the
health nutrition responses to relevant       workshops as either “good” or
applications.                                “excellent”, exceeding the 70% target.
For further information contact:
                                             Six months after attending the
Bronwyn Ashton                               workshop, 80% of respondents were             The first round of training in the use of
Email:      using the Australian Guide to Healthy         the new Growing Strong - Feeding You and
                                             Eating and 64% were using the National        Your Baby resources has been conducted
Helen Vidgen’s responsibilities include
                                             Physical Activity Guidelines in their work,   by Central Zone Public Health Unit
Maternal and Child Health and School
                                             both of which exceed the target of            Network nutrition staff. The resources
Nutrition issues. Helen will be taking
                                             50%.                                          were developed by a statewide team to
maternity leave from March.
                                                                                           help health and child care sector staff
In Tropical Public Health Unit               Healthy Weight Program (HWP)                  talk with Indigenous families about
Network (TPHUN), Leah Galvin has             Two HWP Facilitator Training courses          nutrition for mothers and babies and
joined the Cairns team to work on            were conducted between July and               include a book for clients and a manual
food supply issues, principally in Cape      December 2002.Eleven participants             for workers.
York, and Chris Toby, an Indigenous          attended the course conducted by
male nutrition health worker has joined                                                    Case study based training sessions have
                                             TPHUN in Townsville in August and             been run in Cherbourg, Woorabinda
the Mt Isa public health team. Lindy         11 participants attended the course
Spring is the new Public Health                                                            and Hervey Bay. Tropical Public
                                             jointly conducted by CPHUN, SPHUN             Health Unit staff are currently
Nutritionist based in the Mackay Public      and the Inala Indigenous Health
Health Unit. Lindy has taken over the                                                      negotiating with TAFE to incorporate
                                             Service in Brisbane in September.             training in use of the Growing Strong
work on healthy eating and physical          Facilitator surveys have been conducted
activity for adults from Michelle Elwell.                                                  resources into the Health Worker
                                             in the Northern and Southern Zones            education program. Face-to-face
Michelle is now working on the               to identify the type of support and
development and implementation of                                                          training via a series of two to three
                                             assistance HWP facilitiators required to      shorter sessions is the preferred
Growth Assessment and Action for                       .
                                             run HWP Recommendations are
north Queensland.                                                                          delivery mode, with Indigenous
                                             being implemented through the                 Nutrition Promotion Officers providing
Vivienne Hobson from the Northern            conduct of regular teleconferences,           a key role in communication.
Territory is acting as Director of Public    distribution of the newsletter and
Health Nutrition in the Tropical Public      offering professional development             Further training sessions will be
Health Unit Network while Dympna             opportunities (eg CHQ). A number of           delivered in the coming months across
Leonard takes 12 months leave to             resources have been reviewed and              the state, and broader distribution of
                                                                                           the resources is being planned.

For further information contact:                      maintaining a health weight.”             ●    Promoting and increasing the
Melinda Hammond                                                                                      demand for healthy food
Email:                                                Eat Well Queensland: Smart Eating for                     a Healthier State has been developed      ●    Developing infrastructure and
                                                      over the past 18 months and looks              capacity to support better food and
Nutrition plan to fight diet-related                  beyond what we eat as individuals, to          nutrition in the state.
disease in Queensland                                 the broader issues which impact on
(Media Release 19 February 2003)                                                                “Eat Well Queensland recognises that
                                                      food and nutrition like availability,
                                                                                                reducing illness and death from diet-
The Queensland Public Health Forum                    transport, cost and advertising.
                                                                                                related disease is not an issue for just a
released the first public health food                 “It’s about making healthy choices easy   single organisation, but something
and nutrition strategy if this kind in                choices.”                                 which must be addressed by
Australia on February 19, 2003.                                                                 government, the food industry and
                                                      “Eat Well Queensland acknowledges
As well as addressing the issues related                                                        community agencies working as
                                                      the programs that are currently in
to overweight and obesity, the Strategy                                                         partners,” Dr Abernethy said.
                                                      place throughout the state identifies
sets the direction for the state to                   the priority areas which members of       Launched by Health Minister Wendy
reduce illness and death caused by                    the Forum and other partners can          Edmond, Eat Well Queensland: Smart
diet-related chronic diseases like                    address through their ongoing and         Eating for a Healthier State is a
diabetes, cancer and cardiovascular                   future work.” Dr Abernethy said.          blueprint for action for better health
disease.                                                                                        and wellbeing, and will be
                                                      The Strategy concentrates on six
“It is now recognised that poor                                                                 implemented over the next 10 years.
                                                      priority areas including:
nutrition contributes at least as much                                                          The forum is currently setting up an
as cigarette smoking to death, illness                ●   Addressing food supply issues         Eat Well Queensland Implementation
and disability,” said Dr Peter                        ●   Enhancing the health of mothers,      Steering Committee.
Abernethy, Chair, Queensland Public                       infants and children                  Established in 1998, the Queensland
Health Forum.                                                                                   Public Health Forum is a partnership
                                                      ●   Increasing the consumption of
“For example, it is now estimated by                      vegetables and fruit                  of 18 organisations and networks
the World Cancer Research Fund that a                                                           committed to improving public health

third of all cancers could be prevented
                                                      ●   Achieving and maintaining a healthy   in the state.
by healthy eating, physical activity and                  weight

                                                                                                    For further information about public
                         Queensland Public Health Forum members include:                            health nutrition programs in
                                                                                                    Queensland contact:
                             Australasian Faculty of Public Health Medicine
                                                                                                    Dr Amanda Lee
                                   Australian Health Promotion Association                          Email:

                              Australian Institute of Environmental Health
                           Commonwealth Department of Health and Aging
                     Department of Aboriginal and Torres Strait Islander Policy
                                           Department of Families
                                          Diabetes Australia (QLD)
                                           James Cook University
                              Local Government Association of Queensland
                              Public Health Association of Australia (QLD)
                          Queensland Aboriginal and Islander Health Forum
                                          Queensland Cancer Fund
                                    Queensland Centre for Public Health
                                    Queensland Council of Social Service
                                           Education Queensland
                                         National Heart Foundation
                                   Queensland Division of General Practise
                                             Queensland Health

      SA Roundup
Promoting healthy weight: SA                - ten years of data gathered by DHS            Services, to develop food and
update                                        is being collated to give a picture of       nutrition guidelines for schools and
                                              rates of obesity and associated              pre-schools, commenced in January
Promoting healthy weight is a priority                                                     2003.
                                              factors. This will inform action as
of the state public health nutrition
                                              well as the development of a             Contact Karen Dewis
action plan, Eat Well South Australia
                                              monitoring strategy.                     Email:
(draft). It is also expected that strong
links will be built with emerging state     The Social Development Committee of        - A one-year project to support
physical activity initiatives. A range of   the Parliament of South Australia is         community gardens, in
activities are currently under way:         planning an enquiry into the impact of       collaboration with Community and
                                            obesity on South Australian individuals,     Neighbourhood Houses and
- a reference group of academics,
                                            families and the community. It is likely     Centres Association commenced in
  researchers, health service
                                            to be scheduled later in 2003.               February 2003.
  providers and DHS representatives
  has been formed to assist in                                                         Contact Ian Lillington
  planning initial strategies to tackle                                                Email:
  the prevention of overweight and
  obesity in SA                             In addition, a range of other activities   - In February 2003, the SA Child
                                            promoting physical activity (eg Be           Care nutrition partnership launched
- a project officer has been engaged                                                     a checklist and associated resources
                                            Active as a state physical activity
  to specifically focus on strategies to                                                 to support planning of long day care
                                            message used across all sectors and a
  address overweight and obesity                                                         centre menus.
                                            campaign with children 8-12 years old)
  prevention – work will include
                                            and healthy eating (eg state               Contact Thea Pruul
  developing a shared understanding
                                            breastfeeding program) contribute to       Email:
  among health and other relevant
                                            obesity prevention.
  workforces of issues around                                                          In addition, state strategies to promote
  overweight and obesity as well as
  organising an intersectoral forum
- a community demonstration project
  that incorporates strategies to
  increase physical activity and
  promote healthy eating as well as a
                                            Other public health nutrition
                                            Other current/recent South Australian
                                            activities include:
                                            - Eat Well SA schools, a one-year
                                                                                       vegetable and fruit consumption and
                                                                                       increase breastfeeding rates are being
                                                                                       developed and initial work to scope the
                                                                                       development of a food and nutrition
                                                                                       monitoring strategy is under way.
                                                                                       For further information contact:
  strong evaluation component is              collaborative project of the             Patricia Carter
  being planned                               Departments of Education and             Health Promotion SA
                                              Children’s Services and Human            Department of Human Services

      TAS Roundup
Tasmanian Food and Nutrition                workforce development, and catering.       of a key partner from the Tasmanian
Policy                                      The Policy will be finalised by February   Nutrition Promotion Taskforce who
                                            2003 when it will be forwarded to the      oversaw the Campaign. Since then the
The final touches are now being added       Tasmanian Government for                   Taskforce has joined forces with The
to the redeveloped Tasmanian Food           endorsement across all government          Cancer Council of Tasmania and has
and Nutrition Policy. A public              departments.                               been successful in tendering to run the
consultation on the final draft occurred                                               Campaign. The Cancer Council
over December and January with              Eat Well Tasmania up and running           Tasmania has appointed Miriam
around 30 submissions from a diverse        again                                      Herzfeld as the executive officer for the
range of people including those with                                                   Eat Well Tasmania Campaign. Miriam
environmental, business, education and      After 15 months of down time the Eat
                                            Well Tasmania Campaign is up and           has a background in environmental
health interests. The Policy covers a                                                  health, has a graduate diploma in
wide range of issues related to food        running again. The Campaign began in
                                            1995 with the aim of increasing            health promotion from Curtin
and nutrition including: environmental                                                 University and keen interest in
protection, food production,                intersectoral action in nutrition
                                            promotion and raising the profile of       nutrition. Miriam can be contacted
advertising and marketing, food safety,                                                on (03) 6233 2923 or by email
nutrition promotion, breastfeeding,         nutrition promotion projects and
                                            programs. The Campaign hit some            <>
food security, food labelling, food
retail, wholesale and distribution,         obstacles in 2001 following withdrawal

For further information contact:            the development of a six week program         ●   shopping and cooking skills, and
Judy Seal                                   based on best practice.
Email:                                                          ●   building life skills in families.
Ph: (03) 6233 4746                          The initial pilot will include a              The pilot program will be evaluated
                                            maximum of eight families (two                and reported upon with respect to
Home Grown – Healthy families,              parents/carers from each family) who
healthy kids: a family focussed                                                           changes in physical parameters such as
                                            have been referred by a paediatrician.        body mass index, waist measurements
weight management program for               The program supports parents being            and family lifestyle practices. This will
children                                    targeted as the exclusive change agents       occur in week six of the program and
In Tasmania a multidisciplinary             in the management of childhood                six months after it is completed. If the
Childhood Obesity Working Group has         obesity.                                      program demonstrates its effectiveness
been established to plan, implement         A dietitian, psychologist and an              it is intended ongoing programs will be
and evaluate a program for the families     occupational therapist will facilitate the    run in Tasmania.
of children who are overweight or           HOME GROWN program. The                       For further information contact
obese. Review of existing programs in       program will cover:                           Monique Reardon
conjunction with the draft NH&MRC’s                                                       Ph: (03) 6222 7222
National Clinical Guidelines for Weight
                                            ●   healthy eating and activity habits,
Control and Obesity Management in           ●   building self esteem and body
Children and Adolescents have resulted in       image in children,

      VIC Roundup
Public Health Nutrition Workforce           ●   re-orientating community dietetics,       ●   Promoting Independence at mealtimes:
Mentoring / Skill Development                   and                                           In-service Package - Includes a
Initiative                                                                                    checklist, presentation resources
                                            ●   evidence-based public health
                                                                                              and case studies designed to assist
An innovative approach to providing             nutrition practice.
                                                                                              staff to develop assessment and
support and additional skills to the                                                          management skills. An
nutrition professional community of         Well for Life – improving the
                                            nutrition and physical activity of                occupational therapist is required
Victoria is now underway. This is a                                                           to conduct the training.
trial program being conducted by the        residents in aged care facilities
Monash University Nutrition                                                               ●   Physical Activity in Aged Care Facilities:
                                            Well for Life is a package aimed to
Department and the Department of                                                              Seminar Package - Includes both
                                            improve the health, independence and
Human Services (DHS) Public Health                                                            presentation resources and case
                                            well being of residents living in aged
Nutritionist.                                                                                 studies designed to guide staff
                                            care facilities. It aims to support
                                                                                              through the research evidence on
The program has been developed in           residential aged care staff to increase
                                                                                              the benefits of physical activity.
response to recommendations from            nutrition and physical activity
Phase One of the Victorian Workforce        opportunities for older residents. This       Be Active, Eat Well: A community
Project commissioned by the DHS.            program is an initiative of the Victorian     building approach
The mentoring program aims to assist        Department of Human Services Public
practice improvement and provide            Health and Aged Care branches.                In this unique pilot, the township of
professional support in the field of                                                      Colac (approx 10,000 people) is
                                            The Well for Life resource package            aiming to improve the health and
public health nutrition. Sessions will      includes:
be run via the Victorian Public Health                                                    wellbeing of individuals while
and Community Special Interest              ●   Working Together for change - A           strengthening the community. This
Group. Conducted over four sessions             discussion guide designed to help         will be achieved through a coordinated
throughout 2003, this program will              staff work through the process of         set of initiatives based on healthy eating
cover topics including:                         solving relevant workplace                and physical activity promotion. The
                                                problems;                                 first nine months of the project have
●   theories and models of public                                                         seen the community prioritise
    health,                                 ●   Good Practice Checklist - Designed as     strategies for intervention within each
                                                a self-assessment tool for the facility   setting, ie. school, home, non-school
●   how to construct a community                to identify key areas of nutrition
    profile,                                                                              care, primary care, recreation,
                                                and physical activity practice that       transport, food service and health and
●   conducting a nutrition needs                could be improved                         community services. The project
    assessment,                             ●   Thirty-two help sheets - Evidence         objectives are to:
●   managing change in community                based guidelines for best practice        ●   increase the community’s
    organisations,                              covering a broad range of topics on           awareness and capacity to promote
                                                nutrition, activity and other areas           healthy eating and physical activity,
                                                relevant to best practice.

●   establish a monitoring program,           ●   increase fruit by 1/4 piece/school day.   To assist the community in providing
                                                                                            the appropriate messages, Robert
●   decrease television viewing and           ●   increase active play between 3-6pm,
                                                                                            Donovan from WA assisted the steering
    increase walking/cycling to school        ●   improve the quality of deep-fried         community in beginning to develop a
    by 10%.
                                                  foods, and                                social marketing campaign.
●    decrease high sugar drinks and                                                         For further information contact:
                                              ●   provide an obesity management
    energy dense snacks by 10%.                                                             Veronica Graham
                                                  service for 7-9 year olds.
                                                                                            State Public Health Nutritionist
                                                                                            Phone: (03) 9637 4047

      WA Roundup
‘Find thirty. It’s not a big’ exercise        along with innovative ‘Find thirty’           The campaign was successful in
physical activity campaign                    community public relation activities          encouraging people to think about
                                              throughout WA supported the                   their fruit and vegetable intake (42%
                                              television advertising.                       ‘yes, have done’ and 25% ‘ yes, intend
                                              For further information on the                to’). It has also reached around 25%
                                              campaign or to view the television            of respondents in terms of buying
                                              commercials visit:                            more fruit (26%) and vegetables
                                              For further information contact:              Visit for
                                              Gemma Bacon                                   further information.
The multi-strategy ‘Find thirty. It’s not a   Email:
                                                                                            For further information contact:
big exercise’ physical activity campaign                                                    Jenny Leong
aims to demonstrate how 30 minutes            Go for 2 & 5 campaign                         Email:
of daily physical activity can be
                                                                                            WA Nutrition Awards
achieved by offering the audience
simple suggestions.
Building on the success of the
advertising campaign, in September
2002 the three existing commercials
(gardening, car park and wiggles) along
with a new one featuring the family
dog to promote walking were aired as          To assess the latest phase of the Go for 2
part of the second media burst. All           & 5 campaign a telephone tracking
four television commercials were well         survey of 360 respondents was
received, with those depicting walking        conducted in the Perth metropolitan
and gardening considered the most             area between October 2002 and                 Food manufacturers can have a
likely physical activity behaviours to be     January 2003.                                 significant impact on fostering a
carried out regularly by respondents.         There was high awareness of the Go for        healthy eating environment. Since it’s
                                              2 & 5 campaign (82% prompted                  inception in 1997, the WA Nutrition
A telephone tracking survey of adults in                                                    Awards has encouraged West Australian
the Perth metropolitan area found that        recognition) with the slogan well
                                              understood in terms of message take-          businesses to realise the benefits of
85% were aware of one or more of the                                                        providing low-fat, nutritious food
television commercials following the          out.
                                                                                            products. These products make a
second phase of advertising in                This phase of the campaign included           healthy diet more accessible for all
February 2003.                                promotion of the Healthy Food Fast            West Australians, they can also make
Importantly, around half of                   cookbook. There was good prompted             good business sense by meeting
respondents stated they had tried to          (35%) awareness of the cookbook,              consumer demand for healthier
increase their level of physical activity     which was launched in November                products.
in the past few months, with most             2002. There was greater awareness of
                                              the overall campaign and the cookbook         On 14 April 2003 seventeen products
indicating they had been successful.                                                        from nine West Australian food
Among those who were unsuccessful,            amongst females across all age groups.
                                                                                            manufacturing companies were
perceived lack of time and motivation         To date 20,000 copies of Healthy Food         recognised for their commitment to
were identified as the major barriers         Fast have been sold, making this the          improving the health of West
for not being more physically active.         best selling Department of Health             Australians by producing innovative and
Daily physical activity tips delivered        cookbook.                                     healthy food products. These
during the Channel 7 weather update                                                         companies have developed products

that meet set criteria indicating that      ●   To make a healthy diet more           look out for them in local food retail
they are tasty, healthy and safe, and           accessible to all West Australians.   stores.
produced in WA. A judging panel
                                            The Department of Health WA               Visit
assessed the foods for taste,
                                            Nutrition Awards are conducted in
convenience and consumer appeal. All
                                            conjunction with the Western              otion/wa_nutrition.cfm for more
companies who received the award also
                                            Australian School Canteen Association,    information.
assist the community by supporting
                                            Curtin University of Technology and       For further information contact:
Foodbank of WA who provides
                                            Food Technology Association of            Ana Toquero
emergency food relief for families in
                                            Western Australia.                        Email:
                                            The total number of products that will    Start Right – Eat Right
There are three distinct aims of the
                                            now carry the WA Nutrition Award
WA Nutrition Awards:
                                            logo is 121. All winning companies
●    To foster partnerships between the     can now use the WA Nutrition Award
     DOH and the food industry;             logo on their packaging to inform
                                            customers that they are buying a food
     To improve nutritional composition
                                            that has been judged to be of a high
     and food hygiene practices in the
                                            standard in terms of nutrition, hygiene
     food industry; and
                                            and consumer appeal. Consumers can

                                                                                      The Start Right - Eat Right Award
                                                                                      Scheme aims to increase access to and
                                                                                      availability of healthy food choices
                                                                                      (consistent with the Dietary Guidelines
                                                                                      for children and adolescents) in long
                                                                                      day care centres (LDCC). This scheme
                                                                                      has been implemented throughout

                                                                                      Western Australia since 1998. The
                                                                                      award recognises LDCC that meet
                                                                                      standards in nutrition, food safety and
                                                                                      social aspects of eating. The
                                                                                      Department of Health WA publicly
                                                                                      recognises awarded centres biannually
                                                                                      with statewide press advertising and
                                                                                      centres use their Start Right - Eat Right
                                                                                      and FoodSafe™ awards for promotion.
                                                                                      The nutrition capacity of childcare staff
                                                                                      is increased through nationally
                                                                                      recognised nutrition and food safety
                                                                                      training and the provision of learning
                                                                                      The 2001 Community Services (Child
                                                                                      Care Regulation 1988) review
                                                                                      amended Regulation 31(1)a to include
                                                                                      “…a person employed to prepare meals
                                                                                      must complete an approved course of training
                                                                                      in food handling and hygiene within one
                                                                                      month of commencing employment and an
                                                                                      approved course in nutrition within three
                                                                                      months of commencing employment.”
                                                                                      The Department of Health’s “Guidelines
                                                                                      for Nutrition in Long Day Care” have been
                                                                                      disseminated statewide.

    West Australian newspaper, April 2003

After five years of implementation:         Fruit n Veg Week                          and vegetables. This year schools were
●   87% of all LDCC in WA are                                                         able to choose how they would
                                            Department of Health’s Fruit ‘n’ Veg
    registered into the award scheme                                                  participate in Fruit ‘n’ Veg Week. By
                                            Week 2003, was launched Monday
    and 48% hold the award                                                            accessing the website www.etc.teachers
                                            April 7. This annual event has been
                                                                                      could select curriculum materials and
●   1074 staff from 304 LDCCs have          part of the Department’s fruit and veg
                                                                                      resources to use in their classrooms.
    been trained in the Food Service        campaign over the past decade.
                                                                                      Students could find fruit ‘n’ veg
    Planning for Childcare Centres          Go for Fruit ‘n’ Veg                      information, easy recipes and activities
    short course. Of these, 63%                                                       to do at home. School canteens could
    attained competency in a unit of        The message for children during Fruit
                                            ‘n’ Veg Week 2003 was:                    select fruit ‘n’ veg promotion ideas and
    the Australian National Training                                                  catering quantity recipes. In addition,
    Authority’s Community Services          “I need to eat more fruit ‘n’ veg”        school promotions including fruit ‘n’
    Training Package. (Note: 20% of all                                               veg activities that involve the whole
                                            “I should eat fruit ‘n’ veg everyday”
    meal preparers had no food service                                                school community were provided. A
    or cooking training/qualifications in   During Fruit ‘n’ Veg Week, West           competition offering prizes for schools,
    1996)                                   Australian primary school students,       classes and canteens encouraged
                                            teachers, canteen staff and parents       participation.
    60% of centres achieved
                                            participate in a range of activities to
    FoodSafe™ certification, compared                                                 The website provides access to
                                            increase the school community’s
    to 18% in 1996                                                                    successful curriculum based Fruit ‘n’
                                            awareness of the need to eat more fruit
For further information contact:                                                      Veg Week promotions held over the
Ana Toquero                                                                           past five years including: Fruit ‘n’ Veg
Email:                                                   Fiesta (2001 and 2002), Eat Your Way
                                                                                      Through Fruit ‘n’ Veg (1999 and 2000)
                                                                                      Fruit ‘n’ Veg Meal Creation
                                                                                      Competition (1998). Resources can be
                                                                                      downloaded and activities planned to
                                                                                      suit individual schools.
                                                                                      In the future additional materials can
                                                                                      be added to the website including
                                                                                      successful fruit ‘n’ veg promotions at
                                                                                      local schools and new resources
                                                                                      produced by the Department of

                                                                                      For further information contact:
                                                                                      Sonia Hribar

West Australian newspaper, December 2002

                                           What’s On
                                        8 – 10 May 2003
            Dietitians Association of Australia National Conference Cairns, Queensland
                                      12-14 November 2003
                          National Physical Activity Conference Perth WA

                   FOODChain Deadlines for Articles
                                August 2003 Edition
          Theme                                                   Deadline for articles
          Australian Dietary Guidelines                           16 May 2003

FOODChain is published by the Strategic Inter-Governmental Nutrition Alliance

Christina Pollard
Ph: (08) 9222 2062
Fax: (08) 9222 2088
SIGNAL Secretariat details:
Leticia White
Ph: (02) 6289 8052

Marketing and Campaign Support, Department of Health (WA).

The views expressed in this newsletter do not necessarily represent those of SIGNAL, the
Commonwealth Department of Health and Ageing, or the Department of Health in Western
The FOODChain newsletter is also available from the SIGNAL website:

                           Produced by the Nutrition and Physical Activity Branch
                                           with assistance from
                                    Marketing and Campaign Support
                                        Population Health Division
                                      © Department of Health 2003
                                                 HP 8543


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