Shifting the dial on obesity

Australia’s health system is facing unsustainable pressure, with preventable chronic disease a leading contributor to the overall disease burden. In 2021–22, it was estimated that almost half of the Australian population (47%) have one or more chronic conditions¹.

In 2018, 8.4% of the total burden of disease in Australia was due to overweight and obesity, making it the second leading risk factor contributing to disease burden after tobacco use². Additionally, overweight and obesity were attributed to the total burden of disease for:

• type 2 diabetes (55% of burden)
• hypertensive heart disease (51% of burden)
• chronic kidney disease (42% of burden)
• coronary heart disease (28% of burden)
• osteoarthritis (28% of burden)³.
   

As the burden of obesity and associated health conditions continues to grow, it places increasing and untenable demand on the health system. Shifting the focus of healthcare service towards improving overall health and wellbeing, alongside treating established illness, is critical to the long-term sustainability of the health system.

Health expenditure is currently spent primarily on the treatment of illness and disease. Investment in prevention needs to be enhanced to achieve a better balance between treatment and prevention in Australia. There is significant division between healthcare sectors limited by fractured funding arrangements, lack of integrative data systems and a siloed approach to service planning.

What is the cause?

The onset and progression of chronic disease results from a complex interplay of factors associated with the determinants of health and requires a systems approach to address. It is imperative to acknowledge that the roots of chronic diseases often take hold in childhood and are further exacerbated by inequities and a multitude of non-medical factors that influence health.

Obesity affects some people more than others. Largely, this is due to unfair systems, barriers and circumstances that make achieving and maintaining a healthy weight especially difficult for some people. These inequities mean that Australians who are most disadvantaged are more likely to be impacted by obesity.

Such inequities are the result of a complex interplay of genetic, biological, environmental and social factors which can create barriers to access healthy foods, physical activity opportunities and healthcare services.

For example, for Aboriginal and Torres Strait Islander peoples and some refugee populations, the impacts of intergenerational trauma related to colonisation and forced displacement have significantly impacted health, wellbeing and weight⁴.

What is the solution?

The solution is clinical prevention focused on identifying key prevention opportunities within the health and support systems to promote good health and timely and appropriate detection and early intervention of chronic disease. Clinical prevention takes a health and support system approach to health by facilitating care pathways to relevant community support services to address the underlying determinants of health and support healthy behaviours. 

Clinical prevention is a holistic and systems approach to prevention reflecting the interdependence of stakeholders to effectively enable health and wellbeing.

The health system alone cannot prevent chronic diseases on a population level; however, it plays a critical role in connecting and collaborating with the social system to address the broader health determinants that contribute to poor health. Traditionally prevention services and programs receive inconsistent funding and are delivered by a range of health and social care providers, resulting in disparate and siloed approaches. To maximise impact and ensure continuity of care, a coordinated approach to preventative health care is imperative.

Every day, thousands of Australians connect with the healthcare system. Health professionals are well placed to discuss healthy behaviour changes with their patients and identify those at risk of unhealthy behaviours. Every connection is an opportunity to refer their patients to appropriate prevention programs and support.

A coordinated, integrated approach to health care is needed to deliver the right care, in the right setting at the right time; responsive to consumer needs informed by evidence. An approach that bridges the jurisdictional and healthcare sector divide to healthcare planning and delivery is required to leverage sector strengths and reduce service duplication.

What happens if we don’t act?

Australia faces significant consequences if it fails to address the escalating challenges posed by obesity and chronic diseases. If we don’t change the systems that hold obesity in place by changing policies, practices, networks and mindsets, the impact on the health system, workforce, economy and climate will be profound.

A lack of healthy, accessible and inclusive services and environments will mean Australians will not feel empowered or skilled to adopt healthy behaviours and maintain a healthy weight contributing to more Australians’ health and wellbeing impacted by overweight and obesity.

If we neglect to tackle the underlying factors driving chronic disease, the environmental consequences will become increasingly evident. Recognising the interconnectedness between the drivers of chronic diseases and environmental impact emphasises the importance of addressing these root causes for a more sustainable and environmentally friendly future.

Creating positive change requires comprehensive, collective and sustained action across multiple sectors to address the wider determinants of health. All parts of our community have a role to play in addressing obesity in Australia.

<sup>1. Australian Institute of Health and Welfare. Chronic conditions and multimorbidity. Australian Institute of Health and Welfare. 2022. Updated August 16, 2022. Accessed March 9, 2023. https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity
2. Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018. 2021. Updated April 6, 2022. Accessed February 9, 2023. https://www.aihw.gov.au/reports/burden-of-disease/abds-impact-and-causes-of-illness-and-death-in-aus/summary
3. Australian Institute of Health and Welfare. Australian Burden of Disease Study 2018: Interactive data on risk factor burden. 2021. Updated November 1, 2021. Accessed February 9, 2023. https://www.aihw.gov.au/reports/burden-of-disease/abds-2018-interactive-data-risk-factors/contents/overweight-including-obesity
4. Australian Institute of Health and Welfare. Children living in households with members of the Stolen Generations. Australian Institute of Health and Welfare reports & data. 2019. Updated November 25, 2021. Accessed February 6, 2023. https://www.aihw.gov.au/reports/indigenous-australians/children-living-in-households-with-members-of-the/summary</sup>

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