EDITORIAL

Nutrition and disease burden in Australia:Intervening for the nation’s healthndi_1354 134..••

The most recent Australian National Health Survey for theperiod 2007–2008 released in May of this year paintsa disturbing picture of the health burden of disease inAustralia.1 An estimated 818 200 persons (4% of the popu-lation) had medically diagnosed diabetes, an increase fromthe 3.5% prevalence reported in the 2004–2005 survey.Alarmingly, almost 90% of these cases were type 2 diabetes,which be considered mostly preventable. However, whatthese figures hide is the true prevalence of diabetes, as thereis an estimated equivalent number of Australians who haveundiagnosed diabetes or pre-diabetes.

In 2007–2008, 16% of the population reported one ormore of the long-term conditions associated with cardiovas-cular disease. Hypertension was the leading cardiovasculardisease morbidity, reported by 9% of the population. Six percent of the population reported high levels of blood choles-terol with the prevalence highest at 19% for the 65- to74-year age group and 16% for those 75 years and over.While there is evidence of a levelling off in population cancerincidence rates, the majority of cancer cases afflictingAustralians can be considered preventable by lifestylechoices. Taken together, cardiovascular disease, diabetes andcancer represent the major contributors to the health burdenfrom chronic disease in Australia. Diet, bodyweight andphysical activity all play a part in the aetiology and preven-tion of these conditions. Despite this, the National HealthSurvey confirmed that Australian waistlines continue toexpand. In 2007–2008, 68% of men and 55% of womenwere classified as overweight or obese. This is much higherthan for the period 1989–1990, when 45% of men and 32%of women were classified as overweight or obese.

The prevalence of overweight and obesity among childrenin Australia has also risen at an alarming rate. An estimated25% of children aged 5–17 years were considered to beoverweight or obese in 2007–2008, which is double theprevalence recorded in 1986. A recent study predicts that,based on current trends in childhood overweight and obesityrates, Australian children’s life expectancy will fall 2 years bythe time they are 20 years old, setting them back to levelsseen for men in 2001 and for women in 1997.2 Many parentsappear as bystanders to the problem, with research showingthat only one in four parents can recognise when their childis carrying too much weight.3

Overweight and obesity is now one of the biggest healthproblems facing Australians today and despite the best inten-tions of public health programs, the problem shows no signof abating. Obesity is not a condition that needs a scientificdiscovery of the ‘fat pill’ or a new miracle diet to solve. At its

heart, overeating and underactivity are indisputably thecause of weight gain, yet the reasons for these occurring inthe first place are more complex and include a combinationof genetics, environmental factors and psychologicalreasons.

While pervasive food advertising, increased availability offast food, decreasing activity levels and television viewingappear to attract attention as major contributors to weightgain, there are many other factors for which there is scientificevidence to support a link. Lack of sleep, endocrine disor-ders and increased use of antipsychotic and antidiabeticmedications can all play a role.4 Changes in ethnicity and ageof the population, increasing maternal age, nutrition duringpregnancy and pairing of physically similar people are allacknowledged factors contributing to weight.4

So where should the focus lie for addressing the burden ofdisease attributed to poor diet and excess weight? Someinsights come from the National Preventative Health Task-force convened by the Australian government.5 One of theaims of the Taskforce is to halt and reverse the rise in over-weight and obesity, in addition to addressing the healthburden of tobacco use and excessive alcohol consumption.

In order to improve the weight and physical activity ofAustralians, there is much we can learn from how tobaccosmoking has been controlled over the past decades. Whilesmoking is a legal activity, restrictions on the sale and adver-tising of tobacco combined with vigorous public health cam-paigns and bans on where smoking can occur have beeninstrumental in reducing smoking rates.6 The state of healthand life expectancy for someone who is obese could beconsidered alongside those of a smoker, suggesting merit inadopting a similar approach. Attenuating and reversing therising tide of excess weight gain may not require such drasticmeasures, however. Shifting the food supply, changing mar-keting and influencing consumer demand to healthier lif-estyle choices might be achieved through taxation incentivesto increase access to healthier foods and encourage activerecreation. Introduction of a consumer-friendly food label-ling system, such as the ‘traffic light’ guide, provides aneasy-to-interpret indication of nutritional quality rather thanconfusing information that only the nutritionally literate cancomprehend. Restricting the sale of foods of low nutritionalquality in schools, combined with controls on their promo-tion to children through television and other media are otheroptions. Widespread adoption of school and communityhealthy eating and activity programs, supported by a well-resourced and -trained health workforce, is fundamental toall of these initiatives.

Nutrition & Dietetics 2009; 66: 134–135 DOI: 10.1111/j.1747-0080.2009.01354.x

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A litmus test of the nutritional quality of the diet ofAustralians from the National Health Survey showed thatjust 10% of women and 7% of men over the age of 15 yearsate five or more serves of vegetables each day and only halfof the same people ate two or more serves of fruit per day.1

The impact that small dietary changes and modest weightloss can have on disease risk cannot be emphasised enough,as the study in the this issue of the journal by Huxley et al.show that a 10% reduction in LDL cholesterol levels inAustralia would prevent almost 3000 deaths from cardiovas-cular disease alone.7 Combining legislative changes withstrongly supported and targeted public health programs isrequired to stem arguably one of the greatest health prob-lems facing Australia today. While the benefits of such policyshifts may not be seen for decades to come, for governmentsto be truly committed to the long-term health of Australiansthere is little choice but to act now.

Tim Crowe, PhD, APDSenior Lecturer (Nutrition),

School of Exercise and Nutrition SciencesDeakin University

Burwood, Victoria, Australia

REFERENCES

1 Australian Bureau of Statistics. National Health Survey2007-08: summary of results. ABS cat.no. 4364.0. Canberra:

ABS. (Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.02004-05, accessed June 2009).

2 Holman CDJ, Smith F. Implications of the obesity epidemicfor the life expectancy of Australians. Report to the PublicHealth Advocacy Institute of Western Australia. Feb 2008. (Avail-able from: http://www.phaiwa.org.au/images/ObesityandLifeExpectancy.pdf, accessed June 2009).

3 Jeffery AN, Voss LD, Metcalf BS, Alba S, Wilkin TJ. Parents’awareness of overweight in themselves and their children: crosssectional study within a cohort (EarlyBird 21). Br Med J 2005;330: 23–4.

4 Keith SW, Redden DT, Katzmarzyk PT et al. Putative contribu-tors to the secular increase in obesity: exploring the roads lesstravelled. Int J Obes 2006; 30: 1585–94.

5 National Preventative Health Taskforce. Australia: the healthiestcountry by 2020. Canberra: Commonwealth of Australia, 2008.(Available from: http://www.preventativehealth.org.au, accessedJune 2009).

6 West R. What lessons can be learned from tobacco control forcombating the growing prevalence of obesity? Obes Rev 2007; 8:S145–50.

7 Huxley R, Clifton P, Perkovic V, Woodward M, Neal B. Howmany Australian deaths from heart disease and stroke could beavoided by a small reduction in population cholesterol levels?Nutr Diet 2009; 66: 158–63.

ERRATAndi_1355 135..••

The Editor would like to draw the reader’s attention to the following errors:

Goodwin R, Mullan BA. Predictor’s of undergraduates’ intention to incorporate glycaemic index into dietary behaviour. NutrDiet 2009; 66: 54–9.

The following error was published on page 54:

Diabetes is a lifestyle disease—the fastest growing chronic disease in Australia—and an estimated one in four adults hasdiabetes or impaired glucose metabolism.

The sentence was incorrect and should have read:

Type 2 diabetes is a lifestyle disease—the fastest growing chronic disease in Australia—and an estimated one in four adults hastype 2 diabetes or impaired glucose metabolism.

Batterham M, Cavanagh R, Jenking A, Tapsell L, Plasqui G, Clifton P. High-protein meals may benefit fat oxidation and energyexpenditure in individuals with higher body fat. Nutr Diet 2008; 65: 246–58.

The following error was published in the appendix on page 252:

The Lunch meal in the High-protein GI category should have also included Tapioca pudding.

Errata

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