Recommendations for preventing an obesity-related surge in cancer burden in Australia

Transcription

1 Recmmendatins fr preventing an besity-related surge in cancer burden in Australia Submissin frm the Cancer Cuncil Australia t the Huse f Representatives Health and Ageing Cmmittee inquiry int besity in Australia June 2008 The Cancer Cuncil Australia is Australia s peak nn-gvernment natinal cancer cntrl rganisatin. Its member bdies are the eight state and territry cancer cuncils, whse views and pririties it represents n a natinal level. Respnsibility fr cntent is taken by the Chief Executive Officer f the Cancer Cuncil Australia, Prfessr Ian Olver. Cntact fr further infrmatin: Paul Grgan, Directr, Advcacy, the Cancer Cuncil Australia: paul.grgan@cancer.rg.au, (02) Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 1

2 Cntents Key pints... 3 Recmmendatins... 4 Overview... 6 Obesity and cancer... 7 Australia: an unenviably bese natin... 9 Hw we can reverse besity trends References Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 2

3 Key pints Obesity/verweight is an imprtant cause f cancer in Australia, assciated with 11% f cln cancers, 9% f pst-menpausal breast cancers and a number f less cmmn cancers. On current trends, clrectal and breast cancer incidence is already likely t increase by mre than 30% and 25% respectively in line with ppulatin ageing ver each f the next three decades irrespective f the significant impact besity/verweight will als have, as the prjectins are based nly n ppulatin ageing Australia therefre faces an unprecedented clrectal and breast cancer burden, cmpunded by besity/verweight at a time when ppulatin ageing will impse enrmus strain n the health system Rarer cancers such as endmetrial cancer, esphageal adencarcinma, kidney cancer and gall bladder cancer are at risk f becming cmmn, due t their clse assciatin with besity/verweight Obese peple diagnsed with cancer generally have prer prgnses than nn-bese peple with cancer The ttal financial csts f besity were estimated at $3.7 billin, f which 37% is brne by the Cmmnwealth In 2007, Australia was listed as the fifth fattest natin in the OECD; a new natinal reprt suggests we are the fattest In the 10-year perid frm 1985 t 1995, the level f cmbined verweight/besity in Australian children mre than dubled, while the level f besity tripled in all age grups and fr bth sexes Australia urgently requires a natinal besity strategy, supprted by all gvernments, t preempt a majr preventable future increase in cancer burden Reducing besity must be integral t the Health and Hspitals Refrm prcess Cancer Cuncil Australia recmmendatins n hw this can be achieved fllw. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 3

4 Recmmendatins general Cnsistent with the principles and bjectives f the Health and Hspitals Refrm Cmmissin, COAG shuld endrse a cmprehensive natinal besity cntrl strategy built int the Australian Health Care Agreements/Preventative Health Partnerships The strategy shuld have a clear implementatin plan, including targeted funding, agreed plicy bjectives and mandatry reprting/perfrmance benchmarks The strategy shuld set as a key perfrmance benchmark a measurable reductin in the prprtin f Australians wh are verweight/bese, as recmmended in the Health and Hspitals Refrm Cmmissin s preliminary reprt t COAG, Beynd the blame game The strategy shuld integrate all interventins shwn t reduce besity, including: Scial marketing mass media campaigns, cmmunity-based cmmunicatins prgrams prmting healthy weight Scial marketing initiatives which prmte healthy eating and physical activity acrss the life curse Research build the evidence base n what wrks best t prevent besity; cntinue t mnitr behaviural trends, including an nging cmmitment t the natinal nutritin and physical activity survey Plicy fd marketing refrm, e.g. restrict children s expsure t junk fd advertising (see belw); regulate fd labelling t priritise public health by facilitating mre infrmed chice and preventing deceptive claims (see belw); with state and lcal gvernment, fster residential and wrking envirnments cnducive t physical activity Prgram interventins supprt fr the primary care sectr t encurage healthy weight amng patients. The strategy shuld incrprate specific measures t prmte increased physical activity and imprved nutritin, as fllws. Recmmendatins physical activity Increase public awareness abut the link between physical inactivity and cancer, thrugh scial marketing, primary care and cmmunity/educatin prgrams Encurage increased levels f physical activity thrugh primary care prgrams Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 4

5 COAG t endrse a whle-f-gvernment apprach t develping residential and ccupatinal envirnments cnducive t physical activity, as utlined at the 2020 Summit Cmmnwealth t mnitr physical activity trends thrugh an nging cmmitment t the natinal nutritin and physical activity survey Cmmnwealth t supprt epidemilgical research that builds the evidence base n the relatinship between cancer and physical inactivity. Recmmendatins fd labelling COAG t mandate a simplified, easily understd and applied system fr nutritin labelling f packaged fd prducts in particular frnt-f-pack labelling Such a system shuld be designed t infrm healthier cnsumer chice accrding t independent research n cnsumer perceptin and understanding (Cancer Cuncil Australia and CHOICE are currently researching Australian cnsumers understanding f varius frnt-f-pack nutritin labelling frmats). Recmmendatins junk fd advertising t children Prhibit the marketing f unhealthy fd and beverages directed t children in all media (bth bradcast and nn bradcast) Restrict TV fd marketing s that unhealthy fd and beverage advertisements are nt shwn befre 9pm Regulate persuasive marketing techniques used t prmte unhealthy fd t children, in particular the use f premium ffers and cartn and celebrity endrsements. Recmmendatins natinal nutritin strategy Reinvigrate the Natinal Fd Industry Strategy, with its scpe extended t imprved public health as well as cmmercial benefits In develping a natinal nutritin strategy that is clearly in the public interest, supprt measures t ensure fd industry sustainability is assisted by incentives t prduce safe, nutritius fds fr dmestic cnsumptin The strategy shuld imprve access t healthy fd chices fr peple wh are scially r gegraphically disadvantaged. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 5

6 Overview Obesity/verweight is an imprtant cause f cancer in Australia. 1 It is linked t 11% f cln cancers and 9% f pst-menpausal breast cancers. 2 These are increasingly prevalent tumur types in Australia due t ppulatin ageing. 3 A number f rarer cancers are at risk f als becming prevalent due t their strng assciatin with besity, ntably endmetrial cancer (39% attributed t besity/verweight), esphageal adencarcinma (37%), kidney cancer (25%) and gall bladder cancer (24%). There is als emerging evidence that besity is linked with increased risk f cancers f the pancreas and liver, and multiple myelma and nn-hdgkin lymphma. 4 (See Table 3.) Extraplating the ppulatin ageing trends used by the Australian Institute f Health and Welfare t determine cancer prjectins beynd 2011 suggests an increase in cancer incidence f arund 30% ver each decade until the middle f the century. 3,5 These prjectins indicate that cancer is set t impse an unprecedented impact n ur health system as ur ppulatin ages and they d nt factr in the effects f a 50% increase in the number f bese r verweight Australians ver the past 15 years. 1 In 2005, it was estimated that mre than 20,000 Australians had cancer as a result f being bese, and the health system csts alne frm cancers assciated with besity were estimated t be $107 millin in A high bdy mass accunts fr 3.9% f the ttal cancer burden and causes an estimated 7.5% f the ttal burden f disease and injury in Australia. 1 The attributable burden f a high bdy mass is likely t rise in the future as the prevalence f verweight and besity increases. Cancer mrtality figures are higher fr peple with besity, as they have a wrse prgnsis. A large chrt study in the USA estimated that 14% f all deaths frm cancer in men and 20% f thse in wmen culd be attributed t verweight and besity. 4 Mrever, besity/verweight is an imprtant risk factr fr a range f ther expensive chrnic diseases, with an Access Ecnmics reprt estimating the health system csts f besity in 2005 t be $873 millin. 6 The ttal financial csts f besity were estimated at $3.7 billin, f which 37% is brne by the Cmmnwealth. The ttal health csts frm cancer due t besity were $107.3 millin, with 79% f the csts related t bwel and breast cancers. Given the scial and psychlgical cnsequences f besity, intangible csts such as impaired quality f life are significant, with estimates fr besity-related cancers at $218 millin. 7 A 2007 OECD reprt identified Australia as the fifth-fattest natin in the develped wrld, 8 while an Australian study fcused n middle-aged waistlines and published in June 2008 indicated Australia was the fattest natin in the wrld. 9 In the 10-year perid frm 1985 t 1995, the level f cmbined verweight/besity in Australian children mre than dubled, while the level f besity tripled in all age grups and fr bth sexes. 10 Reducing besity must therefre be integral t the COAG Health and Hspitals Refrm prcess. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 6

7 Defining besity Obesity is defined as having a bdy mass index (BMI) f 30 and ver; verweight is defined be a BMI f 25 t (Table 1). 1 BMI is calculated by dividing a persn s weight in kilgrams by their height in metres squared (kg/m 2 ). Table 1: Bdy mass index (BMI) definitins accrding t the Wrld Health Organizatin 11 Categry BMI (kg/m 2 ) Underweight <18.5 Healthy weight 18.5 t <25 Overweight 25 t <30 Obese 30 Anther way t measure verweight and besity is waist circumference, where a measurement (arund the narrwest pint fr wmen r arund the navel fr men) 80cm and ver fr wmen r 94cm and ver fr men indicates being verweight (Table 2). 12 Table 2: NHMRC waist circumference definitins 12 Risk f metablic Waist Circumference (cm) cmplicatins Wmen Men Increased Substantially increased Weight gain and besity develp when there is an imbalance between the energy intake frm fd and drink and energy expenditure frm physical activity and ther metablic prcesses. 12 Obesity and cancer Preventin The Wrld Cancer Research Fund (WCRF) recently released a cmprehensive reprt n fd and the preventin f cancer. 13 The reprt fund cnvincing evidence that excess bdy fat (ttal adipse tissue) is a risk factr fr cancers f the clrectum, kidney, pancreas, esphagus, endmetrium and pst-menpausal breast cancer. 13 It als fund that excess bdy fat prbably increased the risk f gallbladder cancer and there was limited suggestive evidence that excess bdy fat increased the risk f liver cancer. 13 Hwever, excess bdy fat was als fund t prbably decrease the risk f premenpausal breast cancer. 13 The WCRF fund that abdminal fatness (central adipse tissue) was cnvincingly assciated with an increased risk f clrectal cancer, and prbably increased the risk f cancer f the pancreas, endmetrium and breast (in pst-menpausal wmen). 13 The WCRF als fund that weight gain in adulthd prbably increased the risk f pst-menpausal breast cancer. 13 Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 7

8 Table 3: Prprtin f cancers attributable t verweight and besity 2,14,15 Cancer type Endmetrial cancer Oesphageal adencarcinma Renal (kidney) cancer Gallbladder cancer Clrectal cancer 11% Pst-menpausal breast cancer Prprtin f incidence attributable t verweight r besity Cancer-causing mechanisms Aspects f the assciatin between verweight r besity and cancer 39% Wmen with a BMI f >25 have a tw- t three-fld increase in risk Limited evidence suggests risk is similar in pre- and pstmenpausal wmen Risk is greater with upper bdy besity 37% Strng assciatin between being verweight and adencarcinmas f the lwer esphagus and the gastric cardia, with a tw-fld increase in risk in individuals with a BMI f >25 Assciatin seems greater in men than wmen 25% Individuals with a BMI f >30 have a tw- t three-fld increase in risk cmpared t thse belw 25 The effect is similar in men and wmen 24% Limited evidence available but there is a suggestin f almst a tw-fld risk, especially in wmen Assciatin seems greater in men than wmen Risk nt dependent n whether persn has been verweight in early adulthd r later in life 9% Increase in risk f 30% in wmen with a BMI >28 cmpared t thse with a BMI f <21 The evidence linking besity/verweight t cancer is clear. Studies int the bilgical mechanisms respnsible fr the link are nging. The latest research suggests that excess bdy weight may influence cancer risk because it can: lead t elevated levels f insulin-like grwth factr 1 (IGF-1), insulin and leptin which can prmte the grwth f cancer cells. 13 Excess bdy weight (particularly abdminal fatness) exacerbates insulin resistance which leads t the pancreas prducing mre insulin. Hyperinsulinaemia increases the risk f clrectal and endmetrial cancer, and pssibly pancreatic and kidney cancer. 4 Increased circulating leptin levels are assciated with an increased risk f clrectal and prstate cancer. 16,17 increase sex sterid hrmnes, including estrgens, andrgens and prgesterne. 13 Adipse tissue is the main site f estrgen synthesis in men and pst-menpausal wmen. 4 Increased insulin and IGF-1 levels (frm bdy fatness) result in higher estradil levels in men and wmen, 4 and teststerne levels in wmen. 13 Higher sex hrmne levels are particularly assciated with endmetrial and pst-menpausal breast cancer. 18 Bdy fatness may prtect against pre-menpausal breast cancer, as bese wmen tend t have anvulatry menstrual cycles, which lead t lwer levels f estrgen. 18,19 Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 8

9 raise the inflammatry respnse which can prmte cancer develpment. 18 Obesity has been described as a state f lw-grade chrnic inflammatin. Adipse tissue prduces prinflammatry factrs, and bese peple have higher levels f tumur necrsis factr alpha (TNF-α), interleukin-6 and C-reactive prtein than nrmal weight individuals. 20 Leptin is als higher with excess bdy weight, and it can functin as an inflammatry cytkine. 21 Bdy weight and cancer survival As well as a healthy bdy weight being assciated with preventing cancer, it is als assciated with preventing cancer recurrence and imprving survival fr peple diagnsed with cancer. 22 There is a reasnable level f evidence that weight management and physical activity psitively impacts n quality f life, cancer recurrence and verall survival fr cancer survivrs. 23 Randmised cntrlled trials, such as the Wmen s Interventin in Nutritin Study (WINS), have shwn encuraging results f the effectiveness f nutritin and physical activity interventins in imprving utcmes fr cancer survivrs. 22 Weight lss and cancer risk Up t nw we have knwn that excess bdy weight increases cancer risk, but there is a lack f evidence t suggest whether lsing weight wuld lwer cancer risk. Recent evidence indicates that weight lss in thse wh are verweight lwers breast cancer risk. 23 This is prbably linked t the fall in circulating estrgen levels seen with weight reductin. 23 Australia: an unenviably fat natin Our besgenic envirnment In 2007 a glbal reprt identified Australia as the fifth-fattest natin in the develped wrld, 8 while an Australian study fcused n middle-aged waistlines and published in June 2008 indicated Australia was the fattest natin in the wrld. 9 A number f factrs cntribute t the recent increase in besity/verweight in Australia. In the past, Australian lifestyles fstered a higher degree f physical activity and restricted fd chices. Tday there is access t a wide variety f cheap, energy dense/nutrient pr fds that are marketed pwerfully; and the ppulatin is encuraged, directly r indirectly, t avid expending energy thrugh physical activity. This has led researchers t describe the envirnment as besgenic, in that it inhibits apprpriate dietary and physical activity patterns and encurages energy imbalance. 24 Table 4: Factrs that are linked t weight gain and besity. 3 Evidence Decreased risk Increased risk Cnvincing Regular physical activity Sedentary lifestyles High intake f dietary fibre High intake f energy-dense* and micrnutrient-pr* fds Prbable Hme and schl envirnments that supprt healthy fd chices fr children Heavy marketing f energy-dense* fds and fast-fd utlets High intake f sugar-sweetened sft drinks and fruit juices Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 9

10 Breastfeeding Adverse sciecnmic cnditins Pssible Lw glycaemic index fds Large prtin sizes High prprtin f fd prepared utside the hme Rigid restraint and peridic disinhibitin eating patterns Insufficient Increased eating frequency Alchl * Energy-dense and micrnutrient-pr fds tend t be prcessed fds that are high in fat and/r sugars. Lw energy-dense fds, such as fruit, legumes, vegetables and whle grain cereals, are high in dietary fibre and water. In children specifically, verweight and besity are influenced by a lack f sufficient activity and excessive time spent in sedentary activities. 25,26,27 Pr fd habits such as the cnsumptin f sugary drinks, cnfectinery and high-fat fds are als cntributing factrs. 26,27 Breastfeeding and birth weight The WCRF reprted that being breastfed # prbably decreases the risk f weight gain and becming verweight r bese. 7 In additin, breastfeeding * cnvincingly decreases a wman s chance f develping breast cancer and there is limited suggestive evidence that it can decrease the risk f varian cancer. 7 Furthermre, breastfeeding is knwn t help prtect infants against infectins and ther childhd diseases. 7 Higher birth weights have been linked t a prbable increased risk f breast cancer in premenpausal wmen. 7 Obesity in Australian Adults In Australia, besity has mre than dubled in the past 20 years. 28 Obesity rates rse frm 7.2% in men in 1980 t 17.1% in 2000, and fr wmen the rise was even greater, mving frm 7.0% in 1980 t 18.9% in Between 1995 and , the average weight f an Australian adult male rse frm 80kg t 84kg, while females rse frm 65kg t 68kg. 30 Research has cnfirmed that peple are gaining weight faster than previus generatins, with a higher number f peple entering adulthd weighing mre. 31,32 Thse brn later in the 20 th century (Generatin X) will gain weight at a faster rate than their parents did. 31,32 In 2003, the Australian Institute f Health and Welfare estimated that there may be as many as 3.3 millin Australian adults wh are bese and 5.6 millin wh are verweight. 33 Recent figures frm the Natinal Health Survey (using self reprted data) shw that 54% f Australian adults are either verweight r bese. 34 This has increased frm 15 years ag when 38% f adults were regarded as being verweight r bese. 34 In , 62% f men were verweight r bese cmpared with 45% f wmen. 34 * Studies reprting n breastfeeding use the term with different meanings: sme distinguish nly between ever and never, while thers reprt results frm extended and exclusive breastfeeding. Hwever, the evidence n cancer shws that sustained, exclusive breastfeeding is prtective fr the mther and child. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 10

11 Overweight and besity are higher in thse living in remte areas, and lwer in affluent urban areas in NSW. 30 It is als mre cmmn amng thse with a lw sciecnmic status, lw incme, peple frm Suthern Eurpean and Middle Eastern backgrunds and indigenus Australians. 30 Obesity in Australian children Over the last 20 years, rates f besity in children have risen greatly in many cuntries, including Australia, leading sme researchers t speak f an internatinal epidemic f besity. 35 A study lking at weight changes amng Australian children ver three decades fund that between , the prevalence f verweight and besity cmbined dubled, and that f besity trebled amng yung Australians, but the increase ver the previus 16 years was far smaller. 36,37 The NSW Schls Physical Activity and Nutritin Survey (SPANS) fund in 2004 that 1 in 4 children, with 25% f bys and 23% f girls verweight r bese. 27 Children in Years 6-8 had sme f the highest rates f verweight and besity. 27 In bys, the prevalence rse frm 15% amng kindergarten children t 32% amng Year 6 bys and then fell t 27% amng secndary schl bys. 27 In girls, the prevalence was abut 20-25% in all grups except Year 4 students where it peaked at 30%. 27 The prevalence f verweight was higher in children with lwer sciecnmic status, and children were mre likely t be verweight if they came frm a Middle Eastern backgrund. 27 Arund 25-50% f bese adlescents remain bese in adulthd. 38 This means that less than half f children wh are bese during childhd g n t becme bese adults. Hwever, the later int adlescence verweight persists and the mre severe the besity, the greater the likelihd f persistence int adulthd. 38 Als the number f bese children and adlescents is grwing, therefre the likelihd f verweight persisting int adulthd will increase in the future. This makes childhd besity a pririty fr targeted preventive actin. Hw we can reverse besity trends The evidence base n hw t reduce besity n a ppulatin basis is grwing, with researchers recmmending a range f measures. Table 5 summarises the best ptins t prevent weight gain based n a framewrk fr a brad prtfli f actins fr tackling weight gain preventin. 39 This framewrk cnsiders the level f ptential health gain and level f uncertainty f risk assciated with different interventins, and adpts the cncept f assessing the level f prmise t judge the wrth f interventins. Table 5. Best ptins t prevent weight gain Target setting Activities Best ptins fr families Reduce time spent watching TV and ther sedentary behaviurs Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 11

12 Best ptins fr early childhd care Best ptins fr schls Best ptins fr active neighburhds Imprve parental knwledge and skills thrugh early childhd care facilities Enhance fd service plicies in early childhd care facilities Enhance plicies in early childcare facilities t prmte physical activity Establish a netwrk f health prmting schls: plicy n fd and drinks schl physical envirnment physical activity pprtunities health educatin curricula prgrams fr ut f schl hurs care Active transprt Safe space fr exercise facilities Imprve access t fd ptins fr families Best ptins fr wrkplaces Best ptins fr primary care Increase ptins fr incidental physical activity Reduce passive wrk envirnments Imprve wrkplace fd service ptins Imprve skills and knwledge f health wrkers Best ptins fr industry / fd supply Best ptins fr media / marketing Wrk with lcal suppliers t reduce fat in cmmn fds Intrduce taxatin measures and subsidies t make healthy fd ptins cheaper Develp a simplified fd labelling system indicating energy and fat cntent Reduce expsure f children t fd advertising Implement scial marketing strategies t supprt imprvement f parents as healthy rle mdels Best ptins fr supprt structures Imprve mnitring f weight and fitness status Implement whle f cmmunity demnstratin prjects Surce: Gill, King & Webb 2005; frm the Cancer Cuncil Australia's Natinal Cancer Preventin Plicy Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 12

13 Current appraches Despite the increasingly urgent need t prevent an besity-related increase in disease burden, there is n cmprehensive natinal strategy t address besity and verweight in Australia s ppulatin. A piecemeal cllectin f gvernment initiatives, largely funded and administered at the state level, have been in place ver a number f years, with limited natinal crdinatin and evaluatin. In 2003, a Natinal Obesity Taskfrce, with representatin frm the Cmmnwealth and states, develped a fur-year natinal actin plan fr tackling besity. 40 This was preceded by Acting n Australia s weight: a strategic plan fr the preventin f verweight and besity (NHMRC 1997), Eat well Australia: a strategic framewrk fr public health nutritin, (SIGNAL 2001), and Be active Australia: a framewrk fr health sectr actin fr physical activity Nne has been cmprehensive, sufficiently funded nr mandated t address plicy issues such as fd marketing. Fd marketing in Australia perates under c-regulatin system, with the Australian Cmmunicatins and Media Authrity respnsible fr the Children s Televisin Standards, which include sme regulatins fr limiting fd advertising t children. The Advertising Standards Bureau administers industry cdes f practice develped by Free TV Australia and the Australian Assciatin f Natinal Advertisers, which add little t the statutry regulatins. Other fd plicy levers include regulatry systems fr fd safety and marketing, including Fd Standards Australia New Zealand (FSANZ), which is respnsible fr setting standards fr the prductin and sale f fd in Australia. ABHI In February 2006, COAG annunced a jint $500 millin cmmitment t health thrugh the Australian Better Health Initiative (ABHI), with a majr fcus n besity cntrl. Mre than tw years later, there is n measurable besity-related utcme t reprt in relatin t ABHI. It is understd initial wrk n ABHI fcused n gvernance issues arund prgram management acrss nine jurisdictins. This is reflected in cmments frm Federal Labr in 2007, that ABHI was a psitive step, but prgress is slw. 41 The Cancer Cuncil Australia welcmes the Cmmnwealth Gvernment s subsequent cmmitment t build besity cntrl int the Health and Hspitals Refrm prcess, with mdest budget initiatives under this heading seen as a step twards a cmprehensive natinal strategy supprted by all jurisdictins thrugh the Australian Health Care Agreements/Preventative Healthcare Partnerships. Nne f these appraches appears t have made a significant impact n reversing the besity/verweight trends in Australia. While they were all generally welcmed by the public health cmmunity, initiatives t date have lacked sufficient whle-f-gvernment supprt and an effectively cmprehensive and integrated apprach. The Cancer Cuncil Australia strngly recmmends that a cmprehensive apprach t besity cntrl plicy be adpted, integrating research, scial marketing, plicy refrm and prgram interventins t maximise return n investment. We will engage clsely with the Preventative Health Taskfrce t prmte ur pririties in greater detail. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 13

14 Recmmendatins general Cnsistent with the principles and bjectives f the Health and Hspitals Refrm Cmmissin, COAG shuld endrse a cmprehensive natinal besity cntrl strategy built int the Australian Health Care Agreements/Preventative Health Partnerships The strategy shuld have a clear implementatin plan, including targeted funding, agreed plicy bjectives and mandatry reprting/perfrmance benchmarks The strategy shuld set as a key perfrmance benchmark a measurable reductin in the prprtin f Australians wh are verweight/bese, as recmmended in the Health and Hspitals Refrm Cmmissin s preliminary reprt t COAG, Beynd the blame game The strategy shuld integrate all interventins shwn t reduce besity, including: Scial marketing mass media campaigns, cmmunity-based cmmunicatins prgrams prmting healthy weight Scial marketing initiatives which prmte healthy eating and physical activity acrss the life curse Research build the evidence base n what wrks best t prevent besity; cntinue t mnitr behaviural trends, including an nging cmmitment t the natinal nutritin and physical activity survey Plicy fd marketing refrm, e.g. restrict children s expsure t junk fd advertising (see belw); regulate fd labelling t priritise public health by facilitating mre infrmed chice and preventing deceptive claims (see belw); with state and lcal gvernment, fster residential and wrking envirnments cnducive t physical activity Prgram interventins supprt fr the primary care sectr t encurage healthy weight amng patients. The strategy shuld incrprate specific measures t prmte increased physical activity and imprved nutritin, as fllws. Recmmendatins physical activity Increase public awareness abut the link between physical inactivity and cancer, thrugh scial marketing, primary care and cmmunity/educatin prgrams Encurage increased levels f physical activity thrugh primary care prgrams COAG t endrse a whle-f-gvernment apprach t develping residential and ccupatinal envirnments cnducive t physical activity, as utlined at the 2020 Summit Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 14

15 Cmmnwealth t mnitr physical activity trends thrugh an nging cmmitment t the natinal nutritin and physical activity survey Cmmnwealth t supprt epidemilgical research that builds the evidence base n the relatinship between cancer and physical inactivity. Recmmendatins fd labelling COAG t mandate a simplified, easily understd and applied system fr nutritin labelling f packaged fd prducts in particular frnt-f-pack labelling Such a system shuld be designed t infrm healthier cnsumer chice accrding t independent research n cnsumer perceptin and understanding (Cancer Cuncil Australia and CHOICE are currently researching Australian cnsumers understanding f varius frnt-f-pack nutritin labelling frmats Recmmendatins junk fd advertising t children Prhibit the marketing f unhealthy fd and beverages directed t children in all media (bth bradcast and nn bradcast) Restrict TV fd marketing s that unhealthy fd and beverage advertisements are nt shwn befre 9pm Regulate persuasive marketing techniques used t prmte unhealthy fd t children, in particular the use f premium ffers and cartn and celebrity endrsements. Recmmendatins natinal nutritin strategy Reinvigrate the Natinal Fd Industry Strategy, with its scpe extended t imprved public health as well as cmmercial benefits In develping a natinal nutritin strategy that is clearly in the public interest, supprt measures t ensure fd industry sustainability is assisted by incentives t prduce safe, nutritius fds fr dmestic cnsumptin The strategy shuld imprve access t healthy fd chices fr peple wh are scially r gegraphically disadvantaged. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 15

16 References 1 Australian Institute f Health and Welfare, The Burden f Disease and Injury in Australia 2003; May Bergstrm A, Pisani P, Tenet V, Wlk A & Adami HO, Overweight as an avidable cause f cancer in Eurpe. Int J Cancer, AIHW, Cancer incidence and prjectins, Australia , Calle EE, Rdriguez C, Walker-Thurmnd K & Thun MJ Overweight, besity, and mrtality frm cancer in a prspectively studied chrt f US adults. N Engl J Med, ABS, Ppulatin Prjectins, Australia, 2004 t 2101, Access Ecnmics. The Ecnmic Csts f Obesity. Canberra, Diabetes Australia Australian Bureau f Statistics. Overweight and besity in adults, Australia , Organisatin fr Ecnmic C-peratin and Develpment, Health data 2007, Oct Baker Heart Research Institute, Australia s future fat bmb reprt, Camern AJ, Welbrn TA, Zimmet PZ, Dunstan DW, Owen N, Salmn J, Daltn M, Jlley D & Shaw JE Overweight and besity in Australia: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust 11 Wrld Health Organizatin. Obesity: preventing and managing the glbal epidemic. WHO Technical Reprt Series n 894. Geneva, WHO NHMRC, Clinical Practice Guidelines fr the Management f Overweight and Obesity in Adults. Natinal Health and Medical Research Cuncil. Canberra Australia, Cmmnwealth f Australia The Wrld Cancer Research Fund and American Institute fr Cancer Research. Fd, nutritin, physical activity and the preventin f cancer: a glbal perspective. Washingtn DC: AICR Internatinal Agency fr Research n Cancer. Weight cntrl and physical activity. Vlume 6. Lyn: IARC Byle P, Autier P, Bartelink H, Baselga J, Bffetta P, Burn J et al. Eurpean Cde Against Cancer and scientific justificatin: third versin (2003). Ann Oncl Chang S, Hursting SD, Cntis JH, Strm SS, Yamamura Y, Babaian RJ et al. Leptin and prstate cancer. Prstate Stattin P, Lukanva A, Biessy C, Sderberg S, Palmqvist R, Kaaks R et al. Obesity and cln cancer: des leptin prvide a link? Int J Cancer Kaaks R, Lukanva A, Kurzer MS. Obesity, endgenus hrmnes, and endmetrial cancer risk: a synthetic review. Cancer Epidemil Bimarkers Prev The Endgenus Hrmnes and Breast Cancer Cllabrative Grup. Endgenus sex hrmnes and breast cancer in pstmenpausal wmen: reanalysis f nine prspective studies. J Natl Cancer Inst Rexrde KM, Pradhan A, Mansn JE, Buring JE, Ridker PM. Relatinship f ttal and abdminal adipsity with CRP and IL-6 in wmen. Ann Epidemil Lffreda S, Yang SQ, Lin HZ, Karp CL, Brengman ML, Wang DJ et al. Leptin regulates prinflammatry immune respnses. FASEB J Chlebwski RT, Blackburn GL, Thmsn CA, Nixn DW, Shapir A, Hy MK et al. Dietary fat reductin and breast cancer utcme: interim efficacy results frm the Wmen's Interventin Nutritin Study. J Natl Cancer Inst Dyle C, Kushi LH, Byers T, Curneya KS, Demark-Wahnefried W, Grant B et al. Nutritin and physical activity during and after cancer treatment: an American cancer sciety guide fr infrmed chices. CA Cancer J Clin Gebel K, King L, Bauman A, Vita P, Gill T, Rigby A & Capn A Creating healthy envirnments: a review f links between the physical envirnment, physical activity and besity. Sydney: NSW Department f Health and NSW Centre fr Overweight and Obesity. Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 16

17 25 Amisla RV, Jacbsn MS. Physical activity, exercise, and sedentary activity: relatinship t the causes and treatment f besity. Adlescent Medicine State f the Art Reviews Batch JA, Baur LA. Management and preventin f besity and its cmplicatins in children and adlescents. Medical Jurnal f Australia Bth M, Okely T, Denney-Wilsn E, Hardy L, Yang B, Dbbin T. NSW Schls Physical Activity and Nutritin Survey (SPANS) 2004: Summary reprt. NSW Department f Health Camern AJ, Welbrn TA, Zimmet PZ, Dunstan DW, Owen N, Salmn J et al. Overweight and besity in Australia: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust Dunstan D, Zimmet P, Welbrn T, (AusDiab Steering Cmmittee). Diabesity and assciated disrders in Australia The accelerating epidemic. The Australian Diabetes, Obesity and Lifestyle Syidy (AusDiab). Melburne, Internatinal Diabetes Institute Linacre S. Overweight and Obesity. Canberra, Australian Bureau f Statistics Allman-Farinelli M, King L, Bnfiglili C, Bauman A. The weight f time: time influences n verweight and besity in wmen. Sydney, NSW Centre fr Overweight and Obesity Allman-Farinelli M, King L, Bnfiglili C, Bauman A. The weight f time: time influences n verweight and besity in men. Sydney, NSW Centre fr Overweight and Obesity Australian Institute f Health and Welfare. Indicatrs f health risk factrs: the AIHW view. AIHW Cat. N. PHE 47. Canberra, AIHW Australian Bureau f Statistics. Overweight and Obesity in Adults, Australia, Canberra, Australian Bureau f Statistics Ebbeling CB, Pawlak DB, Ludwig DS. Childhd besity: public-health crisis, cmmn sense cure. Lancet Bth ML, Chey T, Wake M, Nrtn K, Hesketh K, Dllman J et al. Change in the prevalence f verweight and besity amng yung Australians, Am J Clin Nutr Magarey AM, Daniels LA, Bultn TJ. Prevalence f verweight and besity in Australian children and adlescents: reassessment f 1985 and 1995 data against new standard internatinal definitins. Med J Aust Must A, Strauss RS. Risks and cnsequences f childhd and adlescent besity. Int J Obes Relat Metab Disrd Gill T, King L & Webb K Best ptins fr prmting healthy weight and preventing weight gain in NSW. Sydney: NSW Department f Health. 40 Natinal Obesity Task Frce (NOTF) Healthy weight 2008: the Natinal Agenda fr Children and Yung Peple and Their Families. Canberra: Australian Gvernment Department f Health and Ageing. 41 Australian Labr Party, Fresh Ideas Future Ecnmy - Preventative Health Care, electin plicy dcument, June Submissin t Huse f Representatives inquiry int besity Cancer Cuncil Australia 17