Obesity: Policy context

The role of high body weight, physical inactivity, and poor diet in the development of cancer and other chronic diseases has led to the development of policy frameworks aimed at reducing their impact.

Prevalence of overweight and obesity in Australia

Australia’s adult obesity rate is the fifth highest among OECD countries.¹ Adult obesity rates in Australia have nearly tripled in the last 30 years, and if effective interventions are not put in place, it is estimated that more than 18 million Australians (34% of the projected population), will have overweight or obesity by 2030. ²

Almost two-thirds (66%) of Australians aged 18 and over had overweight or obesity in 2022, and over a quarter (28%) of children and adolescents aged 5-17 had overweight or obesity.³ Children with obesity are more likely to carry that weight into adulthood.⁴ Overweight and obesity rates are also higher in regional areas of Australia compared with major cities.⁵ Further, in 2022, 13% of adults ≥18 were classified as having severe obesity, defined as having a BMI of 35 or more. ⁶

In 2018-19, 71% of Aboriginal and Torres Strait Islander peoples aged 15 and over were living with overweight or obesity. ⁷ While the combined overweight/obesity rates for Aboriginal and Torres Strait Islander people aged 15 years and over are similar to those for non-Indigenous people, the obesity rates are significantly higher in this population. Aboriginal and Torres Strait Islander people are 1.6 times as likely as non-Indigenous people to have a BMI in the obesity range.⁸ The disproportionate risk for overweight and obesity observed between Aboriginal and Torres Strait Islander people and non-Indigenous people is underpinned by a range of complex factors. The health outcomes of Aboriginal and Torres Strait Islander people are often sustained by inequalities in accessing preventive healthcare, the lack of tailored and appropriate health promotion initiatives and ongoing experiences of discrimination and racism. ⁹

In 2022-23, the prevalence of obesity was highest among adults in the most disadvantaged socioeconomic group (35.3%) and lowest in the least disadvantaged group (25.5%). This could be explained by the obesogenic environment whereby energy dense, nutrient poor food items are often more readily available in low socioeconomic areas and fitness and health care facilities are often limited. ¹⁰

Economic impacts

The current economic impacts of obesity in Australia are significant, with the total obesity costs per capita found to be US$940 million in 2019. Medical costs comprise 90 per cent of direct expenses. In 2019, the total cost of obesity as a percentage of GDP was 1.7% in Australia.¹¹

If further action is not taken to prevent and reduce obesity, it is estimated that the total health expenditure by 2025 will be $87.7 billion. ¹²

The rising incidence of obesity-related cancers are becoming particularly important to address given the higher costs associated with treating these cancers compared to other cancers. ¹³ In Australia, healthcare expenditure has been shown to increase with BMI.¹⁴ For adults with a BMI between 30 and 35 and those with a BMI higher than 35 annual health spending is 19% and 50% higher respectively than spending on those with a BMI 18.5 – 25kg/m².¹⁴

International policy context

The World Health Organization (WHO) published an Acceleration Plan to Stop Obesity in 2023, aimed at prompting and supporting multi-sector population level action across various countries. It comprises of five workstreams including;

• proven policy interventions with impact-modelling estimates,
• programme delivery,
• global advocacy encouraging advocacy campaigns, media and scientific paper development,
• partner engagement and
• accountability and reporting to monitor the global progress of the acceleration plan.

The Plan places emphasis on responding to the environmental influences that exacerbate risk of obesity as well as the structural drivers contributing to the growing obesogenic environment. It also calls for the integration of obesity prevention and treatment into primary health care services, including the provision of resources necessary for prevention and treatment counselling. ¹⁵

The World Health Organization (WHO) published a Global Action Plan for the Prevention and Control of Non-communicable Diseases in 2013, aimed at reducing the burden of non-communicable diseases by 2025 through action on nine targets (including halting the rise in obesity) measured by 25 indicators of performance. ¹⁶ However, the Global Action Plan only considers obesity as a risk factor and fails to recognise obesity as a non-communicable disease in its own right. Appendix III of the Global Action Plan provides a menu of policy options for healthy diet and physical activity, identifying those proven to be especially effective and cost-effective as the ‘Best Buys’ for NCDs. These ‘best buys’ include front-of-pack food labelling, reformulation policies such as trans-fat bans or salt reduction policies; policies to protect children from unhealthy food marketing, and mass media campaigns for healthy diets. Taxation on sugar-sweetened beverages was also identified as an effective policy intervention.¹ An independent mid-point evaluation of the Global Action Plan was conducted in 2020 revealing that despite the progress across all objectives under the Global Action Plan, ongoing action would require considerable upscaling to achieve the targets which were not on track. The end point of the Global Action Plan was extended to 2030 in 2022 with corresponding updates to the targets. A final evaluation is scheduled after 2030.¹⁷

The World Cancer Research Fund (WCRF) International has developed a food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases, known as the NOURISHING framework.¹⁸ The NOURISHING Framework brings together 10 policy areas across three domains of food environments, food systems and behaviour change communications. The framework is based on the principle that food policies to prevent obesity should aim to improve dietary behaviours by addressing the availability, affordability, and acceptability of healthy diets, while decreasing the availability, affordability and acceptability of unhealthy diets. WCRF’s MOVING database provides a similar framework for physical activity policies. The WCRF Policy Blueprint demonstrates how the policies in the NOURISHING and MOVING frameworks can help people achieve WCRF’s Cancer Prevention Recommendations, discussed below under 'Existing Guidelines'.

Action on obesity, particularly childhood obesity, has been recognised as a human rights issue. Most notably, the Committee on the Rights of the Child, which is established under the Convention on the Rights of the Child to supervise its implementation, issued General Comment No. 15 in 2013 to guide Parties’ interpretation of the right of the child to the enjoyment of the highest attainable standard of health. General Comment No. 15 elaborates that “States should also address obesity in children, as it is associated with hypertension, early markers of cardiovascular disease, insulin resistance, psychological effects, a higher likelihood of adult obesity, and premature death.¹⁹ Children’s exposure to “fast foods” that are high in fat, sugar or salt, energy-dense and nutrient-poor, and drinks containing high levels of caffeine or other potentially harmful substances should be limited. The marketing of these substances – especially when such marketing is focused on children – should be regulated and their availability in schools and other places controlled.²⁰

^{1. This appendix is regularly updated and the most recent edition is published separately as: World Health Organization, Tackling NCDs: Best buys and other recommended interventions for the prevention and control of noncommunicable diseases (2023) 9789240091078-eng.pdf}

Australian policy context

National Preventive Health Strategy 2021-2030

The National Preventive Health Strategy focuses on ensuring Australians have a good start in life and live in good health as long as possible, with an emphasis on the need for health equity in priority populations. The Strategy highlights the top three risk factors with the greatest impact on the burden of disease: tobacco use, overweight and obesity and dietary risk factors. It emphasises the need for collaboration across sectors for the prevention of disease and to promote environments that support individual health and wellbeing.

National Obesity Strategy 2022-2032

Aligning with the National Preventive Health Strategy, the National Obesity Strategy is a 10-year roadmap to prevent, reduce and treat overweight and obesity in Australia. It acknowledges the importance of addressing the wider determinants of health such as inequities, creating healthy environments, empowering individuals to stay healthy and ensuring access to early intervention and supportive health care. To date there has been limited implementation of the recommendations across both the National Preventive Health Strategy and National Obesity Strategy.

Australian National Breastfeeding Strategy: 2019 and beyond

The Australian National Breastfeeding Strategy serves as a guide to support parents to breastfeed as well as to increase the number of babies who are breastfed. Exclusive breastfeeding has been found to be moderately protective against excessive early infant weight gain and the development of obesity later in life. ²¹

Food policy

The food regulatory system is the system of policy and laws relating to food in Australia and New Zealand. The system is established through the Food Regulation Agreement and the Joint Food Standards Treaty with these agreements underpinning the Food Standards Australia New Zealand (FSANZ) Act 1991 and legislation in each state and territory. ²² FSANZ is the Trans-Tasman regulator that manages the Australia and New Zealand Food Standards Code. The role of states and territories is to enforce the code. Food Ministers from across the Commonwealth, States and Territories as well as New Zealand are responsible for approving the standards. Food Ministers will seek FSANZ review and endorsement of new and existing standards. ²²

However, there is currently no National Food and Nutrition Plan, which has been identified as a priority area for action to guide co-ordinated food and nutrition policy in Australia. ²³ The 2022 Australian budget ²⁴allocated funds to develop a National Nutrition Policy Framework to identify, prioritise, drive and monitor healthy eating in Australia and a policy framework is under development.

Voluntary initiatives

The Australian Government has identified programs, including the voluntary Healthy Food Partnership ²⁵ and the voluntary Health Star Rating system²⁶, as part of a national response to promote healthy eating. ²³ The 2022 Australian budget ²⁴allocated funds to develop a National Nutrition Policy Framework to identify, prioritise, drive and monitor healthy eating in Australia and a policy framework is under development.

In 2015, the Government launched the Healthy Food Partnership²⁵ together with industry, public health and consumer agencies, focusing on improving the dietary habits of Australians by making healthier food options more accessible and increasing consumer knowledge on healthier options and portion sizes through voluntary measures such as product reformulation to decrease sodium, saturated fat and added sugar content and serving size reductions. ²⁵However, the Partnership has not shown notable improvements in these areas due to suboptimal industry participation in the program and weak reformulation targets.^27-29

Front of pack food labelling

Clear food labelling can help consumers identify healthier food options, which can support healthier eating habits, and contribute to reducing cancer risk. However, industry marketing claims about nutrients, ingredients and health benefits on the front of food labels compete with mandatory factual information on the back of packs such as Nutrition Information Panels (NIP) and ingredients lists.^30-32

In 2014, the Health Star Rating (HSR) system was implemented on a voluntary basis by the Australian state and territory governments and the New Zealand Government.²⁶ The Health Star Rating is a front-of-pack labelling system that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars; more stars indicate a healthier option within a given food category.

A five-year review was finalised in 2020 and resulted in modifications to improve the HSR system, including a specific industry uptake target of 70% by end 2025 and greater penalties applied to total sugars and sodium. However, the system remains voluntary and the uptake target is not on track at 36% and unlikely to be achieved due to inconsistent uptake across the food supply, with less healthy products more likely to not display an HSR.²⁸ The Australia New Zealand Food Ministers’ have agreed to support exploring mandatory application of the Health Star Rating System.

In July 2024, Food Ministers asked FSANZ to commence preparatory work to explore how the HSR system could be mandated through the Australian New Zealand Food Standards Code. As part of this work FSANZ also initiated a review of the Nutrition Information Panel.

FSANZ had also been considering the inclusion of added sugar information on Nutrition Information Panels but this work has been suspended and will be considered as part of a review of the Nutrition Information Panel in parallel with mandating the Health Star Rating system.

Food marketing to children

Regulations to reduce exposure of children to the marketing of unhealthy food is an area where Australia is significantly lagging behind recommended actions.²³ In 2010, the WHO launched a guideline on policies to protect children from the harmful impact of food marketing. The WHO have continued to advocate for policy actions to address this issue for the last two decades and now recommend mandatory regulation of the marketing of unhealthy foods and non-alcoholic beverages.³³ Research indicates that acute and cumulative exposure to food marketing has the propensity to influence thoughts and behaviour patterns of children, particularly their attitudes, preferences and consumption of unhealthy food products. ³⁴ Such factors are key constituents of a multitude of effects of unhealthy food marketing that can drive childhood overweight and has subsequent effects into adulthood.³⁵

The Australian Government, under the Preventative Health Strategy, has invested in a feasibility study exploring options to limit unhealthy food marketing to children. The study will allow for a better understanding of the available options including associated costs and benefits, acceptability, feasibility, impact on priority groups and implications for monitoring and evaluation. This work is supported by the National Preventive Health Strategy 2021-2030 and the National Obesity Strategy 2022-2032 which both include the policy goal of restricting unhealthy food marketing to children. This work has undergone consultation and the findings will be used to inform a range of policy options which will undergo cost and benefit analysis prior to their consideration by the Health Minister.

Physical activity

Any effective strategy for increasing population physical activity levels will require a national plan focused on promoting physical activity through a variety of areas, including active transport, urban planning, and sport and recreation. The National Preventive Health Strategy has set targets for reducing the prevalence of insufficient physical activity which can be achieved through a number of actions across systems including mass media campaigns, modifying urban design, land use and infrastructure and national guideline and policy revisions which reflect the latest evidence. See Cancer Council’s Physical Inactivity Policy for more information.

Existing Guidelines

The World Cancer Research Fund (WCRF) has published recommendations based on its review of evidence on diet, weight, and physical activity in relation to cancer risk. Recommendations include maintain a healthy weight; move more and sit less; eat wholegrains, fruit, vegetables and legumes; limit fast food and processed foods high in fats, starches and sugars; limit red and processed meat, sugar sweetened drinks and alcohol.³⁶ Similarly, the International Agency for Research on Cancer (IARC) has published the European Code against Cancer which includes similar recommendations to reduce cancer risk.³⁷ The Australian Dietary Guidelines and Physical Activity Guidelines are consistent with WCRF and IARC recommendations to reduce cancer risk and are endorsed by Cancer Council Australia. The Clinical Practice Guidelines for the Management of Overweight and Obesity for Adults, Adolescents and Children in Australia are currently being reviewed and updated to align with the recommendations provided in the National Obesity Strategy 2022-2032. The Guidelines highlight the need for integrated and coordinated provision of care for people living with obesity who seek clinical help. The Guidelines are scheduled for release in the latter half of 2025.

The Australian Dietary Guidelines provide specific, evidence-based recommendations on types and amounts of foods, food groups and dietary patterns to promote health and reduce the risk of chronic disease by age group as well as for pregnant and breastfeeding women.³⁸ These guidelines recommend healthy eating patterns that are consistent with recommendations for cancer prevention and should form the basis of all food and nutrition policies and regulations in Australia. Funding for the promotion of these guidelines is crucial to improve the health of Australians. These guidelines are currently under review with the date of release anticipated for the end of 2026.

Australia’s Physical Activity and Sedentary Behaviour Guidelines for children, young people, adults and older Australians provide evidence-based recommendations on minimum levels of physical activity required to gain a health benefit, as well as how to minimise sedentary behaviour to reduce the risk of chronic disease and obesity.³⁹  These guidelines are currently under review as part of the development of the 24-Hour Movement Guidelines.