Food environment interventions to address obesity and related non-communicable diseases in Australia

Abstract

In less than 30 years the prevalence of overweight and obesity has nearly doubled worldwide. Unhealthy food environments encourage unhealthy diets and energy overconsumption, which is a prevailing driver of unhealthy weight gain, and are seen as an important contributor to the obesity epidemic. This thesis aimed to identify potential public health actions to improve the nutritional composition of the Australian packaged food environment in an effort to address obesity and related non-communicable diseases (NCDs). The research comprises of three components: (i) a review of the existing evidence on the contributions of the food supply to obesity and related-NCDs, including a cross-sectional analysis of the Australian packaged food supply; (ii) a cross-sectional analysis on currently implemented food environment interventions to address obesity and NCDs; (iii) a modelled assessment on the potential health impacts and cost-benefits of implementing selected food environment interventions in Australia. Analyses of the Australian packaged food environment found that the proportion of foods defined as discretionary was 53.0% and proportion of foods defined as highly processed was 60.5%. Population-wide food supply interventions addressing sodium and trans fat reduction have proven highly effective and comparable efforts are now required to target obesity. The evidence suggests that strategies focusing upon reducing the energy density and portion size of foods will be more effective than those targeting specific macronutrients. Specifically, cost-effectiveness analyses of a portion size cap and energy reduction of sugar-sweetened beverages were ‘dominant’, and likely to offer excellent ‘value for money’ as obesity prevention measures in Australia. Governments around the world have recognised the need to implement public health policies and initiatives to curb the epidemic at hand. The nutritional composition of the food environment is one such area where action is needed. Globally there is a strong need for a governance framework which monitors and reports on the implementation and impact of such initiatives to determine what is working, and to hold key stakeholders such as the food industry accountable for their contribution or lack thereof.