health & science

Calls for tougher regulation to fight obesity

The head of UNICEF NZ is calling for more government control of the food and beverage industry following the publication of shocking new obesity statistics, Laura Walters reports

The head of UNICEF NZ says children’s health cannot be left to the market, and is urging the government to step in and enact new regulations to help fight the country’s obesity problem.

These calls have been backed up by a leading nutrition and non-communicable disease specialist, who says New Zealand’s governments have done “precisely nothing” for almost 20 years, while Kiwis die of obesity-related health issues.

The calls for tougher regulation comes as UNICEF’s annual Innocenti Report Card has named New Zealand adolescents as some of the most overweight and obese in the rich world.

Out of 41 OECD and EU countries, New Zealand ranked second-to-worst for childhood obesity.

The global research report found more than 39 percent of the country’s adolescents aged five to 19 were either overweight (BMI over 25) or obese (BMI over 30).

The only country to score worse than New Zealand was the United States, with a childhood obesity rate of 42 percent.

Although New Zealand is known for its love of sport and the outdoors, obesity rates - and rates of diabetes - have been high for a long time, with Māori and Pasifika faring the worst.

As noted by the Innocenti report, obesity is a problem for both medical and psychological reasons. It takes a social and emotional toll by limiting participation in social life and lowering self-esteem.

It also contributes to diabetes, cardiovascular diseases, hypertension, cancer, gallbladder disease and a shorter life expectancy.

And people with obesity, and related illnesses, have some of the worst outcomes if they contract Covid-19.

In recent years, rates of overweight and obesity have increased substantially in high-income countries. 

The number of obese children and adolescents aged five to 19 worldwide is expected to grow from 158 million in 2020, to 254m by 2030, according to the report.

UNICEF’s research arm attributes the recent rise in obesity to lifestyle changes and insufficient regulation of food production and advertising, including predatory commercial practices, which could be addressed by governments.

“As a country, we’ve been through a 30-year journey where we’ve really asked the market to set our pace and the parameters for how we make decisions."

In response to these findings, UNICEF NZ executive director Vivien Maidaborn is calling for the next government to step up regulation of the food and beverage industry.

“As a country, we’ve been through a 30-year journey where we’ve really asked the market to set our pace and the parameters for how we make decisions,” she said.

This hadn’t worked for housing, and the most recent government recognised that, and has made moves to take a heavier-handed approach to regulation.

While the country’s problem with a lack of affordable housing was not yet fixed, there was a growing consciousness that such an important issue could not be left to the market.

“And I would say that the food industry is the next industry that we will feel more and more comfortable and confident to say the food industry has failed our health and wellbeing, and we can’t leave it to the market.”

Maidaborn said the industry was failing New Zealand’s health and wellbeing, and the country was past the point of saying the results were the product of individual consumer choice.

“We’ve gotta have a much more sophisticated approach to obesity and physical wellbeing, generally…

“Just like housing, is too important. We can’t leave this to the market.”

Many of the situations that make it hard for New Zealand families to access affordable, healthy food for their children have been well-canvassed in recent years.

A lack of accessible, affordable fruit and vegetables in some of New Zealand’s poorest areas, such as South Auckland and the East Coast, mean it’s often cheaper for families to buy fish and chips, takeaways, biscuits and other sugary or highly processed foods.

Of course, these areas also have a high proportion of Māori and Pasifika people, who are already more likely to be affected by obesity and diabetes.

“We have done precisely nothing in New Zealand for nearly 20 years.”

There has been recent discussion about the country’s supermarket duopoly and questions over whether the big chains are offering fair prices to consumers. The supermarket industry has been mooted as a possible focus of a Commerce Commission market study.

These issues are compounded by the advertising of junk food and takeaways. 

Industry groups say the numbers quoted regarding the amount of junk food ads aimed at kids is overplayed and misleading. 

They point to the current restrictions under the Advertising Standards Authority’s Children and Young People’s Advertising Code, and the Health Star Rating system (more on that later), as balances to stop industry giants pushing unhealthy food at kids and families.

However, researchers, experts and advocates - and the new UNICEF report - say kids are over-exposed to unhealthy foods and drinks, and research from Otago and Auckland universities show some Kiwi children are being exposed to an average of 27 junk food ads a day.

The study found children were twice as likely to see junk food marketing as ads for healthy foods.

There have been incremental changes in terms of labelling, advertising regulations, and a scattering of campaigns that encourage children to get active, eat healthy, and teach families about growing and cooking nutritional meals.

But many of these programmes have petered out or are no longer in the public eye (think 5+ a Day).

And experts say there is a lack of public education and awareness campaigns, as well as a lack of purposeful government regulation.

While the past few years have seen a growing discussion about the types of regulation New Zealand could enact, no significant changes have been introduced.

These include a ‘sugar tax’ or ‘fizzy drink tax’, as has been used in other countries struggling with obesity, including the UK.

More recent studies have pointed to the potential benefits of a ‘junk food tax’ - one that goes further than just sugary drinks.

Last year, New Zealand researchers conducted a world-first virtual supermarket shopping study looking at the impacts of a tax on unhealthy foods would have on consumer choice. It found raising the price of unhealthy foods not only had the potential to deter people from buying a certain product, but would see them substitute it for something healthier, and more affordable.

But the last government ruled out any new taxes in its first term, and Health Minister Chris Hipkins said they have no plans for a sugar tax or a junk food tax.

On the flipside, both Labour and New Zealand First have previously proposed removing GST on fresh fruit and vegetables, or ‘basic foods’.

While some see this as a good idea, officials who have looked into the proposal say it would be nearly impossible to implement.

It appears the during approach is incremental changes, largely led by industry.

“Having your foot chopped off is less exciting than having cancer or having a heart disease."

University of Otago professor of medical and human nutrition Jim Mann - someone who has extensive experience writing public nutrition policy - said he was baffled by the inaction from the previous two governments.

“We have done precisely nothing in New Zealand for nearly 20 years.”

Mann said the country was just starting to make progress on school and community nutrition campaigns, and regulations, in the early 2000s, then the focus shifted.

“It’s been a poor relation for a very long time in New Zealand…

“Having your foot chopped off is less exciting than having cancer or having a heart disease. And having kidney failure is less exciting than having a heart attack or having cancer.”

He also attributed some of the lack of government action to pressure from industry lobby groups. 

Mann said it might sound ‘corny’ but obesity was a “silent killer”, and the issue was escalating.

“It’s a pandemic. And New Zealand is up at the top of the pandemic list.”

While he was not surprised at the report’s findings - as they were in-line with recent studies of obesity in the country’s adult population - he said a pressing issue in New Zealand was the lack of data.

The Ministry of Health has not completed a national nutrition survey since 2002 - something most countries regularly conduct.

So while experts and health professionals knew people were overweight and suffering from obesity-related diseases, there wasn’t good data on what Kiwis were actually consuming.

In order for the country to get on top of this ‘pandemic’, the next government needed to first show it cared, he said.

“I don’t think one can underestimate the importance of just signalling this is important.”

That should start with practical changes.

“The medical profession should be more proactive. Whether they like it or not, they’re quite influential in the community.”

Firstly, advertising should be restricted, he said.

This would include overhauling the food labelling system, known as star-ratings. At the moment, a product could achieve a high rating if it added good ingredients (like fibre), even if it had a lot of bad ingredients (like sugar).

While consumer and government pressure has seen the industry reduce the amount of sugar in foods, and add health labels to their foods, Mann said more was needed.

Then school-based programmes should be next, with regulations around food sold at schools, food-based fundraisers, and education programmes. Mann said school-based policies were effective, and the impacts flowed into communities.

Lastly, the government should look at taxes, he said.

While Mann does support a sugar tax, he said it was important to raise the profile of the issue, and pull on other levers first.

And part of raising the profile of obesity rested with health professionals.

Mann said he had been disappointed in the lack of leadership shown by health professionals on this topic.

“The medical profession should be more proactive. Whether they like it or not, they’re quite influential in the community.”

And if doctors and nurses, and other health professionals, were engaged, the public would be engaged, and the politicians would hopefully pay more attention, he said.

“In general terms many citizens need to eat less and move more, but government is limited in terms of what it can do to encourage lifestyle or behavioural change."

Food & Grocery Council chief executive Katherine Rich said she agreed childhood obesity was a major concern in New Zealand, and around the world.

But she did not believe more regulation was the answer.

Rich said the industry was already highly regulated, and claims that there were not enough state controls were incorrect.

Instead, she advocates for more exercise, and continued partnerships between industry; NGOs and government on nutrition education, reduction of salt, sugar and fat in foods; and accurate, understandable labelling systems.

“Progress is being made but to fix this as a society New Zealand can certainly do more to encourage better nutrition and more activity to burn off excess energy. 

“In general terms many citizens need to eat less and move more, but government is limited in terms of what it can do to encourage lifestyle or behavioural change,” she said.

Like Mann, Rich pointed to a lack of current nutrition data.

Without an up-to-date national nutrition survey, the Ministry of Health was “flying blind” when trying to create a nutrition policy.

Minister of both Education and Health Chris Hipkins said all the issues raised in the UNICEF report captured some of the countries most significant intergenerational wellbeing challenges.

Obesity, in particular childhood obesity, was a complex problem that had been growing for many years, he said.

Achieving real change required government and the food industry to collaborate and make a concerted effort to address obesity.

He pointed to the government’s work with the food industry to implement the WHO recommendations on the marketing of foods and non-alcoholic beverages to children, as well as the free and healthy lunches in schools programme.

“Reducing child poverty and improving child wellbeing has been a priority for this government right from the outset but we’ve always been upfront that it will take time to fix,” Hipkins said.

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