Joint Media Conference - Launch of AMA Family Doctor Week, Sydney 15 July 2001

There are a couple of factors involved here. One is that children are far more sedentary than they ever were a generation ago. They are spending more time watching television, playing computer games, sitting around inside the house playing television - games and watching the television, and they're not getting outside and playing, playing sport, opportunistically exercising by walking to and from school, walking to and from the shops. People are more likely to get in their cars than to ride bikes in the street or to walk back and forth from where they have to go.

The second thing is that there are far more fast foods available. Now, this is partly convenience and it's partly, I think, driven by advertisers who are pushing these high cost, high fat, high sugar foods, and parents are buying them. So what can parents do about this? Firstly, they can be good role models. They can exercise regularly and they can eat well and only have good quality foods in the house. I think it's important that parents have a hands-on approach to childhood obesity; that they make sure that they put their hands on the right foods in the supermarket and put only those foods which they want their children to eat in the trolley and that they also, when they're packing their children's lunches for school and teaching their children to pack their own lunches, that they teach them about healthy food choices.

And the other thing parents can do is to be seen eating a healthy diet as well, because I think the most powerful influence is going to be role models. And our other message today is for the Advertising Standards Group and that is to make sure that advertising aimed at children doesn't push high fat, high sugar foods at the expense of good quality foods like fruits, vegetables and grains.

The message also for children is that there are everyday foods like fruit and vegetable and grains and cereals and there are sometimes foods, which might be the higher fat, higher sugar foods but they're not for every day. I'm joined this morning by Associate Professor Louise Baur and I'd like to ask her to make a few comments.

PROFESSOR BAUR: Thank you. Yes, in Australia about two thirds of adult men and about one half of adult women are overweight or obese. This is a problem that we are very well aware of, and so we shouldn't be surprised that children also have a similar problem. About one fifth to one quarter of children in Australia are overweight or obese because of the lifestyle that we lead as a whole community and that's problems like leading a very sedentary lifestyle, eating high fat foods, high sugar foods. So there are a lot of concerns - if I just reword that.

Overweight and obesity in childhood can cause significant health problems. Children who are overweight or obese experience stigmatisation at school. They get bullied; they get teased. They can have decreased self-esteem. These are very significant health problems. In addition, children who are overweight or obese can have high cholesterol levels, high blood pressure and other health problems like that. So we want to take it seriously.

GPs can play an important role in helping families make healthy lifestyle changes that will help the parents but especially the children. The sorts of things that we would encourage families to do is, for example, get outside and go for a walk. Go to the park; kick a ball; have fun as the family being active. I'd also encourage families to make television and computer just a part of their life, not the focus of their life. Try to get up and get moving and, in addition, we want to encourage families to provide healthy food choices for their children. So having lots of good, healthy, everyday foods and keeping the sometimes food to sometimes.

DR PHELPS: We're happy to take any questions.

JOURNALIST: On a practical level, I mean, how do you get kids to choose fruit over lollies and fruits?

DR PHELPS: Children are a captive audience when it comes to food. They don't have an income of their own and if they are hungry and they come home from school and the only choice they have is for fresh bread and fruit, then that's what they'll choose because that's what's there; and that's where I think parents can really take a very active role in making sure that the foods that are in the house are foods that they want them to eat, and if they have sometimes foods, that they're the foods that are outside the house at birthday parties, maybe just every so often but they're not the foods that they can expect to have every day when they're packing their school lunches, having breakfast or having their afternoon snacks.

JOURNALIST: If there's lots of peer pressure when they're at school every day, there's kids, obviously, in the neighborhood, advertising, it's around them everywhere, it's going to cause tensions within the family, that they're going to be saying 'Hang on, why can't I have some?'

DR PHELPS: I think that parents really need to exert some authority in this regard and I think it's much easier to exert that authority within the house if the healthy food choices are the only ones in the house. Do you want to make a comment about that?

PROFESSOR BAUR: No, I agree about that. I think a lot of children experience peer pressure. There's a huge in-your-face advertising directed at children and at families orienting them towards having high fat, high sugar foods. But there are a lot of, what we would call, everyday foods that are actually very nice. A lot of kids like eating dried fruits. They like having, you know, grains; they like having fruit as part of their snack for the day. So it's not as if they're sort of foods that kids don't like to eat. They're fun foods. Or they can made to be fun foods if parents spend a bit of time thinking about how they present it. The other thing, I suppose, is that parents can try to talk to the school about ways in which the school can encourage children to have healthy foods as part of their snacks as well. So this is a role for school canteens, school councils, school teachers also, to support this healthy lifestyle for children.

JOURNALIST: Can you go through the health problems of children being obese?

PROFESSOR BAUR: The most significant one that children raise all the time is what we call psychosocial distress. So this is children being stigmatised because they're overweight, children experiencing bullying and teasing and this can lead eventually to problems with self-esteem. So we take that seriously. But there are some very significant medical complications as well. Overweight and obese children and adolescents are more likely to have high blood pressure, high cholesterol and perhaps even glucose intolerance. We're starting to see teenagers with adult-onset diabetes. We never used to see this. Now we are. And this is purely as a result of obesity becoming more and more common in our community.

In addition, children who are overweight or obese can have problems with hip joints, knee joints, ankle joints, a lot of orthopaedic problems; they can have liver problems, gastro-oesophageal reflux and the list goes on and on: lots and lots of health problems.

JOURNALIST: Which is the biggest culprit? Is it bad food or not enough exercise?

PROFESSOR BAUR: It's a package: it's called '21st Century Lifestyle'. It doesn't come of one element. It's sedentary behaviour. It's decreased healthy food choices. It's lack of physical activity. They come as a package in our world. It's hard to tease one out.

DR PHELPS: A message today to parent is to get active, to get active physically, but also thinking about what their children are eating, what the parents are buying them, what they're putting into the school canteens and into their kids' school lunches and to make sure that their children are aware of what is healthy food: that it is simply a matter that the children will have the foods there that are healthy and that they come to expect that that is the food that is appropriate for them to eat. And perhaps before too long children will be putting peer pressure on their friends to eat healthy foods and not junk foods.

Our other message today and it's a very strong message is this: it's time that governments - sorry, it's time that governments and the Advertising Standards Bureau of Australia had a look at the barrage of junk food advertising that is being aimed at children and do something to make sure that that advertising is more appropriate to healthy choices for children.

JOURNALIST: What is it you are seeking to do? Do you want an investigation?

DR PHELPS: I think it's important that the government and the Advertising Standards Bureau of Australia have a look at the amount of advertising of junk food that is saturating children's television, particularly at the hours that children are watching it, and perhaps have a look at that from a health censorship point of view to say: is this an appropriate message to be going to children when we have what is basically a public health disaster on our hands for the next generation, and that is that one in five of our children are obese?

JOURNALIST: So we should be seeing fewer of these ads?

DR PHELPS: Absolutely, yes. We should be seeing fewer ads for junk foods and there should be some way of censoring the sorts of messages that are getting across to children in the popular media.

JOURNALIST: We are talking about a very powerful industry here. What sort of success do you think you will have?

DR PHELPS: I think that the medical profession well I think that the medical profession needs to take a stand here and I think parents also need to take a stand, and even though we are talking about a powerful industry lobby I do believe that the health interest groups and the health interests of Australian children should supersede that and the government does have it within its power to do something about that.

PROFESSOR BAUR: Australia has more food advertising, has a greater - sorry, Australia has a greater amount of food advertising directed towards children in children's TV viewing time than, for example, countries like Sweden. So if Sweden can actually regulate food advertising directed towards children then perhaps Australia also can do it.

JOURNALIST: Is your concern that we will end up like the US; that Australia will end up following a pattern of the United States -

PROFESSOR BAUR: Would end up - we're already doing it. Sorry, I shouldn't have interrupted you. We aren't just following the United States, we are already doing exactly what is - what's happening in the United States. So we're catching up quickly. We're not quite where the United States is but it won't take long. I remind you that two thirds of adult men and one half of adult women are overweight and obese in our community so that's a very significant health problem. Yes, more people in the United States have obesity as a significant health problem but we're not far behind, and both countries are grappling with this early 21st Century lifestyle: it's a big issue.

JOURNALIST: I spoke to you about this before, one of the things you were talking about earlier is that Australia did a national survey …?

PROFESSOR BAUR: Yes, in 1997 Australia - Australia was the first country in the world to come up with a national strategy for the prevention of overweight and obesity. That document was published in 1997 and was overseen by the National Health and Medical Research Council. But we've really yet to implement many of the plans that came out of that strategy. It was really lauded internationally as being a fantastic advance that came up with a national strategy for preventing this problem but what's happened is that it's very difficult, it requires funding and so we haven't moved very far on that

JOURNALIST: Reducing advertising, would that need government regulation to ensure that there's only …?

PROFESSOR BAUR: I'm sure the food advertisers would be only too happy to decrease the amount of advertising they do. Of course it will need government regulation.

JOURNALIST: Do we need a law?

PROFESSOR BAUR: It's got to be owned by the community. The community has to see that this is important but then it needs to have government backup to regulate what is going on.

JOURNALIST: There was a report today in the Sunday Telegraph about a Sydney group posing billboards along railway stations warning women of a 30 per cent increase in the risk of breast cancer if they'd had abortions. Your thoughts on that? You would be concerned by that sort of scare campaign?

DR PHELPS: I'd be very concerned about that sort of scare campaign. I think that if women are in the situation of having to decide whether or not to proceed with a pregnancy, they don't need to be bombarded with misinformation. They need to take the information from their doctors, their GP, their obstetrician; and it is a very private decision that is made with a woman and her partner, and one that I don't think that should be interfered with by a misinformation scare campaign.

JOURNALIST: Is there any sort of figures or research here in Australia supporting that kind of argument?

DR PHELPS: I'm certainly not aware of any statistics that would support that argument. Any other questions?

JOURNALIST: Can I ask you about the safety in New South Wales hospitals … obviously, an alarming increase in numbers on medical staff, the Nurses Association Federation, everyone who's been up in arms about it for quite some time, they're calling for urgent action. $5 million has been earmarked for hospital security. Would you be supporting that?

DR PHELPS: Absolutely. I think that it's unfortunate that we have to wait for a tragedy for action to be taken on an issue that's been recognized for some time to be a problem. But certainly understaffing, particularly in our emergency wards and in the area of mental health, has long been recognized as a problem in our hospitals and I think that it's high time that we had an inquiry into the security in our hospitals, what can be done to improve safety for a start and for patients, and we look also at the work-force numbers so that we can assess to what extent work-force problems are related to some of the security issues.

JOURNALIST: How important is it for parents to be in consultation with doctors; are they able to go it on their own with respect to food education?

DR PHELPS: I think - it depends on the level of education that the parents - in matters of nutrition and, for example, some parents would know exactly what to do: it's just a matter of having the will to do it, to say 'I'm going to the go to the supermarket and I don't care how many tantrums I see. I'm going to make sure that I don't put the high sugar' - without mentioning any Australian names - 'high sugar, high fat cereals into the trolley today. I'm not going to do it and I won't' and you do need to have willpower when you've got a couple of kids who are throwing themselves on the floor in front of the trolley, beating their fists on the ground it's very hard to say 'No, you can't have the chocolate bars'. But you can do it and what I would say to parents is to encourage them to have strength and to be able to withstand that pressure and it's not just peer pressure on children, it's paediatric pressure on parents and I think it's very important that parents try to withstand that paediatric pressure from their children. And you can do it. They can, can't they? I had to do it.

PROFESSOR BAUR: They can do it but they do need to be - and that's a role that GPs can sometimes play is actually being part of that support to help parents make good food choices. I think if a child has a significant problem with overweight or obesity then it's worthwhile having - the child having a medical assessment and that's an important role that a GP can play. GPs can play a very important role in providing counselling about healthy lifestyle choices for the whole family and that will have an impact on the child as well. So I really want to reiterate the point about including GPs in talking about these healthy lifestyle choices.

DR PHELPS: The theme of Family Doctor Week is: your doctor is with you for life and that is for life and for lifestyle. And so, really, from the moment of conception through to death the general practitioner has a very important role all the way along in disease management and in disease prevention, and when we're talking about childhood obesity we're talking about very early intervention into what is potentially a major public health disaster for the next generation. Thank you everyone.

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