OBESE NATION: It's time to admit it – Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.
Today Julie Brimblecombe discusses the incidence of obesity in Indigenous communities.
After tobacco, overweight and obesity contributes most heavily to the disease burden affecting Aboriginal and Torres Strait Islander Australians. It accounts for 16% of the health gap between Indigenous and non-Indigenous Australians, and is linked with physical inactivity, which accounts for a further 12% of the gap.
Type 2 diabetes, cardiovascular disease and kidney failure – each driven by obesity – are all rife among this population. Promising inroads have been made into tobacco cessation through political commitment, legislation, and community support. But obesity prevention in remote Indigenous Australia has not received equal attention.
For the individual most often affected by diseases associated with overweight and obesity during what should be the most productive years of his or her life, the social, health and economic costs of obesity are enormous. And this effect ripples through society.
Paradoxically, the poor are most affected, and many remote Indigenous households are now dealing with the double burden of obesity in adult members and under-nutrition in children.
Traditionally, Indigenous Australians were physically lean and did not gain weight with age. Thirty years ago, a small family group of Aboriginal people living “a traditionally oriented lifestyle” in north-east Arnhem Land were extremely slim (BMI of 16.7). And showed no risk of type 2 diabetes or heart disease.
Fast forward 20 years and this picture had completely changed. Half of the population in a north-east Arnhem Land community aged 15 years and over (47.3%) were still considered lean (BMI of less than 22), and this was particularly the case for young people (15 to 24 years), all of whom showed no sign of type 2 diabetes. In those of middle-age (35 to 64 years), however, 38% of the study population were overweight or obese.
Many factors contribute to people becoming overweight or obese in remote Indigenous communities. Most such communities are obesogenic environments because food prices (in the NT) are 45% more than urban centres; few healthy fast food options exist; there are limited recreational facilities and safe walking paths; and there's inadequate housing. What's more, there are often poor cooking and storage facilities and limited opportunities to access meaningful information on healthy food.
It's now recognised that these factors are largely driven or controlled by elements that are external to the individual. At a national level, strategies are increasingly focusing less on the individual and ideas of a lack of self-control, and more on better understanding and modifying the obesity-promoting environment.
The environment is complex, and like strategies for tobacco cessation, lowering obesity levels requires a coherent, multi-level, multi-sector integrated approach – supported by political will and resources. But the environment of remote Indigenous communities is also unique in a number of ways – and this may make it more conducive to effective action.
First, remote communities have the benefit of a food system that can be more clearly demarcated and defined than the urban setting. Second, in general, community leaders are highly committed to health improvement and support an integrated and holistic approach that resonates with an Aboriginal view of health. This can promote excellent coherence within a community, encouraging different sectors to work together.
In many settings, just beyond the built community lies a health-promoting environment that provides cultural, spiritual and physical nourishment for many community residents. The remote community Gunbalanya in Arnhem Land, for instance, overlooks a wetlands billabong teeming with long-necked turtle, file snack and fresh water fish.
Just down the track from the Nyirripi community in Central Australia, bush tomatoes and sultanas line the unsealed road and honey-ants are plentiful. Community elders are desperate to maintain these environments and their spiritual, cultural and physical connection to the land. They are also eager to educate and connect the younger generations to this environment.
When Indigenous Australians lived a traditional hunter-gatherer lifestyle, their diets were rich in lean animal foods that provided abundant protein, and sources of slowly digested carbohydrate. Energy dense foods were highly-prized and limited by season and their procurement burned calories.
Now, food stores in remote communities stock mainly energy-dense, nutrient-poor processed foods that are high in fat, sugar and salt. These processed foods provide excessive calories at a relatively low price, compared with the high expense of fresh nutrient-rich foods (fruit, vegetables, lean meats, fish, dairy and whole-grain cereals). So cheap refined carbohydrates and processed foods now make up the bulk of the diet available to most people living in remote Indigenous communities.
There's no question that the price of food influences consumption patterns. So economic levers are a logical approach to help move the dietary balance closer to the traditional diet and improve health outcomes – and many Aboriginal people in communities support this.
Tax policies, although getting traction in the United States, United Kingdom and Denmark, need closer consideration in Australia, as remote Indigenous families may be the hardest hit. They already spend a greater part of their budget on food. Subsidies are likely to be more effective.
Rigorous testing of solutions is needed to inform fiscal policy to curb overweight and obesity in remote Indigenous Australia.
Aboriginal people living in remote communities are among Australia's poorest. Yet they pay much more for food, and have limited availability to a healthy diet. Innovative economic strategies are needed to help alter this imbalance.
This is part ten of our series Obese Nation. To read the other instalments, follow the links below:
Julie Brimblecombe receives funding from The National Health and Medical Research Council and The Fred Hollows Foundation.
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