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Found this interesting article - could relate to a strategy that could be put in place

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Did you catch the write up about The Lunch Box in the Advocate today? If you missed it here you go 😄 Looking forward to expanding this year. If you are a local business and feel like this could fit...

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Post by thelunchboxwhangarei.

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Being Maori is the biggest risk to poor health outcomes and an early death, a report has shown.

The bleak outlook highlighted the risk for Maori women with cancer who are twice as likely to die from the disease than non-Maori.

It also exposed the hundreds of child hospitalisations in the region every year - all of them avoidable.

Snapshots of Maori health across the twenty district health boards in New Zealand revealed inequalities between Maori and non-Maori.

Lead researcher Bridget Robson said it would be harder for people to ignore that institutional racism was part of the health sector, given the major disparities.

"It's so terrible that these are the [statistics] but it isn't surprising given the socio-economic factors," she said.

"The profiles remind us that stark inequalities in health continue. They provide a useful base for identifying key issues and planning actions to improve Maori health."

Robson said the current system needs to change.

"The current system is failing."

Robson said it was important that the desire to change came from all directions, not just Maori.

Waikato DHB has the highest number of Maori people compared to any other health board in New Zealand, with a population of 84,990 in 2013.

Between 2009 and 2013, Maori accounted for 40 per cent of all live births in the Waikato.

Waikato DHB general manager Maori health, Ditre Tamatea, said other factors also contribute to Maori health outcomes.

"First nations people at a global level, that are through the process of colonisation, are more negatively disproportionately represented in a whole range of statistics," he said.

"That's a global fact and it's no different for Maori.

"That directly correlates to the issue of poverty and of course if you're poor, you're going to have a whole range of poor health outcomes.

"So what we need to do is work with those other sectors that work with the wider social determinants of health - housing, education, employment, income, justice."

A positive from the report included a decrease in smoking rates among young people and adults.

Tamatea said the numbers were still higher than non-Maori but health promotion, targets and incentivisation programmes have helped to decrease smoking rates.

An initiative called Hapu Wananga is believed to be the first of its kind in the country and is part of the Waikato DHB Maori Health Plan 2015/2016.

It mirrors that of Finland where mothers are given starter packs with clothes, sheets and toys and a bed for their baby.

They were also using the initiative to get women to quit smoking as 40 per cent of pregnant Maori women within the Waikato smoked.

Preliminary findings suggest that with incentivisations, success rates increase from less than five per cent to 33 per cent.
Read more: Freebies given to get Waikato Maori women healthy
Acting Deputy Director-General Maori Health Paula Searle said while the health system works for most people, most of the time, there are persistent health inequalities that need to be addressed.

"The work by Otago University is part of our work to best understand health need so the whole health system is able to respond in the most appropriate way," said Searle.

"[There are] specific efforts to address particular areas in health where there are disproportional high levels amongst Maori... some programmes have had particular success in improving health for Maori."

Some of the current initiatives involved immunising children under two and the Whanau Ora programme, which integrated community services.

New Zealand First MP and party health spokesperson Barbara Stewart said chronic underfunding in the health sector had a direct impact on Maori health.

"Enough funding? No. Is the government doing enough? No. Can more be done? Definitely."

Stewart said ensuring targets are met does not address the wider issues.

The vision for Maori, Tamatea said, is to be the healthiest people on the planet, rather than have health as good as the rest of the population, "but we'll start there".

- Stuff

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Report highlights New Zealand's health system failing Maori

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Being Maori is the biggest risk to poor health outcomes and an early death, a report has shown. The bleak outlook highlighted the risk for Maori women with cancer who are twice as likely to die from the disease than non-Maori. It also exposed the hundreds of child hospitalisations in the region every year - all of them avoidable.

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Cultural Anthropology: An Applied Perspective

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In addition to a comprehensive overview of the discipline, CULTURAL ANTHROPOLOGY: AN APPLIED PERSPECTIVE, Ninth Edition, goes beyond basic introductory material by emphasizing the application of the theory, insights, and methods of cultural anthropology to contemporary situations that students, both majors and non-majors, are likely to encounter in their professional and personal lives.

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A wellness blogger has revealed the ingredients health fanatics could never live without if they want to eat clean.

Lily Simpson, who founded healthy food delivery service and deli chain The Detox Kitchen, says there are 10 staples that she always keeps in her cupboards at home, according to The Daily Mail.

The co-author of The Detox Kitchen Bible favours organic fare and dairy-free produce for her super-healthy diet - and of course, avocados are on her list too.

Lily's list of top 10 foods, which she shared in a video with Tor Cardona for Sheer Luxe, to keep in stock at all times gives an insight into the virtuous eating habits of influential wellness bloggers - and it could inspire you to throw out the chocolate and replace it with brown rice, seeds and herbs instead.

ORGANIC EGGS

Fried, boiled, poached, or scrambled - but I also love to make a frittata in the evenings, it's super quick and easy.

SEEDS

I love sunflower seeds, and pumpkin seeds. I flash fry them and chuck them into a salad, it literally transforms any salad.

KUMARA

I'm often roasting them off, and I love making a sweet potato dhal.

ORGANIC OAT MILK

I always have oat milk in my fridge. It's a great alternative to dairy, it's great in cereal, with tea or with coffee. It's really great to have as a drink before you go to bed.

BROWN RICE

One of my favourite all-time salads is a brown rice salad with loads of spring onions, nuts, cucumber, and tomatoes. I have brown rice maybe five times a week.

MIXED HERBS

Just throw them into a stew or soup or salad and it will transform the dish and give it an extra boom of flavour.

CAULIFLOWER

Probably my favourite vegetable. Amazing in soups, stews, curries.

AVOCADO

Amazing on toast or on a salad or grilled is good too.

ROLLED OATS

They are my go-to breakfast. I have it as a porridge or make my own granola by covering them in golden syrup and then roasting it in the oven and then mixing with chopped nuts.

CORIANDER

It's my favourite herb. You love it or hate it, I absolutely love it. I throw it into any salad or it's great just chopped on a curry or in a soup.

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Ten ingredients healthy people have in their kitchens

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A wellness blogger has revealed the ingredients health fanatics could never live without if they want to eat clean. Lily Simpson, who founded healthy food delivery service and deli chain The Detox Kitchen, says there are 10 staples that she always keeps in her cupboards at home, according to The Daily Mail.

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Adult obesity statistics

The New Zealand Health Survey 2019/20 found that:

around 1 in 3 adults (aged 15 years and over) were obese (30.9%)

the prevalence of obesity among adults differed by ethnicity, with 63.4% of Pacific, 47.9% of Māori, 29.3% of European/Other and 15.9% of Asian adults obese

adults living in the most socioeconomically deprived areas were 1.8 times as likely to be obese as adults living in the least deprived areas*

the overall prevalence has remained relatively stable since 2012/13, however there was an increase between 2011/12 and 2019/20 for adults aged 45-54 years and 55-64 years.

Child obesity statistics

The New Zealand Health Survey 2019/20 found that:

around 1 in 10 children (aged 2-14 years) were obese (9.4%)

the prevalence of obesity among children differed by ethnicity, with 29.1% of Pacific and 13.2% of Māori obese, followed by 3.4% of Asian and 7.2% of European/Other children

children living in the most socioeconomically deprived areas were 2.7 times as likely to be obese as children living in the least deprived areas*

the child obesity rate has decreased since 2018/19, and while this has decreased since last year, it is too early to report a trend.

For more information refer to the Tier 1 statistics 2019/20: New Zealand Health Survey.

* Adjusted for differences in age, sex and ethnicity.

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The New Zealand Health Survey 2019/20 found that: around 1 in 3 adults (aged 15 years and over) were obese (30.9%) the prevalence of obesity among adults differed by ethnicity, with 63.4% of Pacific, 47.9% of Māori, 29.3% of European/Other and 15.9% of Asian adults obese adults living in the most socioeconomically deprived areas were 1.8 times as likely to be obese as adults living in the least deprived areas* the overall prevalence has remained relatively stable since 2012/13, however there was an increase between 2011/12 and 2019/20 for adults aged 45-54 years and 55-64 years.

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Key Points:

The Ministry of Health is considering a radical and controversial expansion of obesity surgery financed by taxpayers.

District health boards have given provisional approval to the scheme to operate on more than 900 "morbidly obese" people annually. This would cost more than $17 million in the first year and around $15 million in each of the next two years.

But there will be debate over using taxpayers' money for what some regard as an individual problem caused by overeating and laziness - despite the argument that the obesity "pandemic" is caused by our electronic lifestyles and appetite for commercially prepared food.

A survey of 400 people, commissioned by health boards, found that 61 per cent believed obesity surgery should be state funded and 35 per cent said it should not be. Seventeen per cent of the sample agreed "strongly" that it should be state funded, and 20 per cent strongly opposed the idea.

The strong supporters said it would save money for the health system long term, and nothing else worked.

The strong opponents said individuals were responsible for what they ate and taxpayer money should not be spent on fixing something individuals had done to themselves.

The ministry says it and DHBs are still to make their final decisions about the proposal. A spokesman for Health Minister Tony Ryall said it would need his approval only if boards wanted new money, rather than funding it out of their existing budgets.

Obesity surgery is the fastest-growing surgical area in Australia. Several private clinics offer it in New Zealand and some health boards, including those in Auckland, pay for a limited amount.

Private and public sector surgeon Michael Booth said North Shore Hospital performed 20 to 30 of the operations a year.

The surgery was life-changing for the majority of those who had it, he said. But it failed in 40 to 50 per cent of gastric-band cases because the patient did not eat or exercise properly or the band slipped or eroded. In up to 30 per cent of gastric bypass cases the patients regained weight because they snacked constantly - instead of eating three small meals a day - and stopped exercising.

There was also a risk of death of 1 per cent or less.

Whether funded privately or by the Government, he said, the operations should be done only on those who were already motivated to lose weight by dieting and exercise.

The aim is to treat 0.5 per cent of the "morbidly obese" - those above body mass index 40, or above 35 with significant illnesses like diabetes. It is estimated that 5.8 per cent of the population, more than 200,000 people, are morbidly obese. The percentages are much higher among Maori and Pacific people, who are expected to particularly benefit if the scheme proceeds.

An assessment for the ministry found that providing the surgery would be cost-effective. It offered "a potential cost saving for the health sector, with a payback time of around eight years post surgery". The operations cost between $15,000 and $25,000.

Obesity increases many risks, including type 2 diabetes, heart disease and cancer. The mortality risk for the morbidly obese is double that of lean people.

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The Ministry of Health is considering a radical and controversial expansion of obesity surgery financed by taxpayers. District health boards have given provisional approval to the scheme to operate on more than 900 "morbidly obese" people annually. This would cost more than $17 million in the first year and around $15 million in each of the next two years.

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Most recent data

The graphs below are interactive. Hover over data points to see exact values. Click legend text to hide or show variables.

Figure 1

See information about this data.
Figure 2

See information about this data.
Figure 3

Note: Chile, Hungary, and Poland are as at 2009. The Czech Republic is at 2010. Australia, Turkey, and Spain are at 2011. Germany, Mexico, Estonia, France, Iceland, Norway, Slovenia, and Switzerland are at 2012. All other countries are as at 2013. The following countries use measured data for obesity: Australia, Canada, Chile, the Czech Republic, Germany, Hungary, Japan, Korea, Luxembourg, Mexico, New Zealand, the Slovak Republic, the United Kingdom, and the United States. For all other list countries, obesity rates are self-reported.

See information about this data.

Information about the New Zealand data

Figures 1 and 2

Date published: March 2017
Next update expected: December 2017
Update frequency: Annually
Specific classification used: Body Mass Index (BMI). BMI is calculated by dividing weight in kilograms by the square of height in metres (kg/m ²).
Geographic coverage: National
Demographic information available? Yes
Internationally recognised measure? Yes
Source: Ministry of Health - New Zealand Health Survey
Purpose of the survey or data: The New Zealand Health Survey (NZHS) provides information about the health and well-being of New Zealanders. The NZHS collects information that cannot be obtained more effectively or efficiently through other means. The NZHS is the best source of information at a population level for many of the topics covered.
Data quality: Methodology report 2015/16: New Zealand Health Survey

Information about the international data

Figure 3

Date published: March 2017
Next update expected: 2018
Update frequency: Annually
Geographic coverage: OECD countries
Source: OECD Health Statistics 2015
Purpose of the survey or data: To provide comprehensive and dynamic statistics about all OECD member countries. Includes area totals.
Data quality: The quality of the data for each indicator is included in the indicator description - OECD Health Statistics 2016: Definitions, sources and methods.

Want to know more?

Ministry of Health - New Zealand Health Survey
Tier 1 statistics 2015/16: New Zealand Health Survey
Ministry of Health - Methodology report 2015/16: New Zealand Health Survey
Ministry of Health - Annual update of key results 2015/16: New Zealand Health Survey
Ministry of Health - Indicator Interpretation Guide
OECD - Non-Medical Determinants of Health: Body weight
Ministry of Social Development - The Social Report 2016 - Te pūrongo oranga tangata

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The graphs below are interactive. Hover over data points to see exact values. Click legend text to hide or show variables. Figure 1 See information about this data. Figure 2 See information about this data. Figure 3 Note: Chile, Hungary, and Poland are as at 2009. The Czech Republic is at 2010.

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https://www.parliament.nz/en/pb/research-papers/document/00PLLawRP2014041/obesity-and-diabetes-in-new-zealand

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The “Health Star Rating” system implemented
in Australia and New Zealand in 2014 is a front-of-pack labelling system that rates the overall nutritional pro le of packaged food based on energy, saturated fat, sodium, total sugar, and bre content, assigning a rate from 1⁄2 star to 5 stars. It provides a quick, easy, standard way to compare similar packaged foods. The more stars, the healthier the choice.

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The Internet (almost) exploded this week when Americans Against the Tea Party linked to a video with the title: "Nestlé Chairman: Water Not a Right, Should Be Given a 'Market Value' and Privatized." In it, Nestlé Chairman and former CEO Peter Brabeck suggests that declaring water a right is 'extreme' and asserts that water is a foodstuff best valued and distributed by the free market.
Video below -- starts about at 2:00 mark.
The rhetoric is admittedly absurd. But before we rip out our hair in a fit of #OccupyNestlé rage, let's talk back-story.

The five-minute clip is part of a larger video about food security filmed in 2005. Every few months it surfaces, triggering a firestorm of criticism. This time, it even trended on Twitter.

People were shocked at the inhumanity of Brabeck's statement, and rightly so. Taken at face value, the video appears to pit the world's largest seller of bottled water against the 783 million people struggling to access what little water they need to survive. That's after allegations and rebuttals regarding Nestlé's role in restricting water access to several poor communities.

The fact remains: humans have a right to clean water.
Apart from making good moral sense, the right to water is recognized by the United Nations and protected by several treaties and national constitutions.

But wait! Brabeck and Nestlé have since recognized the right to water. Nestlé's corporate policy asserts "the right of all people to have access to clean water to meet their basic human needs..." Brabeck states his position on his blog:

Let me be very clear about this again here on the blog, because I think the video clip, which took my views out of context, isn't clear about the point I was trying to make. The water you need for survival is a human right, and must be made available to everyone, wherever they are, even if they cannot afford to pay for it.

Perhaps the question was settled sometime between 2005 and the present. Perhaps Brabeck's original comments were in fact desperately out of context. Perhaps we're just meant to feel better. Whatever the case, most of us are left scratching our heads, wondering what having a 'right to water' really means.

While we're on the subject, it might be helpful to run through a few clarifications regarding one of our most important human rights -- both for Mr. Brabeck's sake and for ourselves.
1. The right to water takes precedence.
The right to water entitles every person to sufficient, safe, acceptable, accessible and affordable water for personal and domestic use. It establishes a relationship between states and their citizens. States must respect the right to water, protect water access from interference and continually improve access for those lacking it.

Human rights have priority, meaning that water -- all water -- is first a human right, and second a resource to be used for development in line with our obligation to live sustainably.
2. The right to water means more than survival.
The human right to water protects both the water we need to survive and the water we need to live in dignity. There's an important distinction between the two.

The World Health Organization estimates that human beings need between 25-50 liters of water a day to maintain basic health and hygiene. This is called our Basic Water Requirement . But imagine living on list 25 liters of water a day and maintaining your dignity. For many of us, this would be difficult.

States have an obligation to protect access to the water a person needs to survive (25-50 liters), while at the same time working to ensure that all persons have access to the amount of water they need to thrive.
3. The market has both a role and a responsibility.
The market has an important role to play in water management. That role is primarily a responsibility on the part of businesses to respect access to water in their plans and processes. Beyond that, markets should price goods in a way that recognizes the value of the water used to create them. Every product has a 'water footprint' that gives it a very real cost.

Private firms may also have a role to play in public water delivery, but they will never be able to cost-effectively meet the needs of those who cannot pay market rates. That's the government's job (with the help of aid, if needed).

4. Americans need a new attitude.

Mr. Brabeck insists that by assigning water a price, we'll become more aware of just how precious it really is. Like him or not, he's right to point out how desperately out of touch we've become.

In a survey of American 'Water Attitudes' taken by the firm Xylem last year, 67 percent of Americans admitted that they take water access for granted. In fact, half of us estimate our daily water use at around 50 gallons (227.3 liters), when it's double that number or more. Americans have a right to water like anyone else, but it's a right we neither appreciate nor understand.

One question remains after this week's debate: How can we be so angered by the positions of our business leaders when we seem so unaware of water's importance in our own lives?

Someone make a video about that.

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Nestlé Chairman Peter Brabeck Says We Don't Have a Right to Water, Believes We Do Have a Right to Water and Everyone's Confused. (Video)

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The Internet (almost) exploded this week when Americans Against the Tea Party linked to a video with the title: "Nestlé Chairman: Water Not a Right, Should Be Given a 'Market Value' and Privatized." In it, Nestlé Chairman and former CEO Peter Brabeck suggests that declaring water a right is 'extreme' and asserts that water is a foodstuff best valued and distributed by the free market.

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More Auckland adults are overwight but the number of overweight and obese pre-schoolers in Auckland has dropped by 2 per cent, according to the latest research from the Healthy Auckland Together coalition.

The monitoring report on the city's obesity rates shows the percentage of obese and overweight 4-year-olds dropped to 20 per cent in 2015 from 22 per cent in the previous year.

On the other hand, the percentage of Aucklanders over 18 who were overweight and obese rose to 61.5 per cent in 2015 compared to 60.7 per cent in 2014.

Almost 80,000 Auckland children were weighed at before school checks in 2015, with the gap in obesity rates closing between Maori, Pacific Island and European/other children.

Despite the drop, the report also showed the effect of too much sugar in children's diets and that many were less physically active.

Coalition spokesperson Dr Michael Hale said looking at what was happening in schools, early childhood education centres and neighbourhoods would help identify why Auckland was seeing this encouraging change.

"We need to find if this trend is a pre-school blip that reverses as children get older," he says.

The research found that fewer 5-14-year-olds were biking or walking to school than in previous years.

"We also know that children are more attached to screens from 7 years onwards, and more exposed to bad food around schools. Without the benefit of more in-depth research, we are just speculating on the reasons at this point.

"Something positive is happening for preschoolers, but not being able to identify the causes makes it difficult to push for change to achieve the same result for older children," Hale said.

Most adults were still not being active enough, or eating the minimum quantities of fruit and vegetables to keep them healthy.

"It is so easy for adults to put on weight, and this is exacerbated by environments that encourage sitting at work, in the car and at leisure, and poor quality snacking and meals."

The figures
* A slow rise in adult obesity from 24 per cent in 2007 to 28 per cent in 2015.
*The 43 per cent of all adults meeting the physical activity guidelines hasn't changed over the past year, except for a 4 per cent increase among Pacific Island women.
*There's been a drop in the number of 5-14-year-olds getting to school by bike, scooter, skateboard or on foot.
*The number of missing, filled or decayed teeth in 5-year-olds remains persistently high, with the highest among Pacific Island and then Maori children.

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More Auckland adults overweight or obese, new report shows

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More Auckland adults are overwight but the number of overweight and obese pre-schoolers in Auckland has dropped by 2 per cent, according to the latest research from the Healthy Auckland Together coalition. The monitoring report on the city's obesity rates shows the percentage of obese and overweight 4-year-olds dropped to 20 per cent in 2015 from 22 per cent in the previous year.

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Obesity is a medical term used to describe being too heavy for your height so that your health is affected. Obese children and adults are at much greater risk of acute and long-term health problems. The World Health Organisation describes the worldwide prevalence of obesity as an epidemic.

Being overweight, or obese, can lower your quality of life as well as decreasing your life expectancy. It makes moving around more difficult, and is harder on your heart, muscles and bones.

Obesity in adults is associated with a long list of health conditions including:

Obesity in children increases the likelihood of:

being obese as an adult

abnormal lipid profiles

impaired glucose tolerance

high blood pressure

musculoskeletal problems

asthma

psychological problems including body dissatisfaction, poor self-esteem, depression and other mental health problems.

What causes obesity?

Excess weight or obesity is the result of an energy imbalance. This means too much energy (kilojoules/calories in the form of food) is put into the body and not enough is used (ie, through exercise). The excess energy is stored by the body as fat.

Although some people are more prone to weight gain than others, the increase in the number of people who are obese in recent years has occurred too quickly to be explained by genetic changes. Most experts now believe that this 'obesity epidemic' is caused by our modern lifestyle, which promotes over-eating/drinking and limits opportunities for physical activity.

How is obesity measured?

Body mass index (BMI) is a commonly used measure that can be used to estimate if you are in the healthy weight range for your height and ethnicity. Your BMI is calculated by dividing your weight in kilograms by your height in metres squared (kg/m2).

Tips for losing weight

Losing weight normally involves a fair amount of hard work and determination. The key is to make slow, steady lifestyle changes, which over the long-term will help you to lose weight and keep it off. There is no quick fix - but the ongoing benefits in terms of your health and well-being make it well worth the effort.

If you are a parent you have an important role in shaping your child's dietary habits. You can control what, when and how your child eats, as well as being a role model.

Here are some tips to help you get started:

Make physical activity part of your day, every day. Find exercise you enjoy doing and try to work it into your daily routine. It's important you see it as an enjoyable part of your day not a punishment!

Create a healthy environment for your family by limiting time spent in front of electronic devices. Less time in front of a screen gives you more time to be active.

Eating smaller amounts is the best way to cut down energy (kilojoules/calories). Don't try to change too many foods at once. Build small changes into your everyday habits.

Limit the amount of sweet baking, chips, fried foods and fizzy drinks as these are high in energy, fat and sugar.

Quench your thirst with water - it's calorie free and essential for your body to function well.

Read more about weight loss in our Healthy Living section.

Learn more

Obesity Statistics New Zealand
Obesity data and stats Statistics New Zealand, Annual Update of Key Results 2013/14

Obesity - a public health problem (series)

Video series - experts claim that sugar is a toxin causing the global rise in obesity.

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Site designed and developed by bka interactive ltd, Auckland, New Zealand (www.bka.co.nz)

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Obesity is a medical term used to describe being too heavy for your height so that your health is affected. Obese children and adults are at much greater risk of acute and long-term health problems. The World Health Organisation describes the worldwide prevalence of obesity as an epidemic.

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More than 4000 obese 4-year-olds a year are expected to be referred to experts in healthy eating and physical activity under a new Government plan to tackle obesity.

Health Minister Jonathan Coleman today announced the plan, which, as foreshadowed in the Herald in February, will make childhood obesity one of his Health Targets.

The Health Targets, although controversial, have succeeded in making the health sector do what health ministers want, such as helping more smokers to quit and reducing delays in emergency departments.

Other highlights of the plan are that:

* The Advertising Standards Authority will review the code of advertising food to children. The Government acknowledges that children's food choices are "strongly influenced by advertising".

* Government negotiators are discussing with food and drink industry leaders the possibility of voluntary industry pledges and changes to food labelling, marketing and advertising to children.

* The Education Review Office, which monitors schools and early childhood centres, will do a special review of nutrition, physical activity and health.

* A national media campaign will focus on childhood obesity.

* Children will be given more opportunities to be physically active.

There is no mention of the Mexico-style soft-drink or sugar taxes promoted by a number of public health specialists and the Green Party but repeatedly rejected by the food industry and Dr Coleman.

Thirty per cent of adults and 10 per cent of children are obese, although the rates are skewed by ethnicity. Pacific people have the highest rate among adults, at 67 per cent. New Zealand has the third highest rate of adult obesity of developed countries.

"Childhood obesity is a serious issue which means some of our kids could end up living shorter lives than their parents," Dr Coleman said.

"Being overweight or obese is expected to overtake tobacco as the leading preventable risk to health in New Zealand within the next 12 months.

"There is no single solution that will fix obesity. That's why we have developed a range of interventions across Government, the private sector, communities, schools and families.

"The Childhood Obesity Plan includes improved public information and resources; increasing physical activity, some of which will be done in education settings; actions for the health sector, and the food and beverage industry.

"Our plan focuses on children as that's where the evidence shows we can have the greatest influence. By focusing on children we expect to also influence the whole family."

The child obesity health target is at the heart of the plan and will join the Minister's other Health Targets next July, through the "B4 School Check", the health check done, at no charge, among 4-year-olds.

The target will be for 95 per cent of children identified as obese to be referred to an appropriate health practitioner for assessment and family-based nutrition, activity and lifestyle interventions.

More than 58,000 children have participated in the B4 School Check in the last year, of whom 1400 were referred for obesity-related support.

"With this target we expect that will treble to over 4000 a year by December 2017," Dr Coleman said.

Children referred via the B4 School Checks will have improved access to nutrition and activity programmes such as Active Families, an existing no-charge community programme run for children and their families who can join on approval from a GP, the Ministry of Health said.

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More than 4000 obese 4-year-olds a year are expected to be referred to experts in healthy eating and physical activity under a new Government plan to tackle obesity. Health Minister Jonathan Coleman today announced the plan, which, as foreshadowed in the Herald in February, will make childhood obesity one of his Health Targets.

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"There is no question that being obese or overweight is more costly than being normal weight," a 2010 George Washington University concluded of Americans.

It estimated the cost of being obese was just over US$2600 for men, and just under US$4900 for women.

Being merely overweight added cost to a life, the university found, but obesity was a personal finance killer.

Obesity was defined in the study as having a Body Mass Index of 30 or more when a "normal" BMI is between 18.5 and 25.

There are two sides to the "cost" equation in any life, no matter the weight of the person living it: costs and income.

With 100,000 more kiwis set to become seriously obese in the next decade, here are some of the financial consequences:
COSTS
Some costs are easy to work out, and are very personal. Others are harder to judge, or socialised through our health and benefits systems.

For example, insurance costs obese people more than people with healthy BMIs.

Pinnacle Life's premium for $250,000 of life insurance for a healthy, non-smoking 40-year-old New Zealand European male with a BMI of around 25 (180cm and 80kg) would be $21 a month, or $252 a year.

If he was 100kg (BMI of nearly 31), it'd cost $283. If he was 120kg, it'd be $371.

Income protection and trauma insurance are more costly too for obese people.

They are also more likely to make joint-related claims on their health insurance, says Southern Cross, which can result in having to dip into their pocket to co-fund their treatment.

The obese are unlikely to qualify for the 10 per cent "healthy living" discount at Southern Cross.

Expense is often a matter of what the little things add up to.

Having to have a larger car to cope with a family of larger girth can mean having to go for a more costly, or older vehicle. And carrying around heavy loads means using more petrol.

It is estimated that obesity adds over a billion gallons a year to the US' total petrol consumption.

The Social Policy Evaluation and Research Unit (Superu) lists, "My fuel costs are higher because of my weight" as being one of the personal costs of obesity.

Bigger calorie intakes can mean larger food and drink bills, especially if it involves buying fast food and takeaways.

And, research in 2012 by Auckland nutritionist Rebecca Whiting laid to rest the myth that junk food was cheaper than healthy food.

READ MORE: Junk food argument is garbage.

Dieting can be a big drag on the purse too.

Research by Southern Cross shows three in ten of us have been "on a diet" in the past five years, with most who have dieted having tried in the past one or two years.

It costs $4.78 a week ($24856 a year) to be one Jenny Craig's 12 month signature programme (not including any discounts currently available). The current price for one on one Weightwatcher coaching for three months is $139.90, though usually it's $279.90.

These costs reflect an awful truth about obesity: It's easy to keep weight off, but it is costly, and hard to lose it once you've packed it on.

It requires massive and sustained habit changes.

Otago University's Edgar Diabetes and Obesity Research Centre's film on the obesity epidemic leaves no doubts about the difficulty of losing weight.

The film features Lesley Willocks, a man who decided to shed weight after a medical wake-up. It required a big change in diet, and huge jump in exercise. "It's a hard job to get rid of weight. It's taken me about six years to lose 30kg."

Six years that involved frequent swimming and 12,000 kilometres on a bike.

The university's professor Jim Mann says: "The treatment of obesity is extremely difficult. The drugs that we have are extremely ineffective. There is not a single really useful drug available."

And surgery costs a bomb, as the case of Jason Patterson shows. He was seeking to raise $20,000-$25,000 to have a gastric sleeve operation.

READ MORE: Worldly goods sold for gastric sleeve.

End of life costs are higher too. Big people are costly to bury, says Martha-Louise Asmus from Auckland's Manning Funeral Cottage.

Auckland's Waikumete Cemetery charges an extra $270 to dig an extra big hole, and some people are so large they have to have costly plus-size, or custom coffins made.

"The biggest person I had was 242kg, and he needed a casket that was a cube shape," Asmus says.
INCOME
Earlier this year, a Morgan Stanley report attempted to estimate the national economic drag caused by obesity.

It estimated obesity could cost this country around 20 per cent in lost economic growth in the next two decades.

This effect gets written small over individual lives made harder by low mobility and bad sleep, which is a side effect of being obese. Poor health can result in lower productivity, and even the inability to work.

A recent study on a cohort of Christchurch people appeared to show that being heavier actually had a positive impact on men's incomes.

But the study only covered young people at ages 30 and 35, which gives little insight into whether carrying a lot of excess weight throughout a life hits your income prospects.

READ MORE: Obese men and skinnier women earn more, study says.

Overseas studies indicate there it does, and they show the stakes are higher for women, and higher still for women from ethnic minorities.

That could reflect society judging women more harshly for carrying extra weight, academics postulate, and the hit to confidence they can suffer as a result.

Ministry of Health figures show a greater proportion of women are obese compared to men, and a greater proportion of Maori and Pacific Island people are obese compared to Pakeha.

Low incomes are associated with obesity.

Adults living in the most deprived areas are four times as likely to be extremely obese as those living in the least deprived, and nearly twice as likely to be obese.

But Auckland University researcher Nicola Shackleton published research this month which indicated that it was education, not income, which was the key factor driving obesity.

Discrimination in employment is something the obese face.

Superu list of the challenges facing obese people include: "It's harder for me to find a job", "I am discriminated against" and "I take more sick leave".

A 2012 study published in the International Journal of Obesity involved asking people in New Zealand, Australia, and the UK to assess both obese and non-obese women for a managerial position.

The findings showed clear discrimination. It seems that people who are not able to control their weight are judged as unable to control an organisation.

Weight discrimination has not been an issue for the Equal Employment Opportunities Trust, however. Its chief executive Bev Cassidy-Mackenzie says: "It's not something that's come up on our radar."

And she disputes the slim, athletic, gym-honed bodies increasingly common in the corporate world indicate the overweight can't make it to the top of the corporate ladder. "I do meet a lot of chief executives who are overweight, me included."

- Stuff

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"There is no question that being obese or overweight is more costly than being normal weight," a 2010 George Washington University concluded of Americans. It estimated the cost of being obese was just over US$2600 for men, and just under US$4900 for women.

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HEALTH RISKS

Obesity leads to very serious health problems, on a par with smoking. It substantially reduces life expectancy.

Harvard School of Public Health has an excellent summary of the associations between obesity and adult health.

Health risks for children

Obesity exposes children to some serious health risks - both physical and psychological. It also greatly increases their risk of becoming obese adults, with all the serious health effects that this brings.

Risks to children's physical health include

asthma and breathing problems during sleep

liver disease

type 2 diabetes

high blood pressure and other risk factors for heart disease

menstrual problems and early periods in girls

problems with bones, joints and muscles.

Type 2 diabetes was virtually unknown in children before the obesity epidemic.

Risks to psychological and social well-being

Overweight and obese children and adolescents are more likely than those of normal weight to experience isolation, stigmatisation and bullying, and to have psychological and psychiatric problems.

Childhood obesity persists into adulthood

The risk of obesity in adulthood is three to ten times higher for people who were obese as children. Cardiovascular disease in adulthood can have its origins in childhood obesity. There is an increased risk of earlier death for those overweight or obese at age 18.

Health risks for adults

Risks to physical health

Obesity in adulthood raises the risk for a number of serious diseases and conditions, including those that most New Zealanders will die from. The result can be a serious reduction in quality of life, as well as increased risk of earlier death.

Risks to health include heart disease, some cancers, type 2 diabetes, stroke, metabolic syndrome, gallbladder disease, liver disease. reproductive disorders, osteoarthritis and gout, respiratory problems, and sleep-related breathing disorders.

An American study showed that obesity appears to have an even stronger association with chronic medical conditions such as heart disease, type 2 diabetes and cancer than either smoking or problem drinking.

The risk of earlier death

A Ministry of Health and University of Auckland study estimated that in 1997 more than 3000 deaths in New Zealand were attributable to overweight and obesity. This was 11 percent of all deaths. More than 37,000 years of life were estimated to be lost as a result.

These deaths occurred through the impact of higher body weight on heart disease, stroke, diabetes, and colorectal and breast cancers.

A study estimated that Americans aged 40 have a life expectancy 6 to 7 years less than that of normal-weight Americans. This is similar to the risk from being a smoker.

Obesity and type 2 diabetes

Type 2 diabetes is a serious and growing health problem in New Zealand, particularly among Maori and Pacific peoples. It can lead to severe disability and death.

Increased obesity is considered to be the main reason for the increase in type 2 diabetes.

Among the more serious outcomes of type 2 diabetes are blindness, kidney disease leading to kidney failure, neurological problems, cardiovascular complications, and foot amputation.

A Ministry of Health study estimated that in 1996 almost 1500 deaths in New Zealand were attributable to diabetes (mainly type 2), with almost 20,000 years of life lost.

Obesity and cancer

A major international review published in 2007 pulled together research on the relationship between body fat and cancer. It found convincing evidence that body fatness increases the risk for a wide range of cancers.

Risks to social well-being and psychological health

Research evidence, mainly from the United States, shows that obese individuals are often stigmatised and discriminated against. Because of their obesity they can be denied jobs, disadvantaged in education, and marginalised by health care professionals. This can have a large impact on their social status and quality of life.

These social disadvantages can contribute to psychological problems.

References on the health risks of obesity

Sturm, R. The effects of obesity, smoking and drinking on medical problems and costs. Health Affairs, 21(2), 245-253.

Ministry of Health and University of Auckland. Nutrition and the burden of disease: New Zealand 1997-2011. Wellington: Ministry of Health, 2003.

Peeters, A.,et al. Obesity in adulthood and its consequences for life expectancy: A life-table analysis. Annals of Internal Medicine, 138(1), 24-32 (PDF)

World Cancer Research Fund / American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective.Washington DC: AICR, 2007.

Submission to the Health Select Committee Inquiry into Obesity and Type 2 Diabetes in New Zealand. Wellington: FOE, 2006. Chapter 4. (PDF)

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Obesity leads to very serious health problems, on a par with smoking. It substantially reduces life expectancy. Harvard School of Public Health has an excellent summary of the associations between obesity and adult health. Obesity exposes children to some serious health risks - both physical and psychological.

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New Zealand's weight problem is gobbling up more than 4 per cent of what we spend on health care, according to a study out today.

That was $624 million, estimated to have been spent on health care for the obese and overweight in 2006. The sum includes both private and government spending.

Two-thirds of New Zealand adults are overweight or obese.

The researchers' paper, in the Australian and New Zealand Journal of Public Health, says studies in other countries, using different methods from the New Zealand analysis, have estimated the costs of obesity at between 2 per cent (Sweden) and 7.6 per cent (Australia) of national health spending.

The New Zealand study estimated lost productivity associated with being overweight and obese was worth between $98 million and $225 million.

The health care costs included spending on GP visits, drugs, hospital care, laboratory tests, allied health care (such as podiatrists) and aged residential care.

At 38 per cent, type 2 diabetes accounted for the greatest share of the health care costs followed by high blood pressure at 27 per cent. Of the cancers, bowel cancer had the highest level of expenditure at $7 million, or 1 per cent of the total.

The researchers said: "Policies and interventions are urgently needed to reduce the prevalence of obesity, thereby decreasing these substantial costs." One researcher, Professor Boyd Swinburn, of Auckland University, urged the Government to act on his six-point prescription to deal with New Zealand's "obesity epidemic".

"There are policies and regulations that most Governments, including New Zealand's, are not taking up. They have been shown to be cost effective and have a big impact, but they are not doing it because the food industry doesn't like it and puts pressure on the Government.

"It was short-sighted to remove the guidelines [ virtually banning schools from selling unhealthy foods]."

Health Minister Tony Ryall said the Government was considering extending Project Energize to all primary schools. Project Enegize is funded by the Waikato DHB and aims to improve nutrition and physical activity levels among school children.

TV food advertising during "children's television time" had been restricted but there was no plan to bring back Labour's rule limiting unhealthy food sales at schools to once a term, Mr Ryall said.

What the Govt could do
1. Reduce junk-food ads aimed at children.
2. Traffic-light labelling to identify healthy and unhealthy foods.
3. Remove GST from healthy foods.
4. Require government departments and hospitals to have healthy-food policies.
5. Prevent schools from selling unhealthy foods.
6. Extend Waikato's Project Energize to all primary schools.

Source: Professor Boyd Swinburn

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New Zealand's weight problem is gobbling up more than 4 per cent of what we spend on health care, according to a study out today. That was $624 million, estimated to have been spent on health care for the obese and overweight in 2006. The sum includes both private and government spending.

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Obesity, poverty and education are all linked, but like a whole chicken and half a dozen eggs it's difficult to know what part of the problem should be addressed first.

One thing's for sure, just giving poor, under educated obese people more money is unlikely to be successful in addressing the problem.

A report by the Institute of Economic Research says that Obesity linked to cycle of poverty.

Obese people are more likely to be stuck in a "vicious cycle" of poverty because they perform poorly in school and miss out on jobs, researchers say.

A report, by the New Zealand Institute of Economic Research, said adults living in poor areas were 1.6 times as likely to be obese as those in other areas, and "face challenges at lifting their socio-economic status", starting with lower education.

"Obese children don't tend to do as well academically as their peers," the report said.

"Those lead in turn to lower wages, employment and social deprivation which increase the likelihood of obesity."

It's a First World problem where poor people tend to be fatter.

Edgar National Centre for Diabetes and Obesity Research director Professor Jim Mann said low socio-economic status was a "vicious cycle" for those with obesity.

"Being economically disadvantaged is a predisposing factor to obesity. One reason is good food preparation requires either time or money. If you are rich you can get good food or if you have a lot of time you can soak the lentils, et cetera.

But most of the poorest people are beneficiaries. They generally should have more time to prepare food than working parents. So do they make poor choices with their selection of food?

Just giving poor people more money risks them making more poor food choices.

Countering the high economic and social costs started with the surrounding environment, said Mann.

"If people are not bombarded with high saturated fat, high sugar kind of food everywhere they go . . . if you didn't have people who are socio-economically disadvantaged you would lose an enormous amount of obesity.

Fast food and convenience food advertising often targets the more poorly educated demographic. For example a lot of McDonalds advertising seems to feature dumb people.

Poorly educated people may be more susceptible to being duped by advertising and high pressure sales methods.

"The most important thing is to create an environment that reduces the risk of obesity,

Better education.

Better education to improve employment and earning opportunites.

Better education on nutrition food preparation.

And education on how not to be sucked into manky marketing? A lot of advertising tries to sell things people don't need or are bad for them.

The big problem is that these are ingrained inter-generational problems.

Taking over parent's responsibilities and feeding kids at school won't fix obesity - the kids will still overeat at home.

There are Government initiatives that try to address this at the level of young school leavers. I know of second chance educators who provide food free to teenagers who have failed in the education system. But that food is largely ignored,

In a society that's more advanced than any in world history it's ironic that we haven't figured out how to do one our most fundamental functions - to eat sensibly and safely.

A major problem is that the rate of change of society has been much faster than normal human learning and evolution works.

This is potentially a lot more serious a problem for humankind than climate change - the climate has fluctuated for eons, but the current state of a high tech high pressure marketing fattening society is unique.

Will we ever catch up? Or will we kill ourselves off?

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Obesity, poverty and education are all linked, but like a whole chicken and half a dozen eggs it's difficult to know what part of the problem should be addressed first. One thing's for sure, just giving poor, under educated obese people more money is unlikely to be successful in addressing the problem.

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New Zealand children live in an environment where unhealthy food is more heavily promoted, more accessible and, for the most part, cheaper than healthy food. That's the conclusion from several studies from the Health Promotion and Policy Research Unit (University of Otago, Wellington).

"Obesity is a serious problem and it's getting worse," says director and lead researcher Dr Louise Signal. "Our research shows that it's a significant health issue that will have huge costs for the public health system in the future from diseases such as diabetes. "Over the last four years we've investigated whether or not our children live in an 'obesogenic' environment - one that encourages them to become obese. Our research findings now show that they do."

Signal and her colleagues believe there is enough evidence to act to improve children's food environment. The research suggests advertising and marketing restrictions are needed, that zoning by-laws around schools should be considered and that there is an urgent need to ensure that no children go hungry in a food-rich society. These findings are supported by other New Zealand and international research.

Ministry of Health figures show that one in five children under 14 years is now overweight, one in 12 is obese and the rate of obesity for Māori is twice that of European New Zealanders. The World Health Organisation has long identified major links between childhood obesity and chronic diseases in adulthood, and this is accepted by most international public health experts. "What we've done in the New Zealand context is to explore what's encouraging obesity in our children. A key factor appears to be living in an environment that promotes consumption of energy dense, nutrient poor or 'junk' food," says Signal.

Signal's research reveals that, compared to Australia, New Zealand TV channels show a very high proportion of food advertisements that can be classed as "obesogenic". She says the ads promote unhealthy food that is high fat/high sugar, with 70 per cent of food ads counter to improved nutrition.

On the same channels only five per cent of advertisements favour improved nutrition. The number of food advertisements per hour on one channel (TV2), mainly watched by younger age groups, increased from eight ads an hour in 1997 to 12 per hour in 2005. This research suggests that New Zealand children are exposed to at least 5,000 television advertisements for unhealthy food every year, if they watch two hours of television a day - and many New Zealand children watch much more.

Sponsorship of sports for young people is another area the Wellington researchers say is dominated by unhealthy products - mainly ads for gambling, alcohol, and "junk" food. The researchers suggest increased regulation to control this sponsorship and to provide alternative funding for these sporting activities.

Signal and her colleagues have also revealed that advertising of "junk" food is more prevalent near secondary schools and is not compatible with nutritional guidelines for adolescents. More than 70 per cent of these ads can be classified as unhealthy. Salad options are less available in lower socio-economic areas and there are more "junk" food outlets closer to these secondary schools.

In a controversial study of a nutritional food - milk - Signal and Moira Smith also revealed the health impacts on children of escalating prices. The study clearly demonstrated that milk prices have increased rapidly in recent years, making access to this basic food increasingly difficult for many families. "This is ironic in a country that produces enough milk each year to feed one hundred million people," says Signal.

She says 17 per cent of New Zealand children do not drink milk at all, 34 per cent drink it weekly and only 38 per cent drink it on a daily basis. At the same time, unhealthy, sugar-laden fizzy drinks are cheaper than milk in most supermarkets.

On a more positive note, Signal says there has been some improvement in the foods available in settings such as schools, under the Ministry of Health's Healthy Eating - Healthy Action Strategy.

"While some interventions have been withdrawn by the incoming government before they could be fully evaluated, the challenge now is to keep policies and resources in place to cement such improvements, and work to improve the availability and promotion of healthy food where children live."

Signal and colleagues are now furthering their investigations into children's food environments by looking at the extent sports settings encourage unhealthy eating. They are particularly interested in the availability and promotion of "junk" food around the two most popular winter sports, rugby and netball.

Funding

Health Research Council of New Zealand (Sports setting research)

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New Zealand children live in an environment where unhealthy food is more heavily promoted, more accessible and, for the most part, cheaper than healthy food. That's the conclusion from several studies from the Health Promotion and Policy Research Unit (University of Otago, Wellington).

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Children in poor schools are not just poor - they're also more likely to be overweight and obese than their counterparts in rich schools.

Data from 125 schools gathered for the Waikato District Health Board's "Project Energize" has found that boys and girls are more than twice as likely to be obese at the age of 10 if they attend schools in the poorest three income deciles than if they go to schools in the richest three deciles.

The project has found that an "alarming" two out of every five 10-year-olds in the poorest schools are overweight.

One in every six boys in those schools, and one in every seven girls, are officially obese.

But in the richest schools, significantly fewer girls and less than half as many boys are overweight, and only about one in every 20 is obese.

Paediatrician Dr Dave Graham, who is leading the research, said the figures showed that poor families could not afford to buy their children healthy food.

Their children were more likely to suffer tooth decay, high blood pressure, asthma and eventually diabetes and heart problems.

Waipareira Health clinical director Dr Nikki Turner told a post-Budget breakfast in Auckland yesterday the $76 million anti-obesity campaign unveiled in the Budget would not tackle the problem unless the root causes of child poverty were addressed.

Prime Minister Helen Clark told another post-Budget event that today's children could be the first generation to die at an earlier age than their parents unless obesity was beaten.

Project Energize, which started early last year, is testing the effects of changing children's diet and exercise in 62 Waikato primary schools, compared with 63 "control" schools that do not receive the programme.

Project workers are organising "walking school buses", teaching children to ride bikes to school, and running seminars for parents on healthy food, playing with their children and giving children outside play time.

All pupils in the 11 schools in the poorest decile 1 are getting a free piece of fruit a day through the Government's Fruit in Schools scheme, and 5- and 6-year-olds in those schools are getting free milk from Fonterra.

Children in decile 2 to 4 schools are getting a free apple a day through the winter months, thanks to Hamilton orchardist Bob Christey and the Perry Foundation.

Although the first report on the results is not due until next January, Dr Graham said the attitudes of both schools and communities "appear to be changing for the better".

He said a trial in Auckland last year found that many children in low-decile schools did not recognise common fruits because their parents had never been able to buy them.

"I support the observation that the most impoverished among us are also likely to be the least healthy, because of access to resources and to healthy, nutritious food," he said.

"If Coke is less expensive than milk, what are you going to drink? When you can get a cheap loaf of bread for $1, what are you going to eat?"

Dr Turner said poor people were more likely to fill up on "poor-quality, high-density" foods such as white bread and jam, rather than eating healthier but dearer foods such as fruit and vegetables.

"We are not going to solve obesity until we address the issue of children in poverty," she said.

"There is no new income in this Budget for children whose parents are on benefits. Why are those children marginalised because they have the misfortune to have been born in a family whose parents are on a benefit?"

She called on the Government to provide free, nutritious breakfasts to all children in decile 1 and 2 schools.

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Children in poor schools are not just poor - they're also more likely to be overweight and obese than their counterparts in rich schools.

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Childhood obesity in New Zealand - New Zealand Medical Journal

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New Zealand has an unacceptably high rate of childhood obesity at 11 percent of children. The cause is due to an over consumption of food particularly in the form of junk food. To reverse this serious problem an all of society approach with leadership from the government is going to be required.

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Research has shown how ditching sugary drinks in favour of water has a tangible impact on cavities in children's teeth.

In 2007, decile 1 Yendarra School in South Auckland adopted a 'water only' policy for drinks and asked parents to provide healthy lunches made up of salads, sandwiches, fruit, water and milk.

Over seven years the average number of cavities dropped 'significantly' and the number of extractions due to decay halved, according to a study by Auckland Regional Public Health Service.

"Sugar is the most important determinant of rotten teeth," lead author Dr Simon Thornley of Auckland Regional Public Health Service said.
READ MORE: * Coca-Cola Amatil NZ boss Chris Litchfield says soft drinks are fine in moderation
* Call for ban on all juices and soft drinks in schools as 29,000 kids' teeth pulled in a year
* Ground-breaking sugary drinks policy at Nelson Marlborough DHB
* New Zealand dentist Rob Beaglehole convinces World Health Organisation to remove sugary drinks
Thornley and his team examined 3813 records of children who attended dental exams in the schools of interest and found the number of cavities in primary and adult teeth was 0.37 lower for Yendarra's pupils, when compared to schools that were similar.

"It is significant because it means basically there's 0.4 less decayed teeth per child compared to comparable schools," public health dentist and veteran anti-sugar campaigner Dr Rob Beaglehole said.

Yendarra School principal Susan Dunlop was still on holiday on Wednesday and could not be reached.

The majority of the school's pupils are Maori and Pasifika. It has a 1a decile rating.

"What that means in laymans terms, on the socio-economic scale, it's the lowest of the low," Dunlop said in a Tedx talk in Manukau, Auckland, in 2015.

The school had historically been plagued by poor attendance, bad behaviour and food choices, Dunlop said.

Since the switch, Dunlop has reported behaviour, achievement levels and attendance has improved, and there has been a reduction in skin infections, as well as better dental health.

She expected a raft of parent complaints when the initiative began, but the school received just one.

"The kids lost so much weight because they weren't having sugary drinks that they had to bring in smaller uniforms," Beaglehole said.

Beaglehole and Thornley both want to see a 'water only' policy implemented by all schools.

Thornley said the strict nutrition policy was "likely to reduce health-care costs associated with the treatment of cavities".

"I think we worked out we spend about $20m a year in NZ putting kids under general anesthetic to treat the sugar addiction. To me it's totally unnecessary."

"But because we are swimming in sugar as a society, that's the price we have to pay.

"If we can use schools and early childhood centres to get the message through, that's great."

Nationally, 5500 children aged under 8 had to have their teeth pulled under general anaesthetic in 2015, Beaglehole said.

"The number one reason children are admitted to hospital in New Zealand is to get their teeth out under general anaesthetic.

"Dentists are sick and tired of this pain and suffering they are seeing daily.

"I've taken out 10 teeth on an 18-month-old who was still in nappies and had been consuming Coke in a baby bottle."

- Stuff

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The decile 1 school that quit sugar and improved its pupils' teeth

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Research has shown how ditching sugary drinks in favour of water has a tangible impact on cavities in children's teeth. In 2007, decile 1 Yendarra School in South Auckland adopted a 'water only' policy for drinks and asked parents to provide healthy lunches made up of salads, sandwiches, fruit, water and milk.

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Obesity policy-makers place too much emphasis on exercise, smoking and weight loss, and not on complex biological and cultural factors, says a New Zealand-led study.

The commentary paper co-authored by the Prime Minister's chief science adviser Professor Peter Gluckman urges politicians and scientists to see the bigger picture in their attempts to stem rising epidemics of obesity worldwide.

The paper, which is aimed at the treatment of obesity in poorer countries, is published today in the journal Science Translational Magazine.

Professor Gluckman and colleagues wrote that wealthy nations' failure to lower obesity rates and its related disorders was partly due to the focus on changing adult life-styles - banning tobacco, and encouraging exercise and weight loss.

The authors emphasised that this limited prescription must not be naively passed on to poorer countries, which are experiencing alarming increases in obesity.

"It is crucial that we apply lessons from the failure of wealthy countries to curb obesity and not extend ineffective strategies to the developing world," the article said.

Professor Gluckman said the capacity for developing countries to deal with people who had already been diagnosed with obesity-related disorders was limited. He said more emphasis should be placed on the biological drivers of obesity.

"The more and more we look, the more we realise that there are fundamental differences in biology which determine whether you are going to get diabetes or not, which are set up in early life."

The paper said there was evidence that during development, an embryo, fetus or infant took cues from its environment to set patterns of metabolism or energy use in later life, and that these contributed to its body-type.

In April, the Liggins Institute contributed to breakthrough research which showed a pregnant mother's diet could alter her future child's DNA, potentially determining whether they will grow up to be obese.

Professor Gluckman said these biological factors needed to be viewed alongside cultural perceptions in poorer countries.

The paper cited several complex cultural factors. Populations and individuals showed contrasting patterns of fat deposition. The ideal body shape was different depending on cultural and social influences. And symptoms of obesity were slow to develop, making it difficult for people to commit money to unseen problems.

The authors noted that economic transition towards affluence often gave poorer countries more access to junk food, which was cheaper than high-quality fresh foods.

Weighty problem
* Different societies have widely varying perceptions of ideal body shape.
* Diseases associated with obesity are often slow to develop, making it difficult to commit money to treatment.
* Economic progress gives countries greater access to cheaper, refined foods which have lower nutritional value.

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'Biology, culture play big part in obesity'

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Obesity policy-makers place too much emphasis on exercise, smoking and weight loss, and not on complex biological and cultural factors, says a New Zealand-led study. The commentary paper co-authored by the Prime Minister's chief science adviser Professor Peter Gluckman urges politicians and scientists to see the bigger picture in their attempts to stem rising epidemics of obesity worldwide.

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They are low-income workers or beneficiaries, they like sport on television but can't afford the gym, they love the ease of takeaway food and can't afford to buy healthily.

These are the New Zealanders most likely to be obese - with researchers saying obesity is a symptom of poverty rather than an issue of education or culture.

New profiling research from Roy Morgan has identified those most prone to weight issues in New Zealand, where they live, how much they earn and how concerned they are about it.

According to the research, working-class suburbs such as Otara, Manurewa and Glen Innes in Auckland, as well as Porirua, north of Wellington, are home to the biggest people.

These people watch a lot of television and being on a low wage or unemployed, cannot afford healthy food or gym memberships.

Research shows they are most likely to be Maori or Pacific Islander, young, from a single-income household and with small children.

Many are unemployed or underemployed, using part-time work to supplement benefits. They are unhappy with their lot but resistant to change.

Another group very likely to be battling their weight are Pacific Island or Maori families with adult children still living at home and on very low incomes.

They don't feel financially stable and those who do work are likely to be in transport or warehouse work.

Anti-obesity campaigner Robyn Toomath said the research supported her findings that it was poverty, not culture, that led to obesity.

"It's the affordability and accessibility of healthy food, it's not just a matter of straight cost. There are a lot of Pacific Island families where people are working two jobs - the low wage economy means people don't have the time [to cook healthily]."

South Auckland residents spoken to by the Sunday Star Times agreed money and accessibility was a barrier to their health.

Mangere town ambassador Monique Takie, 39, said she knew she needed to do more exercise but generally stuck to a bit of walking as gyms were expensive.

"If you have money then you can afford to buy vegetables, fish or healthy food like chicken. Health is a priority but because everything costs money, it's very hard.

"I have takeaways sometimes and fizzy drink because it's cheaper than bottled water."

Takie believed tap water wasn't healthy to drink.

Retiree Mata Ella, 74, said she knew she was big but she had never thought of herself as unhealthy.

She said her six children had all grown up and had kids of their own and her family were all big naturally.

"I'm low income but the way I look at my life, I never put money on the wrong thing.

"But the more money you have the better."

She said she ate hot chips sometimes and might have McDonald's for lunch but she ate slowly so it would be healthier.

Cash-strapped segments of society made up half the 10 obesity-prone profiles put together in the research.

They might be provincial families who prefer television to physical exercise or blue-collar households struggling enough to be more worried about finances rather than their weight.

Big Boy Burgers owner Chris Finan, 35, guessed only one per cent of businesses in South Auckland sold fresh food and he thought someone needed to "examine" the situation. His business was mobile but he stuck to South Auckland because he said "rich people" wouldn't eat his food.

"Fast food is just so easily accessible. The first thing you see in the supermarket there is chips and drinks. I reckon it's too expensive to buy healthy food."

About one in three New Zealanders are above the acceptable weight category.

The flipside to the poor and fat profile is the slim and wealthy.

The research shows those who are young, educated and urban and, more often than not, from Asian descent are 65 per cent more likely than the average New Zealander to be an acceptable weight. They are said to be health-conscious but not overly so, and on their way to big pay packets.

The over-representation of poor people among obese adults was concerning, Roy Morgan research general manager Pip Elliot said.

"These people can't afford health food or gym memberships, much less medical treatment for the health conditions that often arise from obesity [diabetes, for example]. What's more, the areas they live in aren't always well-equipped to provide the services they need."

Toomath said poorer suburbs often did not have the infrastructure to support healthy lifestyles. There were often not enough cycleways, it wasn't safe to walk alone in some areas and there were limited playgrounds for children.

Toomath wanted the Government to add a significant tax on soft drinks and take GST off fruits and vegetables.

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They are low-income workers or beneficiaries, they like sport on television but can't afford the gym, they love the ease of takeaway food and can't afford to buy healthily. These are the New Zealanders most likely to be obese - with researchers saying obesity is a symptom of poverty rather than an issue of education or culture.

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It's tempting to blame poor diets on the cost of healthy food. But does that stand up to scrutiny? Chloe Winter speaks to the experts..
It's a familiar complaint: why is Coke cheaper than bottled water? Why are fish 'n' chips cheaper than a home-cooked meal?

How can we be expected to eat healthy, so the line goes, when takeaways and treats are cheaper and more convenient?

There is more than a grain of truth there - but experts say the wider issue is our attitude towards food preparation..

Fifty years ago, the default scenario had the man of the house as the breadwinner, and the woman as a full-time housewife who prepared home-cooked meals. Nowadays, men and women both have demanding jobs, so there is less time to cook a meal from scratch.

Otago University department of human nutrition associate professor Winsome Parnell said healthy foods were not always more expensive, and the real issue was that Kiwis lacked food preparation skills.

"Fifty years ago, supermarkets didn't look like they do today - I'm old enough to remember that - and we cooked food from scratch. So you made a meal by peeling potatoes, chopping carrots, cutting up a cabbage, cooking a casserole, you didn't buy a pizza, or pre-prepared foods. You just did it.

"What has changed is that people now expect to spend little time preparing food and to be able to buy a lot of it pre-prepared," she said.

"So if you want to do that, the cost of the food is higher because there is still processing gone into it - it's halfway there before you buy it.

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"You are paying for the preparation. Now that's an expectation, which, 50 years ago, we didn't have."

But how has the cost of food changed how we eat?

"It hasn't," Parnell said.

"Put it this way: if you are on a constrained income - either on a low income, or on a benefit - you will find it difficult to buy all the healthy foods you need because cost becomes a greater influence.

"So cost affects the food that all of us choose - whether we are on a high income or low income - but ... when the proportion you would spend on food gets constrained, you will probably be forced to buy less of the healthy options."

So is eating healthier more expensive?

"For some things yes, for other things no," she said.

​Sally Mackay, a research assistant at the University of Auckland, said New Zealanders did not need to spend more to have a healthy diet.

"People can be tempted to buy convenience foods and fast-food due to lack of time. Preparing healthy meals can take time.

"We compared the cost of popular takeaway meals to similar healthy meals prepared at home - the home-cooked meals were cheaper than the takeaway meals."

Adding the cost of preparation and waiting time meant half the home-cooked meals were still cheaper than the takeaway meals, Mackay said.

"There is a perception that healthy food costs more.

"I think the increase in availability, accessibility and marketing of cheap junk foods that are high in energy, salt, fat and sugar has made it easier to choose unhealthy foods over healthy core foods like fruit and vegetables."

However, New Zealanders had made some positive changes to their diets, such as eating less saturated fat.

"But fruit and vegetable intake is still inadequate for many and of course the prevalence of overweight and obesity has increased."
OUR KEY FINDINGS (based on inflation-adjusted figures):
* Food prices followed a downward trend (with the odd blip) for 30 years between 1975 and 2005, but have begun to creep up again in the past decade.

* The price of all items have come down over time, except beef and milk.

* Beef prices saw the biggest increase, up 87 per cent, while milk was up 37.5 per cent.

* Cheese and ice cream prices have come down by about 50 per cent over 50 years.

* In 1987, the cost of buying every item (excluding eggs and oats) in our basket was down 16 per cent on the year before. Almost all items were down, with the biggest decreases being onions, potatoes and carrots, which were all down by between 27 per cent and 35 per cent.

* In 2008, the largest annual increase in recent times, with the total cost of buying one of each item (excluding eggs and oats) in our basket up 13.7 per cent. Carrots, potatoes and butter were all up by more than 30 per cent.
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- Stuff

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Is healthy food really more expensive than junk food?

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It's tempting to blame poor diets on the cost of healthy food. But does that stand up to scrutiny? Chloe Winter speaks to the experts.. It's a familiar complaint: why is Coke cheaper than bottled water? Why are fish 'n' chips cheaper than a home-cooked meal?

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Tylah Mani

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Adult obesity statistics

The New Zealand Health Survey 2019/20 found that:

around 1 in 3 adults (aged 15 years and over) were obese (30.9%)

the prevalence of obesity among adults differed by ethnicity, with 63.4% of Pacific, 47.9% of Māori, 29.3% of European/Other and 15.9% of Asian adults obese

adults living in the most socioeconomically deprived areas were 1.8 times as likely to be obese as adults living in the least deprived areas*

the overall prevalence has remained relatively stable since 2012/13, however there was an increase between 2011/12 and 2019/20 for adults aged 45-54 years and 55-64 years.

Child obesity statistics

The New Zealand Health Survey 2019/20 found that:

around 1 in 10 children (aged 2-14 years) were obese (9.4%)

the prevalence of obesity among children differed by ethnicity, with 29.1% of Pacific and 13.2% of Māori obese, followed by 3.4% of Asian and 7.2% of European/Other children

children living in the most socioeconomically deprived areas were 2.7 times as likely to be obese as children living in the least deprived areas*

the child obesity rate has decreased since 2018/19, and while this has decreased since last year, it is too early to report a trend.

For more information refer to the Tier 1 statistics 2019/20: New Zealand Health Survey.

* Adjusted for differences in age, sex and ethnicity.

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The New Zealand Health Survey 2019/20 found that: around 1 in 3 adults (aged 15 years and over) were obese (30.9%) the prevalence of obesity among adults differed by ethnicity, with 63.4% of Pacific, 47.9% of Māori, 29.3% of European/Other and 15.9% of Asian adults obese adults living in the most socioeconomically deprived areas were 1.8 times as likely to be obese as adults living in the least deprived areas* the overall prevalence has remained relatively stable since 2012/13, however there was an increase between 2011/12 and 2019/20 for adults aged 45-54 years and 55-64 years.

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New Zealanders walk an average of almost four kilometres a day, according to new research by Stanford University. Sounds pretty decent, right?

Unfortunately, at 4,582 steps a day we pale in comparison to many other nations (even Americans, who take an average of 192 more steps than us). Australia and the UK beat us too, alongside almost every country in Europe and Asia.

Perhaps we can put this down to our car culture - few people walk to work, unlike a city such as Hong Kong (inhabitants of which take the world's most steps a day at 6,880).

Regardless, the Stanford study finds that the total amount of steps a person walks in a day doesn't have much of a correlation to overall obesity.
READ MORE:
* How did NZ get so fat?
* Fighting fat in NZ
* Move over obesity, the new problem is 'overfat'
You're probably breathing a sigh of relief: Kiwis aren't that lazy after all

We go to the gym, we ride bikes, we swim, we play sports... all things that don't count in daily steps.

Unfortunately, New Zealanders are still fat. Really fat.

In 2016, Kiwis were found to be the chubbiest of 11 nations surveyed by Cigna 360° Wellbeing Score research, and we're also in denial about it. We underestimate how overweight we are on the whole, we're used to seeing children who are fat, and we're not comfortable accepting the word "obese".

And we're getting worse: in the latest 2017 research, our general health score is 1.7 per cent lower than last year. How on earth have we become so large around the middle?
IT'S IN THE FAMILY
Swedish research has found that overweight mothers are nearly three times more likely to have overweight children than non-overweight mums. Sometimes this is down to lifestyle choices, but it can also be genetic: The Auckland-based Maurice Wilkins Centre is currently researching how 500+ genes affect your appetite and the way your energy metabolism is controlled.

Some genes have already been discovered in other studies; for example the gene CREB R.F helps explain why 80 per cent of Samoan men and 91 per cent of Samoan women are overweight or obese.
OBESITY STARTS YOUNG
Between November 2016 and May 2017, more than 2000 four-year-olds were diagnosed as obese in New Zealand in before-school screening programmes.

Children's high activity levels are vital in preventing obesity as adults (University of Auckland researchers have found that exercise in early life counteracts some of the damaging programming effects of a high-fat diet), but as one third of Kiwi children is already considered overweight of obese, we're not giving them a fighting chance with critical early-life intervention.
NZ TEENS ARE LAZY TOO
According to the Ministry of Health, only 10 per cent of secondary school pupils meet the daily youth exercise recommendation of one hour per day.

Sixty-five per cent of teenagers are also watching more than an hour of television every day, while 28 per cent watch more than three hours. Additionally, 32 per cent of male teenagers (but only nine per cent of females) in New Zealand can be found gaming for more than three hours a day.
PROCESSED JUNK FOOD IS EVERYWHERE
Australian research published in the Lancet journal in 2014 points the finger at the low level of regulation in Australasia for junk food manufacturers.

With no sugar taxes in place and an advertising and marketing environment geared towards consumption of "junk drink and junk food" (alongside the relatively low cost of such food compared to fresh vegetables, fruit, meat, and dairy), processed and unhealthy food is literally everywhere.

No wonder one-third of Kiwis have sugary drinks in their fridge and we have more fast food outlets per capita than almost any other nation on the planet.
WE DON'T REALLY PLAY RUGBY
We're known as a sport-playing nation, but that's seemingly just a lie we tell ourselves.

According to Cigna 360° Wellbeing Score research, we don't actually play sport. We watch sport. A minuscule four per cent of Kiwis actually play rugby, and seven of 10 rugby fans can be medically classified as overweight or obese.
ONLY HALF OF US ARE ACTIVE
Statistics NZ data shows that less than 50 per cent of Kiwis overall participate in physical exercise. The most active groups overall are18-24 and 25-44 year old males (53.8 per cent are active), while the least active groups are 15-17 and 75+ year old females (33.6 and 29.9 per cent active, respectively).

Statistics NZ and the Ministry of Health defines "active" as "at least 30 minutes of brisk walking or moderate-intensity physical activity (or equivalent vigorous activity), for at least 10 minutes at a time, at least five days a week", but more than half of us aren't even doing that minimum amount.
* Comments on this story are now closed.
- Stuff

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Why New Zealanders are still among the fattest people in the world

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New Zealanders walk an average of almost four kilometres a day, according to new research by Stanford University. Sounds pretty decent, right? Unfortunately, at 4,582 steps a day we pale in comparison to many other nations (even Americans, who take an average of 192 more steps than us).

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Overweight and obesity prevalence among adult Pacific peoples and Europeans in the Diabetes Heart and Health Study (DHAHS) 2002-2003, Auckland New Zealand - New Zealand Medical Journal

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There is little information on perceptions and attitudes of body weight in New Zealand. Furthermore, information specific to Pacific ethnic groups on obesity and overweight is scarce. This study aims to address these information gaps by reporting ethnic-specific proportions of overweight, obese and average BMI by gender.

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Obesity policy-makers place too much emphasis on exercise, smoking and weight loss, and not on complex biological and cultural factors, says a New Zealand-led study.

The commentary paper co-authored by the Prime Minister's chief science adviser Professor Peter Gluckman urges politicians and scientists to see the bigger picture in their attempts to stem rising epidemics of obesity worldwide.

The paper, which is aimed at the treatment of obesity in poorer countries, is published today in the journal Science Translational Magazine.

Professor Gluckman and colleagues wrote that wealthy nations' failure to lower obesity rates and its related disorders was partly due to the focus on changing adult life-styles - banning tobacco, and encouraging exercise and weight loss.

The authors emphasised that this limited prescription must not be naively passed on to poorer countries, which are experiencing alarming increases in obesity.

"It is crucial that we apply lessons from the failure of wealthy countries to curb obesity and not extend ineffective strategies to the developing world," the article said.

Professor Gluckman said the capacity for developing countries to deal with people who had already been diagnosed with obesity-related disorders was limited. He said more emphasis should be placed on the biological drivers of obesity.

"The more and more we look, the more we realise that there are fundamental differences in biology which determine whether you are going to get diabetes or not, which are set up in early life."

The paper said there was evidence that during development, an embryo, fetus or infant took cues from its environment to set patterns of metabolism or energy use in later life, and that these contributed to its body-type.

In April, the Liggins Institute contributed to breakthrough research which showed a pregnant mother's diet could alter her future child's DNA, potentially determining whether they will grow up to be obese.

Professor Gluckman said these biological factors needed to be viewed alongside cultural perceptions in poorer countries.

The paper cited several complex cultural factors. Populations and individuals showed contrasting patterns of fat deposition. The ideal body shape was different depending on cultural and social influences. And symptoms of obesity were slow to develop, making it difficult for people to commit money to unseen problems.

The authors noted that economic transition towards affluence often gave poorer countries more access to junk food, which was cheaper than high-quality fresh foods.

Weighty problem
* Different societies have widely varying perceptions of ideal body shape.
* Diseases associated with obesity are often slow to develop, making it difficult to commit money to treatment.
* Economic progress gives countries greater access to cheaper, refined foods which have lower nutritional value.

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'Biology, culture play big part in obesity'

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Obesity policy-makers place too much emphasis on exercise, smoking and weight loss, and not on complex biological and cultural factors, says a New Zealand-led study. The commentary paper co-authored by the Prime Minister's chief science adviser Professor Peter Gluckman urges politicians and scientists to see the bigger picture in their attempts to stem rising epidemics of obesity worldwide.

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Tylah

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Barely a month goes by without the spectre of sugar tax being raised as a weapon in the fight against obesity. We asked experts on either side of the debate to put forward their best arguments for and against implementing a sugar tax in New Zealand.

Dr Simon Thornley is a public health physician and spokesman for FIZZ, a a group of researchers and doctors who advocate for ending the sale of sugary drinks.

He's arguing the case for a sugar tax. Jenesa Jeram is a policy analyst with The New Zealand Initiative, a think tank, which conducts public policy research. She's in the no camp.
THE CASE FOR SUGAR TAX: FIZZ's Dr Simon Thornley New Zealanders are suffering a health crisis likely to be caused by excess sugar intake
New Zealand has the third highest proportion of overweight children in the developed world out of 34 countries, as measured by the Organisation for Economic Co-operation and Development (OECD), with about 33 per cent of children classified as either overweight or obese in 2010.

About-one third of New Zealand adults are obese, and our country is the third fattest nation on this score in the OECD, behind Mexico and the United States. New Zealand is 10th in the OECD in terms of proportion of people with diabetes (one in 10 adults) with one in four adults having pre-diabetes. A disease strongly linked with diabetes and obesity - cardiovascular disease - is the leading cause of death in New Zealand.

New Zealand also has high rates of dental caries in children and treatment poses a significant cost burden to the taxpayer. About 5000 Kiwi children per year require treatment each year to remove severely decayed teeth. Most of these problems are attributable to excess sugar intake.

The weight of scientific evidence shows that people who eat more sugar (sucrose) are more likely to put on weight, become diabetic and develop cardiovascular disease, compared to people who eat less. A range of other diseases and conditions are associated with excess sugar intake, including rotten teeth, high blood pressure, gout, and behavioural and learning disorders in children.
We are eating and drinking too much sugar
Our supermarkets are loaded with sugar, particularly in the form of fruit juices, cordials, soft drinks, breakfast cereals, biscuits and cakes. New Zealand children report eating and drinking about 17 teaspoons per day of sugar, with about 25 per cent of this from sugary drinks.

This figure is likely to be underestimated, since adults and children tend to underestimate their sugar intake. Scientific authorities recommend no more than six teaspoons per day of added sugar for children and none for children less than 2 years old.
Evidence indicates that a sugar tax will improve the health of Kiwis
The most effective means of reducing harm from tobacco has been through imposing an excise tax. We see no reason why a price increase for sugary drinks will not lead to a similar reduction in sugar intake.

Mexico has implemented a 10 per cent excise tax on sugary drinks. Initial results suggest a reduction in intake in sugary drinks. Substantial long-term benefits to the country in terms of improved health and reduced healthcare costs are projected.

A sugary drink tax (US $0.01/30g) in Berkeley, California was introduced in 2014. It has seen an average 21 per cent reduction in sugary drink intake in that city, compared to an average 4 per cent increase in intake in comparison US cities.

A sugar tax is administratively simple to introduce, in a manner similar to taxes on alcohol, tobacco and fuels. Such a tax is likely to save the taxpayer thousands of dollars in avoided healthcare costs.

Funds raised by the tax, which are likely to be substantial, may be used to fund obesity and disease prevention programmes.
THE CASE AGAINST SUGAR TAX: The New Zealand Initiative's Jenesa Jeram A sugar tax could hurt the poor
There are certain policies worth experimenting with. If they are of low cost and will not leave the population any worse off, there is no harm in trying. A sugar tax is not one of those policies. No matter which way you cut it, a sugar tax is regressive: people on lower incomes will pay disproportionately more of the tax than people on higher incomes.

Obesity and obesity-related diseases are disproportionately suffered by lower socioeconomic groups, and it is understandable that sugar tax advocates would want to ease the financial and emotional burdens related to illness. But a sugar tax is a punitive and counter-intuitive way of addressing the problem: make poor people poorer because it's for their own good.

There will be some who argue that those on lower incomes will be most responsive to price increases. But one way of cutting spending is to shift to cheaper brands. Many sugar tax advocates argue that an excise tax worked to reduce tobacco consumption, so it should work for sugar. Yet it is important to remember the magnitude tobacco taxes are currently at. If the tax is really high, like tobacco excise, then there is a greater likelihood people could reduce their consumption accordingly.

Tobacco also has few substitutes, while sugary foods have many. Keep in mind that the more comprehensive (thus likely more effective) the tax, the more likely it is that it will cover what some would consider "essentials". But just like with tobacco, the tax remains extremely regressive for those who do not change their eating habits.

In reality, there are a variety of reasons why people make the diet decisions they do, and sustenance is just one reason. For those who cannot afford other material luxuries, food may be one of the few luxuries a family can indulge in.
Most studies used as evidence do not adjust for how people act in the real world
In the absence of real world evidence, most of the public health studies used as evidence for a sugar tax are based on economic modelling. The problem is, any economic model is only as reliable and strong as the assumptions it makes. And there are two common flaws with the assumptions made in these public health studies (see The New Zealand Initiative's The Health of the State report for examples).

The first is that many studies do not adjust for substituting taxed unhealthy items with untaxed but equally unhealthy items. For example, for people who want to satisfy their sugar cravings, a soda tax may encourage people to switch to candy or flavoured milk.

The second flaw is that many studies that focus on consumer expenditure do not consider the fact people might be downshifting to cheaper brands or cheaper sizes ("family sized" or bulk items). Switching from Coca-Cola to Homebrand cola will cost less but have no health benefits.

There are a growing number of countries that have introduced a sugar tax, and some commentators are urging New Zealand to jump on the bandwagon. While various countries have implemented different variations of food taxes, there has yet to be formal evaluations that prove these taxes reduce obesity.

Other proxies of success, such as purchasing decisions still do not give us the missing piece of the evidence puzzle: whether sugar taxes affect obesity. It is far too early to celebrate examples like Mexico's miniscule decrease in soda purchases when it is not yet clear if the total calories consumed has been affected, and how that affects health outcomes.
The "costs to taxpayers" argument is overblown
A seemingly compelling argument for a sugar tax is that obesity costs the public purse. Treating obesity-related illnesses is expensive but the "costs to taxpayers" of avoidable diseases can exaggerate the real burden to the public purse.

Most "cost of illness" studies talk about the cost of diseases like obesity, without putting those costs into context. After all, there are costs related to living long and healthy too, including end-of-life care and superannuation. In other words, they don't talk about the net costs of obesity. "Cost of illness" studies also often conflate fiscal costs with private costs into one big scary number, rather than being upfront about the real cost to taxpayers. It is likely that compared to the costs of living long and healthy, the costs of obesity to the public purse are not disproportionately large.
Ring-fencing the revenue of sugar taxes is a poor justification
Sugar taxes should not be introduced with the expectation that the revenue gathered could be used to fund health-promoting programmes, or any other "worthy" initiatives. If the purpose of the tax is to discourage consumption of the taxed product, then if successful, advocates should hope that the tax will not raise a lot of revenue.

If the point of the tax is to raise funds for worthy health promotion programmes or other public service projects, it is not clear why these cannot be funded by the government's existing budget or by raising the existing taxes.
Evidence that a sugar tax will work is necessary, but not sufficient
A sugar tax is likely to be regressive, it is not supported by an evidence base, might not address the costliest fiscal problems, and won't raise money for other health programmes if successful.

While a strong evidence base is necessary for any new policy, it is not a sufficient justification for introducing one. Any policy also needs to be scrutinised on a philosophical basis: sugar taxes are a blunt policy tool that affects the entire population: is this an acceptable reason for overriding personal liberty?

Some people might roll their eyes at the idea of liberty.But for anyone who takes pleasure in cutting into a chocolate lava cake, who enjoys a soda on a hot day, or would just plain rather be fat and happy than skinny and miserable, those benefits matter. If sugar tax advocates ignore the benefits of consuming these products, they ignore the very reason people might not act the way advocates want them to.

* Comments have been closed

- Stuff

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The case for and against a sugar tax in New Zealand

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Barely a month goes by without the spectre of sugar tax being raised as a weapon in the fight against obesity. We asked experts on either side of the debate to put forward their best arguments for and against implementing a sugar tax in New Zealand.

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It has become a cultural norm to shun smokers and treat them as pariahs. It was made possible, not by the fact that smokers die younger, but because smokers impacted on those around them.

A fear of second-hand smoke allowed us to treat smokers as second-class citizens.

But obesity, which is now overwhelming this country in terms of presence and impact on our health service, does not receive the same contempt and fear, possibly because of too many links to political correctness and the freedom to live your life your own way.

Basically, if a person gets obese, it's not something I breathe in. I'm not affected by it in a person-to-person sense. It does not affect my mobility, my quality of life. But figures tell me that two-thirds of adults around me are either overweight or obese. A million people in New Zealand are obese. That is going to impact on me as a New Zealand citizen at some point.

Diabetes, obesity and poor health affect productivity, taxes, health care and birth rates. Obese people are a severely negative impact on New Zealand society. If they allow their children to follow the same pattern, could that be called child abuse?

The question New Zealand needs to ask itself is a hard one: are we going to have to be cruel about this? We were pretty cruel to smokers. We talk generically about the "obesity epidemic", lumping in all the fatties in one gigantic impersonal mass, but God forbid we should actually lean hard and get nasty or rude with individuals like we did with smokers. It's not politically correct to let our disgust show.

If we cross that line to the realisation that obese people are detrimental to New Zealand's society, and a drain on our taxes, then maybe it is time to let our disgust show. Perhaps it is time to start taxing and penalising companies and food suppliers that perpetuate the epidemic, and reward those that do not.

We have carbon taxes. There could be fat credits.

It's bloody difficult to be a smoker in New Zealand. But it's far too easy to be obese and still enjoy every privilege of a free, civilised country. We took away a lot of freedoms from smokers, moves that would have been unheard of 30 years ago.

Perhaps, for the good of the country, there needs to be penalties, and loss of certain freedoms, for those who are obese.

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Obesity not seen as big enough of a problem

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It has become a cultural norm to shun smokers and treat them as pariahs. It was made possible, not by the fact that smokers die younger, but because smokers impacted on those around them. A fear of second-hand smoke allowed us to treat smokers as second-class citizens.

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In 2014, the British food industry spent £256million promoting unhealthy foods such as chocolate, fizzy drinks, crisps and ready meals.

The report exposes how firms rely on techniques such as branding packaging with fictional characters popular with children. They also increasingly market junk food using online child-friendly games that subliminally promote products.

Supermarkets are accused of discounting more unhealthy foods than healthy ones and holding far more promotions than shops in other countries - pushing customers to buy sugary treats.

It warns: 'Children in England are exposed to a high volume of marketing in different forms both old (TV advertising, radio, cinema, press and billboards) and new (advergames, social media, online advertising), as well as through sponsorship by food and drinks companies of TV programmes, public amenities and events.

'Available research evidence shows that all forms of marketing consistently influence food preference, choice and purchasing in children and adults.

'The behavioural and health impact of these approaches, particularly on children, has been of concern for some time.'

One of the techniques which came in for particular criticism is the use of 'advergames' to promote unhealthy products.

PHE said they 'persuade on a subconscious, emotional level and can change children's behaviour without their conscious awareness' - and can push them towards unhealthy eating.

'Children as old as 15 often don't recognise these games as marketing,' the report said.

'One study found that children playing advergames promoting unhealthy snacks consumed 77kcal more over the 25 minute snacking period of the study than those playing advergames promoting fruit.'

It added: 'Products considered to be less healthy are being advertised through online channels, including social networks and mobile apps, raising concerns that children might now be exposed to more advertising for less healthy products.'

The study found that sweet manufacturers often use characters as part of their branding, such as Sugar Puffs, Percy Pig, Cadbury Animals and M&Ms. Others make use of film and TV characters.

'Evidence demonstrated that use of brand or "spokes-characters" may increase preference for, or intake of, high sugar foods in young children aged two to seven,' it said.

'Parents find it increasingly difficult to deny their children food products where endorsed by their favourite characters.'

PHE said there is clear evidence that in supermarkets there is a 'promotional bias' towards discounting sugary food items. Buy one get one free deals are heavily skewed towards less healthy products.

Food retail price promotions are more widespread in Britain than anywhere else in Europe, and foods on promotion account for 40 per cent of all food and drink consumed at home.

'Price promotions increase the amount of food and drink people buy by around one fifth,' it said. 'They also increase the amount of sugar purchased from higher sugar foods and drinks by 6 per cent.'

Sales of sugary foods could be reduced, it says, if such items were not so heavily promoted in supermarket displays. 'One study found end-of-isle display locations increased sales of carbonated drinks by 50 per cent,' it concluded.

Earlier this week Dr Alison Tedstone, PHE director of diet and obesity, told MPs that she would like to see the Coco Pops monkey outlawed.

'The evidence is that things like those Coco Pops monkeys do engage children and affect food preference and choice,' she said.

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Daniel Martin Chief Political Correspondent For The Daily Mail

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How Percy Pig and friends target children

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In 2014, the British food industry spent £256million promoting unhealthy foods such as chocolate, fizzy drinks, crisps and ready meals. The report exposes how firms rely on techniques such as branding packaging with fictional characters popular with children. They also increasingly market junk food using online child-friendly games that subliminally promote products.