Explaining resistance to regulatory interventions to prevent obesity and improve nutrition: A case-study of a sugar-sweetened beverages tax in Australia

Globally, 43 jurisdictions have implemented a tax on sugar-sweetened beverages (SSBs) for obesity prevention; however, there is significant political resistance to adopting such a policy in Australia. This paper applies Kingdon’s Multiple Streams Framework (MSF) to the case study of an SSB tax in Australia to identify barriers and enablers to policy adoption, and to inform future advocacy strategies in local and international contexts. A systematic search was conducted of scholarly literature, parliamentary documents and media articles relating to an SSB tax. Information retrieved was analysed and integrated under the ‘problem’, ‘policy’ or ‘political’ streams of the MSF. The findings reveal that Australia is a substantial way from having the conditions in place where a tax might be successfully implemented due to industry influence, fragmented advocacy efforts, political opposition to paternalistic policies, conflicting political agendas, and inadequate pressure for change from civil society. Opening a policy window will require a shift in political ownership of the obesity problem, or the coupling of an SSB tax to an alternative problem. The public health community also needs to agree that an SSB tax deserves greater priority, relative to alternative policies for addressing obesity, and to agree on the most effective tax design.     

‘Globesity’? The effects of globalization on obesity and caloric intake

We examine the effect of globalization, in its economic and social dimensions, on obesity and caloric intake, namely the so –called ‘globesity’ hypothesis. Our results suggest a robust association between globalization and both obesity and caloric intake. A one standard deviation increase in globalization is associated with a 23.8 percent increase in obese population and a 4.3 percent rise in calorie intake. The effect remains statistically significant even after using an instrumental variable strategy to correct for some possible reverse causality and ommited variable bias, a lagged structure, and corrections for panel standard errors. However, we find that the primary driver (of the ‘globesity’ phenomenon) is the ‘social’ rather than the ‘economic’ dimension of globalization, and specifically the effect of changes in ‘information flows’ and ‘social proximity’ on obesity. A one standard deviation increase in social globalization increased the percentage of obese population by 13.7 percent.     

Children aged 9-14 living in disadvantaged areas in England: Opportunities and barriers for cycling

The aim of this paper is to take a holistic perspective to explore levels of cycling and opportunities and barriers to increase children’s safer cycling in disadvantaged areas in England. The study was one part of a larger study which explored the factors underlying the high level of road traffic casualties especially among children in the most disadvantaged areas of England and to explore how this impacts on mobility and quality of life. The methods involved a cross sectional survey comprising school based questionnaire surveys with children aged 9-14 and focus groups with parents who had children within this age range. The surveys were conducted in 2007 and the focus groups during 2008. 4286 children completed the survey and eight focus groups were held. Bike ownership (77%) was high, use in previous week moderate (39%) but only 2% cycled to school. Ownership was significantly lower in minority ethnic groups. Despite young children’s strong preference to travel by cycle (30%) than walk or go by car, most parents felt it was too hazardous. It is unlikely that these findings would be any different from the rest of England, however the combination of environmental and social factors may elevate the risks for young cyclists in these areas. This paper concludes that a number of barriers exist to increasing levels of cycling among children living in disadvantaged areas particularly amongst ethnic groups. These barriers could be addressed by environmental modifications to reduce speeds and by reducing the levels of antisocial driving and riding in residential areas and around destinations where children travel, by providing cycle training to improve children’s skills and parent’s confidence, and by providing secure storage facilities for bikes. Until these barriers are addressed it is unlikely that cycling will increase despite the strong preferences children have to travel by bike. Such preferences to cycle provide an opportunity for local authorities to act on.     

The nutrition transition and agricultural transformation: a Preston curve approach

The nutrition transition in diets and health is closely tied to other aspects of economic development, including agricultural transformation and urbanization as well as demographic change and epidemiological transition from infectious to noncommunicable disease. Over time, dietary patterns typically shift from widespread inadequacy of many foods and nutrients, especially for children and mothers, into surplus energy intake and rising obesity with continued inadequacy of healthier foods. Diet‐related diseases remain the largest single cause of premature death and disability in all regions. This article combines food availability and dietary intake data from more than 100 countries over 30 years with a wide range of other evidence to characterize the nutrition transition and its association with changes in agricultural production and the food environment, asking how future dietary patterns might be steered toward healthier outcomes as national incomes grow.     

营养降脂方便粥的研制

本文重点对营养降脂粥的配方、制作工艺以及操作要点作了介绍。     

The Cost of Obesity in the United Kingdom

Summary

This study provides economic information on the costs of obesity in the UK using a modified method of attributable risk to establish the full resource implications of treating obesity and associated diseases. Prevalence estimates of obesity, defined as a Body Mass Index (BMI) greater than 30 kg/m², together with estimates of the risk of obesity-related diseases relative to a BMI range close to ideal, are used as the basis of the costing. The total costs of treating obesity and its related diseases are estimated at £355 million (in 1995 prices). The total costs of treating obesity directly, estimated at £3.8 million, are dominated by the costs arising from the treatment of attributable diseases, estimated at £351 million.     

The literature on the economic causes of and policy responses to obesity

This paper discusses economic perspectives on obesity, summarizes the economic literature and outlines potential policy responses. The paper provides the most up-to-date review of the literature. The literature illustrates the potential role of informational market failures and the dichotomy between the private and social costs of obesity. Market failures can act to provide a rationale for government intervention. Suggested factors for explaining the increase in the prevalence of obesity are discussed as relating to imperfect information, lifestyle changes and technology changes. Some of the potential remedial policies that are being debated in the literature include applying Pigouvian taxes, labelling regulation and advertising limitations.     

Investigating menu kilojoule labelling policy adoption from a political science perspective

Implementation of internationally recommended policy options for obesity prevention has generally been slow and inadequate globally, and, as such, it is important to understand barriers and enablers to policy action in the area. This study aimed to apply political science theories to understand influences on the adoption of Menu Kilojoule Labelling Legislation in Victoria, Australia over the period 2009–2017. Data collection included 13 in-depth semi-structured interviews with participants of the policy development and decision-making processes, analysis of 68 policy documents, and field note observations. Data were analysed using established political science theories: the Advocacy Coalition Framework (ACF) and the Multiple Streams Theory (MST). There were numerous and interrelating factors that influenced the Menu Kilojoule Labelling Legislative policy processes. Barriers to policy reform included electoral turnover, a dominance of neoliberal ideology, and policy maker concerns regarding potential food industry backlash. Key enablers to eventual policy change included the accumulation of evidence on policy effectiveness and feasibility of implementation, increased recognition of the importance of tackling the issue, as well as reductions in political risks achieved, in part, through relatively long consultation and negotiation processes. Findings highlight several tactics that can be used to secure similar policy change in future, including generation, dissemination and translation of implementation evidence, effective mobilisation of supporters, and negotiation and consultation processes that can reduce the degree of opposition to proposed policies.     

Separating what we eat from where: Measuring the effect of food away from home on diet quality

Many argue that food away from home (FAFH) is a contributing factor to the obesity epidemic, showing that body mass index and consumption of FAFH are positively correlated. However, correlation analyses using a simple regression approach, such as the Ordinary Least Squares (OLS), do not prove that FAFH causes weight gain. We use a first-difference estimator to establish a causal relationship between FAFH and dietary intakes. Using dietary recall data from the 2003–2004 National Health and Nutrition Examination Survey and the 1994–1996 Continuing Survey of Food Intakes by Individuals, we find that FAFH does indeed increase caloric intake and reduce diet quality, but that the effect is smaller than if estimated using OLS. Thus, models based on associations are likely biased upward, as much as 25% by our estimates.     

Does weight status affect academic performance? Evidence from Australian children

This article investigates the impact of children’s weight status on their academic performance using the Longitudinal Survey of Australian Children. Considering the endogeneity of the weight status variable (obesity or overweight), to obtain consistent estimates of its impact, we use the body mass index of biological parents as instrumental variables. The two-stage least square estimation shows that obesity or overweight has a significant negative impact on academic performance. Furthermore, the effect of child weight status is different across grade levels. Overweight has a larger negative impact on academic performance for senior year students, especially on numeracy.