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Submission No. 53(Inq mto Obesity)

SOUTH AUSTRALIAN GOVERNMENT'S SUBMISSIONTO THE HOUSE OF REPRESENTATIVES STANDINGCOMMITTEE ON HEALTH AND AGEING'S INQUIRYINTO OBESITY IN AUSTRALIA

May 2008


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IntroductionThe South Australian Government (South Australia) welcomes the House ofRepresentatives Standing Committee on Health and Ageing's Inquiry intoObesity in Aus tralia w ith its terms of reference:

1 . to inquire into and report on the increasing prevalence of obesity in theAustralian population, focusing on future implications for Australia'shealth s ystem ; and2. to recommend what governments, industry, individuals and the broadercommunity can do to prevent and manage the obesity epidemic inchildren, youth and adults.

In recent years, the Parliament of South Australia's Social DevelopmentCommittee has undertaken two inquiries into obesity, namely the Inquiry into Obe sity - M ay 2004 Fast Foods and Obesity Inquiry - March 2007

Both reports provide comprehensive and valuable information which may beof relevance to the current Inquiry. The R eports can be accessed via theParliament of South Australia web site:http://www,parliament.sa.goy.au/Commjttees/Standing/LC/SocialDevelopmentCommfeThe South Australian submission provides a summary of the key initiativesand future directions in South Australia towards the promotion of healthyweight and the prevention and management of obesity. The submissionsuggests recommendations that the Australian Government could considerimplementing in collaboration with State and Territory Governments.


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Overweight and Obesity in South AustraliaWorldwide, rates of overweight and obesity are rising with few, if anycountries, experiencing success in reversing this trend. The following graphindicates trends inweight status for the South Australian population using selfreport data from the SA Health Health Omnibus survey. Information from theNorth West Adelaide Health Study indicates that self report data consistentlyunder estimates rates of obesity. Sou th Australia's Strategic Plan (SAS P)target is also shown. The rising rates of obesity coupled with falling numbersin the healthy weight or normal range are of significant concern.We igh t s ta tus by Body Mass Index (BM!) age 18 + pro jec ted to 2014

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20 -10 -0 -\

SASP HW target52% #

1 9 9 0 1 9 9 2 1 9 9 4 1 9 9 6 1 9 9 8 2 0 0 0 2 0 0 2 2 0 0 4 2 0 0 6 2 0 0 8 2 0 1 0 2 0 1 2 2 0 1 4Y e a r

Underweight Healthy weight 1Overweight Obese

South Australia also has Body Mass Index (BMI) data for four year oldchildren collected through routine child health checks. Rates increasedsteadily and quite dramatically from 1995 but nowappear to have stabilised.The data shows the percentage of 4 year old South Australians who areoverweight or obese in 2007 was an average of 18.8 percent comprising 16.8percent males and 20.7 percent females .Overweight and obesity pose a health burden at all ages and is therefore asignificant public health concern. An elevated BMI is associated with illhealth. Recent research has shown that even a modest weight gain inadulthood is also associated with increased health risks.1 Weight gain inadults consistently increases the risk of developing serious illnesses includingtype 2 diabetes, cardiovascular disease, high blood pressure and certaintypes of cancer (eg bowel cancer). Obese people are more likely to sufferfrom a number of serious chronic diseases, many of which are life lim iting. Arecent study showed that having a BMI greater than 30, which is consideredto be in the obese category, led to an average of seven years of life lost ascompared to a person w ith a healthy weight.2


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Overweight in children and adolescents may have its most immediateconsequ ences in emo tional and social wellbeing. Teasing and bullying ofchildren because of their weight, has long been recognised in westerncultures.3 While a primary concern with childhood obesity is the affect onwe llbeing , it also has significant physical health consequences. Overwe ight inchildhood is associated with increased risk factors for heart disease such asraised blood pressure, blood cholesterol and blood sugar. Childhood obesityis likely to persist into adulthood, with overweight children having a 50 percentchance of being overwe ight adults. Obese adults who were overweight inado lescen ce have higher levels of weight related ill hea lth. Of the manyhealth consequences of childhood obesity, one of the most concerning is theincreased prevalence of type 2 diabetes. 4Overweight and obesity also have serious economic consequences for theindividua l, the community and for governments. In 200 3, the direct cost ofobesity nationally was put at $1.3 billion per annum, with SA costs estimatedat $100 million per annum. 5 In 2006, national estimates of direct costs morethan trebled to $3,767 billion per annum, in financial costs such as healthtreatments, lost productivity and $17.2 billion to lost wellbeing. 6Further research is currently being undertaken on the costs of obesity inSouth Australia which should provide better information about the futureimplications for the health system. Nonetheless, it is clear that rising rates ofoverweight and obesity will impact in the following ways: Loss of productivity and costs gained due to staff sickness and disabilityare likely to rise, as could injury rates. This will exace rbate seriousworkforce pressures By an increase in rates of chronic disease, there will be additionalpressure on all parts of the health system including: increased demand,increased complexity of conditions, increased difficulties in diagnosis andtherefore risk of problems Increased burden on facilities and need for adjustmen ts to facilities due todealing with obese patients (eg beds, mortuary facilities, equipment,adjustments to ambulances, increased need for disability related aids andbuilding modifications) Increased psychological problem s may increase the burden on mentalhealth facilities Reduced numbers of people participating in com mun ity life andvolunteering7 Increased use of Pharm aceuticals associated with the managem ent ofchronic disease Increased need for carers and therefore opportunity loss for carers toparticipate in the paid workforce


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Increased need for mobility aids and home modifications due to disabilityrelated to chronic disease (eg ramps, handrails, canes, crutches, walkingsticks, wa lking fram es, wheelchairs, scoo ters and the like8).In addition, the major burden will be on the morbidity and premature mortalityfor the comm unity, especially those who are most disadvantaged. Theevidence shows, disproportionate numbers of those suffering obesity andoverweight in lower socio-economic groups.Summary of South Austral ia's commitment to obesityprevention and the promotion of healthy weightPrevention of obesity is a high priority for the South Australian Government.South Australia's Strategic Plan (SASP) includes a target to increase theproportion of South Australians aged 18 years and over with a healthy weightby 10 percentage points by 201 4. Obesity prevention is also a priority in thehealth reform agenda being undertaken in Sou th Australia. The creation ofthis target acknowledges the significant impact of obesity upon populationhealth outcomes, the implications of this for the health system and thebroader social and economic impacts of high levels of obesity across thepopulation.South Australia's Eat Weil Be Active Healthy Weight Strategy 2006-2010 (theHealthy Weight Strategy) provides the overarching framework to combatobesity and prom ote healthy weight. The Healthy We ight Strategy's whole-of-government mandate enables action across multiple, targeted settings andsectors, including education, transport, urban planning, primary industries,local governm ent and comm unity services. An across-government HealthyWeight Taskforce ensures interagency collaboration on shared SASP targetactivities and Healthy Weight Strategy initiatives. It also provides advice onthe development of significant new initiatives such as healthy weight withinthe disability sector, urban planning for health, policy change in schoolcanteens and w ork w ith the sport and recreation sector.A number of South Australian programs are also provided through thefederally funded Australian Better Health Initiative. These programs enhanceexisting State efforts and add value to initiatives which benefit from nationalcooperation such as the proposed national social marketing campaign.SA Health provides leadership, coordination and significant funding ofprograms with other Government departments also funding and supportingprograms with nutrition and physical activity benefits. Examp les include:

The Office of Recreation and Spo rt's Workplace Physical ActivityProgram to build physical activity knowledge and skills in adultsworkplace settings


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The Department for Environment and Heritage (DEH) Healthy ParksHealthy People Strategy being implemented across South Australia. In2008/09 DEH will target populations most at risk of poor healthoutcomes and develop new initiatives to target particular populationgroups The Department of Transpo rt, Energy and Infrastructure: initiativespromote active transport in the community, such as cycling, walkingand the use of public transport. Increased physical activity for primaryschool-aged children is encouraged through initiatives such as "TravelSmart" and the "Walking School Bus" Project" The Department of Education and Children's Services: implem entationof the Right Bite healthy food and drink strategy across state-fundedschooling sites, which includes a ban on all junk food in the 'redcategory'.

In 2007 South Australia hosted Professor llona Kickbusch as its Thinker inResidence. Professor Kickbusch is known throughout the world for herinnovative approaches to improving public health, health promotion and globalhealth. During her residency Professor Kickbusch proposed three keyinitiatives Health in All Policies, Generation HISA and Health Literacy asmechanism s to improve the health outcomes o f South Australians. The Health in All Policies initiative (HiAP) recognises that many of thesocial determinants of health lie outside the remit of health services.

Public policy is seen as a powerful lever in creating healthy societies.HiAP requires all government agencies to review policy directions withthe health of the community in mind. To date, selected SASP targetshave been reviewed and a conference held to determine policyprinciples and further actions. Further details of HiAP and the HiAPconferenc e can be found at the following websites:http://www.health.sa.gov.au/pehs/health-in-all-policies.htrrthttp://www .health.sa.gov.au/pehs/publications/0803-PHB-HIAP-vol5-noijxJf The Generation HISA initiative (Generation Healthy South Australia) is

focusse d on achieving health sustainability for the next generation. Ittargets unhealthy environments, transforms them into healthyenvironments and develops child-specific policies which focus onwellbeing. Generation HISA is a long-term and intergenerationalstrategy based on an environmental approach. It requires partnershipand citizen participation. Generation H!SA identifies the need for newaccountability mechanisms across-government, improving existingefforts by the health and education sectors, secure funding, dedicatedresearch, modelling, surveillance and evaluation. It builds on andsupports the directions of the Eat Well Be Active Healthy WeightStrategy


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The Health Literacy initiative aims to foster better rates of health literacy,develop health competencies for the 21st century and create literacy-friendly environments. It recognises that people need skills to makeinformed decisions regarding their health, including healthy choices ineveryday life. It also recognises the strong links between levels ofliteracy and overall health and we llbeing. This initiative links with theGeneration HISA initiative and brings together a range of partners fromdifferent sectors.

Further information about these initiatives can be found in ProfessorKickbusch's interim report entitled South Australia Takes the Lead in 21 stCentury Health, written during her time as Adelaide's Thinker in Residence in2007 . The report can be foun d at the following website:http://www.thinkers.sa.gov.ay/repgrts,html

Key directionsTackling obesity and improving nutrition and physical activity requires wholepopulation approaches, as well as targeting particular at risk populationgroups. The Eat Well Be Active Healthy Weight Strategy 2006 - 2010encomp asses four areas to improve health:

1 . Assisting the community to know and act on healthy eating, physicalactivity and healthy weight guidelines through social marketing2. Ensuring easier access to programs, services and environments for allSouth Aus tralians to eat a healthy diet and be ac tive3. Making healthy living easier through regulatory and policy mechanism s4. Building capacity to assist South Australians to maintain a healthyweight through w orkforce development, research and evaluation.

South Australia's four health regions have been funded to coordinate andimplement a wide range of programs to promote breastfeeding, healthy eatingand physical activity. These programs include "community foodies" a foodproject targeting women and men of low socio economic status; "Start RightEat Right' a nutrition training and accreditation program for child care centres;and "eat well be active" comm unity programs. These programs use multi-strategy and com munity developme nt approaches to obesity prevention.There are also dedicated programs for the Aboriginal and Torres StraitIslander comm unity. The se target neonatal and early childhood settings andadd ress food supply, qua lity and sustainability for remote com munities. Sou thAustralia also funds the non-government sector to run programs in thecommunity, to develop supportive policy such as the "Healthy By Design"urban planning project based with the Heart Foundation and to build capacitywithin the health and comm unity services sectors.


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The proportion of adults living in areas of greatest disadvantage is almostdouble that of obese adults living in areas with the least disadvantage.Overweight and obesity and the associated burden of chronic diseaserepresent significant health issues for people of low socio-economic status,exposing them to higher risks of cardiovascular disease and cancer, the twoleading causes of death and reduced healthy life expectancy.South Australia has identified obesity-related morbidity and death amongpeople of low socio-economic status as part of its wider agenda for healthequity. This includes the Australian Better Health Initiative Schools andCommunity Program, investigation into models of antenatal care for womenunder-served by current services and building capacity to meet the nutritionaland physical activity needs of vulnerable populations.In addition to preven ting obesity, it is also vital to m aximise our efforts at ea rlydetection and intervention for common risk factors of poor nutrition, physicalinactivity, excess weight and waist circumference, as well as smoking andalcohol misus e. Sou th Australia is emp loying up to 50 lifestyle coordinatorsover four years to work with individuals who have chronic disease risk factorssuch as poor diet, physical inactivity and excess weight to assist them to altertheir behaviour to prevent the development of chronic conditions such asdiabetes and cardiovascular conditions.The PEACH (Parenting Eating and Activity for Child Health) Program will alsobe expanded to assist parents whose children are overweight or obese. Thepilot program has shown long term outcomes and training will now beprovided to health workers to expand the program beyond the pilot.

Po l icy FrameworkSouth Australia's healthy weight agenda is supported by robust policies,projects and regulatory frameworks that support eating well and being active.These include:

Healthy living guidelines into urban planning activities in SouthAus tralia. These guidelines are available at the following web site:ht tp : / /www.goforvour l i fe^by Design?OpenDocument The developm ent of a "Healthy Food in SA Health Facilities" policy toensure that South Australian Government health facilities provide andpromote healthy food and also breastfeeding. Draft policyrecommendations and a discussion paper were released forconsu ltation in early 2008. Comm ents are currently being collated. Thediscussion paper can be accessed at the following website:http://www.health.sa.gov.au/pehs/health-prornotion.htm


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Expansion of the Baby Friendly Hospital Initiative, to more broadlyincorporate policy change and workforce training into its serviceaccreditation scheme.Bann ing Junk FoodSouth Australia has taken a strong position in advocating for nationalcooperation on the development of policies and legislation to reduceadve rtising and p romotion of "junk" foods to children. If coope ration cannot beachieved nationally, South Australia will move to ban advertising should junkfood and drink advertisers fail to implement stricter controls during children'stelevis ion viewing times . A discussion pape r will be released shortly invitingindustry to identify action they can take to assist in reducing childhoodobesity.Food Regulat ionThe national food regulatory system has an important role in making healthyfood choices easier for the com mu nity. Internationally, there are exam ples offood regulatory agencies that contribute to a preventative health agenda. Forexample, in the United Kingdom the Food Standards Agency, an independentGovernment department, has been created to protect the public's health andconsum er interests in relation to food.In Australia, the Food Standards Australia New Zealand (FSANZ) Act 1991objectives (in descending priority order) are:

a. the protection of public health and safetyb. the provision of adequate information relating to food to enableconsum ers to make informed choicesc. the prevention of misleading or decep tive conduct.Based on these objectives, Australian food standards set by FSANZ couldcontribute to the prevention and management of the obesity epidemic andma ke a contribution to a health policy focused on prevention. A significantstandard currently under development by FSANZ is Nutrition Health andRelated Claims. This is based on the principles of giving priority to protectingand improving the health of the population and to enabling the responsibleuse of scientifically va lid nutrient, health and related claims.The recent national '2020' summit identified reforming food labelling with asimple "traffic light" indicator and regulating the allowable content of unhealthyingred ients, as two key areas of action in food regulation. These two issuesare currently under consideration by the Australia New Zealand FoodRegulation M inisterial Council (the Council). In 2006, the Council asked theFood Regulation Standing Committee to explore and report to them on thefollowing issues related to food labelling:


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Wh ether a uniform front-of-pack food labelling system designe d toguide consumer choice to healthier food options would be an effectivehealth strategy; and if so The efficacy of a range of options, both regulatory and non-regulatory,

for such a labelling sy stem which may include the "traffic light" labellingsystem and/or the "behavioural labelling system", which shows howmuch physical activity is needed to burn up calories in an averageserving of food, and an y other options.To date, the work has identified that there is local and international researchthat indicates potential effectiveness of front-of-pack food labelling systems asa health strategy. This aids in increasing consumer understanding and intentto purchase, driving product reformulation to healthier products and increasingsales of healthier foods. The C ouncil has also sought the advice of theAustralian Population Health Development Principal Committee of theAustralian Health Ministers Advisory Council about how a front-of-packsystem could fit with other, current Australian and New Zealand healthstrategies.The Council is also considering a policy guideline which will establish thepolicy framework for the Australian food regulatory system regarding thecircumstances under which substances, other than vitamins and minerals,should be permitted to be added to food. This will complement the PolicyGuideline on Fortification of Food with Vitamins and Minerals already agreedon by the Council, which determines how FSANZ should make regulatorydecisions regarding the addition of vitamins and minerals to food. Otherpertinent issues to be considered by the Council in the near future include aPolicy Guideline for Infant Formula.

Heal th Work forceWorkforce issues also affect the potential of governments to prevent andma nag e obesity. W orkforce sho rtages, especially in rural areas, along withthe complexity of preventing obesity and the need to use a variety ofapproaches and working across sectors, means it has been difficult to attractperso nne l. South Australia believes that comprehensive workforce planningfor health promotion generally, and for obesity prevention specifically, isrequired.In South Australia, there are three linked professional development initiativesto improve workforce capacity:

The "Healthy Eating and Physical Activity in the Early Years" project,developed through the Australian Better Health Initiative, whichpromotes healthy eating and being active in preschools, childcarecentres and Family Day Care. The project has so far beenimplemented in over 30 sites across South Aus tralia. It will also beimplemented in 20 Children's Centres across the State

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The Healthy We ight Introductory Cou rse, targeting workers in thehealth sector, which is being expanded in 2008-09 Training program s for the Aboriginal health workforce.

The first two initiatives are in their second and third years of implementationrespectively. The Statewide Aboriginal Health Workforce Initiative is currentlyunder deve lopm ent. Future priorities for wo rkforce capacity include localgovernment, disability and community service sectors.Health ResearchSouth Australia has identified obesity as a health research priority, with threecurrent state-funded research projects. These projects are investigating:

the links between psychological distress and weigh t the econom ic costs associated with overwe ight and obesity in Sou thAustralia links between food supply and access, socioeconomic status andoverweight/obesity.

In addition, South Australia funds Body Mass Index monitoring of all four tofive year old children . This data set is an important complement to thesurveillance o f the national four year old health check schem e. The lack of along term monitoring and surveillance system covering adults and children, inrelation to nutrition and physical activity, impe des work in this area.Major new directionsSouth Australia has a number of significant new commitments to combatobesity and promote healthy weight across the population.EPOD E for South Australia: EPODE ("Together W e Can Prevent Ch ildhoodObesity")EPODE for South Australia is based on EPODE developed in France, whichis a community-based and multi-strategy obesity prevention program.EPODE in France encompasses programs and activities to support healthyeating and physical activity through schools, local government, healthservices and comm unity organisations. It features nationally coordinatedsocial marketing, complemented by strong local leadership and collaborativeaction which is central to the success of the prog ram. Obesity related resu lts,measured through school-based weighing and measurement of children,show a levelling of the increase in childhood obesity in intervention sites.South Australia plans to adapt this program with a major focus on primaryprevention. An initial five sites are planne d, increasing by five per annum toapproximately 20 sites by 2011-12. Significant funds will be allocated forimplementation and evaluation.

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Schoo l-based healthy eating and physical activity programThe School-based healthy eating and physical activity program is aninnovative and sustainable approach to promoting healthy eating and physicalactivity in school communities. The schools program focuses on buildingpartnerships between school districts, school sites and service providers andwill be rolled out in conjunction with the EPODE initiative. The schoolsprogram provides comprehensive, evidence based programs for targetedprimary schoo ls. The first phase of rollout includes:

Curriculum based activities for students; professional learningactivities; resources and supporting information for teachers toenhance existing knowledge confidence and skills about promotinghealthy eating and physical activity Prov ision of information to support parents by raising awaren ess about

the importance of healthy eating and physical activity in childhood; andthe relationships between eating well, being active, learning andwellbeing outcomes for children Developm ent of a consistent evalua tion and monitoring framew ork Enlistme nt of up to 200 schools over the next four years. The SouthAustralian Government is currently considering proposals fromproviders and organisations to implement a comprehensive healthyeating and physical activity program in SA schools.

Children's Centres for Early Childhood Development and Pa rentingChildren's Centres for Early Childhood Development and Parenting are a jointinitiative between the Department of Education and Children's Services, SAHealth and the Department for Family and Community Services to ensurehigh quality early education and care for children from birth through to theearly years of school. Seven Children's Centres have been established sofar, with an additional 13 to be established across the State. The Centres offera mix of information, services, support and specialist referral when health orlearning concerns are identified. They have multidisciplinary staff to work withthe child's family to foster child deve lopme nt, health and we llbeing. TheCentres support families, communities and services to provide the best startin life for ch ildren .SA Healthy We ight Resea rch and Evaluation Unit:

A SA H ealthy Weight Research and Evaluation Unit is planned to : mo nitor healthy weight indicators at the population level provide timely strategic research and evaluation advice relating to

the development, implementation and ongoing monitoring ofSouth Australia's healthy weight strategies, programs and policies12


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formulate and conduct applied healthy weight research andevaluation participate in collaborative applied research and evaluation projectsat the regional, state, national and international level disseminate resea rch and evaluation ma terials to state, nationaland international audiences generate professional development activities to support healthprofessionals with an interest in healthy weight.

Consultations are currently being undertaken with key stakeholders to informthe op erational mode l of the ce ntre. It is likely to be aligned with a proposedNational Centre for Intergenerational Health which will provide aninterdisciplinary capability for research into factors that are crucial forsustaining good health across the life span, within and between generations,particularly later in life.

Wider effort and collaboration to prevent obesityA number of issues require greater effort and collaboration acrossjurisdictions.South Australia makes the following recommendations for the Inquiry'sconsideration:

1 . Establish governance mechanisms to oversee and coordinatecollaborative action to prevent obesity and promote healthy weight.Mechanisms should have the capacity to advise and provide directionacross government portfolios. The National Preventative HealthTaskforce could ensure progress in this area2. Define obesity as a chronic condition under Medicare3. Develop a national app roach to reduce the advertising of junk food and

drinks to ch ildren4. Encourage an integrated approach to primary and secondaryprevention programs and funding5. Develop a na tional m ultidisciplinary obesity prevention researchagenda with supportive infrastructure and strong links to jurisdictionalresearch p riorities a nd activities6. Review healthy food access in relation to the cost, supply and theimpact of taxation on the cost and ava ilability of healthy food

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7. Consider and recommend strengthening the role of Australia's foodregulatory system in protecting public health, with a focus on: the prevention and management of obesity a national health policy on public health nutrition and chronicdisease prevention8. Identify good practice and development of guidelines that supporthealthy eating and adequate physical activity across society settingsincluding schools and preschools, government departments,wo rkplaces, food and advertising indus tries. This includes finalisationof the national physical activity guidelines for children under five yearsof age9. Increase collabo ration in the developm ent, im plementation andevaluation of nationally applicable social marketing campaigns1 0. Ensure strong policy linkage across agriculture, food processing anddistribution, town planning, environmental sustainability, taxation andsocial policy to ensure equitable access to good food for all Australiansregardless of location and income. Strengthening a Health in AllPolicies approach at the national level would be ideal1 1 . Use funding and policy levers through the health system to maximisesupport for prevention including: supporting General Practice screening programs and requirementsfor hospitals and health services to be breastfeeding friendly andhealth promoting more broadly supporting M edicare billing for obesity prevention work of alliedhealth workers including, dieticians, exercise physiologists andpractice nurses supporting better linkages between hospitals, General Practice andcommunity care for early intervention and management of chronicconditions, including obesity investigating and implementing innovative models of cost effectivechronic disease prevention, delivered through non-GP settings.12. Progress national workforce reform to ensure all relevant workgroups

are trained and equipped with the knowledge and skills to supportuptake of nutrition and physical activity guidelines (eg in health,education, care, hospitality, town planning, welfare, and public policysectors)1 3. Increase evidence-based early intervention programs that enhancehealthy development through national standard and accreditationlevers for child care facilities14. Review fringe benefits taxation and other financial incentives to makeworkplace health promotion more affordable

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1 5. Investigate incentives and recognise organisations that proactivelypromote and support policies, practices and infrastructure that promotehealthy eating and physical activity1 6. Subsidise membership and insurance costs of childhood sports for low

income fam ilies.ConclusionSouth Australia's efforts demonstrate our commitment to the promotion ofhealthy weight and the prevention and management of obesity throughevidence based approaches and practices.South Australia's commitment recognises the impact of obesity on the qualityof life of the population, the health care system and the State's economy.Federal, State and Territory Governments can benefit from the establishmentof national governance mechanisms that encourage collaboration across theareas of health promotion and prevention of obesity. This would allownational strategic planning and collaboration in areas such as research,monitoring and surveillance, population data collection, workforce reform andsocial m arketing , just to name a few . The "Health in All Policies" approa chwould also be effective if adopted by all levels of Government.In addition, there are areas where the Australian Government would be bestplaced to take the lead through national funding and policy levers for examplethrough the development of appropriate items under Medicare and thedevelopment of appropriate tools for General Practice.South Australia welcomes the formation of the National Preventative HealthTaskforce and the anticipated development of a National Preventative HealthStrategy which will ensure progress in the area of national collaboration andreform in preventative health, including obesity prevention.

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1 NSW Centre for Public Health Nutrition. Best O ptions for prom oting healthy w eight and preventingweight gain in NSW. NSW Department of Health. Sydney 2005.2 Peeters A , et al. Obesity in adulthood and its consequences for life expectanc y: a life-table analysis.Annals of Internal Medicine 138, 2003.3 N H M R C . Clinical Practice Guidelines for the Manag ement of Overw eight and Obesity in Childrenand Adolescents. Canberra 2003.4 Kop lan JP, Liverman CT, Kraak VI eds. Preventing Ch ildhood Obesity: Health in the Balance.Co mm ittee on Prevention of Obesity in Children and Youth. National Academ ies Press. Wash ingtonDC 2005.5 Australian Health Minister' Conference, Healthy Weight 2008 - Australia's Future. The NationalAction Agenda for Children and Yo ung People an d their Families. Canberra 2003.

The Economic Cost of Obesity Report by Access Economics Pty Limited to Diabetes Australiareleased on 13 October 20067 Social Developm ent Committee. Repo rt into Obesity. South Australian Parliament. NineteenthRep ort of the Social Developmen t Comm ittee. Adelaide 2004.8 The Economic Costs of Obesity - Report by Access Economics Pty Ltd to Diabetes Australia.October 2006.

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