Background
Rates of overweight and obesity in Australia have been steadily climbing. In 2014–15, 63.4% of adults and 27.4% of children were classified as overweight or obese [
1], with models predicting significant increases in the prevalence of severe obesity (BMI > 35) by 2025 [
2]. The social, health and economic impacts of overweight and obesity are significant, including increased risk of non-communicable diseases such as cancer, cardiovascular disease and type 2 diabetes, and reduced quality of life [
3]. The financial cost of overweight and obesity was estimated at $58.2 billion in 2008, including productivity costs, government subsidies, and loss of wellbeing [
4]. A growing literature recognizes the impact that changes in the food environment, including the increased availability, affordability and marketing of energy-dense, nutrient-poor foods and beverages are having on dietary behaviours and rates of overweight and obesity [
5‐
7]. Poor diet is now identified as the leading preventable behavioural risk factor for global burden of disease, overtaking tobacco use [
8].
From both a health and economic standpoint, there is an urgent need to improve the healthiness of diets and prevent overweight and obesity. The World Cancer Research Fund International developed the NOURISHING framework to highlight the various policy actions governments should take under three domains; the food environment, food system and behaviour change [
9]. To date, Australian governments at the state and federal level have prioritised behaviour change strategies, investing public health dollars into education campaigns and settings-based programs for obesity prevention at the level of the individual. What regulatory action the government has taken to promote a healthier food environment and improve population-level dietary behaviours has been uncoordinated between the states and territories, and has had limited success in preventing the continued rise in rates of overweight and obesity [
10‐
12]. New South Wales (NSW), Australian Capital Territory (ACT), Queensland and South Australia have introduced mandatory kilojoule labelling in fast food restaurants, although other states are yet to take action [
9]. The Australian Government also introduced the health star rating scheme in 2014, a front-of-pack labelling system that provides a quick and easy way for consumers to select healthier packaged foods [
13]. This scheme is still voluntary for the food industry, and it is currently estimated to appear on only 60% of packaged foods [
14]. At the Commonwealth level, Baker and colleagues point to a range of factors which jointly contribute to the lack of priority given to obesity prevention [
15]. These factors include the substantial political influence wielded by food companies and industry associations, assisted by their ease of access to policy elites, their importance to Australia’s economy, and their adoption of voluntary and self-regulatory instruments [
15,
16]. Broader contextual factors include the dominance of a political culture in which regulatory actions are framed as “nanny state” interventions that inappropriately seek to displace parental and personal responsibility. Crammond and colleagues also point to the need to subject new policy proposals to regulatory impact analysis and to show that the benefit of each individual proposal outweighs the cost to business [
17].
Policy and regulatory controls, including taxation of unhealthy foods and beverages and restrictions on unhealthy food advertising to children have been recognised by the World Health Organization as priority areas for action [
18,
19], and recommendations for government intervention in Australia are building [
10,
20,
21]. There is evidence to support the effectiveness of taxes and advertising restrictions for improving dietary behaviours within countries where these policies have been adopted. Mexico’s 1 peso per litre tax on sugar-sweetened beverages (SSBs) resulted in a 5.5% decline in purchases of taxed beverages in 2014, and a 9.7% decline the following year, with an average 7.6% decline over two years [
22]. In Hungary, the introduction of a tax on junk food in 2011 resulted in an estimated 3.4% reduction in consumption of processed foods, and a 1.1% increase in consumption of unprocessed foods [
23]. Further, bans on commercial food advertising to children in Quebec resulted in a reduction of US$88 million spent on fast food during 2010, and a reduction of 13.4–18.4 billion fast food calories consumed by French-speaking households [
24]. Although taxation and advertising restrictions have not yet been implemented in Australia for obesity prevention, they have been successfully implemented in the field of tobacco control. Between 1991 and 2016, daily smoking in people aged 14 years and older fell from 24.3% to 12.2% through the combined impact of increases in the tobacco excise, the introduction of graphic health warnings on tobacco packages, comprehensive bans on tobacco advertising, including tobacco plain packaging legislation, and bans on smoking in enclosed public places and outdoor public areas [
25]. Tobacco taxation has been consistently recognised as the most effective public health policy for reducing tobacco consumption in Australia [
26].
Although evidence of regulatory effectiveness is important for informing obesity prevention efforts, the acceptability of these measures to the food industry and to the wider public are significant variables affecting their likely implementation. Governments are sensitive to public opinion and unlikely to take action in the absence of significant levels of public support [
27]. Studies in the United States (US) [
28], United Kingdom [
29] and across the European Union [
30,
31] have reported strong public support for food labelling policies and restrictions on unhealthy food advertising to children, with the least support recorded for price-raising policies such as junk food and SSB taxes. Within Australia, there have been few large-scale surveys comparing support for different regulatory approaches. Morley et al. interviewed 1511 adults from across Australia who were the main grocery buyer in their household, revealing up to 90% support for restricting unhealthy food advertising to children, and 71% support for a tax on unhealthy foods and controls on sponsorship of sport by food companies [
32]. Similarly, a survey of 2147 Western Australian adults reported 84% of respondents to be in favour of advertising restrictions [
33]. These studies were not conducted on a nationally representative sample, and therefore may not accurately reflect Australia’s attitudes towards regulatory approaches to obesity prevention. Other Australian studies have been conducted on small samples [
34‐
38], have targeted a niche group of participants [
34,
39,
40], or have measured support for only one form of regulation [
41,
42]. In addition, evidence about which demographic characteristics are associated with greatest policy support have been inconclusive and variable between studies and more data are needed if advocacy efforts are to be appropriately targeted. This study aimed to: (1) determine the level of public support in Australia for regulation of the food environment; and (2) assess the demographic characteristics that determine support for regulatory interventions to prevent overweight and obesity. The results of this study will be used to inform future strategies to influence regulatory action by the Australian government and contribute to more strategic and effective advocacy by the public health sector.
Acknowledgements
We thank Online Research Unit for overseeing the recruitment of participant’s and dissemination of the survey. We also thank the expert panel that provided guidance throughout survey development: Louise Sylvan, Timothy Gill, Teresa Davis, Amanda Salis, Andrew Hill, and Margaret Allman-Farinelli.