Socio-economic divergence in public opinions about preventive obesity regulations: Is the purpose to ‘make some things cheaper, more affordable’ or to ‘help them get over their own ignorance’?

How an agreement with restriction of unhealthy food marketing and sodium taxation influenced high fat, salt or sugar (HFSS) food consumption

BACKGROUND

Food taxation and food marketing policy are very cost-effectiveness to improve healthy diets among children. The objective of this study was to investigate the socio-demographic characteristics of Thais and attitude towards on policy unhealthy food marketing restriction and sodium taxation which influence high fat, sodium, and sugar (FHSS) food eating.

METHODS

The data were obtained from the 2021 Health Behavior of Population Survey, four-stage sampling method of the Thai people, aged 15 years and above, using a offline survey application-assisted face-to-face interview. Logistic Regression were used to analyze the explanatory variables on agreement and HFSS food intake.

RESULTS

Almost half (48.4%) of samples disagreed with sodium taxation, and 42.7% of the samples disagreed with food marketing restriction. Most (99.6%) of Thai respondents consumed HFSS food, including sugar sweetened beverages (SSB). Gender, age, education, income, BMI, and health status were associated with agreement with food marketing restriction policy and sodium taxation policy. There is no association between agreement with policy on sodium taxation and food marketing and HFSS food consumption.

CONCLUSION

Nearly half of Thais indicated that they disagreed with policy on food marketing restriction and sodium taxation. Therefore, understanding and awareness of the two policies among Thais should be further investigated in order to develop better policy communication for increased public understanding and engagement.

Impact of front-of-pack nutrition labelling in consumer understanding and use across socio-economic status: A systematic review

An unhealthy diet is a leading contributor to the increasing burden of overweight and obesity. Front-of-pack labelling (FOPL) is being recognized as a policy strategy to promote healthier choices yet there is limited evaluation of FOPL to suggest if it is effective for all population subgroups. This systematic review aimed to assess the impact of FOPL on consumer understanding and usage across socio-economic gradients. Six electronic databases were searched through a systematic search process using key terms for FOPL and socioeconomic status (SES) from 2011 to March 2022 to include studies evaluating the effectiveness of FOPL. A narrative synthesis was conducted and the results were assessed according to the effects of FOPL on consumer awareness, understanding, and usage across SES. The review included 36 articles. In general, people of all SES groups were aware of and more likely to pay attention towards FOPL than the nutrition information panel provided on the back of the package. However, the understanding and usage were relatively poor, particularly in low SES groups. While studies conducted in low SES populations suggest FOPL increased the purchase intention of healthy products, the stratified analysis across SES showed less beneficial effects in low SES individuals. The findings highlight simplified and easy-to-understand FOPLs such as Nutri-score and traffic light labelling are likely to be effective for all populations including low SES groups. Overall, the review suggests FOPLs are more visible than the nutrition information panel and may guide healthier food choices for people of all SES backgrounds. It is unclear whether FOPL influences actual purchasing and food intake as there are insufficient studies comparing the effects among higher and lower SES populations.

Competing public narratives in nutrition policy: insights into the ideational barriers of public support for regulatory nutrition measures

Background

Enacting evidence-based public health policy can be challenging. One factor contributing to this challenge is a lack of public support for specific policies, which may stem from limited interest or conviction by policy arguments. This can happen when messaging strategies regarding policy do not resonate with the target group and/or policy narratives compete in public discourse. To understand how policy messaging can better resonate with a target audience, we examined the frames and narratives used by the Australian public when discussing nutrition policies.

Methods

We conducted 76 street intercept interviews in urban and regional settings in Queensland, Australia. Quantitative data were analysed using mean agreement scores and t-tests, and the qualitative data were analysed using an adapted qualitative narrative policy framework (QNPF). The QNPF is used to illustrate how competing narratives vary in the way they define different elements. These elements often include setting, characters, plot, policy solution and belief systems.

Results

Level of support for all nutrition policies was generally moderate to high, although nutrition policies perceived to be most intrusive to personal freedoms were the least popular among the public. The value of fairness was consistently invoked when participants discussed their support for or opposition to policy. Using the QNPF, two distinct settings were evident in the narratives: concern for the community or concern for self. Villains were identified as either “other individuals, in particular parents” or “Big Food”. Victims were identified as “children” or “the food industry, in particular farmers”. Frequently used plots focused on individuals making poor choices because they were uneducated, versus Big Food being powerful and controlling people and the government.

Conclusions

The study examined the frames and narratives used by the Australian public when discussing nutrition policies. By examining these frames and narratives, we gained insight into multiple strategies which may increase public support for certain nutrition policies in Australia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00891-6.

Public Opinion on Food Policies to Combat Obesity in Spain

(1) Introduction: Poor diet is the fourth-leading cause of mortality in Spain, where adherence to the Mediterranean diet has declined in recent decades. To remedy this situation, a series of food policies have been proposed that would be easier to implement if they had public support. (2) Material and methods: Cross-sectional study covering a representative sample of the Spanish population (n = 1002), using telephone interviews that addressed nine food policies under four headings, namely, advertising, labeling, composition, and provision and sale. The sociodemographic determinants of support for these policies were analyzed using the chi-squared (χ²) test and Poisson multiple regression models with robust variance. (3) Results: All the proposed measures received more than 60% support. The policies that received greatest support were those targeting labeling at 96.6%, while the policies that received the least support were those directed at banning free refills at restaurants, at 63%. Support for policies was higher among women, older adults, and persons professing left-wing ideological affiliations. Compared with men, women’s support for advertising policies was 21% higher: similarly, compared with the youngest age group (18–29 years), support by the over-65 segment for provision and sale policies was 52% higher. Support for composition policies was 28% lower among persons with right-wing as opposed to left-wing political sympathies. (4) Conclusions: The authorities enjoy the support of the Spanish public as regards implementing food policies proposed by experts and overcoming the resistance of sectors opposed to such measures.

Public Support for the Imposition of a Tax on Sugar-Sweetened Beverages and the Determinants of Such Support in Spain

(1) Background: Taxes on sugar-sweetened beverages are an effective public health intervention, but can be difficult to implement in the absence of public support. This is the first study to analyze the Spanish population’s support for a tax on sugar-sweetened beverages. (2) Methods: We conducted a cross-sectional study of a representative sample of the Spanish adult population (n = 1002), using a computer-aided telephone interview with a questionnaire on nutritional policies. The support for the tax was calculated by the percentage of those who agreed plus those who strongly agreed with the measure. The sociodemographic determinants of support for the tax were analyzed using chi-squared test (χ2) and Poisson multiple regression models with robust variance. (3) Results: Of the participants, 66.9% supported a tax on sugar-sweetened beverages. Support for the tax was 9.2% higher (70% vs. 64.1%) when responders were first asked about support for tax relief and subsidies for healthy foods (p = 0.049). Support for the tax was 16% and 35% lower among persons reporting center and right-wing political sympathies (p < 0.01), and 16% lower among regular consumers of sugar-sweetened beverages (p = 0.01). (4) Conclusions: A clear majority of the Spanish population is in favor of imposing a tax on sugar-sweetened beverages. Awareness-raising campaigns and a policy of combining the measure with subsidies or tax cuts on healthy foods could increase the level of support among those currently against the intervention.

Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods

Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.

Community support for policy interventions targeting unhealthy food environments in public institutions

ISSUE ADDRESSED

Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions.

METHODS

An online cross-sectional survey was completed by 2,006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal, and behavioral characteristics.

RESULTS

Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n=7) initiatives. Support for food environment policies was highest for schools (76-82%) and hospitals (67-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support.

CONCLUSION

There is significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.

Public Health Virtue Ethics

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed.

Exploring attitudes toward taxation of sugar-sweetened beverages in rural Michigan

BACKGROUND

While policies to address "obesity" have existed for decades, they have commonly focused on behavioral interventions. More recently, the taxation of sugar-sweetened beverages is gaining traction globally. This study sought to explore individuals' attitudes and beliefs about sugar-sweetened beverages being taxed in a rural Michigan setting.

METHODS

This qualitative study was conducted using critical policy analysis. Data were collected in 25 semi-structured, audio-recorded interviews with adult Michiganders. Following data collection, transcripts were coded into themes using NVivo software.

RESULTS

Four themes emerged in participants' perspectives regarding sugar-sweetened beverages being taxed: resistance, unfamiliarity, tax effects, and need for education. While some participants were unfamiliar with sugar-sweetened beverage taxes, many viewed taxation as a "slippery slope" of government intervention, which invoked feelings of mistrust. In addition, participants predicted a sugar-sweetened beverage tax would be ineffective at reducing intake, particularly among regular consumers, who were frequently perceived as mostly low income and/or of higher weight.

CONCLUSIONS

Further research is needed to explore perceptions of sugar-sweetened beverage taxes in different geographic areas in the USA to examine how perceptions vary. Policymakers should be aware of the potential implications of this health policy with respect to government trust and stigma towards lower income and higher-weight individuals.

Are young adults' discussions of public health nutrition policies associated with common food industry discourses? A qualitative pilot study

OBJECTIVE

Unhealthy diets are a key risk factor for chronic disease, with young adults (18-30 years old) in high-income countries like Australia and the UK particularly at risk. Improved public health nutrition policies can help address unhealthy diets in the population, but many of the more regulatory policies are opposed by food industry groups. This research explores how young adults in Australia and the UK discuss a range of topical public health nutrition policies and analyses whether and how their views may be associated with food industry discourses.

METHODS

Eight focus groups were held in Sydney, Australia, and Glasgow, UK, with a total of thirty young adults participating. A deliberative-style method was used in the focus groups to generate discussion about six public health nutrition policies, such as taxation of sugar-sweetened beverages and restrictions on advertising of less-healthy foods. Discourse analysis was used to examine participants' discussions.

RESULTS

Twenty discourse codes were developed iteratively from the focus group data. These were thematically linked with nine food industry discourses found in the peer-reviewed literature, including industry self-regulation, personal responsibility, corporate social responsibility and challenging nutrition science.

CONCLUSIONS

These results demonstrate there is an association between common food industry discourses and some young adults' views about public health nutrition policies. Implications for public health: Identifying, engaging with and responding to common industry discourses is a priority in order to build greater public support and acceptability of policies that will improve diet and prevent chronic disease.

What do the Australian public think of regulatory nutrition policies? A scoping review

Effective government policies are crucial to creating healthy food environments. However, changing public policy is a slow and challenging process involving many competing factors. One cited factor is public opinion towards a proposed policy. This study aimed to systematically explore public opinion on regulatory nutrition policy issues in Australia from 2009 to 2019, to determine whether low levels of public opinion corresponded with the low levels of regulatory policy action in this country. We found that there was varying levels of public support in Australia for public health nutrition action. Regulatory- and legislative-based policies generally had moderate to high levels of support except for food and drink taxes, which had low to moderate support. Despite high levels of public support for certain policy initiatives, national public health nutrition policy in Australia has not evolved consistently with the level of public support nor the evidence base over the past decade indicating other more important factors at play in policymaking.

Are perceptions of government intervention for prevention different by gender and age? Results from the AUStralian Perceptions Of Prevention Survey (AUSPOPS)

OBJECTIVES

Understanding public opinion and community attitudes is needed to help the implementation of chronic disease prevention policies that are acceptable to the population. The AUStralian Perceptions Of Prevention Survey ('AUSPOPS') is a national survey designed to provide evidence on the views of Australians regarding government intervention for prevention. However there is limited evidence whether age and gender have modifying effects on attitudes about prevention.

METHODS

Using results from the 2018 AUSPOPS dataset, this study examines whether the effect of age on attitudes about prevention is modified by the effect of gender. Survey questions included views about statements for government intervention and whether government had gone far enough for thirteen different preventive interventions.

RESULTS

2601 Australian residents aged 18 years or older participated in the survey (response rate 16.7%). Results showed strong support for prevention framed as a shared responsibility between governments and individuals. Interventions where >50% of respondents felt the government had not gone far enough in prevention were restricting unhealthy food advertising for children and setting salt limits on processed food. There were significant age by gender interactions in a small number (n = 4) of questions examining support for government intervention for prevention, suggesting young men were least in favour of more action by government.

CONCLUSIONS

There is general support in the Australian community for government intervention for prevention. Policymakers could capitalize on this sentiment by prioritizing policies with high levels of support across all groups, and target population subgroups on issues where acceptability appears to be heterogenous.

The independent role of deprivation in abdominal obesity beyond income poverty. A population-based household survey in Chinese adults

BACKGROUND

Individual-level deprivation takes into account the non-monetary aspects of poverty that neither income poverty nor socio-economic factors could fully capture; however, it has rarely been considered in existing studies on social inequality in obesity. Therefore, we examined the associations of deprivation, beyond income poverty, with both general and abdominal obesity.

METHODS

A territory-wide two-stage stratified random sample of 2282 community-dwelling Hong Kong adults was surveyed via face-to-face household interviews between 2014 and 2015. Deprivation was assessed by a Deprivation Index specific to the Hong Kong population. General obesity was defined as body mass index (BMI) ≥ 25 kg/m2, while abdominal obesity was defined as waist circumference (WC) ≥ 90 cm/80 cm for male/female. Multivariable binary logistic regressions were performed.

RESULTS

Deprivation was independently associated with abdominal obesity (odds ratios (OR) = 1.68; 95% confidence intervals (CI): 1.27-2.22); however, no significant association was found with general obesity (OR=1.03; CI: 0.77-1.38). After additional adjustment for BMI, deprivation remained strongly associated with abdominal obesity (OR=2.00; CI: 1.41-2.83); and after further adjustment for WC, deprivation had a marginal inverse association with general obesity (OR=0.72; CI: 0.51-1.01).

CONCLUSIONS

Deprivation is an important risk factor of abdominal obesity and plays a critical role in capturing the preferential abdominal fat deposition beyond income poverty.

Strong support for broad policies to prevent childhood obesity among mothers in New South Wales, Australia

ISSUE ADDRESSED

Support for broad policies to prevent childhood obesity is not clear. This study aimed to investigate the level of support for state government health promotion policies among mothers with infants and its associated factors.

METHODS

This secondary analysis of data from 1155 mothers in NSW assessed approval for six policy options derived from public health approaches to obesity. Descriptive statistics were used to show the extent of policy approval across the cohort. Logistic regression models tested associations between perceived susceptibility and perceived severity of childhood obesity and approval of each policy option.

RESULTS

The proportion of mothers who felt these policy options were 'about the right amount' (56%-68%) or 'not going far enough' (24%-36%), collectively represented 89%-95% approval of government intervention. In comparison, 5%-11% felt that these policies were 'going too far'. Factors associated with their levels of support varied between each policy option, based on mothers' characteristics and perceptions of childhood obesity.

CONCLUSION

These findings indicate high support for government intervention to prevent obesity among mothers in NSW and support health promotion advocacy in this area. SO WHAT?: Governments should give due consideration to implementing each of the six policy options and prioritise the implementation of restrictions on fast food advertising in publicly owned or controlled areas.

Utility and justice in public health

Background

Many public health practitioners and organizations view themselves as engaged in the promotion or achievement of equity. However, discussions around public health frequently assume that practitioners and policy-makers take a utilitarian approach to this work.

Methods

I argue that public health is better understood as a social justice endeavor. I begin by presenting the utility view of public health and then discuss the equity view. This is a theoretical argument, which should help public health to justify interventions for communicable and non-communicable diseases equally, and which contributes to breaking down the 'old/new' public health divide.

Results

This argument captures practitioners' views of the work they are engaged in and allows for the moral and policy justification of important interventions in communicable and non-communicable diseases. Systemic interventions are necessary to remedy high rates of disease among certain groups and, generally, to improve the health of entire populations.

Conclusions

By viewing diseases as partly the result of failures of health protective systems in society, public health may justify interventions in communicable and non-communicable diseases equally. Public health holds a duty to improve the health of the worst-off in society; by prioritizing this group, the health of the whole community may improve.

Obesity, equity and choice

Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature.

Experiences of weight-related stigma among low-income rural women of higher weights from the midwestern United States

Weight-related stigma and stereotypes are widespread. Despite established research highlighting the disproportionate disparities rural individuals face, studies focusing on women in rural and low-income environments are underrepresented in the literature. The current study addressed these gaps in the literature using 25 in-depth interviews, which were analyzed using interpretive phenomenological procedures. The research questions were: i) what are low income rural women of higher weights’ understandings and experiences of weight stigma in healthcare? and ii) to what extent do their experiences of stigma affect or do not affect their healthcare-related behaviors? Sixteen women in the study experienced weight-related stigma in healthcare. Many delayed their care while others felt their care was essentially denied. Findings indicate that more can be done to address weight-related stigma.

Why do the public support or oppose obesity prevention regulations? Results from a South Australian population survey

ISSUE ADDRESSED

Australian policymakers have acknowledged that implementing obesity prevention regulations is likely to be facilitated or hindered by public opinion. Accordingly, we investigated public views about possible regulations.

METHODS

Cross-sectional survey of 2732 persons, designed to be representative of South Australians aged 15 years and over. Questions examined views about four obesity prevention regulations (mandatory front-of-pack nutrition labelling for packaged foods; zoning restrictions to prohibit fast food outlets near schools; taxes on unhealthy high fat foods; and taxes on sugar-sweetened beverages). Levels of support (Likert scale) for each intervention and reasons for support/opposition were ascertained.

RESULTS

Views about the regulations were mixed: support was highest for mandatory nutrition labelling (90%) and lowest for taxes (40%-42%). High levels of support for labelling were generally underpinned by a belief that this regulation would educate "Other" people about nutrition. Lower levels of support for zoning restrictions and taxes were associated with concerns about government overreach and the questionable effectiveness of these regulations in changing behaviours. Levels of support for each regulation, and reasons for support or opposition, differed by gender and socio-economic status.

CONCLUSION

Socio-demographic differences in support appeared to reflect gendered responsibilities for food provision and concerns about the material constraints of socio-economic deprivation. Engagement with target populations may offer insights to optimise the acceptability of regulations and minimise unintended social consequences. SO WHAT?: Resistance to regulations amongst socio-economically disadvantaged target populations warrants attention from public health advocates. Failure to accommodate concerns identified may further marginalise these groups.

Public support for government regulatory interventions for overweight and obesity in Australia

Background

There is growing recognition among public health circles of the need for regulatory action for overweight and obesity, but there has been limited research into whether the Australian public supports government intervention. This study aimed to determine the level of public support for food-related regulations for obesity, and to assess the determinants of support.

Methods

A nationally representative sample of Australian adults (n = 2011) was recruited by market research company Online Research Unit to complete an online survey. The survey measured respondents’ perception of the obesity problem in Australia, and level of agreement on a 5-point Likert scale (strongly disagree to strongly agree) with proposed regulations in three domains; advertising, sponsorship of children’s sport, and taxation. Binary logistic regression models were run to examine the association between demographic variables and support for regulation.

Results

The majority of respondents (92.5%) considered overweight and obesity to be a somewhat or very serious problem in Australia, and almost 90% felt there should be at least some government regulation to protect the public. Respondents agreed that the government should regulate food and beverage advertising (69.5%), with strongest support for restricting unhealthy food advertising to children (78.9%). There was lower support for prohibiting unhealthy food and beverage company sponsorship of children’s sport (63.4% agreement), and for taxing sugar-sweetened beverages (54.5%), although the majority were still in favour. Support for fiscal policies slightly increased if revenue was to be used for health purposes. Females and tertiary educated respondents showed stronger agreement with proposed regulations (p < 0.05).

Conclusions

The survey findings suggest the majority of the Australian population recognises obesity to be a serious health problem, and support government regulation of the food environment as a population-level preventative strategy.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5455-0) contains supplementary material, which is available to authorized users.

Fat as Productive: Enactments of Fat in an Australian Suburb

By foregrounding positive and productive capacities of fat, we explore experiences of expanding, maintaining, or diminishing body sizes to accommodate the different meanings and enactments of fat. Drawing on fieldwork conducted in a South Australian community that has experienced significant socioeconomic disadvantage, we detail how the "problem" of fat in public health discourse is countered in the lived experience of people targeted for obesity intervention. In so doing, we attend to the multiple meanings and practices of fat that differ to the focus within public health interventions on the negative health consequences of overweight and obesity.

Community perspectives on the use of regulation and law for obesity prevention in children: A citizens' jury

INTRODUCTION

Childhood obesity is a significant challenge for public health internationally. Regulatory and fiscal measures propagated by governments offer a potentially effective response to this issue. Fearing public criticism, governments are often reluctant to use such measures. In this study we asked a descriptively representative and informed group of Australians their views on the use of legislation and fiscal measures by governments to address childhood obesity.

METHODS

A citizens' jury, held in South Australia in April 2015, was asked to consider the question: What laws, if any, should we have in Australia to address childhood obesity?

RESULTS

The jury agreed that prevention of obesity was complex requiring multifaceted government intervention. Recommendations fell into the areas of health promotion and education (n=4), regulation of food marketing (n=3), taxation/subsidies (n=2) and a parliamentary enquiry. School-based nutrition education and health promotion and mandatory front-of-pack interpretive labelling of food and drink were ranked 1 and 2 with taxation of high fat, high sugar food and drink third.

CONCLUSION

The recommendations were similar to findings from other citizens' juries held in Australia suggesting that the reticence of decision makers in Australia, and potentially elsewhere, to use legislative and fiscal measures to address childhood obesity is misguided. Supporting relevant informed public discussion could facilitate a politically acceptable legislative approach.