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Tipping the Scales

The Challenge

Michael Brissenden from Four Corners addressed this topic last Monday evening, presiding over a discussion that opined that Australia is in the grip of an obesity and diabetes epidemic that potentially condemns many of us to a lifetime of broken health.

It went to say that despite this we still have no national obesity strategy, and public health advocates say one of the main reasons is that the food and drink industry has had an undue influence on our public health policy. Health advocates have been lobbying for years for a tax on sugar-sweetened beverages. 28 countries have so far adopted such a tax – the most recent being the United Kingdom – but here in Australia there is still no mainstream political support for the idea. Public health advocates accuse the food and drink lobby of actively working against reforms - using tactics similar to the tobacco industry.

  • If this is the case, how effective is current legislation and policy?
  • What do you consider we need ‘more of’, and what do we need ‘less of’ to strengthen current policy, legislation and regulation?

 

Each Monday MindHive Number One ranked consulting problem-solver, statistician Peter Grimbeek, leads a challenge on Australia's Four Corners’s investigation. We take seriously the often quoted “if you’d like to continue the conversation head to our Twitter or Facebook site”. What’s missing with that invite is the ability to collectively co-create various potential solutions and ideas to the challenges the production exposes. We’re missing the power of our collective intelligence on the issue at hand. The outcome of the challenge will be faciloitated by Peter, creating a 600-800 idea published on Mindhive, submitted to ABC and other mainstream media. Mindhive also allows for impact recognition by ORCID, uniquely identifying scientific and other academic authors and contributors ensuring you get credit for your work.

 

Challenge Opened: 02:59 PM, Wednesday 02 May 2018
Challenge Closes: 01:30 PM, Saturday 05 May 2018
Time to go: Closed

 

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The context

MICHAEL BRISSENDEN: The rolling green fields of northern Tasmania are home for Gary Fettke. But for this Launceston based orthopaedic surgeon it's not the postcard perfect countryside that makes this part of the world special.

DR GARY FETTKE, ORTHOPAEDIC SURGEON: I've often called Tasmania the canary in the mine; we do have poorer health outcomes - and some of the poorest in Australia. We've got diabetes and obesity that is out of control.

MICHAEL BRISSENDEN: Ulceration of the feet is one of the most debilitating conditions of late stage diabetes.

DR GARY FETTKE: This is a heel ulcer on someone whose got diabetes, obviously this portion of the foot has been far more involved and she's lost the majority of what we call the two rays, the big toe and the second ray. This person is losing the back of their heel and will ultimately require an amputation.

MICHAEL BRISSENDEN: It used to be an old person's disease. Not anymore. The youngest person seen in Australia with type 2 diabetes is just 5 years old. Gary Fettke is now seeing end stage complications much earlier too.

DR GARY FETTKE: The youngest person I've got with diabetic ulcer is in their 20's.

MICHAEL BRISSENDEN: "Wow, horrendous isn't it? Horrific"

MICHAEL BRISSENDEN: Around Australia last year there were 4,400 amputations directly related to diabetes . . . it’s not an easy operation for the patient or the surgeon.

DR GARY FETTKE: When you have to amputate someone's leg, it is one of the most awful operations that I do, and I've never enjoyed it, and the sound of cutting through someone's bone and having to put the leg into the bucket doesn't leave you. That's it. I can say it's one operation I hate doing more than anything.

MICHAEL BRISSENDEN: And the worse thing is he says - it's all so preventable.

DR GARY FETTKE: The current explosion is clearly related to our lifestyle. Now we can pencil in which bit of that lifestyle it is, but for me, it's the majority of this is actually a problem of processed food, and particularly sugar and highly refined carbohydrates.

MICHAEL BRISSENDEN: It's not just diabetes on the rise; obesity is also a growing problem. Australia is now one of the fattest countries in the world.

JANE MARTIN, EXECUTIVE MANAGER - OBESITY POLICY COALITION: We have such a serious public health problem on our hands, 27% of children above a healthy weight, 63% of adults, 11 million people . . . This is a society-wide problem, and we cannot leave it up to the food industry to solve this. They have an imperative to make a profit for their shareholders. They don't have an imperative to create a healthy, active Australia.

MICHAEL BRISSENDEN: In 1980, just 10 per cent of Australian adults were classified as obese - that is a Body Mass Index of 30 or over. BMI is a measure of weight compared to height. Today 30% are considered obese by that measure and another 30% are overweight. By 2025, 80% of Australians are expected to be overweight or obese. Stephanie Clarke is one of Australia's obesity statistics.

STEPHANIE CLARKE: Can I help you put your socks on? Sit up there.

STEPHANIE CLARKE: You know, when you're by yourself and you're looking in that mirror and you go, "Gosh, I wish I could change that", you know? I wish I could go on those rides with my daughter and not have to worry about if I'm going to fit in them or not.

MICHAEL BRISSENDEN: Here on the outer edges of Melbourne, it's another early start. Stephanie is doing whatever she can to ensure her daughter doesn't follow her path.

STEPHANIE CLARKE: I think if I can try and educate myself and then educate her, then she is going to be able to make better choices - yeah.

MICHAEL BRISSENDEN: Stephanie blames her weight problem on poor food choices: Too much fast food, large portion sizes, snacks and sugary drinks.

STEPHANIE CLARKE: I'd drink at least a can of Coke a day, and even when I got home, you know, I'd have a cupful or a mouthful or what-have-you, and that was just a regular part of my diet.

JANE MARTIN: We know that 52% of people exceed the guidelines for added sugar. We know that the largest proportion of added sugar in teenagers' diets, 60%, is coming from sugary drinks. That's a huge problem. We need to do a lot more to address this problem of added sugar from sugary drinks.

MICHAEL BRISSENDEN: One can of coke has nine teaspoons of sugar. The World Health Organisation currently recommends that only 10% of the energy in our diets should come from added sugar - that's about 12 teaspoons a day. Reducing that to just 6 teaspoons a day, it says, would have added health benefits.

DR AHMAD ALY, UPPER GASTROINTESTINAL SURGEON: It's the stuff of despair, personally when I see some of these young people it's almost hard to imagine that we've got to this point. This isn't about, as the food industry put it, people making their own choices and therefore determining what their weight will be. It is not as simple as that, and the science is very clear.

MICHAEL BRISSENDEN: Stephanie Clarke is one of many Australians turning to bariatric surgeons like Ahmad Aly for help.

DR AHMAD ALY: So Stephanie what have you tried in the past for your weight?

STEPHANIE CLARKE: Yep, So I've tried, you know, I should have mentioned, cutting out all junk food, cutting out coke, soft drinks, anything fizzy, uhm, trying cutting out sugar from my food, limiting the amount of sugar that I get.

MICHAEL BRISSENDEN: Once in the obese category, the science shows it's almost impossible to return to a normal weight.

DR AHMAD ALY: It's very clear to us, and the evidence is overwhelming, and there's really no dispute about it, really once you are in that obese category, it's virtually impossible to lose weight and keep it off. No study outside of surgical studies has demonstrated that it's possible. Approximately two to five percent of people will manage to keep off about 10% of their body weight.

DR ROBERT LUSTIG, PROFESSOR OF PAEDIATRICS, UNIVERSITY OF CALIFORNIA: How did the entire world get this fat, this fast . . . did everyone just become a bunch of gluttons and sloths.

MICHAEL BRISSENDEN: In California Dr Robert Lustig has become one of the world's most notable crusaders against sugar.

DR ROBERT LUSTIG: Sugar is 50 times more potent . . .

MICHAEL BRISSENDEN: His speeches and documentaries detailing exactly how sugar affects the body have become Internet sensations.

DR ROBERT LUSTIG: Sugar's made up of two molecules, one called glucose which is not very sweet and not very interesting, and fructose, which is very sweet and very interesting and it's the thing we seek, it's the thing we crave . . .

MICHAEL BRISSENDEN: According to Dr Lustig, it's the fructose element of sugar that's the big problem.

DR ROBERT LUSTIG: Fructose metabolises to fat, driving every one of these single diseases and when your pancreas can't make enough insulin and it burns out, it drives diabetes as well.

DR ROBERT LUSTIG: Back in 1965 type 2 diabetes was a disease of ageing, and it's a disease we only saw with alcohol consumption. Fatty liver disease was unheard of, except in alcoholics, prior to 1980. Today, it is the most common cause of liver transplant in the United States. 40% of all American adults have fatty liver disease and 17% of children, 40% of obese children. This is a disease that hadn't even been recognised till 1980. You want to talk about epidemics? That is the biggest epidemic of all.

MICHAEL BRISSENDEN: Dr Lustig calls sugar a poison.

DR ROBERT LUSTIG: The data are there to demonstrate that when we consume sugar over our proscribed upper threshold it acts as a chronic poison just like alcohol does.

MICHAEL BRISSENDEN: Sugar's role in this explosion of diet related disease is now being targeted around the world.

GEORGE OSBORNE, CHANCELLOR OF THE EXCHEQUER: "Obesity drives disease. It increases the risk of cancer, diabetes and heart disease - and it costs our economy GBP 27 billion a year; that's more than half the entire NHS pay bill. And here's another truth we all know. One of the biggest contributors to childhood obesity is sugary drinks. "

MICHAEL BRISSENDEN: In 2016 the UK Chancellor of the Exchequer first signalled an intention to tackle this developing health crisis with a new tax.

GEORGE OSBORNE: Mr Deputy Speaker, I'm not prepared to look back at my time here in this Parliament, doing this job and say to my children's generation: "I'm sorry. We knew there was a problem with sugary drinks. We knew it caused disease. But we ducked the difficult decisions and we did nothing. "

MICHAEL BRISSENDEN: Last month the UK became the 28th country to introduce a sugar sweetened beverages tax. Here in Australia there are calls for a 20% sugary beverages tax supported by the Australian medical association, the Australian Dental Association and the Public Health Association.

JANE MARTIN: There's a huge range of drinks that fit into the sugary drink category. So there's not just soft drinks, there's sports drinks, energy drinks, milk- based drinks like iced coffee, cordials, fruit juice drinks with added sugar.

DR AHMAD ALY: The sugar tax alone is not the whole story. I liken it to a ladder, to which you want to reach the top rung. If we really want to effect significant environmental change that will impact on obesity, we need a suite of measures, and we need dramatic change in our environment. But the sugar tax may well be the first rung in getting to the top of that ladder.

MICHAEL BRISSENDEN: The major parties have remained opposed to the idea and lobby groups like the Beverages Council are happy for it to stay that way.

GEOFF PARKER, CEO AUSTRALIAN BEVERAGES COUNCIL: One week chocolate's bad for you, and the next week, have you know, have a couple of bars. Coffee's good, coffee's bad, red wine's good, red wine's bad. Now, it's no wonder people are getting confused out there around the concept of a balanced diet, everything in moderation, and not forgetting around the importance of physical activity.

MICHAEL BRISSENDEN: So yeah, lobbyists are in this building all the time, aren't they?

MICHAEL BRISSENDEN: The corridors and offices of Parliament House are the key to influence.

MICHAEL MOORE, CEO PUBLIC HEALTH ASSOC OF AUSTRALIA: Big industry knows that if you're going to have influence then you're actually going to have to talk to members.

MICHAEL BRISSENDEN: As a former politician Michael Moore knows how the game works. He's seen it from the inside as a Territory Health Minister and as the Head of the Public Health Association.

MICHAEL MOORE: Around here in Parliament House this is what you get, this is where the influence happens, and industry can put much more into it than public health and consumer voices.

MICHAEL BRISSENDEN: One of the loudest voices is that of the Beverages Council - the body that represents non-alcoholic drinks companies.

GEOFF PARKER: We are encouraged by the government here in Australia, and indeed the opposition here in Australia, who continue to look to the evidence base and continue to reject this type of tax as some sort of silver bullet or white-knight to solve what is a really complex problem, and that is our nation's collective expanding waistline. This type of discriminatory and regressive tax continues to be a minority public health measure.

JANE MARTIN: It's not the public aren't on board. The politicians aren't on board, and the reason that a lot of the politicians aren't on board is because of this influence that we're seeing of groups like the Beverages Council, of these alliances in Canberra, working against effective recommendations.

MICHAEL BRISSENDEN: The Beverages Council holds its AGM at Parliament House - an event it describes as a "primary engagement opportunity" that helps build industry support it admits its spent a "vast amount of resources" lobbying against a sugar tax. The Beverage Council's 2016 annual report boasted of its success at "keeping the topic of a tax off the table from both of the major political parties. "

JANE MARTIN: I think it’s concerning that they are boasting about their influence, the fact that they've taken that annual report down off their website is I think they don't want to be as open as they were.

MICHAEL MOORE: There's no doubt. There will be a levy on sugary soft drinks. It's just a question of when, and that's what the industry understands. That's why they're trying to delay. Everything they're doing is not about stopping it; it's actually about delaying it. That's the way they work.

MICHAEL BRISSENDEN: While we do hear a lot from industry we don't hear much from politicians, and to understand the lack of political will for a sugar tax you need to look here - the sugar country of northern Australia.

MICHAEL BRISSENDEN: There is one really politically pragmatic reason why Australia has so steadfastly rejected the idea of a sugar tax; it's the power of the so-called sugar seats. The seat of Leichhardt where we are now stretches from Cairns to Cape York. It's what's called a bell-weather seat: A seat that usually swings to the party that forms government. Labor, further south, won the seat of Herbert, at the last election with just 37 votes. Dawson is held by the Maverick LNP backbencher George Christensen on around three and a half percent. And in Northern NSW, the seat of Page is often a contest between the Nationals and the Labor party. In an era of increasingly tight elections, sugar has guaranteed these four seats have added political weight.

MICHAEL BRISSENDEN: So Don, how long has this mill been here?

DON MURDAY, CHAIRMAN, AUSTRALIAN CANE FARMERS ASSOCIATION: Construction started in 1894 and the first cane was crushed, 15 thousand tons I believe, was crushed in 1897.

MICHAEL BRISSENDEN: And it's been a big part of the community ever since I assume?

DON MURDAY: Oh absolutely probably up until the 1980's it was the major industry in the shire. Since then the tourism industry has taken over but it's still a big player, big employer.

MICHAEL BRISSENDEN: Don, nice old house, been here for a few generations?

MICHAEL BRISSENDEN: Don Murday's great-grandfather was the first chairman of the Mossman sugar mill and one of the pioneers of sugar in Far North Queensland. His family has been growing sugar here for generations.

DON MURDAY: I'm a fourth-generation farmer. My great grandfather settled this block in, uh, 1883, we came out here and took up two selections and gave the low-lying one to his brother and kept this one here, and he worked on all sorts of crops and discovered that sugarcane was the crop to grow in the tropics.

MICHAEL BRISSENDEN: Like all sugar farmers Don Murday is opposed to a sugar tax. Even though only 20% of the sugar grown here goes to the domestic market profit margins are tighter than they've even been. Farmers say they are getting the same price for their sugar today as they were in 1964.

DON MURDAY: We can't afford to be wearing any of that cost. I just am opposed to taxes upon taxes upon taxes. I just don't think it's the right way to get the message across. It's a cultural thing. We need to change the culture of people's eating habits, and education is the best way to do that.

MICHAEL BRISSENDEN: So would a tax on sugar-sweetened beverages, for instance, cost jobs here?

DON MURDAY: Potentially it could, yeah. Anything that impacts on the profitability, if it does come back to the growers and it affects on profitability. Well, then, it definitely does. It has to impact on jobs.

MICHAEL BRISSENDEN: The growers believe sugar has been unfairly targeted. But Don Murday is a sugar grower with some unexpected opinions about his crop.

DON MURDAY: I produce sugar. I'm not the one who's actually abusing sugar, by loading up soft drinks and other things. I produce sugar in the hope that it's consumed responsibly and moderately. I know plenty of people who eat sugar and have a healthy, active life, and it's not an issue. But I know growing up, to have a Coca-Cola was a treat. You didn't drink Coca-Cola all day. And not meaning to single Coca-Cola out, but it's just sort of a cultural shift, isn't it? So, sugar, for that reason, is being targeted.

MICHAEL BRISSENDEN: What about you? You look like a bloke that looks after your health. Do you eat sugar?

DON MURDAY: I don't have sugar, except if it's in the alcohol that I drink, but I've made a choice, probably four years ago for health reasons, to cut sugar out of my diet and I can do that easily.

MICHAEL BRISSENDEN: That's like a beef farmer saying he doesn't eat steak.

DON MURDAY: Yeah. Well, if I were a beef farmer, I wouldn't be saying that.

GEORGE CHRISTENSEN, MP LNP: if you want to do something which is going to impact on the sugar industry, bring in a soda tax, because it'll do that, but I'll guarantee you, I would be willing to bet a lot that it will not do anything in terms of obesity whatsoever.

MICHAEL BRISSENDEN: George Christensen's seat of Dawson is the biggest sugar growing area in the country. This is a man who knows a thing or two about sugar and about the dangers of overconsumption.

GEORGE CHRISTENSEN: My grandfather used to make me, every time I went over there, what he called the sugar butty. Bread and butter sprinkled with sugar, a lot of sugar. I mean I can't imagine too many parents or grandparents doing that today.

MICHAEL BRISSENDEN: His love of sugar and fast food has had serious consequences. Last year he hit 176 kilos and took the drastic step of having 85% of his stomach surgically removed.

GEORGE CHRISTENSEN: I'm a fat bloke, right? You know, I've been fat ever since I was probably about 20, 21. I don't blame the sugar industry. I don't blame Coca-Cola. I don't blame XXXX or Bundaberg rum I don't blame them. I blame myself for putting that product down my gob. That's what caused it, me myself and I, and I think that a lot of the issue with obesity has got to come back to telling people that they are personally responsible for the choices they make: 20% on a $2. 00 can of Coke, we're talking about an extra 20 cents, is that really going to stop someone from buying a can of Coke?

MICHAEL BRISSENDEN: As the world's most popular and recognizable sugar sweetened beverage the finger is often pointed at Coca-Cola. And as it turns out, with good reason, around the world Coke has spent considerable time, effort, and money attempting to undermine public health strategies that single out sugar as the primary cause of obesity, and trying to influence the debate about sugar taxes.

MICHAEL BRISSENDEN: In 2016 internal Coca-Cola emails were leaked that showed how Coke executives in the US had worked to pressure local governments, influence journalists and aggressively lobby politicians against a sugar sweetened beverages tax.

DR STEVEN BLAIR, GLOBAL ENERGY BALANCE NETWORK: We just got approval for the funding to establish a Global Energy Balance Network.

MICHAEL BRISSENDEN: Coca-Cola paid scientists to conduct research that would shift the blame for obesity from sugar to a lack of exercise. They established what they called the Global Energy Balance Network

STEVEN BLAIR: "Most of the focus in the popular media and in the scientific press is either eating too much, eating too much, eating too much, blaming fast food, blaming sugary drinks and so on. And there's really, virtually no compelling evidence that that in fact is the cause. "

DR ROBERT LUSTIG: The New York Times exposed the Global Energy Balance Network, a consortium of three institutions and three scientists who were basically dedicated to the notion that the obesity problem was due to a lack of exercise. These three scientists were paid directly from Coca-Cola.

MICHAEL BRISSENDEN: Public health officials and scientists in the US criticised Coca-Cola and the Global Energy Network for spreading scientific nonsense. The network has since shut down. But that wasn't Cokes only expensive attempt to influence the debate.

DR ROBERT LUSTIG: Another paper came out last year demonstrating that Coca-Cola had given money to 94 separate public health agencies specifically to use calories as the marker of obesity and physical activity as the problem rather than sugar beverages. So, the fact is this kind of influence, under the table influence continues to go on even today.

MICHAEL BRISSENDEN: Here in Australia the Coca-Cola company has left most of the lobbying work to its bottler - Coca-Cola Amatil. Although it is a separate listed company the Coca Cola company is still the major shareholder of Coca-Cola Amatil. In Canberra, Coca-Cola Amatil engages one of the nations premier lobbying firms - Newgate communications. The company now has a policy of not making political donations but between 1999 and 2015 it gave about a million dollars to each of the major parties. MICHAEL MOORE: People who donate to both parties -there's only one reason you can be doing that, and that is to buy influence. To buy access to ministers, to members and that access is influence.

MICHAEL BRISSENDEN: And it works, doesn't it? You donate, you get access.

MICHAEL MOORE: There's no question, if you make donations, of course you get access.

MICHAEL BRISSENDEN: And influence isn't always realised with money. Last year Coca-Cola headquarters in Sydney provided the venue for a seminar on the future of foods run by the Dieticians Association of Australia. Philip Juffs is the Association's president

MICHAEL BRISSENDEN: Surely that must have been a mistake?

PHILIP JUFFS, PRESIDENT, DIETICIANS ASSOCIATION OF AUSTRALIA: So that particular event was ... the offices that were offered up were from someone working there and that was for convenience. Look, you know, I concede that there are some 'optics' issues, as you describe it, with that, and, you know, we learn and move on.

MICHAEL BRISSENDEN: So it was a mistake?

PHILIP JUFFS: I don't think I'd call it a mistake. The members who were having that meeting, work in the food industry, and that's a part of their normal, you know, part of their normal workplace.

MICHAEL BRISSENDEN: The Dieticians Association of Australia says it supports the idea of a tax on sugary drinks. The Association is the professional body representing 6500 dieticians. It takes hundreds of thousands of dollars a year in sponsorships - some of its corporate partners include food giants Nestle, Campbell, Arnott’s and a group called Cereal 4 Brekkie - representing big cereal manufacturers.

PHILIP JUFFS: We have an annual budget of around $5 million dollars, as an organisation. And around 8% of that is derived from corporate partnerships. And, of that, only no more than about 1% comes from any single partner, so we're able to minimise any influence like that.

MICHAEL BRISSENDEN: Do you think sugar's to blame for the obesity and diabetes crisis that we're having at the moment?

PHILIP JUFFS: It's an easy thing to say yes, but it's a lot more complicated than that. In its simplest terms, weight management really is about energy in: how much we eat. And energy out: how much physical activity we do. But that doesn't happen in isolation. We don't live in a test tube.

MICHAEL BRISSENDEN: In Tasmania surgeon Gary Fettke says the Dieticians Association has been campaigning against the advice he's been giving to his patients to cut their sugar intake. Dr Fettke is puzzled by the Dieticians position given the clear results he's seen in his patients.

GARY FETTKE: Within days these people start feeling better, and particularly in diabetes they start getting blood glucose control that they haven't achieved in decades. They actually come back a week down the track, two weeks down the track, saying, 'Hey, doc, I'm actually reducing my medication. I feel better. My brain's working again. ' Over a longer period of time, we see their ulcers heal. We see their function improve. I've seen patients, their peripheral neuropathy improve. That's not supposed to happen, but I can guarantee it.

MICHAEL BRISSENDEN: Gary Fettke has become a fierce champion of a low carbohydrate diet - quitting sugar is the first step.

GARY FETTKE: So I came up with a handout, which advised patients to reduce their sugar intake. As it turns out, what I was advising is completely now in lines with the recommendations of the World Health Organisation. So I gave that handout to my patients, and that's when the trouble started.

MICHAEL BRISSENDEN: The Dieticians Association complained to the medical board about the advice he's been giving to his patients.

MICHAEL BRISSENDEN: Many people would be surprised that a doctor couldn't give dietary advice, right. Don't you think?

PHILIP JUFFS: Doctors can give dietary advice. It's about the scope of that advice. And so dieticians are there, you know, they are the trained professionals in nutrition. Just like doctors are the professionals in medicine, dieticians are there to be the experts in nutrition. Gary's clearly a staunch nutrition advocate for his patients and that's a good thing, absolutely no doubt. In terms of ...

MICHAEL BRISSENDEN: But you say he can't do it?

PHILIP JUFFS: No. I'm not saying he can't do it. It's about the level of advice. There's a line across which specific type of advice should be provided by particular professionals.

MICHAEL BRISSENDEN: The Australian Health Practitioner Regulation Agency found he was working outside his scope of practise and was not qualified to give specific nutritional advice. Gary Fettke is still advising his patients to cut their sugar intake.

MICHAEL BRISSENDEN: What are the consequences? Could you be struck off?

DR GARY FETTKE: Yes, that is the potential that if I keep receiving complaints that I have the potential to be struck off. And each year I get reported by another dietician. So each year I've had a dietician anonymously report me to the Medical Board for giving this advice.

Government Health Video: "Australia has one of the highest rates of obesity in the world. "Despite our current health crisis Australia has no national obesity strategy. What we do have is two key federal initiatives. Government Health Video: "When you're out shopping there are some things you want less off . . . The healthy food partnership to encourage healthy eating and the health star rating - a front of packet labelling system. "The health star ratings system takes in all this information to help you make the healthier choice. The rules have been agreed by committees that include representatives from government, public health and the food industry - including companies like Coca-Cola, PepsiCo, Unilever, Nestle and Kellogg’s. Jane martin was a member of the Healthy Star Rating Committee

JANE MARTIN: I was on the committee for two and a half years. But it moved very slowly, and some of the key elements that were on the table, such as that the system should be mandatory, ended up being off the table by the time the negotiations closed and the system went live, basically. And that's because industry didn't want it to be mandatory, so they took their time, they lobbied behind the scenes and it wasn't made mandatory, and that's a big flaw in the system.

MICHAEL MOORE CEO Public Health ASSOCIATION of Australia: "Look, the reality is that industry is, by and large, making most of the policy. Public Health is brought in, so that we can have the least worst solution. "

Both Michael Moore and Jane Martin say many of the committees are dominated by vested interests and they say industry has had too much sway.

JANE MARTIN: "Industry should be consulted around what policies should be implemented, but they shouldn't have a role in deciding what they are. They should be decided separately based on the evidence and the potential impact, and then industry should be involved in how to make that happen. "

GEOFF PARKER: "To suggest that industry shouldn't be at the policy development table, as some in the public health fraternity have suggested, that we should only be brought in at implementation is disappointing and is perplexing when there are these really great examples of what can actually happen when this collaboration model to try and solve a really complex problem can be enacted. "

Public Health advocates are concerned by the industry’s behaviour. They say they've seen these tactics before.

MICHAEL MOORE: "What we see is tactics that were used by tobacco being picked up by big food industry, and that's actually what worries us. It's about obfuscation. It's about delay. It's about challenging, or making assertions, but then public health has to go and try to find the evidence to counter. And that uses up a lot of our time. "

JANE MARTIN: "I feel like it's some kind of Groundhog Day here, just with a different issue, and particularly on the sugary drinks issue. Even the alliances are similar. So the tobacco industry worked to set up these alliances with the retailers, with the Australian Association of National Advertisers, with the convenience stores, with industry groups, very similar to this alliance that's working against a health levy on sugary drinks. "

GEOFF PARKER: "We refute any analogy with consuming soft drinks and sugar with smoking and cigarettes and tobacco. There's no safe level of smoking, and so we refute any sort of comparison between what's happening with reducing the prevalence of smoking with reducing the consumption of sugar sweetened beverages. They're not the same, and we shouldn't be using that sort of comparison or analogy. "Industry influence on policy has been exposed in the past. In February 2014, the then assistant health minister Fiona Nash moved against the newly introduced health star rating system STRAP (February 2012).

SENATOR PENNY WONG, ALP SENATOR PENNY WONG: "All it took was one phone call to Senator Nash's office from the Australian Food and Grocery Council and the next thing that happened was the assistant minister's chief-of-staff instructed her department to take down the website immediately. It emerged Fiona Nash's chief-of-staff was a director of a lobbying firm that represented the food industry”.

SENATOR PENNY WONG: "Mr Deputy President, this is a textbook example of a conflict of interest."

Michael Brissenden: "Well Jane we've got a selection here of breakfast cereals, all of which have health star ratings . . . "Public health advocates say what consumers have been left with is better than nothing but doesn't go far enough. And Jane Martin says the voluntary code can be confusing

JANE MARTIN: "This cereal has, you know, a cricketer on the front and as far as sugar goes its 26. 9% sugar so that's regarded as a high sugar cereal, yet it gets four stars so that's a concern. "Four stars for milo cereal - just behind no-sugar Weetbix with five stars. The health star rating is currently being reviewed.

MICHAEL MOORE: "It's being reviewed to try and address those anomalies. The most important issue for addressing those anomalies, in my mind, is to include added sugar in the algorithm. It hasn't been done. It needs to be done. "The science of sugar is still clearly a key battle ground. Industry cites studies including one commissioned by the Beverages Council from the CSIRO based on consumers own estimates of their sugar consumption.

GEOFF PARKER: "The recent CSIRO secondary analysis of the Australia Health Survey that shows not only is the percent of people consuming soft drinks decreasing, but also the amount that they're consuming is also decreasing and that's also off the back of a peer-reviewed Sydney University paper, which showed that added sugar consumption and sugar from sugar sweetened beverages had been decreasing since the 1970s. "George Christensen also touts that Sydney university research paper.

GEORGE CHRISTENSEN: "The findings challenge the widespread belief that energy from added sugars or sugars in solution are uniquely linked to the prevalence of obesity. So, there's something else rather than just sugar that is causing obesity rates to blow out and it's not just an Australian problem, it's a problem right throughout the Western world. "

Michael Brissenden PTC: That paper is regularly quoted by pro-sugar politicians and industry. It was produced here at the science faculty at Sydney University and is a follow up to an earlier 2011 research paper known as the 'Australian Paradox' . . . Both papers have been discredited - critics say they're based on incomplete data and that serious errors were made in the conclusions. The study's authors had to issue a correction after it was pointed out that a graph they claimed showed a 10% decline in sugary drink consumption in Australia actually showed a 30 per cent increase.

PROFESSOR ROBERT BOAKES: "I can have a look at that over the next couple of days. As it happens some of the fiercest critics of this study also work at Sydney University.

DR KIERON ROONEY: "Okay, ready to go ... so we're looking for the switch experiment in two more weeks' time, which will be saccharin and sucrose. "

PROFESSOR ROBERT BOAKES: "So I'll order the rats for when I get back. "

DR KIERON ROONEY: "I think one of the most telling things about that study is that the only people you'll find singing its praises are industry, whether or not the plot's going up or down or a flat line, is really open to question. But one of the things to take from that is that even if it is on the decline, the data we have shows that what we're consuming now is still too much. "

PROFESSOR ROBERT BOAKES: "What we do is put two objects into the middle of the arena . . . "Professor Robert Boakes and Dr Keiron Rooney are coming up with very different conclusions about the consumption of sugar.

PROFESSOR ROBERT BOAKES: "Okay. This is a very simple test of spatial memory, we'll call it, and it takes advantage of the fact that rats, like household pets, are curious and if it's something new, then they go and sniff at it. "These rats are fed a diet of up to 40% energy from sugar - similar to the amount consumed by some teenage boys. After four weeks the rat’s memory is seriously impaired.

PROF ROBERT BOAKES: "What we find is that the animals have been on sugar drinks for a long time and they don't seem to remember where things were.

MICHAEL BRISSENDEN: "So they have a cognitive problem? It affects their brain?

PROF ROBERT BOAKES: "They do. Yeah.

MICHAEL BRISSENDEN: "So, I guess the question is, this happens in rats, does it happen in humans?"

PROF ROBERT BOAKES: "It probably happens in people, yeah. "

MICHAEL BRISSENDEN: "Right, that's the conclusion. "

PROF ROBERT BOAKES: "That's why we do it. The thing about rat research is you can control their diet completely and you know exactly what they've eaten, how much they've drunk and so forth. Of course, with human research it's not like that. "

MICHAEL BRISSENDEN: "No, but your conclusion from this is what? That drinking too much ..."

PROF ROBERT BOAKES: "Too much sugar drinks harms the brain. Yeah. It will recover if the rats are taken off the sugar drinks. Then they recover this ability. "The physical damage is even more alarming. After just four weeks on a high sugar diet the rats gain weight, they develop fatty livers and show signs of insulin resistance - the beginning of type 2 diabetes. Stop the sugar and the female rats fully recover - the males don't.

DR KIERON ROONEY: "These animals still carry more body fat than if they had never consumed sugar previously. "

MICHAEL BRISSENDEN: "And the biggest consumer of sugary beverages are young men. Isn't that the case?"

DR KIERON ROONEY: "That's right. That's right, so when you look at the population data, how sugar-sweetened drinks are the number one source of free sugars from almost every age group that we have and every sex. But the greatest consumers of sugar-sweetened drinks are our young men, and this would suggest to us that we are potentially having a generation of young men now who are laying down metabolic damage that they may never recover or will take a lifetime to recover. "The human path to obesity is complex - but what is clear is that both men and women who suffer from this are desperately looking for a solution. Anaesthetist: "Just going to get you into this little holding bay, Stephanie, alright?" Increasing numbers of people are turning to surgery

DR AHMAD ALY: "I'm alright, how are you . . . "It's a big day for Stephanie Clarke. In her battle with obesity she's tried everything. She sees this as her last option.

DR AHMAD ALY: "You'll be fine we'll take good care of you, you'll be ok, start of a new life - huh?"

STEPHANIE CLARKE: "Yep - thank you" Today she's having an operation called a sleeve gastrectomy - she's having three quarters of her stomach removed.

AHMAD ALY: "It is a crisis. There's really good reason why the word epidemic keeps coming up alongside obesity. This is the number one health issue of our time. And yeah, we're slow to react, but it's time to catch up. "

JANE MARTIN: "We need a strategy. We have no national obesity strategy. The leading public health issue currently in our society, and we do not have a strategy. We are developing an alcohol strategy, we have a sports strategy, but we don't have an obesity strategy. Yet as obesity rates continue to climb - and the toll of associated diseases like diabetes puts ever more strain on health systems around the world ... calls for governments to act, get louder. Australian Public Health advocates say we need to do something and everyone - including industry - knows it.

JANE MARTIN: "So we need to think about what kind of future we want. We have this huge public health problem. The things that we are currently doing are not good enough.

In the UK the tax on sugar-sweetened drinks has already caused some companies to reduce the amount of sugar in their products sold in Britain. The amount of sugar in Fanta has been cut by nearly a third, while the sugar content in Ribena has halved. Coke and Pepsi remain unchanged. And finally an update on Stephanie Clarke's bariatric surgery - we're told it went well and she was released from hospital yesterday.

Challenge Opened: 02:59 PM, Wednesday 02 May 2018
Challenge Closes: 01:30 PM, Saturday 05 May 2018
Time to go: Closed

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Peter Grimbeek Statistics & Methods Counsellor
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Richard Ferrers Research Data Analyst, Australian Research Data Commons (formerly Australian National Data Service)
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Elizabeth Watts Project Manager
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Mark Sydney A/Senior Director
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Bill Wyatte Integrated Criminal Justice Governance and Program Manager
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William Bell Research Associate
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Annette Gough Emeritus Professor
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Timothy Flor Policy Analyst
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