Overweight and obesity is a global health problem.1 Being overweight or obese is a risk factor for colorectal, breast (post-menopause), oesophageal (adenocarcinoma), endometrial, pancreatic, liver and kidney cancers.2,3 Obesity is the second highest contributor to disease burden after tobacco use among Aboriginal and Torres Strait Islander peoples.4,5 Being overweight or obese has been shown to contribute 16% to the overall health gap observed between Aboriginal and Torres Strait Islander peoples and the broader Australian community.5
The complex interplay of socio-environmental factors that contribute to obesity among Aboriginal and Torres Strait Islander peoples are well known.6 Meaningful collaboration and empowering Aboriginal communities to have control over programs that affect their health and wellbeing are more likely to result in positive health outcomes.6
About this measure
Being overweight or obese is a risk factor for colorectal, breast (post-menopause), oesophageal (adenocarcinoma), endometrial, pancreatic, liver, and kidney cancers.2,3 It is estimated that 3.6% of all new cancers in adults worldwide are attributable to excess bodyweight.8 In the long term, obese children are also at risk of acquiring other chronic conditions; including, cardiovascular disease, diabetes, depression, and arthritis, and premature mortality.9
Overweight and obesity is an important cancer control measure to monitor due to the significant variations between Aboriginal and Torres Strait Islander peoples at the national level (e.g. sex, area of residential remoteness etc.). The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 identifies the importance of addressing the social and cultural determinants of health to reduce the inequalities that lead to poorer health outcomes, including unhealthy weight and obesity.10
For a comparison with the broader Australian community see the NCCI 'Overweight and obesity'.
Current status
Children and young people (2-14 years)
In 2018-19, more than half (54.2%) of young Aboriginal and Torres Strait Islander people aged 2 to 14 years were in the normal weight range. Around one-quarter (24.3%) of young Aboriginal and Torres Strait Islander people were overweight and more than one in 10 (12.7%) were obese.11
Weight ranges were similar among males and females. The proportion of males and females were similar for normal weight (55.3% compared with 52.8%), overweight (22.2% compared with 26.5%), obese (12.3% compared with 13.3%) or underweight (10.2% compared with 7.4%).11
The proportion of young Aboriginal and Torres Strait Islander people being overweight or obese increased with age, with the highest prevalence among those aged 12-13 years (48.3%). For males, 12-13 years age group (54.4%) had the highest prevalence for overweight or obesity and the lowest in the 2-3 years age group (21.6%). For females, the highest proportion was reported in the 2-3 years age-group (44.0%) and the lowest in the 4-8 years age group (34.7%).11
Persons aged 15 years and older
In 2018-19, one-quarter (24.9%) of Aboriginal and Torres Strait Islander people aged 15 years and over were in the normal weight range. Around seven in ten (71.2%) people were not in the healthy weight range, being either overweight (28.5%) or obese (42.6%). The combined overweight and obesity rates were similar between males and females. A higher proportion of females were obese in comparison to males (45.0% compared with 40.0%) while overweight rates were higher among males (30.6% compared with 26.5%). There was no marked difference between males and females who were normal weight (26% compared with 24% respectively) and underweight (3.2% compared with 4.5% respectively).11
The proportion of overweight or obese Aboriginal and Torres Strait Islander people generally increased with age, reaching a maximum of 82.1% among those aged 55 years and over. While the overweight rates were similar across all age groups, the proportion of obese adults steadily increased with age.11
Remoteness
In 2018-19, Aboriginal and Torres Strait Islander obesity rates varied by remoteness of residence for those aged 15 years and over. A higher proportion of Aboriginal and Torres Strait Islander people who were overweight or obese resided in Non-remote areas (73.0%) than Remote areas (63.9%). Of the Non-remote areas, a higher proportion lived in Inner Regional areas (76.4%) followed by Major Cities (73.2%). Of the Remote areas, a higher proportion of Aboriginal and Torres Strait Islander people lived in Remote areas (67.6%) compared to Very remote areas (62.0%).11
Trends
Children and young people aged 2-14 years
The proportion of children aged 2-14 years who were overweight or obese increased from 30.4% in 2012-13 to 37.1% in 2018-19. This can be attributed to the overweight and obesity rate among females increasing by 7.6 percentage points (32.2% to 39.8%). In comparison, the overweight and obesity rate for males increased by 5.8 percentage points (28.6% to 34.4%). The overall normal weight range among children aged 2-14 years decreased by 7.5 percentage points (61.7% to 54.2%).11,12
The availability of takeaway and convenience foods as well as the affordability of healthy foods such as fruits and vegetables has contributed to the increased obesity prevalence in Indigenous communities.6,13 One way of addressing this disparity among the Aboriginal and Torres Strait Islander population, is by having ready access to affordable, healthy food options.6
Persons aged 15 years and over
Between 2012-13 and 2018-19, the proportion of Aboriginal and Torres Strait Islander people aged 15 years and over who were overweight or obese increased by 5.6 percentage points (65.6% to 71.2%). This mirrored the increase in persons who were obese by 5.6 percentage points (37.0% to 42.6%), with the proportion of persons who were overweight remaining steady (28.6% in 2012-13 and 28.5% in 2018-19).11,12
The increasing rate of overweight or obesity between 2012-13 and 2018-19 was higher among males. Males who were overweight or obese increased by 6.8 percentage points (63.9% to 70.7%) compared to females (increase of 4.4 percentage points, 67.3% to 71.7%).11,12
Remoteness
From 2012-13 to 2018-19, the proportion of persons who were overweight or obese increased across both remote and non-remote areas. Aboriginal and Torres Strait Islander people who were overweight or obese living in non-remote areas increased by 6.1 percentage points (66.9% to 73.0%) and those living in Remote areas increased by 2.6 percentage points (61.3% to 63.9%).11,12
Barriers and opportunities
It is important to recognise and address the social and economic barriers which make it difficult for Aboriginal and Torres Strait Islander peoples to modify their behaviour and reduce the risk of becoming overweight or obese.13 Some of these barriers could include housing instability, lower levels of education, lower income levels and unemployment, and living in disadvantaged neighbourhoods.14
Common characteristics of studies which reported success in reducing obesity include: a focus on physical activity and diet opposed to diet alone; the ability to accommodate the preferences of participants; a group focus; and choice between a number of physical activities. Programmes must also be culturally acceptable, evidence-based, conveniently located, easily understood and incorporated into the daily schedule and show goal attainment that is realistic and appropriate.15,16 In addition, food supply in Aboriginal and Torres Strait Islander communities should ensure healthy, good quality food options that are available at competitive prices.17,18
About the data
Overweight and obesity is calculated using the Body Mass Index (BMI), a scale based on height and weight commonly used to define if a person is underweight, normal weight, overweight or obese.19 BMI is calculated by dividing a person’s weight (in kilograms) by their height (in meters) squared.
Guidelines established by the World Health Organisation20 and the National Health and Medical Research Council21 place adults aged 18 years and older into the following categories based on their BMI.
| BMI (kg/m2) | Classification |
|---|---|
| Less than 18.5 | Underweight |
| 18.5 to less than 25 | Normal weight |
| 25 to less than 30 | Overweight |
| 30 or more | Obese |
| 35 or more | Morbidly obese |
Where relevant, rates were age-standardised for this measure to account for differences in age structure over time. Age-standardisation was also applied for comparisons between population groups, including: area of residential remoteness, and level of socioeconomic disadvantage.
Children and young people
This measure shows the proportions of children and young people aged 2-14 years who were overweight or obese.
Numerator: Number of children and young people aged 2-14 years who were overweight or obese.
Denominator: Number of children and young people aged 2-14 years whom had their height and weight measured
There is a separate BMI scale for children and young people where BMI calculations take into account the age and sex of the person. The cut-off points for each BMI classification for children and young people are based on the corresponding cut-off points for adults aged 18 years and over. For example, a score of 24 for a 10 year old boy is equivalent to a score of 30 (obese) for an adult.
The cut-points are sourced from Cole et al (2007), Establishing a standard definition for children overweight and obesity worldwide: international survey, 2000.
Persons 15 years and over
This measure shows the proportions of people aged 15 years and over who were overweight or obese.
Numerator: Number of persons aged 15 years and over who were overweight or obese (i.e. BMI score of 25 or greater).
Denominator: Number of persons aged 15 years and over having their height and weight measured
BMI score: overweight = 25 to less than 30; obese = 30 or greater; morbidly obese = 35 or greater.
Data sources
ABS 2018-19 National Aboriginal and Torres Strait Islander Health Survey
ABS 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey – Core Content
Methodology
Proportions have been age standardised to the 2001 Australian population to account for differences in age structures between the populations.
Data caveats
Table 2 below presents the age-groups of children and young people for whom height and weight were measured across the different survey years. The proportions of children and young people who did not have their height and/or weight measured are also presented in the table:
Table 2: Age groups and proportions of children and young people who did not have their height and/or weight measured, by survey year
|
Survey Year |
Age group in scope (years) |
Height and/or weight not measured (%) |
|
2012-13 |
2-14 |
23.3 |
|
2018-19 |
2-17 |
52.4* |
*For these respondents, imputation was used to obtain height, weight and BMI scores.
Although BMI is correlated with body fat, it does not measure body fat directly or the distribution of body fat.19 Therefore, two individuals with the same BMI can have very different patterns of body fat distribution which contributes to different levels of risk of developing chronic diseases. However, BMI is a simple tool in measuring and monitoring trends in overweight and obesity across different populations.
The calculation of BMI is based on measured height and weight data collected from the 2018-19 National Aboriginal and Torres Strait Islander Health Survey and the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey - Core content.11,12
Table 3 presents the proportions of persons aged 18 years and over who did not have their height and/or weight measured across the survey years:
Table 3: Proportions of persons aged 15 years and over who did not have their height and/or weight measured by survey year
|
Survey Year |
Age group in scope (years) |
Height and/or weight not measured (%) |
|
2012-13 |
15 years and over |
17.5 |
|
2018-19 |
18 years and over |
39.9* |
*For these respondents, imputation was used to obtain height, weight and BMI scores.
References
Activity in this area
Data
Australian Bureau of Statistics. 4727.0.55.001 – Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, Australia, 2012-13. Canberra: ABS; 2014 [Accessed May 2020]; Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.001main+features12012-13
Australian Bureau of Statistics. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19. Canberra: ABS; 2019; [Accessed May 2020]; Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12018-19?OpenDocument
Policy
National Health and Medical Research Council. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia (2013). Canberra: NHMRC; 2015 [Accessed May 2020]; Available at: https://www.nhmrc.gov.au/guidelines-publications/n57
Australian Department of Health and Ageing. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra; 2013 [Accessed May 2020]; Available at: https://www1.health.gov.au/internet/main/publishing.nsf/content/B92E980680486C3BCA257BF0001BAF01/$File/health-plan.pdf
Australian Health Ministers’ Advisory Council, 2017, Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra [Accessed May 2020]; Available at: https://www.niaa.gov.au/sites/default/files/publications/2017-health-performance-framework-report_1.pdf
Department of Health, Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, Australian Government, Canberra, 2015 [Accessed May 2020]; Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/indigenous-implementation-plan
Cancer Australia. National Aboriginal and Torres Strait Islander Cancer Framework. 2015 Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/overlay-context=affected-cancer/aboriginal-and-torres-strait-islander-people/national-aboriginal-and-torres-strait-islander-cancer-framework
Cancer Australia. Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer. 2018 Available from: https://canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/optimal-care-pathway-aboriginal-and-torres-strait-islander-people-cancer
Australian Indigenous HealthInfoNet – bodyweight: information about policies and strategies, resources, publications, programs and organisations that address Aboriginal and Torres Strait Islander body weight.
References
1. Organization for Economic Cooperation and Development. "Obesity Update 2017", OECD Publishing; 2017 [Accessed May 2020]; Available at: https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf
2. Cancer Australia. Lifestyle risk factors and the primary prevention of cancer. Sydney: Cancer Australia; 2015 [Accessed May 2020]; Available at: https://canceraustralia.gov.au/publications-and-resources/position-statements/lifestyle-risk-factors-and-primary-prevention-cancer
3. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research; 2007.
4. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra, 2017 [Accessed May 2020] Available at: https://www.niaa.gov.au/sites/default/files/publications/2017-health-performance-framework-report_1.pdf
5. Vos T, Barker B,Begg S, Stanley L, Lopez A. Burden of disease and injury in Aboriginal and Torres Stait Islander peoples: the Indigenous health gap. 2009; 2: 470-477.
6. Sherriff SL, Baur LA, Lambert MG, Dickson ML, Eades SJ, Muthayya S. Aboriginal childhood overweight and obesity: the need for Aboriginal designed and led initiatives. Public Health Res Pract. 2019;29(4):e2941925.
7. Stewart BW. Priorities for cancer prevention: lifestyle choices versus unavoidable exposures. The Lancet Oncology. 2012;13(3):e126-33.
8. Colditz GA, Wolin KY, Gehlert S. Applying what we know to accelerate cancer prevention. Sci Transl Med. 2012;4(127):127rv4.
9. Australian Institute of Health and Welfare. Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW; 2014 [Accessed May 2020]; Available at: https://www.aihw.gov.au/reports-data
10. Department of Health, Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, Australian Government, Canberra, 2015 [Accessed May 2020]; Available at: https://www1.health.gov.au/internet/main/publishing.nsf/Content/indigenous-implementation-plan
11. Australian Bureau of Statistics. 4715.0 - National Aboriginal and Torres Strait Islander Health Survey, 2018-19. Canberra: ABS; 2019; [Accessed May 2020]; Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12018-19?OpenDocument
12. Australian Bureau of Statistics. 4727.0.55.006 - Australian Aboriginal and Torres Strait Islander Health Survey: Updated Results, 2012–13. Canberra: ABS; 2014 [Accessed May 2020]; Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4727.0.55.006main+features12012-13.
13. Thurber KA, Boxall, A, Partel, K. Overweight and obesity among Indigenous children: individual and social determinants. Deeble institute issues brief, 2014 [Access May 2020]; Available at: https://ahha.asn.au/publication/issue-briefs/overweight-and-obesity-among-indigenous-children-individual-and-social
14. Australian Health Ministers’ Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2017 Report, AHMAC, Canberra, 2017[Accessed May 2020]; Available at: https://www.niaa.gov.au/sites/default/files/publications/2017-health-performance-framework-report_1.pdf
15. Canuto KJ, McDermott RA, Cargo M, Esterman AJ. Study protocol: a pragmatic randomised controlled trial of a 12-week physical activity and nutritional education program for overweight Aboriginal and Torres Strait Islander women. 2011:11:655.
16. Stevens JA, Egger G, Morgan, B. A novel, culturally appropriate approach to weight management in Aboriginal and Torres Strait Islander people, Med J Aust 2018; 209(1)68.
17. Australian Department of Health. Healthy weight for adults and older Australians, 2011, [Accessed May 2020]; Available at: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/hw-ad-old-aus-toc~hw-ad-old-aus-ab
18. Thurber KA, Joshy G, Korda R, Eades SJ, Wade V, Bambrick H, Banks E. Obesity and its association with sociodemographic factors, health behaviours and health status among Aboriginal and non-Aboriginal adults in New South Wales, Australia, J Epidemiol Community Health 2018;72:491-498.
19. Center for Disease Control. Body Mass Index: Considerations for Practitioners. Atlanta, GA: Department of Health; 2015 [Accessed May 2020]; Available at: http://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf.
20. World Health Organization. Obesity and overweight. Geneva: WHO; 2016 [Accessed May 2020]; Available at: http://www.who.int/mediacentre/factsheets/fs311/en/.
21. National Health and Medical Research Council. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia. Canberra: NHMRC; 2013 [Accessed January 2022]; Available at: https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity.