A Critical Analysis of Representations of Inequalities in Childhood Obesity in Australian Health Policy Documents

Document Type : Original Article


1 School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

2 Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia


In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as ‘problems’ in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019.
Australia’s federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy.

Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions.
Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH).


  1. Freedman DS, Lawman HG, Skinner AC, McGuire LC, Allison DB, Ogden CL. Validity of the WHO cutoffs for biologically implausible values of weight, height, and BMI in children and adolescents in NHANES from 1999 through 2012. Am J Clin Nutr. 2015;102(5):1000-1006. doi:10.3945/ajcn.115.115576
  2. Simmonds M, Llewellyn A, Owen CG, Woolacott N. Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Obes Rev. 2016;17(2):95-107. doi:10.1111/obr.12334
  3. Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev. 2008;9(5):474-488. doi:10.1111/j.1467-789X.2008.00475.x
  4. Reilly JJ, Kelly J. Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. Int J Obes (Lond). 2011;35(7):891-898. doi:10.1038/ijo.2010.222
  5. Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005. Obesity (Silver Spring). 2008;16(2):275-284. doi:10.1038/oby.2007.35
  6. Barriuso L, Miqueleiz E, Albaladejo R, Villanueva R, Santos JM, Regidor E. Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990-2013. BMC Pediatr. 2015;15:129. doi:10.1186/s12887-015-0443-3
  7. Chung A, Backholer K, Wong E, Palermo C, Keating C, Peeters A. Trends in child and adolescent obesity prevalence in economically advanced countries according to socioeconomic position: a systematic review. Obes Rev. 2016;17(3):276-295. doi:10.1111/obr.12360
  8. Hardy LL, Mihrshahi S, Gale J, Drayton BA, Bauman A, Mitchell J. 30-year trends in overweight, obesity and waist-to-height ratio by socioeconomic status in Australian children, 1985 to 2015. Int J Obes (Lond). 2017;41(1):76-82. doi:10.1038/ijo.2016.204
  9. World Health Organization (WHO). Report of the Commission on Ending Childhood Obesity. Geneva, Switzerland: WHO; 2016.
  10. Davison KK, Birch LL. Childhood overweight: a contextual model and recommendations for future research. Obes Rev. 2001;2(3):159-171. doi:10.1046/j.1467-789x.2001.00036.x
  11. Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253-272. doi:10.1146/annurev.publhealth.29.020907.090926
  12. Wilkinson R, Marmot M. Social Determinants of Health: The Solid Facts. Geneva: World Health Organization; 2003.
  13. Solar O, Irwin A. A Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Geneva: World Health Organization; 2010.
  14. Commission on Social Determinants of Health. Closing The Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.
  15. Moore TG, McDonald M, Carlon L, O'Rourke K. Early childhood development and the social determinants of health inequities. Health Promot Int. 2015;30 Suppl 2:ii102-115. doi:10.1093/heapro/dav031
  16. Swinburn BA. Obesity prevention: the role of policies, laws and regulations. Aust New Zealand Health Policy. 2008;5:12. doi:10.1186/1743-8462-5-12
  17. Kumanyika SK. A framework for increasing equity impact in obesity prevention. Am J Public Health. 2019;109(10):1350-1357. doi:10.2105/ajph.2019.305221
  18. Backholer K, Beauchamp A, Ball K, et al. A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight. Am J Public Health. 2014;104(10):e43-50. doi:10.2105/ajph.2014.302066
  19. Dahlgren G, Whitehead M. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Futures Studies; 1991.
  20. Baker P, Gill T, Friel S, Carey G, Kay A. Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study. Soc Sci Med. 2017;177:141-149. doi:10.1016/j.socscimed.2017.01.047
  21. Peeters A. Obesity and the future of food policies that promote healthy diets. Nat Rev Endocrinol. 2018;14(7):430-437. doi:10.1038/s41574-018-0026-0
  22. Swinburn BA, Sacks G, Hall KD, et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378(9793):804-814. doi:10.1016/s0140-6736(11)60813-1
  23. Ulijaszek SJ, McLennan AK. Framing obesity in UK policy from the Blair years, 1997-2015: the persistence of individualistic approaches despite overwhelming evidence of societal and economic factors, and the need for collective responsibility. Obes Rev. 2016;17(5):397-411. doi:10.1111/obr.12386
  24. Stone D. Causal stories and the formation of policy agendas. Polit Sci Q. 1989;104(2):281-300. doi:10.2307/2151585
  25. Bacchi C. Problematizations in health policy: questioning how “problems” are constituted in policies. Sage Open. 2016;6(2):2158244016653986. doi:10.1177/2158244016653986
  26. Jenkin GL, Signal L, Thomson G. Framing obesity: the framing contest between industry and public health at the New Zealand inquiry into obesity. Obes Rev. 2011;12(12):1022-1030. doi:10.1111/j.1467-789X.2011.00918.x
  27. Browne J, Coffey B, Cook K, Meiklejohn S, Palermo C. A guide to policy analysis as a research method. Health Promot Int. 2019;34(5):1032-1044. doi:10.1093/heapro/day052
  28. Baker P, Hawkes C, Wingrove K, et al. What drives political commitment for nutrition? a review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Glob Health. 2018;3(1):e000485. doi:10.1136/bmjgh-2017-000485
  29. Bacchi C. Analysing Policy: What’s the Problem Represented to Be? Frenchs Forest: Pearson Education; 2009.
  30. Bastian A. The future of public health nutrition: a critical policy analysis of Eat Well Australia. Aust N Z J Public Health. 2011;35(2):111-116. doi:10.1111/j.1753-6405.2010.00630.x
  31. Vallgårda S. Governing obesity policies from England, France, Germany and Scotland. Soc Sci Med. 2015;147:317-323. doi:10.1016/j.socscimed.2015.11.006
  32. Zorbas C, Browne J, Chung A, et al. National nutrition policy in high-income countries: is health equity on the agenda? Nutr Rev. 2020. doi:10.1093/nutrit/nuaa120
  33. Bastian A. Representations of childhood obesity in Australian newsprint media and academic literature. Aust N Z J Public Health. 2011;35(2):135-139. doi:10.1111/j.1753-6405.2011.00660.x
  34. Whitehead M, Dahlgren G. Concepts and Principles for Tackling Social Inequities in Health: Levelling Up Part 1. Copenhagen, Denmark: World Health Organization; 2007.
  35. Whitehead M, Dahlgren G, Gilson L. Developing the policy response to inequities in health: a global perspective. In: Evans T, ed. Challenging Inequalities in Health Care: From Ethics to Action. New York: Oxford University Press; 2001.
  36. Marmot M, Atkinson T, Bell J, et al. Fair Society Healthy Lives (The Marmot Review). United Kingdom: Institute of Health Equity; 2010.
  37. Pearce A, Dundas R, Whitehead M, Taylor-Robinson D. Pathways to inequalities in child health. Arch Dis Child. 2019;104(10):998-1003. doi:10.1136/archdischild-2018-314808
  38. Loring B, Robertson A. Obesity and Inequities: Guidance for Addressing Inequities in Overweight and Obesity. Denmark: WHO Regional Office for Europe; 2014.
  39. Phillips C, Fisher M, Baum F, MacDougall C, Newman L, McDermott D. To what extent do Australian child and youth health policies address the social determinants of health and health equity?: a document analysis study. BMC Public Health. 2016;16:512. doi:10.1186/s12889-016-3187-6
  40. Bronfenbrenner U. The Ecology of Human Development: Experiments by Nature and Design. Cambridge, MA: Harvard University Press; 1979.
  41. Braun V, Clarke V. Thematic analysis. In: Cooper H, ed. APA Handbook of Research Methods in Psychology. Vol 2. American Psychological Association; 2012.
  42. Miles M, Huberman M, Saldana J. Qualitative Data Analysis: A Methods Sourcebook. 3rd ed. USA: SAGE; 2014.
  43. Russell C, Lawrence M, Cullerton K, Baker P. The political construction of public health nutrition problems: a framing analysis of parliamentary debates on junk-food marketing to children in Australia. Public Health Nutr. 2020;23(11):2041-2052. doi:10.1017/s1368980019003628
  44. Bonfiglioli C, Holding S, Chapman S, King L, Smith B. Obesity in the media: political hot potato or human interest story? Aust J Rev. 2007;29(1):53-61.
  45. Lupton D. “How do you measure up?” assumptions about “obesity” and health-related behaviors and beliefs in two Australian “obesity” prevention campaigns. Fat Stud. 2014;3(1):32-44. doi:10.1080/21604851.2013.784050
  46. Patchett AD, Yeatman HR, Johnson KM. Obesity framing for health policy development in Australia, France and Switzerland. Health Promot Int. 2016;31(1):83-92. doi:10.1093/heapro/dau066
  47. Barry CL, Brescoll VL, Gollust SE. Framing childhood obesity: how individualizing the problem affects public support for prevention. Polit Psychol. 2013;34(3):327-349. doi:10.1111/pops.12018
  48. Peeters A, Backholer K. How to influence the obesity landscape using health policies. Int J Obes (Lond). 2017;41(6):835-839. doi:10.1038/ijo.2017.24
  49. Whelan J, Love P, Millar L, Allender S, Bell C. Sustaining obesity prevention in communities: a systematic narrative synthesis review. Obes Rev. 2018;19(6):839-851. doi:10.1111/obr.12675
  50. Boelsen-Robinson T, Peeters A, Beauchamp A, Chung A, Gearon E, Backholer K. A systematic review of the effectiveness of whole-of-community interventions by socioeconomic position. Obes Rev. 2015;16(9):806-816. doi:10.1111/obr.12297
  51. Friel S, Hattersley L, Ford L, O'Rourke K. Addressing inequities in healthy eating. Health Promot Int. 2015;30 Suppl 2:ii77-88. doi:10.1093/heapro/dav073
  52. Hunter DJ, Popay J, Tannahill C, Whitehead M. Getting to grips with health inequalities at last? BMJ. 2010;340:c684. doi:10.1136/bmj.c684
  53. Medvedyuk S, Ali A, Raphael D. Ideology, obesity and the social determinants of health: a critical analysis of the obesity and health relationship. Crit Public Health. 2018;28(5):573-585. doi:10.1080/09581596.2017.1356910
  54. Mihrshahi S, Baur LA. What exposures in early life are risk factors for childhood obesity? J Paediatr Child Health. 2018;54(12):1294-1298. doi:10.1111/jpc.14195
  55. Katz AS, Hardy B-J, Firestone M, Lofters A, Morton-Ninomiya ME. Vagueness, power and public health: use of ‘vulnerable‘ in public health literature. Crit Public Health. 2020;30(5):601-611. doi:10.1080/09581596.2019.1656800
  56. Vallgårda S. Health inequalities: political problematizations in Denmark and Sweden. Crit Public Health. 2007;17(1):45-56. doi:10.1080/09581590601071705
  57. Munari SC, Wilson AN, Blow NJ, Homer CSE, Ward JE. Rethinking the use of ‘vulnerable’. Aust N Z J Public Health. 2021;45(3):197-199. doi:10.1111/1753-6405.13098
  58. Fogarty W, Bulloch H, McDonnell S, Davis M. Deficit Discourse and Indigenous Health: How Narrative Framings of Aboriginal and Torres Strait Islander People Are Reproduced in Policy. Melbourne: The Lowitja Institute; 2018.
  59. Askew DA, Brady K, Mukandi B, et al. Closing the gap between rhetoric and practice in strengths-based approaches to Indigenous public health: a qualitative study. Aust N Z J Public Health. 2020;44(2):102-105. doi:10.1111/1753-6405.12953
  60. Vallgårda S. Social inequality in health: dichotomy or gradient? a comparative study of problematizations in national public health programmes. Health Policy. 2008;85(1):71-82. doi:10.1016/j.healthpol.2007.07.004
  61. World Cancer Research Fund International. Building Momentum: Lessons on Implementing a Robust Sugar Sweetened Beverage Tax. World Cancer Research Fund International; 2018.
  62. Baum FE, Bégin M, Houweling TA, Taylor S. Changes not for the fainthearted: reorienting health care systems toward health equity through action on the social determinants of health. Am J Public Health. 2009;99(11):1967-1974. doi:10.2105/ajph.2008.154856
Volume 11, Issue 9
September 2022
Pages 1767-1779
  • Receive Date: 14 January 2021
  • Revise Date: 12 June 2021
  • Accept Date: 10 July 2021
  • First Publish Date: 07 August 2021