Sugar sweetened beverages (SSBs) is linked to obesity in children. SSBs include sweetened soft drinks, fruit juices with added sugars, sweetened tea, coffee, sodas, among others. Consumption of SSBs has increased in children, adolescents and adults as well. These are associated with dental caries, obesity and other medical conditions. SSB consumption is associated with a high body mass index (BMI) and increased deposition of fat. Daily consumption of SSBs can give rise to approximately 6.5 kg of weight gain in individuals in a year. Australia is one of the top countries in the consumption of sugary drinks and majority of the consumers are children (Vichealth.vic.gov.au, 2017).
This report focuses on understanding the ill effects of SSB consumption in the Australian children particularly the indigenous Aboriginal and Torres Strait island children. Consumption of SSBs results in obesity, diabetes, hypocalcaemia (increased levels of serum calcium), decreased bone mineral density, dental caries, kidney stones, increase in the systolic and diastolic blood pressure, among others. Type 2 diabetes is the prevalent form of diabetes among the children consuming large amounts of SSBs (Rethinksugarydrink.org.au, 2017). In Australia, intake of sweetened beverages were high among teenagers aged between 14-18 years, but on the average, children aged between 2-18 years of age showed higher consumption than adults. About 50% of the Aboriginal and Torres Strait Island children aged from 2 years drank high amounts of SSBs compared to the non-indigenous people (Laws et al. 2014, p.779).
Figure 1: Graphical representation of BMI
(Source: Pmc.gov.au, 2017)
This report at first focuses on the SSB consumption and the health risks associated with it. This report specifically focuses on SSB consumption of the indigenous children of Australia. The second part of the report deals with program planning and evaluation.
Magnitude and significance of the problem generally to children’s health
Health risks
Increase in sugar availability has resulted in increased sugar intakes in the form of various sweetened drinks. These SSBs include a variety of drinks like sodas, energy drinks, sweetened fruit juices, soft drinks, sweetened tea, and coffee, among others (Scharf and DeBoer 2016, pp.273-293). Popularity of SSBs has increased among children, adolescents and adults. Various health risks can arise due to consumption of SSBs. The most significant health risk being obesity. Among 10 million Australians who are overweight or obese, 47% were found to consume large amounts of SSBs. About 56% of the Aboriginal or Torres Strait Island children aged about 2 years were found to consume SSBs (Abs.gov.au, 2017). Total intake of sugars, starches, carbohydrates, fats, fibre and sodium were higher for the aboriginal children than the non-indigenous children. Other health risks include, high body mass index, increased hypocalcaemia, loss of bone mineral density, dental caries, kidney stones, and increase in systolic and diastolic blood pressure. High BMI and higher deposition of fat was found compared to the non-drinkers. Moreover, children also showed increase in the incidence of dental caries. Hypocalcaemia or increase in the level of calcium in the serum was also evident. Increase in SSB consumption among the Aboriginal and Torres Strait Islander children causes an increased risk of developing heart diseases and type 2 diabetes (Brimblecombe et al. 2013, pp.380-384).
Intake of large amounts of beverages or foods containing added sugars increases the total energy consumption and subsequently results in dilution of the total nutrient intake. In recent years, the occurrence of obesity among young children has increased particularly in the industrialized countries. Obesity in children gives rise to obese adults who can develop a number of co-morbidities like cardiovascular diseases and diabetes (Sydney.edu.au, 2017). In type 2 diabetes, children develop insulin resistance and glucose levels increases in their blood stream leading to various heart diseases, blindness as well as kidney failure. Diet plays a very important role in development of atherosclerosis in children. Atherosclerosis and other heart diseases are the primary cause of human death worldwide. The consumption of SSBs is the leading cause of cardiovascular disease development in children. Soft drinks generally contain phosphoric acid, which leads to the development of hypocalcaemia in children (Calvo and Tucker 2013, pp.29-35). Hypocalcaemia results in increased serum calcium levels. Hypocalcaemia in children can give rise to poor intelligence, papilledema, heart failure, intestinal malabsorption, among others.
Figure 2: Dental caries due to SSB consumption
(Source: Armfield et al. 2013, pp. 494-500)
Extent of SSB consumption
Increased consumption of SSBs particularly by children and adolescents can result in high calorie intake. Sweetened beverages are responsible for the total intake of daily energy. Higher consumption of SSBs is also associated with poor intake of fruits and higher intake of unhealthy fast foods. Research has shown that increased intake of food is associated with those consuming high amounts of SSBs. Increased intake of SSB has also been associated with poor levels of physical activity leading to obesity in children all around the world (Maher et al. 2013). The causes of obesity are complex in nature and involve the influence of family members, friends, and relatives, among others. Throughout the world, low levels of physical work, leading a sedentary lifestyle and consumption of energy rich foods and beverages can give rise to obesity in children as well as in adults. Other factors leading to obesity could be socio-economic factors, cultural background, societal and cultural dispossession, acceptance of western influenced diets, among others. Consumption of SSBs has increased all around the world. Consumption of SSB has been linked to obesity epidemic, particularly in children.
In Australia, the consumption of carbonated drinks increased to 240% from 1969-1999. Survey of schools of South Australia, Victoria, Tasmania and Queensland revealed, 31% children between 5-7 years of age, 32% children of 8-10 years of age, 26.7% children of 11-13 years age and 10.5% children of 14-16 years of age consume SSBs daily. A larger proportion of obese children drank SSBs than normal weight children. A large number of children with poor socio-economic background consumed more amounts of SSBs than children of high socio-economic status. 30.2% children of low socio-economic background consumed SSBs when compared to only 19.4% in children of high socio-economic background. Children from rural areas consumed more amounts of SSBs than those in the urban areas (Aifs.gov.au, 2017).
Table 1: Mean soft drink consumption per day based on socio-economic status.
(Source: Sahealth.sa.gov.au, 2017)
Additionally male children were found to consume more SSB than the female children. Relation of SSB consumption with poor public health is an important issue in Australia. Consumption of SSB consumption was higher among the indigenous Australians, especially children than in the non-indigenous population. About 50% of the Aboriginal and Torres Strait Islander inhabitants showed SSB consumption compared to about 34% of the non-indigenous community. Among the Aboriginal and Torres Strait Islander population, 66% adults were obese; while 29.7% children showed obesity (Avery et al. 2017, p. e016431). Diabetes and cardiovascular diseases are largely experienced by the Aboriginal population than by the non-indigenous population.
Synthesis of the data
Health problems like obesity, type 2 diabetes, cancer and various cardiovascular diseases places a significant amount of burden on the Aboriginal and Torres Strait Islander individuals and their families and the society in general. Sweetened beverages are the major concern in association with these health outcomes, as consumption of these beverages lead to significant intake of high amounts of sugar, which is highly deleterious for a person’s health. Consumption of high amounts of sugar results in increased calorie intake, resulting in weight gain and subsequent associated health concerns. The National Health and Medical Research Council (NHMRC) recommended in the Australian dietary guidelines the limited consumption of sugar rich drinks and replace them with fruit drinks, vitamin and sports drinks (Abs.gov.au, 2017). This is a highly pressing issue regarding the health of the Aboriginal and Torres Strait Islander inhabitants, since Australia is one of the highest consumers of the sweetened beverages. The indigenous Australians were found to drink more amount of SSBs than the non-indigenous Australians did. Most of the consumers are children and teenagers. Good health from childhood lays the stepping stone for a good and healthy future ahead; however, such problems will prevent the indigenous Australian children to look forward to a bright and healthy future.
Summary and Conclusion
This section focuses on the growing problem in Australia in association with increased consumption of SSBs, particularly, among the Aboriginal and Torres Strait Islander people. The children and the teenagers are the major consumers. SSBs like soft drinks, coffee, sweetened tea, cordials, sweetened fruit juices are highly consumed by the indigenous Australians. This results in high intake of sugar and calories thereby resulting in overall weight gain. Such weight gain can give rise to serious health concerns among the children. The majority of the health concerns include obesity, type 2 diabetes, dental caries, cancer and various cardiovascular diseases. The children being the future, it is necessary to address this problem and limit the use of SSBs to prevent such health risks in the future.
Many factors or determinants were associated with SSB consumption. These factors were categorized into environmental and personal factors. Moreover, socio-demographic factors were taken into account.
Individual determinants
Various lifestyle factors play an essential role in contributing to obesity development. Poverty management is essential in tackling obesity (Alvaro et al. 2010, pp.91-99). Social aspects and food behaviours play an important role (Germov and Williams 2008, pp.3-23). Various personal factors like attitude towards soft drinks also play an important role. Attitudes like preference for soft drinks during meals, as a thirst quencher and soft drinks providing good health are also important factors that determine the increased consumption of SSBs among children. Research revealed that regular soft drinks were considered suitable to be taken with meals as a thirst quencher and to have health benefits. Preferences like the taste of the soft drink also played an important part in increasing soft drink consumption among children (van de Gaar et al. 2017, p.195).
Socio-environmental determinants
Various environmental factors like accessibility, modelling (parents and elders who drink soft drinks) and distance of the shop from home are important determinants for increased rates of SSB consumption (Ogden 2011). Various socio-demographic factors like grades, gender, future education plans and diet played a very important role in increased SSB consumption among children (Pollard et al. 2016, pp.71-77). Boys were found to drink more soft drinks sometimes twice a week or more. Moreover, those without any future education goals or plans were found to drink more SSB compared to those who had a specific higher education plan in mind. The tenth grade students were found to drink more regular soft drinks than their ninth grade counterparts. Those dieting were found to drink more of diet soft drinks compared to those who were not dieting (Armfield et al. 2013, pp.494-500).
The children of the Aboriginal and Torres Strait suffer from a worse socio-economic disadvantage compared to that of the non-indigenous Australian population. They are more exposed to various environmental risk factors that affect their health. Moreover, they are also exposed to various behavioural factors that affect their health (Shepherd, Li and Zubrick 2012, pp.439-461). They live in poor households with minimum sanitary conditions that do not support their development of good healthy habits. Very few of the Aboriginal and Torres Strait children complete their class twelve education. Moreover, they also suffer from poor employment rates (Sacks, Swinburn and Lawrence 2009, pp.76-86). Moreover, according to these people, health as a holistic approach rather than being based on biomedical approach towards healthcare. Moreover, they have poor access to fresh water, they experience many hardships, culture dispossession, land dispossessions, racism and health exclusion. All these factors have led the Aboriginal and Torres Strait Island community to be ignorant towards their health and thereby resulting in increased consumption of soft drinks.
Figure 3: Graphical representation of gender difference in SSB consumption
(Source: Abs.gov.au, 2017)
At first, the traditional lifestyle of the indigenous people involved a lot of physical activity and consumption of healthy diets. There was also a low risk of developing any serious medical conditions. However, foreign invasion resulted in transfer of the indigenous people from their original surroundings. As a result, they had to adapt to the cultures of the foreign community. This resulted in disruption of the original lifestyle, feeding habits, among others. This also caused the indigenous people to lead a sedentary lifestyle and consumption of unhealthy foods leading to development of various life threatening medical conditions. Colonization has also caused a socio-economic disadvantage for the indigenous Australians, thereby resulting in increased rates of unemployment among youths.
Figure 4: Graphical representation of Beverage consumption
(Source: Abs.gov.au, 2017)
Stakeholders and partners
Interventions are needed to prevent or reduce the intake of SSBs among the indigenous Australian children. In order to ensure the continuation of the intervention projects, stakeholders and partners are needed who are interested in the project and have the resources to carry out the interventions.
The stakeholders should include both aboriginal and non-aboriginal stakeholders. Various stakeholders can be obtained from within the community such as from the management departments of stores, from health services, schools, local land administrative division called shires and other government services. Stakeholders outside the community can include retail staff, government officers and medical professionals. Moreover, other stakeholders can include members of the aboriginal community, senior members, store managers and academicians among others (Brimblecombe et al. 2017). Various aboriginal related health organizations like WA, SA, QLD, NARNA and DAA. Partnerships can be carried out with the local medical professionals or clinicians, diabetes centers, among others. Primary, community and specialist health care providers can also suffice the need of potential partners who can interact directly with the consumers. Government agencies, community organizations, businesses and NGOs can also function as possible partners. An advisory board concentrating on aboriginal health can also function as potential partners, as they can ensure the efficacy of the intervention programs specific for that community. Various healthcare groups like the NSW Health, PANORG, HNE Population Health and the New Castle University can provide the necessary resources for carrying out the intervention strategies (Sydney.edu.au, 2017).
Relationship to the problem and potential interventions
The most important feature of the intervention strategies keeping in mind the Aboriginal and Torres Strait Islander children include the participation of the indigenous population in the planning and execution of the programs. Effective interventions can be targeted towards the nutritional needs, primary education, employment, housing, cultural communities, among others. Nutrition based intervention programs can determine the diets and the increase in children’s weights and percentages of insulin levels, blood sugar and cholesterol in the indigenous children. Interventions can also include providing knowledge and education to the local health workers. Moreover, the children can be provided healthy meals prepared by these local health workers. Promotions for healthy eating and importance of physical activity can be carried out in local institutions (Health.gov.au, 2017).
Environmental or behavioural interventions like targeting dietary preferences, attitudes, knowledge, motivation, skills of individuals, and their perception of food and drinks consumption (Hu 2013, pp.606-619). Marketing regulations may help to influence the individuals in altering their preferences. Promotion of alternative drinks like water or fruit juices. Moreover, other alternatives include low or fat free milk, which are sources of calcium, vitamins like vitamin D, phosphorus among others. Moreover, other interventions can be the banning of sweetened food consumptions in schools, supply of healthy free meals for the schoolchildren (Health.gov.au, 2017).
Questions asked to stakeholders
Primary healthcare service
Primary healthcare methods or principles form the basis of program development and promotion of health among the Aboriginal and Torres Strait Islander people. Questionnaires can be developed to determine the eating habits, activity levels, behaviour, knowledge and socio-economic condition of the population. These questionnaires are used to obtain the information from the children, parents, teachers, canteen supervisors and principals about the surrounding environment and diet preference of the population. Questionnaires can also cover other domains of interest like individual behaviour or attitude, knowledge and skills of the teacher, and the emotional well-being of the children.
Moreover, the ANGELO tool can be used to determine the physical, socio-economical and socio-cultural environments associated with the development of obesity (Belon et al. 2016, pp.e92-e100). Social and emotional well being screening tools that can be used are Kessler 5, Kessler 6, Kessler 10, Patient Health Questionnaire 2, Patient Health Questionnaire 9 and Edinburgh Postnatal Depression Screen (Jorm et al. 2012, p.118). Mental health of an individual controls their behaviour and day-to-day activities.
Depending on the informations obtained after the survey, various healthcare practices can be carried out. These include promotion of healthy food choices, increased physical activity, and supply of resources, tools and information for making healthy choices.
Conclusion
Consumption of sugar rich foods and beverages are a serious health concern that has affected many countries around the world, particularly, those countries that are highly industrialized. SSBs include various soft drinks, health drinks, sodas, sweetened tea, sweetened coffee, sweetened canned fruit juices, among others. These sweetened beverages contain high amounts of sugar, which affects the general health and lifestyle of individuals around the world. Consumption of these sweetened beverages has increased in children all around the world. This results in the development of obesity among children. Obesity in childhood can give rise to serious health concerns like cardiovascular diseases, kidney failure and diabetes in adults. Australia is one of the top countries consuming large amounts of sweetened beverages. The indigenous Australians are particularly involved in consuming large amounts of SSBs every day. Their socio-economic and socio-environmental background is responsible for this. The rural population is mostly affected because of their poor knowledge about the ill effects of these sugar dense beverages. Other factors include the poor education and unemployment rates of these indigenous people. Moreover, preference for tasty sweetened beverages over healthy drinks also plays an important role in their consumption of large amounts of SSBs. Other factors like easy availability and family modelling plays an important role. Various intervention programs are needed with the help of stakeholders and partners in order to determine the number of children affected by various medical conditions because of SSB consumption. It is also necessary to determine the mental health and emotional well being of the indigenous people, so that proper interventions can be carried out in the future to prevent serious life threatening medical conditions. Thus, it is necessary to take drastic steps in the future in order to prevent an obesity epidemic among children in Australia as well as around the world.
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