The intense marketing of fast food is one of the reasons why obesity and type 2 diabetes have grown, according to a discussion paper issued by Waikato District Health Board's Population Health service.

The paper, "Obesity, diabetes and fast food - the impact of marketing to children", looks at how modern "obesogenic" environments including car-based urban design, sedentary jobs and passive forms of recreation promote the over-consumption of food and drinks and limit opportunities for physical activity.

"The aim is to get communities and individuals thinking how they can change to a healthier environment - for the sake of their children's future health," says the paper's author Nick Chester, Population Health policy analyst.

The marketing of energy-dense, nutrient-poor food to children is of particular concern. Although obesity prevalence in children has remained relatively steady in recent years, one in five New Zealand children are overweight, and one in twelve are obese. Children who are obese are more likely to remain obese into adulthood, adding to the likelihood of future ill health and the cost of treatment.

The 2006/07 Health Survey found that 70% of children between the ages of 2 and 14 years ate fast food at least once a week, 14% ate fast food twice a week and 7% ate it three or more times a week. These figures suggest that the consumption of fast food is a common and well established pastime for the majority of New Zealand children.

Within the Waikato region, there are over 70 fast food chain outlets operating; over half of these are in Hamilton City. Many other takeaway food outlets operate in all areas; dairies, supermarkets and petrol stations all sell a wide variety of unhealthy food.

Promotion of energy-dense, nutrient-poor food has reached almost saturation levels through conventional advertising and indirect marketing within local communities such as sponsorship.

The paper presents a number of interventions that may address concerns with marketing, at both a policy level and also at a local level through health promotion, education and community partnerships.

Current Waikato programmes include:

NourishMEnt is a programme providing information to community health workers on obesity and type 2 diabetes, and how diet and exercise plays a role in these diseases. The programme discusses barriers to good nutrition and how these can be overcome in a local community.

Kai @ the Right Price is an established intervention with the aim of increasing consumption of fresh fruit and vegetables. This is through the provision of items at a lower price. This has been a successful intervention and has been used in many locations within the region.

Project Energize is a project within Waikato primary schools to improve nutrition and increase physical activity of children. The project began in 2005 and is funded by Waikato District Health Board. Partners in the project include Sport Waikato and AUT University, University of Waikato, Waikato Institute of Technology, Sport and Recreation NZ, New Zealand Heart Foundation. A total of 44,000 primary and intermediate schoolchildren are now part of Project Energize through 244 Waikato schools. A number of evaluations have taken place on the project, the latest being in March-April 2011. This showed fewer children were obese, more were physically active and had a better understanding of healthy eating than during the 2006 assessment.

The Population Health service says affected groups need to look at what initiatives will be most valuable for them, and how they can use these to best effect. "Population Health service will look to work with other agencies such as Sport Waikato to provide support and advice in such situations," Mr Chester said.

The next stage will be to look at how the issue can be addressed in the Waikato region, and how Population Health can provide information and advice to schools or communities who have concerns relating to the issues raised in the discussion paper. This will begin early this year.

The discussion paper can be accessed on Waikato DHB's website at: www.waikatodhb.health.nz/populationhealth

Some facts:

• Obesity prevalence has risen in New Zealand from 16.6% of males and 20.6% of females in 1997 to 24.8% of males and 26.0% of females in 2006/07. One in five New Zealand children are overweight and one in twelve are obese.

• Obesity is the result of a number of factors including genetics, but the rapid increase in the prevalence of obesity suggests that genetics are unlikely to be the main cause of the epidemic.

• There is a disproportionate burden of obesity and diabetes in Māori and Pacific populations, and those living in more deprived areas.

About Waikato District Health Board and Health Waikato:

Waikato DHB is responsible for planning, funding and providing quality health and disability support services for the 365,300 people living in the Waikato DHB region. It has an annual turnover of $1.2 billion and employs more than 6000 people.

Health Waikato is the DHB's main provider of hospital and health services with an annual budget of more than $674 million and 4980 staff. It has six groups across five hospital sites, three primary birthing units, two continuing care facilities and 20 community bases offering a comprehensive range of primary, secondary and tertiary health services.

A wide range of independent providers deliver other Waikato DHB-funded health services - including primary health, pharmacies and community laboratories.