Is social exposure to obesity associated with weight status misperception? Assessing Australians ability to identify overweight and obesity.

INTRODUCTION: Overweight and obesity prevalence has increased significantly over the past two decades, currently impacting greater than 60% of Australians. It is unclear if a social perception of a healthy weight has been obscured by the increase in prevalence and thus has become inconsistent with the medical definitions. METHODS: An electronic questionnaire was distributed via email and social media using the authors' informal networks. Australian adults were eligible to participate. Participants were asked to categorise their own body size using medically accepted words and previously published silhouettes, before identifying underweight, healthy weight, overweight or obesity in a series ofsilhouettes. RESULTS: Eight hundred six questionnaires were completed, a majority of participants had attained a high level of education and were employed female health professionals. Under half the studied population had a Body Mass Index (BMI) corresponding to overweight or obese categories (n = 349, 47%). Accuracy in self-perceived weight status using medicalised words was higher among respondents with BMI corresponding to the healthy weight category (n = 311, 85%) and overweight category (n = 133, 74%) than for respondents with BMI corresponding to obesity (n = 79, 45%) or underweight (n = 5, 31%). A majority of respondents were able to accurately self-perceive their weight status using silhouettes (n = 469, 70%). Females were significantly more likely to be accurate in their self-perception than males, using both medicalised words (p = < 0.001) and silhouettes (p = 0.045). Respondents with a BMI corresponding to the obese category were significantly more likely to be accurate with weight status self-perception using silhouettes than words (87% versus 46% respectively, p = < 0.001). Less than half (41%) of respondents accurately perceived silhouettes corresponding to an overweight BMI and less than one in ten respondents (9%) accurately perceived the lower limit of the silhouettes corresponding to an obese BMI. CONCLUSIONS: Repondents were challenged to accurately perceive silhouettes corresponding to an obese BMI in themselves and others. Weight status misperception was more likely to exist among those with a BMI less than 18.5 or 30 or more (underweight BMI and obese BMI). Accuracy decreased as BMI increased. Respondents with a BMI in the obese category were significantly more likely to accurately self-perceive their weight status using silhouettes than medicalised words. Silhouettes may act as an effective visual cue in initiating weight related discussions.

'Believe in me and I will believe in myself', a rural Australian health service learns how to mangan dunguludja ngatan (build strong employment) for Aboriginal and Torres Strait Islander people: a qualitative study.

BACKGROUND: Australian Aboriginal people have higher rates of unemployment and poorer health than non-Aboriginal Australians. Historical segregation policies that spanned 60 years negatively impacted workforce inclusion. A Victorian regional health service recently developed an Aboriginal Employment Plan (AEP) targeted to reach 2% employment of Aboriginal people by 2020. This study aimed to identify strategies that will build strong Aboriginal employment. METHODOLOGY: A qualitative research protocol was designed. Purposive recruitment of people with a vested interest in the growth of Aboriginal employment at the health service participated in focus groups and individual interviews. RESULTS: Twenty-four people including local Elders, past and present Aboriginal employees, key community stakeholders and health service executives participated. Learnings from the past, the present and strategies for the future emerged from two important stories: (1) the story of a strong group of local Aboriginal people who successfully approached the matron of the hospital in the early 1960s for employment. (2) The story of the 'verandah babies'. DISCUSSION: The history of the health service in question demonstrated the power of the possible with a self-determined group of Aboriginal people, who, in the face of cultural inequity, achieved employment at the health service. The opportunity for healing and a new start was illustrated by the story of women who gave birth on the verandahs due to their exclusion from the main hospital. Today, the 'verandahs' have been replaced with a modern hospital decorated with Aboriginal art, expressing cultural safety and inclusion, presenting fertile ground for strengthening and sustaining Aboriginal employment. CONCLUSION: Eleven strategies have emerged from three themes; safety, equity and pathway, offering mainstream health services insight into how to mangan dunguludja ngatan (build strong employment). Cultural safety can be achieved through acknowledging the past and reconciling that through engaging, partnering and collaborating with the Aboriginal community. Visual representations of culture and participation in celebratory activities engender awareness and understanding. The development of local, flexible career development pathways for Aboriginal people facilitates a 'sense of belonging' to the health service and a dual 'sense of pride' within the community: whereby the Aboriginal person feels proud to represent their community and the community is proud to be represented. Cultural equity is facilitated through mutual learning and reciprocal understanding of difference.

Why Australia needs to define obesity as a chronic condition.

BACKGROUND: In Australia people with a diagnosed chronic condition can be managed on unique funded care plans that allow the recruitment of a multidisciplinary team to assist in setting treatment goals and adequate follow up. In contrast to the World Health Organisation, the North American and European Medical Associations, the Australian Medical Association does not recognise obesity as a chronic condition, therefore excluding a diagnosis of obesity from qualifying for a structured and funded treatment plan. BODY: The Australian guidelines for management of Obesity in adults in Primary Care are structured around a five step process -the '5As': Ask & Assess, Advise, Assist and Arrange'. This article aims to identify the key challenges and successes associated with the '5As' approach, to better understand the reasons for the gap between the high Australian prevalence of overweight and obesity and an actual diagnosis and treatment plan for managing obesity. It argues that until the Australian health system follows the international lead and defines obesity as a chronic condition, the capacity for Australian doctors to diagnose and initiate structured treatment plans will remain limited and ineffective. CONCLUSION: Australian General Practitioners are limited in their ability manage obesity, as the current treatment guidelines only recognise obesity as a risk factor rather than a chronic condition.