Prevalence of overweight and obesity among males

In 2013/14, the BMI scores of Australian males varied considerably by age; overall, the average BMI was higher among older males compared to those who were younger (Figure 3.1). For 10–14 year olds, the average BMI score was around 20. This increased to a score of 23 for young men aged 15–17. For adult men aged 18–24, the average BMI was around 25 (on the border of being overweight). By the age of 45–57, the average BMI was around 28, which is greater than the threshold for being overweight.

Aligning with the patterns in BMI scores outlined above, the prevalence for being overweight and obese was significantly higher among older versus younger Australian males (Figure 3.2). Around one in five boys aged 10–14 (20%), and around one in three young men aged 15–17 (29%), were classified as overweight or obese. In comparison, approximately two in five men aged 18–24 (40%) were either overweight or obese. In older groups, this percentage was consistently higher. Among men aged 35–57, more than seven in 10 were overweight or obese, with around 5–7% classified as severely obese (BMI scores of 35–39) and 2.5% as morbidly obese (BMI 40 or greater). This equates to around half a million males aged between 35 and 57 being classified as severely obese (406,126 males) or morbidly obese (145,045 men) at that point in time.

In contrast, the proportion of TTM males classified as being underweight in 2013/14 decreased with age: specifically, 4% of 10-14 year olds, 5% of 15-17 year olds, 3% of 18-24 year olds, 1% of 25–35 year olds, and less than 1% of those aged 36 years and older were underweight at this point.

Figure 3.1: Distribution of BMI scores for Australian males aged 10–57 years, by age group (years), 2013/14

Notes: The green vertical line indicates a BMI underweight cut-off point; the blue vertical line indicates a BMI overweight cut-off point; the red vertical line indicates a BMI obese cut-off point. n = 1,035 (10–14 years); n = 816 (15–17 years); n = 1,612 (18–24 years); n = 2,743 (25–34 years); n = 3,810 (35–44 years); n = 4,194 (45–57 years). 
Source: TTM data, Wave 1, adult cohort, weighted 
Credit: Ten to Men 2020

Figure 3.2: Weight classification of Australian males aged 10–57 years, by age group (years), 2013/14

Notes: n = 969 (10–14 years); n = 816 (15–17 years); n = 1,612 (18–24 years); n = 2,743 (25–34 years); n = 3,810 (35–44 years); 
n = 4,194 (45–57 years). Percentages <5% not displayed here. 
Source: TTM data, Wave 1, all cohorts, weighted 
Credit: Ten to Men 2020

Rates of overweight and obesity among these age groups did not change much over time. Similar proportions were observed in 2015/16, with the only difference being a slightly higher prevalence of overweight and obesity among boys (29%) compared to young men (25%).

These estimates are comparable to those of other Australian research (AIHW, 2017b; Australian Bureau of Statistics [ABS], 2015), and indicate that overweight and obesity remain serious public health challenges for males nationwide.

Risk factors for being overweight/obese

Research has shown that being overweight or obese is associated with a number of risk factors. These risk factors often coexist and interact, making it challenging to holistically address these conditions and their associated consequences (AIHW, 2019). Evidence shows that nutrient-poor diets, reduced levels of physical activity and a rise in sedentary behaviours are consistently key risks for overweight and obesity among the Australian population (AIHW, 2017c; Brown & Siahpush, 2007; National Health and Medical Research Council [NHMRC], 2013).

Building on such research, this section examines associations between being overweight or obese and a number of behavioural risk factors such as fruit and vegetable intake, physical activity,¹ smoking, drinking and medication use. It is crucial to improve understanding of the relationships between these factors and overweight and obesity to inform appropriate health promotion programs and interventions. A number of socio-demographic characteristics including age, Indigenous status, language background and neighbourhood disadvantage are also investigated in an attempt to identify male subgroups who are at high risk of developing overweight/obesity and experiencing associated adverse health consequences.²

Among boys and young men, low physical activity was a key factor in contributing to the risk of being overweight or obese (Table 3.1). Compared to boys and young men who were active (i.e. doing 150 minutes or more of moderate-intensity physical activity per week), those who were not sufficiently active (i.e. doing some but less than 150 minutes of moderate-intensity physical activity per week) had 1.6 times higher likelihood of being overweight or obese. Indeed, the likelihood of being overweight or obese almost tripled for boys and young men who were sedentary (i.e. doing no moderate-intensity physical activity per week).

In contrast, fruit and vegetable intake, having ever smoked a cigarette, and lifetime alcohol consumption were not found to be significantly associated with being overweight or obese among younger males.

Among adult men, several health and lifestyle factors were linked to the risk of being overweight and obese (Table 3.1). Consistent with the above findings, men who were sedentary (i.e. doing no moderate-intensity physical activity per week) or not sufficiently active (i.e. doing some activity but either not enough in total time or not enough sessions per week to obtain a health benefit) had significantly higher likelihood of being overweight or obese compared to physically active men (i.e. doing at least 150 minutes of activity over at least five sessions per week). The odds of being overweight or obese was also around 20% higher for men who were taking over-the-counter non-steroidal anti-inflammatory medications (e.g. ibuprofen, aspirin) on at least a weekly basis compared to those taking it less frequently.

In contrast, eating the recommended number of serves of vegetables per day (i.e. five or more) decreased the likelihood of being overweight or obese among adult men by 24%.

Health risks such as heavy smoking and drinking also had significant effects on the likelihood of adult men being overweight or obese. Compared to men who were heavy smokers (25+ cigarettes per day), those who were non-smokers had 40% lower likelihood of being overweight or obese. Similarly, compared to heavy drinkers, men who were non-drinkers had 28% lower odds of being overweight or obese, and those who drank at low-risk levels had 20% lower odds of being overweight or obese.

Factors such as overall satisfaction with life across domains including standard of living, health, life achievements, relationships, safety and community connectedness also had significant associations with weight among men. Those who reported lower overall satisfaction on these domains had around 20% higher likelihood of being overweight or obese.

Table 3.1: Risk factors associated with overweight/obesity among boys/young men and adult men, 2013/14

Notes: (a) *** p < 0.01, ** p < 0.05, * p < 0.10; SE = robust standard error. (b) Recommended intake of fruit and vegetables were based on Department of Health age- and gender-specific Australian dietary guidelines (NHMRC, 2013). See Eat for health: Australian dietary guidelines (c) Classification of boys and young male respondents into sedentary, insufficiently active and sufficiently active categories for health was based on questions about their physical activity on each day of the week (time only), including for leisure and travel. Classification of adult male respondents into sedentary, insufficiently active and sufficiently active categories for health was derived using Active Australia Survey (AIHW, 2003), which captures total sessions and hours/time of vigorous and moderate physical activities in the last seven days. (d) Drinking behaviours were assessed according to the Alcohol Use Disorders Identification Test (AUDIT), developed by WHO (Saunders, Aasland, Babor, De la Fuente, & Grant, 1993). It is a 10-item questionnaire used to screen for excessive drinking practices. More details on the AUDIT are provided in Chapter 3. (e) Wellbeing was measured using the Personal Wellbeing Index. (f) NSAID = Nonsteroidal anti-inflammatory drug, e.g. ibuprofen and aspirin 
Source: TTM data, Wave 1, all cohorts, unweighted

Some socio-demographic factors were also shown to have a strong impact on the risk of being overweight or obese among younger males. Aboriginal and Torres Strait Islander boys and young men were almost twice as likely to be overweight or obese compared to non-Indigenous boys and young men. Similarly, boys who lived in areas of greater social and economic disadvantage (based on the SEIFA Index) had 2.5 times higher likelihood of being overweight or obese. In contrast, socio-demographic factors such as age, being from a culturally and linguistically diverse (CALD) background, and living in inner or outer regional (vs metropolitan) areas of the country did not have significant effects on the risk of being of overweight or obese among boys and young men.

Among adult men, many socio-demographic factors were found to be associated with being overweight or obese. Aboriginal and Torres Strait Islander adult men were almost 1.4 times more likely to be overweight or obese compared to non-Indigenous adult men, although the estimate was only marginally significant. Similarly, adult men who lived in areas of greater social and economic disadvantage (based on SEIFA Index) were 1.4 times more likely to be overweight or obese.

As opposed to boys and younger males, for adult men, factors such as age, cultural background and region of residence all had a significant impact on the risk of being overweight and obese. Adult men who lived in outer regional areas were significantly more likely to be overweight or obese, whereas men from CALD backgrounds had significantly lower likelihood of being overweight or obese. Moreover, married men and those in in a de facto relationship had 1.4 times higher likelihood of being overweight or obese, while men with a university degree and those who were employed were less likely to be overweight or obese.

Persistence and change in weight status over time

Understanding transitions in and out of weight classifications, and the maintenance or persistence of overweight and obesity, is important for identifying males who are more at risk of experiencing associated adverse consequences over the long term. It can also help to inform programs aimed at achieving and maintaining a healthy weight.

Sustaining a healthy weight appears to be more achievable among younger Australian males. Among those who were classified as being of healthy weight in 2013/14, 91% of 10–14 year olds were still of a healthy weight in 2015/16, compared to 82% of 18–24 year olds and 77% of 45–57 year olds (Table 3.2).

Age also appears to affect the ability of males to return to a healthy weight after weight gain. Around four in 10 boys and young men who were overweight or obese in 2013/14 had transitioned to a healthy weight by 2015/16, compared to around one in 10 of those aged 35–57 years.

Among older men, a larger proportion of those who were overweight in 2013/14 were either still overweight or had become obese by 2015/16. For instance, among men age aged 35–57 who were overweight in 2013/14, around nine in 10 either remained overweight or had become obese in 2015/16, compared to around seven in 10 boys and young men (10–17 year olds).

These findings suggest that as men age, the likelihood of transitioning from overweight or obese to a healthy weight is reduced.

Table 3.2: Transitions in weight status among all males between 2013/14 and 2015/16

Note: Percentages may not total exactly 100.0% due to rounding. 
Source: TTM data, Waves 1 and 2, all cohorts, weighted

Physical health effects of overweight and obesity

Experience of overweight and obesity over the long term can have substantial adverse effects on health. Previous evidence suggests that overweight and obese people are more likely to experience certain chronic conditions such as cardiovascular disease, diabetes, arthritis and asthma (AIHW, 2017a, 2017b; WHO, 2000a). An evidence review by the International Agency for Research on Cancer also found that being overweight or obese increased the risk for several types of cancer, including breast and colon cancer (Lauby-Secretan et al., 2016). The Australian National Men’s Health Strategy 2020–2030 recognises chronic conditions such as diabetes, heart disease and cancer as key priority health issues for men (Department of Health, 2019).

Overweight and obese people experience a range of health conditions that can reduce their physical functioning and quality of life (AIHW, 2019). In 2011, 7% of the total burden of disease and injuries in Australia was due to overweight and obesity (AIHW, 2017a). Further, Australian males were likely to experience a greater burden of disease and injury due to being overweight or obese than females, particularly from the age of 25 (AIHW, 2017a).

This section builds on current evidence and provides some new information on how the longer experience – as well as movement in and out – of overweight and obesity relates to the risk of developing certain physical health conditions among adult men in Australia (see Box 3.2 for a list of these conditions). Analyses used data from participants who responded to both waves of the survey (a ‘balanced’ sample). The focus here is on four groups of adult men according to changes in their weight classification between 2013/14 and 2015/16, as per their BMI results.³

The four groups included those who (Figure 3.3):

• were classified as being of healthy weight in both 2013/14 and 2015/16
• were classified as being overweight or obese in both 2013/14 and 2015/16
• transitioned from a healthy weight in 2013/14 to being overweight/obese in 2015/16
• transitioned from being overweight/obese in 2013/14 to a healthy weight in 2015/16.

Figure 3.3: Patterns of weight change between 2013/14 and 2015/16, by age group

Notes: n = 977 (18–24 years); n = 1,671 (25–34 years); n = 2,630 (35–44 years); n = 3,862 (45–57 years). Brackets above/below bars represent 95% Confidence Intervals. 
Source: TTM data, Wave 1 and 2, adult cohort, weighted 
Credit: Ten to Men 2020

Only key results related to weight change patterns (the main independent variable) are presented in this section (see the Appendices for comprehensive results, including estimates for socio-demographic variables).

Overall, being overweight or obese at all, either at one time point or two, was associated with a significantly increased risk of developing cardiovascular disease, even after adjusting for the influence of key socio-demographic characteristics (Table 3.3). Men who were classified as being overweight or obese at either 2013/14 or 2015/16 were 1.5 times more likely to have had symptoms or had been treated for cardiovascular conditions in the 12 months prior to 2015/16, compared to men who were of a healthy weight at both time points. For men who were overweight or obese over the two time periods, the risk was almost tripled (2.8 times) that of men who were of a healthy weight in both 2013/14 and 2015/16 for symptoms or needing treatment for cardiovascular conditions in the 12 months prior to 2015/16 (Table 3.3).

Table 3.3: Associations between specific chronic conditions and overweight and obesity patterns among adult Australian men

Notes: *** p < 0.01, **p < 0.05, *p < 0.10. aOR = adjusted Odds Ratio; SE = Robust standard error. All health conditions are self-reported (see Box 3.2). Socio-demographic variables controlled for the regression models were: Wave 2 – age, area disadvantage, region of residence, highest education, employment status, marital status; Wave 1 – sexual orientation, Aboriginal and Torres Strait Islander status and CALD background. 
Source: TTM data, Waves 1 and 2, adult cohort, unweighted, balanced sample

A heightened risk of developing other chronic conditions such as respiratory problems, diabetes and arthritis was only found in men who were overweight or obese for longer periods (i.e. in both 2013/14 and 2015/16), not in men who were only overweight or obese at one time point. For instance, compared to men who were of a healthy weight at two time points, those who were overweight or obese at both time periods had around a 1.4 times higher likelihood of having symptoms of – or being treated for – any respiratory conditions in the past 12 months, in addition to a 3.4 times higher likelihood of having symptoms or being treated for diabetes during that time. This group also had a significantly greater risk (1.4 times) of having symptoms or being treated for arthritis in the last 12 months. Again, no such risks were found for men who were overweight or obese at only one wave of data collection.

Weight loss was associated with being diagnosed or treated with cancer. Men who moved from being overweight or obese at Wave 1 to a normal/healthy weight at Wave 2 had a significantly higher likelihood of having symptoms or being treated for cancer in the past 12 months. One reason for this association could be that cancer and its treatments can lead to reduced appetite and changes to metabolism, which can result in weight loss (Huhmann & Cunningham, 2005; Tchekmedyian, Zahyna, Halpert, & Heber, 1992).

Use of key health care service by weight status

As shown in the previous section, overweight and obesity is associated with a broad range of comorbidities (i.e. co-existing conditions) including cardiovascular disease, diabetes, arthritis and respiratory conditions. Managing these can be associated with increased expenditure on medication and more contact with health care services (Sturm, 2002). This section looks at the use of key health care services among overweight or obese men and those classified as being of healthy weight in 2013/14. This information about the use of certain services does not provide details about the value, benefits or effectiveness of these services. It does, however, outline opportunities for introducing and tracking the effectiveness of potential interventions and measures.

Compared to men of a healthy weight classification, those classified as overweight or obese were significantly more likely to have gone to a GP in the past 12 months (approximately 79% vs 84%, respectively). They were also more likely to have had seen a specialist during that time (23% vs 28%, respectively).

Even though the proportion of men consulting a dietitian was low overall, men classified as being overweight or obese were significantly more likely to have consulted a dietitian in the past 12 months compared to those of healthy weight (3% vs 2%). Similarly, overweight or obese men were more likely to have consulted a diabetes educator in the past 12 months.

Note: *** p < 0.01, **p < 0.05, *p < 0.10. 
Source: TTM data, adult cohort, Wave 1, weighted

Conclusion

Overweight and obesity are major public health concerns in Australia. These conditions can result in considerable personal burden and lowered quality of life, in addition to substantial costs to health care systems. This chapter examined the prevalence of overweight and obesity among Australian males. It identified some modifiable and non-modifiable risk factors for these conditions, as well as the persistence or maintenance of overweight and obesity over time and the possible effects of this on certain health outcomes.

Overall, the prevalence of overweight and obesity among Australian males in recent years has been high. In 2013/14, around 20% of boys aged 10–14 were either overweight or obese (a slight decline from 22% in 1995), whereas almost 29% of adolescents aged 15–17 were overweight or obese (a 5% increase from 1995 levels). These findings point to some fluctuation in the prevalence of overweight and obesity over time that may be partially age-dependent. Regardless of this, the issue requires ongoing monitoring (Parliament of Australia, 2006).

Among adult men, the prevalence of overweight and obesity was very high, and levels appear to have remained relatively stable over the past two decades (AIHW, 2002). Six in 10 men aged 25–34 were overweight or obese at Wave 1 of TTM in 2013/14. More than 7 in 10 men aged 35–57 were overweight or obese at both waves of the study (similar to levels recorded in 2000).

Several socio-demographic factors were associated with a heightened risk of being overweight and obese, including age, neighbourhood disadvantage, living in a regional area, and lower levels of education. Although these factors are more difficult to modify, these findings do provide critical information regarding certain subgroups of men who can be at higher risk of developing unhealthy weight conditions. Prevention strategies can be targeted to these groups and relevant medical services could be localised.

Among the risk factors examined in this chapter, several were significantly associated with an increased likelihood of being overweight or obese. These included poor physical activity, heavy smoking, harmful levels of alcohol consumption and lower life satisfaction. This reflects previous research that has pointed to numerous personal, social and environmental determinants of overweight and obesity (e.g. Loring & Robertson, 2014; Newman, 2014).

Some of these factors can be modified at individual, community and even population levels through improved self-management and initiatives promoting healthy diets and increased physical activity. However, a growing body of research suggests that holistic, innovative and longer-term approaches are necessary to combat overweight and obesity (and associated conditions) comprehensively and on a larger and more sustainable scale. For example, Newman (2014) referenced an approach adopted by the South Australian Government that involved participation from agencies other than just the Department of Health. Changing public housing conditions to address overweight and obesity, for instance, could involve landscaping properties to incorporate fruit trees and vegetable gardens. Such initiatives could form the dual purpose of encouraging healthier diets while promoting social connection. Further investigation is warranted to identify additional novel and cost-effective approaches to combat overweight and obesity across all levels of society and especially among high-risk groups (e.g. older males).

The findings presented here suggest that experiencing ongoing or persistent overweight and obesity is associated with a much higher likelihood of experiencing a range of other chronic health conditions such as cardiovascular and respiratory conditions, diabetes and arthritis. This suggests that initiatives to help Australian males achieve and maintain a healthy weight could be highly beneficial. Importantly, males who were overweight or obese were significantly more likely to have consulted all health care services examined here (including GPs, dietitians and specialist doctors). This highlights the increased levels of engagement with the health care system in general among those classified as overweight or obese, but also points to possible opportunities for health interventions.

Effective monitoring and management of overweight and obesity in the population is important to contribute to efforts to reduce the burden on both individuals and the health care system. Moving forward, future waves of TTM data collection will allow much more comprehensive investigations of trajectories in weight status over time (including transitions between healthy and overweight and obese weight classifications), and more nuanced examinations of the diverse risk factors including mental health and health consequences associated with changes in weight status, in addition to maintaining overweight and obesity over long periods.

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