Cardiometabolic diseases are a major public health challenge in Australia and a leading cause of death nationally. Central obesity is a significant contributor to this burden, increasing the risk of cardiovascular disease, type 2 diabetes and other metabolic disorders. While lifestyle factors such as diet, physical inactivity, smoking, alcohol consumption, sleep and psychological wellbeing all play a role, obesity prevention is harder where healthy food, health services and locally tailored programs are less accessible.

Obesity rates are higher in rural and remote areas than in urban centres. Yet public health policies often overlook the specific conditions that shape health behaviours in these communities, including geographic isolation, limited healthcare access and socio-cultural factors. As such, many obesity prevention programs, often designed for urban settings, are less effective in rural and remote contexts. Additionally, a recent review found that few experimental studies of diabetes interventions include First Nations people, many of whom live in rural and remote areas. The five focal points outlined below offer a practical starting point.

Where current obesity strategies fall short

National and state health strategies provide a good starting point, including the National Preventive Health Strategy 2021-2030, the  National Obesity Strategy 2022-2032 and the Australian Dietary Guidelines 2013. However, these strategies contain limited provisions for the specific challenges of obesity in rural and remote areas. Gaps persist in areas such as monitoring, cultural adaptation, workplace-based intervention, workforce capacity and local implementation.

Five focal points for addressing obesity in rural and remote Australia

To address gaps in policy and healthcare for obesity in rural and remote areas, there are five focus areas that governments at the state and federal level could adopt: (1) food insecurity and unhealthy food consumption; (2) education and prevention; (3) place-based policy and community engagement; (4) data collection and integration with general public health responses; and (5) strengthening rural and remote health outcomes.

Focal point 1: Food insecurity and unhealthy food consumption

Food insecurity and limited access to healthy food options tend to be more prevalent in socioeconomically disadvantaged households, including in rural and remote areas. In Australia, low socioeconomic areas tend to have a higher density of fast-food outlets, increasing the likelihood of unhealthy food consumption. Several factors can drive this disparity, including the higher cost and limited availability of healthy food options: compared with major cities, a healthy food basket costs 26 per cent more in remote Queensland, 31 per cent more in very remote areas, and 49 per cent more in remote and very remote parts of the Northern Territory than in Darwin. Given high poverty levels and poor health outcomes in these communities, reducing the cost of healthy food should be a policy priority.

Policy interventions to improve access to affordable, nutritious food in rural and remote areas are well-documented. For example, subsidising healthy food items, enhancing distribution infrastructure and supporting local agriculture are strategies highlighted by both the National Indigenous Australians Agency and the National Rural Health Alliance. Additionally, programs such as community gardens, farmers’ markets and food hubs can be effective measures to address food insecurity.

Focal point 2: Education and prevention

Access to education is vital for prevention, with more than 80 per cent of people consulted for the National Obesity Strategy supporting healthy school policies and curriculum-based obesity prevention. However, mandating the National Healthy School Canteen Guidelines in school canteens is likely to have a positive effect only in schools with the funds to support the canteen. Educational intervention programs that reduce screen time and improve body image could help decrease childhood obesity.

Providing culturally appropriate information from a trusted source that respects religious values, can have a meaningful impact. Implementing culturally sensitive, locally funded educational and community interventions are essential.

Culturally sensitive programs should integrate traditional knowledge with modern health practices, engage local leaders and First Nations health workers and use culturally appropriate resources to deliver nutrition and obesity prevention education. Sustainable funding can strengthen community ownership, trust, networks, local capacity and program effectiveness. These principles should also guide initiatives for non-Indigenous rural communities.

Focal point 3: Place-based policy and community engagement

Place-based, co-designed approaches have effectively addressed obesity prevention in rural and remote Australia, particularly in Queensland, Victoria and NSW. Aboriginal Community Controlled Health Organisations (ACCHOs) exemplify this model, offering tailored healthcare that meets local community needs. Scaling up place-based approaches, as exemplified by ACCHOs, involves flexible frameworks, strong partnerships between local healthcare and non-health care sectors, investment in infrastructure and workforce (e.g., telehealth), and robust monitoring. Furthermore, evaluating co-designed interventions in collaboration with local communities is essential to ensure their effectiveness.

Focal point 4: Data collection and integration with general public health responses

Accurate data on food costs and their influencing factors is crucial for developing effective social and health policies. However, there is currently no national framework for monitoring food costs outside capital cities and some regional centres. High-quality, accurate data will enable targeted responses. The NSW Performance and Wellbeing Framework (2025-26 Budget) should use rural-specific data to guide targeted interventions and reduce urban–rural wellbeing disparities.

Focal point 5: Strengthening rural and remote health outcomes

The 2024 parliamentary inquiry on diabetes called for a coordinated national research approach to tackle rising obesity and diabetes rates. That coordination is especially important in rural and remote areas, where GP shortages, limited health services and health disparities heighten chronic disease risks. Strengthening government collaboration with regional research institutes and boosting clinical trial funding can enhance access, awareness, and innovation in underserved communities. Ongoing evaluation and tailored strategies are essential to improve health outcomes and reduce chronic disease burdens in rural Australia.

Obesity has now overtaken tobacco use as Australia’s leading chronic disease risk factor and requires stronger national policies to address rural and Indigenous health inequities. Drawing on the success of tobacco-control regulation, a coordinated obesity regulation framework could improve long-term health outcomes, reduce inequities and lower future healthcare costs. Stronger food policies should regulate unhealthy foods, particularly fast-food consumption among people under 18, strengthen school nutrition standards, and improve access to affordable healthy options.

Rural and remote Australia will of course also benefit from publication-wide public health measures on obesity. Relevant measures include stricter regulation of marketing unhealthy foods and strengthening front-of-pack nutrition labelling through the Health Star Rating system. Other measures include levies on unhealthy food items such as sugary drinks, workplace and aged care wellness programs, subsidies or tax breaks to improve the affordability and supply of healthy foods, interventions that promote healthy behaviours through positive social networks (social ties), and healthy eating programs in school canteens. Where possible, these should be tailored to the needs of rural and remote communities.

All Australians deserve an equal chance at a healthy and happy life. A greater focus on food affordability, better data and rural health system capacity will help ensure obesity policy works for rural and remote Australia, not just urban centres.

Dr Shakeel Mahmood is a research fellow at Charles Sturt University, specialising in culturally sensitive health policy. With over 20 years of expertise in health policy, quantitative and qualitative analysis, and monitoring frameworks, he has worked with the international health research organisation ICDDR,B and universities globally. He holds a PhD in Health Policy and an MPA from the University of Maine, as well as an MBA from Trinity University and has undertaken professional trainings at Harvard University.

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