Changing the Future of Obesity

Abstract

Over the past 3 decades, the prevalence of obesity has increased worldwide, affecting all countries and segments of society. Despite overwhelming evidence showing the devastating consequences of inaction on human health, the health care system, society, and the economy, there is no clear consensus on effective policy or programmatic strategies to combat obesity. The necessary actions to reverse current obesity patterns are well known. Sustained interventions are required at several levels, including the government, food industry, individual behavior, the education system, homes, and workplaces, as well as agriculture and food services. Efforts to address this growing problem have been sporadic and ineffective largely due to government apathy or inaction, opposition by the food industry, the high costs required, and cultural norms. The current policy is one of indecision and inaction. This review provides evidence on strategies for preventing obesity and links emerging scientific evidence on clinical efficacy and cost-effectiveness with concerns of policy makers on the feasibility of implementation and the sustainability of suggested interventions. The rise in obesity has been associated with effective marketing by the food industry of high calorie, highly processed, inexpensive food and beverages to adults and especially children. Regulation of the marketing of these food products has been a focus of policy strategies to combat obesity. Nearly all the food policies recommended as priority actions have been vigorously opposed by the food industry. Modeled forecasts suggest that projected rates of obesity will affect future life expectancy and have detrimental effects on the economy. Validated energy gap mathematical models have demonstrated the dynamic relationship of changes in dietary intake and physical activity to weight change. However, few rigorous studies have examined the cost-effectiveness of suggested interventions or policy changes, which should be a priority of policy makers for implementation. The recent development of a new systems approach to prevent obesity using quantitative modeling has important policy implications and shows the need for integrated multifaceted initiatives by governments and across several sectors (including the private sector, civil society, and international organizations) to develop an overall coordinated strategy. Governments must take an active leadership role in these initiatives, establish priorities in public policies and provide substantially more funding for obesity monitoring and prevention programs. In addition to the health sector, nonhealth sectors, such as agriculture, finance, trade, transportation, education, and urban planning, may have great influence in creating and sustaining policies and environments conducive to prevention. The recent UN High-Level Meeting on noncommunicable diseases was a call to action for the international community to take a leadership role in the fight against obesity. None of the UN member states have adequately addressed this problem. The framework of a global approach to obesity control encompasses a wide range of public health service policies, health promotion programs, and the socioeconomic determinants of health. It is unclear at present whether policy makers are willing or able to make the difficult choices required to meet this growing threat to human health, society, and the economy.