An international team of scientists is urging health professionals to adopt a more social approach to tackling the global obesity epidemic.
Writing in this week’s issue of the British Medical Journal (BMJ), Sharon Friel, Principal Research Fellow with the Commission on Social Determinants of Health at the Department of Epidemiology and Public Health, University College London, UK, and colleagues, suggest a different policy agenda is needed.
Curiously, in more developed countries, obesity is linked to social disadvantage, whereas in low income countries, the inverse is true, wrote Friel and colleagues. They want the health profession to start taking into account the unequal distribution among different countries of the social opportunities for maintaining a healthy weight, rather than just focus on healthy eating and exercise.
Eating habits have changed dramatically since the middle of the 20th century, leading to a global shift in the human diet toward highly refined foods and meat and dairy products with high levels of saturated fats, while at the same time, people use up less energy, resulting in the rise of obesity. Tackling the causes and solutions to these large scale changes in eating habits and physical activity, and their unequal social distribution, said the scientists, is where the focus should be.
Friel and colleagues discuss a range of political, economic and social pressures, including commerce, trade, living and working conditions, that differ among countries and affect people’s behaviour, their weight, and ultimately, their health, in different ways. They consider, for instance, the impact of food subsidies, advertising, urban planning, social structure, and employment.
They suggest that food subsidies have distorted food supplies so that the less healthy foods, for instance those high in saturated fats, are favoured over healthier options, and global companies have flooded the market with cheap, energy dense food, devoid of nutritional value. Supermarket bulk purchasing and supersized portions are now the norm, replacing the habit of making smaller purchases that used to take place at family run stores.
In both high income and the “transitioning countries”, wrote the authors, energy density and fat intake have gone up, and although on average food prices have gone down, in the richer countries the healthier foods generally cost more than the less healthy ones.
In rich countries, and increasingly in the developing countries, argued Friel and colleagues, the majority of people watch television and see food advertisements aimed at persuading adults and children alike, that they want to eat food that is high in saturated fats, sugar, and salt.
The researchers also cite studies in high income countries that link urban planning to people’s weight. The design of residential areas, for example, can encourage or discourage the amount of daily walking people do. Similarly, the availability and ease of access to recreation and play facilities that increase people’s physical activity are also affected by urban planning and design schemes.
There is evidence to suggest that availability of transport affects people’s ability to exercise choice when buying food, and that less availability is linked to poorer food choices. An overreliance on cars, while increasing transport opportunities, reduces physical activity.
Unless these, and other issues are addressed, warned the researchers, the obesity epidemic will not go away and may even get worse.
Friel and colleagues acknowledge that action is being taken on widening the policy for tackling obesity around the world. For example, they mention the World Health Organization (WHO) has put forward a stragety to tackle diet, physical activity and health that also identifies the social causes of obesity, and in the European Union, ministers have committed to balancing individual responsibility with social responsibility.
They also mention that the UK government’s recent Foresight Report also points out that most “drivers of obesity are societal issues” and therefore need societal solutions.
But, in spite of these efforts at all levels the obesity crisis persists, as does its “social gradient”, wrote Friel and colleagues who called for joint national and local action to create equal access to affordable nutritious food, and more equitable living and working conditions.
They urged health professionals to take the lead in spearheading such an effort.
“Unequal weight: equity oriented policy responses to the global obesity epidemic.”
Sharon Friel, Mickey Chopra, and David Satcher.
BMJ, Dec 2007; 335: 1241 – 1243.
doi:10.1136/bmj.39377.622882.47
Written by: Catharine Paddock