The final paper in The Lancet Obesity Series by Professor Steven L Gortmaker, Harvard School of Public Health in Boston, MA, USA, and colleagues addresses the interventions required to halt and reverse the epidemic by saying that the changes needed are likely to require many sustained interventions at several levels, but that national governments should lead them.

The author states:

“Many parties – such as governments, international organizations, the private sector, and civil society – need to contribute complementary actions in a coordinated approach. Priority actions include policies to improve the food and built environments, cross cutting actions (such as leadership, healthy public policies, and monitoring), and much greater funding for prevention programs. Increased investment in population obesity monitoring would improve the accuracy of forecasts and evaluations,”

They came up with various effective and cost saving policies suggesting governments should prioritize these for implementation, including taxes on unhealthy food and drink (such as sugar sweetened beverages) and restrictions on food and beverage TV advertising to children. Studies into cost effectiveness suggest the importance of such policy approaches and their potential to reduce long-term health-care costs. The authors remarked that similar policies such as higher tobacco tax and limited marketing to children have already proved effective.

According to the authors, decision makers should also consider implementation issues including feasibility, sustainability, and effects on equity as policy makers need to weigh the relative benefits of high-impact interventions reaching a modest number of people against lower-impact interventions reaching wider populations.

The authors state that all countries require a greatly improved system to monitor obesity trends and physical activity, including high-income countries that are way behind in where they could be. Most countries still don’t have basic data; only a third of European Union nations have representative data on children’s weight and height and even less countries have set targets for rates of obesity or for changes in determinants such as dietary intake and physical activity. With political leadership for action being low in many countries; the USA’s First Lady, Michelle Obama’s interest in obesity issues demonstrates the value of such attention.

According to a previous paper in the Series, for U.S. adults to attain their 1978 BMI levels requires drastic reductions in calories; around 240 calories per day for the average person but double for obese adults whose BMI is 35 or higher. Countries have to concentrate on obesity prevention from birth onwards, so that normal-sized children do not become overweight or obese in adulthood as the reversal of obesity trends becomes more difficult as excess weight accumulates.

In September, UN Member States will meet in New York for the first High-Level Summit of the UN General Assembly focused on non-communicable diseases. Described as a “wicked problem”, the global obesity epidemic will be an enormous challenge for Member States due to its complex and intractable nature.

To tackle the obesity epidemic requires a wide-ranging effort from many sectors of society. The authors believe that since national governments have the ability to regulate down to individual population levels and introduce new policies, such as junk food taxes, they are the most important players and should therefore take the leading role in obesity prevention efforts. A more systems-based approach is required where greater investments are made in the core, structural support systems for obesity prevention, such as workforce development, healthy public policies, leadership and cross-sectoral platforms for action. International agencies, the private sector (through self-regulation), civil society, health professionals, and individuals must all play their part to tackle the fight against obesity.

In a concluding statement the authors say:

“The UN meeting provides a key opportunity to strengthen international leadership from the UN and its agencies, and to stimulate other agencies and states to begin to seriously address the continuing global epidemic of obesity. Beyond that meeting, the test will be how well Member States match their declarations with supportive funding and policies to support global actions.”

Written by Petra Rattue