The Lancet – Obesity 2015 Series

This new series of papers from the Lancet summarises the latest available knowledge on obesity and what can be done to address the problem. The series introduction describes how today’s food environments exploits people’s biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods. This in turn reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments. The authors call for regulatory actions from governments and increased efforts from industry and civil society to break these vicious cycles.

The first paper, by Roberto et al, provides a helpful overview of the content of all the papers, which we copy as follows:

“In this first paper of this Lancet Series, we have proposed that the debate over individual choice versus environmental influence be reframed so as to acknowledge the interaction between the two. We frame obesity as a problem driven largely by environmental effects that undermine the self-regulatory capacity people have to make responsible decisions about personal diet and physical activity. The second paper by Hawkes and colleagues also challenges the dichotomy between a traditional public health-based perspective (which identifies food systems, food environments, and the food industry as the leading cause of obesity) and an individual-based perspective (which argues that consumer demand drives unhealthy food consumption because the market simply delivers what consumers want). Hawkes and colleagues discuss the ways in which the food, social, and information environments affect the development of personal dietary preferences and the ability of people to express existing food preferences. They argue that an understanding of the interaction between these supply-and-demand factors is critical to the development of smart and effective obesity prevention policies. The paper by Huang and colleagues builds on this broad theme by challenging the false dichotomy that either top-down (eg, government) or bottom-up (eg, grassroots) solutions are needed. Public health experts and policy makers tend to focus on top-down solutions (i.e., the policies that can be passed now to alter the environment and improve health), which treats people as passive recipients of information and change. However, the reality is that many policy efforts have little support from voters and intended programme participants, and although the passage of policies is crucial, there is also a need to mobilise policy action from the bottom up. Huang and colleagues focus on bottom-up strategies that view people as active agents who can change their environments. Lobstein and colleagues focus their paper on childhood obesity, which is showing increases in prevalence worldwide and a recent, steep increase in low income to middle-income countries. Their paper, in part, explores the difficulties of prioritising undernutrition versus overnutrition in policy making. Many countries, communities, and even households struggle with the coexistence of people who are undernourished and people who have excess weight. Yet policy makers focusing on undernutrition or on obesity address these problems in different ways and advocate for different policy approaches, despite having very similar goals. This situation suggests a need for solutions that target both issues simultaneously. In the fifth paper of this Series, Dietz and colleagues discuss treatment approaches for weight loss and maintenance. They also note the difficulty of prioritising investment between obesity prevention (with its low costs but long-term benefits) or obesity treatments (with its shorter-term gains but higher costs). They argue that reduction of global obesity will need a combination of effective and compassionate health care, coupled with policy and environmental changes to both support those who have lost weight and prevent weight gain. They also note the power of doctors and health professionals as advocates for prevention and societal approaches. The final paper in the Series by Swinburn and colleagues focuses on accountability systems as a means to ensure action on obesity and healthy food environments. Classically, enactment of food policies has been framed as a responsibility of the government, production of healthy foods as a responsibility of the food industry, and the demand for healthy foods as a responsibility of the consumers. Swinburn and colleagues shift the focus of debate from the responsibility framework, where the obligation lies with one party, to an accountability framework, where the obligations are between two or more parties. In their analysis, there are many opportunities for parties to hold each other to account within the range of government regulations, which is the highest accountability but strongly  contested, and voluntary industry codes, which have very little evidence of effect. In particular, quasiregulatory approaches hold some promise for overcoming the impasse over the regulation versus non-regulation dichotomy.

Read the full series here

The Lancet has also produced an infographic which describes how governments can support healthy food choice preferences which you can view  here.

An earlier 2011 Lancet series on obesity can be found here.

You can find more resources on the topic of obesity in our research library here.

26 Feb 2015